History of Hansen's disease control policy in the United States

Although Hansen's disease (leprosy) is still a significant problem in many parts of the world, the effectiveness of multidrug therapy has allowed people affected by this disease to be treated on an outpatient basis. However, throughout much of the twentieth century, people diagnosed with Hansen's disease were isolated from their families in facilities known as 'leprosaria'. This article presents a brief history of isolation policies and the development of community structures at two such facilities, Carville and Curupaiti, in the United States and Brazil, respectively. The modern dilemmas faced by the administration, staff, and residents of these institutions will also be discussed.

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Hansen's Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw194.06 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Cited By ~ 1

Author(s):

Sarah Labuda ◽

Barbara Stryjewska

Keyword(s):

Rheumatoid Arthritis ◽

United States ◽

Clinical Symptoms ◽

Case Series ◽

The United States ◽

Hansen's Disease ◽

Hansen’S Disease

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Hansen’s Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.17-0197 ◽

2017 ◽

Vol 97 (6) ◽

pp. 1726-1730 ◽

Cited By ~ 3

Author(s):

Sarah M. Labuda ◽

John S. Schieffelin ◽

Jeffrey G. Shaffer ◽

Barbara M. Stryjewska

Keyword(s):

Rheumatoid Arthritis ◽

United States ◽

Clinical Symptoms ◽

Case Series ◽

The United States ◽

Hansen's Disease ◽

Hansen’S Disease

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Mycobacterium lepromatosis as a Second Agent of Hansen’s Disease

Frontiers in Microbiology ◽

10.3389/fmicb.2021.698588 ◽

2021 ◽

Vol 12 ◽

Author(s):

Patrícia Deps ◽

Simon M. Collin

Keyword(s):

United States ◽

Case Reports ◽

The United States ◽

Lepromatous Leprosy ◽

Clinical Aspects ◽

Red Squirrels ◽

Hansen's Disease ◽

Hansen’S Disease ◽

Mycobacterium Lepromatosis

Mycobacterium lepromatosis was identified as a new species and second causal agent of Hansen’s disease (HD, or leprosy) in 2008, 150years after the disease was first attributed to Mycobacterium leprae. M. lepromatosis has been implicated in a small number of HD cases, and clinical aspects of HD caused by M. lepromatosis are poorly characterized. HD is a recognized zoonosis through transmission of M. leprae from armadillos, but the role of M. lepromatosis as a zoonotic agent of HD is unknown. M. lepromatosis was initially associated with diffuse lepromatous leprosy, but subsequent case reports and surveys have linked it to other forms of HD. HD caused by M. lepromatosis has been reported from three endemic countries: Brazil, Myanmar, and Philippines, and three non-endemic countries: Mexico, Malaysia, and United States. Contact with armadillos in Mexico was mentioned in 2/21 M. lepromatosis HD case reports since 2008. M. lepromatosis in animals has been investigated only in non-endemic countries, in squirrels and chipmunks in Europe, white-throated woodrats in Mexico, and armadillos in the United States. To date, there have only been a small number of positive findings in Eurasian red squirrels in Britain and Ireland. A single study of environmental samples found no M. lepromatosis in soil from a Scottish red squirrel habitat. Future studies must focus on endemic countries to determine the true proportion of HD cases caused by M. lepromatosis, and whether viable M. lepromatosis occurs in non-human sources.

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Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw063 ◽

2016 ◽

Vol 3 (2) ◽

Cited By ~ 11

Author(s):

Kristoffer E. Leon ◽

Jesse T. Jacob ◽

Carlos Franco-Paredes ◽

Phyllis E. Kozarsky ◽

Henry M. Wu ◽

...

Keyword(s):

United States ◽

Delayed Diagnosis ◽

Retrospective Chart Review ◽

The United States ◽

Nerve Damage ◽

Hansen's Disease ◽

Delay In Diagnosis ◽

Hansen’S Disease ◽

Time Period ◽

Delays In Diagnosis

Abstract Background. Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods. A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results. Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease “reactions”, severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1–96), but no single factor was associated with a delay in diagnosis. Conclusions. The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage.

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Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

Journal of Neurosurgery ◽

10.3171/2014.9.jns142210 ◽

2015 ◽

Vol 123 (5) ◽

pp. 1238-1243 ◽

Cited By ~ 7

Author(s):

Russell Payne ◽

Jennifer Baccon ◽

John Dossett ◽

David Scollard ◽

Debra Byler ◽

...

Keyword(s):

United States ◽

Differential Diagnosis ◽

Peripheral Neuropathy ◽

Ulnar Nerve ◽

The United States ◽

Health Concern ◽

Radiographic Evaluation ◽

Causative Organism ◽

Hansen's Disease ◽

Hansen’S Disease

Hansen’s disease, or leprosy, is a chronic infectious disease with many manifestations. Though still a major health concern and leading cause of peripheral neuropathy in the developing world, it is rare in the United States, with only about 150 cases reported each year. Nevertheless, it is imperative that neurosurgeons consider it in the differential diagnosis of neuropathy. The causative organism is Mycobacterium leprae, which infects and damages Schwann cells in the peripheral nervous system, leading first to sensory and then to motor deficits. A rare presentation of Hansen’s disease is pure neuritic leprosy. It is characterized by nerve involvement without the characteristic cutaneous stigmata. The authors of this report describe a case of pure neuritic leprosy presenting as ulnar nerve neuropathy with corresponding radiographic, electrodiagnostic, and histopathological data. This 11-year-old, otherwise healthy male presented with progressive right-hand weakness and numbness with no cutaneous abnormalities. Physical examination and electrodiagnostic testing revealed findings consistent with a severe ulnar neuropathy at the elbow. Magnetic resonance imaging revealed diffuse thickening and enhancement of the ulnar nerve and narrowing at the cubital tunnel. The patient underwent ulnar nerve decompression with biopsy. Pathology revealed acid-fast organisms within the nerve, which was pathognomonic for Hansen’s disease. He was started on antibiotic therapy, and on follow-up he had improved strength and sensation in the ulnar nerve distribution. Pure neuritic leprosy, though rare in the United States, should be considered in the differential diagnosis of those presenting with peripheral neuropathy and a history of travel to leprosy-endemic areas. The long incubation period of M. leprae, the ability of leprosy to mimic other conditions, and the low sensitivity of serological tests make clinical, electrodiagnostic, and radiographic evaluation necessary for diagnosis. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.

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Lepromin Skin Testing in the Classification of Hansen's Disease in the United States

The American Journal of the Medical Sciences ◽

10.1097/00000441-199301000-00004 ◽

1993 ◽

Vol 305 (1) ◽

pp. 18-24 ◽

Cited By ~ 4

Author(s):

Wojciech A. Krotoski ◽

Tomasz F. Mroczkowski ◽

Thomas H. Rea ◽

Pablo I. Almodovar ◽

Bruce C. Clements ◽

...

Keyword(s):

United States ◽

Skin Testing ◽

The United States ◽

Hansen's Disease ◽

Hansen’S Disease

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Family History of Convulsions in Candidates for Immunization With Pertussis-Containing Vaccines (Diphtheria, Tetanus, Pertussis)

PEDIATRICS ◽

10.1542/peds.80.5.743 ◽

1987 ◽

Vol 80 (5) ◽

pp. 743-744

Author(s):

Keyword(s):

United States ◽

Family History ◽

Disease Control ◽

Febrile Seizures ◽

The United States ◽

Increased Risk ◽

History Of ◽

Dtp Vaccine

Family history of convulsions is not presently a contraindication to the use of pertussis vaccine.1,2 It was suggested in a recent report that there might be an increased risk of seizures following diphtheria, tetanus, pertussis (DTP) vaccination in individuals who have a "family history of convulsions." Unfortunately, the degree of relatedness was not specified in the questionnaire from which these results were derived.3 A subsequent questionnaire specifying relatedness only to siblings and parents also indicated an increased risk. A family history of convulsions was obtained in 17.3% and 16.7% of children who had febrile and nonfebrile convulsions, respectively, following DTP vaccine as compared with 4.8% in vaccinees who had nonneurologic complications following DTP vaccination (Centers for Disease Control, unpublished data, 1987). The risk of seizures following DTP vaccination is approximately one in 1,750 doses. These are usually febrile seizures.4,5 Follow-up of these patients had indicated that they rarely, if ever, have sequelae.5 Convulsions of this type (DTP vaccination induced) are differentiated from encephalopathy which occurs once in about 1:140,000 doses, one third of which result in permanent sequelae.6 Recent studies have demonstrated that the administration of acetaminophen, 15 mg/kg per dose, at the time of immunization with DTP and four and eight hours later, reduces febrile reactions.7 Although this study was too small to allow determination of the effect on seizures following DTP, it is reasonable to expect that reduction in fever also would decrease the likelihood of febrile seizures following DTP. Local pertussis epidemics in the United States occur in unpredictable fashion.

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