| Synonyms |
Hansen's disease, hanseniasis,
elephantiasis grecorum and names in local languages in endemic
areas. |
| Definition |
A chronic infectious disease of man,
caused by Mycobacterium leprae, affecting peripheral
nerves, skin and sometimes other tissues. |
| Etiology |
Mycobacterium leprae, has been
classified separately from the other mycobacteria because of the
failure to grow it on artificial culture media. Mycobacterium leprae
grows at 30-33oC, and divides every
12-13 days. It contains few antigens as compared with BCG but
the phenolic glycolipid found in the foamy capsule is
biologically unique and antigenically specific to M.Leprae. |
| Incidence |
In 1999, the world incidence of
Hansen’s disease was estimated to be 640,000; and in 2000,
738,284 cases were identified. In 1999, 108 cases occurred in
the United States. In 2000, WHO listed 91 countries as endemic,
with India, Myanmar, and Nepal having 70% of cases. |
| Epidemiology |
Although the mode of transmission of
Hansen's disease remains uncertain, most investigators think
that M. leprae is usually spread from person to person in
respiratory droplets. The clinical incubation period is usually
3-5 years and the disease tends to have a bimodal age
distribution, with peaks at 10-14 and 35-44 years. |
| Risk
Groups |
Close contacts with patients with
untreated, active, predominantly multibacillary disease, and
persons living in countries with highly endemic disease. |
| Clinical
Features |
This chronic infectious disease
usually affects the skin and peripheral nerves but has a wide
range of possible clinical manifestations. Patients are
classified as having paucibacillary or multibacillary Hansen's
disease. Paucibacillary Hansen's disease is milder and
characterized by one or more hypopigmented skin macules.
Multibacillary Hansen's disease is associated with symmetric
skin lesions, nodules, plaques, thickened dermis, and frequent
involvement of the nasal mucosa resulting in nasal congestion
and epistaxis. |
| Sequelae
|
Worldwide, 1-2 million persons are
permanently disabled as a result of Hansen's disease. However,
persons receiving antibiotic treatment or having completed
treatment are considered free of active infection. |
| Challenges |
The main challenges for Hansen's
disease elimination efforts are to reach populations that have
not yet received multidrug therapy services, improve detection
of disease, and provide patients with good quality services and
free drugs. |
| Treatment |
The principles of treatment are:
chemotherapy, prevention and treating reactions, educating the
patients to cope with existing nerve damage and rehabilitating
them socially and psychologically.
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