Leprosy (Hansen's Disease) Classification and external resources
A 24-year-old man infected with leprosy.
ICD-10	A30.
ICD-9	030
OMIM	246300
DiseasesDB	8478
MedlinePlus	001347
eMedicine	med/1281  derm/223 neuro/187
MeSH	C01.252.410.040.552.386

Leprosy, or Hansen's disease, is a chronic infectious disease caused by the bacterium Mycobacterium leprae. In Medicine, a chronic disease is a Disease that is long-lasting or recurrent An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Mycobacterium leprae, also known as Hansen’s bacillus, mostly found in warm tropical countries is the Bacterium that causes Leprosy (Hansen's ^[1] Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external symptom. In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted The peripheral nervous system ( PNS) resides or extends outside the Central nervous system (CNS which consists of the Brain and Spinal cord. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in The Upper respiratory tract refers to the following parts of the Respiratory system: Nose and Oral cavity Throat ^[2] Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes. Contrary to popular conception,^[3] leprosy does not cause body parts to simply fall off, and it differs from tzaraath, the malady described in the Hebrew scriptures and previously translated into English as leprosy. Tzaraath ( Hebrew צרעת and numerous variants of English Transliteration, including tzaraas, tzaraat, tsaraas and ^[4]

Historically, leprosy has affected humanity since at least 600 BC, and was well-recognized in the civilizations of ancient China, Egypt and India. Chinese civilization originated in various city-states along the Yellow River ( valley in the Neolithic era Ancient Egypt was an Ancient Civilization in eastern North Africa, concentrated along the lower reaches of the Nile River in what is now This article is about the history of South Asia prior to the Partition of British India in 1947 ^[5] In 1995, the World Health Organization (WHO) estimated that between two and three million people were permanently disabled because of leprosy. ^[6] Although the forced quarantine or segregation of patients is unnecessary—and can be considered unethical—a few leper colonies still remain around the world, in countries such as India, Japan, Egypt, and Vietnam. For other uses see Quarantine (disambiguation Quarantine is voluntary or compulsory isolation typically to contain the spread of something Ethics is a major branch of Philosophy, encompassing right conduct and good life A leper colony, leprosarium, or lazar house is a place to Quarantine leprous people India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country For a topic outline on this subject see List of basic Japan topics. This article is about the country of Egypt For a topic outline on this subject see List of basic Egypt topics. Vietnam (ˌviːɛtˈnɑːm Việt Nam) officially

The age-old social stigma associated with the advanced form of leprosy lingers in many areas, and remains a major obstacle to self-reporting and early treatment. Social stigma is severe social disapproval of personal characteristics or Beliefs that are against cultural norms. Effective treatment for leprosy appeared in the late 1930s with the introduction of dapsone and its derivatives. Dapsone (diamino-diphenyl sulfone is an pharmacological Medication most commonly used in combination with Rifampicin and Clofazimine as multidrug However, leprosy bacilli resistant to dapsone gradually evolved and became widespread, and it was not until the introduction of multidrug therapy (MDT) in the early 1980s that the disease could be diagnosed and treated successfully within the community. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics.

Contents 1 Characteristics 2 Classification 3 Cause 4 Pathophysiology 5 Treatment 6 Prevention 7 Epidemiology 7.1 Risk groups 7.2 Disease burden 7.3 Global situation 8 History 9 Popular culture 10 Famous People 11 External links 12 References 12.1 Further reading

Characteristics

The clinical symptoms of leprosy vary but primarily affect the skin, nerves, and mucous membranes. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in ^[7] Patients with this chronic infectious disease are classified as having paucibacillary Hansen's disease (tuberculoid leprosy), multibacillary Hansen's disease (lepromatous leprosy), or borderline leprosy.

Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; rather, a long investigation by Paul Brand yielded that insensitivity in the limbs extremities was the reason why unfelt wounds or lesions, however minute, lead to undetected deterioration of the tissues, the lack of pain not triggering an immediate response as in a fully functioning body. Dr Paul Wilson Brand ( July 17, 1914 - July 8, 2003) was a pioneer in developing Tendon transfer techniques for use in the hands of ^[8] Recently, leprosy has also emerged as a problem in HIV patients on antiretroviral drugs. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome ^[9]

Classification

There is some confusion over classification because the WHO replaced an older, more complicated classification system with a simpler system that identifies two subtypes of leprosy - paucibacillary and multibacillary. The older system included six categories: Indeterminate Leprosy, Borderline Tuberculoid Leprosy, Midborderline Leprosy, Borderline Lepromatous Leprosy, Lepromatous Leprosy, and Tuberculoid Leprosy.

Paucibacillary leprosy encompasses indeterminate, tuberculoid, and borderline tuberculoid leprosy. It is characterized by one or more hypopigmented skin macules and anaesthetic patches, i. Hypopigmentation is the loss of skin color It is caused by Melanocyte depletion &mdash a decrease in the amino acid Tyrosine, which is used by melanocytes to make The macule is the simplest dermatological Lesion. It is flat and can only be seen and not felt e. , damaged peripheral nerves that have been attacked by the human host's immune cells.

Multibacillary leprosy includes midborderline, borderline lepromatous, and lepromatous leprosy. It is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds) but typically detectable nerve damage is late. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma In Medicine, a nodule refers to a relatively hard roughly spherical abnormal structure Epistaxis (or a nosebleed in Plain English) is the relatively common occurrence of Hemorrhage from the Nose, usually noticed when the blood drains

Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.

Cause

Main article: Mycobacterium leprae

Mycobacterium leprae is the causative agent of leprosy. ^[2] An intracellular, acid-fast bacterium, M. Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have leprae is aerobic, gram-positive, and rod-shaped, and is surrounded by the waxy cell membrane coating characteristic of Mycobacterium species. An aerobic organism or aerobe is an Organism that has an Oxygen based Metabolism. Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. The cell membrane (also called the plasma membrane, plasmalemma, or "phospholipid bilayer" is a Selectively permeable Lipid bilayer Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae ^[10]

Due to extensive loss of genes necessary for independent growth, M. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance leprae is unculturable in the laboratory, a factor which leads to difficulty in definitively identifying the organism under a strict interpretation of Koch's postulates. A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory Koch's postulates are four criteria designed to establish a causal relationship between a causative Microbe and a Disease. ^[11] The use of non-culture-based techniques such as molecular genetics has allowed for alternative establishment of causation. Molecular genetics is the field of Biology which studies the structure and function of Genes at a molecular level

Pathophysiology

The exact mechanism of transmission of leprosy is not known: prolonged close contact and transmission by nasal droplet have both been proposed, and, while the latter fits the pattern of disease, both remain unproven. ^[12] The only other animals besides humans known to contract leprosy are the armadillo, chimpanzee, sooty mangabey, and cynomolgus macaque. Armadillos are small Placental Mammals known for having a leathery armor shell Chimpanzee (often shortened to chimp) is the common name for the two extant Species of Apes in the Genus Pan. The Sooty Mangabey ( Cercocebus atys) is an Old World monkey found in forests from Senegal east to Ghana. The Crab-eating Macaque ( Macaca fascicularis) is a primarily Arboreal Macaque native to Southeast Asia. ^[13] The bacterium can also be grown in the laboratory by injection into the footpads of mice. ^[14] There is evidence that not all people who are infected with M. leprae develop leprosy, and genetic factors have long been thought to play a role, due to the observation of clustering of leprosy around certain families, and the failure to understand why certain individuals develop lepromatous leprosy while others develop other types of leprosy. ^[15] It is estimated that due to genetic factors, only 5 percent of the population is susceptible to leprosy. ^[16] This is mostly because the body is naturally immune to the bacteria, and those persons who do become infected are experiencing a severe allergic reaction to the disease. However, the role of genetic factors is not entirely clear in determining this clinical expression. In addition, malnutrition and prolonged exposure to infected persons may play a role in development of the overt disease.

The incubation period for the bacteria can last anywhere from two to ten years.

The most widely held belief is that the disease is transmitted by contact between infected persons and healthy persons. ^[17] In general, closeness of contact is related to the dose of infection, which in turn is related to the occurrence of disease. Of the various situations that promote close contact, contact within the household is the only one that is easily identified, although the actual incidence among contacts and the relative risk for them appear to vary considerably in different studies. In incidence studies, infection rates for contacts of lepromatous leprosy have varied from 6. Incidence is a measure of the risk of developing some new condition within a specified period of time 2 per 1000 per year in Cebu, Philippines^[18] to 55. Cebu is one of the Provinces of the Philippines. It lies to the east of Negros Island; to the west of Leyte and to the southeast is Bohol The Philippines ( Filipino: Pilipinas, officially known as the Republic of the Philippines (fil ''Republika ng Pilipinas'' RP 8 per 1000 per year in a part of Southern India. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country ^[19]

Two exit routes of M. leprae from the human body often described are the skin and the nasal mucosa, although their relative importance is not clear. It is true that lepromatous cases show large numbers of organisms deep down in the dermis. The dermis is a layer of Skin beneath the epidermis that consists of Connective tissue, and cushions the body from stress and strain However, whether they reach the skin surface in sufficient numbers is doubtful. Although there are reports of acid-fast bacilli being found in the desquamating epithelium of the skin, Weddell et al have reported that they could not find any acid-fast bacilli in the epidermis, even after examining a very large number of specimens from patients and contacts. Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body Epidermis is the outermost layer of the Skin. It forms the waterproof protective wrap over the body's surface and is made up of stratified squamous Epithelium with ^[20] In a recent study, Job et al found fairly large numbers of M. leprae in the superficial keratin layer of the skin of lepromatous leprosy patients, suggesting that the organism could exit along with the sebaceous secretions. Keratins are a family of fibrous structural proteins; tough and insoluble they form the hard but nonmineralized structures found in Reptiles Birds The sebaceous glands are Glands found in the Skin of Mammals Locations and morphology A branched type of Acinar gland, these ^[21]

The importance of the nasal mucosa was recognized as early as 1898 by Schäffer, particularly that of the ulcerated mucosa. ^[22] The quantity of bacilli from nasal mucosal lesions in lepromatous leprosy was demonstrated by Shepard as large, with counts ranging from 10,000 to 10,000,000. ^[23] Pedley reported that the majority of lepromatous patients showed leprosy bacilli in their nasal secretions as collected through blowing the nose. ^[24] Davey and Rees indicated that nasal secretions from lepromatous patients could yield as much as 10 million viable organisms per day. ^[25]

The entry route of M. leprae into the human body is also not definitely known. The two seriously considered are the skin and the upper respiratory tract. While older research dealt with the skin route, recent research has increasingly favored the respiratory route. Rees and McDougall succeeded in the experimental transmission of leprosy through aerosols containing M. leprae in immune-suppressed mice, suggesting a similar possibility in humans. ^[26] Successful results have also been reported on experiments with nude mice when M. A nude Mouse is a genetic Mutant that has a deteriorated or removed Thymus gland resulting in an inhibited Immune system due to a greatly reduced leprae were introduced into the nasal cavity by topical application. ^[27] In summary, entry through the respiratory route appears the most probable route, although other routes, particularly broken skin, cannot be ruled out. The CDC notes the following assertion about the transmission of the disease: "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. "^[28]

In leprosy both the reference points for measuring the incubation period and the times of infection and onset of disease are difficult to define; the former because of the lack of adequate immunological tools and the latter because of the disease's slow onset. Incubation period is the Time elapsed between exposure to a Pathogenic Organism, or Chemical or radiation, and when Symptoms Even so, several investigators have attempted to measure the incubation period for leprosy. The minimum incubation period reported is as short as a few weeks and this is based on the very occasional occurrence of leprosy among young infants. ^[29] The maximum incubation period reported is as long as 30 years, or over, as observed among war veterans known to have been exposed for short periods in endemic areas but otherwise living in non-endemic areas. It is generally agreed that the average incubation period is between 3 to 5 years.

Treatment

Until the development of dapsone, rifampicin, and clofazimine in the 1940s, there was no effective cure for leprosy. Dapsone (diamino-diphenyl sulfone is an pharmacological Medication most commonly used in combination with Rifampicin and Clofazimine as multidrug Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Clofazimine is a fat-soluble riminophenazine dye used in combination with Rifampicin and Dapsone as multidrug therapy (MDT for the treatment of Leprosy However, dapsone is only weakly bactericidal against M. leprae and it was considered necessary for patients to take the drug indefinitely. Mycobacterium leprae, also known as Hansen’s bacillus, mostly found in warm tropical countries is the Bacterium that causes Leprosy (Hansen's Moreover, when dapsone was used alone, the M. leprae population quickly evolved antibiotic resistance; by the 1960s, the world's only known anti-leprosy drug became virtually useless. eVolution is the third Album by eLDee, it was due to be released in 2008 Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics.

The search for more effective anti-leprosy drugs than dapsone led to the use of clofazimine and rifampicin in the 1960s and 1970s. ^[30] Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance. ^[31] Multidrug therapy (MDT) and combining all three drugs was first recommended by a WHO Expert Committee in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens. None of them is used alone because of the risk of developing resistance.

Because this treatment is quite expensive, it was not quickly adopted in most endemic countries. In 1985 leprosy was still considered a public health problem in 122 countries. The 44th World Health Assembly (WHA), held in Geneva in 1991 passed a resolution to eliminate leprosy as a public health problem by the year 2000 — defined as reducing the global prevalence of the disease to less than 1 case per 100,000. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given At the Assembly, the World Health Organization (WHO) was given the mandate to develop an elimination strategy by its member states, based on increasing the geographical coverage of MDT and patients’ accessibility to the treatment.

The WHO Study Group's report on the Chemotherapy of Leprosy in 1993 recommended two types of standard MDT regimen be adopted. ^[32] The first was a 24-month treatment for multibacillary (MB or lepromatous) cases using rifampicin, clofazimine, and dapsone. The second was a six-month treatment for paucibacillary (PB or tuberculoid) cases, using rifampicin and dapsone. At the First International Conference on the Elimination of Leprosy as a Public Health Problem, held in Hanoi the next year, the global strategy was endorsed and funds provided to WHO for the procurement and supply of MDT to all endemic countries.

Between 1995 and 1999, WHO, with the aid of the Nippon Foundation (Chairman Yōhei Sasakawa, World Health Organization Goodwill Ambassador for Leprosy Elimination), supplied all endemic countries with free MDT in blister packs, channelled through Ministries of Health. is a private charity organization with headquarters in Tokyo, Japan. 　(born January 8 1939 is chairman of The Nippon Foundation, the World Health Organization Goodwill Ambassador for Leprosy Elimination and Japan's Ambassador for the WHO Goodwill Ambassadors are celebrity advocates of the World Health Organization (WHO and utilize their talent and fame to advocate for Health and well-being This free provision was extended in 2000 with a donation by the MDT manufacturer Novartis, which will run until at least the end of 2010. At the national level, non-government organizations (NGOs) affiliated to the national programme will continue to be provided with an appropriate free supply of this WHO supplied MDT by the government.

MDT remains highly effective and patients are no longer infectious after the first monthly dose. ^[5] It is safe and easy to use under field conditions due to its presentation in calendar blister packs. ^[5] Relapse rates remain low, and there is no known resistance to the combined drugs. A relapse (etymologically "who falls again" occurs when a person is affected again by a condition that affected them in the past Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. ^[5] The Seventh WHO Expert Committee on Leprosy, ^[33] reporting in 1997, concluded that the MB duration of treatment—then standing at 24 months—could safely be shortened to 12 months "without significantly compromising its efficacy. "

Persistent obstacles to the elimination of the disease include improving detection, educating patients and the population about its cause, and fighting social taboos about a disease for which patients have historically been considered "unclean" or "cursed by God" as outcasts. Where taboos are strong, patients may be forced to hide their condition (and avoid seeking treatment) to avoid discrimination. The lack of awareness about Hansen's disease can lead people to falsely believe that the disease is highly contagious and incurable.

The ALERT hospital and research facility in Ethiopia provides training to medical personnel from around the world in the treatment of leprosy, as well as treating many local patients. ALERT is a medical facility on the edge of Addis Ababa, specializing in Hansen’s disease also known as “ Leprosy ” Surgical techniques, such as for the restoration of control of movement of thumbs, have been developed there.

Prevention

A single dose of rifampicin is able to reduce the rate of leprosy in contacts by 57% to 75%. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group ^[34][35]

BCG is able to offer a variable amount of protection against leprosy as well as against tuberculosis. Bacillus Calmette-Guérin (or Bacille Calmette-Guérin, BCG) is a vaccine against Tuberculosis that is prepared from a strain of the attenuated Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common ^[36][37]

Epidemiology

Worldwide, two to three million people are estimated to be permanently disabled because of Hansen's disease. ^[6] India has the greatest number of cases, with Brazil second and Myanmar third. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld Burma, officially the Union of Myanmar ( pjìdàunzṵ mjàmmà nàinŋàndɔ̀ is the largest country by geographical area in mainland Southeast Asia.

In 1999, the world incidence of Hansen's disease was estimated to be 640,000; in 2000, 738,284 cases were identified. Incidence is a measure of the risk of developing some new condition within a specified period of time In 1999, 108 cases occurred in the United States. The United States of America —commonly referred to as the In 2000, the World Health Organization (WHO) listed 91 countries in which Hansen's disease is endemic. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when India, Myanmar and Nepal contained 70% of cases. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country Burma, officially the Union of Myanmar ( pjìdàunzṵ mjàmmà nàinŋàndɔ̀ is the largest country by geographical area in mainland Southeast Asia. Nepal (नेपाल) is a Landlocked country in South Asia. In 2002, 763,917 new cases were detected worldwide, and in that year the WHO listed Brazil, Madagascar, Mozambique, Tanzania and Nepal as having 90% of Hansen's disease cases. |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld Madagascar, or Republic of Madagascar (older name Malagasy Republic) is an Island nation in the Indian Ocean off the southeastern Mozambique, officially the Republic of Mozambique (Moçambique or República de Moçambique, ʁɛ'publikɐ d musɐ̃'bik is a country in southeastern Africa Tanzania ˌtænzəˈniːə officially the United Republic of Tanzania (Jamhuri ya Muungano wa Tanzania is a country in East Africa bordered by Kenya Nepal (नेपाल) is a Landlocked country in South Asia.

According to recent figures from the WHO, new cases detected worldwide have decreased by approximately 107,000 cases (or 21%) from 2003 to 2004. This decreasing trend has been consistent for the past three years. In addition, the global registered prevalence of HD was 286,063 cases; 407,791 new cases were detected during 2004.

Hansen's disease is tracked by the Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated Its prevalence in the United States is believed to be rising and underreported. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given ^[38] Although the number of cases worldwide continues to fall, pockets of high prevalence continue in certain areas such as Brazil, South Asia (India, Nepal), some parts of Africa (Tanzania, Madagascar, Mozambique) and the western Pacific. |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country Nepal (नेपाल) is a Landlocked country in South Asia. Tanzania ˌtænzəˈniːə officially the United Republic of Tanzania (Jamhuri ya Muungano wa Tanzania is a country in East Africa bordered by Kenya Madagascar, or Republic of Madagascar (older name Malagasy Republic) is an Island nation in the Indian Ocean off the southeastern Mozambique, officially the Republic of Mozambique (Moçambique or República de Moçambique, ʁɛ'publikɐ d musɐ̃'bik is a country in southeastern Africa The Pacific Ocean is the largest of the Earth 's Oceanic divisions

Risk groups

At highest risk are those living in endemic areas with poor conditions such as inadequate bedding, contaminated water and insufficient diet, or other diseases (such as HIV) that compromise immune function. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Recent research suggests that there is a defect in cell-mediated immunity that causes susceptibility to the disease. Less than ten percent of the world's population is actually capable of acquiring the disease. The region of DNA responsible for this variability is also involved in Parkinson's disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level. Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Biochemistry is the study of the chemical processes in living Organisms It deals with the Structure and function of cellular components such as In addition, men are twice as likely to contract leprosy as women.

Disease burden

Although annual incidence—the number of new leprosy cases occurring each year—is important as a measure of transmission, it is difficult to measure in leprosy due to its long incubation period, delays in diagnosis after onset of the disease and the lack of laboratory tools to detect leprosy in its very early stages. Incidence is a measure of the risk of developing some new condition within a specified period of time

Instead, the registered prevalence is used. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given Registered prevalence is a useful proxy indicator of the disease burden as it reflects the number of active leprosy cases diagnosed with the disease and retrieving treatment with MDT at a given point in time. The prevalence rate is defined as the number of cases registered for MDT treatment among the population in which the cases have occurred, again at a given point in time. ^[39]

New case detection is another indicator of the disease that is usually reported by countries on an annual basis. It includes cases diagnosed with onset of disease in the year in question (true incidence) and a large proportion of cases with onset in previous years (termed a backlog prevalence of undetected cases). The new case detection rate (NCDR) is defined by the number of newly detected cases, previously untreated, during a year divided by the population in which the cases have occurred.

Endemic countries also report the number of new cases with established disabilities at the time of detection, as an indicator of the backlog prevalence. However, determination of the time of onset of the disease is generally unreliable, is very labour-intensive and is seldom done in recording these statistics.

Global situation

Table 1: Prevalence at beginning of 2006, and trends in new case detection 2001-2005, excluding Europe
Region	Registered Prevalence (rate/10,000 pop. )	New Case Detection during the year
	Start of 2006	2001	2002	2003	2004	2005
Africa	40,830 (0. 56)	39,612	48,248	47,006	46,918	42,814
Americas	32,904 (0. The Americas are the lands of the Western hemisphere or New World, consisting of the Continents of North America and South America 39)	42,830	39,939	52,435	52,662	41,780
South-East Asia	133,422 (0. 81)	668,658	520,632	405,147	298,603	201,635
Eastern Mediterranean	4,024 (0. 09)	4,758	4,665	3,940	3,392	3,133
Western Pacific	8,646 (0. The Pacific Ocean is the largest of the Earth 's Oceanic divisions 05)	7,404	7,154	6,190	6,216	7,137
Totals	NA	763,262	620,638	514,718	407,791	296,499

Table 2: Prevalence and Detection, countries still to reach elimination
Countries	Registered Prevalence (rate/10,000 pop. )			New Case Detection (rate/100,000 pop. )
	Start of 2004	Start of 2005	Start of 2006	During 2003	During 2004	During 2005
Brazil	79,908 (4. |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld 6)	30,693 (1. 7)	27,313 (1. 5)	49,206 (28. 6)	49,384 (26. 9)	38,410 (20. 6)
Mozambique	6,810 (3. Mozambique, officially the Republic of Mozambique (Moçambique or República de Moçambique, ʁɛ'publikɐ d musɐ̃'bik is a country in southeastern Africa 4)	4,692 (2. 4)	4,889 (2. 5)	5,907 (29. 4)	4,266 (22. 0)	5,371 (27. 1)
Nepal	7,549 (3. Nepal (नेपाल) is a Landlocked country in South Asia. 1)	4,699 (1. 8)	4,921 (1. 8)	8,046 (32. 9)	6,958 (26. 2)	6,150 (22. 7)
Tanzania	5,420 (1. Tanzania ˌtænzəˈniːə officially the United Republic of Tanzania (Jamhuri ya Muungano wa Tanzania is a country in East Africa bordered by Kenya 6)	4,777 (1. 3)	4,190 (1. 1)	5,279 (15. 4)	5,190 (13. 8)	4,237 (11. 1)
Totals	NA	NA	NA	NA	NA	NA

As reported to WHO by 115 countries and territories in 2006, and published in the Weekly Epidemiological Record the global registered prevalence of leprosy at the beginning of the year was 219,826 cases. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given ^[40] New case detection during the previous year (2005 - the last year for which full country information is available) was 296,499. The reason for the annual detection being higher than the prevalence at the end of the year can be explained by the fact that a proportion of new cases complete their treatment within the year and therefore no longer remain on the registers. The global detection of new cases continues to show a sharp decline, falling by 110,000 cases (27%) during 2005 compared with the previous year.

Table 1 shows that global annual detection has been declining since 2001. The African region reported an 8. 7% decline in the number of new cases compared with 2004. The comparable figure for the Americas was 20. 1%, for South-East Asia 32% and for the Eastern Mediterranean it was 7. 6%. The Western Pacific area, however, showed a 14. 8% increase during the same period.

Table 2 shows the leprosy situation in the four major countries which have yet to achieve the goal of elimination at the national level. It should be noted that: a) Elimination is defined as a prevalence of less than 1 case per 10,000 population; b) Madagascar reached elimination at the national level in September 2006; c) Nepal detection reported from mid-November 2004 to mid-November 2005; and d) D. R. Congo officially reported to WHO in 2008 that it had reached elimination by the end of 2007, at the national level.

History

Numerous leprosaria, or leper hospitals, sprang up in the Middle Ages; Matthew Paris estimated that in the early thirteenth century there were 19,000 across Europe. Gerhard Henrik Armauer Hansen ( July 29, 1841 – February 12, 1912) was a Norwegian physician remembered for his identification Mycobacterium leprae, also known as Hansen’s bacillus, mostly found in warm tropical countries is the Bacterium that causes Leprosy (Hansen's Matthew Paris (c 1200 &ndash 1259 was a Benedictine monk English chronicler, artist in Illuminated manuscripts and Cartographer ^[41] The first recorded leprosarium was in Harbledown. Harbledown is a village to the west of Canterbury, Kent, now contiguous with the city and in effect a suburb (See Leper colony. A leper colony, leprosarium, or lazar house is a place to Quarantine leprous people ) These institutions were run along monastic lines and, while lepers were encouraged to live in these monastic-type establishments, this was for their own health as well as quarantine. Indeed, some medieval sources indicate belief that those suffering from leprosy were considered to be going through Purgatory on Earth, and for this reason their suffering was considered more holy than the ordinary person's. See also Intermediate state Limbo|Heaven|Sheol|Hades in Christianity|Hell in Christianity Purgatory, in the original sense is the condition or process of purification More frequently, lepers were seen to exist in a place between life and death: they were still alive, yet many chose or were forced to ritually separate themselves from mundane existence. The Separatio Leprosorum was a ceremony performed during the Middle Ages whenever a person was declared a leper by their community ^[42]

Radegund was noted for washing the feet of lepers. Radegund (also spelled Rhadegund) (c 520–587 was a 6th century Frankish princess who founded the Convent of Our Lady of Poitiers. Orderic Vitalis writes of a monk, Ralf, who was so overcome by the plight of lepers that he prayed to catch leprosy himself (which he eventually did). Orderic Vitalis (1075&ndashc 1142 was an English chronicler who wrote one of the great contemporary Chronicles of 11th and 12th century Normandy and The leper would carry a clapper and bell to warn of his approach, and this was as much to attract attention for charity as to warn people that a diseased person was near.

Mycobacterium leprae, the causative agent of leprosy, was discovered by G. H. Armauer Hansen in Norway in 1873, making it the first bacterium to be identified as causing disease in humans. Mycobacterium leprae, also known as Hansen’s bacillus, mostly found in warm tropical countries is the Bacterium that causes Leprosy (Hansen's Gerhard Henrik Armauer Hansen ( July 29, 1841 – February 12, 1912) was a Norwegian physician remembered for his identification ^[43][44] Historically, individuals with Hansen's disease have been known as lepers, however, this term is falling into disuse as a result of the diminishing number of leprosy patients and the pejorative connotations of the term. The term most widely accepted among people and agencies working in the field of Hansen's disease is "people affected by Hansen's disease. "

Historically, the term Tzaraath from the Hebrew Bible was, erroneously, commonly translated as leprosy, although the symptoms of Tzaraath were not entirely consistent with leprosy and rather referred to a variety of disorders other than Hansen's disease. Tzaraath ( Hebrew צרעת and numerous variants of English Transliteration, including tzaraas, tzaraat, tsaraas and The term Hebrew Bible is a generic reference to those books of the Bible originally written in Biblical Hebrew (and the related Biblical Aramaic ^[45]

In particular, tinea capitis (fungal scalp infection) and related infections on other body parts caused by the dermatophyte fungus Trichophyton violaceum are abundant throughout the Middle East and North Africa today and might also have been common in biblical times. Tinea capitis is a superficial fungal infection ( Dermatophytosis) of the Scalp. A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ A dermatophyte is a parasitic fungus ( Mycosis) that infects the skin Similarly, the related agent of the disfiguring skin disease favus, Trichophyton schoenleinii, appears to have been common throughout Eurasia and Africa before the advent of modern medicine. Favus (Latin for "honeycomb" is a Disease of the Scalp, but occurring occasionally on any part of the skin and even at times on Mucous membranes Persons with severe favus and similar fungal diseases (and potentially also with severe psoriasis and other diseases not caused by microorganisms) tended to be classed as having leprosy as late as the 17th century in Europe. Psoriasis (səˈraɪəsɪs ( suh-RI-uh-sus) is a non-contagious disorder which affects the Skin and Joints It commonly causes red scaly ^[46] This is clearly shown in the painting Governors of the Home for Lepers at Haarlem 1667 by Jan de Bray (Frans Hals Museum, Haarlem, the Netherlands), where a young Dutch man with a vivid scalp infection, almost certainly caused by a fungus, is shown being cared for by three officials of a charitable home intended for leprosy sufferers. Jan de Bray (ca1627 Haarlem - ca Apr 1 1697, Amsterdam) was a Dutch painter The Frans Hals Museum is a Hofje and municipal Museum in Haarlem, The Netherlands. in the past usually Harlem in English is a city in the Netherlands. The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands The use of the word "leprosy" before the mid-19th century, when microscopic examination of skin for medical diagnosis was first developed, can seldom be correlated reliably with Hansen's disease as we understand it today.

The word "leprosy" derives from the ancient Greek words lepros, a scale, and lepein, to peel. ^[47] The word came into the English language via Latin and Old French. The first attested English use is in the Ancrene Wisse, a 13th-century manual for nuns ("Moyseses hond. . bisemde o þe spitel uuel & þuhte lepruse. " The Middle English Dictionary, s. v. , "leprous"). A roughly contemporaneous use is attested in the Anglo-Norman Dialogues of Saint Gregory, "Esmondez i sont li lieprous" (Anglo-Norman Dictionary, s. v. , "leprus").

Popular culture

• In the film Ben-Hur, Judahs' mother and sister suffer from leprosy. Ben-Hur (or Benhur is a 1959 Movie directed by William Wyler, and is the third film version of Lew Wallace 's novel Ben-Hur
• R.E.M. has a song entitled New Test Leper on their New Adventures in Hi-Fi album. REM is an American rock band formed in Athens, Georgia, in 1980 by Michael Stipe ( lead vocals) Peter Buck ( Guitar " New Test Leper " is a song by REM It is included on their tenth studio album New Adventures in Hi-Fi, which was released in 1996 New Adventures in Hi-Fi is the tenth full-length studio album by the American band R
• The book series The Chronicles of Thomas Covenant, the Unbeliever revolves around the main character's leprosy. The Chronicles of Thomas Covenant the Unbeliever is a trilogy of Fantasy novels by Stephen R
• The Motorcycle Diaries depicts Ernesto Che Guevera, at the age of 24, working at the San Pablo leper colony in Peru: 'Che' was a medical student at the time, specializing in leprosy. The Motorcycle Diaries is a book that traces the early travels of Marxist revolutionary Ernesto 'Che' Guevara, then a 23-year-old medical student Ernesto "Che" Guevara (June 14 Following the Cuban revolution,Guevara reviewed He wrote of the poor treatment and living conditions of the patients there. This, and other disparities he witnessed, contributed to his strong belief in the need for public health care.
• Weird Al Yankovic has a song entitled "Party at the Leper Colony". Alfred Matthew "Weird Al" Yankovic (ˈjæŋkəvɪk born October 23 1959 is a Grammy Award winning American singer Musician, actor satirist Poodle Hat is the eleventh Album by "Weird Al" Yankovic.
• The King of Jerusalem in the 12th century, Baldwin IV, suffered from leprosy. Jerusalem (יְרוּשָׁלַיִם, he-Latn Yerushaláyim; Arabic: ar القُدس, ar-Latn al-Quds) is the Baldwin IV of Jerusalem (1161&ndash 16 March 1185) called the Leper or the Leprous, the son of Amalric I of Jerusalem and his first This was portrayed in Kingdom of Heaven, a 2005 film directed by Ridley Scott. Kingdom of Heaven is a 2005 Epic film, directed by Ridley Scott and written by William Monahan. Sir Ridley Scott (born November 30 1937 in South Shields, Tyne and Wear) is a British Academy Award Nominated and Golden Globe Emmy Award and BAFTA Award winning The Director's Cut of the film also depicts the king's nephew and heir to the throne, Baldwin V, in the early stages of leprosy. Baldwin V of Jerusalem ( Baldwin of Montferrat, also known as Baudouinet) (1177 &ndash August 1186 was the son of Sibylla of Jerusalem and her first husband
• The aging Robert the Bruce Sr. in the 1995 film Braveheart. Robert de Brus 6th Lord of Annandale and Jure uxoris Earl of Carrick (July 1243 - March 1304) was a feudal lord in both Scotland and Braveheart is a 1995 historical action-drama movie produced and directed by Mel Gibson, who also starred in the title role
• Dimmu Borgir has a song entitled Lepers Among Us. Dimmu Borgir (ˌdɪmuːˈbɔːrɡɪr is a Symphonic black metal band from Norway.
• The famous Vietnamese poet Han Mac Tu suffered and died from leprosy in the 1930s.
• David Bowie describes Ziggy Stardust as a "leper messiah" in the song "Ziggy Stardust". David Bowie (ˈboʊiː born David Robert Jones on 8 January 1947 is an English Musician, actor producer, and arranger.
• The band Metallica has a song called "Leper Messiah" on their Master of Puppets album. Metallica is an American heavy metal band that formed in 1981 in. Master of Puppets is the third studio album by American heavy metal band Metallica.
• In The Simpsons episode "Little Big Mom", Homer and Bart are tricked into believing they have leprosy. " Little Big Mom " is the tenth episode of the eleventh season of The Simpsons, and the first episode written by Carolyn Omine.
• Death Metal band Death has an album titled Leprosy
• The American TV show House featured a young boy with leprosy in Season 1, Episode 13, "Cursed". Death was an influential American Death metal band founded in 1983 by guitarist and vocalist Chuck Schuldiner, considered a "pioneering death Leprosy is the second album released by Death in 1988 Notably different in tone and quality from the 1987 debut it is the first example of Scott Burns House, also known as House MD, is an American Medical drama, which debuted on the FOX network on November 16 2004
• The book entitled Hawaii by James A. Michener tells one story of a Chinese man, Mun Ki, who discovers that he has leprosy, as termed 'mai Pake'. Hawaii is a novel by James Michener published in 1959. Written in episodic format like most of Michener's works the book narrates the story of the original James Albert Michener ( February 3, 1907 – October 16, 1997) was an American author of more than 40 titles the majority of which He is then banished to the isolated leper colony of Kalawao on the island of Moloka'i with other afflicted people. A leper colony, leprosarium, or lazar house is a place to Quarantine leprous people Kalaupapa is a small Village on the island of Moloka‘i in the state of Hawai‘i, and part of Kalawao County. Molokai (also Molokai) is an Island in the Hawaiian archipelago. ^[48]
• In an episode of the American sitcom Seinfeld, Jerry compared the DMV's high concentration of unattractive people to that of a leper colony. Seinfeld is an American Situation comedy, or sitcom that originally aired on NBC from July 5 1989 to May 14 1998 lasting nine seasons
• In the song "One" by the rock band U2, Bono sings "Did you come here for forgiveness? Did you come to raise the dead? Did you come here to play Jesus to the lepers in your head?'
• An episode of the TV series Monk is titled Mr. Monk and the Leper. Monk is an American Dramedy series created by Andy Breckman and starring Tony Shalhoub as the title character The following is an episode list for the dramedy television series Monk.
• One of the incarnations of the antagonist in Stephen King's It is afflicted with advanced leprosy. Stephen Edwin King (born September 21, 1947) is an American Author, Screenwriter, Musician, Columnist, It is a Horror novel by Stephen King, published in 1986 Considered one of King's most visceral and graphic works and his masterpiece alongside
• In the original and remake of the John Carpenter film The Fog a ship carrying a migrating leper colony is robbed of a fortune to build the fictional Antonio Bay California, USA. For the 2005 film see The Fog (2005 film. For the unrelated James Herbert novel see The Fog (1975 novel. A leper colony, leprosarium, or lazar house is a place to Quarantine leprous people
• In the animated film Princess Mononoke the leader of Irontown, Lady Eboshi, takes in lepers and cares for their wounds and provides shelter for them. is a 1997 Japanese Anime film written and directed by Hayao Miyazaki of Studio Ghibli.
• The band Opeth wrote a song called "The Leper Affinity", and their song, "Blackwater Park", contains the lines "Lepers coiled 'neath the trees, dying men in bewidered soliloquys". Opeth is a Swedish heavy metal band that formed in 1990 in Stockholm.
• Kenshin Himura of the anime Rurouni Kenshin suffered and died of symptoms resembling leprosy in his final days. (anime in Japanese, is a Japanese Manga series written and illustrated by Nobuhiro Watsuki. Though the writers cannot explain his illness, the lesions and the manner of transmission to his wife Kaoru Kamiya resembles that of leprosy.

Famous People

• Blessed Damien of Moloka'i was a Roman Catholic missionary who became a leper when he spent the rest of his life serving in the leper colony at Moloka'i. Blessed Damien de Veuster ( January 3, 1840 &ndash April 15, 1889) born Jozef de Veuster and also known as Blessed Damien Molokai (also Molokai) is an Island in the Hawaiian archipelago.

External links

• Leprosy and Human Rights - event held at Woodrow Wilson International Center for Scholars, March 2008
• National Hansen's Disease Programs (NHDP), U.S. Health Resources and Services Administration
• Hansen's Disease (Leprosy) - Centers for Disease Control and Prevention
• World Health Organization (WHO) leprosy website
• American Leprosy Missions
• The Global Campaign to Eliminate Leprosy article from PLoS Medicine
• LEPRA - Health in Action UK Based organisation founded in 1924 to treat leprosy and related diseases of poverty. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated

History of leprosy

• History of Leprosy, Urban Environment and French Colonization in West Africa.
• Anthropology and History of leprosy (Histoire & Anthropologie, 15 (1995) 115-122).
• ILA Global Project on the History of Leprosy
• National Hansen's Disease Museum
• BBC News: Slave trade key to leprosy spread

• Interview with author John Tayman (The Colony) (MP3 audio: runtime = 00:23:20, 10. MPEG-1 Audio Layer 3, more commonly referred to as MP3, is a Digital audio encoding format using a form of Lossy data compression 7 mb). IT Conversations Tech Nation (2006-02-07). Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 457 - Leo I becomes emperor of the Byzantine Empire. 1074 - Battle of Montesarchio in which the Prince Retrieved on 2007-03-22. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 238 - Gordian I and his son Gordian II are proclaimed Roman emperor.

Research

• Pathology Images of Leprosy and Other Granulomatous diseases Yale Rosen, M. D.
• INFOLEP Leprosy Information Services
• Leprosy Review
• Medical anthropology, Leprosy and Health Care in French speaking West-Africa.
• Anthropologie, lèpre et santé publique.
• Gender and Leprosy.

References

Further reading

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