Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Most (95 percent) of the human population is not susceptible to infection with
M. leprae, the bacteria that causes Hansen's disease (leprosy).
Treatment with standard antibiotic drugs is very effective.
Patients become noninfectious after taking only a few doses of medication and need not be isolated from family and friends.
Diagnosis in the U.S. is often delayed because health care providers are unaware of Hansen's disease (leprosy) and its symptoms.
Early diagnosis and treatment prevents nerve involvement, the hallmark of Hansen's disease (leprosy), and the disability it causes.
Without nerve involvement, Hansen's disease (leprosy) is a minor skin disease.
166 new cases were reported in the U.S. in 2005 (the most recent year for which data are available.
Most (100 or 60%) of these new cases were reported in
California
Louisiana
Massachusetts
New York
Texas
SOURCE:
U.S. Department of Health and Human Services, Health Resources and Services Administration
What is leprosy?
Leprosy is a disease caused by the bacteria Mycobacterium leprae, which causes
damage to the skin and the peripheral nervous system. The disease develops
slowly (from six months to 40 years!) and results in skin lesions and deformities,
most often affecting the cooler places on the body (for example, eyes, nose,
earlobes, hands, feet, and testicles). The skin lesions and deformities can be
very disfiguring and are the reason that infected individuals historically were considered
outcasts in many cultures. Although human-to-human transmission is the primary
source of infection, three other species can carry and (rarely) transfer M.
leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The
disease is termed a chronic granulomatous disease, similar to tuberculosis, because it produces
inflammatory nodules (granulomas) in the skin and nerves over time.
What is the history of leprosy (Hansen's disease)?
Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest research suggests that at least as early as 4000 B.C. individuals had been infected with
M. leprae, while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India, and there are several references to the disease in the Bible. Because the disease was poorly understood, very disfiguring, slow to show symptoms, and had no known treatment, many cultures thought the disease was a curse or punishment from the gods. Consequently, leprosy was left to be "treated" by priests or holy men, not physicians.
Picture of a person with leprosy (Hansen's disease)
Since the disease often appeared in family members, some people thought it was hereditary; other people noted that if there was little or no contact with infected individuals, the disease did not infect others. Consequently, some cultures considered infected people (and occasionally their close relatives) as "unclean" or as "lepers" and ruled they could not associate with uninfected people. Often infected people had to wear special clothing and ring bells so uninfected people could avoid them.
The Romans and the Crusaders brought the disease to Europe, and the Europeans brought it to the Americas. In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting leprosy was an infectious disease, not
a hereditary disease or a punishment from the gods. However, patients with the disease were still ostracized by many societies and cared for only at missions by religious personnel. Patients with leprosy were encouraged or forced to live in seclusion up to the 1940s, even in the U.S. (for example, the leper colony on Molokai, Hawaii, and at Carville, La.), often because no effective treatments were available.
Because of Hansen's discovery of M. leprae, efforts were made to find treatments that would stop or eliminate
M. leprae; in the early 1900s to about 1940, oil from Chaulmoogra nuts was used with questionable efficacy by injecting it into patients' skin. At Carville in 1941,
promin, a sulfone drug, showed efficacy but required many painful injections. Dapsone pills were found to be effective in the 1950s, but soon (1960s-1970s),
M. leprae developed resistance to dapsone. Fortunately, drug trials on the island of Malta in the 1970s showed that a three-drug combination (dapsone,
rifampicin
[Rifadin], and clofazimine [Lamprene]) was very effective in killing
M. leprae. This multi-drug treatment (MDT) was recommended by the WHO in 1981 and remains, with minor changes, the therapy of choice. MDT, however, does not alter the damage done to an individual by
M. leprae before MDT is started.
Currently, there are several areas (India, East Timor) of the world where the WHO and other agencies (for example, the Leprosy Mission) are working to decrease the number of clinical cases of leprosy and other diseases such as rabies and schistosomiasis that occur in remote regions. Although researchers hope to eliminate leprosy like smallpox, endemic (meaning prevalent or embedded in a region) leprosy makes complete eradication unlikely. In the U.S., leprosy has occurred infrequently but is considered endemic in Texas, Louisiana, Hawaii, and the U.S. Virgin Islands by some investigators.
Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to have patients forgo the stigmas attached to being diagnosed with leprosy.
Foot pain may be caused by injuries (sprains, strains, bruises, and fractures), diseases (diabetes, Hansen disease, and gout), viruses, fungi, and bacteria (plantar warts and athlete's foot), or even ingrown toenails. Pain and tenderness may be accompanied by joint looseness, swelling, weakness, discoloration, and loss of function. Minor foot pain can usually be treated with rest, ice, compression, and elevation and OTC medications such as acetaminophen and ibuprofen. Severe pain should be treated by a medical professional.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Alopecia areata is a condition that causes hair loss on the scalp and sometimes other parts of the body. It is believed to be caused by an abnormality of the immune system that causes the body's immune system to attack the hair follicles. Typically, hair regrows within a year without treatment. Steroid injections, creams, and shampoos may be used during treatment.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
Blindness is the state of being sightless. Causes of blindness include macular degeneration, stroke, cataract, glaucoma, infection and trauma. Symptoms and signs may include eye pain, eye discharge, or the cornea or pupil turning white. Treatment of blindness depends upon the cause of the blindness.
Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death.
Aseptic necrosis can be caused by trauma, damage to the blood vessels that supply bone its oxygen, poor blood circulation to the bone, abnormally thick blood (hypercoagulable state), and atherosclerosis or inflammation of the blood vessel walls (vasculitis).
Steroid medications (cortisone, such as
prednisone [Deltasone, Liquid
Pred] and methylprednisolone
[Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis.
Risk factors for aseptic necrosis include
alcoholism, cortisone medications,
Cushing's syndrome, radiation exposure,
sickle cell disease,
pancreatitis,
Gaucher disease, and
systemic lupus erythematosus.
Aseptic necrosis may or may not cause pain.
The treatment of aseptic necrosis is critically dependent on the stage of the ...
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