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.
Are there different forms (classifications) of leprosy?
There are multiple forms of leprosy described in the literature. The forms of
leprosy are based on the person's immune response to M. leprae. A good immune
response can produce the so-called tuberculoid form of the disease, with limited
skin lesions and some asymmetric nerve involvement. A poor immune response can
result in the lepromatous form, characterized by extensive skin and symmetric
nerve involvement. Some patients may have aspects of both forms. Currently, two
classification systems exist in the medical literature: the WHO system and the
Ridley-Jopling system. The Ridley-Jopling system is composed of six forms or
classifications, listed below according to increasing severity of symptoms:
Indeterminate leprosy: a few hypopigmented macules; can heal spontaneously,
persists or advances to other forms
Tuberculoid leprosy: a few hypopigmented macules, some are large and some
become anesthetic (lose pain sensation); some neural involvement in which nerves
become enlarged; spontaneous resolution in a few years, persists or advances to
other forms
Borderline tuberculoid leprosy: lesions like tuberculoid leprosy but smaller
and more numerous with less nerve enlargement; this form may persist, revert to
tuberculoid leprosy, or advance to other forms
Mid-borderline leprosy: many reddish plaques that are asymmetrically
distributed, moderately anesthetic, with regional adenopathy (swollen lymph
nodes); the form may persist, regress to another form, or progress
Borderline lepromatous leprosy: many skin lesions with macules (flat lesions)
papules (raised bumps), plaques, and nodules, sometimes with or without
anesthesia; the form may persist, regress or progress to lepromatous leprosy
Lepromatous leprosy: Early lesions are pale macules (flat areas) that are
diffuse and symmetric; later many M. leprae organisms can be found in them.
Alopecia (hair loss) occurs; often patients have no eyebrows or eyelashes.
As
the disease progresses, nerve involvement leads to anesthetic areas and limb
weakness; progression leads to aseptic necrosis (tissue death from lack of blood
to area), lepromas (skin nodules), and disfigurement of many areas including the
face. The lepromatous form does not regress to the other less severe forms. Histoid leprosy is a clinical variant of lepromatous leprosy that presents with clusters of histiocytes (a type of cell involved in the inflammatory response) and a grenz zone (an area of collagen separating the lesion from normal tissue) seen in microscopic tissue sections.
The Ridley-Jopling classification is used globally in evaluating patients in
clinical studies. However, the WHO classification system is more widely used; it
has only two forms or classifications of leprosy. The 2009 WHO classifications
are simply based on the number of skin lesions as follows:
Paucibacillary leprosy: skin lesions with no bacilli (M. leprae) seen in a
skin smear
Multibacillary leprosy: skin lesions with bacilli (M. leprae) seen in a skin
smear
However, the WHO further modifies these two classifications with clinical
criteria because "of the non-availability or non-dependability of the
skin-smear services. The clinical system of classification for the purpose of
treatment includes the use of number of skin lesions and nerves involved as the
basis for grouping leprosy patients into multibacillary (MB) and paucibacillary
(PB) leprosy." Investigators state that up to about four to five skin lesions constitutes
paucibacillary leprosy, while about five or more constitutes multibacillary
leprosy.
Multidrug therapy (MDT) with three antibiotics (dapsone, rifampicin, and clofazimine) is used for multibacillary leprosy, while a modified MDT with two antibiotics (dapsone and rifampicin) is recommended for paucibacillary leprosy and composes most current treatments today (see treatment section below). Paucibacillary leprosy usually includes indeterminate, tuberculoid, and borderline tuberculoid leprosy from the Ridley-Jopling classification, while multibacillary leprosy usually includes the double (mid-) borderline, borderline lepromatous, and lepromatous 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.
Infectious Disease RSS
Healthy Living Tips
