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.
The majority of cases (mainly clinically diagnosed) are treated with
antibiotics. The recommended antibiotics, their dosages, and length of time of
administration are based on the form or classification of the disease and
whether or not the patient is supervised by a medical professional. In general,
paucibacillary leprosy is treated with two antibiotics, dapsone and rifampicin,
while multibacillary leprosy is treated with the same two plus a third
antibiotic, clofazimine. Usually, the antibiotics are given for at least six to 12
months or more.
Antibiotics can treat paucibacillary leprosy with little or no residual effects
on the patient. Multibacillary leprosy can be kept from advancing, and living M.
leprae can be essentially eliminated from the person by antibiotics, but the
damage done before antibiotics are administered is usually not reversible.
Recently, the WHO suggested that single-dose treatment of patients with only one
skin lesion with rifampicin, minocycline (Minocin), or ofloxacin (Floxin) is effective. Studies of
other antibiotics are ongoing. Each patient, depending on the above criteria, has a schedule for their individual treatment, so treatment schedules should be planned by a clinician knowledgeable about that patient's initial diagnostic classification.
The role for surgery in the treatment of leprosy occurs after medical treatment
(antibiotics) has been completed with negative skin smears (no detectable
acid-fast bacilli) and is often only needed in advanced cases. Surgery is
individualized for each patient with the goal to attempt cosmetic improvements
and, if possible, to restore limb function and some neural functions that were
lost to the disease.
How is leprosy prevented?
Prevention of contact with droplets from nasal and other secretions from
patients with untreated M. leprae infection currently is a way
recommended to avoid the
disease. Treatment of patients with appropriate antibiotics stops the person
from spreading the disease. People who live with individuals who have
untreated leprosy are about eight times as likely to develop the disease, because
investigators speculate that family members have close proximity to infectious
droplets. Leprosy is not hereditary, but recent findings suggest susceptibility to the disease may have a genetic basis.
Many people get exposed to leprosy throughout the world, but the disease in not highly contagious; researchers suggest that over 95% of exposures result in no disease, and further studies suggest that susceptibility may be based, in part, by a person's genetic makeup.
In the U.S., there are about 200-300 new cases diagnosed per year, with most coming from exposures during foreign travel. The majority of worldwide cases are found in the tropics or subtropics (for example, Brazil, India, and Indonesia). The WHO reports about 500,000 to 700,000 new cases per year worldwide, with curing of about 14 million cases since 1985.
There is no commercially available vaccine available to prevent leprosy. However, there are reports of using BCG vaccine, the BCG vaccine along with heat-killed
M. leprae organisms, and other preparations that may be protective or help to clear the infection or to shorten treatment. Except for BCG in some countries, these preparations are not readily available.
Animals (chimpanzees, mangabey monkeys, and nine-banded armadillos) rarely transfer
M. leprae to humans; nonetheless, handling such animals in the wild is not advised. These animals are a source for endemic infections.
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.
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