Amanda DeSalvo BIO 230 Dr.

Suran Outline- Research Assignment Part 2 Due: July 7 2011 Topic: Mycobacterium leprae and Leprosy

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Leprosy- also referred to as Hansens disease, is a chronic infectious disease caused by Mcyobacterium leprae. M. leprae is an acid fast rod-shaped organism...It is believed that only leprosy bacilli which stain carbol-fuscin as solid acid-fast rods are viable ("Leprosy elimination," 2011). M. leprae has some unique properties. It is...the only mycobacterium that loses its acid fastness after treatment with pyridine. M. leprae is an obligate intracellular pathogen and multiplies in macrophages and Schwann cells. The bacillus has a long generation time (12-20 days) and can be cultured in vivo in animals such as nude mice, armadillos and different monkey species, but even more than 130 years after its discovery, it cannot be cultured in vitro (Dogra, & Kanwar, 2011)

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Incubation period- 2 to 5 years (Dogra, & Kanwar, 2011) Mode of transmission (Dogra, & Kanwar, 2011) S/S can vary based on the form of leprosy that a person has a. Tuberculoid- also known as paucibacillary leprosy, is the mild form of the disease. Early signs and symptoms of tuberculoid leprosy can include one or more light or slightly red patches of skin that appear on the trunk or extremities. This may be associated with a decrease in light-touch sensation in the area of the rash. Other signs and symptoms can include:

 Skin stiffness and dryness Loss of fingers and toes Eye problems, which leads to blindness Severe pain Muscle weakness, especially in the hands and feet Enlarged nerves, especially those around the elbow (ulnar nerve) and knee (peroneal nerve). It is important to note that not all people with leprosy lose their fingers and toes. With early diagnosis and leprosy treatment, many of these signs and symptoms of leprosy can be prevented. Many patients with tuberculoid disease can even self-heal without benefit of treatment. In order to prevent problems with fingers or toes, people should avoid injury and infections to these areas and take their medicines as prescribed ("Signs and symptoms," 2010) b. Lepromatous- also known as multibacillary leprosy, is the severe form of leprosy. Signs and symptoms of lepromatous leprosy can include a symmetrical skin rash more commonly found on the: Elbows Knees Buttocks Face Ears Wrists.

This skin rash can be: Small or large Flat or raised Light or dark. Other signs and symptoms include:

 Thinning of eyebrows and eyelashes Thickened skin on face Nasal stuffiness Bloody nose Laryngitis Collapsing of the nose Swelling of the lymph nodes in the groin and armpits Scarring of the testes that leads to infertility Enlargement of male breasts (gynecomastia). ("Signs and symptoms," 2010) 5. Questions the author addresses: (Heukelbach et.al, 2011) a. Is there low adherence to multidrug therapy against leprosy? b. Does the low adherence to MDT explain the reason for difficulty in managing disease control? 6. Techniques the author used: (Heukelbach et.al, 2011) a. population based study in Central Brazil b. applied structured questionnaires on leprosy-affected individuals c. used two outcomes for assessment of risk factors: defaulting (not presenting to health care center for supervised treatment) and interruption of MDT 7. Results/Conclusion of experiment: (Heukelbach et.al, 2011) a. patients defaulted= 3.0% i. due to low number of rooms per household, moving to another residence after diagnosis, low family income b. patients interrupted MDT= 18.2% i. low number of rooms per household, difficulty swallowing MDT drugs, temporal non-availability of MDT at the health center, moving to another residence c. conclusion:

i. Defaulting and interruption of MDT are associated with some poverty-related variables such as family income, household size, and migration. Intermittent problems of drug supply need to be resolved, mainly on the municipality level. MDT producers should consider oral formulations that may be more easily accepted by patients (Heukelbach et.al, 2011). 8. Unanswered questions/opportunities for further research: a. An integrated approach is needed for further improving control, focusing on most vulnerable population groups and the local health system (Heukelbach et.al, 2011) b. Poverty and its consequences, similar to other neglected tropical diseases, has been shown to be associated with leprosy in general, and our results reflect this complex interaction of causation leading to higher risk of disease in underprivileged populations (Heukelbach et.al, 2011) c. Do studies from other parts of the world show different risk factors? (Heukelbach et. al, 7) d. Does demographics change the variables on adherence to treatment? e. What limitations are there? i. number of defaulters, as a result of the ongoing leprosy control measures, has been reduced significantly in the past years, and we included only 28 patients who defaulted treatment (Heukelbach et.al, 8) ii. non-participation bias, mainly of those who abandoned treatment... (Heukelbach et.al, 8)

iii. Did analysis take into account adherence to drugs taken at home? (Heukelbach et.al, 8) iv. Finally, incomplete patients charts and subsequent missing data hampered analysis regarding clinical variables in some cases (Heukelbach et.al, 8)

Works Cited Dogra, S, & Kanwar, A.J. (2011). Leprosy (hansen disease). Harper's Textbook of Pediatric Dermatology, 1,2(3), Retrieved from http:// onlinelibrary.wiley.com.libdb.dccc.edu/doi/10.1002/9781444345384.ch70/ summary doi: 10.1002/9781444345384.ch70 Heukelbach, J., Chichava, O.A., Rodriguez de Oliveira, A., Hafner, K., Walther, F., Morais de Alencar, C.H., Ramos, A.N., Ferreira, A.C., & Ariza, L. (2011). ruption and defaulting of multidrug therapy against leprosy: population-based in brazil's savannah region. Experimental Dermatology, 5(5), Retrieved http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0625.2011.01270.x/abstract 10.1111/j.1600-0625.2011.01270.x Leprosy elimination. (2011). Retrieved from http://www.who.int/lep/microbiology/en/ index.html Signs and symptoms of leprosy. (2010, August 19). Retrieved from http:// diseases.emedtv.com/leprosy/signs-and-symptoms-of-leprosy.html Interstudy from doi: