NATIONAL HANSEN’S DISEASE PROGRAMS. DIAGNOSIS & TREATMENT OF HANSEN’S DISEASE DIAGNOSIS & TREATMENT OF HANSEN’S DISEASE.

NATIONAL HANSEN’S DISEASE

PROGRAMS

NATIONAL HANSEN’S DISEASE

PROGRAMS

DIAGNOSIS & TREATMENTOF HANSEN’S DISEASE

DIAGNOSIS & TREATMENTOF HANSEN’S DISEASE

Hansen’s disease is an infectious disease of man primarily involving:Hansen’s disease is an infectious disease of man primarily involving:

• Skin

• Peripheral Nerves

• Eyes

• Mucous Membranes (Nose and Throat)

• Skin

• Peripheral Nerves

• Eyes

• Mucous Membranes (Nose and Throat)

HANSEN’S DISEASE IN THEUNITED STATES

HANSEN’S DISEASE IN THEUNITED STATES

Average number of new casesReported annually is between150 - 225

Average number of new casesReported annually is between150 - 225

ETIOLOGY - MYCOBACTERIUM LEPRAEETIOLOGY - MYCOBACTERIUM LEPRAE

• Acid Fast Bacteria

• Discovered by Hansen in Norway in 1873

• Never Been Cultured in Laboratory

• Found in Man, Armadillos, and Some Monkeys

• Acid Fast Bacteria

• Discovered by Hansen in Norway in 1873

• Never Been Cultured in Laboratory

• Found in Man, Armadillos, and Some Monkeys

MODE OF TRANSMISSIONMODE OF TRANSMISSION

• Untreated Lepromatous Patients - Respiratory Route

• Armadillos?

• Soil or Vegetation?

• Incubation Period Average 3 - 5 years

• Untreated Lepromatous Patients - Respiratory Route

• Armadillos?

• Soil or Vegetation?

• Incubation Period Average 3 - 5 years

SUSCEPTIBILITYSUSCEPTIBILITYSUSCEPTIBILITYSUSCEPTIBILITY

• Only 3 - 5% of Populations are Susceptible

• Children or Contacts of Treated Patients Rarely Get the Disease

• Attack Rate of Spouses is 2 - 10%

• Genetic Factors

• Immune Factors

• Only 3 - 5% of Populations are Susceptible

• Children or Contacts of Treated Patients Rarely Get the Disease

• Attack Rate of Spouses is 2 - 10%

• Genetic Factors

• Immune Factors

TT BT BB BL LL TT BT BB BL LL

CMICMI

TUBERCULOID

FEWBACTERIA

LOWANTIBODY

LEVELS

HIGH RESISTANCETO M. LEPRAE

TUBERCULOID

FEWBACTERIA

LOWANTIBODY

LEVELS

HIGH RESISTANCETO M. LEPRAE

LEPROMATOUS

MANYBACTERIA

HIGHANTIBODY

LEVELS

LOW RESISTANCETO M.LEPRAE

LEPROMATOUS

MANYBACTERIA

HIGHANTIBODY

LEVELS

LOW RESISTANCETO M.LEPRAE

The Hansen’s Disease SpectrumThe Hansen’s Disease Spectrum

BIBI

ENLENL

ANTIBODY

LEVELANTIB

ODY

LEVEL

Reversal Reaction

Reversal Reaction

CLASSIFICATION FOR TREATMENTCLASSIFICATION FOR TREATMENT

• I - Indeterminate

• TT - Tuberculoid

• BT - Borderline Tuberculoid

• I - Indeterminate

• TT - Tuberculoid

• BT - Borderline Tuberculoid

• BB - Midborderline• BL - Borderline Lepromatous• LL - Lepromatous

• BB - Midborderline• BL - Borderline Lepromatous• LL - Lepromatous

PAUCIBACILLARY (PB)(No Bacilli in Skin Smears)

PAUCIBACILLARY (PB)(No Bacilli in Skin Smears)

MULTIBACILLARY (MB)(Skin Smears: 1+ to 6+ Bacilli)MULTIBACILLARY (MB)

(Skin Smears: 1+ to 6+ Bacilli)

DIAGNOSIS OF HANSEN’S DISEASEDIAGNOSIS OF HANSEN’S DISEASE

• Skin

• Nerves

• Eyes

• Hands & Feet

• Skin

• Nerves

• Eyes

• Hands & Feet

• Slit Skin Smears

• Skin Biopsies

• Slit Skin Smears

• Skin Biopsies

Clinical Exam ProceduresClinical Exam Procedures Lab ProceduresLab Procedures

DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA

• Anesthetic Skin Lesions

• Enlarged Peripheral Nerves

• Acid Fast Bacilli in Skin Smears

• Biopsy Evidence of Nerve Damage or Acid Fast Bacilli

• Anesthetic Skin Lesions

• Enlarged Peripheral Nerves

• Acid Fast Bacilli in Skin Smears

• Biopsy Evidence of Nerve Damage or Acid Fast Bacilli

Posterior TibialNerve

Posterior TibialNerve

Peroneal NervePeroneal Nerve

Radial CutaneousNerve

Radial CutaneousNerve

UlnarNerveUlnarNerve

Great AuricularNerve

Great AuricularNerve

PERIPHERAL NERVESPERIPHERAL NERVES

BACTERIAL INDEX (BI)BACTERIAL INDEX (BI)

0 = None found in 100 OIF

1+ = 1 - 10 Per 100 OIF

2+ = 1 - 10 Per 10 OIF

3+ = 1 - 10 Per OIF

4+ = 10 - 100 Per OIF

5+ = 100 - 1000 Per OIF

6+ = 1000+ Per OIF

0 = None found in 100 OIF

1+ = 1 - 10 Per 100 OIF

2+ = 1 - 10 Per 10 OIF

3+ = 1 - 10 Per OIF

4+ = 10 - 100 Per OIF

5+ = 100 - 1000 Per OIF

6+ = 1000+ Per OIF

(OIF = Oil Immersion Field)(OIF = Oil Immersion Field)

BIOPSIESBIOPSIES

• Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm)

• Deep Enough to Include Subcutaneous Tissue and Fat

• Fix Promptly in at Least 10 Volumes of 10% Formalin

• Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm)

• Deep Enough to Include Subcutaneous Tissue and Fat

• Fix Promptly in at Least 10 Volumes of 10% Formalin

DRUGS FOR CHEMOTHERAPYDRUGS FOR CHEMOTHERAPY

• DAPSONE (DDS)

• RIFAMPIN

• CLOFAZIMINE (B663 - LAMPRENE)

• DAPSONE (DDS)

• RIFAMPIN

• CLOFAZIMINE (B663 - LAMPRENE)

CHEMOTHERAPY OF HANSEN’S DISEASECHEMOTHERAPY OF HANSEN’S DISEASE

• U.S. Short Term

• World Health Organization

• U.S. Short Term

• World Health Organization

U. S. SHORT TERM THERAPYU. S. SHORT TERM THERAPY

PAUCIBACILLARY - 1 Year TreatmentPAUCIBACILLARY - 1 Year Treatment

• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Dapsone 100 mg Daily• Rifampin 600 mg Daily

MULTIBACILLARY - 2 Year TreatmentMULTIBACILLARY - 2 Year Treatment

• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Clofazimine 50 mg Daily

• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Clofazimine 50 mg Daily

LABORATORY MONITORINGLABORATORY MONITORING

Baseline Studies - CBC, Platelets, Liver Functions, and G-6-PD

Rifampin - CBC and Liver FunctionStudies Every 2 to 3 Months

Dapsone - CBC Every 6 Months

Clofazimine - No Specific Studies Required

Baseline Studies - CBC, Platelets, Liver Functions, and G-6-PD

Rifampin - CBC and Liver FunctionStudies Every 2 to 3 Months

Dapsone - CBC Every 6 Months

Clofazimine - No Specific Studies Required

SIDE EFFECTSSIDE EFFECTS

• DAPSONE - Mild Anemia

• RIFAMPIN - Liver ToxicityThrombocytopenia

• CLOFAZIMINE- Skin Pigmentation GI Disturbances

• DAPSONE - Mild Anemia

• RIFAMPIN - Liver ToxicityThrombocytopenia

• CLOFAZIMINE- Skin Pigmentation GI Disturbances

MONITORING RESPONSE TO TREATMENTMONITORING RESPONSE TO TREATMENT

• Regular Examination of Eyes, Hands and Feet

• Examination of Skin Lesions

• Repeat Skin Smears Annually

• Repeat Biopsies

• Regular Examination of Eyes, Hands and Feet

• Examination of Skin Lesions

• Repeat Skin Smears Annually

• Repeat Biopsies

NATIONAL HANSEN’S DISEASE PROGRAMS1770 Physicians Park Drive

Baton Rouge, Louisiana 70816Phone: 1-800-642-2477

Fax: (225) 756-3760

NATIONAL HANSEN’S DISEASE PROGRAMS1770 Physicians Park Drive

Baton Rouge, Louisiana 70816Phone: 1-800-642-2477

Fax: (225) 756-3760