Hansen's Disease (Leprosy)
• Transmission - not completely understood, ?nasal droplets
• Symptoms appear ~5 years after exposure but can take 20 years to appear
• Many people do not contract disease after exposure
• Endemic: China, India, Nepal, Egypt
• Risk factors: Close contact, Armadillo exposure, Age, Genetic influences, Immunosuppression (e.g., chemotherapy, SOT, HIV)
Histopathologic Manifestations - Dependent on cellular response to M. leprae complex:
• Tuberculoid leprosy (TT) and borderline tuberculoid (BT)
- Infiltration of dermis & SC fat with well-defined epithelioid non-caseating granulomas and few or absent AFB
• Lepromatous leprosy (LL) and borderline leprosy (BL)
- Macrophages with a vacuolar cytoplasm, plasma cells, lymphocytes, and numerous AFB
Treatment Regimen:
• Tuberculoid disease: Dapsone 100mg daily + rifampin 600mg daily x 12 m
• Lepromatous disease: Dapsone 100mg daily + rifampin 600mg daily + clofazimine 50mg daily x 24 m
BIDMC Infectious Diseases Fellowship @BIDMC_IDFellows
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