Advertisement

Burden of Leprosy

      Highlights

      • Hansen disease (HD) still occurs globally, including in the United States.
      • Antimicrobial therapy is available and effective in the treatment of HD.
      • Nurse practitioners should include HD in the differential diagnosis.
      • National resources are available to assist in the diagnosis and management of HD.

      Abstract

      Hansen disease, also known as leprosy, is a curable infectious disease that continues to cause great disability and stigma globally, including in the United States. Nurse practitioners may believe that Hansen disease is a rare and ancient disease localized to underdeveloped countries, but it still exists in the US and should be included in the differential diagnosis. Hansen disease, although curable, can lead to deformity and disability if not diagnosed early. This article aims to raise awareness of Hansen disease by providing an introductory understanding of the disease process, diagnosis, and treatment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • White C.
        • Franco-Paredes C.
        Leprosy in the 21st century.
        Clin Microbiol Rev. 2015; 28: 80-94https://doi.org/10.1128/CMR.00079-13
      1. World Health Organization (WHO). Working to overcome the global impact of neglected tropical diseases: first WHO report on neglected tropical diseases. http://www.who.int/neglected_diseases/2010report/en/. Updated 2010. Accessed April 18, 2017.

      2. WHO. Leprosy; fact sheet. http://www.who.int/mediacentre/factsheets/fs101/en/. Updated 2017. Accessed April 18, 2017.

        • Mankar M.
        • Joshi S.
        • Velankar D.
        • Mhatre R.
        • Nalgundwar A.
        A comparative study of the quality of life, knowledge and belief about leprosy disease among leprosy patients and community members in Shantivan Leprosy Rehabilitation centre, Nere, Maharashtra, India.
        J Glob Infect Dis. 2011; 3: 378-382https://doi.org/10.4103/0974-777X.91063
      3. WHO. Leprosy elimination. http://www.who.int/lep/in_vitro/en. Updated 2016. Accessed April 18, 2017.

      4. Health Resources and Services Administration. Hansen’s disease data and statistics. http://www.hrsa.gov/hansensdisease/dataandstatistics.html. Updated 2016. Accessed April 18, 2017.

      5. US Department of Health and Human Services Health Resources and Services Administration National Hansen’s Disease Program. A summary of Hansen’s disease in the United States-2015. https://www.hrsa.gov/hansensdisease/pdfs/hansens2015report.pdf. Updated 2016. Accessed April 18, 2017.

      6. Health Resources and Services Administration. National Hansen's disease (leprosy) program caring and curing since 1894. http://www.hrsa.gov/hansensdisease/. Updated nd. Accessed April 18, 2017.

        • Forno C.
        • Hausermann P.
        • Hatz C.
        • Itin P.
        • Blum J.
        The difficulty in diagnosis and treatment of leprosy.
        J Travel Med. 2010; 17: 281-283https://doi.org/10.1111/j.1708-8305.2010.00419.x
        • Leon K.L.
        • Jacob J.T.
        • Franco-Paredes C.
        • Kozarsky P.E.
        • Wu H.M.
        • Fairley J.K.
        Delayed diagnosis, leprosy reactions, and nerve injury among individuals with Hansen's disease seen at a United States clinic.
        Open Forum Infect Dis. 2016; 3: ofw063https://doi.org/10.1093/ofid/ofw063
        • Marcos L.A.
        • Dobbs T.
        • Walker S.
        • Waller W.
        • Stryjewska B.M.
        Indigenous cases of leprosy (Hansen's disease) in southern Mississippi.
        J Miss State Med Assoc. 2015; 56: 188-191
        • Guerra I.
        Indigenous Hansen’s disease cases diagnosed in Texas, 1960-1989; A descriptive case series.
        ([master's thesis]) University of Texas Health Science Center School of Public Health, Houston, TX1991
        • Lockwood D.
        • Reid A.
        The diagnosis of leprosy is delayed in the United Kingdom.
        QJM. 2001; 94 (Accessed April 18, 2017): 207-212
      7. Scollard D, Stryjewska B. Epidemiology, microbiology, clinical manifestations, and diagnosis of leprosy. http://www.uptodate.com/contents/treatment-and-prevention-of-leprosy#H310299817. Updated 2016. Accessed April 18, 2017.

        • Clark B.M.
        • Murray C.K.
        • Horvath L.L.
        • Deye G.A.
        • Rasnake M.S.
        • Longfield R.N.
        Case-control study of armadillo contact and Hansen’s disease.
        Am J Trop Med Hyg. 2008; 78: 962-967https://doi.org/10.4269/ajtmh.2008.78.962
        • Renault C.
        • Ernst J.
        Mycobaterium leprae (leprosy).
        in: 8th ed. Principles and Practices of Infectious Diseases. Vol 2. Elsevier Saunders, Philadelphia, PA2015: 2819-2831
        • Bhat R.M.
        • Prakash C.
        Leprosy: an overview of pathophysiology.
        Interdiscip Perspect Infect Dis. 2012; 2012: 181089https://doi.org/10.1155/2012/181089
        • Zhang F.
        • Huang W.
        • Chen S.
        • et al.
        Genomewide association study of leprosy.
        N Engl J Med. 2009; 361: 2609-2618https://doi.org/10.1056/NEJMoa0903753
        • Misch E.A.
        • Berrington W.R.
        • Vary Jr., J.C.
        • Hawn T.R.
        Leprosy and the human genome.
        Microbiol Mol Biol Rev. 2010; 74: 589-620https://doi.org/10.1128/MMBR.00025-10
        • Truman R.W.
        • Singh P.
        • Sharma R.
        • et al.
        Probable zoonotic leprosy in the southern United States.
        N Engl J Med. 2011; 364: 1626-1633https://doi.org/10.1056/NEJMoa1010536
        • Taulman J.F.
        • Robbins L.W.
        Range expansion and distributional limits of the nine-banded armadillo in the United States: an update of Taulman & Robbins (1996).
        J Biogeogr. 2014; 14: 1626-1630https://doi.org/10.1371/journal.pone.0068311
      8. Moschella SL, Garcia-Albea V. Differential diagnosis of leprosy. In: Scollard DM, Gillis TP, eds. International Textbook of Leprosy. 2016. http://www.internationaltextbookofleprosy.org/chapter/differential-diagnosis-leprosy. Accessed July 2, 2017.

      9. Health Resources and Services Administration. Skin biopsy in the diagnosis of Hansen's Disease. https://www.hrsa.gov/hansensdisease/diagnosis/biopsy.html Updated nd. Accessed April 18, 2017.

      10. Health Resources and Services Administration. Preparation and examination of skin smears. https://www.hrsa.gov/hansensdisease/diagnosis/skinsmears.html. Updated 2008. Accessed April 18, 2017.

        • Graham A.
        • Furlong S.
        • Margoles L.M.
        • Owusu K.
        • Franco-Paredes C.
        Clinical management of leprosy reactions.
        Infect Dis Clin Pract. 2010; 18: 235-238https://doi.org/10.1097/IPC.0b013e3181deba2a
        • Dacso M.
        • Jacobson R.
        • Scollard D.
        • Stryjewska B.
        • Prestigiacomo J.
        Evaluation of multi-drug therapy for leprosy in the United States using daily rifampin.
        South Med J. 2011; 104: 689-694https://doi.org/10.1097/SMJ.0b013e31822d6014
        • Van Veen N.H.
        • Nicholls P.G.
        • Smith W.C.S.
        • Richardus J.H.
        Corticosteroids for treating nerve damage in leprosy.
        Cochrane Database Syst Rev. 2016; 23: CD005491https://doi.org/10.1002/14651858.CD005491.pub3
      11. WHO. Leprosy elimination; WHO multidrug therapy (MDT). http://www.who.int/lep/mdt/en/. Updated 2016. Accessed April 18, 2017.

      12. WHO. Leprosy elimination; WHO recommended MDT regimens. http://www.who.int/lep/mdt/regimens/en/. Updated 2016. Accessed April 18, 2017.

      13. Health Resources and Services Administration National Hansen’s Disease Program. The national Hansen's disease museum. http://www.hrsa.gov/hansensdisease/museum/index.html. Accessed April 18, 2017.

        • Doull J.
        • Guinto R.
        • Rodriguez J.
        • Bancroft H.
        Risk of attack in leprosy in relation to age at exposure.
        Am J Trop Med Hyg. 1944; 25 (Accessed April 18, 2017): 435-439
        • Worth R.
        Is it safe to treat the lepromatous patient at home? A study of home exposure to leprosy in Hong Kong.
        Int J Lepr Other Mycobact Dis. 1968; 36 (Accessed April 18, 2017): 296-302
        • Sales A.
        • Ponce de Leon A.
        • Duppre N.
        • et al.
        Leprosy among patient contacts: a multilevel study of risk factors.
        PLoS Negl Trop Dis. 2011; 5: e1013https://doi.org/10.1371/journal.pntd.0001013
        • Sermrittirongs S.
        • Van Brakel W.H.
        Stigma in leprosy: concepts, causes and determinants.
        Lepr Rev. 2014; 85: 36-47https://doi.org/10.1371/journal.pone.0129086

      Biography

      Rebecca D. Martin, DNP, FNP, is a part-time lecturer at Baylor University Louise Herrington School of Nursing in Dallas, TX, and can be reached at [email protected].

      Biography

      Ivorry F. Gomez, DNP, FNP-BC, lives in Dallas, TX.

      Biography

      Lori A. Spies, PhD, FNP, is an assistant professor at Baylor University Louise Herrington School of Nursing in Dallas, TX.