NATIONAL HANSEN’S DISEASE PROGRAMS

DIAGNOSIS & TREATMENT OF HANSEN’S DISEASE DIAGNOSIS & TREATMENT OF 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 THE UNITED STATES HANSEN’S DISEASE IN THE UNITED STATES Average number of new cases Reported annually is between Average number of new cases Reported annually is between

ETIOLOGY - 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 TRANSMISSION Untreated Lepromatous Patients - Respiratory Route Armadillos? Soil or Vegetation? Incubation Period Average years Untreated Lepromatous Patients - Respiratory Route Armadillos? Soil or Vegetation? Incubation Period Average years

SUSCEPTIBILITYSUSCEPTIBILITY Only 3 - 5% of Populations are Susceptible Children or Contacts of Treated Patients Rarely Get the Disease Attack Rate of Spouses is % 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 % Genetic Factors Immune Factors

TT BT BB BL LL CMI TUBERCULOID FEW BACTERIA LOW ANTIBODY LEVELS HIGH RESISTANCE TO M. LEPRAE TUBERCULOID FEW BACTERIA LOW ANTIBODY LEVELS HIGH RESISTANCE TO M. LEPRAE LEPROMATOUS MANY BACTERIA HIGH ANTIBODY LEVELS LOW RESISTANCE TO M.LEPRAE LEPROMATOUS MANY BACTERIA HIGH ANTIBODY LEVELS LOW RESISTANCE TO M.LEPRAE The Hansen’s Disease Spectrum BI ENL ANTIBODY LEVEL ANTIBODY LEVEL Reversal Reaction

CLASSIFICATION 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 DISEASE Skin Nerves Eyes Hands & Feet Skin Nerves Eyes Hands & Feet Slit Skin Smears Skin Biopsies Slit Skin Smears Skin Biopsies Clinical Exam Procedures Lab Procedures

DIAGNOSTIC 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 Tibial Nerve Posterior Tibial Nerve Peroneal Nerve Radial Cutaneous Nerve Radial Cutaneous Nerve Ulnar Nerve Ulnar Nerve Great Auricular Nerve Great Auricular Nerve PERIPHERAL NERVES

BACTERIAL INDEX (BI) 0=None found in 100OIF 1+=1 - 10Per 100OIF 2+=1 - 10Per 10OIF 3+=1 - 10PerOIF 4+= PerOIF 5+= PerOIF 6+=1000+PerOIF 0=None found in 100OIF 1+=1 - 10Per 100OIF 2+=1 - 10Per 10OIF 3+=1 - 10PerOIF 4+= PerOIF 5+= PerOIF 6+=1000+PerOIF (OIF = Oil Immersion Field)

BIOPSIES 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 CHEMOTHERAPY DAPSONE (DDS) RIFAMPIN CLOFAZIMINE (B663 - LAMPRENE) DAPSONE (DDS) RIFAMPIN CLOFAZIMINE (B663 - LAMPRENE)

CHEMOTHERAPY OF HANSEN’S DISEASE U.S. Short Term World Health Organization U.S. Short Term World Health Organization

U. S. SHORT TERM THERAPY PAUCIBACILLARY - 1 Year Treatment Dapsone 100 mg Daily Rifampin 600 mg Daily Dapsone 100 mg Daily Rifampin 600 mg Daily MULTIBACILLARY - 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 MONITORING Baseline Studies-CBC, Platelets, Liver Functions, and G-6-PD Rifampin-CBC and Liver Function Studies 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 Function Studies Every 2 to 3 Months Dapsone-CBC Every 6 Months Clofazimine-No Specific Studies Required

SIDE EFFECTS DAPSONE-Mild Anemia RIFAMPIN-Liver Toxicity Thrombocytopenia CLOFAZIMINE-Skin Pigmentation GI Disturbances DAPSONE-Mild Anemia RIFAMPIN-Liver Toxicity Thrombocytopenia CLOFAZIMINE-Skin Pigmentation GI Disturbances

MONITORING 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 PROGRAMS 1770 Physicians Park Drive Baton Rouge, Louisiana Phone: Fax: (225)