1. “the biggest disease of our time is not leprosy or tuberculosis, but the feeling of being unwanted ”- Mother Teresa April 6, 2010 Photo from the German Federal Archive, Bild 105-DOA0199 Leprosy A Disease of the Forgotten April 6, 2010 Meagan Davis

2. Leprosy = Hansen’s Disease April 6, 2010 One of the world’s oldest infectious diseases Photos from http://www.bevscountrycottage.com/images/leper.jpg and http://symptomsofleprosy.com/treatment-for-leprosy.php

3. -Skin -Peripheral nerves -Eyes -Extremities -Respiratory mucosa April 6, 2010 Hansen’s Disease is a chronic disease affecting

4. Leprosy is identified by skin lesions and progressive debilitation April 6, 2010 Photos from http://symptomsofleprosy.com/leprosy.php and http://www.asnom.org/image/421_lepre/IB071_lepre.jpg

5. Forms of Leprosy Tuberculoid (75%) –Partial T-cell immunity –Paucibacillary Lepromatous –Little to no T-cell immunity –Multibacillary April 6, 2010 Photo from http://pathmicro.med.sc.edu/Infectious%20Disease/MYCOBACTERIAL%20DISEASES.htm

6. April 6, 2010 1873: Dr. Amauer Hansen of Norway Microphotograph from CDC, US Government public domain, 1979) Public Health Image Library (PHIL) #2123 and photo from http://en.wikipedia.org/wiki/File:Gerhard_Armauer_Hansen.jpg

7. Mycobacterium leprae April 6, 2010 http://bioweb.uwlax.edu/bio203/s2008/jaedike_alic/scientificclassification.htm Identical in appearance to M. tuberculosis

8. April 6, 2010 Mycobacterium leprae http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1471987/figure/f2/:

9. We can’t grow Mycobacteria leprae in the lab! We need living cells… April 6, 2010

10. The Solution? Armadillos, of course! April 6, 2010

11. Image from http://genomebiology.com/2001/2/8/reviews/1023 Cell Wall Features

12. Mycobacterium leprae has affinity for April 6, 2010 1.Schwann cells 2. Macrophages http://www.mc.vanderbilt.edu/histology/slide.php?image_name=myelin&slide_f ile=images/histology/nervous_tissue/display/schwann3.jpg&image_id=1058 http://www.hhmi.org/biointeractive/disease/leprosy/leprosy1.html

13. April 6, 2010 How does Mycobacterium leprae target the peripheral nervous system? Interaction with Schwann Cell

14. April 6, 2010 Interaction with Macrophage No phagocytosis! Janeway, C., Travers, P., Walport, M., Shlomchik M. Immuno Biology: the immune system in health and disease. 6th Ed. 2005. New York: Garland Science Publishing. http://newscenter.lbl.gov/wp-content/uploads/phagocytosis.jpg

15. Genome Reductive evolution: pseudogenes Sequenced in 2001 Unique proteins PARK2/PACRG April 6, 2010 Image from http://www.nature.com/nature/journal/v409/n6823/full/4091007a0.html

16. How infectious? April 6, 2010

17. Treatment Completely CURABLE! MDT (Multi-drug Treatment) –Dapsone –Rifampicin –Clofazimine April 6, 2010 http://www.searo.who.int/en/Section10/Section20/Section57_9882.htm

18. History of Leprosy http://www.nytimes.com/2009/05/27/science/27leprosy.html?_r=1&pagewanted=print April 6, 2010

19. Middle Ages April 6, 2010 Photo from http://www.associatedcontent.com/image/625316/index.html?cat=70

20. Leper Colonies April 6, 2010 http://irrevocable.wordpress.com/2009/02/ http://www.historycooperative.org/journal s/jah/92.3/images/lechtreck_fig01b.jpg

21. April 6, 2010 Curse! Sexually Transmitted! Hereditary! a highly misunderstood disease

22. April 6, 2010 WHO’s Leprosy Elimination Project World Health Organization

23. A disease of poverty April 6, 2010 Why? Photo from http://www.flickr.com/photos/medapt/408552571/

24. April 6, 2010 “ The biggest disease of our time is not leprosy or tuberculosis, but the feeling of being unwanted ” - Mother Teresa Photo from http://baba.niya.org/index.php?mact=Album,cntnt01,default,0&cntnt01albumid=1&cntnt01pictureid=10&cntnt01returnid=64 Quote from http://quotationsbook.com/quote/11148/

25. Sources Comment in: Am J Clin Pathol. 2008 Dec;130(6):849-52. Brophy, Peter J. "Microbiology: Subversion of Schwann Cells and the Leper's Bell." Science 296.5569 (2002): 862-863. Print. Abulafia, Jorge. “Leprosy: pathogenesis updated.” International Journal of Dermatology 38 (1999): 321-334. Chacha, JJ. “Peripheral nervous system and grounds for the neural insult in leprosy.” An Bras Dermatol 84.5 (2009): 495-500. Suzuki, Koichi. “Localization of CORO1A in the Macrophages Containing Mycobacterium leprae.” Acta Histochem Cytochem 39.4 (2006): 107-112. Cole, S. T. “Massive gene decay in the leprosy bacillus.” Nature 409 (2001): 1007-1011 Baillie, Rebecca A. “Biblical Leprosy as Compared to Present-Day Leprosy.” Southern Medical Journal 75.7 (1982): 855-857. Vissa, Varalakshmi D. “The genome of Mycobacterium leprae: a minimal mycobacterial gene set.” Genoma Biology 2:reviews1023.1-1023.8 (2001). Rambukkana, Anura.“How does Mycobacterium leprae target the peripheral nervous system? “ Trends in Microbiology 8.1 (2000): 23-28. Han, X. Y. “A new Mycobacterium species causing diffuse lepromatous leprosy.” Am J Clin Pathol. 2008 Dec;130(6):849-52. Scollard, D. M. “The Continuing Challenges of Leprosy.” Clinical Microbiology Review. 19.2 ( 2006) 338-381. Miller, Timothy S. “Medieval Leprosy Reconsidered.” International Social Sciene Review, Spring-Summer 2006. http://findarticles.com/p/articles/mi_m0IMR/is_1-2_81/ai_n16701818/pg_2/?tag=content;col1 Nester, Eugene, W. Microbiology. Mcgraw Hill, 6 th edition (2009).

26. April 6, 2010 Sources http://www.phgfoundation.org/news/5107/ http://genomebiology.com/2001/2/8/reviews/1023 http://www.webspawner.com/users/MlepBacillus/ http://www.webspawner.com/users/LEPROMAT/ http://www.webspawner.com/users/immunity/ http://newswire.rockefeller.edu/index.php?page=engine&id=519 http://health.nytimes.com/health/guides/disease/leprosy/overview.html http://www.medicinenet.com/leprosy/page2.htm http://spittoon.23andme.com/2009/12/16/snpwatch-genetic-association-study-of-leprosy-yields- new-insights-into-an-ancient-disease/ http://www.hhmi.org/biointeractive/disease/leprosy/leprosy1.html http://www.thaindian.com/newsportal/lifestyle/scientists-measure-mercury-level-in-human bones-from-medieval-times_10055550.html http://www3.niaid.nih.gov/topics/leprosy/Understanding/history.htm http://emedicine.medscape.com/article/1104977-overview http://www.informaworld.com/smpp/section?content=a777379128&fulltext=713240928 http://www.europaworld.org/week113/50worldleprosyday24103.htm http://www.who.int/mediacentre/factsheets/fs101/en/ http://www.searo.who.int/EN/Section10/Section20/Section57_8963.htm WHO http://www.ghananewsagency.org/s_health/r_13273/ http://pathmicro.med.sc.edu/fox/mycobacteria.htm http://www.mdconsult.com/das/book/body/193191995-2/0/1492/1203.html http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=mmed&part=A1833