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Leprosy Lingers in the U.S.
Date:12/12/2008

But American physicians often overlook the illness, delaying diagnosis

FRIDAY, Dec. 12 (HealthDay News) -- Many doctors view leprosy as a scourge of Biblical times or faraway places, but there are still thousands of U.S. cases, with more diagnosed each year, experts say.

And because leprosy, also known as Hansen's Disease, remains a largely forgotten illness, U.S. physicians are often missing its diagnosis, say experts who discussed the problem this week at the American Society of Tropical Medicine and Hygiene's annual meeting in New Orleans.

"We are seeing more and more cases that are advanced," noted James Krahenbuhl, one of the experts on the panel. He is director of the U.S. Department of Health and Human Service's National Hansen's Disease Program in Baton Rouge, La, one of many regional clinics across the country.

Krahenbuhl said that there are about 150 new cases of leprosy diagnosed in the United States annually. In all, about 6,500 people in the United States now have Hansen's, with about half needing active medical management.

Cases are showing up not only in port cities -- where experts expect cases due to the arrival of immigrants -- but in many other parts of the country. That's due to changing patterns of immigration, Krahenbuhl said.

Leprosy is caused by an organism called Mycobacterium leprae. According to the U.S. National Institutes of Health, the disease can have a long incubation period, making it difficult to figure out where or when it was contracted.

While leprosy has been around for thousands of years, not enough is known about how it is contracted. The bacteria is likely found in the soil, experts say. Armadillos are commonly infected in Texas and Louisiana, for instance, and the prevalence of the infection in animals coincides with the prevalence in humans in that area, Krahenbuhl noted.

Symptoms include skin lesions lighter than your normal skin color. These become numb to touch, pain or heat and don't heal. Eventually, nerve damage occurs in the arms and legs, causing muscle weakness.

"Leprosy awareness among physicians is needed," Krahenbuhl said.

Dr. David Scollard, chief of the HRSA National Hansen's Disease Program clinical branch in Baton Rouge, agreed: "Although this disease is not common, it's also not gone," he said.

Antibiotics can kill the bacteria, but Krahenbuhl and Scollard stressed that treatment should begin as soon as possible to minimize nerve damage.

Scollard cites the case of a 30-something man who migrated from the Marshall Islands to Utah and didn't realize his skin lesions were serious. When he finally sought help, the lesions were advanced. He's been on treatment for nearly two years and will need another few years more, Scollard said.

"There is no epidemic," Scollard emphasizds. "There is no cause for great alarm." But awareness would increase the chances of catching and treating leprosy cases early, he said.

"Ultimately it is a disease of the peripheral nerves," Krahenbuhl said. "The earlier you treat, the more likely you are to arrest and block it."

The horrible stigma of contagious leprosy persists, Krahenbuhl and Scollard said, with its legacy of ostracized "leper colonies." The reality is that those who catch the disease almost always have been exposed for a prolonged period of time to a family member with it. In fact, once patients have had a few doses of medicine, he said, they are no longer infectious.

More physician awareness about the disease is definitely needed, agreed Dr. Samuel Moschella, a dermatologist at Lahey Clinic in Boston. He was not involved in the panel discussion but is an expert on the topic.

Skin lesions with numbness should make any physician think about the possibility of a leprosy diagnosis, he said, especially in patients from India, Brazil, Burma, Nepal or other areas where the disease is more common. "The last 20 cases I've seen have been from Brazil," Moschella said.

More information

To learn more about leprosy, visit the U.S. Health Resources and Services Administration's National Hansen's Disease Program.



SOURCES: James Krahenbuhl, Ph.D., director, Health Resources and Services Administration's National Hansen's Disease Program, Baton Rouge, La.; David Scollard, M.D., Ph.D., chief, clinical branch, Health Resources and Services Administration's National Hansen's Disease Program, Baton Rouge, La.; Dec. 9, 2008, panel presentation, American Society of Tropical Medicine and Hygiene annual meeting, New Orleans; Samuel Moschella, M.D., dermatologist, leprosy expert, Lahey Clinic, Boston


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