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Terri Bianchi, DNP, ARNP
Ormond Beach Dermatology, Ormond Beach, FL

2014

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* http://abcnews.go.com/Health/leprosy-caseshit-florida-counties/story?id=29258128
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Important consideration when encountering & treating any chronic skin or rheumatological disorder
* 95% humans naturally immune
* Pathogen incubation 9 mo – 20 years
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SSx appearance may follow this time frame
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Reportable federally & in most states, including FL
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Armadillo host, not villain
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Transmission can be fomite, such as soil
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Lack of awareness! CDC reported most cases in US delay dx by 3 years (onset SSx to accurate dx)

* Gulf coast region reported
100-150 cases each year past few years
* Previously FL typically reported 8-10 cases/year
* 68% cases male (ages 11-92)
* Human:human transmission, droplets nose & mouth
(household contact 25% risk)
* These states account for 70% cases (2010):
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TX 36
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HI 35
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NY 34
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CA 32
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FL 30
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LA 21 and MA 15
* Fortuitously, humans become non-infectious w/ 1 st few doses
* appropriate oral abx tx

* Morally suspect, quarantine
* Mycobacterium Leprae 1873 bacterial bacillus
• Cure 1940 (sulfone drug)
• Out pt treatment 1982
• Hansens Disease 1931
• Latin ‘lepra’ or scaly

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location: Carville, Louisiana (LA)
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LA Leper Home est. 1894 in an abandoned plantation home built 1859, 350-400 acres
- Nat’l Leprosarium 1894-1999
- voluntary admission 1970
- home to 4,500 victims of dz
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Simultaneously sponsored research & lead to successful tx
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Now called, Gillis W. Long Hansens Disease
Center (1982 USDHHS)
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1992 Carville Historic District > Nat’l Register
Historic Places
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1993 several aged elect to remain > ALF
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1994 founded Nat’l Hansens Disease Museum >
@HRSA , Virtual Tour
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Most suffered inflamed sores, ulcers, lesions eyes, throat & numbness peripherally
(ear lobes, toes/fingers) > disfigured
Pen name, Betty
Miller , NY Times
Best Seller, 1950 memoir
Miracle@Carville
& No One Must
Ever Know , 1959
1899-1967
Pen name, Stanley Stein
Prints newsletter, STAR, mission, spread light
& truth of HD (advocate
Leprosy > HD)

1928 “pale rose spots on thighs”, debutante, engaged to medical student

* Carville/National Hansens Disease Center simultaneous research
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2011 Whole genome resequencing from 1 wild armadillo & 3 humans w/ dz revealed identical strain M. lepare
* Autochthonous cases
* Native born (SE USA), no foreign travel
* No h/o foreign exposure
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Important in research
& current vaccine development effort
4/28/11 N Engl J Med; 364: 1626, accessed 7/25/15 www.nejm.org/doi/full/10.1056

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9 Banded (Dasypus novemcinctus), decendents prehistoric,
South America 50 million years ago

Cannot hear or see well, great sense smell. No bite.
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- Armadillos related to sloths & anteaters
- Cannot thrive in very cold, very dry environments
- FL is much like the Mother Land: humid, rain, & bugs galore!

* Texas – state mammal
* Armadillo racing
* People hunt & eat them
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“Hoover hogs” during
Depression
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Moved w/ cattle, TX to other states, train cattle cars
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Florida
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Pets, easy to catch
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1936 escaped traveling circus
* 1924 released small zoo & escaped Cocoa,
FL
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FL Crackers “possum on the half shell”
* FL Dept Health, leprosy reported since
1921
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The Clinical Advisor April 2015, case 2 = leprosy!

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Journal of Drugs in
Dermatology
* May 2015
* NY Hansen’s Disease
Program, Dept Derm,
Bellevue Hospital, NY
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“leprosy often presents as rheumatology d/o”:
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Lupus erythematous
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RA
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Anticardiolipin syndrome
(aka antiphospholipid/APS)
* During RA tx for 2 years, cutaneous lesions erupted > referral derm
>punch bx w/ fite stain
* dx leprosy
* Caution, age of biologics
(immune suppressive) tx in RA, Ps
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* 55 yod Caucasian male
* Landscaper, Florida
- Sores hands off/on x 2 years, claw like hand
- Sores > ulcerations
- Pain on ambulation
* Admit to hospital, systemic vasculitis
Ddx: granulomatis w/ polyanglitis, SLE, APS
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Accurate Dx, Leprosy
AEB skin bx!

* Cutaneously & commonly, early on: pale, reddish skin patch w/ or w/o diminished sensation
* 1 or more chronic or recalcitrant maculopapular lesions
* Slight, if any prodromal
* 90% have numbness (maybe years) before skin lesion
- temp goes 1 st
- light touch 2 nd
- pain last to go
(hence injuries hands & feet)
• 4mm punch, full thickness, +/- suture
• Fite stain
• Dermatopathologist!
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Rare, but tragic to miss it

Cool areas of body affected
Superficial peripheral nerves
Anterior chamber eyes
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Testes
Chin
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Malar (cheeks)
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Ear lobes
Knees, elbows
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Distal BULEs
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Thickened superficial peripheral nerve

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- Provides all HCPs w/ knowledge to dx & tx the disease
- Introduces methods used to prevent disabilities caused by disease
- Aids in dx & management, including complications

Add thank you & skin ca ad
- An American’s life time risk melanoma is
1 in 36
- Melanoma #1 cancer adults ages 25-29
- 1 blistering sun burn in youth doubles lifetime risk US incidence melanoma increased each year x last 30