Leprosy in Northwest Louisiana: A case series.

Hansen's disease, commonly known as leprosy, is a chronic mycobacterial infection caused by Mycobacterium leprae. Although generally uncommon in the United States, it is endemic in the Southern United States. We diagnosed and managed five leprosy patients from Northwest Louisiana, each presenting a distinct set of challenges. A retrospective study was performed to collect demographic, clinical, and laboratory data from our cases. The information was analyzed with a specific focus on associated factors, diagnosis, and management. The mean age at diagnosis was 67.6 years (range 56-83 years), and the average delay in diagnosis was 8.4 months (range 1-20 months). All five patients presented with nonhealing rashes, and three initially sought help from primary care providers. Only two patients developed subjective numbness. Leprosy was not suspected before skin biopsy in three cases, while noninfectious diagnoses were considered, including mycosis fungoides, erythema multiforme, vasculitis, and amyloidosis. In the other two cases, leprosy was in the initial differential diagnosis. Ultimately, the diagnosis of leprosy was established in all five individuals based on clinical presentation, routine histopathology, and tissue acid-fast staining. This case series highlights the importance of leprosy, especially in the Southern United States where its incidence is increasing.

From isolation to prosperity: Rediscovering the Carville Leprosarium.

For centuries, patients afflicted with the peripheral nerve damaging disease, leprosy-sometimes referred to as Hansen's Disease-were excluded from society and harshly stigmatized. Such stigmatization often stemmed from the belief that the disease was a punishment by G-d for wrongdoing. Leprosy's origins remain rooted throughout various European countries; however, the disease established its presence in North America around the late 18th century. In particular, major port cities that experienced high volume trade, such as New Orleans, were most susceptible to infection. In response to the ensuing Louisiana leprosy endemic, various medical pioneers established the first hospital in America dedicated solely to the treatment of lepers, the Carville Leprosarium. The World Health Organization's treatment recommendation, multidrug therapy, is one of many lifesaving discoveries made at the facility located nearly 70 miles north of New Orleans. Since opening in 1894, the Carville Leprosarium has treated hundreds of Americans infected with Mycobacterium leprae, the disease-causing agent responsible for leprosy.

Arresting Leprosy: Therapeutic Outcomes Besides Cure.

This essay focuses on the use of the concept of "arrest" in Hansen's disease (leprosy) in the United States in the early to middle part of the 20th century, as well as the transformations the concept underwent with the arrival of sulfone drugs and the implications of these changes for patients and public health officers. An "arrest" was a therapeutic outcome characterized by a long course of treatment, noncontagiousness, a very small chance of reactivation, and a need for postdischarge maintenance that depended on sociomedical infrastructures beyond the clinic as well as self-imposed lifestyle limitations. The concept of disease arrest shows that experts and laypeople alike have valued therapeutic outcomes other than "cure" that signal certain optimal therapeutic milestones, despite the practical difficulties they imply and despite the fact that they do not promise a return to a pre-illness stage.

Zoonotic Leprosy in the Southeastern United States.

Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae-infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding.

Translating leprosy: the expert and the public in Stanley Stein's anti-stigmatization campaigns, 1931-60.

This article examines three campaigns through which patient activist Stanley Stein sought to combat the stigmatized connotations of the word "leprosy." In 1931, soon after starting the first patient newspaper at the U.S. national leprosy hospital at Carville, Stein became convinced of the necessity of finding an alternative to "leprosy." His ensuing campaign to promote the use of the words "Hansen's Disease" to describe the condition from which he and fellow Carville patients suffered became his most passionate and life-long project. In the 1950s, Stein became involved in efforts to change the translation of "leprosy" in the Bible. Finally, in 1960, he waged a campaign to de-stigmatize encyclopedia entries on leprosy. These campaigns illustrate how even elevation of the medical expert and a seeming disdain for the public can function as a protest of medical authority and reveal a presumption that a significant degree of authority actually resides with the public.

A case study for demonstrating the application of U.S. EPA's monitored natural attenuation screening protocol at a hazardous waste site.

Natural attenuation assessment data, collected at a Superfund site located in Louisiana, USA, are presented. The study site is contaminated with large quantities of DNAPL waste products. Source characterization data indicated that chlorinated ethene and ethane compounds are the major contaminants of concern. This case study illustrates the steps involved in implementing the U.S. EPA's [U.S. EPA, 1998. Technical protocol for evaluating natural attenuation of chlorinated solvents in ground water, by Wiedmeier, T.H., Swnason, M.A., Moutoux, D.E., Gordon, E.K., Wilson, J.T., Wilson, B.H., Kampbell, D.H., Hass, P.E., Miller, R.N., Hansen, J. E., Chapelle, F.H., Office of Research and Development, EPA/600/R-98/128] monitored natural attenuation (MNA) screening protocol at this chlorinated solvent site. In the first stage of the MNA assessment process, the field data collected from four monitoring wells located in different parts of the plume were used to complete a biodegradation scoring analysis recommended by the protocol. The analysis indicates that the site has the potential for natural attenuation. In the second stage, a detailed conceptual model was developed to identify various contaminant transport pathways and exposure points. The U.S. EPA model and BIOCHLOR was used to assess whether the contaminants are attenuating at a reasonable rate along these transport paths so that MNA can be considered as a feasible remedial option for the site. The site data along with the modeling results indicate that the chlorinated ethene and chlorinated ethane plumes are degrading and will attenuate within 1000 ft down gradient from the source, well before reaching the identified exposure point Therefore, MNA can be considered as one of the feasible remediation options for the site.

Armadillos (Dasypus novemcinctus) as a model to test antileprosy vaccines; a preliminary report.

The efficacy of two candidate leprosy vaccines, BCG and a mixture of BCG and killed Mycobacterium leprae, was tested in 62 armadillos caught in the wild. The abilities of the vaccines to convert lepromin-negative armadillos to a positive reaction were compared with a group of control animals. Both vaccines upgraded subsequent lepromin skin-test histopathology. The conversion results parallel the protection values obtained in some BCG vaccine trials against leprosy in humans. Before conducting expensive human trials with new antileprosy vaccines, it would be worthwhile first to evaluate them in the armadillo model.