[HANSEN'S DISEASE IN ISRAEL].

INTRODUCTION: Hansen's disease (HD) is an anthropophylic, infectious, chronic disease, caused by Mycobacterium leprae. The systemic disease, affecting both males and females at any age, involves mainly the skin and the peripheral nerves located in the limbs close to the skin. Traditionally the treatment of HD patients was entrusted to dermatologists. Current drug therapy given at an early stage can prevent many of the complications, and enables patients to go on with life. In 95% of the population there is an innate immunity, which following exposure, enables the development of an effective immune response preventing the development of overt clinical disease. So far, there is neither an effective vaccination nor a simple test which can predict susceptibility to the infection. A long history of ignorance and stigmatization may add a social dimension to the physical ailment and suffering of HD patients. Despite the elimination campaign declared by the WHO in the early 1990s, the disease continues to exist. New patients are diagnosed each year, though in lower numbers and HD patients can be found all over the world. The relatively low prevalence of HD in non-endemic countries and the misconception that it has been eradicated long ago, make the awareness to the disease extremely poor. HD is usually not included in the differential diagnosis even when clear symptoms are present. This results in a very late diagnosis of new HD patients, thus missing the window of opportunity for early treatment which could prevent complications and disability. The purpose of this update is to raise awareness to the existence of HD in Israel and its diagnosis, to present updated epidemiological data for Israel and a glimpse at the global situation.

The plague of the Philistines and other pestilences in the Ancient World: exploring relations between the religious-literary tradition, artistic evidence and scientific proof.

In ancient times the term pestilence referred not only to infectious disease caused by Yersinia pestis, but also to several different epidemics. We explore the relations between references in the Bible and recent scientific evidence concerning some infectious diseases, especially the so-called Plague of the Philistines and leprosy. In addition, some considerations regarding possible connections among likely infectious epidemic diseases and the Ten Plagues of Egypt are reported. Evidence suggesting the presence of the rat in the Nile Valley in the II millennium BC is shown; a possible role of the rat in the plague spreading already in this historical period should be confirmed by these data. While the biblical tale in the Book of Samuel may well report an epidemic event resembling the plague, as to date this infectious disease remains unknown, it is not conceivable to confirm the presence of leprosy in the same age, because the little palaeopathologic evidence of the latter disease, in the geographic area corresponding to Egypt and Palestine, is late, dating back only to the II century AD.

Molecular exploration of the first-century Tomb of the Shroud in Akeldama, Jerusalem.

The Tomb of the Shroud is a first-century C.E. tomb discovered in Akeldama, Jerusalem, Israel that had been illegally entered and looted. The investigation of this tomb by an interdisciplinary team of researchers began in 2000. More than twenty stone ossuaries for collecting human bones were found, along with textiles from a burial shroud, hair and skeletal remains. The research presented here focuses on genetic analysis of the bioarchaeological remains from the tomb using mitochondrial DNA to examine familial relationships of the individuals within the tomb and molecular screening for the presence of disease. There are three mitochondrial haplotypes shared between a number of the remains analyzed suggesting a possible family tomb. There were two pathogens genetically detected within the collection of osteological samples, these were Mycobacterium tuberculosis and Mycobacterium leprae. The Tomb of the Shroud is one of very few examples of a preserved shrouded human burial and the only example of a plaster sealed loculus with remains genetically confirmed to have belonged to a shrouded male individual that suffered from tuberculosis and leprosy dating to the first-century C.E. This is the earliest case of leprosy with a confirmed date in which M. leprae DNA was detected.

Dorsal sensory impairment in hands and feet of people affected by Hansen's disease in Israel.

INTRODUCTION: Sensory testing in people affected by Hansen's disease is usually performed on palms and soles only. In Israel, both palmar/plantar and dorsal aspects of limbs are routinely tested. OBJECTIVES: The aim of this study was to describe the magnitude of dorsal sensory impairment (SI) in limbs and compare the frequency of SI on palms and soles with that on the dorsum of hands and feet. DESIGN: In a cross-sectional study, limbs of 140 patients registered at The Israel Hansen's Disease Centre during the years 1999-2003 were tested for their sensory status. Both palmar/plantar and dorsal aspects were tested using Semmes-Weinstein monofilaments. SI was defined as not feeling stimuli applied with the 2 g monofilament. RESULTS: SI was detected on the dorsum in 43% of sites on hands and only in 27% on palms. 64% of sites on dorsum of feet had SI compared to 53% on the soles. SI was detected in up to 18% in hands with no palmar SI, and in 6% of feet with no plantar SI. Furthermore, SI on palms and soles was found to be accompanied by dorsal SI in all hands and in 97% of feet. CONCLUSION: SI on dorsum of limbs occurs more frequently than SI on palms and soles. Therefore sensory testing should also consider inclusion of the dorsal aspect of hands and feet.

[Psoriasis, biblical afflictions and patients' dignity].

The currently accepted Hebrew word for psoriasis is 'sapachat'. The word 'sapachat' is biblical and its original meaning is unknown. Similar uncertainty applies also to the biblical word 'tzaraat', the currently accepted Hebrew term for leprosy. This article discusses possible explanations of the biblical terms 'sapachat' and 'tzaraat'. The link between 'sapachat' and psoriasis was made only several decades ago. The word 'sapachat' conveys a definite negative connotation, and imposes an emotional burden on psoriatic patients. We therefore recommend preferable use of the word 'psoriasis' and avoid using the offending term 'sapachat'.

Leprosy in Israel: an imported disease--the support of histopathological examination for its detection.

Leprosy is rare and non-endemic in Israel. Cases of leprosy are invariably imported by immigrants or foreign workers arriving from endemic areas. In view of the relative rarity of the disease, clinicians and pathologists are not always alert to the possibility of the disease or recognize potential symptoms. A case history is presented of a 31-year-old immigrant presenting symptoms of skin lesions and nodules on the hands and facial region, especially the ear lobe. Confirmation of the infection was provided by histopathology of suspected lesions stained for acid-fast bacilli (modified Fite-Faraco staining).

Psoriatic arthritis in a fifth-century Judean Desert monastery.

Psoriatic arthritis is a greatly underreported seronegative erosive arthropathy, due to the ambiguous lesions it leaves on bone in all but the most severe cases. For a confident diagnosis of psoriatic arthritis to be made, sacroiliac and intervertebral joint fusion must be present together with erosive lesions of the peripheral skeleton including most especially the terminal interphalangeal joints. In modern times it is only a small percentage of cases who experience such debilitating disease, which may explain who so few cases of psoriatic arthritis can confidently be identified from past populations. This report describes this pathological condition as observed in the comingled skeletal remains of nine males and one female from the tomb of Paulus in the Byzantine Monastery of Martyrius, in the Judean Desert. Visual study was complemented using radiographic techniques along with scanning electron microscopy. Two adult males show characteristic lesions of psoriatic arthritis, demonstrating the form known as arthritis mutilans. A third individual shows less widespread erosive lesions which may signify a pauciarticular example of psoriatic arthritis, as is true of most cases in modern times, or the remains may represent Reiter's disease. During the Byzantine period the earlier practise of expelling those with disfiguring diseases (biblical leprosy) evolved into a philanthropic, caring philosophy where the sick were housed and fed out of charity, often within monasteries. The presence of these cases of psoriatic arthritis within such a Judean Desert monastery confirms earlier suggestions that psoriasis was one of the diseases included by those in the ancient eastern Mediterranean under the umbrella term of biblical leprosy.

[Epidemiology of Hansen's disease in Israel].

There are currently 200 patients with Hansen's disease in Israel who are being followed by the Hansen's Disease Government Hospital and the Ministry of Health (prevalence 4.4/100,000). Most of them immigrated from countries where the disease is endemic. Dermatological findings dominated the initial clinical picture, although 5% of patients are asymptomatic contacts of known cases. Age at onset of disease was less than 20 years in 1/4 of the cases. The incidence in Israel is falling: 0.4/100,000 in 1985-89 compared to 3.6/100,000 in 1950-54. Neurologic and dermatologic findings in an immigrant of any age originating from countries where Hansen's disease is endemic, should prompt appropriate diagnostic evaluation, even years after immigration to Israel. Contacts of known cases of Hansen's disease should be aggressively screened, even if asymptomatic.

Health profile of Ethiopian immigrants in Israel: an overview.

The health profile of two groups of Ethiopian immigrants in Israel was evaluated. Trichophytosis and active trachoma were observed in 5%-8.7% of prepubertal children. Among adults 13% had corneal opacities and 10.4% had cataracts. Goiter, spastic bronchitis, valvular heart disease, leprosy and onchocerciasis were prevalent. Malnutrition was common, with average body weights ranging from 72.4% to 85.2% of normal. Anemia was observed in 6.3% of young children and 70% of all immigrants. Fifty percent of children over 12 years and 98% of adults over 40 years of age had been exposed to hepatitis B virus; 9.8%-11.8% were HBsAg carriers. Tuberculin tests were positive in 9.8%-13%; and intestinal parasites were identified in 86%-98%. Hospitalization was required for 15.7% of immigrants arriving during the period 1978-90, and for 3.7% of those arriving in mid-1991 (Operation Solomon).