Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic.

In non-endemic countries, leprosy, or Hansen's disease (HD), remains rare and is often underrecognized. Consequently, the literature is currently lacking in clinical descriptions of leprosy complications in the United States. Immune-mediated inflammatory states known as reactions are common complications of HD. Type 1 reactions are typical of borderline cases and occur in 30% of patients and present as swelling and inflammation of existing skin lesions, neuritis, and nerve dysfunction. Type 2 reactions are systemic events that occur at the lepromatous end of the disease spectrum, and typical symptoms include fever, arthralgias, neuritis, and classic painful erythematous skin nodules known as erythema nodosum leprosum. We report three patients with lepromatous leprosy seen at a U.S. HD clinic with complicated type 2 reactions. The differences in presentations and clinical courses highlight the complexity of the disease and the need for increased awareness of unique manifestations of lepromatous leprosy in non-endemic areas.

[Clinical leprosy in Japan].

The Leprosy Prevention Law was abolished at the end of March, 1996. Since medical insurance for leprosy started in April, 1996, dermatologists in clinics have to take care of leprosy patients. However, dermatologists have not learned enough about leprosy, and only a few of them are familiar with it. Japanese patients newly diagnosed with leprosy in Japan have decreasing, and patients who come from foreign countries to work in Japan have more important in leprosy control. Therefore, it is important to educate dermatologists about leprosy. Recently, diagnostic guides including information about network systems have become available in book stores. It is possible to obtain all kinds of information about leprosy from the network systems.

Imported leprosy in the United States, 1978 through 1988: an epidemic without secondary transmission.

OBJECTIVES: Leprosy remains a major health problem in many regions of the world. In the United States, although leprosy continues to be reported, approximately 90% of cases are imported (i.e., occur among immigrants and refugees). An increase in imported cases began in 1978. This study was conducted to analyze this trend and to characterize the contributing cases. METHODS: Centers for Disease Control leprosy surveillance data from 1971 through 1988 were analyzed. RESULTS: The number of imported cases reported annually was relatively constant from 1971 through 1977 (mean = 119 per year), increased to 307 in 1985, and then decreased to 102 in 1988. Of the 957 excess cases reported from 1978 through 1988, 73.4% were among persons from Southeast Asia, including 51.3% from Vietnam, Cambodia, and Laos (Indochina). There was no coincident increase in indigenous cases of leprosy; the mean annual number of such cases was 17.7 (range = 10 to 29). Leprosy remains endemic in Texas, Hawaii, Louisiana, and possibly California. CONCLUSIONS: An epidemic of imported leprosy began in the United States in 1978, peaked in 1985, and ended by 1988. This increase was primarily due to cases among refugees from Indochina and was limited by a decrease in the influx of Indochinese refugees in the mid-1980s. There is no evidence that these cases resulted in transmission in the United States.

Specific health problems of Southeast Asian refugees in middle Tennessee.

Three diseases representative of specific health conditions affecting the Southeast Asian refugees living in middle Tennessee are leprosy (chronic bacterial infections), liver fluke infection (parasitic diseases), and hemoglobin E-beta-thalassemia (hematologic disorders). In this paper we discuss incidence, causative agent, mode of transmission, metabolic abnormalities, and management of these conditions.

Leprosy. Our Southeast Asian refugee experience.

In the past two years, we have diagnosed four cases of leprosy at the St Paul-Ramsey Hospital Dermatology Clinic. This is a markedly increased incidence for the state of Minnesota. All of these cases have been found among recently arrived Southeast Asian refugees not noted to have their disease by previous screening examinations. The purpose of this study is to report these four cases (two tuberculoid, one lepromatous, and one borderline leprosy) and to review the Southeast Asian Refugee Resettlement Program, focusing on medical screening programs. We recommend refugee health education, health personnel training, and refugee medical screening centers as ways to detect leprosy among refugees entering the United States.