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Leprosy (Penyakit Kusta)
From Wikipedia, the free encyclopedia.
(Redirected from Hansen's disease)
This article is about the infectious disease also known as Hansen's disease. For the malady found in the Hebrew Bible, see the article Tzaraas. For the album Leprosy by Death see the article Leprosy (album).

Father Damien was a Roman Catholic missionary who helped lepers on Hawaii and also died of the disease.Leprosy, sometimes known as Hansen's disease, is an infectious disease caused by Mycobacterium leprae, an aerobic, acid fast, rod-shaped mycobacterium. The modern term for the disease is named after the discoverer of the bacterium, Gerhard Armauer Hansen.

Sufferers of Hansen's disease have historically been known as lepers, however this term is falling into disuse as a result of the diminishing number of leprosy patients and the pejorative connotations of the term. The terms "leprosy" and "lepers" can also lead to public misunderstanding because the Bible uses these terms in reference to a wide range of incurable skin conditions other than Hansen's disease.

Historically, leprosy was an incurable and disfiguring disease. Lepers were shunned and sequestered in leper colonies. Today, leprosy is easily curable by multidrug antibiotic therapy. The main challenges in the eradication of Hansen's disease is in reaching populations that have not yet received multidrug therapy services, improving detection of the disease, and providing patients with high-quality services and affordable drugs.

Other than humans, the only animals known to be susceptible to leprosy are the armadillo and mice (on their footpads)..

History
Hansen's disease has been recognized as a problem since the beginning of recorded history. It has been reported as early as 1350 BC in Egypt, making it the oldest disease known according to Guinness World Records. Lepers have frequently lived on the edge of society, and the disease was believed for a long time to have been caused by a divine (or demonic) curse or punishment. However, in the Middle Ages it was believed that lepers are cursed by humans, but loved by God.

The Bible contains many references to "leprosy". Referred to most often as tzaraas, the disease was often seen as a "message" from God to a sinner, in attempts to get him or her to repent. It was said that if the afflictee repented properly, the lesions would vanish. Those afflicted often had to wait a number of days for the community kohein to make a visit to check their condition, and in this period of time, the afflictee was encouraged to repent for the misdeeds that supposedly led to the illness.

In the Middle Ages, it was believed that leprosy was highly contagious and could be spread by the glance of a leper or an unseen leper standing upwind of healthy people. Nowadays, it is known that leprosy is much less contagious.

Minorities like the Navarrese agotes or French cagots were accused of being lepers.


Clinical features
The disease is caused by a mycobacterium which multiplies very slowly and mainly affects the skin, nerves, and mucous membranes. The organism has never been grown in bacteriologic media or cell culture, but has been grown in mouse foot pads and more recently in nine-banded armadilloes. It is related to M. tuberculosis, the mycobacterium that causes tuberculosis. The difficulty in culturing the organism appears to be due to the fact that the organism is an obligate intra-cellular parasite that lacks many necessary genes for independent survival. This loss of genes is apparently also the reason for the extremely slow replication rate.

The mode of transmission of Hansen's disease remains uncertain. Most investigators think that M. leprae is usually spread from person to person in respiratory droplets. What is known is that the transmission rate is very low. In addition, it appears that a majority of the population is naturally immune. Also, contrary to popular belief, Hansen's disease does not cause rotting of the flesh; however, due to nerve damage, extremities may become numb which may lead to minor infected wounds being unnoticed until damage is permanent.

This chronic infectious disease usually affects the skin and peripheral nerves but has a wide range of possible clinical manifestations. Patients are classified as having paucibacillary (tuberculoid leprosy) or multibacillary Hansen's disease (lepromatous leprosy). Paucibacillary Hansen's disease is milder and characterized by one or more hypopigmented skin macules. Multibacillary Hansen's disease is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds).

Incidence
In 1999, the world incidence of Hansen's disease was estimated to be 640,000; and in 2000, 738,284 cases were identified. In 1999, 108 cases occurred in the United States. In 2000, the World Health Organization (WHO) listed 91 countries in which Hansen's disease is endemic, with India, Myanmar, and Nepal having 70% of cases. In 2002, 763,917 new cases were detected worldwide, and in that year the WHO listed Brazil, Madagascar, Mozambique, Tanzania and Nepal as having 90% of Hansen's disease cases.

Worldwide, one to two million people are permanently disabled because of Hansen's disease. However, persons receiving antibiotic treatment or having completed treatment are considered free of active infection.

Hansen's disease is one of the infectious diseases tracked passively by the Centers for Disease Control and Prevention. Its prevalence in the United States has remained low and relatively stable. There are decreasing numbers of cases worldwide, though pockets of high prevalence continue in certain areas such as Brazil, South Asia (India, Nepal), some parts of Africa (Tanzania, Madagascar, Mozambique) and the western Pacific.

Risk groups
Those having close contacts with patients with untreated, active, predominantly multibacillary disease, and persons living in countries with highly endemic disease are at risk of contracting the disease. Recent research suggests that there is genetic variation in susceptibility. The region of DNA responsible for this variability is also involved in Parkinson's disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level.

Asylums
There are still a few leper colonies around the world, in countries such as India and the Philippines. In the United States, the island of Moloka慽 in the Hawaiian archipelago contains the country's oldest asylum (see Father Damien and Kalawao County, Hawaii).

Western humanitarian and church organizations regularly send relief supplies, including handmade "leper bandages" to these colonies. Leper bandages are knitted or crocheted out of cotton, for better breathing than traditional gauze, and more durability梩he bandages can be washed, sterilized, and reused. The bandages can be machine made, but the colony inhabitants appreciate handmade bandages.

In 2001, government-run leper colonies in Japan came under judicial scrutiny, leading to the determination that the Japanese government had mistreated the patients, and the District Court ordered Japan to pay compensation to former patients. [1] In 2002, a formal inquiry into these colonies was set up, and in March of 2005, the policy was strongly denounced. "Japan's policy of absolute quarantine... did not have any scientific grounds." Many children of those with Hansen's disease were executed by staff at colonies up to the 1950s

[ Last edited by ying05 at 29-9-2005 01:13 AM ]

Leeches

Definition

Leeches are bloodsucking worms with segmented bodies. They belong to the same large classification of worms as earthworms and certain oceanic worms.

Leeches can primarily be found in freshwater lakes, ponds, or rivers. They range in size from 0.2 in (5 mm) to nearly 18 in (45 cm) and have two characteristic suckers located at either end of their bodies. Leeches consume the blood of a wide variety of animal hosts, ranging from fish to humans. To feed, a leech first attaches itself to the host using the suckers. One of these suckers surrounds the leech's mouth, which contains three sets of jaws that bite into the host's flesh, making a Y-shaped incision. As the leech begins to feed, its saliva releases chemicals that dilate blood vessels, thin the blood, and deaden the pain of the bite. Because of the saliva's effects, a person bitten by a leech may not even be aware of it until afterwards, when he or she sees the incision and the trickle of blood that is difficult to stop.

For centuries, leeches were a common tool of doctors, who believed that many diseases were the result of "imbalances" in the body that could be stabilized by releasing blood. For example, leeches were sometimes attached to veins in the temples to treat headaches. Advances in medical knowledge led doctors to abandon bloodletting and the use of leeches in the mid-nineteenth century. In recent years, however, doctors have found a new purpose for leeches--helping to restore blood circulation to grafted or severely injured tissue.

Purpose

There are many occasions in medicine, mostly in surgery and trauma care, when blood accumulates and causes trouble. Leeches can be used to reduce the swelling of any tissue that is holding too much blood. This problem is most likely to occur in two situations:

Trauma. Large blood clots resulting from trauma can threaten tissue survival by their size and pressure. Blood clots can also obstruct the patient's airway.
Surgical procedures involving reattachment of severed body parts or tissue reconstruction following burns. In these situations it is difficult for the surgeon to make a route for blood to leave the affected part and return to the circulation. The hardest part of reattaching severed extremities like fingers, toes and ears is to reconnect the tiny veins. If the veins are not reconnected, blood will accumulate in the injured area. A similar situation occurs when plastic surgeons move large flaps of skin to replace skin lost to burns, trauma or radical surgery. The skin flaps often drain blood poorly, get congested, and begin to die. Leeches have come to the rescue in both situations.

Precautions

It is important to use only leeches that have been raised in the laboratory under sterile conditions in order to protect patients from infection. Therapeutic leeches belong to one of two species--Hirudo michaelseni or Hirudo medicinalis.

Description

One or more leeches are applied to the swollen area, depending on the size of the graft or injury, and left on for several hours. The benefits of the treatment lie not in the amount of blood that the leeches ingest, but in the anti-bloodclotting (anticoagulant) enzymes in the saliva that allow blood to flow from the bite for up to six hours after the animal is detached, effectively draining away blood that could otherwise accumulate and cause tissue death. Leech saliva has been described as a better anticoagulant than many currently available to treat strokes and heart attacks. Active investigation of the chemicals in leech saliva is currently under way, and one anticoagulant drug, hirudin, is derived from the tissues of Hirudo medicinalis.

Aftercare

The leeches are removed by pulling them off or by loosening their grip with cocaine, heat, or acid. The used leeches are then killed by placing them in an alcohol solution and disposed of as a biohazard. Proper care of the patient's sore is important, as is monitoring the rate at which it bleeds after the leech is removed. Any clots that form at the wound site during treatment should be removed to ensure effective blood flow.

Risks

Infection is a constant possibility until the sore heals. It is also necessary to monitor the amount of blood that the leeches have removed from the patient, since a drop in red blood cell counts could occur in rare cases of prolonged bleeding.


Terms:
Anemia
A blood disorder marked by low hemoglobin levels in red blood cells, which leads to a deficiency of oxygen in the blood.
Anticoagulant
A chemical or medication that prevents blood from clotting

Sumber: http://www.chclibrary.org/micromed/00054540.html

[ Last edited by ying05 at 29-9-2005 01:37 AM ]

JohnDeSouza

hmmm... korang rindu hur jun dak?

tentulah rindu...

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