Abstract
Hansen's disease, leprosy, is a chronic infectious disease caused by the acid-fast bacillus Mycobacterium leprae. There are multiple forms of the disease ranging from the relatively benign to the progressive, malignant lepromatous leprosy. There is effective antimicrobial treatment available that is capable of curing the disease. We report the case of a post heart transplant patient acquiring Hansen's disease.
LEPROSY. The very word conjures up images of grossly deformed features, of the outcast dressed in robes, and hood that hid the face. It is an ancient disease referred to in the Bible as making the sufferer "ceremonially unclean." 1 From the outset, the development of leprosy was a double-edged sword with the sufferer viewed variously as a scourge to someone touched by God. 2
The first written record of leprosy is found in India about 600 BC. Leprosy was brought to the Mediterranean area by Alexander the Great and his returning army in 327-326 BC. 3,4 From this introduction, leprosy spread across Europe, so it was quite common in the Middle Ages. However, by the early 18th century, leprosy had become relatively rare in Europe. 5
Although there is effective treatment for leprosy, more than 500,000 new cases were reported by the World Health Organization (WHO) in 2002. 6 There were 112 new cases of leprosy reported in the United States. 7 As late as 1996, in Japan, patients with leprosy were forcibly removed from their families and communities and sequestered. 8 The greatest number of people with leprosy reside in India, Brazil, and Indonesia, but the disease is endemic in other Third World countries. 7
The bacillus that causes Hansen's Disease (leprosy) was discovered in 1873 by G. H. Armauer Hansen of Norway when he isolated the bacillus in samples taken from leprous tubercules found on patients with leprosy. 4,9 Prior to Hansen's discovery, the diagnosis of leprosy was made by purely clinical observations. While there is no single pathognomic feature in leprosy, the presence of autoamputation of the digits accompanied by nasal destruction, coarsening of the face, and voice changes occur together in no other disease. 3,10