Hansen's Disease (Leprosy)

Current and Future Pharmacotherapy and Treatment of Disease-related Immunologic Reactions

Davey P. Legendre, Pharm.D.; Christina A. Muzny, M.D.; Edwin Swiatlo, M.D., Ph.D.

Disclosures

Pharmacotherapy. 2012;32(1):27-37. 

In This Article

Abstract and Introduction

Abstract

Hansen's disease, also known as leprosy, remains an important public health problem throughout the world, including North America. The causative microbe in Hansen's disease is Mycobacterium leprae, an acid-fast organism that is difficult to grow in vitro. The nine-banded armadillo is the major animal reservoir in the United States. Manifestations of disease vary based on host immune response and can range from tuberculoid to lepromatous leprosy (paucibacillary to multibacillary disease). Hansen's disease typically affects the skin, nerves, and eyes, and patients may present with skin lesions, weakness, numbness, eye pain, or loss of vision. Definitive diagnosis is based on a combination of physical examination findings and skin biopsy and/or smear. Modern antibacterial therapy typically consists of combinations of dapsone and rifampin with or without clofazimine. Clofazimine is available only as an investigational drug through the National Hansen's Disease Program. Other options include moxifloxacin, ofloxacin, minocycline, and clarithromycin. Hansen's disease is associated with type 1 (reversal) and type 2 (erythema nodosum leprosum) immunologic reactions, during which the disease process appears to worsen dramatically. These reactions may occur at any time before, during, or after treatment. Antibacterial therapy should usually be continued during these reactions. Treatment options for these reactions differ based on clinical manifestations and include corticosteroids, thalidomide, pentoxiphylline, tumor necrosis factor inhibitors, and T cell inhibitors. Prompt diagnosis, antimicrobial therapy, and treatment of reactions dramatically reduce complications of the disease.

Introduction

Hansen's disease, also known as leprosy, is an ancient infectious disease, with references dating back to Biblical times.[1] Recent research suggests that individuals have been afflicted with this disease dating back as early as 1550 B.C.[2] Throughout the course of history, Hansen's disease has played a significant role in the lives of mankind as a feared, misunderstood, and disfiguring disease for which no treatment was available.[2] Infected persons were forced to live in secluded "leper colonies," until the 1940s when modern antibacterial therapy became available, due to concern for contagiousness and lack of effective treatment.[2] Mycobacterium leprae, the causative agent of this disease and the first human pathogen to be described, was identified in 1873 by Dr. Armauer Hansen of Norway.[2] Because of Hansen's discovery, successful efforts to characterize the disease and find treatments that would slow or eliminate its progression were pursued.

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