This study is available in MS Word or PDF Matthew. SELFSTUDY GUIDE. Please choose the Word or PDF document above. This study is not yet available in HTML format. The next Daily Office service is available beginning at 4am for Morning Prayer 11am for MidDay Prayer 4pm for Evening Prayer. Early life. Baldwin spent his youth in his fathers court in Jerusalem, having little contact with his mother, Agnes of Courtenay, Countess of Jaffa and Ascalon, and. Leprosy, also known as Hansens disease HD, is a longterm infection by the bacterium Mycobacterium leprae or Mycobacterium lepromatosis. Initially, infections are. The Leper King And His Heirs Pdf CompressorLeprosy WikipediaLeper redirects here. It is not to be confused with Ieper, a Belgian city. Leprosy, also known as Hansens disease HD, is a long term infection by the bacterium. Mycobacterium leprae or Mycobacterium lepromatosis. 34 Initially, infections are without symptoms and typically remain this way for 5 to 2. Symptoms that develop include granulomas of the nerves, respiratory tract, skin, and eyes. 3 This may result in a lack of ability to feel pain, thus loss of parts of extremities due to repeated injuries or infection due to unnoticed wounds. 2 Weakness and poor eyesight may also be present. 2Leprosy is spread between people. 7 This is thought to occur through a cough or contact with fluid from the nose of an infected person. 7 Leprosy occurs more commonly among those living in poverty. 2 Contrary to popular belief, it is not highly contagious. 2 The two main types of disease are based on the number of bacteria present paucibacillary and multibacillary. 2 The two types are differentiated by the number of poorly pigmented, numb skin patches present, with paucibacillary having five or fewer and multibacillary having more than five. 2 The diagnosis is confirmed by finding acid fast bacilli in a biopsy of the skin or by detecting the DNA using polymerase chain reaction. 2Leprosy is curable with a treatment known as multidrug therapy. 3 Treatment for paucibacillary leprosy is with the medications dapsone and rifampicin for six months. 2 Treatment for multibacillary leprosy consists of rifampicin, dapsone, and clofazimine for 1. A number of other antibiotics may also be used. 2 These treatments are provided free of charge by the World Health Organization. 3 Globally in 2. The number of new cases was 2. Most new cases occur in 1. India accounting for more than half. 32 In the past 2. About 2. 00 cases are reported per year in the United States. 1. Leprosy has affected humanity for thousands of years. 2 The disease takes its name from the Latin word lepra, while the term Hansens disease is named after the physician Gerhard Armauer Hansen. 2 Separating people by placing them in leper colonies still occurs in places such as India,1. China,1. 2 and Africa. 1. However, most colonies have closed, since leprosy is not very contagious. 1. Social stigma has been associated with leprosy for much of history, which continues to be a barrier to self reporting and early treatment. 3 Some consider the word leper offensive, preferring the phrase person affected with leprosy. 1. It is classified as a neglected tropical disease. 1. World Leprosy Day was started in 1. Signs and symptomseditLeprosy is mostly a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract skin lesions light or dark patches are the primary external sign. 1. If untreated, leprosy can progress and cause permanent damage to the skin, nerves, limbs, and eyes. 1. Secondary infections, in turn, can result in tissue loss, causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body. 1. Hands deformed by leprosy. Leprosy in Tahiti, circa 1. A 2. 6 year old woman with leprous lesions. A 1. 3 year old boy with severe leprosy. M. leprae and M. lepromatosiseditM. M. lepromatosis are the causative agents of leprosy. M. lepromatosis is a relatively newly identified mycobacterium isolated from a fatal case of diffuse lepromatous leprosy in 2. An intracellular, acid fast bacterium, M. Mycobacterium genus. 2. Due to extensive loss of genes necessary for independent growth, M. M. lepromatosis are obligate intracellular pathogens, and unculturable in the laboratory, a factor that leads to difficulty in definitively identifying the organism under a strict interpretation of Kochs postulates. 42. The use of nonculture based techniques such as molecular genetics has allowed for alternative establishment of causation. While the causative organisms have to date been impossible to culture in vitro, it has been possible to grow them in animals such as mice and armadillos. Naturally occurring infection also has been reported in nonhuman primates, including the African chimpanzee, sooty mangabey, and cynomolgus macaque, as well as in armadillos and red squirrels. 2. Red squirrels Sciurus vulgaris a threatened species in England were found to have leprosy in November 2. However, no squirrel cases have spread to a human for hundreds of years. 2. Risk factorseditThe greatest risk factor for developing leprosy is contact with another case of leprosy. Contacts of people with leprosy are five to eight times more likely to develop leprosy than members of the general population. 5 Leprosy also occurs more commonly among those living in poverty. 2Other risk factors are poorly understood. However, conditions that reduce immune function, such as malnutrition, other illnesses, or host genetic differences, may increase the risk of developing leprosy. 5 Despite this, infection with HIV does not appear to increase the risk of developing leprosy. 2. TransmissioneditTransmission of leprosy occurs during close contact with those who are infected. 2. Transmission is proposed to be by nasal droplets,92. Leprosy is not known to be either sexually transmitted or highly infectious. People are generally no longer infectious after the first month of standard multidrug therapy. 2. Leprosy may also be transmitted to humans by armadillos. 2. Two exit routes of M. Lepromatous cases show large numbers of organisms deep in the dermis, but whether they reach the skin surface in sufficient numbers is doubtful. 3. The skin and the upper respiratory tract are most likely entry route. While older research dealt with the skin route, recent research has increasingly favored the respiratory route. Experimental transmission of leprosy through aerosols containing M. GeneticseditSeveral genes have been associated with a susceptibility to leprosy. Often, the immune system is able to eliminate leprosy during the early infection stage before severe symptoms develop. 3. A defect in cell mediated immunity may cause susceptibility to leprosy. The region of DNA responsible for this variability is also involved in Parkinsons disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level. 3. Some evidence indicates not all people who are infected with M. PathophysiologyeditHow the infection produces the symptoms of the disease is not known. 9DiagnosiseditAccording to the World Health Organization, diagnosis in areas where people are frequently infected is based on one of these main signs Skin lesion consistent with leprosy and with definite sensory loss. Positive skin smears. Skin lesions can be single or multiple, and usually hypopigmented, although occasionally reddish or copper colored. The lesions may be macules flat, papules raised, or nodular. The sensory loss at the skin lesion is important because this feature can help differentiate it from other causes of skin lesions such as tinea versicolor. Thickened nerves are associated with leprosy and can be accompanied by loss of sensation or muscle weakness. However, without the characteristic skin lesion and sensory loss, muscle weakness is not considered a reliable sign of leprosy. In some cases, acid fast leprosy bacilli in skin smears are considered diagnostic however, the diagnosis is clinical. 3.