U.S. Man Diagnosed With HIV Develops Leprosy10/19/11
WEDNESDAY, Oct. 19 (HealthDay News) -- Ohio doctors report they
got a diagnostic surprise when an HIV patient tested positive for
the bacterium that causes leprosy.
What was even more surprising was that the initial infection
most likely occurred decades earlier, from exposure to an
Soon after starting treatment for the HIV infection, the Ohio
man developed lesions on his skin that didn't respond to antibiotic
treatment. His doctors eventually confirmed that the lesions were
Mycobacterium leprae bacteria, an infection more commonly
known as leprosy.
"With the way he presented, typically, any clinician would think of an infection with bacteria, and that's what we were thinking, but he was not responding to regular antibiotic treatment," said Dr. Madhuri Sopirala, the lead author of a letter on the unusual case in the Oct. 20 issue of the New England Journal of Medicine.
And, it was his failure to respond to antibiotic treatment that
prompted his physicians to look for less common reasons for the
Leprosy, which is also called Hansen's disease, is quite
uncommon in the United States. In 2008, the last year for which
statistics are available, just 150 people contracted Hansen's
disease in the United States, according to the National Hansen's
Disease Program. The majority of these cases occurred in
California, Florida, Hawaii, Louisiana, Massachusetts, New York and
The main symptom of the disease is skin lesions that may be
raised or flat, light-colored or pigmented, and there may be no
feeling within the skin lesion. The disease can only be diagnosed
through a skin biopsy, and long-term treatment with antibiotics is
effective when started early.
People who live in Texas or Louisiana are more likely to
contract Hansen's disease, as are people who've traveled to parts
of the world where leprosy is still common.
In April, Hansen's disease experts added armadillo exposure to
the list of possible risk factors, cautioning that people should
stay away from armadillos.
In the case of the Ohio man, however, he hadn't been around
armadillos since he was a teenager. He was 41 when he was diagnosed
with Hansen's disease. He had never traveled outside of the United
States, and said he hadn't been around anyone who had lived in
areas where leprosy was still common. He had lived in Ohio all of
his adult life, but had grown up in Mississippi, where he hunted
armadillos as a teenager and touched their carcasses.
"The long duration of incubation is not a surprise to people who deal with this disease -- 20 years' incubation is not outside of our experience," said Dr. David Scollard, chief of the clinical branch and a pathologist at the National Hansen's Disease Program. "And, we have certainly seen this turn up as an opportunistic infection in people who are immunosuppressed: people with HIV, people who have had heart or kidney transplants, people receiving chemotherapy, [and people on certain medications that dampen the immune system response]. The biggest problem we have is that most clinicians don't think of it."
Sopirala, who is with the Ohio State University Medical Center
in Columbus, said that if someone has symptoms consistent with
leprosy, such as skin lesions that have no feeling of pain, and the
symptoms don't improve with antibiotic treatment, leprosy should be
considered as a possible diagnosis, especially if someone lives or
has lived in an area of the southern United States where armadillo
exposure is a possibility.
"This was a nice piece of detective work," Dr. Richard Truman said of the study. "Leprosy remains a very rare disease, but it's another one of the diseases that should be considered with chronic [skin] lesions that don't respond to treatment," he said. Truman is a research scientist from the National Hansen's Disease Program at Louisiana State University in Baton Rouge.
Learn more about leprosy from the
National Hansen's Disease Program.
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