Prevention and Treatment

No proven vaccine to control leprosy is yet available. Tuberculoid leprosy can be arrested by treatment with the antimicrobials dap-sone and rifampin administered in combination for 6 months. Lepromatous leprosy is generally treated for a minimum of2 years, with a third drug, clofazimine, included in the treatment regimen. As in tuberculosis, multiple drug therapy is required to minimize the development of strains resistant to the antimicrobials.

Some features of Hansen's disease are summarized in table

26.3. Botulism

Botulism, classically a severe form of food poisoning, is not a nervous system infection. It is considered here because its princi-

Table 26.3 Hansen's Disease (Leprosy)

Symptoms

Anaesthetic skin lesions, deformed face, loss of fingers or toes

Incubation period

3 months to 20 years; usually 3 years

Causative agent

Mycobacterium leprae, an acid-fast, non-culturable rod

Pathogenesis

Invasion of small nerves of skin; multiplication in macrophages; course of disease depends on immune response of host; activated macrophages limit growth of bacterium; attack of immune cells against infected nerve cells produces nerve damage, leading to deformity; immunity sometimes overwhelmed by accumulating bacterial antigen, allowing unrestrained growth of M. leprae

Epidemiology

Direct contact with M. leprae from mucous membrane secretions

Prevention and treatment

No vaccine. Treatment: dapsone plus rifampin for months or years; clofazimine added for lepromatous disease

pal symptom is paralysis, but is also discussed in section 32.5 covering foodborne illness. It is one of the most feared of all diseases because it strikes without warning and is often fatal. The name botulism comes from botulus, meaning "sausage," chosen because some of the earliest recognized cases occurred in people who had eaten contaminated sausage. The majority of cases worldwide represent foodborne botulism, caused by eating food in which the organism has grown and released a poisonous substance. A small percentage of cases occur when the organisms colonize the intestine or a wound, however, causing intestinal botulism and wound botulism, respectively. ■ food-borne botulism, p. 812

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