Hansen's disease begins gradually, usually with the onset of increased or decreased sensation in certain areas of skin. These areas typically have either increased or decreased pigmentation.

Later, they enlarge and thicken, losing their hair, sweating ability, and all sensation. The nerves of the arms and legs become visibly enlarged with accompanying pain, later changing to numbness, muscle wasting, ulceration, and loss of fingers or toes (figure 26.9). In some patients the skin lesions are not sharply

Figure 26.9 A Person with Leprosy Notice the absence of her fingers as a result of the disease.

26.2 Bacterial Nervous System Infections 671

Table 26.2 Listeriosis

© Causative organism Listeria monocytogenes is ingested with food such as Mexican cheese, soft cheeses, non-pasteurized milk, hot dogs, or coleslaw.

@ The bacteria rapidly penetrate the intestinal epithelium and establish bacteremia, especially in pregnant women, the elderly, and the immunodeficient.

@ In pregnant women, circulating L. monocytogenes crosses the placenta and fatally infects the fetus or bacteria transmitted to the baby at birth cause meningitis in one to four weeks.The mother usually does not have a serious illness.

@ In older people and those with underlying diseases L. monocytogenes attacks brain and meninges, causes meningitis, brain abscesses.

Symptoms Fever and muscle aches, with or without gastrointestinal symptoms; headache and stiff neck mark the onset of meningitis

Incubation period A few days to 2 to 3 months; in newborn babies, 1 to 4 weeks Causative agent Listeria monocytogenes, a non-spore-forming Gram-positive rod able to grow at 4°C Pathogenesis Ingested L. monocytogenes penetrate the intestinal epithelium and enter the bloodstream; the resulting bacteremia seeds the meninges, causing meningitis Epidemiology Epidemics from contaminated soft cheeses, non-pasteurized milk, coleslaw, hot dogs. Pregnant women get bacteremia, fetal infection, miscarriage. Infants contract infection at birth, develop meningitis in the first month of life. Elderly and those with immunodeficiency, cancer, and diabetes also at high risk Prevention and Care in handling, cooking of raw meats; treatment thorough washing of vegetables;

reheating of cold cuts, hot dogs, and refrigerated leftovers. Antibacterial medications such as penicillin, given promptly, are effective treatment defined, but slowly enlarge and spread. Changes are most obvious in the face, with thickening of the nose and ears and deep wrinkling of the facial skin. Collapse of the supporting structure of the nose occurs with accompanying congestion and bleeding.

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