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close this book Combatting Hansen's disease
View the document Table of contents
View the document List of common abreviations
View the document I. Introduction
Open this folder and view contents II. Pertinent physiology and immunology
Open this folder and view contents III. Hansen's disease - Three perspectives
Open this folder and view contents IV. Health education
Open this folder and view contents V. Case finding
Open this folder and view contents VI. Diagnosis - Symptoms and testing in HD
Open this folder and view contents VII. Patient management
Open this folder and view contents VII. Co-operating institutions
Open this folder and view contents IX. Getting started
View the document Appendix I
View the document Appendix II
View the document Appendix III
View the document Appendix IV

Appendix II

GLOSSARY OF TERMS FOR VOLUNTEERS WORKING IN LEPROSY CONTROL

Suggestions for additions or deletions are welcomed. Corrections are expected. Please communicate any to the health program office,

absorption

In Hansen's Disease, this term means the gradua loss of fingers, a widely recognized stigma of the disease. It occurs secondary to misuse and injury of the hand following loss of sensation. It also can occur in other diseases if nerves are destroyed.

acid-fast bacillus

A bacillus not readily decolorized by acid alcohol when stained-a characteristic of both Mycobacterium leprae and M. tuberculosis.

active immunity

A disease specific defence mechanism of the body which can modify or prevent the disease resulting from contact with microorganisms or their products. The body cells and tissues react to produce the specific immunity.

Acute

Having a short and relatively severe course.

Agent

Any power, principle, or substance capable of acting upon the organism, whether curative, morbific (causing illness), or other.

Anesthesia

Loss of feeling or sensation. An early sign of Hansen's Disease.

Anhidrosis

An abnormal deficiency of sweat.

animal model

Animal susceptible to a specific disease and, thus, an animal which serves as a model for the study of that disease.

Antibody

A globulin found in serum and tissues produced by lymphoid tissue (by B-cells of lymphoid tissue - B for bone marrow) in response to a specific antigen.

Antigen

A protein or protein-polysaccaride complex foreign to the body which, when introduced into the tissues, induces specific antibody formation or response. This antigen-antibody response is specific and can be demonstrated in vivo (in the body) and in vitro (in the laboratory).

Antitoxin

A type of antibody produced in response to particular bacterial toxins. Some antitoxins are induced in animals and the animal serum used for treatment or prevention of specific diseases (tetanus, rabies, diphtheria.)

armadillo

Animal under study as a possible model for Hansen's Disease study.

"at risk"

Those individuals most likely to develop a disease. In Hansen's Disease, since the means of acquiring the infection are not known, the population at risk is not precisely known. Relatives and household contacts of patients are considered as the "at risk" population.

BCG

Bacillus Calmette-Guerin, an organism of the strain Mycobacterium tuberculosis var. bovis, rendered completely avirulent by cultivation for many years on bile-glycero-potato medium. It is used to produce a vaccine against tuberculosis for high risk populations. It is also used to produce a generalized, non-specific response from the immune system to possibly play a role in prevention of leprosy and in the treatment of certain blood malignancies. Although the use of BCG for the prevention of Hansen's Disease has been under study for over 10 years, experts conclude that general use cannot be recommended until studies have had definitive evaluation.

B-cell

D for bone marrow, a type of lymphocyte (white blood cell) involved in body defences, synthesizes antibody in response to an antigen.

Bacterial Index (BI)

A scale for reporting the number of M. leprae bacilli Been on a skin smear.

Biopsy

The removal and examination, usually microscopic, of tissue or other material from the living body for purposes of diagnosis.

Blister

A localized collection of fluid in the upper layers of skin causing the separation and elevation of the upper layers. In Hansen' Disease, in that it may indicate an area of injury to anesthetic skin? it is important in prevention of ulcers.

Borderline

A diagnostic term for classification of Hansen's Disease. Also called "dimorphous." Has the characteristics of both tuberculoid and lepromatous leprosy. Extremely variable in its manifestations often changing toward tuberculoid or toward lepromatous classification.

Bruise

A superficial injury produced by impact but without laceration. Of importance in Hansen's Disease as it may indicate an injury to anesthetic skin and an important precursor of ulcers.

callus (callosity)

Circumscribed thickening of the skin due to friction, pressure, or other irritation. Important in the patient with Hansen's Disease as a precursor of ulceration.

"cardinal signs"

For the diagnosis of leprosy, two of the three following signs should be present: anesthesia, thickened nerves, or characteristic skin lesions. The presence of acid fast bacilli in skin smears alone is sufficient for diagnosis.

Center for Disease Control

U.S. national center for disease control, part of Department of Health, Education, and Welfare and the U.S. Public Health Service, located in Atlanta, Georgia, source of epidemiologic, therapeutic, diagnostic information.

Chemoprophylaxis

The prevention of disease by chemical agents.

Chemotherapy

The treatment of disease by chemical agents.

Chronic

Persisting over a long period of time.

Clawed hand

Deformity common in leprosy which results from destruction of the ulnar and/or median nerve.

Clofazimine

An alternate drug for the treatment of Hansen's Disease, It is expensive and stains the skin, especially the diseased areas.

Communicable

Capable of being transmitted from one person to another.

Conjunctiva

The delicate membrance that lines the eyelids and covers the exposed surface of the eyeball.

Contact

A person who has or had close association with an individual with Hansen's Disease (usually family member).

Contagious

Communicable by personal contact.

Contracture

A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibers.

Control

Refers to attempts to reduce prevalence of Hansen's Disease by the systematic treatment of existing case in a program area, and, finally, to reduce incidence

cornea

The transparent structure forming the anterior part of the eye. Lepromatous infiltration may occur in the cornea. It is subject to severe damage if lagophthalmus occurs.

Corticosteroids

A group name for compounds derived from or chemically the same as substances produced by the adrenal cortex. In Hansen's Disease, they are used in the treatment of lepra reactions.

Culture

The propagation of microorganisms or of living tissue cells in specie' media conducive to their growth. Culture of M. leprae has not been successfully carried out.

Cutaneous

Refers to the skin.

Dapsone (DDS)

Diaminodipnenyl sulphone, a bacteriostatic drug for the M. leprae bacillus. It was first used in treating leprosy in 1941. Sulfones (of which DDS is one) remain the most important drugs in the treatment of leprosy.

Debridement

The removal of all foreign matter and devitalized tissue in or about a lesion.

Defined population

Operational area of known number. This population figure becomes the denominator for determination of rates for the area-morbidity, disease-specific, mortality, etc., rates.

Dermatitis

Inflammation of the skin.

Differential diagnosis

A list of diseases to consider for any one sign, symptom or group of signs and symptoms.

Disability Classification

A standardized description of deformities resulting from Hansen's Disease ranging from "mild" to "moderate" to "severe" with specific criteria for hands, feet, and eyes. (See WHO Tech. Report Series No. 459, Expert Committee on Leprosy, Fourth Report.)

drug resistance

The condition in which particular microorganisms are no longer susceptible (sensitive) to a given drug

dry skin

A condition associated with nerve damage and paralysis. The sweat glands do not function and the normal elasticity of the skin is lost. Important to recognize in the prevention of progressive deformity in Hansen's Disease.

Erythema

A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes.

Erythema nodosum leprosum (ENL)

A form of hypersensitivity reaction which occurs with lepromatous form of leprosy. An immunologic. response.

Endemic

Present in a community at all times, but occurring in only small numbers of cases, usually one per 1000 to 10 per 1000.

Epidemic

(1) Attacking many people in any region at the same time; widely diffused and rapidly spreading.

 

(2) A disease of high morbidity which is only occasionally present in a human community.

 

(3) A season of the extensive prevalence of any particular disease.

Epidemiology

The field of science dealing with the relationships of the various factors which determine the frequencies and distributions of an infectious process, a disease, or a physiological state in a human community.

Exacerbation

Increase in the severity of any symptoms or disease.

Fomite (fomes)

An object, such as a book, wooden object, or an article of clothing, that is not in itself corrupted but is able to harbor pathogenic microorganisms which may by that means be transmitted to others.

foot drop

Results from paralysis and is an inability to properly lift the foot resulting in dragging of the toes and also a tendency to turn the foot inwards and walk on the outer edge of the foot, producing chronic injury.

Genetic

Inherited.

Glaucoma

A condition of the eye characterized by increased intra-ocular pressure which can progress to blindness. Glaucoma may result from conditions of the eye associated with acute, recurring lepra reactions.

Globe

Refers to the eyeball.

Hansen, Armauer

Norwegian who discovered M. leprae in 1873.

Health education

Education with the aim of altering behavior to prevent disease or mote effectively treat disease.

Hematoma

A tumor (lump) containing effused blood.

 

Important as precursor of ulcer in insensitive area of body, particularly the feet.

Host

A man, animal, plant which harbors or nourishes another organism (parasite.)

hyperendemic

Present in a community at all times, usually above the rate of 10 per 1000.

Hypersensitivity

Specific or general ability to react with characteristic symptoms to the application or contact with certain substances. This response is a function of T-cells (a type of lymphocyte) and is the mechanism involved in reaction to tuberculin and lepromin. The "reaction" which occurs in Hansen's Disease with signs of acute inflammation in lesions arc episodes of acute hypersensitivity to bacilliary antigens. The manifestations of such a "reaction" are greatly varied.

Immunity

Security against any particular disease or poison.

 

The power which an individual sometimes acquires to resist and/or overcome an infection to which most or many of its species are susceptible.

Immunology

The study of immunity.

Immunopathology

Structural or functional changes in immune mechanisms of the body which produce disease.

Inactive

As applied to Hansen's Disease, this term indicates that there are no clinical signs of activity (signs apparent to a physician or trained worker) and skin smears arc negative for M. leprae.

Incidence

The number of new cases of a specific disease occurring during a certain period. It can also be described as the frequency of addition, or transaction into the disease account.

Incubation period

The time from the entrance of an infectious disease producing agent into the body and the appearance of the first symptom or sign.

Indeterminate

A specific term for the first lesions of leprosy which have not developed characteristics to place the disease on the spectrum of tuberculoid to lepromatous. Many heal spontaneously but a few become determinate and progress to be classified clinically.

Index case

The first identified patient with a specific infectious disease from which secondary cases result or, after initial identification, similar or identical patients are found and a common source of the disease discovered or sought.

Induration

An abnormally hard spot or place, The hardness is relative to the surrounding normal skin.

Infectious

Caused by or capable of being communicated by infection (invasion of the body by disease producing microorganisms.)

infectivity

Infectiousness.

Infiltration

The diffusion or accumulation in a tissue of substances not normal to it.

Inflammation

The condition into which tissues enter as a reaction to injury. To the classical signs of inflammation-pain, heat, redness, and swelling - is sometimes added loss of function.

Integration

The need for integration of leprosy control programs into the structure of the general health services is widely recognized, as arc the difficulties of achieving it. Full integration will result from a long-drawn-out process but the first step in that direction should be encouraged area by area utilizing methods appropriate to that particular part of the country.

Intradermal

Into the dermis (into the skin). A characteristic of an intradermal injection is that it produces a definite wheal on the surface-not true of subcutaneous (under the skin) injections. Lepromin and tuberculin skin tests are intradermal injections.

Intramuscular

Into muscle. When giving an intramuscular injection, the needle enters the skin perpendicular to it. (In intradermal injections, the needle is close to parallel to the skin. In subcutaneous injections, the needle is approximately at a 45 degree angle with the surface of the skin.

iritis, iridocyclitis

Inflammatory response of eye as part of a "reaction" with pain, photophobia, blurring of vision, "pink eye" (especially at the edge of the iris, colored center of eye), constriction of the pupil, cloudiness.

Itis

A suffix used with medical terms to indicate an inflammatory (often infectious) disease process.

 

Example neuritis.

jet injector

A device for giving injections of medication or vaccine through the skin by the use of compressed air. It has the advantage of great speed for mass inoculations.

lacrimal

Pertaining to the tears.

lagophthalmos

A condition in which the eye cannot be completely closed.

lepra reaction

See "hypersensitivity reaction."

leproma

The characteristic lesion of leprosy, a granulomatous nodule.

lepromatous

A clinically recognized from of leprosy which represents the severe end of the spectrum. Characterized by multiple organ involvement, steady downhill course, predisposition to complications of antigen-antibody reactions, etc., if untreated.

lepromin

An antigenic preparation of M. Ieprae used in the study of delayed (skin) hypersensitivity.

 

Preparations in use include suspension of whole autoclaved homogenized leproma, more purified bacillary suspensions, non-coagulated soluble bacillary proteins, etc.

lesion

A wound or injury; a circumscribed pathological alteration of tissue; a point or patch of a skin disease.

lymphocyte

A white blood eel. formed in Iymphoid tissue (as lymph modes, spleen, thymus, tonsils) and constituting from 20 to 30 percent of the white blood cells in the normal adult. The lymphocytes are an important part of the defence system of the body.

macrophage

A large wandering phagocytic cell which originates in the tissues, is found in lesions of leprosy, and has different microscopic characteristics depending on the form of the disease.

macule (macula)

A stain or spot; used in anatomical nomenclature as a general term to designate an area distinguish able by color or otherwise from its surroundings.

 

A discolored spot on the skin that is not elevated above the surface.

"mild disability"

See "Disability Classification."

minimal effective dose (MED)

Drug dosage determination used especially in the testing and screening of new drugs. minimal inhibitory concentration (MIC)

 

Standard terminology for drug concentration determination in blood and tissue, amount necessary to inhibit multiplication of bacilli, especially important in the study of new drugs

"moderate disability"

See "Disability Classification."

morbidity rate

Sickness rate for an identified population.

mortality rate

Death rate. This may be a general death rate (all causes) or disease-specific. For tuberculosis, it is usually expressed as the number of death-e due to tuberculosis per 100,000 population.

mouse food pad

An animal model for the study of M. leprae.

 

The bacilli will multiply locally when inoculated into the footpads of mice. It is a sensitive and reproducible model for bacteriological studies and growth can be quantified within certain limits.

morphological index (solid ratio) (MI)

The number of solid forms per 100 total bacilli examined. An indication of the viability of the bacilli. Of importance in determining response to treatment. Subject to interpretation by individual technicians.

mycobacterium

A family of microorganisms which includes the tubercle bacillus and leprae bacillus This family is distinguished by acid-fast staining qualities.

nasal

Refers to the nose. Nasal smears for M. leprae are not considered to be of value as other acid fast bacilli may be present In the nose. If M. leprae are present in the nose, they will also be present in the skin.

natural immunity

Immunity which results from having a disease.

 

For example, the immunity which follows chickenpox is natural immunity.

neural

Refers to nerves.

neuritis

Inflammation of a nerve. The condition is attended by pain and tenderness over the nerves, anesthesia and paresthesias, paralysis, wasting, and disappearance of the reflexes.

neuropathy

A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system.

nodule

A small boss or node which is solid and can be detected by touch.

"open case"

Patient with Hansen's Disease whose skin smears are positive.

"out of control"

"Out of control", "absentee" and "lost sight of" are terms that have been used for registered patients who have not been under control for two or more years.

palmar

Refers to palm of hand.

papule

A small circumscribed, solid elevation of the skin.

paralysis

Loss or impairment of motor function in a part due to a lesion of the neural or muscular mechanism. Also, by analogy, impairment of sensory function.

parenteral

Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.

passive immunity

A short lasting immunity produced when antibodies from one human or animal are injected into another. The body cells take no part in the product on of this immune state. Antibodies passed from mother to fetus through the placenta also produce a temporary, passive immune state. Examples include the use of gamma globulin for the prevention of hepatitis or measles, antirabies serum, diphtheria and tetanus antitoxin.

pathogenesis

The development of morbid conditions or of a -disease.

pathology

Study of the essential nature of disease especially of the structural and functional changes in tissues and organs of the body.

photophobia

Abnormal intolerance of light.

planter

. Referring to the sole of the foot.

plaque

Any patch or flat area.

prevalence

The frequency of a disease at a given point of time. It is usually expressed as a rate for a given-population. Example: In the 1970 survey, 65% of the Korean population were found to be infected with M. tuberculosis.

primary medical care

In Hansen's Disease, this refers to early treatment with special emphasis on health education directed toward a preventive approach of progressive disability.

prospective study

A study planned to observe events that have not yet occurred.

public health

"Medicine of man in the aggregate." The branch of medicine concerned with the health of the community or other defined population.

rate

A quantitative measure of a part to a whole; proportion.

reaction

In Hansen's Disease, it refers to the appearance of symptoms and signs of acute inflammation in the lesions of a patient; an immunological complication. See "hypersensitivity"

reactor

Refers to an individual with a positive skin test for lepromin or a patient with a generalized inflammatory response in lesions of leprosy.

"regular treatment"

According to criteria accepted by WHO, this includes patients taking at least 75% of their prescribed medication.

rehabilitation

To restore to useful life through education and therapy.

"release from control"

Certain administrative definitions have been accepted for inactive cases in order to release from control and are: no sign of clinical activity and negative bacteriological examinations for one and a half years for tuberculoid leprosy, three years for indeterminate leprosy, and at least ten years for lepromatous and borderline cases.

repository preparation

A parenteral medication which is "stored" in muscle and released slowly into the blood stream and tissues over a long period of time.

resistance

Applied to a disease, implies specific as well as nonspecific mechanisms of the body involved in preventing or modifying the process. Applied to microorganisms, implies that certain therapeutic agents are not effective in attenuating or killing the organism.

retrospective study

One based on past data or past events.

rifampacin

A potent antibiotic under study in the treatment of leprosy, particularly in sulphone-resistant lepromatous cases. An important drawback is the high cost of the drug.

scar tissue

Healing, usually by the production of fibrous tissue.

secondary infection

Invasion of a diseased area of the body by organisms other than those causing the original infection.

sensation

An impression conveyed by nerves to the central nervous system,

serum

The clear liquid which separates in the clotting of blood from the clot and the corpuscles.

"severe disability"

See "Disability Classification."

signs

Any indication of the existence of something; any objective evidence of a disease.

"spared areas"

Warm areas of skin which usually are not involved with lepromatous disease until very late (if at all); scalp, axillae and groins, palms and soles, antecubital and popliteal fossae and midline of the back.

subcutaneous

Under the skin.

sulfones

The name of a group of drugs related to the sulfas, used for the treatment of uncomplicated leprosy. The "parent" sulfone, DDS, is the moat commonly used drug because of low cost and infrequency of resistance. The drawbacks are slow bacteriostatic action, the need to give for long periods of time, and its inability to quickly clear the body of bacilli.

surveillance

In Hansen's Disease control programs with limited resources, the term is used moat commonly for the follow-up of contacts. Priority is given to household contacts of infectious cases and particularly to children.

survey

To examine or look at in a comprehensive way. In public health, it generally refers to a specific, planned study of one or more characteristics of a defined population.

symptoms

Any phenomenon experienced by an individual as a departure from normal function, sensation, or appearance, generally indicating disorder or disease.

syndrome

A set of symptoms which occur together; the sum of signs of any morbid state; a symptom complex.

systemic

Pertaining to or affecting the body as a whole.

T-cell

Type of lymphocytes (white blood cells) which ''patrol'' through the tissues, lymph nodes and blood stream as part of the defence system of the body. T is for thymus through which these particular lymphocytes pass. They are the cells most involved in resistance to tuberculosis and leprosy.

Technical Report Series (TRS)

A frequent but irregular publication of the WHO which is the vehicle of disseminating opinions and advice of expert committees and other international groups of experts convened for that purpose, Example: TRS 459, Fourth Report of WHO Expert Committee on Leprosy published in 1970.

thalidamide

An anti-inflammatory drug used for the control of reactions. Originally, a drug of infamy in the 1950's as it caused severe deformities of infants when taken by the mother during pregnancy. It therefore must never be used in any woman of childbearing age.

thymectomized

With thymus (one of the organs of lymph tissue) removed. In Hansen's Disease, the thymectomized rat is one of the commonly used "animal models."

toxin

A poison produced by bacteria which are highly toxic for other organisms.

trophic ulcer

An ulcer caused by nervous system factors.

tuberculoid

A term used to describe one form of leprosy. This form may appear as a single lesion. Often this form heals spontaneously. Nerve involvement usually is limited and damage readily prevented by treatment. This form of the disease represents the end of the spectrum occurring in an individual with a marked degree of general immunity to the disease.

26 guage platinum

The size and kind of needle (with a short bevel)

27 guage steel

recommended for administration of intradermal skin tests,

ulcer

Loss of substance on a cutaneous or mucous surface, causing gradual disintegration and necrosis of the tissues.

vaccine

A suspension of attenuated or killed microorganisms administered for the prevention, amelioration, or treatment of infectious diseases.

vector

A carrier, especially the animal (usually an arthropod), which transfers an infective agent from one host to another.

vesiculation

Blistering of the skin, usually with very small blebs.

viability

Ability to live.

visceral lesions

Lesions of a disease in any large internal organ. In Hansen's Disease, the lesions usually are in liver, spleen, glands.

virulence

The degree of pathogenicity of a microorganism as indicated by case fatality rates and/or its ability to invade the tissues of the host. The competence of any infectious agent to produce pathologic effects.

wheal

A smooth, slightly elevated area on the body surface which is redder or paler than the surrounding skin, often with itching, usually evanescent.

World Health Organization (WHO)

A specialized agency related to the United Nations, formed in 1948, with more than 120 member nations for exchange of knowledge and experience in health and for collaboration for the achievement of the highest possible level of health throughout the world.

A variety of dictionaries, texts, manuals, and reprints have been quoted above.

Griffith/shp

5/19/75

50 copies