02207nas a2200241   4500000000100000008004100001653001400042653001700056653001200073653002200085100001200107700001300119700002100132700001500153700001000168700001400178245013100192856007100323300001100394490000600405520154000411022001401951       2016                            d10aReactions10aNerve damage10aleprosy10aDelayed Diagnosis1 aLeon KE1 aJacob JT1 aFranco-Paredes C1 aKozarsky P1 aWu HM1 aFairley J00aDelayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866574/pdf/ofw063.pdf  aofw0630 v33 a<p>Background.  Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods.  A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results.  Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease "reactions", severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1-96), but no single factor was associated with a delay in diagnosis. Conclusions.  The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage.</p>
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