Laboratory diagnostics, prevention and treatment of leprosy. Leprosy (Hansen's disease, leprosy)

Leprosy is a chronic infectious disease caused by the acid-fast mycobacterium leprosy (Hansen-Neisser rod). With this infection, the skin, peripheral nervous system, eyes and internal organs are mainly affected. In the world of patients with leprosy, there are currently more than two million. Men suffer from this disease twice as often as women. Leprosy can occur at any age, but children under one year of age rarely get sick.

Leprosy is not very contagious. The only reservoir of leprosy is a sick person. Infection occurs by airborne droplets or by direct contact with the patient.

Clinical symptoms of leprosy

Immunological and clinical manifestations of the disease are characterized by great diversity (from the tuberculoid form of infection to lepromatous). The first symptoms of leprosy disease usually appear on the skin of a person in the form of one or more hypopigmented or hyperpigmented plaques or spots. At the site of the skin lesion, partial or total loss sensitivity. Upon contact with a sick person in a healthy person, single lesions with reduced sensitivity may appear on the skin. Affected areas of the skin can spontaneously disappear within a few years, but in this case, you can not do without specific treatment. With early tuberculoid leprosy, clearly demarcated patches of hypopigmentation of the skin appear. Later, the lesions increase, their edges are rounded and rise, acquiring an annular shape. Nerve damage leads to muscle atrophy. Very often contractures of the foot and hand develop. Defeat facial nerves often leads to lagophthalmos, keratitis and corneal ulceration leading to loss of vision.

In lepromatous leprosy, the lesions are hypopigmented macules, nodules, plaques, or papules. The boundaries of the lesions are unclear, and their central sections are slightly raised above the surface of the skin, convex and compacted, and not concave, as in tuberculoid leprosy. Diffuse infiltration is usually observed between lesions. The favorite sites for localization of lesions in lepromatous leprosy are the ears, face (eyebrows, cheeks, nose), elbow joints, wrists, knees and buttocks. At this stage of the disease, the lateral sections of the eyebrows very often fall out, and later the earlobes sag, and the skin of the face wrinkles and thickens (lion's face).

Early symptoms of leprosy are difficulty breathing, nosebleeds, hoarseness, laryngitis, and nasal obstruction. When defeated anterior section eyes develop iridocyclitis and keratitis. In men, scarring and infiltration of the testicles lead to infertility. A very common symptom of leprosy is the development of a saddle nose as a result of perforation of the nasal septum and the formation of a small depression in the middle part of the back of the nose.

Leprosy treatment

In 1943, sulfonic drugs were proposed for the treatment of leprosy. In addition to them, ethyl mercaptan compounds or thiourea derivatives, the antibiotic Rifadin and isonicotinic acid derivatives are prescribed.

Antibiotic Rifadin has a high antileprosy activity and good tolerance when taken orally. The antibiotic is easily absorbed from the digestive tract, penetrating into the tissues of the body. This drug is especially effective in lepromatous leprosy. It provides fast bacteriological negativity.

Treatment of leprosy should be carried out by several medicines. Usually these are Rifadin, Clofazimine and Dapsone. The combination of Rifadin and Dapsone will be quite effective for the borderline lepromatous and borderline forms of the disease. In the lepromatous form of the disease, it is desirable to use all three drugs. During the treatment of leprosy, objective methods for evaluating the effectiveness of ongoing therapy, including biopsies and scrapings, should be used. Treatment of the disease should be continued until laboratory methods diagnostics will not produce persistently negative results. The optimal duration of treatment has not been established, but it is recommended to adhere to the therapeutic regimen for at least two years.

Prevention of leprosy

Infection of a child with leprosy does not occur in utero, but only through contact with the mother. To avoid infection of the newborn, it should be isolated from the mother immediately after birth.

Persons who have been in contact with a patient with leprosy should be especially carefully examined. long time. The closest relatives of the patient need to do a lepromine test. In areas where outbreaks have been identified, mass vaccinations with BCG anti-tuberculosis vaccine should be carried out. Identified patients must be isolated in clinics for rational therapy.

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Leprosy is mentioned in the most ancient sources. For centuries, the external manifestations of chronic granulomatous infection have been called leprosy, black sickness, lazy death, and Crimean. Now these names are outdated, modern synonyms are considered to be Hansen's disease, hanseniaz, hansenoz.

The sick terrified the inhabitants of the cities, communication with lepers was forbidden, so they were expelled from the settlements. Later, leprosariums were created to isolate such people.

The vast majority of cases of leprosy are detected in countries with a hot and tropical climate. The number of such patients is decreasing every year, but leprosy is still common in South Asia (Nepal, Burma, India), in East Africa (Mozambique, Madagascar, Tanzania), in parts of Brazil, in Latin America and in the Western Pacific Islands. The natural reservoir for the infection is armadillos, great primates, water bodies and soil, but this route of infection is not considered decisive in its spread.

Disease can develop in people of all ages, but is more often recorded in adolescents and young people from 13 to 19-20 years old, while the severe lepromatous form is predominantly found in men. The incubation period, as a rule, is 3-5 years, but sometimes ranges from six months to several decades. The early diagnosis of leprosy is significantly hampered by the non-specificity of the signs of the latent period and their optionality - any symptoms may be completely absent.

Contrary to popular belief, leprosy is not highly contagious. It is not inherited and during pregnancy from mother to child. After birth, such children are isolated and transferred to artificial feeding. Infection with leprosy is possible after prolonged contact with the patient. Immunological and genetic instability to mycobacteria plays an important role in this process.

Even with many years of living together with a patient with leprosy, infection within the family occurs only in 5-10% of cases. Episodes of the latent course of the disease were also recorded. When studying the puncture of the lymph nodes and scrapings taken from the membrane of the nasal cavity, it was possible to identify mycobacterium leprosy, but there were no signs of the disease. Despite these facts, there is a high risk of infection in children, especially if they are prone to allergic reactions.

Most of the patients with a detailed clinical picture of leprosy found among people aged 30 to 50 years, while black men are more susceptible to infection. The transition of the disease from latent to active form contribute to harsh living and working conditions, malnutrition, infectious diseases and bad habits. All these reasons contribute to a decrease in the body's resistance, but living in an endemic focus of infection is considered one of the highest risk factors.

The reasons

A sick person is a natural reservoir of infection, as well as a source of infection. The mode of transmission has not been reliably studied. From ulcers on the mucous membranes and from the surface of the skin, the pathogen spreads to in large numbers in environment. In theory the infection enters the body of a healthy person through skin lesions and through the mucous membranes of the upper respiratory tract. Mycobacteria during reactivation of leprosy infection are found in breast milk, semen, tears, blood and urethral secretions. There have been cases of infection after using the things of the patient.

In the primary stages of the disease, mycobacterium leprosy is often found in the femoral lymph nodes. It is assumed that their penetration occurs through the skin lower extremities. This process is facilitated by varicose veins, mycoses of the feet and impaired microcirculation in the tissues.

Classification

According to the Madrid classification, adopted in 1953, there are two polar species and two intermediate forms of leprosy.

Types of leprosy

Lepromatous type- This is the most serious variety, difficult to treat. Typical lesions: skin, eyes, surface of the respiratory tract, peripheral nerves, lymph nodes and internal organs. Analysis of scrapings taken from the outer parts of the body shows the accumulation of mycobacteria, the internal skin test is negative.
Tuberculoid type runs in more mild form. There is damage to the skin, peripheral nerves and lymph nodes. In samples of scrapings from the mucous membranes and external integuments, the pathogen is not detected, but the lepromine test indicates the presence of mycobacteria.

Forms of leprosy

undifferentiated- conditionally benign, initial form, proceeding with skin lesions and peripheral nervous system. Outwardly, it appears as flat red spots on the skin. When analyzing scrapings, pathogenic bacilli are often not detected. The result of the lepromine reaction depends on the intensity of the infectious process. Histological analyzes indicate the presence of lymphocytic infiltration in the lesions.
dimorphic is a severe borderline and malignant form, affecting the skin, mucous and nerve branches. In scrapings of the skin during bacteriological analysis, a huge accumulation of pathogens is found, and when analyzing samples from the nasal mucosa, this is not always the case. As a rule, the lepromine test shows a negative result. The study of affected tissues may indicate the presence of cellular structures characteristic of the two polar forms.

Along with the Madrid classification, the Ridley-Jopling classification is used, which takes into account the clinical, immunological, bacteriological and histological criteria for the analysis of the disease.

Symptoms

The severity of the disease and its manifestations depend on the severity cellular immunity regarding the causative agent of leprosy. In 75% of patients, a single skin lesion is observed, which resolves spontaneously, the rest develop typical Clinical signs leprosy. The symptoms of the latent period are so blurred that it is extremely difficult to diagnose leprosy at this stage.

Early symptoms of leprosy:

weakness, malaise, chilliness;
decreased sensation in the limbs;
change in skin pigmentation;
skin rashes, marbling of the skin;
the formation of nodes, papules and bumps on the skin;
nasal congestion, inflammation of the mucosa and nosebleeds;
rashes on mucous membranes;
intensive loss of vellus hair, eyebrows and eyelashes;
neurogenic trophic ulcers;
swollen lymph nodes.

The described symptoms are mainly associated with external lesions. This is due to the specific action of the pathogen, which mainly affects tissues in contact with the external environment. With absence proper treatment the disease progresses.

Spectrum external signs depends on the form of the disease. The lepromatous type of the disease is characterized by predominant lesion of the skin, for tuberculoid the target is the nervous system.

Diagnostics

To establish the correct diagnosis, doctors, first of all, rely on the clinical manifestations of the disease. Late and advanced stages of the disease have pronounced diagnostic signs , whereas early symptoms often blurred and atypical.

Early manifestations of the leprosy process are varied, leprosy can mimic various syndromes. Initial symptoms leprosy is characterized by signs of dermatoses, syphilis, exudative erythema, dyschromia, vasculitis and various lesions of the nervous system, so misdiagnosis at this stage is not uncommon. Experienced specialists pay attention to the state of innervation of the affected area, since mycobacteria cause a violation of tactile, pain and temperature sensitivity. Noticeable thickening of the peripheral and larger nerve branches near the sites of rashes.

Bacteriological and pathomorphological studies provide a more reliable result for the final diagnosis. During microscopic analysis of tissue fluid material, in histological preparations and smears taken from the nasal mucosa, leprosy bacilli can be detected. It is difficult to determine the lepromatous and undifferentiated type of the disease due to the absence of mycobacteria in the test samples. To exclude such cases, the reaction of precipitation and complement fixation is used.

With the help of lepromin, differentiation of the type of leprosy is possible. The lepromine test is positive for the tuberculoid type, while it is negative for the lepromatous type.

An informative method for diagnosing the initial forms of leprosy is try nicotinic acid . A few minutes after an intravenous infusion of a solution of nicotinic acid, the rash of leprosy becomes red in color and swells.

Treatment

Until the middle of the 20th century leprosy was considered an incurable disease, patients were isolated in a leper colony in order to prevent the spread of the disease. A breakthrough in solving this problem was the discovery of drugs of the sulfonic group. After their active introduction for the treatment of leprosy, most patients recovered after several years of intensive therapy.

In order to increase the effectiveness of treatment at the end of the 20th century, antibiotics began to be used in combination with sulfones. Complex and long-term therapy consists of several courses with the simultaneous administration of 2-3 antileprosy drugs. To avoid the development of resistance to antibiotics, they are regularly changed and combined. Along with antileprosy drugs, adaptogens, vitamins, immunocorrectors and iron preparations are prescribed.

There are certain studies that prove that BCG vaccination helps to increase the immunoreactivity of patients, but there are no reliable data on this issue yet.

Such a technique provides high chances for recovery patients with initial forms leprosy. In more advanced cases intensive therapy will help get rid of the disease, but acquired pathological changes in the patient's body often lead to disability.

Complications

Diagnosis of leprosy at the initial stages is difficult, so the patient often has to be treated for a long time for non-existent diagnoses, which ultimately leads to serious consequences:

the appearance of a person and the outlines of his face change;
neurotrophic ulcerations are formed;
the mucous membrane of the nasopharynx is affected, perforation of the hard palate and nasal septum occurs;
there is atrophy of the muscles of the limbs, especially the hands;
men develop infertility;
eye damage occurs up to loss of vision;
possible damage to the visceral organs.

Mycobacteria provoke paralysis, neuritis, contracture of the feet and hands. Directly the causative agent of leprosy does not cause necrosis and loss of parts of the limbs, this leads to development of a secondary bacterial infection. Insensitive tissues are susceptible to injury, which are left unattended and become a breeding ground for infection.

Prevention

Special preventive measures to combat the spread of leprosy does not exist. The main importance in this process is the timely detection of patients on early stages diseases, their treatment and, if necessary, isolation in infectious institutions.

Leprosy is not highly contagious, so complete isolation in leper colonies is impractical. In the future, the patient's family members and people who have been in contact with him should undergo an annual examination for 3-10 years.

Patients with leprosy most often do not pose a danger to medical staff and loved ones, therefore, any special rules, other than the usual observance of hygiene standards, are not required when communicating with them.

Forecast

The level of modern medicine has allowed reclassify leprosy as a curable disease. Prediction depends on the stage of development of the disease, its type and the correct prescription of drugs. After the invention medicines sulfone series, the number of deaths from leprosy approached the mortality rates from other diseases.

With early diagnosis of leprosy, no more than 12 months after the onset of the first symptoms of the disease, regular and effective treatment results in no severe injury. If treatment is started 1-3 years after the detection of the disease, then the patient remains neurotic changes associated with loss of sensitivity, contracture of the fingers and amyotrophy. All this leads to a loss of muscle strength and performance.

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It is a systemic infectious process with chronic course caused by mycobacterium leprosy and accompanied by epidermal, visceral manifestations, as well as signs of damage to the nervous system. There are 4 clinical forms of leprosy: lepromatous, tuberculoid, undifferentiated and borderline. Typical signs of leprosy are skin manifestations (erythematous-pigmented spots, nodules, tubercles), polyneuritis, severe deformity and disfigurement of the face, limbs, etc. The diagnosis of leprosy is facilitated by a lepromine test, bacterioscopy and pathology. histological examination biopsy from the affected lesions. Treatment of leprosy is carried out for a long time, with repeated courses of antileprosy drugs.

ICD-10

A30 Leprosy [Gansen's disease]

General information

Leprosy (leprosy, Hansen's disease) is a low-contagious infection leading to a generalized granulomatous lesion of integumentary tissues, peripheral nerves, and in severe cases, the musculoskeletal system, eyes and internal organs. Leprosy is considered one of the oldest diseases of mankind, which for many centuries inspired ominous horror. In the Middle Ages, "lepers" were declared "dead alive", were ostracized or isolated for life in specialized hospitals - leper colonies. Today, the attitude towards the disease has changed significantly, however, despite the availability of specific treatment, the problem of the incidence of leprosy remains relevant for a number of countries in Asia, Africa, and Latin America. According to various data, in the world from 3 to 12-15 million people are sick with leprosy; more than 500-800 thousand new cases of the disease are diagnosed annually.

Causes of leprosy

Sources of leprosy infection are sick people who secrete pathogens with nasal mucus, saliva, breast milk, seminal fluid, urine, stool, discharge of ulcerated leprosy skin. Also, animals - armadillos and monkeys can be natural reservoirs of infection. Infection with mycobacterium leprosy occurs mainly by airborne droplets, less often - with damage skin or bites of blood-sucking insects. Cases of infection during tattooing are described.

Leprosy is considered a low contagious disease; usually infection is preceded by regular and prolonged contact with the patient. Healthy people have a high natural resistance to leprosy. To a greater extent, children are susceptible to leprosy infection, as well as persons suffering from chronic intercurrent diseases, alcoholism, drug addiction. Valid Duration incubation period not installed; according to various authors, it can range from 2-3 months to 20 or more years (average 3-7 years).

Classification

According to the generally accepted classification, there are 4 main clinical types of leprosy: lepromatous, tuberculoid, undifferentiated and borderline (dimorphic). Undifferentiated leprosy is considered an early manifestation of the disease, from which two polar clinical and immunological variants develop later - lepromatous or tuberculoid. The most malignant type, lepromatous leprosy, is characterized by the presence of large amounts of mycobacteria in the body and the negative nature of the lepromine test. With a relatively favorable, tuberculoid type of leprosy, on the contrary, there is a small amount of the pathogen and a positive lepromine reaction.

During each of the variants of leprosy, a stationary, progressive, regressive and residual stage is noted. The first two stages are characterized by leprosy reactions - exacerbation of foci of the disease, despite ongoing therapy.

Leprosy symptoms

Lepromatous leprosy

most unfavorable clinical variant leprosy, occurring with generalized lesions of the skin, mucous membranes, eyes, peripheral nerves, lymph nodes, internal organs. Skin syndrome is characterized by the presence of symmetrical erythematous spots on the face, hands, forearms, shins, buttocks. At first, they are red, round or oval in shape, with a smooth shiny surface, but over time they become brown-rusty in color. After months and even years, the skin in the area of these rashes thickens, and the elements themselves turn into infiltrates and tubercles (lepromas).

In the area of infiltrates, the skin has a bluish-brown color, increased greasiness, enlarged pores. Sweating in the areas of the affected skin first decreases, then completely stops. There is a loss of eyebrows, eyelashes, beards, mustaches. Diffuse infiltrative changes lead to a deepening of natural wrinkles and folds of the skin of the face, a thickening of the nose, superciliary and zygomatic arches, a violation of facial expressions, which is why the face of a patient with leprosy is disfigured and takes on a ferocious look ("lion's face"). Already in the early stages, lepromas are formed in infiltrative foci - painless tubercles ranging in size from 1-2 mm to 2-3 cm, located hypodermally or dermally.

On the smooth, glossy surface of leprosy, areas of skin peeling, telangiectasia can be determined. Left untreated, lepromas ulcerate; healing of ulcers takes a long time with the formation of a keloid scar. The skin of the armpits, elbows, popliteal, inguinal regions, scalp is not affected.

With lepromatous leprosy, the eyes are often involved in the pathological process with the development of conjunctivitis, episcleritis, keratitis, iridocyclitis. Typical interest of the mucous membrane of the oral cavity, larynx, tongue, red border of the lips and especially the nasal mucosa. In the latter case, nosebleeds, rhinitis occur; in the future - infiltration and leprosy. With the development of leprosy in the area of the cartilaginous septum of the nose, its perforation may occur and deformity of the nose may occur. The defeat of the larynx and trachea in the lepromatous type of leprosy leads to a violation of the voice up to aphonia, stenosis of the glottis. Visceral lesions are represented by chronic hepatitis, prostatitis, urethritis, orchitis and orchiepididymitis, nephritis. Involvement in a specific process of the peripheral nervous system proceeds according to the type of symmetrical polyneuritis. With leprosy, sensitivity disorders, trophic and motor disorders develop (paresis of facial muscles, contractures, trophic ulcers, mutilations, atrophy of sweat and sebaceous glands).

The course of lepromatous leprosy is characterized by periodic exacerbations (lepromatous reactions), during which there is an increase and ulceration of leprosy, the formation of new elements, fever, polylymphadenitis.

tuberculoid leprosy

The tuberculoid type of leprosy proceeds more benignly with damage to the skin and peripheral nerves. Dermatological signs are characterized by the appearance of hypochromic or erythematous spots with clear contours on the skin of the face, trunk, upper limbs. Along the periphery of the spots, flat, dense papules of a reddish-violet hue appear, resembling lichen planus. Merging with each other, papules form plaques of an annular configuration (curly tuberculoid), in the center of which an area of depigmentation and atrophy appears. In the affected areas of the skin, the functions of the sweat and sebaceous glands decrease, dryness and hyperkeratosis develop, and vellus hair falls out. Tuberculoid leprosy often affects the nails, which become dull gray, thickened, deformed, brittle.

Due to damage to the peripheral nerves, leprosy is accompanied by a violation of temperature, tactile and pain sensitivity. The most common lesions are facial, radial and peroneal nerves: they thicken, become painful and well palpable. Consequence pathological changes peripheral nerves are paresis and paralysis, muscle atrophy, trophic ulcers of the feet, contractures ("pincer hand", "seal foot"). In advanced cases, resorption of the phalanges and shortening (mutilation) of the hands and feet may occur. Internal organs in tuberculoid leprosy, as a rule, are not affected.

Undifferentiated and borderline leprosy

With an undifferentiated type of leprosy, typical dermatological manifestations are absent. At the same time, asymmetric areas of hypo- or hyperpigmentation appear on the skin of patients with this form of leprosy, accompanied by a decrease in skin sensitivity and anhidrosis. Damage to the nerves proceeds according to the type of polyneuritis with paralysis, deformity and trophic ulceration of the extremities.

Skin manifestations of borderline leprosy are represented by asymmetric pigmented spots, individual nodes or prominent plaques of stagnant red color. Usually rashes are localized on the lower extremities. Neurological manifestations include asymmetric neuritis. In the future, undifferentiated and borderline leprosy can be transformed into both lepromatous and tuberculoid forms.

Diagnostics

Leprosy is not such a forgotten disease, and the likelihood of encountering it in clinical practice have doctors of various specialties: infectious disease specialists, dermatologists, neurologists, etc. Therefore, one should be vigilant and exclude the leprosy process in patients with long-term non-regressing skin rashes(erythema, age spots, papules, infiltrates, tubercles, nodes), violation various kinds sensitivity in certain areas of the skin, thickening nerve trunks and others typical manifestations. A more accurate diagnosis allows bacterioscopic detection of mycobacteria leprosy in scrapings of the nasal mucosa and affected areas of the skin, histological preparations of leprous tubercles and lymph nodes.

The results of the reaction to lepromine allow us to differentiate the type of leprosy. Thus, the tuberculoid form of leprosy gives a sharply positive lepromine test; lepromatous form - negative. In undifferentiated leprosy, the reaction to the lepromatous antigen is weakly positive or negative; with borderline leprosy - negative. have less specificity functional tests with nicotinic acid, histamine, mustard plaster, Minor's test.

Leprosy should be differentiated from a number of diseases of the skin and peripheral nervous system. Among dermatological manifestations, rashes in the tertiary period of syphilis, exudative erythema multiforme, toxicoderma, tuberculosis and sarcoidosis of the skin, red lichen planus, leishmaniasis, erythema nodosum, etc. From the lesions of the nervous system, it is necessary to exclude syringomyelia, traumatic neuritis, Charcot-Marie-Tooth neural amyotrophy, etc.

Leprosy treatment

Leprosy is currently a curable disease. With common skin manifestations, positive results microscopy or relapse of leprosy, patients are hospitalized in special anti-leprosy institutions. In other cases, patients receive outpatient therapy at the place of residence.

Treatment of leprosy is carried out for a long time and in a complex, course method. At the same time, 2-3 antileprosy drugs are prescribed, the main of which are sulfonic drugs (diaminodiphenylsulfone, sulfametrol, etc.). In order to avoid the development of drug resistance, drugs and their combination are changed every 2 courses of treatment. The duration of a course of specific treatment for leprosy is several years. Antibiotics (rifampicin, ofloxacin), immunocorrectors, vitamins, adaptogens, hepatoprotectors, iron preparations are also used. In order to increase immunoreactivity in patients with leprosy, BCG vaccination is indicated.

To prevent disability from the very beginning of treatment, patients with leprosy are prescribed massage, exercise therapy, mechanotherapy, physiotherapy, wearing orthopedic aids. Important components of complex rehabilitation are psychotherapy, professional reorientation, employment, overcoming leprophobia in society.

Forecast and prevention

The prognosis of leprosy depends on clinical form pathology and the timing of the start of therapy. Early diagnosis and initiation of treatment (within a year from the onset of leprosy symptoms) can avoid disabling consequences. In the case of later detection of leprosy, sensory disturbances, paresis, and disfiguring deformities persist. If untreated, the death of patients can occur from leprosy cachexia, asphyxia, amyloidosis, intercurrent diseases.

The leprosy prevention system provides for mandatory registration and registration of patients, hospitalization of newly diagnosed patients, dispensary observation for family members and contacts. General preventive actions aimed at improving the conditions and quality of life, strengthening immunity. Persons who have been ill with leprosy are not allowed to work in the food and communal areas, children's and medical institutions; cannot change their country of residence.

Leprosy (syn. leprosy) is a systemic infectious process with a chronic course, which is provoked by leprosy microbacteria. In this case, the course of the disease is extremely severe - epidermal, visceral and neurological disorder. In some cases, the disease affects the musculoskeletal tissue and organs of vision. In the advanced stage, leprosy leads to deformity and necrosis of individual areas.

Diagnosis of leprosy is carried out by physical examination and the necessary laboratory and instrumental methods of examination. It should be noted that the disease is difficult to treat, which is why the course of therapy is long and carried out in stages.

The prognosis will depend on the stage at which the treatment of the disease was started, the general history and age of the patient. Provided that the treatment will be started at the initial stage of the development of the pathological process, it is possible to avoid the disability of a person. In all other cases, death occurs.

Etiology

The causative agent of leprosy is the microbacterium leprosy. These pathogens are characterized as follows:

gram-positive rod;
length 1-7 microns;
diameter 0.2-0.5 µm;
in properties and morphology it is very similar to tubercle bacillus;
mainly affects tissue microphages.

The source of the disease is an infected person, as well as monkeys. However, it is noted that infection of a healthy person, as a rule, is possible only with prolonged and constant contact with an infected object, since healthy man is highly resistant to leprosy.

The bacterium is transmitted mainly by airborne droplets. Rarely, but still, there are cases when leprosy infection was carried out through damage to the skin or the bite of a blood-sucking insect.

In addition, people who are at risk should be singled out separately:

who suffer from chronic intercurrent diseases;
children;
with a history of alcoholism and drug addiction.

The incubation period for leprosy has not been precisely established. Presumably from several months to several years.

Classification

There are several forms of development of this disease:

tuberculoid leprosy- a relatively benign course, since the internal organs are not affected. The pathological process mainly affects the skin and peripheral nerves;
lepromatous leprosy- differs in an extremely complex course, as it affects not only the skin, but also internal organs, mucous membranes of the eyes, peripheral nerves, The lymph nodes. May be fatal;
borderline leprosy- as a rule, there is no damage to internal organs, rashes are localized in the region of the lower extremities;
undifferentiated- typical dermatological symptoms are absent, nerve damage occurs in the form of polyneuritis with paralysis, trophic manifestation of the limbs is also observed.

It should be noted that the last two forms of the disease can be transformed into a lepromatous form, which in itself has extremely negative consequences.

Symptoms

The clinical picture will depend on the type of leprosy. The most complex clinical picture is lepromatous leprosy:

the skin acquires a bluish-brown hue, becomes excessively greasy;
in the affected areas of the skin, the process of sweating slows down, and later stops altogether;
there is a loss of eyebrows, eyelashes, mustaches and beards;
the natural wrinkles on the face become deeper, the nose and brow ridges thicken, which makes the facial expression ferocious;
mimicry is broken;
painful bumps form on the skin, which are located dermally or hypodermally;
nosebleeds and;
contracture;
atrophy of the sebaceous and sweat glands;

This form of leprosy often leads to death.

Tuberculoid leprosy is characterized as follows:

skin rashes by type;
on the affected areas of the skin, the production of sebum and sweat stops;
thinning of vellus hair and brittle nails;
change in pain and tactile sensitivity;
amyotrophy.

With the borderline form of leprosy, dermatological manifestations of the pathological process are localized mainly in the region of the lower extremities. Rashes can be in the form age spots or plaques of red color, which later transform into ulcers.

As for the undifferentiated form of the disease, in this case there are no dermatological signs, a symptom complex appears, which is characteristic of damage to the peripheral nervous system. The danger of this form of leprosy lies in the fact that it can be transformed into both lepromatous and tuberculoid forms.

Diagnostics

Due to the specific clinical picture the diagnosis of leprosy is not difficult, however, it is impossible to make an accurate diagnosis based on only a physical examination and history taking.

In this case, you may need to consult such specialists:

infectious disease specialist;
dermatologist;
neurologist;
ophthalmologist.

Due to the fact that the clinic of this disease is characterized by damage to all internal organs (in certain forms), several qualified medical specialists take part in the treatment at once.

The diagnostic program may include the following activities:

scraping of the nasal mucosa and affected areas of the skin for bacteriological and histological examination;
reaction to lepromine;
functional tests with histamine and nicotinic acid.

In addition, leprosy must be differentiated from such diseases:

tertiary period;
skin;
shingles.

Depending on the diagnosis, the doctor prescribes the correct treatment.

Treatment

With common dermatological symptoms, patients are subject to hospitalization in special medical institutions. In all other cases, the treatment of the disease is carried out on an outpatient basis at the place of residence of the patient.

The course of active treatment is several years. Medical therapy In this case, it means taking such drugs:

preparations of the sulfonic series;
antibiotics;
adaptogens;
hepatoprotectors;
iron preparations;
immunocorrectors;
vitamin and mineral complex;
BCG vaccination.

In order to prevent disability (especially in childhood leprosy), from the very beginning of the course of treatment, patients are prescribed massage and physiotherapy. In some cases, a course of psychotherapy and social adaptation may be necessary.

The prognosis will depend entirely on the stage and form of development of the disease, the timeliness of the start of therapeutic measures. However, in modern medicine exist effective methods treatment of such diseases.

Prevention

strengthening immunity;
improving the quality of life;
prevention of infectious and inflammatory diseases;
timely passage of preventive medical examinations;
exclusion of alcoholism and drug use.

In addition, it should be noted that persons who have had leprosy and their family members must be registered in medical institutions, undergo systematic medical examinations. Also, they are not allowed to work in the food and communal sector, in medical and children's institutions, they do not have the right to change their country of residence.

In general, it should be noted that preventing this disease is much easier than eliminating its consequences, since in some forms of the disease there is a high risk of disability and death.

The causative agent of the disease is the bacillus Hansen. Gateway for infection in human body are the mucous membrane of the upper respiratory tract and the skin.

The incubation period is long, from 3 to 5 years. there have been cases where several decades have passed from the moment of infection to the appearance of the first signs.

Leprosy symptoms

By clinical manifestations two forms of the disease can be distinguished: tuberculoid and lepromatous.

The lepromatous form is characterized mainly by skin lesions, while the tuberculoid form affects the nerves.

The disease develops gradually. First, the symptom of intoxication increases. The body temperature rises, joint pain and weakness appear. Some patients complain of drowsiness and sweating disorders.

The first symptom characteristic of leprosy is the appearance of dark or light spots on the skin. Their feature is the loss of sensitivity or its perversion. Also, spots are characterized by areas of compaction and infiltration, all this leads to the formation of large folds, especially on the face. That is why one of characteristic symptoms disease is the "lion's face".

Also characteristic is the loss of eyebrows, the retraction of the back of the nose, the drooping of the earlobes.

Leprosy affects the nasal mucosa. This leads to respiratory failure, nasal and destruction of the nasal septum.

There are inflammation of the eyes and larynx.

In men, due to infiltration and scarring of the testicles, infertility develops.

Complications of leprosy

Leprosy, or rather its skin elements, change the appearance of a person, often disfiguring beyond recognition.

As a result of nerve damage, muscle atrophy occurs, which leads to loss of phalanges, ulceration of the cornea, and contractures of the foot and hands.

Diagnosis of leprosy

For diagnosing leprosy great importance have epidemiological data, that is, information about the movements of a person over the past few years. Currently, there are several foci of leprosy in the world. These are Asia, Africa and South America.

To confirm the diagnosis, special studies are carried out, during which acid-resistant mycobacteria are found in the material from the lesions of the skin.