Leper people. Leprosy - what it is, symptoms, how leprosy is transmitted, treatment and diagnosis. Damage to the lymphatic system

Leprosy (leprosy, Hansen's disease) - every person has heard about her at least once in his life. But what is this disease? The etiology of this ailment is due to the penetration of the microorganism Mycobacterium leprae into the human body. This chronic infection is characterized by damage to the surface tissues and peripheral nerves. The disease manifests itself in two main forms and two intermediate ones:

1. Tuberculoid
2. Lepromatous
3. Borderline lepromatous or borderline tuberculoid.

Note! In some cases, an early indeterminate form is revealed. It can either develop into a full-fledged disease or end in spontaneous remission.

How does it develop

Leprosy is equally contagious for people of all ages, although cases of registration of this ailment in children under one year of age are extremely rare. The peak incidence in children occurs at school age up to ten years (about 20% of all cases). In children, the disease affects boys and girls with the same frequency, but among adults, the disease occurs in men twice as often as in women.

Most cases of leprosy are caused by direct contact and transmission of the infection. In the animal kingdom, the carriers of infection are armadillos, as well as, in all likelihood, lower primates, but they do not play a special role in the spread of the disease in the human population.

Since a person can become a source of infection long before the appearance of its first signs, the risk of transmission increases by 8-10 times among members of the same family.

The exact localization of the introduction of the pathogen has not been definitively established, however, most likely, the infection occurs through the mucous membranes of the upper respiratory tract and through the skin. The main exit gate of infection is considered to be the mucous membrane of the nasal passages of untreated patients suffering from lepromatous form of leprosy.

Transmission of the pathogen through breast milk from a sick mother or through bites of blood-sucking arthropods is also possible, but in epidemiological terms, the significance of these factors is quite small.

The incubation period of this ailment is quite long - it ranges from 3 to 5 years with a typical course of infection, and ranges from 6 months to tens of years in other cases of infection.

Signs of the disease

The first signs of the disease are most often found on the skin in the form of one or more hypo- or hyperpigmented areas (spots and / or plaques). In such areas, there is a loss of sensitivity or paresthesia.
If you examine people who have been in contact with the patient, especially children, then they often have a single lesion on the skin, most often eliminating spontaneously within 2-3 years. However, such patients are also indicated for treatment.

Tuberculoid leprosy

• The early period of the tuberculoid type of leprosy most often occurs with a single symptom - clearly demarcated areas of hypopigmented skin with reduced sensitivity.
• Then these foci increase, their edges rise above the surface of the skin and round off, sometimes acquiring the shape of rings. There is a tendency for them to spread from the center to the periphery, while healing processes are observed in the center.
• Fully formed foci completely lose sensitivity, sweat glands and hair follicles are affected. The foci are few in number and asymmetrical.
• Nerve tissue also early becomes involved in the pathological process, the superficial nerves located in the area of \u200b\u200bthe focus, increase in size so much that they become visible. Changes in the peroneal, ulnar and greater ear nerves are especially noticeable.
• Pain along the nerves gradually increases and becomes unbearable.
• As a result of nerve damage, atrophy of the muscular apparatus develops, the muscles of the hands and feet are most affected by changes, on which characteristic contractures of especially small muscles of the hand are formed. Contractures of the hand and foot are common. Additional trauma leads to secondary infection of the hands and feet and to the formation of plantar ulcers. Later, resorption and loss of phalanges may form (as in the photo below)

• If the nerves of the face are involved in the process, this is accompanied by the formation of lagophthalmos and ulcerative keratitis, which ultimately leads to loss of vision (see photo):

Lepromatous leprosy

• Lesions appear on the skin as nodules, spots, plaques, and papules. Pigmentation at the site of these formations is weakened, they have indistinct boundaries. Their central part, in contrast to the formations in the tuberculoid form of the disease, is convex and compacted. Diffuse-infiltrative changes are observed on the skin areas located between such foci. Most often, the lesions are localized on the face, in the elbow joints, on the wrists, knees and buttocks, but they can also occur on other parts of the body.
• As the disease progresses, all new parts of the body are involved in the pathological process, their infiltration gradually develops, in some cases nodules form.
• The patient's hair falls out in the eyebrow area, especially from the lateral sides.
• Gradually, the skin of the face coarsens and thickens, forming the so-called "lion face", earlobes sag.
• Common early signs also include:

1. nasal congestion;
2. bleeding from the nose;
3. difficulty breathing;
4. hoarseness of the voice, inflammation of the larynx;
5. obstruction of the nasal passages;
6. "Saddle nose";
7. iridocyclitis, keratitis;
8. gynecomastia, infiltrative changes in the tissues of the testicles, followed by replacement with scar tissue, sterility;
9. enlargement of lymph nodes in the groin and armpits, painless on palpation.

• There is insufficient data on the involvement of large nerve trunks in the pathological process in this form of the course of the disease, however, with the progression of the disease, diffuse hypesthesia in the region of the peripheral extremities is widespread.

Borderline leprosy

• Pathological foci in the borderline tuberculoid form of leprosy on the skin are more reminiscent of the foci that form in the tuberculoid form of the disease.

1. In this case, there are more of them, and their boundaries are not clear.
2. This form of the course of leprosy, in contrast to tuberculoid itself, is characterized by multiple involvement of peripheral nerve trunks in the pathological process.
3. In addition, the variability of various skin lesions increases, it is this property that gave rise to the second name of this form - "dimorphic" leprosy. The characteristic papules and plaques coexist on the skin with lesions in the form of spots.
4. Loss of sensitivity occurs, but it is less pronounced than with a purely tuberculoid course of the process.

• The borderline lepromatous form manifests itself in patients with heterogeneous skin lesions, mostly symmetrical. The earlobes may have thickening, but the eyebrows and the shape of the nose, if they change, are not significant.

Treatment

There are modern and fairly effective drugs that can effectively treat patients suffering from this disease.

Advice! When you start treating leprosy, in order to exclude the formation of complications from the respiratory, musculoskeletal and nervous systems, as well as the organs of vision, it is recommended to undergo additional consultations of the following specialists:

1. neurologist;
2. otolaryngologist;
3. orthopedist;
4. ophthalmologist;
5. physiotherapist.

• The mainstay of treatment for this ailment is 4,4-diaminodiphenyl sulfone (DDS, Dapsone), a folate antagonist

Its dose varies from 50 to 100 mg in adults. This drug is cheap, indicated even for pregnant women, convenient (used once a day).

Note! Despite the fact that within a few days of use, the drug kills almost all mycobacteria, non-viable microorganisms can be detected in samples taken from a patient within five to ten years. In addition, even a few surviving bacteria are able to wait many years in order to cause a relapse of the disease.

• Rifampicin is a fast-acting antibacterial drug that destroys the causative agent of leprosy to the level of undetectability within a five-day period after ingestion of a single dose of 1500 mg.

However, the economical prescription of the drug in the amount of 600-900 mg once a month is not supported by a sufficient number of studies and is still unjustified. Therefore, until more reliable data are obtained, it is recommended to prescribe rifampicin daily or twice a week, according to the old proven scheme.
The resistance of leprosy strains to this drug is practically not found.

• Clofazimine (Clofazimine) - a drug, the active ingredient of which is a derivative of phenazine dye.

The dosage is 50 to 200 mg / day. Has a toxic effect on the skin and gastrointestinal mucosa. At the moment, the study of the use of this drug for leprosy is still ongoing, although it is already being used in practice.

When it is known for a specific case that mycobacterium leprosy of this strain is sensitive to the drug "Dapsone", then the treatment is limited to a combination of two drugs - dapsone and rifampicin. However, with the existing probability of resistance to dapsone of the pathogen (secondary resistance), the appointment of a third drug will be justified. The same will be true with the lepromatous form of the course of leprosy.

In the course of treatment, biopsies and scrapings from the skin are taken from the patient for examination - until the result is persistently negative. Treatment usually takes at least two years. If the patient suffers from a lepromatous form, then the duration of treatment is not limited to any time frame, it can remain lifelong.
For example, in the USA, if a patient has a disease with a small bacterial load and no lepromatous form, a twelve-month course of "dapsone + rifampicin" is prescribed, and then the next twelve-month course of one dapsone.

In the second or third month of drug therapy, objective visual signs of improvement in the patient's condition should be noticeable. Neurological manifestations should also be of lesser concern to the convalescent.

Reactive states of patients with leprosy

• Mild erythema nodosum responds well to antipyretic and analgesic therapy.

• Erythema, which is severe, is treated with increased doses of drugs:

1. Prednisone (prescribed at a dosage of 60-120 mg / day). Antibiotic therapy during the period of its use continues, since drugs of the corticosteroid group increase the survival rate of the causative agent of leprosy in the human body if anti-leprosy drugs are not used.
2. Rifampicin increases the metabolism of prednisone in the liver, making it justifiable to increase its dosage to achieve a positive effect of therapy.
3. Thalidomide is the most effective drug for the treatment of leprosy-associated erythema nodosum. It is prescribed in an initial dose of 200 mg 2 times / day. In patients suffering from chronic forms of the disease, the dosage is gradually reduced to the level of the maintenance dose, namely 50-100 mg / day.

Note! Thalidomide is absolutely contraindicated in women of childbearing age due to its teratogenicity, however, in the rest of the contingent of leprosy patients, it does not cause pronounced adverse reactions.

Clofazimine is an antimicrobial and anti-inflammatory drug that has found application, including in the treatment of chronic leprosy-associated erythema nodosum. However, only in order for the body to reach its sufficient level, you need to take it for three to four weeks, therefore, in acute forms of the process requiring urgent treatment, its use is not always justified.

Other types of drugs from the class of anti-inflammatory drugs are used for severe cases. Among them are antimalarial chloroquine and a number of cytostatic agents.

• With relapses, often acute, irreversible damage to the nervous tissue is not uncommon. In such cases, it is customary to appoint:

1. corticosteroids;
2. clofazimine. Its use is indicated for a number of chronic forms of the disease. During the period of its use, it is necessary to prolong corticosteroid therapy.

Note! Reactions from a number of relapses do not respond to thalidomide therapy.

• Other measures. Most of the defects that cause disability in patients can be avoided:

1. widespread foot ulcers can be prevented by using shoes with compacted soles or special temporary prostheses;
2. carpal contractures are prevented when physiotherapy is used in treatment or by applying a plaster cast. In some cases, surgery is performed to reconstruct destroyed tissue sites, including nerve transplantation.
3. Tissue grafting is performed to restore deformities in the facial area, which helps to restore the patient's position in society.
4. Severe psychological trauma associated with the isolation of the patient for a long time and with a change in his appearance is now minimized through the introduction of home treatment practices and the help of psychologists.

Prevention

Leprosy control. The modern basis for leprosy control is the timely detection of cases and preventive therapy form the basis of the fight against leprosy. The most important is the early detection of leprosy in patients. In countries where leprosy is endemic, annual population surveys should be carried out. If a case is identified, it is necessary to examine each member of his family and persons in contact with the patient with a lepromin test. The risk of transmission of infection, even in untreated patients, is relatively low; during their initial admission to the hospital, no special measures should be taken to prevent the spread of an infectious agent. Low-dose chemoprophylaxis with dapsone has been clinically proven and effective; however, in most cases, an annual survey of contact persons is sufficient.

Important! Vaccination with an antileprosy vaccine is currently being tested and is already recognized as quite promising.

If there are babies in the family of a sick mother, then they need to be isolated from the patient and transferred to artificial feeding.

The rest of the children without signs of illness continue to attend school, however, they are examined twice a year.

When the pathogen is detected in the body in the laboratory, they are assigned appropriate therapy, and they are temporarily transferred to home schooling or hospitalized due to their condition.

Note! In the area in which frequent outbreaks of the disease are recorded, mandatory immunization of residents with the BCG vaccine is carried out. In the future, it is planned to replace it with an antileprosy vaccine.

Patients with a history of leprosy are not allowed to move to other countries and cannot hold positions in the food industry and childcare. Relatives of a patient with laboratory-confirmed active leprosy undergo a preventive course of special therapy. In order not to get infected with leprosy, you need to follow strict hygiene rules - immediately treat microtraumas with disinfectants and wash your hands thoroughly with soap and water. If you have suspicious skin lesions, be sure to consult a dermatologist at the local dispensary.
If you have any suspicion of contact with a person infected with leprosy, you should contact an infectious disease doctor or directly to a leprologist.

Probably no one needs to explain who a leper or a leper is. These are people with leprosy, a severe infectious chronic disease that affects the skin, nervous system, eyes and some internal organs. This word came to the Russian language from the late Latin language, where it sounds like leprosus, which is consonant with the Latin leprosorium.

In medical terms, a leper or a leper is a patient who has been diagnosed with chronic granulomatosis caused by the microbacteria Mycobacterium lepromatosis and Mycobacterium leprae.

History of leprosy

The named disease has been known since ancient times and is mentioned in the Bible. Hippocrates wrote about leprosy, but he probably confused it with psoriasis. In ancient India, they also knew about leprosy. And in there were many leper colony, as the disease passed into the stage of an epidemic. So, in the XIII century, according to Matthew Paris, an English historian, Benedictine, chronicler, in Europe the number of lepers was 19 thousand people. The first well-known leper colony of St. Nicholas in Harbledown, England.

In the Middle Ages, a leper or a leper was a society doomed to die in terrible torment. Such a person was placed in a leper colony, as if in order to be cured. But in fact, it was a quarantine, from which rarely anyone managed to get out alive. The fact is that leprosy is transmitted through secretions from the mouth and nose during frequent and close contact with people. And in the leper colony, contacts are more than close and frequent.

Leprosy in the modern world

In the 90s of the last century, the number of lepers in the world decreased from 10-12 million people to 1.8 million. Leprosy mainly spreads in tropical countries, where nature has created suitable conditions for the life of microbacteria. Although the incidence has decreased, the disease is still quite widespread in India, Nepal, parts of Brazil, Tanzania, Mozambique, Madagascar and the western Pacific Ocean. The World Health Organization published a list of countries with foci of the disease in 2000. Burma ranks third in terms of the number of infected, Brazil is second, and India is first.

It is important to know that the incubation period for leprosy is very long, on average 4-6 years, and sometimes it takes 10-15 years. The duration of drug therapy, depending on the degree and severity of the disease, can last from 3 to 10 years.

Book "Lepers"

People suffering from the named disease also became heroes of literary works. So, in 1959 the novel by Georgy Shilin "The Lepers" was reissued. The book describes the life of a leper colony. It should be said that the author himself repeatedly visited this institution, visiting a sick friend there, and even lived there.

"Lepers" is a story about the fate of various people who ended up in one place - in a leper colony. Each story touches and shakes to the core. There are a lot of heroes, but the character of each is unique - it is difficult to get confused in them. Thus, the chief physician of the leper colony, Doctor Turkeev, belongs to a rare type of people who are not interested in either fame or money, and who devote all of themselves to serving their chosen cause. Free of charge (unfortunately, a now forgotten word). Shilin's style is beautiful, emotional, bright, expressive.

In 1976 the film "The Leper" was shot in Poland. This is a love story of a simple girl and a noble nobleman who will not leave anyone indifferent.

Finally, we note that lepers, photos of which can be found in sufficient numbers on the Internet, are affected by this disease to varying degrees, and sometimes it is not clear from a person that he is sick. Therefore, avoid close contact with suspicious people, especially if you are on vacation in tropical countries. Be healthy!

How do you imagine a person suffering from such an ailment as leprosy? What kind of disease is this? It is also called leprosy. Few know about her now. Most likely, this is because the disease is not very common in our time. However, everyone should have an idea of \u200b\u200bit, remember that it will help us to protect ourselves from it.

A bit of history

Since ancient times, mankind has known leprosy. "What kind of disease is this?" - ancient healers wondered. Hippocrates wrote about this disease. However, he confused it with psoriasis. In medieval times, leprosy became the "plague of the century." Leper colony began to appear everywhere, where they tried to treat the affected people. As a rule, these ancient medical institutions were located near monasteries. Patients with this terrible disease were encouraged to live in them. This gave a good prophylactic effect and made it possible to contain the rapid spread of leprosy. In medieval France, there was even such a custom, when a patient with leprosy was taken to a church, where he was placed in a coffin and covered with a lid. After that, his relatives went to the cemetery, lowered the coffin into the grave and threw several lumps of earth from above, as if saying goodbye to the "deceased". Then the patient was taken out and taken to a leper colony, where he had to live the rest of his life. People didn't know how to treat this disease. And only in 1873 in Norway G. Hansen discovered the causative agent of leprosy - Mycobacterium leprae. The treatment situation changed immediately.

How can you get infected

Today, outbreaks of leprosy are observed mainly in tropical hot countries. The good news is that the number of patients continues to fall every year. However, in our time there are people who do not know what leprosy is. The disease, the photo of which can be seen here, is very much, as a rule, during close contact of people with each other, as well as through discharge from the mouth and nose.

Disease manifestations

Despite the fact that in our country the number of people suffering from the ailment we are considering is small, there is still a risk of catching it. Leprosy is very insidious. What kind of disease? How do you recognize it? Many of us are interested in these questions. An infected person may initially experience weakness, lethargy, and drowsiness. He then notes that his arms and legs have bumps on the skin. This is the initial stage of leprosy. Then deep damage to the skin and soft tissues occurs, ulcers are formed.

How to protect yourself

Speaking about such an ailment as leprosy, a photo of the patients of which is presented here, it is worth mentioning that it has a rather long incubation period - 15-20 years. This means that its causative agent can be in your body for many years, and you may not even be aware of it. In order to activate it, certain conditions must be met, for example, such as severe hypothermia, poor nutrition, lack of personal hygiene, and secondary infection. Therefore, it is important to strengthen your immunity from childhood and take care of the cleanliness around you. Treatment of the disease is long-term and requires the recommendations of many specialists. As a rule, antimicrobial drugs are used for this. Haulmugr oil is a remedy used by ancient healers for centuries.

In this article, we have told you about such an ailment as leprosy. What kind of disease is leprosy? How to protect yourself from her? You now know the answer to all these questions.

Leprosy or leprosy is one of the oldest diseases in human history. Leprosy is mentioned in the oldest medical manuscripts of Ancient Egypt (the Ebers papyrus), the biblical Old Testament, as well as the ancient Indian Vedas of the 15-10th century BC.

Previously, leprosy was considered an absolutely incurable disease, patients with leprosy were expelled from society and were doomed to a slow and painful death. Since leprosy is a contagious disease, patients had to wear special bells, sounding a warning to others about their approach, so that they have time to scatter. At that time, people did not know that the causative agent of leprosy is not transmitted by touch.

The superstitious fear that leprosy patients caused in those around them became the reason that such people were considered "unclean", cursed and "marked by the Devil" for their sins.

The sick were deprived of all social rights: they could not visit crowded places and churches, drink water from the river or wash in it, touch the things of healthy people and even just be with them. Despite the negative attitude of the church towards divorce, the presence of leprosy in one of the spouses was considered an absolutely legal and official reason for the immediate dissolution of the marriage.

During his lifetime, a leprosy patient was buried in a church, symbolically buried and driven out of the city, having handed him a heavy robe with a hood and bells ringing when walking.

By the end of the fourteenth century, leprosy was widespread throughout all European countries. In this regard, society began to think about more effective methods of isolating patients. Mentions of leper colony, where patients with leprosy could count on minimal medical care, food and a roof over their heads, date back to the sixteenth century AD (the first attempts to open leper colony were noted in the 11 century). Such institutions were located on the territory of monasteries, where monks tended the lepers.

Thanks to the creation of leper colony, by the end of the sixteenth century, leprosy had practically receded. At the moment, leprosy is found in Africa, Asia, South America. In Russia, leprosy occurs once every 1-2 years. For patients with leprosy, three leper colony works (there were sixteen leper colony in the Soviet Union) in Stavropol, Krasnodar and Astrakhan.

The causative agent of leprosy was discovered and investigated in 1873 by the Norwegian physician Gerhard Hansen. He found leprosy in the tissues of patients with Mycobacterium and established their similarity with Mycobacterium tuberculosis.

In 1948, Raoul Follero, a French public figure, writer, poet and journalist, founded the Order of Mercy for Leprosy Patients. In 1953, he also established World Leprosy Patient Day, and in 1966 he founded the European Federation of Anti-Leprosy Associations.

Leprosy disease (leprosy) is a chronic infectious disease, accompanied by damage to the skin, peripheral nervous system, eyes and mucous membranes of the upper respiratory tract.

The causative agent of leprosy is mycobacterium leprae (Mycobacterium leprae). ICD code 10 - A30.

Is leprosy now treated?

At the moment, patients are provided with specialized medical care. In cases where treatment is started at an early stage, the disease does not lead to disability. Many patients with leprosy living in the territory of leper colony are not contagious and can freely be in society, but they prefer to stay on the territory of the leper colony, fearing to face leprosy among others.

With adequate treatment, the disease is not fatal.

Causes of leprosy disease

Lepra (the disease is also called Hansen's disease, lazy or mournful illness), refers to a weakly contagious disease. Less than thirty percent of people are susceptible to leprosy.

The disease often occurs in relatives (familial cases of the disease), which suggests a hereditary predisposition to the disease.

The famous physician Danielsen, in the middle of the nineteenth century, studied the mechanism of transmission of leprosy and the pattern, as well as the stages of its development. To this end, he injected himself with the blood of patients infected with leprosy, but he did not succeed in getting sick himself.

How is leprosy (leprosy) spread?

The pathogen is transmitted by airborne droplets. The entrance gate for infection is the mucous membrane of the upper respiratory tract (upper respiratory tract). There have been isolated cases of infection during tattooing and after surgical interventions.

Also, infection is possible with longskin contacts.

The possibility of transmission of mycobacterium leprosy through soil or water is being considered. In addition to humans, a nine-belt armadillo, monkey or buffalo can serve as a source of infection.

The incubation period for leprosy can last from six months to several decades. The literature describes a case when the incubation period of leprosy lasted almost forty years.

Basically, the incubation period for leprosy is three to nine years.

Is leprosy contagious?

Lepra is contagious, however, it belongs to low-contagious infections. Even out of thirty percent of patients with a predisposition to leprosy, only ten percent fall ill.

In men, the disease is registered three times more often than in women. There is also a hereditary predisposition to the disease. Children get leprosy more easily and faster than adults.

Most people have a high level of immune defense against leprosy.

The indicator of immune defense and resistance also plays an important role in the development of the form of the disease in infected patients.

In the development of leprosy and a decrease in the incubation period, the role of hormonal levels is also noted. The first symptoms or exacerbation of old symptoms may be associated with the onset of puberty, pregnancy or childbirth.

It should be noted that with leprosy, cellular immunity is developed. Its severity is minimal after the transferred lepromatous or diformal type and maximum after tuberculoid leprosy (the tuberculoid form is forty times less infectious than the lepromatous form).

The development of tuberculoid leprosy is characteristic with a small infection of the patient. With massive invasion of the pathogen, an almost complete suppression of the immune response occurs and lepromatous leprosy develops.

Classification of leprosy

According to the classification of the World Health Organization, the course of leprosy can be:

• undifferentiated;
• lepromatous;
• subpolar lepromatous;
• borderline lepromatous;
• borderline;
• borderline tuberculoid;
• tuberculoid;
• unspecified.

Infection can also be:

• multibacterial;
• low bacterial.

Leprosy symptoms

After the end of the long incubation period, patients may experience a long latency period of the disease. Symptoms of leprosy disease in the prodromal period can be manifested by malaise, neuralgic pain, soreness in muscles and joints, muscle weakness, disorders of the gastrointestinal tract, and periodic fever. Violation of skin sensitivity in the initial stage can manifest itself as a decrease or increase in sensitivity.

In the future, the specific symptomatology of leprosy joins. The most often isolated lepromatous, undifferentiated and tuberculoid variant of the course of leprosy.

With a tuberculoid variant of the course of leprosy, lesions of the skin and the peripheral nervous system are observed.

Photo of leprosy disease:

Tuberculoid leprosy

Skin damage is manifested by the appearance of vitilig-like spots (spots have clear, sharply defined borders and do not have pigmentation) or, bright red-violet spots, with a pale area in the center.

These formations are located asymmetrically. The skin in these areas completely loses its sensitivity. In children, the tuberculoid form of leprosy can proceed according to the juvenile type, with the formation of several subtle spots, which later disappear.

The progression of the tuberculoid form of leprosy is accompanied by the appearance on the periphery of spots of flat and dense purple papules. At the confluence of the papules, large or medium-sized plaques with a bright purple tint are formed. Some patients have a ring-shaped plaque configuration.

In the center of the plaques, the development of depigmented, atrophic foci is possible. Around them, foci of depigmentation and severe peeling can form.

A distinctive feature of this form of leprosy is that the first to disappear is temperature and pain sensitivity. Tactile sensitivity in patients can persist for a long time.

Also, in patients with this form of leprosy, damage to the peripheral nervous system is noted, with the formation of compacted cords along the nerve fibers. It should be noted that damage to the nervous system in the tuberculoid type proceeds much easier than in the development of lepromatous neuritis or polyneuritis.

In the future, these symptoms are joined by the complete absence of sweating, impaired thermoregulation, dullness and hair loss (including eyelashes and eyebrows).

The undifferentiated type is intermediate between the tuberculoid and lepromatous course of leprosy. This variant occurs in patients with undetermined immune reactivity. Therefore, after a while, the undifferentiated type is transformed into another variant of the disease.

The lepromatous variant of leprosy is the most difficult.

Photos of patients with leprosy:

This variant of leprosy is accompanied by specific lesions of the skin, which result in the formation of leprosy nodes, in which the causative agent of leprosy multiplies intensively. Lepromas lead to deformation of the supraorbital arches and the patient's nose (with destruction of the cartilaginous septum), contributing to the formation of a "lion" or "fierce" face.

Leproms have a violet-cherry hue and fuzzy borders. In addition to the face, these nodes affect the skin of the limbs. In the initial stages, the tubercles have a greasy, greasy sheen. In the future, their surface may ulcerate, it is also possible to attach a hemorrhagic component, due to which they acquire a reddish-rusty hue. The appearance of sharply deepened wrinkles on the face is noted (due to severe infiltration of the skin).

Sensory impairment occurs later than in the tuberculoid type. The lepromatous type of leprosy is accompanied by destruction and severe deformities of small joints and falling off of the fingers.

This type of leprosy is also accompanied by severe damage to the eyes (up to complete blindness), vocal cords, lymph nodes, damage to peripheral nerves and the development of motor disorders.

The progression of lepromatous leprosy is accompanied by separation and destruction of bones, muscle atony and atrophy, cessation of the work of sweat and sebaceous glands, and severe disorders of the endocrine system.

Kidneys, spleen, liver, etc. are affected. In men, sclerosis of the prostate gland, severe epididymitis, orchioepididymitis may be noted.

Diagnosis of leprosy

The diagnosis can be suspected on the basis of specific skin lesions and sensitivity disorders. Also, contact with someone with leprosy plays an important role.

If leprosy is suspected, a bacterioscopic examination of the material (scraping) from the nasal septum, skin and biopsy specimens of the nodes must be performed.

An important role is played by the performance of specific functional tests (histamine, lepromine, morphine, nicotinic acid tests).

Differential diagnosis is carried out with syphilis and.

Leprosy treatment

At the moment, leprosy is classified as a curable disease. With timely treatment for medical help and early initiation of therapy, the disease does not lead to disability.

The main remedies for leprosy are:

• Rifampicin ®;
• Dapsone®;
• Lampren®.

For multibacterial forms, a special regimen is prescribed, which includes all three drugs. With low-bacterial leprosy, two drugs are prescribed. Treatment takes from six months (minimum) to several years.

Reserve drugs are considered minocycline ® and ofloxacin ®.

Additionally, the use of glucocorticosteroid drugs, vitamins, drugs that improve nerve conduction and prevent the formation of atrophies, desensitizing agents is shown.

Leprosy or leprosy (outdated name), hansenosis, hanseniasis, is an infectious disease that is caused by the mycobacteria Mycobacterium lepromatosis and Mycobacterium leprae and proceeds with predominant lesions of the skin, peripheral nerves and, sometimes, the upper respiratory tract, anterior chamber of the eye, testicles, feet and brushes.

Currently, leprosy has become a curable disease, since antibiotics can destroy its pathogen. In this article, we will introduce you to the causes, symptoms and current treatments for this disease.

There are references to this disease in the Bible, the manuscripts of Hippocrates and the doctors of Ancient India, Egypt and China. Leprue was called a mournful illness, because in those days it inevitably led to death. In the Middle Ages, quarantine places - leper colony - were opened for such doomed patients. There they said goodbye to life. The relatives of the patient were also avoided by those around him, since they were afraid of contracting leprosy.

According to the decree of the king in France, patients with leprosy were subjected to a "religious tribunal." They were taken to the church, where everything was prepared for burial. After that, the patient was laid in a coffin, funeral service and carried to the cemetery. After dropping into the grave, uttering the words: “You are not alive, you are dead for all of us,” and dropping several shovels of earth on the coffin, the “dead man” was again taken out of the coffin and sent to the leper colony. After such a ceremony, he never returned to his home and did not see any of the family members. Officially, he was considered deceased.

Now the prevalence of leprosy has decreased significantly, but the disease is still considered endemic (that is, it occurs in a certain area and renews itself after some time, and not due to a drift from the outside). It is usually found among residents and tourists of tropical countries - Brazil, Nepal, India, the states of the Western Pacific and East Africa. In Russia, a case was identified in 2015 in a Tajik worker who was employed at the construction site of a medical center.

Causes

Leprosy is caused by Mycobacterium lepromatosis and Mycobacterium leprae. After infection, which occurs from a sick person to a healthy person through discharge from the nose and mouth or through frequent contact, it takes a long time before the first signs of the disease appear. The incubation period for leprosy can range from six months to several decades (usually 3-5 years).

After that, the patient begins at least a long prodromal (latent) period, which manifests itself in nonspecific symptoms that cannot contribute to early detection of the disease. This fact, like the long incubation period, predisposes to its spread.

Symptoms and types of disease

When infected with leprosy, there is usually an infection of areas of the body that are open for air cooling - the skin, mucous membranes of the upper respiratory tract and superficial nerves. In the absence of timely and correct treatment, the disease causes severe skin infiltration and nerve destruction. In the future, these changes can cause complete deformation of the face, limbs and deformities.

Changes such as the death of fingers on the extremities are not provoked by mycobacterium pathogens, but by secondary bacterial infections that join with injuries caused by loss of sensitivity in the hands and feet affected by leprosy. Such damage goes unnoticed, the patient does not seek medical help, and the infection leads to necrosis.

Leprae can take the following forms:

• tuberculoid;
• lepromatous;
• dimorphic (or borderline);
• mixed (or undifferentiated).

All forms of leprosy have their own characteristic features, but experts also identify a number of common signs of this infectious disease:

• (up to subfebrile);
• weakness;
• skin manifestations (light or dark spots with impaired sensitivity);
• the appearance of areas of skin infiltration;
• joint pain (especially during movement);
• sagging earlobes and the appearance of a crease between the eyebrows;
• loss of the outer third of the eyebrows;
• damage to the mucous membranes of the nose.

Tuberculoid leprosy

This form of leprosy appears as a hypopigmented patch with clear contours. With any physical impact on him, the patient feels hyperesthesia, that is, an increased sensation of the stimulus.

Over time, the spot increases in size, its edges become raised (in the form of ridges), and the center is sunken, subject to atrophic changes. Its color can range from bluish to stagnant red. A ring-shaped or spiral pattern appears along the edge.

Within such a spot there are no sweat and sebaceous glands, hair follicles, and all sensations disappear. Thickened nerves are felt near the focus. Their changes associated with the disease cause muscle atrophy, which is especially pronounced when the hands are affected. Often, the disease leads to contractures not only of the hands, but also of the feet.

Any trauma and compression in the lesions (for example, wearing shoes, socks, clothing) lead to secondary infection and the appearance of neurotrophic ulcers. In some cases, this causes rejection (mutation) of the phalanges of the fingers.

When the facial nerve is damaged, leprosy is accompanied by eye damage. The patient may develop logophthalmos (the impossibility of completely closing the eyelid). This consequence of the disease leads to the development of keratitis and ulcers on the cornea, which in the future can provoke the onset of blindness.

Lepromatous leprosy

This form of leprosy is more contagious than tuberculoid. It is expressed in the form of extensive and symmetrical skin lesions relative to the median axis of the body. The lesions appear in the form of plaques, spots, papules, leprosy (nodes). Their boundaries are blurred, and the center is convex and dense. The skin between the lesions thickens.

Among the first symptoms of the disease, nosebleeds and shortness of breath are often observed. Subsequently, obstruction of the nasal passages, hoarseness and laryngitis may develop. And with perforation of the nasal septum, the back of the nose ("saddle nose") is pressed in. When infected with the causative agent of the anterior chamber of the eye, the patient develops iridocyclitis and keratitis.

Most often, such skin changes are observed on the face, ears, elbows, wrists, knees and buttocks. In this case, the patient feels weakness and numbness, which is caused by damage to the nerves. In addition to these characteristic symptoms, with lepromatous leprosy, loss of the outer third of the eyebrows occurs. With the progression of the disease, the patient has a proliferation of earlobes and a "lion's face" caused by thickening of the skin and is expressed in the distortion of facial expressions and facial features.

The disease is accompanied by painless enlargement of the axillary and inguinal lymph nodes. In the later stages of lepromatous leprosy, there is a decrease in sensitivity in the legs.

In men, this form of leprosy can lead to development (inflammation of the mammary glands). In addition, the hardening and hardening of the testicular tissue causes the development of infertility.

Dimorphic (or borderline) form

This form of leprosy can combine in its clinical picture the signs of tuberculoid and lepromatous leprosy.

Mixed (or undifferentiated) form

This form of leprosy is accompanied by severe nerve damage, more often the ulnar, peroneal and ear nerves suffer from this process. As a result, a loss of pain and tactile sensitivity develops. Violation of the trophism of the extremities leads to a gradual disability and disability of the patient. If the nerves that are responsible for the innervation of the face are damaged, the patient's diction is impaired and atrophy and paralysis of the facial muscles occurs.

In children, this form of leprosy can occur as. In such cases, red spots with ragged edges appear on the body. They do not rise above the surface of the skin and are accompanied by weakness and fever up to subfebrile.

Diagnostics

A doctor may use several techniques to diagnose leprosy. At the same time, an obligatory part of the patient's survey is to establish places of stay and contacts over the past few years.

The plan for examining a patient with suspected leprosy includes:

• inspection and questioning;
• scraping the mucous membrane of the mouth or nose;
• minor's test to detect a decrease in sweating in the lesions;
• determination of skin sensitivity;
• nicotine test to detect the reaction of the skin to nicotine;
• lepromine test (the introduction of a special drug into the skin of the forearm to identify the form of leprosy).

The most accessible and fastest specific method for diagnosing leprosy is the lepromin test. For its implementation, the patient is injected intradermally in the forearm with Lepromin, a drug based on an autoclaved homogenate of skin lesions of patients with lepromatous leprosy. After 48 hours, a papule or spot appears on the skin, and after 14-28 days - a tubercle (sometimes with an area of \u200b\u200bnecrosis). The appearance of these signs is a positive result and indicates a tuberculoid form of leprosy, and with a negative result, a lepromatous form or the absence of the disease.

Treatment

Treatment of patients with leprosy is always carried out in a specialized infectious hospital, and after discharge, they must regularly undergo dispensary examinations. Its effectiveness largely depends on the timely initiation of therapy at the earliest stages of the disease, that is, at the time of determining the fact of a possible infection. However, in practice, patients are more likely to seek medical help at the stages when symptoms begin to progress. This fact can lead to the appearance of complications of the disease and such residual manifestations as changes in appearance and disability.

For etiotropic therapy aimed at destroying the pathogen, the patient is prescribed a combination of several effective antimicrobial drugs. Medication patterns may vary slightly from country to country.

The drug etiotropic therapy plan may include the following drugs:

• sulfone group preparations: Dapsone, Diaminodiphenylsulfone, Sulfetron, Sulfatin, etc.;
• antibacterial agents: Rifampicin (Rifampin), Ofloxacin, Minocycline, Clofazimine, Clarithromycin, etc.

The World Health Organization recommends combination therapy regimens for all forms of leprosy. With tubercoloid leprosy - Dapsone 1 time per day and Rifampin 1 time per month for six months, and with lepromatous leprosy - Clofazamine and Dapsone 1 time per day and Rifampin 1 time per month for 2 years before negative skin biopsy tests.

Etiotropic treatment is complemented by the intake of Rutin, vitamin C, B vitamins and antihistamines (Suprastin, Loratadin, etc.).

In some cases, to inhibit the growth of mycobacteria and accelerate the regeneration of the skin, the patient is prescribed Haulmugra oil (from chaulmugra seeds). This product should be taken in gelatin capsules that protect the stomach lining from unwanted irritation.

Drugs for the etiotropic treatment of leprosy are taken for long periods (from several months to 2 years), and this contributes to their negative effect on blood composition. In patients, the level of erythrocytes and hemoglobin decreases. To eliminate these signs of anemia, the patient needs to organize a regular intake of vitamins and a balanced diet to replenish the lack of iron in the blood. In addition, he must take control blood tests at least once a month.

To exclude the development of complications from the organs of vision, respiratory, nervous and musculoskeletal systems, consultations of such specialists are recommended.