Leprosy

Leprosy (lepra) is a chronic infectious disease caused by acid and alcohol resistant Bacillus (Mycobacterium) of Hansen-Nasser.
Culture it is not received, animals to infect so far failed. In the world there are about 10-15 million patients with leprosy, mostly in Asia, Africa, South and Central America. Leprosy allocation. Infection occurs from the patient brazillolitas by direct contact through broken skin or through the mucous membrane of the nose. Congenital diseases do not exist. In the epidemiology of leprosy important role played by socio-economic factors (overcrowding, poor nutrition, etc).
There are lepromatous leprosy (lepra L) specific granuloma with big frothy reposname cells (Virchow)containing a lot of mycobacteria; tuberculoid leprosy (lepra T) is a typical granuloma with giant, epitelialna cells and shaft of lymphocytes and with a very small number of bacilli; undifferentiated leprosy (lepra (I) - from the banal lymphocytic infiltration and different number of pathogens (always much smaller than when lepra L); dimorphic or borderline leprosy (lepra D) is transitional between lepra T and L, where there is a combination of both types of granulomas. When lepra L resistance against infiltrated agents of leprosy is practically absent, objective indicator of this is the negative result of nepromokavou samples (intradermal injection of 0.1 ml of water mist killed bacilli from Lesprom); with lepra T organism with pathogens struggles and lapominka test, as with healthy, positive (3 weeks at the injection formed node, sometimes necrosis); with lepra resistance I still undecided and the results of nepromokavou tests (test Mitsuda) may be different; on average 4-5 years this type of leprosy transformed or lepromatosis or tuberculozei.
The average incubation period of leprosy 4-6 years, often longer.
When lepromatous leprosy first on the face and on the extensor surfaces distal extremities appear erythematous-pigmented, "rusty"
spots with unclear borders, which is bottled superficial or deep infiltrates. The skin above them bold; sensitivity, normal at first, gradually lost. Leprosy in the form of bumps or knots occur either on the background of the described changes, either outwardly healthy skin. They can dissolve under the influence of treatment, leaving subseven atrophy, sklerozirovanie or izjasnite; sores typically deep with steep edges, often extensive, with a mass of mycobacteria in the discharge, heal slowly, scars. Leather chin, cheek areas, forehead infiltered, natural folds her become deep; the eyebrows thicken, fall eyebrows and eyelashes, starting from the outer edges (Fig. 1). Often affects the ear-lobe. Later lesions are found on the body. Without treatment, the nose is deformed due to the destruction of walls (Fig. 2). The defeat of the larynx causes hoarseness, afonia, asphyxia. Episcleritis, keratit, irit, iridotsyklit cause impaired vision, and sometimes blindness. Lymph nodes, especially inguinal and femoral, increased, dense. Peripheral nerve trunks (elbow, peroneal and others) knotty thickened, painful, develop zonal anesthesia, contractures fingers (Fig. 3), atrophy of small muscles and other nutritional disorder.

lepametsa leprosy
Fig. 1. Lepametsa leprosy; expressed infiltration of the skin, the complete lack of eyebrows and eyelashes.



Fig. 2. Lepametsa leprosy; diffuse infiltration of the skin, the deformation of nose due to the destruction of the nasal septum, lepromatosis anophthalmic.
undifferentiated leprosy
Fig. 3. Undifferentiated leprosy; contractures of the fingers.
Fig. 4. Tuberkuleznaja leprosy; nearly complete mutilate all the fingers.


In advanced cases, there are plastic the references for additional information osteoporotic tibial, elbow, phalangeal bone ribs and others In the epiphysis, less often in diatezah long bones rentgenograficheskie determined rounded leprosy to 8 mm in diameter; it may be fractures and broken bones.
Osteomyelitis leprosy occurs when specific skin leprosy lesions. The overwhelming frequency bone changes leprosy falls on the peripheral sections of the bones of the limbs: phalanxes of fingers, wrist and metacarpal bones. Radiographically leprosy changes bones are expressed in small foci of enlightenment, sclerosis, sometimes swollen limbs due periosteal osteophytes. Destructive changes in the bones complicated pathological fractures, subluxations and dislocation of limbs. There enlargement of the spleen is usually accompanied by periplaneta. In 1/3 of the patients liver is enlarged, painless, edge plotnostei; patients complaining of General weakness, loss of appetite, bitter taste in the mouth. The long-suffering is secondary renal amyloidosis. Orchoiepididymitis almost always sided; the testis and epididymis dense, often bumpy; the process is completed atrophy. Such patients may have infantilism, gynecomastia, impotence, infertility.
During quiet lepromatous leprosy can be interrupted by aggravation of the process (LR - lepametsa reaction); aggravated all the damage to the skin, nerves, eyes, visceral organs and other, new ones appear in the form of Lesprom, infiltrates, type erythema, pseudomoi and other Temperature ranges from low to 40 degrees and above. The stronger the reaction, the shorter flash, strong outbreaks continue for about a week, weak for several months. During exacerbations may be the collapse of Lesprom, temporary bacillemia. The provoked exacerbation of weakening the body factors (labour, cold, irrational therapy, especially the intake of potassium iodide); they more often in the spring and autumn.
Rash tuberkuleznoy leprosy usually localized to the torso. It is well separated plaques with brighter towering peripheral roller, a circle with a clearer external and less clear inner edges and slightly atrophic centre. Less common are isolated or grouped papules and tubercles or patches of different sizes, too, with sharp edges. The affected areas are missing all kinds of surface sensitivity, do not grow hair, no sweat. Near the rash is often possible to probe thickened skin branches of the nerves. Peripheral nerve trunks thickened and painful; in the distal extremities is observed paresthesia, dysesthesia, anesthesia, top of these zones obliquely passes to the axis of the limb; frequent motor disorders, muscular atrophy and bone phalanges, paresis, and paralysis (masloobraznyj face, logiterm and others), probcause ulcers soles, Mytischi (Fig. 4), osteomyelitis, etc.
Acute tuberkuleznoy leprosy are expressed in the form of reactive tuberculoid (RT) and tuberkuleznoy reactivation (ТR), during which the lesions can be detected bacilli, usually they are missing. RT is either the first manifestation of a disease or a result of transformation spots undifferentiated leprosy; without prodromov appear reddish spots, pimples and bumps (rash may be on the soles, palms and nails of the head), accompanied by swelling, rarely collapse; after resorption remains rabawyzna atrophy. TR - aggravation of already existing acne, the edges of which are inflamed, red, swollen; thick nerve trunks become painful, often formed contracture. Can be transformed into lepromatosis type.
Rashes with undifferentiated leprosy similar spotted tuberculinum and differ from them only in histostructure. Almost always there are mono - and polyneuritis.
For microscopy strokes are made from a fabric juice affected skin scraping from a mucous membrane of nasal septum (from both sides)of the lymph nodes. Smears stained by Zn Nelsen. Unlike tuberculosis, leprosy mycobacteria are not random, but piles in the form of a cigar packs.
To establish the origin anaesthetic on researched and neighbouring area (control) put a drop of histamine (1:1000) or 1% of morphine and through it, the needle to the end its not penetrated into the papillary layer. If formed around papules appear erythematous bezel, this testifies to the security of axon-reflex, i.e. the defeat of the Central origin, and the lack of it - on the peripheral.
Sample Minor sweating: the study and adjacent areas grease iodine tincture, priputnev starch. In the survey area cause sweating; where the sweat appears, he wets the starch that. connecting with iodine, gives slate-black color. After intravenous infusion 3-7 ml of 1% solution of nicotine acid in all places where there are even invisible to the naked eye leprosy spots appear erythema and blisters.
Differential diagnosis. Rash pigment urticaria swell from friction. On the vitiligo patches are fully Oromia and gray hair. Hillocky civility softer, faster izyaslau, more grouped. Gum larger, less frequently and quickly disintegrate, but subcourse rather. Lypamy tuberculous lupus give the phenomenon of the probe and Apple jelly. Syphilis iritis is sharper, more vascularity located in pupillary region, and leprosy in the upper outer quadrant. Iris in tuberculous irate grayish-yellow, and leprosy - pale-gray; tuberculosis vessels and less often suffers posterior segment of the eye.
When those of syringomyelia defeat unilateral, often in the shoulder girdle; sometimes zone anesthesia and atrophy are not the same; often there are paresis have not atrophied muscles, spastic paraplegia, kyphoscoliosis, arthropathy. Sweating on anesthetic sites saved; dominated by the motor, but not the sensory disturbances; topography them not polyneuritises and matematicheskaya. Anesthesia from the beginning dissolvine; deep sensitivity suffering too. In the distal extremities often persists temperature sensitivity. The borders of zones of anesthesia perpendicular to the axis of the leg.
Forecast serious. More recently, many patients lepromatous leprosy was killed in a few years from asphyxia, tuberculosis, amyloidosis; many became heavy with disabilities. Now leprosy is curable.
Prolonged treatment is strictly individual, interleaved antrepriznyh funds. 4-4-diamino-diphenyl-sulfon (DDS) designate 6 days a week, the first 2 weeks of 50 mg 2 times a day, following 3 weeks to 100 mg, and after a fortnight break spend three more of the same cycle. Course - 4 cycle with subsequent 1-1,5-month break. Solusulfon (alferon) in 50% aqueous solution is injected intramuscularly 2 times a week starting from 0,5 up to 3.5 ml, increasing the weekly dose of 0.5 ml At the rate of 50 injection. Break between courses 1-1,5 months. When treating sulfones simultaneously appoint Antianemic remedies.
Ciba-1906 (thiocarbonyl, DPT) appoint 1-2 g / day (6 days a week) for 6 months or in the first 1-2 weeks of 0.5 g once a day for 3-4 weeks 1 g; 7 - 12th 1.5 g and beginning with the 12th, 2, Each course is 8 months.
Therapeutic effect of the drugs listed in fresh cases lepromatous leprosy is greatly improved if both 2-3 times a week to RUB in the skin of 5 g atsula (derived ethyl mercaptan).
During exacerbations Antileprosy treatment or temporarily cease or reduce its intensity, assigning desencibilizirutuyu therapy; subcutaneously injected measles serum (0,5-5 ml daily), 2 ml of 1 % aqueous solution shermanalingageraldi of salt a day (at normal kidney function and the lifting of mandatory sulfones), do transfusion of blood; temporary relief give steroid hormones. When neuritis shown physiotherapy. In recent years, is widely produce plastic and reconstructive surgery.
Prevention. All patients in whom microscopy positive, are placed in a leper colony - treatment-and-prophylactic institutions of the type of agricultural colonies where they are until the disappearance of an active lesions and smear conversion rate, then discharged for outpatient care (outpatient treatment and clinical supervision). Leper colony led by leprosy work of all parts of the health system as a specialized and precinct. In some leprosorium there are specialized orphanages for healthy children whose parents are sick with leprosy (preventoria). All patients with leprosy, their family members and persons that had their close contact, are registered, are subject to periodic examinations according to existing regulations of the Ministry of health of the USSR. In the most disadvantaged areas are the mass examination of the population. Widely deployed health education. On each newly diagnosed patient health workers are required to notify the health authorities.
For the prevention of leprosy is important improvement of material well-being and hygiene standard of living of the population. In several countries, including the USSR, intensively studied the effectiveness of active immunization of leprosy by re-vaccination BCG, that, apparently, increases the resistance not only to tuberculosis, and leprosy (lapominka the sample is positive). Good results. We also study the feasibility of preventive antidepressiva treatment.