Leprosy( leprosy) - Causes, symptoms and treatment. MF.

Leprosy is a disease caused by mycobacteria characterized by prolonged chronic course, damage to the nervous system, skin and mucous membranes, as well as the musculoskeletal system and internal organs.

The disease is common mainly in tropical countries. At the same time, the largest number of cases is registered in Brazil, in second place is India, the third place is Burma. According to data for 2009, about two hundred thousand people suffer from leprosy in the world. In Russia, as of 2007, 600 people have been infected, and only 35% of them are on inpatient treatment. So "leprosy", as they also call leprosy, the disease is not so forgotten and the risk of getting sick is there.

Causes of leprosy

Leprosy is caused by mycobacteria Mycobacterium leprae. The source of leprosy is a sick person. The leading mechanism of infection is aerosol. It is established that within a day a patient with leprosy sputum secretes about one million bacteria. Infection occurs when drops of mucus when coughing, sneezing from a sick person get into the airway of the healthy. In addition, cases of microorganism penetration through microtrauma on the skin and mucous membranes are described. As a rule, people with reduced immunity, with chronic diseases, as well as those living in unhygienic conditions, have a higher risk of infection.

Mycobacteria enter the bloodstream and settle in various organs. Due to the active multiplication of microorganisms, granulomas are formed. Granulomas are tubercles consisting of cells of the immune system. Granulomas are formed on the skin, leading to characteristic changes in the face and development of malformations, in the liver, lungs, spleen, kidneys, lymph nodes, muscles. Granulomas in the bones cause rarefaction of bone substance and lead to fractures, and the location of granulomas in the area of ​​the nerve pathways contributes to the death of neurons and the development of paralysis, disruption of nutrition of surrounding tissues.

Symptoms of leprosy

From infection to the appearance of characteristic symptoms of the disease takes an average of 3-5 years, in some cases this period is extended to 15-20 years.

The disease begins imperceptibly with the appearance of weakness, malaise, drowsiness, lethargy, weakness. Some patients point to the appearance of numbness in the fingers, legs, dense bumps on the skin. Given the meager external manifestations, the diagnosis of leprosy at an early stage is usually difficult.

Depending on the leading symptoms, the following types of leprosy are distinguished.

• The tuberculoid type of the leprosy .The most favorable variant of the disease course. In tuberculoid type, the skin and nervous system are predominantly affected, there is no disturbance of the function of internal organs. At the onset of the disease, a single focus or several( 2-5) elements appear on the skin, which is a spot, papule or plaque. They can be light, or somewhat reddish compared to healthy areas of the skin. Subsequently, these elements merge with one another and form quaint foci with a burgundy contour, cylindrical raised edge and thinning of the skin in the central sections.

Characteristic skin changes in the tuberculoid type of leprosy

On the face and extremities, tumorous formations may appear. The skin in the affected area, as well as 1.5-2 cm above the affected area, becomes numb, numb. Therefore, often there are injuries, burns, which, if the rules of hygiene are not observed, very quickly catch up.

The defeat of the nervous system is a characteristic symptom of tuberculoid type leprosy. Near the skin foci, you can feel the painful thickened nerve trunks. The most often affected are the radial, ulnar, parotid nerve, and also the branches of the facial nerve. The motor activity of the fingers of the hand is disrupted, characteristic external manifestations are formed, such as the "bird's paw", "hanging foot".

Deformity of the brush as a "bird's paw" in case of lesion of the ulnar nerve with leprosy

Deformity of the foot by the type of "hanging stop" with affection of the peroneal nerve with leprosy

Due to a malnutrition, the skin becomes fragile and easily vulnerable, mutation develops( spontaneous detachment of the dead regionbody) of the extremities.

Finger finger wrinkling with leprosy

• The lepromatous type of leprosy is the most severe form of the disease course, which in most cases leads to disability, and in some cases, to the death of the patient. The disease begins with the appearance of shiny spots on the skin without a clear distinction from the healthy skin. These spots in people with dark skin are lighter, and in persons with fair skin have a reddish color. It is noteworthy that the sensitivity of the skin in the affected area is preserved. After 3-5 years in the field of spots hair falls out, there are characteristic nodules and tumor-like formations. With the localization of tumor-like foci in the region of the superciliary arches, chin and ear shells, the face acquires a peculiar kind, described in the literature as a "lion face".

The lion face as a characteristic sign of the lepromatous type of leprosy

Very often ulcers are formed on these elements, they become infected, after the healing on the spot of ulcers, rough ugly scars are formed. A characteristic feature of the lepromatous type of leprosy is the defeat of the nasal mucosa with perforation of the nasal septum and changes in the shape of the nose. Often the pathological process extends to the oral cavity, and the larynx, which leads to a change in the voice.

Over time, the sensitivity in the upper and lower extremities is disturbed, and in the region of the soles and palms, the sensation persists long enough. At later stages of the disease, finger contractures, mutations, and long-term non-healing ulcers are formed. In patients, inflammation of the lymph nodes is observed. In men, orchitis develops - inflammation of the testicles with subsequent violation of their function. In 80% of cases, patients are diagnosed with eye damage, which ultimately leads to blindness. The formation of granulomas in the bones leads to dislocations and fractures. Often, granulomas are formed in the kidneys, lungs, liver, spleen, which leads to a disruption of the functions of these organs.

• The borderline types of leprosy combine features of two main types and are characterized by a softer flow.

Diagnosis of Leprosy

Disease is considered most likely if one of the following symptoms exists.
1. Identification of characteristic skin manifestations with loss of sensitivity, regardless of thickening of nerve trunks.
2. Definition of mycobacteria in the study of the contents of skin lesions. After a shallow cut of the skin, scraping is obtained from the area of ​​the granuloma, and examined under a microscope. In addition, a large number of pathogens can be detected in the study of mucus from the nasal and oral cavity, as well as the contents of lymph nodes.

Treatment of leprosy

Originally leprosy was considered a fatal disease. In the Middle Ages, at the first sign of illness, the unfortunate man was to appear at a religious court, which obligatorily condemned him to death. The patient was taken to church, funeral service, then put in a coffin, taken to the cemetery, dropped into the grave and thrown the earth with the words: "You are not alive, you are dead to all of us."After that they dug it out and drove it to the leper colony. He did not return home again.

At present, with timely treatment, a complete cure for leprosy is possible. Treatment of leprosy is long, aimed at destroying pathogens, preventing and treating complications. Patients are hospitalized in specific institutions - leprosarium, their relatives undergo regular examination. In the leper colony, patients have homes, ancillary facilities, if they wish, they can engage in various crafts. As a rule, medical and service personnel live next to patients, in conditionally isolated, for example, forest plantation, a zone. At present, four leprosariums are functioning in Russia: in the city of Astrakhan, the Sergiev Posad branch, in Stavropol and Krasnodar Krai.

As a rule, patients with newly diagnosed leprosy, as well as when returning the disease, are necessarily hospitalized in a specialized dispensary, since such patients are contagious to others. For patients with lepromatous type of leprosy, the duration of treatment is about 12 months, and for tuberculoid type-6 months.

All patients are shown the use of antibiotics according to a certain scheme. The type of antibacterial preparation, as well as the duration of the course of treatment depends on the type of leprosy and the degree of organ failure. The most common drugs are rifampicin, dapsone, ofloxacin. In addition to antibacterial treatment, patients are recommended anti-inflammatory therapy( acetylsalicylic acid, in some cases - prednisolone).

If within 6-12 months after the course of treatment the patient does not determine mycobacteria, then he can be transferred to an outpatient schedule. At this time the patient can not infect others even if there are residual effects.

For the social adaptation of patients, psychotherapeutic treatment, as well as the use of orthopedic aids, is recommended. In addition, to maintain immunity and prevent infectious complications, patients need adequate nutrition, massage, physical therapy, and physiotherapy. Given the violation of sensitivity in the upper and lower extremities, all patients should be careful to prevent domestic trauma.

Possible complications of leprosy

Injuries and infections can lead to finger deformation, mutation, development of contractures. When the nervous system is damaged, paralysis is formed. Often with a prolonged course of the disease, vision is impaired, until blindness. Granulomas on the face lead to the formation of deformities, and the defeat of bones and joints contribute to the disability of patients. Granulomas in the internal organs contribute to the development of hepatitis, pneumonia, lymphadenitis, nephritis and pyelonephritis.

Forecast of leprosy development

Leprosy itself is not a fatal disease. But mortality with leprosy is four times higher than in the general population. The cause of death is infectious complications and amyloidosis( deposition of pathological protein in inflammation) of internal organs. With late application for medical care, patients continue to have disabling deformities, which may require surgical and orthopedic treatment.

Prevention of leprosy

Vaccines against leprosy are currently not available. In the literature, there is a description of the effectiveness of the vaccine against BCG tuberculosis, but objective evidence has not yet been obtained.

Preventive measures should be aimed at improving the quality of life, improving living conditions, immunity.

A patient with leprosy should have a separate bed, dishes, personal hygiene items. It is necessary to handle ulcers in a timely manner, and regularly change bandages. Patients, even after treatment, are not allowed to work in children's and medical institutions, as well as in food and communal enterprises, since it is possible to return the disease. Persons who come into contact with the sick are advised to follow the rules of personal hygiene( washing hands, using gloves, mask when handling ulcers).

A lepromine test is mandatory for the relatives of the patient. Lepromin test is intradermal injection of weakened mycobacteria leprosy. The appearance of a spot at the injection site, and then turning it into a tubercle, often with ulceration, indicates a positive reaction. A positive reaction is also characteristic of healthy people. Such persons are under the constant supervision of a doctor with the conduct of nonspecific treatment aimed at improving immunity. In the absence of a reaction, a thorough examination and preventive treatment with antibacterial drugs are carried out according to a certain scheme.

Doctor therapist Sirotkina EV