How they get infected with leprosy. What is leprosy? Photos, symptoms and treatment of the disease. Diagnostics - testing doctors for knowledge

There are many diseases in the world that appeared in ancient times and still affect humanity. One of them is leprosy, or, as it is more commonly called, leprosy.

What it is?

At the very beginning, you need to figure out what leprosy is. The disease is infectious and chronic in nature. The causative agent is the microorganisms Mycobacterium leprae. Basically, the problem affects human skin, as well as mucous membranes and the nervous system. It should also be said that the incubation period of the disease is very long. So, you can become infected with a virus, and external manifestations will begin only after 5-20 years. Important: this disease is incurable. However, if therapy is started on time, then disability can be avoided.

Spreading

Leprosy is the disease of the poor. Most often the most disadvantaged segments of the population are infected with it. At risk are the poorest countries of the African continent, as well as Brazil, Angola, Nepal, India, etc. But the world community is actively fighting against foci of infection today. And since 1995, everyone can receive good, high-quality and, most importantly, free treatment for this disease.

A bit of history

Leprosy is a disease that was already known to the inhabitants of ancient civilizations (India, China and Egypt). The disease was first mentioned in 600 BC. Builds to say that at that time, however, as well as much later, such patients were often ostracized (exile, exile) not only by society, but also by close people. With the rise of Christianity, the picture has changed little. People with leprosy were considered punished by the Lord for their sins and were also rejected by society. And only in the middle of the last century, drugs were found that quite effectively help to resist the disease. And since 1995, these drugs in risk areas have been offered to people free of charge. Modern society most often treats such people with tolerance.

Causes of the disease

How and why does leprosy (disease) occur? The reasons are still unknown to doctors. And all because the incubation period of the disease is very long. The first symptoms may appear several years after infection. The only thing that can be said with certainty is that children become infected with leprosy more often and faster than adults. You can get infected with very close contact with a sick person. If the patient is diligently treated, then after a certain time he becomes safe for others. At the same time, the activity of pathogenic organisms is not too high. Only a few can get leprosy from a sick person: people with weakened or not yet fully formed immunity.

Types of leprosy

There are two main types of leprosy:

1. Tuberculoid form. Lighter. It develops if the body is able to withstand the attack of microbacteria.
2. Border form. Somewhat heavier than the previous form. However, it often develops into a lepromatous form.
3. Lepromatous leprosy. The most severe form. It develops in case of severe weakening or damage to the patient's immunity.

Symptoms

How is leprosy disease manifested? The symptoms are as follows:

1. Damage to the skin, tissues that come into contact with air. Also affected are the mucous membranes of the nose, mouth, nerve endings that are on the person's face. Often, leprosy penetrates so deeply into the skin that the destruction of nerve fibers occurs. This leads to the fact that a person becomes ugly, his normal, primary appearance is distorted.
2. Leprosy is a disease that does not cause fingers to die. This is due to reinfection (bacterial infection) and tissue necrosis.
3. The affected areas of the skin become insensitive to pain, cold, heat.
4. Numbness of the patient's limbs. There may also be some loss of sensation in the limbs.
5. The patient develops severe muscle weakness.

Forms of the disease: symptoms

The course of the disease according to the tuberculoin type differs from lepromatous leprosy. In the first case, flat spots appear on the patient's body, which have a white or reddish tint, and they are also often covered with scales. In places of the affected areas of the skin, the sheaths of the nerve fibers become denser, which leads to a decrease in their sensitivity. If pathogens penetrate the largest trunks, destructive changes in joints and bones can occur. Most often, the limbs of a person are affected. However, it should be said that with this form of the disease, the symptoms can disappear by themselves without a trace and irrevocably. If this is lepromatous leprosy, then so-called nodes or plaques most often begin to form on a person's face, the skin in these places loses sensitivity, thickens. Large, rough folds can form on the skin. The patient's face most often in this case takes on the so-called "lion's face" - this is a symptom characteristic of lepromatous leprosy.

Diagnostics

Leprosy (disease) is a difficult problem to detect. Indeed, most often it camouflages itself under other diseases and can manifest itself many years after a person is infected. It also requires lengthy and thorough diagnostics. What can be used in this case:

1. Bacteriological analysis of the patient's skin scraping.
2. PCR (polymerase chain reaction) is a more expensive but effective method for laboratory diagnosis of a disease. Its purpose is to identify the causative agents of infectious diseases.
3. Lepromine test (needed to determine the form of the disease).

Treatment

So, if a person is diagnosed with leprosy (disease), the treatment was carried out differently at each stage of the historical development of civilization.

1. For centuries, leprosy (or leprosy) has been treated with haulmugr oil.
2. Further, this harm was replaced by sulfonic drugs.
3. Since 1950, diaphenylsulfone (dapsone) has been used to combat this disease problem. However, its effect could only be seen after several years. Sometimes the treatment was delayed for 8-10 years. It is worth saying that these drugs are some kind of disease freezers.
4. In the early 80s of the last century, they began to treat leprosy in a complex way with the help of antibiotics: these are drugs such as Rifampicin, Dapsone, Sparfloxacin.

Complications and prognosis

It should be said that leprosy is a chronic disease that cannot be eliminated. You can only slow down its development. Complications include the following:

1. The defeat of the patient's skin beyond recognition.
2. Defeat and destruction of the human nervous system.
3. Also, the disease can lead to blindness.

To avoid such a development of events, the disease must be diagnosed at the earliest possible date. You also need to constantly fight the symptoms of the disease.

Disease of the Poor?

In the light of recent events, the public began to actively talk about the fact that leprosy is not only a disease of the poorest segments of the population. For example, some experts argue that the disease is slowly affecting the Ukrainian elite. At the very beginning, it was only about the former President Viktor Yushchenko (as they say, symptoms on the face and on the face). Further, scientists began to actively assert that this is also Tymoshenko's disease. Leprosy in this case was transmitted during the long-term contact between Yushchenko and Tymoshenko during the 2004 Maidan. The symptomatology of Yulia Vladimirovna manifested itself during her imprisonment. However, there is no reliable information about whether this is really so.

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

Lepra is equally infectious 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 the 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 its first signs appear, 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 finally 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 were in contact with the patient, especially children, then they often find 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 lesions increase, their edges rise above the surface of the skin and are rounded, 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 ​​the focus, increase in size so much that they become visible. Changes in the peroneal, ulnar and greater ear nerves are especially noticeable.
• The 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 in the areas of the skin 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, more and more 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's 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 testicular tissue followed by scar tissue replacement, 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 form of 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 indistinct.
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 be thickened, but the eyebrows and the shape of the nose do not change significantly if they do.

Treatment

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

Advice! When you start the treatment of 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 out periods of 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 economic 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, rifampicin is recommended to be prescribed 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 low 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 an 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, proceeding in a severe form, 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, just 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 the 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 are not amenable 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. hand contractures are prevented when physiotherapy is used in treatment or by applying a plaster cast. In some cases, surgery is performed to reconstruct damaged areas of tissue, 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. The 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.

Prophylaxis

Fight against leprosy. The modern basis for leprosy control is the timely detection of cases and preventive therapy form the basis of the fight against leprosy. Early detection of leprosy in patients is most important. 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, but in most cases, annual examinations of contact persons are sufficient.

Important! Vaccination with an antileprosy vaccine is currently being tested and has already been 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 where 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 anti-leprosy 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 observe 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 regional dispensary.
If you have any suspicion of contact with someone infected with leprosy, you should contact an infectious disease doctor or a leprologist directly.

Leprosy (leprosy) is an infectious disease that affects the skin and the peripheral nervous system of a person. The disease of leprosy is considered one of the most ancient diseases, the mention of which is found in the Old Testament. In those days, those with leprosy were considered "unclean." Healthy people shied away from them, they were persecuted and deprived of the right to a normal life. The peak incidence of leprosy occurs in the 12-14 centuries, when the infection affected the population of almost all European countries.

To combat leprosy, medieval aesculapians used numerous leper colony - institutions that were engaged in identifying and treating lepers. Initially, patients with leprosy were located on the territory of monasteries, where they were allocated houses and plots for agricultural activities. In fact, the unfortunate people lived on a kind of reservations and did not have the opportunity to communicate with the rest of the world. However, then the isolation of patients with leprosy was fully justified and bore fruit. By the 16th century, leprosy had left Europe. For some time, isolated cases of the disease were recorded on the territory of the Mediterranean coast and Scandinavia, but the case did not come to large-scale epidemics.

Today we know almost everything about leprosy. Contrary to popular belief, the infection is not transmitted by simply touching the patient and does not always lead to death. It is known that the disease of leprosy threatens only 5-7% of people, and the rest of the inhabitants of the Earth have strong immunological protection against the pathogen. With regard to the method of transmission of infection. In most cases, long-term direct skin contact is required for infection. There is also a theory that leprosy, the symptoms of which can appear even 10 years after the lesion, enters the body through inhalation of bacteria secreted from the mouth or nasal cavity of a sick person. Perhaps it is this assumption that partly explains the fact that today there are about 11 million people with leprosy in the world, and many of them have not had any skin contact with infected people.

What Causes Leprosy?

Leprosy disease is caused by rod-shaped microorganisms - Mycobacterium leprae... They were discovered in 1874 by the scientist G. Hansen. These microorganisms have properties close to tuberculosis, but do not have the ability to multiply in nutrient media and often do not manifest themselves in any way for many years. Suffice it to say that the incubation period of the disease is often 15-20 years, which is due to the characteristic features of leprosy. By itself, it is not capable of causing tissue necrosis. This means that the activity of microorganisms must be activated by some external factors, for example, secondary bacterial infection, unhealthy diet, polluted water or poor living conditions.

A long incubation and no less long latency period often leads to the fact that, upon diagnosis, the treatment of leprosy begins too late, since doctors experience objective problems with the early diagnosis of the disease.

Currently, experts know two forms of leprosy:

• lepromatous - the pathogen acts mainly on the skin;
• tuberculoid - for the most part, the disease affects the peripheral nervous system.

A borderline form of leprosy is also distinguished, which tends to develop into one of the two main types of the disease.

Leprosy symptoms

The tuberculoid form has the following characteristic symptoms of leprosy:

• the appearance of a well-defined spot, which gradually increases in size;
• absence of hair follicles and sweat glands on the affected skin surface;
• thickened nerves are clearly felt near the spot;
• amyotrophy;
• the formation of neurotrophic ulcers on the soles;
• contractures of the hands and feet.

As the disease of leprosy progresses, the symptoms of the disease also increase. Over time, patients develop phalangeal mutations, corneal ulcers and other lesions of the facial nerve, leading to blindness.

Lepromatous leprosy manifests itself as extensive skin lesions in the form of plaques, papules, spots and nodules. As a rule, such formations occur on the face, ears, elbows, wrists and buttocks. Very often, leprosy is accompanied by loss of eyebrows. For the later stages of the disease, distortion of facial features, proliferation of earlobes, nosebleeds, and shortness of breath are characteristic. People with leprosy also suffer from laryngitis, hoarseness, and keratitis. Infiltration of pathogens into the testicular tissue leads to infertility in men.

Leprosy cure

For several centuries, haulmugr oil has been used against the disease of leprosy, however, modern medicine has much more effective means, in particular, sulfone drugs. They do not belong to specific therapeutic agents, but they can stop the development of infection and have a general strengthening effect on the body.

In milder forms of the disease, cure occurs within 2-3 years. A severe course of leprosy increases this period to 7-8 years. We also add that strains of mite bacteria that are resistant to dapsone (the main drug used in modern medicine) have recently been discovered, therefore, in recent years, sulfamic drugs have been used in combination with other drugs. For example, clofamizine is widely used in the lepromatous type of infection.

Of course, the researchers are not going to be satisfied with what has already been achieved and are looking for more effective ways to combat leprosy, which will shorten the duration of treatment and reduce the severity of symptoms in seriously ill patients.

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Lepra (lat. lepra, Hansen's disease, hanseniasis, leprosy, Saint Lazarus disease, ilephantiasis graecorum, lepra arabum, leontiasis, satyriasis, lazy death, black sickness, mournful illness) is a chronic infection with the acid-fast bacillus Micobacterium leprae, which has a unique tropism for peripheral nerves, skin and mucous membranes. The symptoms of leprosy (leprosy) are extremely varied and include painless skin lesions and peripheral neuropathy. Diagnosis of leprosy (leprosy) is clinical and is confirmed by biopsy data. Leprosy (leprosy) is treated with dapsone in combination with other antibacterial agents.

ICD-10 code

A30 Lepra [Hansen's disease]

B92 Effects of leprosy

Epidemiology

Although most cases are found in Asia, leprosy is also widespread in Africa. Endemic foci also exist in Mexico, South and Central America, and the Pacific Islands. Of the 5,000 cases of the disease in the United States, almost all were detected in immigrants from developing countries who settled in California, Hawaii and Texas. There are several forms of the disease. The most severe, lepromatous form, is more common in men. Leprosy can occur at any age, although the highest incidence is between 13-19 and 20-year-olds.

Until recently, humans were thought to be the only natural reservoir of leprosy, but 15% of armadillos were found to be infected, and great apes may also be a reservoir for infection. However, with the exception of the transmissible route of infection (through bedbugs, mosquitoes), infection from animals is not a determining factor for human disease. M. leprae is also found in soil.

It is believed that the causative agent of leprosy is transmitted by sneezing and by secretion of secretions to patients. An untreated patient with leprosy carries a large number of pathogens located on the nasal mucosa and in secretions, even before the appearance of the clinic; about 50% of patients had close contact with an infected person, often with family members. The short contact results in a low risk of transmission. Mild tuberculoid forms are usually not contagious. The majority (95%) of immunocompetent individuals do not become ill even after exposure; those who become ill are likely to have a genetic predisposition.

Micobacterium leprae grows slowly (doubling period 2 weeks). Usually the incubation period is 6 months - 10 years. With the development of infection, hematogenous dissemination occurs.

Leprosy symptoms

Approximately 3/4 of patients with infection develop a single skin lesion that resolves spontaneously; the rest develop clinical leprosy. The symptoms of leprosy and the severity of the disease differ depending on the severity of cellular immunity to M. leprae.

Tuberculoid leprosy (Hansen's oligobacillary disease) is the mildest form of leprosy. Patients have a strong mediated cellular immunity, which limits the disease to a few areas on the skin or individual nerves. The lesions contain little or no bacteria. Skin lesions contain one or more hypopigmented spots, with sharp raised edges, with reduced sensitivity. The rash, as with all forms of leprosy, does not itch. The lesions are dry, as disorders of the autonomic nerves damage the innervation of the sweat glands. Peripheral nerves can be damaged asymmetrically and are palpated enlarged in adjacent skin lesions.

Lepromatous leprosy (Canean's polybacillary disease) is the most severe form of the disease. Affected patients have an insufficient immune response to M. leprae, as well as a systemic infection with the spread of bacterial infiltrates of the skin, nerves and other organs (nose, testicles, and others). They may have spots, papules, nodules and plaques on their skin, often symmetrical (stuffed with mycobacterium leprosy). Gynecomastia, loss of fingers, and often severe peripheral neuropathy may develop. Patients lose their eyelashes and eyebrows. The disease in western Mexico and throughout Latin America causes diffuse cutaneous infiltration with loss of body hair and other skin lesions, but no signs of foci. This is called diffuse lepromatosis or bonita leprosy. Patients may develop subacute erythema nodosum, and patients with diffuse lepromatosis may develop the Lazio phenomenon, with ulcers, especially on the legs, which often serve as a source of secondary infection, leading to bacteremia and death.

Borderline leprosy (multibacillary) is of an intermediate nature and is the most common. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; affect the whole limb, peripheral nerves with the appearance of weakness, loss of sensitivity. This type has an unstable course and can turn into lepromatous leprosy or reverse development with a transition to a tuberculoid form.

Lepromatous reactions

Patients develop immunologically mediated reactions. There are two types of reactions.

A type 1 reaction develops as a result of a spontaneous increase in cellular immunity. They occur in about one third of people with borderline leprosy, usually after starting treatment. Clinically, there is an increase in inflammation within pre-existing lesions with the development of skin edema, erythema, neuritis with pain, loss of function. New lesions may develop. These reactions play a significant role, especially in the absence of early treatment. As the immune response increases, this is called a reversible response despite possible clinical deterioration.

The second type of reaction is a systemic inflammatory reaction resulting from the deposition of deposits of immune complexes. It is also called leprosy subacute erythema nodosum. Previously, it occurred in about half of patients with borderline and lepromatous leprosy during the first year of treatment. Now it has become less frequent, as clofazimine is added to the treatment. It can also develop prior to treatment. It is a polymorphonuclear vasculitis or panniculitis with possible involvement of circulating immune complexes and increased T-helper function. The level of tumor necrosis factor increases. Leprosy subacute erythema nodosum is erythematous painful papules or nodules with pustules and ulcers. With it, fever, neuritis, lymphadenitis, orchitis, arthritis (large joints, especially knee joints), glomerulonephritis develop. As a result of hemolysis and bone marrow suppression, anemia and hepatitis may develop with a moderate increase in functional tests.

Complications and consequences

Leprosy (leprosy) has complications that develop as a result of peripheral neuritis, as a result of infection or leprosy reaction; there is a decrease in sensitivity and weakness. Nerve trunks and microscopic nerves of the skin, especially the ulnar nerve, can be affected, resulting in claw-like 4th and 5th toes. Branches of the facial nerve (buccal, zygomatic) and the posterior ear nerve may also be affected. Individual nerve fibers responsible for pain, temperature and fine tactile sensitivity may be affected, while the larger nerve fibers responsible for vibration and positional sensitivity are usually less affected. Surgical movements of the tendons make it possible to correct lagophthalmos and functional disorders of the upper extremities, but should be performed 6 months after the start of therapy.

Plantar ulcers with associated secondary infection are the main cause of disability and should be treated with the removal of necrotic tissue and appropriate antibiotics. Patients should avoid weight bearing and wear an immobilizing bandage (Unna's boot) to maintain their ability to move. To prevent relapse, calluses should be treated, and patients should wear custom-made shoes or deep shoes that prevent the foot from rubbing.

Eyes can be very affected. In lepromatous leprosy or leprosy erythema nodosum, iritis can lead to glaucoma. Corneal insensitivity and damage to the zygomatic branch of the facial nerve (which causes lagophthalmos) can lead to corneal injury, scarring, and loss of vision. In such patients, artificial lubricants (drops) should be used.

The nasal mucosa and cartilage can be affected, resulting in chronic rhinorrhea and sometimes nosebleeds. Less commonly, perforation of the nasal cartilage, deformity of the nose, which usually occurs in untreated patients, may develop.

Men with leprosy may develop hypogonadism, as a result of a decrease in serum testosterone levels and an increase in follicle-stimulating and luteinizing hormones, with the development of erectile dysfunction, infertility and genicomastia. Testosterone replacement therapy may relieve symptoms.

In patients with a severe recurrent course of leprosy subacute erythema, amyloidosis with progressive renal failure may develop.

Diagnosis of leprosy

Diagnosis of leprosy (leprosy) is based on the characteristic clinical presentation of cutaneous lesions and peripheral neuropathy and is confirmed by microscopy of biopsy specimens; microorganisms do not grow on artificial media. A biopsy is taken from the raised edges of the tuberculoid lesions. In patients with lepromatous form, a biopsy should be performed from nodules and plaques, although pathological changes may even be in normal areas of the skin.

The test for IgM antibodies to M. leprae is highly specific, but low sensitivity. These antibodies are present in almost all patients with lepromatous form, but only in 2/3 of patients with tuberculoid form. Since the detection of such antibodies may indicate asymptomatic infection in endemic foci, the diagnostic value of the test is limited. They can be useful for monitoring disease activity, as antibody levels drop with effective chemotherapy and rise with relapse.

Leprosy cure

Leprosy has a favorable prognosis, subject to timely treatment of the disease, but cosmetic deformation leads to ostracism of patients and their families.

Leprosy medications

The main drug for the treatment of leprosy is dapsone 50-100 mg orally once a day (for children 1-2 mg / kg). Side effects include hemolysis and anemia (moderate), allergic dermatitis, which can be quite severe; rarely, a syndrome including exfoliative dermatitis, high fever, and changes in blood counts (leukocytes) as in mononucleosis (dapsone syndrome). Although cases of leprosy dapsone resistance have been reported, resistance is low and patients respond to usual doses of drugs.

Rifampin is the first bactericidal drug for the treatment of M. leprae. But it is very expensive for many developing countries when given in the recommended doses: 600 mg orally once a day. Side effects are associated with interruption of treatment and include hepatotoxicity, flu-like symptoms, and, rarely, thrombocytopenia and renal failure.

Clofazimine has a similar activity to dapsone against M. leprae in doses ranging from 50 mg orally once a day to 100 mg 3 times a week; 300 mg once a month are beneficial 1 (X for preventing leprosy reactions of type 2 and possibly type 1. Side effects include gastrointestinal disturbances and reddish-dark dichromia of the skin.

Leprosy is also treated with ethionamide in doses of 250-500 mg orally 1 time per day. However, it can often cause gastrointestinal and liver dysfunction, especially when used with rifampin, and is not recommended unless liver function can be monitored regularly.

Recently, three antibiotics, minocycline (100 mg orally once a day), clarithromycin (500 mg orally twice a day) and ofloxacin (400 mg orally once a day), rapidly kill M. leprae and reduce skin infiltration. Their combined bactericidal activity against M. leprae is higher than that of dapsone, clofazimine and ethionamide, but not rifampin. Only minocycline has been proven to be safe for long-term therapy, which is necessary for leprosy.

Although antimicrobial treatment for leprosy is effective, optimal regimens are not known. In the United States, drug susceptibility testing in mice is often recommended for patients with lepromatous and borderline leprosy.

WHO recommends combination regimens for all forms of leprosy. Treatment of leprosy in the lepromatous form requires more active regimens and duration than for tuberculoid leprosy. In adults, WHO recommends dapsone 100 mg once a day, clofazimine 50 mg once a day + 300 mg once a month, and rifampin 600 mg once a month for at least 2 years or until a negative skin biopsy is found (approximately after 5 years). For tuberculoid leprosy without excretion of acid-fast bacilli, WHO recommends dapsone 100 mg once a day and rifampin 600 mg once a month for 6 months. Many authors from India recommend treatment for more than 1 year.

In the United States, lepromatous leprosy is treated with rifampin 600 mg once daily for 2–3 years + dapsone 100 mg once daily for life. Tuberculoid leprosy is treated with 100 mg dapsone once a day for 5 years.

Lepromatous reactions

Patients with the first type of reaction (excluding minor inflammation) are given prednisone 40-60 mg orally once a day, starting with 10-15 mg once a day, followed by an increase over several months. Minor skin inflammations are not treated.

In the first or second episode of exacerbation of leprosy subacute erythema nodosum in mild cases, aspirin can be prescribed, in more severe cases, prednisone 40-60 mg intravenously 1 time per day for 1 week, plus antimicrobial drugs. In case of relapses, thalidomide is prescribed 100-300 mg orally once a day, but given its teratogenicity, it should not be prescribed to women who may become pregnant. Side effects include constipation, mild leukopenia, and drowsiness.