Leprosy (leprosy): causes, symptoms and modern methods of treatment. Leprosy (Hansen's disease, leprosy) Leprosy disease symptoms and causes

Leprosy is a severe chronic infectious pathology caused by the mycobacterium Mycobacterium leprae hominis. The source of infection is a person with leprosy. Synonyms: leprosy, Hansen's disease, Phoenician anomaly, St. Lazarus disease and others.

There are approximately 11,000,000 people suffering from leprosy worldwide. From a medical and social point of view, leprosy is a serious disease.

Leprosy has been known since ancient times. It was mainly suffered in the countries of the Middle East. Even then, separate settlements were built for the sick closed type, where the patients slowly died. There is a well-known case from the New Testament when Jesus healed a whole group of leper patients.

The prejudiced attitude of society towards patients with leprosy, who are subject to complete physical and social isolation, greatly complicates the problem of identifying cases of the disease and combating it. To this should be added the chronic nature of the disease and the lack of confidence that even after prolonged treatment it is possible to achieve complete liberation of the body from mycobacteria.

WHO drew attention to the problem of leprosy in the first decades of its existence. She was inspired by Raoul Follero, who dedicated himself to the fight against leprosy. In honor of Follero, WHO registered back in 1954, January 30, World Leprosy Day. This day should attract the attention of the international community to a comprehensive review and thorough understanding of the problem of leprosy in the world and the possibility of helping such patients.

Etiology, epidemiology of leprosy (leprosy)

Currently, leprosy is widespread in Africa, Southeast Asia, South America and Oceania. Extremely rare - in Europe and North America. The disease can develop at any age and has no racial restrictions. The concentration of leprosy patients in economically undeveloped countries and its connection with overpopulation is noted quite often. Exogenous high-risk factors play an important role in the spread of leprosy.

The exact method of transmission of the disease is unknown, but long-term observations of patients indicate infection through constant contact of a healthy person with a leprosy patient. There is no evidence regarding the transmission of the disease to humans from rodents, fleas, insects and others. An important factor in persistent infection, as well as the inability to trace the source of infection in reported cases, is the fact that asymptomatic contacts can spread mycobacteria from the nasal cavity long before they are diagnosed with leprosy. It is worth noting that mycobacteria leprosy can spread from lepromatous ulcers of treated patients, from mother's milk, and from skin appendages. Lepromatous mycobacteria can probably be transmitted by airborne droplets. They are in soil and water.

Symptoms, diagnosis of leprosy (leprosy)

The disease has a long incubation period, which can last from six months to several decades, more often – 5-7 years. It is asymptomatic. A long latent period is also possible, manifested mainly in general malaise, causeless weakness, chilliness, etc.

There are two polar forms (types) of leprosy - lepromatous and tuberculoid, as well asfour stages of the disease: progressive, stationary, regressive and the stage of residual effects. In addition, intermediate or dimorphic leprosy is possible.

Tuberculoid leprosy

Tuberculoid leprosy usually begins with the appearance of a clearly defined hypopigmented spot, within which hyperesthesia is noted. Subsequently, the spot enlarges, its edges rise, become roll-shaped with a ring-shaped or spiral pattern. The central part of the spot undergoes atrophy and sinks. Within this lesion, the skin is devoid of sensitivity, there are no sweat glands and hair follicles. Near the spot, thickened nerves innervating the affected areas are usually palpated. Nerve damage leads to muscle atrophy; The muscles of the hand are especially affected. Contractures of the hands and feet are common. Injuries and pressure lead to infections of the hands and feet, and neurotrophic ulcers form on the soles. In the future, mutilation of the phalanges is possible. When the facial nerve is damaged, lagophthalmos and resulting keratitis occur, as well as corneal ulcers, leading to blindness.

Lepromatous leprosy

Lepromatous leprosy is usually accompanied by extensive skin lesions that are symmetrical relative to the midline of the body. Lesions can be represented by spots, plaques, papules, nodes (lepromas). They have vague borders and a dense and convex center. The skin between the elements is thickened. The most commonly affected areas are the face, ears, wrists, elbows, buttocks and knees. A characteristic sign is loss of the outer third of the eyebrows. Late stages of the disease are characterized by so-called “lion face” (distortion of facial features and impaired facial expressions due to thickening of the skin), enlargement of the earlobes. The first symptoms of the disease are often nasal congestion, nosebleeds, and difficulty breathing. Complete obstruction of the nasal passages, laryngitis, and hoarseness are possible. Perforation of the nasal septum and deformation of the cartilages lead to retraction of the nasal bridge (saddle nose). Penetration of the pathogen into the anterior chamber of the eye leads to keratitis and iridocyclitis. The inguinal and axillary lymph nodes are enlarged, but not painful. In men, infiltration and sclerosis of testicular tissue lead to infertility. Gynecomastia often develops. Late stages of the disease are characterized by hypoesthesia of the peripheral limbs. Skin biopsy reveals diffuse granulomatous inflammation.

Immunity in leprosy is cellular in nature, it is maximum in patients with tuberculoid leprosy and minimal in lepromatous form. To assess the immune response and differential diagnosis between the two forms of the disease, the lepromin test is used. The reaction to an intradermally administered suspension of mycobacterium leprosy is positive in the tuberculoid form and negative in the lepromatous form.

Leprosy can be diagnosed by the presence of clinical symptoms of the disease. Confirmatory research methods are bacterioscopic and histological.

Treatment and prevention of leprosy (leprosy)

Treatment is a long-term course (up to 3-3.5 years) with the prescription of anti-leprosy drugs of the sulfone group (diaphenylsulfone, solusulfone, diucifone, etc.). The duration of the course is 6 months, the break in treatment is 1 month. Multibacterial leprosy requires initial treatment with rifampicin, dapsone, or clofazimine, followed by medicines sulfonic group. Evaluation of the effectiveness of treatment is controlled by bacterioscopic and histological research methods. Currently, there are 4 leper colonies in Russia (a place for detection, treatment, isolation, and prevention of leprosy): in Astrakhan, Krasnodar Territory, Sergiev Posad District of the Moscow Region, Stavropol Territory.

The main problem of WHO is the fight against leprosy at the level of primary prevention. Today, the main goal should be early diagnosis and effective drug therapy. Secondary prevention measures - identifying cases of the disease - are also important. This can be achieved through primary health care with the active participation of the entire population of a country where cases of leprosy have been reported. In places where leprosy is endemic, mass surveys of the population, sanitary and educational work among the population and doctors are carried out. In addition to the epidemiological situation great value have socio-economic factors, which explains the widespread prevalence of the disease among the poorest people in Asia and Africa. The health systems of these countries prioritize the expansion of services for identifying and treating leprosy patients and ensuring access to modern treatment to all the sick. Prevention of leprosy among medical personnel and other persons who, by the nature of their work, come into contact with patients, consists of strict adherence to sanitary and hygienic rules (frequent hand washing with soap, mandatory sanitation of microtraumas, etc.). Cases of infection of medical personnel are rare.

Humanity has been suffering from leprosy since ancient times and this disease was well known in the ancient civilizations of China, Egypt and India; With the advent of antibiotics against leprosy in the twentieth century, leprosy became a curable disease.

Steps

Seek help early. If left untreated, leprosy can progress and cause permanent damage to the skin, nerves, limbs and eyes.

Take Dapsone, Rifampicin and Clofazimine for twelve months. This regimen is known as multidrug therapy, and is necessary to minimize the risk of addiction to antibiotics. When Dapsone was used independently to treat leprosy, the body quickly got used to the medicine and the treatment was not effective. The combination of drugs is very in an efficient way treatment, with a low relapse rate and no known cases of resistance to treatment. Paucibacillary or tuberculoid leprosy can be treated with Dapsone and Rifampicin alone for a shorter period of six months. The dosage recommended by the World Health Organization (WHO) is as follows: World Health Organization (WHO)

In the United States, leprosy is treated in a different way:

If desired, a single leprosy lesion can be treated using a single dose of Rifampicin, Ofloxacin and Minocycline. This is an effective and cost-effective way.

Drink plenty of water. Drinking plenty of water helps the body rid itself of toxins produced by the bacteria that cause leprosy.

1. Treatment of recurrent leprosy. Recurrence rates range from 0.65 to 3.0% for oligobacillary leprosy and 0.02 to 0.8% for multibacillary leprosy. Relapses should be treated as follows:

   • If relapse occurs after a course of multidrug therapy: Start another course of multidrug therapy.
   • If relapse occurs after Dapsone monotherapy: begin a course of drug therapy using multiple drugs.
   • If relapse occurs after Dapsone monotherapy followed by a course of drug therapy with Dapsone and Rifampicin alone: ​​take Clofazimine 50 mg daily for 24 months plus two of the following for six months: Ofloxacin 400 mg daily, Minocycline 100 mg daily, or Clarithromycin 500 mg per day; then Ofloxacin 400 mg daily or Minocycline 100 mg daily for the remaining 18 months.
   • Type 2 reactions, also known as erythema nodosum leprosum (ENL), are systemic inflammatory responses affecting the blood vessels and fat layer under the skin, and likely involve decreased immune system resistance or increased function of immune helper T cells. After the addition of clofazimine to drug therapy, cases of ENL became less common. Type 2 reactions can result in red, painful, raised skin lesions that may cause pus and ulcers, fever, inflammation of the nerves, lymph nodes, testicles, joints (especially large joints, usually the knees), kidneys, destruction of red blood cells, or oppression bone marrow, which leads to anemia and inflammation of the liver, which in turn can cause mild abnormalities in liver function tests. Mild cases of ENL are treated with aspirin, and severe cases with 40-60 mg of Prednisolone per day plus antibiotics. For relapses, you should take 100-300 mg Thalidomide per day. Avoid taking thalidomide during pregnancy as it is a potent teratogen. Side effects Thalidomide includes mild constipation, mild leukopenia (decreased white blood cell count), and sedation.
   • To cure leprosy, it is essential to take all three medications while undergoing treatment. Taking only one drug can lead to rapid development of resistance.
   • With adequate treatment, quarantine is not necessary as the disease becomes much less contagious with treatment and is not contagious at all after one month of therapy.
   • Due to the long-standing stigma associated with leprosy (in biblical times, for example, lepers were declared unclean and were isolated and shunned), leprosy can lead to significant stress and social problems for those who suffer from the disease. Seek support from family and friends and seek psychological help if needed.
   • The rationale for treating recurrent leprosy is as follows. It is often difficult to test for drug resistance, especially in countries with limited resources. Thus, if monotherapy was treated, for example, with Dapsone alone, it is believed that a recurrence of leprosy occurred due to the body’s resistance to the monotherapy used. The use of a course of drug therapy with several drugs is considered sufficient when the simultaneous use of two or more drugs to which the patient’s body does not have drug resistance. When leprosy recurs after an adequate course of drug therapy with several drugs, simply repeating the course of drug therapy, as in the case of a new leprosy infection, may help. In case of relapse after using Dapsone, the body is considered to be resistant to Dapsone, but a course of drug therapy consisting of Rifampicin and Clofazimine can be used, since neither of these drugs has been used previously. For relapse after Dapsone monotherapy followed by a course of drug therapy with Dapsone and Rifampicin alone, the leprosy is considered to be resistant to Dapsone because Dapsone monotherapy was given. In addition, since the course of treatment with Dapsone and Rifampicin was used only after monotherapy with Dapsone, the course of treatment with Dapsone and Rifampicin was essentially Rifampicin monotherapy, since the patient was resistant to Dapsone. The same applies to cases of relapse of leprosy with resistance to Rifampicin, which requires a new three-drug regimen.
   • Leprosy is transmitted through airborne transmission during close and frequent contact with untreated leprosy patients. Avoid contact with body fluids of leprosy patients and contact with affected areas of the patient's body.
   • Note that the alternative therapy used in the United States differs from the standard regimen in that Rifampicin is administered daily rather than monthly. Unlike Dapsone, which is less expensive, Rifampin is too expensive a drug to use every day in most countries outside the United States.
   • To prevent leprosy after exposure to a person with leprosy, you can take one dose of Rifampicin, which reduces the incidence of exposure to leprosy by 57% over two years, with the number of people needing treatment being 265 (i.e. 265 people had to undergo treatment to prevent one case of leprosy).
   • Be aware that reactions to leprosy can occur in both treated and untreated patients. The first type of reaction results from a spontaneous increase in cellular immunity and can cause fever, skin inflammation and peripheral nerve damage, resulting in swelling, redness, tenderness and impairment of the nervous system. The first type of reaction is also known as a reverse reaction, since the immune system increases in this reaction, in contrast to the decrease in the nervous system when leprosy changes from tuberculoid to lepromatous. The first type of reaction is treated with systemic corticosteroids, such as Prednisolone 40-60 mg (for adults) or 1 mg/kg (for children) per day for initial stage, and then maintained at a lower dose of 10-15 mg per day for several months. If type 1 reaction does not respond to Prednisone, you may consider applying Cyclosporine 0.1% ointment to the affected skin area, which has been documented to be effective.
   • The incubation period for leprosy (from exposure to a leper until symptoms appear) ranges from six months to ten years, with an average of 5-7 years. The causative agent of leprosy, Mycobacterium leprae, has a very low speed growth (two weeks for double growth).
   • The drug therapy is safe, effective and available free of charge to all leprosy patients worldwide.
   • Also note that for the alternative regimen used in the United States, dapsone monotherapy is administered after completion of a course of multidrug therapy. According to the WHO, this is not a necessary treatment regimen and is used mainly to get patients to come back for re-checks and for patients who do not want to stop treatment. Although Dapsone monotherapy after completion of multidrug therapy is used in some treatment centers, it should be avoided
   • BCG may provide some protection against leprosy and tuberculosis and should be used where the disease is common.
   • Three drugs used in drug therapy act against Mycobacterium leprae in several ways:

   Warnings

   Sources

   1. Sasaki S, Takeshita F, Okuda K, Ishii N (2001). "Mycobacterium leprae and leprosy: a compendium". Microbiol Immunol 45(11):729–36.
   2. New Leprosy Bacterium: Scientists xxxx Use Genetic Fingerprint To Nail "Killing Organism"
   3. G S Kulkarni (2008). Textbook of Orthopedics and Trauma (2 ed.). Jaypee Brothers Publishers. p. 779
   4. "Leprosy" WHO. Retrieved 2010-01-28.
   5. "WHO Communicable Diseases Department, Leprosy FAQ". World Health Organization. 2006-05-25. Retrieved 2010-01-28
   6. Leprosy (Hansen's Disease) Merck Sharp & Dohme Corp. 2009. Retrieved January 29, 2010.
   7. WHO Expert Committee on Leprosy. World Health Organ Tech Rep Ser. 1998;874:1-43.
   8. The Leprosy Unit, WHO. Risk of relapse in leprosy. Indian J Lepr 1995;67:13-26.
   9. Kaimal S, Thappa DM. Relapse in leprosy. Indian J Dermatol Venereol Leprol. 2009 Mar-Apr;75(2):126-35.
   10. Moet FJ, Pahan D, Oskam L, Richardus JH (2008). "Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomized controlled trial." BMJ 336:761.

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

Currently, leprosy has become a curable disease, because antibiotics can destroy its causative agent. In this article we will introduce you to the causes, symptoms and modern methods of treatment of this disease.

There are references to this disease in the Bible, manuscripts of Hippocrates and doctors of Ancient India, Egypt and China. Leprosy was called a mournful disease, because in those days it inevitably led to death. In the Middle Ages, quarantine places were opened for such doomed patients - leper colonies. There they said goodbye to life. Those around him also avoided the patient's relatives, because 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 this, the patient was placed in a coffin, had a funeral service and was taken to the cemetery. After being lowered into the grave, saying the words: “You are not alive, you are dead to all of us,” and throwing several shovels of earth onto 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 dead.

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

Reasons

The causative agent of leprosy is the mycobacteria 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, until the first signs of the disease appear, long time. The incubation period for leprosy can range from six months to several decades (usually 3-5 years).

After this, the patient begins an equally long prodromal (latent) period, manifested in nonspecific symptoms that cannot contribute to the early detection of the disease. This fact, as well as the long incubation period, predisposes to its spread.

Symptoms and types of disease

When infected with leprosy, infection of areas of the body exposed to air cooling is usually observed - 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 deformity.

Changes such as the death of fingers on the extremities are provoked not by pathogenic mycobacteria, but by secondary bacterial infections that occur during injuries, caused by loss of sensitivity in the arms and legs affected by leprosy. Such damage goes unnoticed, the patient does not seek medical help, and the infection leads to necrosis.

Leprosy can occur in 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 low-grade fever);
• weakness;
• skin manifestations (light or dark spots with impaired sensitivity);
• the appearance of areas of skin infiltration;
• joint pain (especially during movement);
• drooping earlobes and the appearance of a fold 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 spot with clear contours. With any physical impact on it, 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 becomes sunken, undergoing atrophic changes. Its color can vary 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. Near the lesion, thickened nerves can be felt. 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, clothes) lead to secondary infection and the appearance of neurotrophic ulcers. In some cases, this causes rejection (mutilation) of the phalanges of the fingers.

When the facial nerve is damaged, leprosy is accompanied by eye damage. The patient may develop logophthalmos (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 leprosy. 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, lepromas (nodules). Their boundaries are blurred, and the center is convex and dense. The skin between the lesions thickens.

The first symptoms of the disease often include nosebleeds and difficulty breathing. Subsequently, obstruction of the nasal passages, hoarseness and laryngitis may develop. And when the nasal septum is perforated, the back of the nose is depressed in the patient (“saddle nose”). When the anterior chamber of the eye is infected with a pathogen, 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 nerve damage. In addition to these characteristic symptoms, lepromatous leprosy causes loss of the outer third of the eyebrows. As the disease progresses, the patient experiences enlargement of the earlobes and a “lion face”, caused by thickening of the skin and expressed in distortion of facial expressions and features.

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

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

Dimorphic (or borderline) form

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

Mixed (or undifferentiated) form

This form of leprosy is accompanied by severe nerve damage, most often the ulnar, peroneal and auricular nerves suffer from this process. As a result, loss of pain and tactile sensitivity develops. Violation of the trophism of the limbs leads to a gradual loss of ability to work and disability of the patient. When the nerves 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 in the form. In such cases, red spots with torn edges appear on the body. They do not rise above the surface of the skin and are accompanied by weakness and an increase in temperature to subfebrile.

Diagnostics

An important stage in making a diagnosis is a medical examination.

To diagnose leprosy, your doctor may use several techniques. In this case, an obligatory part of the patient’s interview is to establish places of stay and contacts over the past few years.

The examination plan for a patient with suspected leprosy includes:

• inspection and survey;
• scraping of the oral or nasal mucosa;
• Minor's test to detect decreased sweating in lesions;
• determination of skin sensitivity;
• nicotine test to detect skin reaction to nicotine;
• lepromin test (injection 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. To perform it, 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 ​​necrosis) appears. The appearance of these signs is a positive result and indicates the tuberculoid form of leprosy, and if the result is negative, it indicates the lepromatous form or the absence of the disease.

Treatment

Treatment of patients with leprosy is always carried out in a specialized infectious diseases hospital, and after discharge they must undergo regular medical examinations. Its effectiveness largely depends on the timely initiation of therapy at the earliest stages of the disease, i.e., at the time the fact of possible infection is determined. However, in practice, patients more often seek medical help at those stages when symptoms begin to progress. This fact can lead to complications of the disease and its residual manifestations, such 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. IN different countries Medication regimens may vary slightly.

The etiotropic drug therapy plan may include the following:

• drugs of the sulfonic group: Dapsone, Diaminodiphenylsulfone, Sulfetron, Sulfatine, etc.;
• antibacterial agents: Rifampicin (Rifampin), Ofloxacin, Minocycline, Clofazimine, Clarithromycin, etc.

The World Health Organization recommends combination therapy regimens for all forms of leprosy. For tubercoloid leprosy - Dapsone once a day and Rifampin once a month for six months, and for lepromatous leprosy - Clofasamine and Dapsone once a day and Rifampin once a month for 2 years until negative skin biopsy tests.

Etiotropic treatment is supplemented by taking Rutin, vitamin C, B vitamins and antihistamines (Suprastin, Loratadine, etc.).

In some cases, to inhibit the growth of mycobacteria and accelerate the regeneration of the skin, the patient is prescribed to take Chaulmugra oil (from chaulmugra seeds). This remedy should be taken in gelatin capsules, which protect the gastric mucosa from unwanted irritant effects.

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 red blood cells and hemoglobin decreases. To eliminate these signs of anemia, the patient needs to organize 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 visual, respiratory, nervous and musculoskeletal systems, consultations with such specialists are recommended.

Leprosy (leprosy) is an infectious disease that affects the skin and peripheral nervous system person. The disease leprosy is considered one of the oldest diseases, mentions of which are found in Old Testament. In those days, people with leprosy were considered “unclean.” Healthy people shunned them, they were persecuted and deprived of the right to a normal life. The peak incidence of leprosy occurred in the 12th-14th centuries, when the infection affected the population of almost all European countries.

To combat leprosy, medieval aesculapians used numerous leper colonies - institutions that identified and treated lepers. Initially, leprosy patients were located on the territory of monasteries, where they were allocated houses and plots for agricultural activities. In fact, the unfortunate people lived in a kind of reservations and did not have the opportunity to communicate with the rest of the world. However, then the isolation of leprosy patients was completely justified and bore fruit. By the 16th century, leprosy had disappeared from Europe. Isolated cases of the disease were recorded for some time on the Mediterranean coast and Scandinavia, but large-scale epidemics never developed.

Today we know almost everything about leprosy. Contrary to popular belief, the infection is not transmitted by simply touching a patient and does not always lead to death. It is known that the disease leprosy threatens only 5-7% of people, and the remaining inhabitants of the Earth have stable immunological protection against the pathogen. As for the method of transmission of infection. In most cases, infection requires prolonged direct skin contact. There is also a theory that leprosy, the symptoms of which can appear 10 years after the infection, enters the body by inhaling 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 leprosy patients registered in the world and many of them have not had any skin contact with infected people.

What causes leprosy?

The disease leprosy is caused by rod-shaped microorganisms - Mycobacterium leprae. They were discovered in 1874 by the scientist G. Hansen. These microorganisms have properties close to those of tuberculosis, but do not have the ability to multiply in nutrient media and often do not show themselves 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, poor diet, contaminated water or poor living conditions.

A long incubation period and an equally long latent period often lead to the fact that when leprosy is diagnosed, treatment 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 affects mainly the skin;
• tuberculoid - for the most part the disease affects the peripheral nervous system.

There is also a borderline form of leprosy, 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 clearly defined spot, which gradually increases in size;
• absence of hair follicles and sweat glands on the affected skin surface;
• thickened nerves can be clearly felt near the spot;
• muscle atrophy;
• formation of neurotrophic ulcers on the soles;
• contractures of the hands and feet.

As the leprosy disease progresses, the symptoms of the disease also increase. Over time, patients develop phalangeal mutilation, 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. Late stages of the disease are characterized by distortion of facial features, enlargement of the earlobes, nosebleeds, and difficulty breathing. Leprosy patients also suffer from laryngitis, hoarseness and keratitis. Infiltration of pathogens into testicular tissue leads to infertility in men.

Treatment of leprosy

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

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

Of course, researchers are not going to stop there and are looking for more effective ways to combat leprosy that will reduce treatment time and reduce the severity of symptoms in severely ill patients.

Video from YouTube on the topic of the article:

Leprosy (leprosy) is a chronic infectious disease manifested in granulomatous inflammation of the skin and peripheral nerves, less commonly, the eyes, nasopharynx, oropharynx, hands and feet. Granulomatous inflammation, or granulomatosis, is the formation of nodules (granulomas) as a result of accelerated reproduction and degeneration of leukocytes responsible for “devouring” pathogens (phagocytosis). Leprosy is caused by mycobacteria: Mycobacterium leprae And Mycobacterium lepromatosis.

In ancient and medieval times, leprosy affected millions of people around the world. Now up to 300 thousand people fall ill with leprosy every year, mainly in developing countries with tropical climates.

The source of leprosy infection is a sick person who is not receiving treatment. Mycobacteria enter respiratory tract a healthy person with saliva, mucus during sneezing and coughing, as well as during close contact between people.

Symptoms of leprosy depend on the clinical form of the disease.

In lepromatous leprosy, there are extensive and symmetrical skin lesions in the form of spots, plaques and nodules (lepromas) with a dense convex center and vague borders. Due to thickening of the skin, deformities gradually form, in particular, the “lion face”.

With tuberculoid leprosy, a weakly pigmented spot with clear contours and decreased skin sensitivity. Then the spot enlarges, its edges rise and become ridge-shaped. The central part, on the contrary, sinks and atrophies.

Leprosy is diagnosed based on examination of the patient, identification of the causative agent of infection, as well as morphological examination of a biopsy from the site of the disease, primarily the skin. To determine the clinical type of leprosy, the body's reactivity to mycobacteria of leprosy is determined using the lepromin test (Misuda reaction).

Leprosy is successfully treated with special anti-leprosy antimicrobial agents (dapsone) in combination with antibiotics (rifampicin, minocycline, ofloxacin, etc.), and anti-inflammatory drugs.

The prognosis with timely and correct treatment is favorable - the patient recovers completely.

Without treatment, leprosy is complicated by obstruction of the nasal passages, hoarseness of voice, perforation of the nasal septum, deformation of cartilage with retraction of the nasal dorsum (saddle nose), vascular obstruction and, as a consequence, trophic ulcers, AA amyloidosis, male infertility, loss of fingers, blindness, etc. Complications from internal organs: , .

There is no vaccine for leprosy. Prevention of leprosy comes down to early detection and isolation of patients, timely treatment and full rehabilitation of patients; normalization of living conditions, proper nutrition, strengthening the immune system.

Causes of leprosy and modes of transmission

Leprosy is caused by bacteria from the genus Actinomycetes: Mycobacterium leprae And Mycobacterium lepromatosis.

The infection enters the respiratory tract of a healthy person when a person with leprosy sneezes and coughs, as well as during close contacts between healthy and sick people. The likelihood of developing the disease increases due to pathological factors:

• poor living conditions;
• malnutrition leading to dystrophy;
• weakened immunity, in particular with;
• living in the tropics.

Leprosy symptoms; clinical forms of leprosy

The incubation period (from infection to the appearance of typical clinical symptoms) lasts a long time: from six months to forty years (on average 2-5 years).

In approximately half of the cases, the appearance of typical symptoms is preceded by general nonspecific symptoms of leprosy: weakness, decreased performance, drowsiness, feeling of chilliness, tingling, burning of the skin, etc.

Granulomatous inflammation in most cases develops on the skin of the face, ears, elbows, wrists, buttocks and knees. The mucous membranes of the nasopharynx and oropharynx and superficial nerves are also affected.

There are 4 clinical types of leprosy.

Lepromatous leprosy- extensive symmetrical skin granulomas in the form of spots, plaques and nodes with unclear boundaries. The center of the granuloma is convex and dense. There is also thickening and compaction of the skin between foci of inflammation. A typical sign of lepromatous leprosy is loss of the eyebrows in the outer third.

Gradually, the foci of granulomatous inflammation thicken; When the skin of the face and ears are affected, the features are distorted, facial expressions suffer - a “lion face” is formed. Characterized by enlargement of the inguinal and axillary lymph nodes, which are not painful.

When infection enters various organs and systems, keratitis, iridocyclitis, gynecomastia, and testicular sclerosis develop, leading to infertility. Due to damage to peripheral nerves, the sensitivity of the skin, primarily the hands and feet, decreases.

Tuberculoid leprosy- the appearance on the skin of a weakly pigmented, insensitive spot with clear contours. Over time, the central part of the spot becomes thinner and sinks, and the edge part, on the contrary, thickens and rises - a skin ridge with a pattern resembling rings or spirals is formed. Near the skin patch, thickened nerves can be felt. Damage to the nerves leads to gradual muscle atrophy with the development of contracture and shortening of the phalanges of the fingers.

With inflammation of the facial skin and concomitant partial paralysis of the facial nerve, lagophthalmos is formed (impossibility of completely closing the eyelids) and, as a result, keratitis, a corneal ulcer.

Border leprosy- average between lepromatous leprosy and tuberculoid leprosy.

Indeterminate leprosy (undifferentiated leprosy)- subtle skin lesions with reduced skin sensitivity and pigmentation disorders, which in 40% of cases spontaneously disappear after 1-2 years.

Leprosy reveals.

The diagnosis is made based on examination of the patient, microscopic and bacterioscopic examination of the affected area, primarily the patient’s skin. Microscopic examination of the biopsy specimen reveals diffuse granulomatous inflammation.

In case of lepromatous leprosy and indeterminate leprosy, Mycobacterium leprosy is absent in the biopsy specimen - special techniques are required: precipitation reactions and compliment binding reactions.

Leprosy treatment

Upon initial detection of leprosy, hospitalization in a specialized infectious diseases hospital will be required. The duration of inpatient treatment reaches 6-12 months - until Mycobacterium leprosy is no longer detected in tests.

The basis of treatment is the destruction of mycobacteria leprosy using antimicrobial drugs. Usually the basic drug dapsone is prescribed in combination with antibiotics, in particular rifampicin.

To relieve inflammation, acetylsalicylic acid and non-steroidal anti-inflammatory drugs, for example, ibuprofen, are used. For intense granulomatous inflammation, glucocorticosteroids - prednisolone - are prescribed.

It is also necessary to establish and strengthen the immune system with the help of immunomodulators. If leprosy is suspected, consult with. Contact the doctors of the medical video consultation service website. how our doctors answer patients' questions. Ask a question to the service doctors for free, without leaving this page, or . at the doctor you like.