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LEPROSY(leprosy), a chronic infectious disease usually affecting the skin and peripheral nerves. Contrary to prejudice, leprosy is not transmitted by the simple touch of a sick person and is not always fatal. Only 5 to 10% of people at risk of contracting leprosy actually become ill with it, since most people have a sufficient level of immunological protection against the pathogen, and in addition, its pathogenicity, i.e. the ability to cause disease is relatively low. It has long been known among doctors that the spread of leprosy occurs as a result of prolonged direct skin contact. However, many modern researchers believe that infection is also possible by inhaling bacteria that enter the air from the patient’s nasal cavity or mouth.

There are two main types of leprosy: lepromatous, which mainly affects the skin, and tuberculoid, which mainly affects the nerves. There are also erased and borderline forms of the disease, but they can be considered intermediate, with a tendency to develop into one of the two main types.

Geographical distribution and frequency.

Currently, leprosy occurs mainly in the tropics and subtropics; in areas with colder climates it is rare. The disease is common in Africa and Asia (especially in India), in Spain and Portugal, in countries former USSR and Korea, in Japan and the Philippines, as well as in the countries of Central and South America. In the United States, leprosy patients are found along the Gulf Coast, Southern California, and Hawaii. Leprosy is not a widespread disease, but according to WHO, about 11 million people suffer from it in the world, among whom there are three times more men than women. Children are more susceptible to leprosy than adults.

Pathogen.

Leprosy is caused by rod-shaped microorganisms Mycobacterium leprae, discovered in 1874 by G. Hansen. The incubation period from infection to manifestations of the disease can last from 2 to 20 years, but in most cases the first symptoms appear after 3–10 years. Leprosy mycobacteria are similar in properties to tuberculosis bacteria, but are unable to grow on artificial nutrient media, which made the study of leprosy difficult. In 1957, Charles Shepard was the first to cultivate them in the paw pads of laboratory mice. In 1971, the armadillo was discovered to be susceptible to leprosy infection. Dasypus novemcinctus and it began to be used to obtain large quantities of mycobacteria leprosy for experimental purposes.

Symptoms.

Leprosy mainly affects air-cooled body tissues: skin, mucous membrane of the upper respiratory tract and superficial nerves. In untreated cases, skin infiltration and nerve destruction can lead to severe deformation and deformity. However, Mycobacterium leprosy itself is not capable of causing death of the fingers or toes. Loss of body parts due to tissue necrosis is caused by secondary bacterial infection when insensitive tissue is injured and goes unnoticed and untreated.

Of the two types of leprosy, lepromatous leprosy is more severe. Mycobacteria multiply profusely in the skin, causing the formation of nodules called lepromas and sometimes scaly plaques. Gradually, the skin thickens, large folds form, especially on the face, which takes on a resemblance to a lion's muzzle.

With leprosy of the tuberculoid type, flat scaly spots of a reddish or whitish hue appear on the skin; in the affected areas, thickening of the nerve sheaths occurs, which, as it progresses, leads to local loss of sensitivity. Damage to large nerve trunks can result in destruction of bones and joints, which is usually limited to the extremities. With leprosy of the tuberculoid type, spontaneous recovery is possible.

Treatment.

Sulfonic preparations have replaced chaulmugra oil, which has been used for centuries in the treatment of leprosy. The therapeutic effect of sulfones appears only after long-term use. They cannot be classified as specific therapeutic agents, but in most cases they are able to stop the development of leprosy. In mild cases, the patient can recover as a result of two years of therapy, but in severe cases, recovery may require at least eight years. However, in the early 1980s, the emergence of strains of Mycobacterium leprosy that were resistant to dapsone (diaphenylsulfone), which had been the main treatment for leprosy since the 1950s, was noted. Therefore, it is now often used in combination with other drugs. For the lepromatous type of the disease, clofazimine is also widely used.

Prevention.

There are currently no ways to prevent leprosy. However, promising research is underway to improve a vaccine containing killed Mycobacterium leprosy; its effectiveness has been demonstrated in experiments on mice and armadillos.

Story.

Leprosy, according to general belief, is one of the oldest diseases. It is mentioned in the Old Testament, but most modern researchers believe that in biblical times leprosy was a name for a number of skin diseases that made the patient “unclean.” In the Middle Ages, those suffering not only from leprosy, but also from many other diseases, such as syphilis, were considered “unclean.”

From 12th to 14th centuries. The incidence of leprosy reached its peak in Europe, then began to fall rapidly and by the end of the 16th century. disappeared in most European countries, with the exception of the Mediterranean coast, a number of regions of Russia and Scandinavia.

Leprosy was brought to America by the first colonists from Spain, Portugal and France. The new rise in incidence was caused by the African-American slave trade, which led to the emergence of leprosy in some areas of the Western Hemisphere.

Despite the fact that this disease was previously considered incurable and deadly, modern medicine has medicines to treat leprosy. With the help of antibiotics, you can get rid of the disease in a few months.

The causative agent of leprosy is the bacterium Mycobacterium leprae. It multiplies very slowly in the human body. The science of microbiology studies it. The causative agent of the disease is similar to Mycobacterium tuberculosis. In microbiology, Mycobacterium leprae was discovered in 1874.

Another name for leprosy is Hansen's disease (after the scientist who discovered the bacterium Mycobacterium leprae).

The incubation period ranges from 2 to 20 years, meaning symptoms of leprosy may appear 20 years after infection. On average, the disease makes itself felt after 3-10 years.

Kinds

There are 4 types of leprosy:

• lepromatous (black leprosy);
• tuberculoid (white leprosy);
• undifferentiated;
• mixed.

These varieties differ in the number and location of ulcers.

Lepromatous

This variety is characterized by the rapid proliferation of bacteria, which causes the formation of nodules (lepromas) or plaques with a scaly surface on the skin. The skin thickens and folds appear.

A characteristic symptom of the lepromatous form is the “lion's face”.

Leprosy has a complex course. Eyebrows fall out, facial features are distorted, facial expressions are disrupted, the back of the nose sinks, and earlobes grow.

With this type, not only the skin and nerves are affected, but also the lymph nodes, the mucous membrane of the eyes and internal organs. The first symptoms are:

• nasal congestion;
• nosebleeds;
• labored breathing;
• hoarseness, laryngitis;

The most commonly affected areas are the face, wrists, elbows, buttocks, knees, kidneys and genitals.

Black leprosy is the most contagious and dangerous as it can be fatal.

Tuberculoid

In this form, the skin and peripheral nerves are affected, the internal organs remain untouched.

Leprosy begins with the appearance of red or white spots on the skin with clear contours, sometimes covered with scales. Over time, they increase in size and rise above the surface of the skin; their middle, on the contrary, sinks. In this area, the hair turns white and falls out, the skin loses sensitivity.

Damage to the nerves leads to muscle atrophy, this is especially felt if the limbs are affected. Destructive changes in bones and joints occur.

Symptoms of tuberculoid leprosy may disappear on their own.

This type of disease is most often localized on the hands and feet.

Undifferentiated

There are no typical skin manifestations. Symptoms include polyneuritis with paralysis and ulceration of the limbs.

Mixed

This type includes features of lepromatous and tuberculoid leprosy.

Symptoms

The first signs appear on the skin. The color of the skin changes, nodules, spots, papules and bumps appear. Further, the mucous membranes of the mouth, eyes and nose are affected, as well as the nerves that are located on the surface of the skin. The sensitivity of nerve endings disappears.

The pathological anatomy of leprosy (pathological anatomy of the disease) looks like this: first of all, those areas of the skin that are constantly in contact with air (face and hands) are affected. The formations can be seen on the ears, elbows, wrists and buttocks.

In advanced cases, the deep layers of the skin are affected, the symptoms of leprosy look like this:

• skin ulcers, tissue necrosis;
• loss of eyebrows and eyelashes;
• rashes on the mucous membranes of the nose and mouth;
• deformation of the face or limbs due to nerve damage and tissue death;
• numbness of the limbs;
• vascular disorders;
• enlarged inguinal and axillary lymph nodes.

The patient experiences malaise and weakness. In later stages, the earlobes grow, nosebleeds often occur, and nasal breathing becomes difficult.

If a person untimely applies for medical care, then there is a high risk that he will have external deformities.

Leprosy bacteria are not capable of causing the death of fingers and do not lead to deformation of the appearance. Necrosis develops due to the addition of a secondary bacterial infection, which occurs due to injuries to the skin.

How is leprosy transmitted?

Leprosy is a rare disease, especially in cold climates, but nevertheless affects more than 11 million people worldwide. To avoid getting sick, you need to know how the disease is transmitted. Is leprosy contagious or not?

The causative agent of leprosy is transmitted through contact with the skin of a sick person, but infection can only be caused by prolonged contact. Leprosy can also be transmitted by airborne droplets if the saliva of a patient enters the respiratory tract of a healthy person.

The disease is common in Africa, Asia, Japan, Korea, Central and South America. Children are more susceptible to the bacterium Mycobacterium leprae than adults.

The risk group includes the following categories of the population:

• children;
• people with chronic, complicated infectious processes and diseases;
• patients suffering from alcoholism or drug addiction.

Which doctor treats leprosy?

If you suspect leprosy, you should contact a dermatologist and infectious disease specialist. Consultation with an ophthalmologist and neurologist may be necessary.

Diagnostics

It is impossible to make a diagnosis based on an external examination. The disease must be differentiated from erythema, syphilis, sarcoidosis and herpes zoster.

Diagnosis of leprosy includes laboratory and bacterioscopic studies, namely:

• scraping of skin or mucous membrane;
• puncture of lymph nodes;
• reaction to lepromin (to determine the form of leprosy);
• tests with histamine and nicotinic acid.

Treatment

Leprosy is treated in specialized medical and preventive institutions - leper colonies. Patients with this diagnosis should undergo therapy in isolation from other people. In developed countries, patients with leprosy are no longer admitted to such institutions.

There are 4 leper colonies in Russia.

Treatment of leprosy is a complex process. The sooner a person goes to the hospital, the higher the chances of curing the disease.

The result of treatment depends on the stage of leprosy and the correctness of the treatment regimen. Recovery takes from 6 months to a year. If the patient has a severe stage of leprosy, then treatment is longer.

The basis of drug therapy is antibiotics, NSAIDs and special drugs for leprosy. The type and regimen of antibacterial therapy is prescribed by the doctor individually for each patient.

Drug treatment:

• anti-leprosy drugs (Prothionamide, Pyrazinamide, Clofazimine, sulfone drugs Dapsone, Sulfetron and Dimocyfon);
• antibiotics (Rifampicin, Dapsone, Clarithromycin, Ofloxacin);
• anti-inflammatory drugs (prednisolone and acetylsalicylic acid);
• immunomodulators (Thimogen, Levomizol).

Treatment must be comprehensive. The course can be supplemented with hepatoprotectors, iron supplements, vitamin complexes and BCG vaccination.

The drug Dapsone inhibits the development of the disease.

Sulfone drugs are indispensable for preventing the development of complications, but they cannot be used in the following cases:

• diseases of the liver, hematopoietic organs and kidneys;
• heart defects;
• gastroenteritis;
• organic diseases nervous system.

Thalidomide, a sedative-hypnotic drug that suppresses the immune system, can be used to treat leprosy. It eliminates the symptoms of the disease.

In addition to medications, physiotherapeutic procedures and therapeutic exercises. The main goal of exercise therapy is to prevent the development of neuritis, contractures and amyotrophies.

Some patients require the help of a psychotherapist.

Complications

The consequences depend on the type of leprosy, its location and the timeliness of treatment. A person may experience the following complications:

• plantar ulcers;
• keratitis, laryngitis;
• chronic nosebleeds due to nasal deformity;
• corneal ulcer, lagophthalmos, glaucoma, blindness;
• distortion of appearance, facial deformation, mutation of phalanges, twisting of limbs;
• renal failure;
• erectile dysfunction and infertility in men.

A person with leprosy loses sensitivity and is often injured, which makes his appearance even more unattractive.

If the patient does not seek medical help, necrotizing vasculitis develops, so death is inevitable.

Prevention

Preventive measures:

• strengthening immunity;
• balanced diet;
• improving quality of life;
• prevention of infectious and inflammatory diseases;
• maintaining a healthy lifestyle.

Leprosy is a completely curable disease, but only those who seek diagnosis and treatment in time have a chance of recovery. We must not forget that this disease has a high probability of disability and death.

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Leprosy is an outdated name for the disease; today the term “leprosy”, or Hansen’s disease, hansenosis, or hanseniasis, is more relevant. This infectious disease that affects the skin and peripheral nervous system of humans has been known to mankind since ancient times.

"Damned" outcasts

Leprosy has already been sufficiently studied, and it is known that the disease is not transmitted by a simple touch of the patient and does not always lead to death. But in Medieval Europe, leprosy was feared more than modern people fear of AIDS or cancer.

Photo: www.globallookpress.com

The first mentions of the disease are found in written monuments dating back to the 15th-10th centuries BC. e. It is likely that in ancient times leprosy was confused with other skin diseases, such as psoriasis.

Leprosy inspired fear and disgust, since for a long time it was incurable and led to inevitable disability and death. This is what became the basis of prejudices, leprophobia and discriminatory attitudes towards patients.

Treatments of that time, such as gastric cleansing and bloodletting, were powerless.

The peak incidence of leprosy occurred in the period from the 12th to the 14th centuries, when the infection affected the population of almost all European countries.

The fate of the sick was clear - they inevitably became outcasts, the leper was considered “cursed.” The sick were deprived of all social rights, they were forbidden to enter the church, visit markets and fairs, wash in or drink running water, touch other people's things, eat near or even talk to uninfected people while standing against the wind.

Leprosy in one of the spouses was considered a legal reason for divorce; when the first signs of leprosy appeared, the person was buried in church as if he were dead, and a symbolic funeral was held, after which the patient was given special clothing - a heavy robe with a hood. Lepers were required to warn of their appearance with a horn, rattle, bell, or shouts: “Unclean, unclean!”

With the advent of the first leper colonies, the life of leprosy patients acquired a more civilized appearance. Leper colonies were places where sick people lived; usually they were located near monasteries.
By the end of the 16th century, leprosy had disappeared from most European countries. Why exactly leprosy has receded is not entirely clear, but many see the reason in the plague epidemic, which primarily affected the weakened bodies of people already suffering from leprosy.

The rise in incidence was noted only during the heyday of the African-American slave trade. Today, leprosy is most widespread in Africa, Asia and South America. In America, patients are treated only on an outpatient basis; in Russia, cases of the disease are detected every few years, but there are four leper colonies in the country.

Gerhard Hansen and Raoul Follero

Two people played a significant role in the history of this disease. Gerhard Hansen, a Norwegian physician, is famous for discovering the causative agent of leprosy in 1873. He announced the discovery of Mycobacterium leprae in the tissues of all patients, but he did not recognize them as bacteria and received little support from his colleagues. Later it turned out that mycobacteria leprosy are similar in their properties to tuberculosis, but are not capable of growth on artificial nutrient media, which made it difficult to study leprosy.

“The Saint Francis of the 20th century” was the name given to Raoul Follero, a French poet, writer and journalist who dedicated his life to the fight against leprosy and discrimination against those affected by it. In 1948 he founded the Order of Charity and in 1966 the Federation of European Leprosy Associations.

It is thanks to him that since 1953, World Leprosy Day has been celebrated on January 30. In another way, this date is called “Leprosy Rights Day.”

In addition, there are cases where doctors infected themselves in order to find out the patterns of development of this terrible disease. So, in the middle of the 19th century, the doctor Daniel Cornelius Danielsen experimented for 15 years, injecting himself with the blood and pus of lepers, but he never succeeded in becoming a leper.

Contrary to prejudices

Leprosy is not transmitted by the simple touch of a sick person and is not always fatal. Only about 10% of those exposed to the disease actually become ill. Most people have the necessary level of immunological protection against the pathogen.

Infection mainly occurs due to prolonged direct skin contact, less often through inhalation of bacteria entering the air from the patient’s nasal cavity or mouth. There are versions that only 30% of people are clinically susceptible to leprosy and that the disease itself is genetically determined. But, despite the fact that some features of the disease are still the subject of debate among scientists, two main types of leprosy are known:

The face of a 24-year-old leprosy patient. 1886 Photo: wikipedia.org

Lepromatous- affects the skin where mycobacteria multiply, causing the formation of nodules called lepromas. Large folds gradually form, and the patient develops a “lion’s face.” When lepromas disintegrate, the nose becomes deformed and the phalanges of the fingers begin to fall off. This is the most severe and malignant form of the disease.

Tuberculoid- mainly affects the skin, peripheral nerves, and sometimes internal organs. Skin lesions are insensitive, asymmetrical, and reddish-brown in color. Tuberculoid leprosy is 40 times less contagious than the leprosy form.

There is also a borderline form of the disease, which usually develops into one of two main types. The juvenile form of leprosy occurs in children and is expressed in many unnoticeable spots on the skin. The indefinite form is the most favorable - several spots appear on the skin, but after a few months the spots disappear, as if the disease goes away on its own.

To make an accurate diagnosis against the background of clinical signs, bacterioscopic and histological examinations are always carried out.

Treatment and personal prevention

In the 50s, sulfone drugs came into practice, which ensured recovery after 2-8 years of treatment. Doctors now have in their arsenal effective drugs for the treatment of leprosy, and with timely diagnosis, the disease is completely cured. But the course duration on average takes about three years. A person is treated either in a leper colony or at his place of residence, if the absence of a pathogen is established.

Prevention of leprosy involves careful adherence to personal hygiene rules. According to Gerhard Hansen himself, cleanliness and soap are the main enemies of leprosy.

Today, leprosy is not a widespread disease, but, according to WHO, about 11 million people worldwide suffer from it. On the one hand, the problem of mortality and the spread of leprosy has been solved, on the other hand, it is important to remember the existence of this disease. And today the problem of late diagnosis is relevant due to the fact that doctors have begun to forget about the possibility of the emergence of individual cases of leprosy. Moreover, the disease leads to severe disability in 42% of cases, and if left untreated, patients with a severe form of the disease die within 5-10 years.

Leprosy was known in ancient times.

It reached its maximum distribution in Europe in the 11th and 12th centuries. Extensive government measures to combat it, mainly in the form of a huge number of special isolation shelters-leper colonies, resulted in a significant reduction in the number of diseases. Currently, leprosy is observed mainly in the form of endemic nests and sporadic, imported cases.

The total number of leprosy patients, according to Rogers' calculations, is approximately 3 million; according to the Hygienic Commission of the League of Nations, it is close to 4 million.

The maximum number of patients occurs in Asia and Africa. In America, it is mainly the northern part of South America that is affected. The islands of Oceania and Polynesia are severely affected.

IN Western Europe There are relatively few people with leprosy.

As a result of the survey and organizational work that began in our country in 1923, about 1,500 patients have now been interned in special leper colonies.

We have small endemic foci: the Volga delta, North Caucasus, Karakalpayuzh, Kazakhstan.

The main leper colonies: in the Leningrad region, in the Moscow region, in the North Caucasus, in Ukraine, in Uzbekistan, in Turkmenistan.

Sporadic (imported) cases of leprosy are observed in a variety of places.

Etiology

The causative agent of leprosy is the Hansen-Neisser bacillus. It has the shape of a long straight or slightly curved stick with pointed ends. It has acid resistance, somewhat weaker than Koch's bacillus, is gram-positive, has a fatty membrane that turns black when treated with osmic acid. It is found in large quantities in the affected tissue (in the cutaneous form of leprosy), often located in heaps like a “pack of cigars” extracellularly in lymphatic crevices and vessels or in cells. In nervous leprosy, the number of rods is extremely small. The most common source of infection is probably nasal discharge, followed by open sores on the skin and oral mucosa.

Prodromal phenomena in leprosy are not very common. They boil down to symptoms of general weakness, anemia, drowsiness, headaches, various, sometimes worsening, sometimes disappearing, paresthesias in the form of increased pain sensitivity, a crawling sensation, tingling in the skin, burning, sometimes neuralgia, sometimes quite severe pain in the joints , lower back, mental depression. Fever is observed quite often, often similar to malarial attacks, with significant increases in temperature - up to 40-41°. Early and often a state of extreme dryness appears in the nasal cavity, accompanied by repeated bleeding for no apparent reason. Sometimes a persistent runny nose develops. Adenitis often appears, especially of the femoral glands. The latter swell quite significantly, are dense, painless, and not prone to suppuration. The listed symptoms in various combinations and unequal intensity can last for several months, even years, unrecognized as manifestations of leprosy and only with the onset of characteristic changes on the skin or in the nervous system for the first time receive a correct assessment.

Clinical picture

It is customary to distinguish:

cutaneous form (lepra cutanea) or, as it is more often called, tubercular form (lepra tuberosa);

nervous (lepra nervosa) or macular anesthetic (lepra maculo-anaesthetica);

mixed (lepra mixta).

Skin form.

Changes in the skin (leprida) during leprosy are varied both in individual patients and in the same patient at different stages of the disease; very often morphologically mixed rashes are simultaneously observed.

Spotted rashes.

Leprosy rashes often begin with the appearance of erythematous spots the size of a little fingernail, similar in appearance to syphilitic roseola. Their color is pink-red, their shape is round, oval or irregular, the surface is smooth, and when pressed with a diascope, newly appeared spots disappear. Over time, their color changes gradually, their pink-red color turns into yellowish, brown. Due to the fact that the rash occurs in repeated outbreaks, big picture becomes variegated: along with the recently appeared pink-red efflorescences, there are dark red, brownish-red, and brown ones. On older spots, fine-plate peeling appears.

Changes in skin sensitivity are peculiar: at first there is clear hyperesthesia on the spots, later anesthesia clearly appears with loss of pain, temperature and, later, tactile sensitivity.

Often the erythematous stage of the spots is very short. Pigmentation disorders in the form of hyperchromia or achromia quickly come to the fore: in the first case, the initial pink-red color of the spots soon turns into ocher-yellow or brown, in the second, the spots become discolored and become completely white. Such spots are mostly larger in size - 2-3 cm in diameter, the size of the palm, and are often located symmetrically or along the course of one or another nerve.

Along with relatively small isolated spots, as a result of their peripheral growth or the merging of neighboring efflorescences, continuous spotted foci sometimes appear, occupying larger areas of the skin, outlined by irregular, often bizarre contours. There is also diffuse, widespread redness, similar at first glance to erysipelas.

With the reverse development of larger efflorescences, ring-shaped elements with a slightly atrophic center and a brownish-red rim along the periphery can be formed.

The most common localization of spotted leprosy: the skin of the face, torso, extensor surfaces of the extremities, and buttocks.

Flow

Spotted rashes in the initial stage of leprosy, usually lasting for quite a long time, disappear without a trace, only to reappear later. There are frequent cases of leprosy, where over a period of years the disease manifests itself on the skin with relapses of exclusively such spotty rashes. But along with this, and even more often, they are replaced by rashes of a different order, consisting of tubercles, more voluminous nodes, superficial or deep infiltrates.

Lumpy rashes.

The main element of tubercular rashes is a peculiar appearance and the development of a nodule, which is given the name “leproma”, or leprosy tubercle. It can appear on completely unchanged skin. This is a hemispherical or slightly flattened nodule, sharply delimited from the surrounding skin, the size of a hemp grain, a lentil to a pea. Its color varies depending on the duration of existence, localization, depth of occurrence in the thickness of the skin, sometimes pale pink with a yellowish nuance, not sharply different in color from the surrounding skin, sometimes deep red with a distinct bluish tint on the distal parts of the limbs, sometimes barely visible through the skin is faded-bluish (on the ears), then yellowish and completely brown if it has been on the skin for a long time.

The surface of the tubercles is smooth, not flaky, often shiny, as if greased with lard. Very often, especially on larger tubercles, telangiectasias are clearly visible. To the touch the tubercles are rather dense, perhaps rather densely elastic. Quite often, hyperesthesia is easily detected - on newly appeared ones, and anesthesia - in the center of tubercles that have already entered the stage of reverse development. The tubercles are located either isolated or merge with each other into more or less large tuberous plaques of infiltrate.

The tubercles can exist without visible changes for many weeks or months. Their reverse evolution proceeds in two ways:

or by “dry” resolution - the tubercle becomes softer, flattens, begins to peel off and eventually turns into a spot, atrophic and pale in the center and pigmented along the periphery;

or at the top of the tubercle an erosion appears with a red granular bottom, little by little deepening and turning into an ulcer, covered with mushroom-shaped granulations at the bottom and surrounded by a dense, sometimes calloused, torn out marginal ridge; the purulent compartment of the ulcer shrinks into crusts. Such ulcers heal with scars, initially pigmented, then discolored.

The localization of the tubercles is varied. More often they are located on the face and extensor surfaces of the limbs.

Leprosy infiltrates.

The initially isolated tubercles tend to transform into more diffuse infiltrates through fusion. The latter often arise directly from spots, which gradually rise above the general level of the skin and turn into plaques with a relatively smooth surface. Finally, in some cases, a diffuse infiltrate develops primarily in apparently normal skin. Coloring, consistency, secondary changes and their reverse evolution are similar to those with isolated tubercles.

Located on the face, namely in the eyebrow area, on the forehead, nose, cheeks, chin, infiltrates give it a completely unique appearance, known under the name facies leonina for its pronounced resemblance to the muzzle of a lion.

With deep infiltrates, the process involves not only the skin in its entire thickness, but also the subcutaneous tissue and can spread to the bones. The accompanying stagnation of lymph and blood causes the development of chronic edema with the proliferation of connective tissue, resulting in the development of elephantiasis, especially in the lower extremities. Deep infiltrates tend to undergo ulcerative disintegration, which can spread to the periosteum, bones, ligaments, resulting in injury. Thus, when the hands or feet are affected, individual phalanges, entire fingers, etc. die and fall off. Subsequent scarring leads to severe disfigurement and significant defects (lepra mutilans).

Leprosy pemphigus.

Leprosy pemphigus is often an early manifestation of nervous leprosy, but also occurs in late period leprosy, both nervous and cutaneous. Recurrent rashes of leprosy pemphigus are quite common. On apparently normal skin, often after previous neuralgic sensations, burning, tingling, large blisters, the size of a pigeon's egg or larger, appear, filled with clear liquid; after several days, the contents of the blisters become cloudy and become purulent. Opened blisters are covered with crusts, under which a relatively superficial ulcer is located. The latter often heals with a depigmented scar; its characteristic feature is anesthesia. The favorite localization of blisters is the extensor surfaces of the elbow and knee joints, hands and feet, less often they appear on the face and other areas.

Hair damage

One of the first signs of leprosy is the loss of eyebrows and specifically the outer half of them. The beard and mustache fall out less frequently, and in most cases the hair on the head is completely preserved.

Lesions of the mucous membranes

The mucous membrane of the nasal cavity is most often affected. It is quite possible that this is where leprosy begins, at least in a significant number of cases. In severe cases of cutaneous leprosy, the lesion is localized here in 90-95%. The most common changes in the mucosa are either limited or diffuse, relatively superficial, sometimes deep and more or less massive infiltrates of a dark red, bluish-red color. They are located mainly on the cartilaginous part of the nasal septum. As a rule, erosions or ulcers soon appear on them, covered with more or less massive bloody-purulent crusts. As a result of these changes, persistent runny nose develops with repeated bleeding, the nasal passages often narrow so much that nasal breathing becomes difficult or even impossible. Ulceration of infiltrates can cause perforation of the nasal septum, and even its complete destruction, the usual consequence of which is the retraction of the nose at the border of the bone and cartilaginous parts of the nose. The bone part, septum and nasal bones are affected much less frequently; the skin of the nose is often preserved.

Quite often the mucous membrane of the oral cavity is affected, in particular the hard and soft palate, and less often the gums, tonsils, and cheeks.

Here, either flat or elevated isolated nodes or merging infiltrates prone to ulceration develop. The tongue is often involved in the process, and either diffuse superficial infiltration or infiltrates deeply penetrating into its thickness are observed, causing a significant increase in the volume of the tongue. On the root and on its edges, especially in the area of ​​the molars, isolated or merging tubercles prone to decay often develop. Often, deep grooves are visible on the surface of a thickened and enlarged tongue, especially in the middle.

The spread of the process to the epiglottis, arytenoid cartilages, false and true vocal cords is not uncommon. Initially, while the infiltration is superficial, the disease of the larynx affects only hoarseness of the voice. With deep infiltrates, their disintegration, successive scarring of ulcers, the matter often ends in complete aphonia, and laryngeal stenosis can occur with all its consequences.

Damage to the lymphatic system

The lymphatic system is often affected even before typical skin rashes appear. Of particular importance is the early swelling of the lymph glands, mainly the femoral ones, they increase in size (up to chicken egg), dense, not painful. The causative agents of leprosy are easily detected in their juice obtained by aspiration with a syringe.

Lymphangitis is also a common occurrence. Tree-like branching dense, thick lymphangitis on the lower and upper extremities, located in connection with the affected lymph glands, have a peculiar appearance.

Diseases of internal organs. Specific diseases of internal organs, in general, seem to be of little character, and usually develop in advanced cases of leprosy.

Leprosy orchitis, or orchipididymitis, is observed in approximately 35% of patients. Most often, the matter begins with the appearance of dense nodules different sizes in the epididymis, which tend to merge into lumpy, almost painless at first infiltrates. Then the same changes develop gradually in the testicle. The course of leprosy orchiepididymitis is chronic. The usual outcome is slowly progressive sclerosis of both the testicle and epididymis, leading to impotence due to azoospermia. Information about ovarian damage is less complete. There is no doubt that they also get sick often, which explains the sterility of many leprosy women. When the disease occurs in childhood, women usually do not experience signs of puberty.

Eye damage

Specific eye disease occurs in 60-75%. Up to 22% of leprosy patients go blind. Leprosy bacilli were found in all parts of the eye during microscopic examination. Most often the iris gets sick, then the cornea, less often the eyelids and conjunctiva. On the conjunctiva there is hyperemia with symptoms of cataracts, and relatively rarely - lepromas. The name pannus leprosus refers to damage to the conjunctiva of the eyeball, resulting in the appearance of flat infiltrates of a yellow-brown color, merging with each other and forming a ridge surrounding the cornea. Diffuse infiltrates and small nodules are found in the sclera. Keratitis punctata and keratitis parenchymatosa develop on the cornea. The most common lesion is iridocyclitis - the main cause of blindness in leprosy. The skin of the eyelids is a frequent localization of leprosy infiltrates: their disintegration and subsequent scarring often result in entropion of the eyelid.

Damage to the nervous system

When describing skin leprosy, we can limit ourselves to only pointing to disorders of skin sensitivity, mentioning, however, that other disorders of the nervous system are no exception here.

Sensitivity disorders of the affected skin, in addition to various types of paresthesia of the prodromal period, consist of a gradual fading of first pain sensitivity, then temperature and, finally, tactile sensitivity. Usually complete anesthesia is observed in the central parts of efflorescence.

In terms of the mental sphere, patients with leprosy often experience various types of disorders, mainly of a depressive nature.

Nervous formLepra nervosa (lepra maculo-anaesthetica, lepra anesthetica).

This form of leprosy also apparently always begins with changes in the skin in the form of the above-described macular or pemphigoid rashes. However, the center of gravity in the clinical picture is occupied by disorders of the nervous system, which are based on peripheral neuritis and polyneuritis. Most often, the superficial nerves of the forearm and cervical plexus are affected; when palpated, the nerve trunks sometimes appear as very sharply thickened cylindrical cords or have numerous knotty swellings like a string of beads. Often their thickening is so significant that they, lifting the skin in the form of elevated strands, are determined simply by the eye, without palpation. The affected nerves, at first painful, then become insensitive to pressure with the development of anesthesia.

Neuritis causes a number of disorders. Neuralgia is often observed, extremely severe and persistent. Initially, a distinct hyperesthesia is detected on the skin along the path of the diseased nerve, sometimes it is limited to certain areas of the skin, especially in the area of ​​rash elements. Neuralgia usually lasts a long time, until the infiltration of the nerve trunks undergoes reverse development and the latter turn into dense connective tissue strands that are completely insensitive to pressure. Hyperesthesia usually gives way to anesthesia relatively quickly. The latter is most often observed on the limbs, but can spread to the entire skin; it often turns out to be symmetrical, affecting all limbs, and, appearing for the first time on the distal parts, gradually rises upward. Quite often, anesthesia is determined on individual segments of the body - in the form of a “belt” on the chest, abdomen or lower back, sometimes symmetrically on both buttocks. The border of anesthesia is usually blurred. The most common is loss of pain sensitivity. Analgesia is often combined with thermal anesthesia - a circumstance that explains such common, sometimes deep burns in patients with leprosy. Loss of tactile sensitivity is much less common. The sense of movement and space in the vast majority of cases is fully preserved, so ataxia in leproses is an exceptional phenomenon. Perversions of sensitivity are not uncommon, for example, a hot object is felt as cold and vice versa. Next is a delay in sensations: a hot object first gives a sensation of touch and only later - warmth.

Movement disorders develop later than sensory disorders and are manifested by muscle atrophy, mainly of the limbs and face. The lesion can also be symmetrical, but this is not the rule; the extensors become more ill. On the extremities, the small muscles of the hands and feet atrophy first, then the forearms and legs. On the hands, atrophy begins with the muscles of the thumb, little finger and interosseous, especially between the thumb and index fingers, due to less damage to the flexors, they gain an advantage over the extensors, and the fingers take on a claw-like position. On the lower extremities, the muscles of the sole are the first to be affected. On the face, the orbicularis eyelid muscle very often undergoes atrophy, as a result of which lagophthalmus develops - the inability to voluntarily close the palpebral fissure. Atrophy of the facial muscles sharply affects facial expressions: it takes on a sad, motionless, mask-like expression.

Damage to the lip muscles causes speech disorder, pronunciation becomes slurred, especially labial sounds.

Trophic disorders occupy a prominent place in the clinical picture of leprosy. Already at the very beginning of the disease, various violations of this order appear on the scene. It was mentioned above about increased sebum secretion, which gives the picture of seborrlioeae oleosae, when the skin appears oily, abundantly lubricated with lard. This hyperfunction of the sebaceous glands is replaced in the further course of the disease by hypofunction, a decrease or even cessation of sebum secretion. As a result of the latter, the skin becomes dry, loses its elasticity, and cracks easily. Completely similar disorders are observed in the sweat glands; the initial excessive sweating is later replaced by anidrosis. Trophic disorders include depigmentation, which is common, especially in the nervous form of leprosy, resembling vitiligo, differing from the latter in the anesthesia of discolored spots. Further, mutilations of the hands and feet, developing not through ulcerative disintegration of leprosy infiltrates of the skin and deep-lying parts, as is the case with tubercular leprosy, but through gradual softening and resorption of the bones of the phalanges without destruction of the skin. As a result, the feet and hands often take on the peculiar shape of a seal's paw, and it goes without saying that the functions of the limbs are more or less severely impaired.

A very common trophic disorder is perforating foot ulcers, characterized by their significant depth, extremely torpid course and complete anesthesia.

Mixed form (Lepra mixta).

This name refers to those cases of leprosy where specific changes in the skin in the form of pronounced tuberculate rashes and infiltrates are combined with more or less strongly developed changes in the nervous system. It is impossible to draw a sharp line between cutaneous and nervous forms of leprosy. It is only a matter of a simple predominance of either skin or nervous symptoms.

Course of leprosy

The exception is the rapid course of leprosy: with high fever and rapidly increasing cachexia, the disease ends in death after a few months. As a rule, leprosy in its course is an exclusively chronic disease, dragging on for many years, even several decades.

The average duration of the course of the cutaneous form of leprosy is 10-11 years, and the nervous form of leprosy is 17 years, but cases that drag on for 20-30 or more years are not uncommon. During the course of the disease, repeated improvements and exacerbations are observed. Remissions are sometimes so significant that the subjective and objective symptoms of leprosy disappear completely. Exacerbations are characterized by attacks of fever with chills and increases in temperature (from a few tenths of a degree to 40° and above - sometimes like a fever, sometimes with sharp fluctuations during the day up to 2-3°), increasing weakness, increased neuralgic phenomena, hyperesthesia, and the appearance of new rashes and exacerbation of existing rashes. The duration of periods of exacerbation is very diverse - from several days to many months. Their frequency and intensity are also not the same. In some cases, the course of the disease is characterized by exceptional torpidity and uniformity, with little effect on the general condition of the patients; in others, frequent and sharp exacerbations greatly weaken the patients, leading to steadily increasing cachexia and death.

Histopathological picture

The histopathological picture of lepra cutanea is peculiar. In fresh leproma, under the preserved and almost unchanged (slightly atrophied in some cases, or moderately acanthotic in others) epidermis, a cellular infiltrate is located in nests. Between it and the epidermis a narrow layer of fibrous connective tissue of normal structure is usually visible. Narrow shoots extend from it deep into the dermis, separating the nests of infiltrate from each other. The infiltrate can occupy the entire length of the skin, from the area of ​​smoothed papillae to the subcutaneous tissue, inclusive, where it spreads through the layers between the fatty lobules. It consists mainly of epithelioid cells, fibroblasts, in smaller quantities - lymphocytes, a few plasma cells and mast single giant cells and, finally, of a large number of completely unique cellular elements, known as leprosy cells. These are large cells of various shapes with foamy protoplasm, in which numerous vacuoles are visible; the nucleus is pale, poorly colored, often flattened, located mostly at the edge of the cell and is often completely invisible. When staining preparations using special methods (for example, according to Ziehl), it turns out that the vacuoles of leprosy cells are filled with Hansen's bacilli, some completely preserved, some disintegrated. The number of bacilli, as well as the cells filled with them, is colossal. These formations are pathognomonic for leprosy. In addition, the causative agents of leprosy are found either in groups or in the form of single specimens. They are located either in the lumen of lymphatic slits and blood vessels, in endothelial cells, or lie completely free outside the cells.

The skin stroma within the infiltrate is very sparse, preserved only in the form of thin bundles of connective tissue fibers. Skin appendages - hair follicles, sebaceous and sweat glands, as a rule, atrophy, often even disappear completely. The blood vessels are either dilated and filled with blood, or their walls are thickened as a result of more or less severe endo- and perivasculitis. Often it comes to complete obliteration of the lumen of blood vessels.

In addition to the usual picture of leproma just described, one can, although much less frequently, encounter the tuberculoid structure of a granuloma, quite similar to what we are used to seeing with tuberculosis.

With lepra nervosa the changes are different. Here, as a rule, there are no pathognomonic leprosy cells. Hansen's bacilli are found relatively rarely and in negligible quantities. Perivascular infiltration is in the nature of simple chronic inflammation, consisting mainly of lymphocytes, plasma cells, a small number of polynuclear cells, single mast cells, and multiplied connective tissue elements. Sometimes infiltrates of a tuberculoid structure are found. Changes in the nerves of the skin boil down to the picture of interstitial neuritis; they begin with a slight thickening of the perineurium due to its infiltration by lymphocytes and plasma cells; later the infiltrate moves to the endoneurium. Consistent cicatricial degeneration of the infiltrate leads to the death of nerve elements. Hansen's bacilli, and then in single copies, are found only at the beginning of the process in the connective tissue of the peri- and endoneurium, located intracellularly or in the lymphatic crevices.

The prognosis for leprosy is clear from the above: with rational therapy, one can and should count on long-term remissions during the course of the disease, and even on remissions so complete that they clinically border on cure. We do not have an impeccable criterion for curing leprosy. Life teaches us that even after long-term complete remissions, outbreaks of the disease can occur.

Diagnosis

It is not difficult to recognize leprosy in severe cases. Daria is right when he says: “You just need to remember about leprosy so as not to overlook it.” The above-described clinical signs of leprosy and, above all, the peculiar rashes and sensitivity disorders (anesthesia in the first place) should lead one to think about leprosy. Anamnestic data on stay in areas where leprosy is endemic always strengthens suspicions. The final recognition is established based on the results of bacterioscopic examination. Most often, they resort to examining nasal mucus, or rather, scraping from the infiltrated membrane of the nose, obtained with a platinum spatula or loop. In preparations stained by the Ziehl-Neelsen method, Hansen rods, typical in their shape and location, are easily found in most cases of cutaneous leprosy. In the nervous form, the study of nasal mucus often does not lead to the goal. It is very practical to examine the punctate of the femoral or inguinal lymph glands for leprosy rods. Excellent results are obtained by examining smears made from the juice of biopsied lepromas.

Skin leprosy is most often confused with manifestations of syphilis.

Prevention

The main preventive measures against the spread of leprosy have long been considered:

if possible, complete registration of all leprosy patients;

providing every leprosy patient with the opportunity for long-term treatment;

isolation of all cases of so-called “open” leprosy (ulcers, rhinitis, etc.).

Isolation of leprosy patients has been carried out since time immemorial. It was expressed in the organization of special shelters for them - leper colonies, the number of which in Europe alone at one time exceeded 19 thousand. The significance of these events is evidenced by the entire history of the fight against leprosy.

In the USSR, the systematic fight against leprosy on the basis of Soviet medicine begins with the resolution of the Council of People's Commissars of the USSR dated July 10, 1923, entrusting the People's Commissariat of Health with maintaining an accurate record of all leprosy patients and taking care of the mandatory isolation of patients who pose a danger to others in leper colonies or at home in conditions that completely protect against the danger of the spread of infection.

Treatment

There are no absolutely specific remedies against leprosy. The most commonly used oil is chaulmugra oil. It is prescribed orally in increasing doses from 2 to 200 or more drops per day in gelatin capsules due to its unpleasant taste. Long-term use of chaulmugra oil causes severe disorders of the gastrointestinal system - belching, nausea, diarrhea and later constipation due to intestinal atony.

In order to avoid these disorders, subcutaneous and intramuscular injections of oil are used in various combinations. They need to be injected 2 times a week into the subcutaneous tissue or intramuscularly, 1-2 cm3. The disadvantage of these injections is their severe pain. Ethyl esters of chaulmugra fatty acids were obtained by fractional distillation. Currently, a number of such drugs are used in various countries. Of them good results gives mugrol, to reduce violent general and local reactions, 2% iodine is added to it. Injections are prescribed 1-2 times a week at 1.0-5.0. Sodium salts of chaulmugra fatty acids - Natrium gynocardicum and Alepol - have also been obtained. Mugrol is also used in the form of rubbing into the skin at 1.0-3.0.

Rogers extracted soda salt from cod oil - Natrum morrhuatum - and proposed it for the treatment of leprosy. It is used for intravenous infusions 1-2 times a week, 0.5-2.0. The results, judging by the reviews, are mixed. Gamza proposed injections of thymol, which won many adherents. Inject 4.0 intramuscularly every 4 days for a month, then once a week. Inject intramuscularly after 4 days in increasing doses of 0.2-0.4-0.6-0.8 cm3.

Various other means were also used: preparations of gold, copper, antimony, salvarsan, etc. They were not widely used.

Some methods of nonspecific therapy play the role of auxiliary means. These include lactotherapy, peptone therapy, autohemotherapy, freezing leprosy with snow carbonic acid, treatment with naphthalan oil baths, etc.

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

The disease is widespread mainly in tropical countries. At the same time, the largest number of cases of the disease was registered in Brazil, India is in second place, and Burma is in third place. According to data for 2009, about two hundred thousand people suffer from leprosy in the world. In Russia, as of 2007, 600 people were infected, and only 35% of them were in hospital treatment. So “leprosy,” as leprosy is also called, is not such a forgotten disease and there is a risk of getting sick.

Causes of leprosy

Leprosy is caused by the mycobacterium Mycobacterium leprae. The source of leprosy is a sick person. The leading mechanism of infection is aerosol. It has been established that during the day, a patient with leprosy secretes about one million bacteria with sputum. Infection occurs when drops of mucus from a sick person coughing or sneezing enter the respiratory tract of a healthy person. In addition, cases of penetration of the microorganism through microtraumas on the skin and mucous membranes have been described. As a rule, people with reduced immunity, with chronic diseases, as well as those living in unsanitary conditions, have a higher risk of infection.

Mycobacteria enter the bloodstream and settle in various organs. Due to the active proliferation of microorganisms, granulomas are formed. Granulomas are bumps made up of cells of the immune system. Granulomas form on the skin, leading to characteristic changes face and the development of deformities, in the liver, lungs, spleen, kidneys, lymph nodes, muscles. Granulomas in the bones cause thinning of the bone substance and lead to fractures, and the location of granulomas in the area of ​​​​nerve tracts contributes to the death of neurons and the development of paralysis, malnutrition of surrounding tissues.

Leprosy symptoms

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

The disease begins imperceptibly with the appearance of weakness, malaise, drowsiness, lethargy, and weakness. Some patients indicate the appearance of numbness in the fingers, toes, and dense tubercles on the skin. Given the scant external manifestations, the diagnosis of leprosy is early stage is usually difficult.

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

Tuberculoid type of leprosy. The most favorable variant of the course of the disease. In the tuberculoid type, the skin and nervous system are predominantly affected; there is no dysfunction of internal organs. At the beginning of the disease, a single lesion or several (2-5) elements appear on the skin, which represent a spot, papule or plaque. They may be light or somewhat reddish compared to healthy areas of the skin. Subsequently, these elements merge with each other and bizarre lesions are formed with a burgundy outline, a ridge-like raised edge and thinning of the skin in the central sections.

Tumor-like formations may appear on the face and limbs. The skin in the affected area, as well as 1.5-2 cm above the affected area, becomes insensitive and numb. Therefore, injuries and burns often occur, which, if hygiene rules are not followed, fester very quickly.

Damage to the nervous system is a characteristic symptom of the tuberculoid type of leprosy. Near the skin lesions, painful thickened nerve trunks can be felt. The most commonly affected are the radial, ulnar, parotid nerves, as well as branches of the facial nerve. The motor activity of the fingers is disrupted, and characteristic external manifestations such as “bird’s foot” and “drop foot” are formed.

Bird's foot deformity of the hand due to damage to the ulnar nerve due to leprosy

Foot deformity of the “drop foot” type due to damage to the peroneal nerve due to leprosy

Due to malnutrition, the skin becomes brittle and easily vulnerable, and mutilation (spontaneous separation of a dead part of the body) of the limbs develops.

Lepromatous type of leprosy- the most severe form of the disease, in most cases leading 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 demarcation from healthy skin. These spots are lighter in dark-skinned individuals, and reddish in color in light-skinned individuals. It is noteworthy that the sensitivity of the skin in the affected area is preserved. After 3-5 years, hair falls out in the area of ​​the spots, characteristic nodules and tumor-like formations appear. When tumor-like foci are localized in the area of ​​the eyebrows, chin and ears, the face acquires a peculiar appearance, described in the literature as a “lion face”.

Very often, ulcers form on these elements, they become infected, and after healing, rough, ugly scars form at the site of the ulcers. A characteristic sign of the lepromatous type of leprosy is damage to the nasal mucosa with perforation of the nasal septum and changes in the shape of the nose. Often the pathological process spreads to the oral cavity and larynx, which leads to a change in voice.

Over time, sensitivity in the area of ​​the upper and lower extremities is impaired, and in the area of ​​​​the soles and palms, sensitivity remains for quite a long time. In later stages of the disease, contractures of the fingers, mutilations, and long-term non-healing ulcers are formed. Patients experience inflammation of the lymph nodes. Men develop orchitis - inflammation of the testicles with subsequent disruption of their function. In 80% of cases, patients develop eye damage, ultimately leading to blindness. The formation of granulomas in bones leads to dislocations and fractures. Granulomas often form in the kidneys, lungs, liver, and spleen, which leads to dysfunction of these organs.

Borderline types of leprosy combine the features of two main types and are characterized by a milder course.

Diagnosis of leprosy

The disease is considered most likely if one of the following signs is present.
1. Identification of characteristic skin manifestations with loss of sensitivity, regardless of the thickening of the nerve trunks.
2. Determination of mycobacteria when examining the contents of skin lesions. After a shallow skin incision, a scraping is obtained from the area of ​​the granuloma and examined under a microscope. In addition, large quantities of pathogens can be detected by examining mucus from the nasal and oral cavities, as well as the contents of the lymph nodes.

Leprosy treatment

Initially, leprosy was considered a fatal disease. In the Middle Ages, at the first signs of illness, the unfortunate person had to appear in a religious court, which without fail condemned him to death. The patient was taken to church, had a funeral service, then put in a coffin, taken to the cemetery, lowered into the grave and covered with earth with the words: “You are not alive, you are dead to all of us.” After that, they dug them up and took them to the leper colony. He never returned home.

Currently, with timely treatment, a complete cure for leprosy is possible.. Treatment of leprosy is long-term, aimed at destroying pathogens, preventing and treating complications. Patients are hospitalized in specific institutions - leper colonies, and their relatives undergo regular examinations. In the leper colony, patients have houses, farmsteads, and, if desired, they can engage in various crafts. As a rule, medical and service personnel live next to patients, in a conditionally isolated area, for example, by forest planting. Currently, there are four leper colonies in Russia: in the city of Astrakhan, Sergiev Posad branch, in the Stavrapol and Krasnodar regions.

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

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

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

For social adaptation of patients, psychotherapeutic treatment is recommended, as well as the use of orthopedic aids. In addition, to maintain immunity and prevent infectious complications, patients need good nutrition, massage, physical therapy, and physiotherapeutic treatment. Given the impairment of sensitivity in the upper and lower extremities, all patients must be careful to prevent household injuries.

Possible complications of leprosy

Injuries and infections can lead to finger deformation, mutilation, and the development of contractures. When the nervous system is damaged, paralysis occurs. Often, with a long course of the disease, vision is impaired, even to the point of blindness. Granulomas on the face lead to the formation of deformities, and damage to bones and joints contributes to the disability of patients. Granulomas in the internal organs contribute to the development of hepatitis, pneumonia, lymphadenitis, nephritis and pyelonephritis.

Leprosy development forecast

Leprosy itself is not a fatal disease. But the mortality rate for leprosy is four times higher than that of the general population. The cause of death is infectious complications and amyloidosis (deposition of pathological protein during inflammation) of internal organs. When seeking medical help late, patients retain disabling deformities that may require surgical and orthopedic treatment.

Prevention of leprosy

There is currently no vaccine against leprosy. The literature contains a description of the effectiveness of the BCG vaccine against tuberculosis, but no objective evidence has yet been obtained.

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

A patient with leprosy should have a separate bed, dishes, and personal hygiene items. It is necessary to treat ulcers promptly and change bandages regularly. Even after treatment, patients are not allowed to work in children's and medical institutions, as well as at food and utility enterprises, since the disease may return. Persons in contact with sick people are advised to observe personal hygiene rules (washing hands, using gloves, masks when treating ulcers).

The patient's relatives are required to undergo a lepromin test. The lepromin test is an intradermal injection of weakened Mycobacterium leprosy. The appearance of a spot at the injection site, and then its transformation into a tubercle, often with ulceration, indicates a positive reaction. A positive reaction is also typical for healthy people. Such persons are under constant medical supervision with nonspecific treatment aimed at increasing immunity. If there is no reaction, a thorough examination is carried out and preventive treatment antibacterial drugs according to a certain scheme.

General practitioner Sirotkina E.V.