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Leprosy

What is lepreing -

Leprosy (Hansen's disease, Hansenosis, Hanseniasis; Outdated names - leprosy, Elephantiasis Gracorum, Lepra Arabum, Lepra Orientalis, Phoenician disease, Satyriasis, sorrowful disease, Crimea, lazy death, Saint Lazari disease, etc.) - chronic granulomatosis (chronic infectious disease) The Mycobacterium Leprae's mycobacterium and open in the 2008 MYCOBACARIUM LEPROMATOSIS, which flows with preferably leather damage, peripheral nervous system, sometimes the front chamber of the eye, the upper respiratory tract above the larynx, testicles, as well as brushes and stop.

If the etiology of the lepros is known, the pathogenesis of the disease, its epidemiology, the conditions of infection and distribution are not fully studied.

The greatest endemic foci of Lepra exists in Karakalpakia, Kazakhstan, the Lower Volga region, in the North Caucasus, the Far East, in the Baltic States. Periodically, in various places, separate sporadic cases of leprosy are detected. In total, in our country there is a relatively small number of patients whose treatment is carried out mainly in leprosaries. Timely isolation and efficient treatment of patients, identification, treatment of sources of infection and surveys of all contacts with patients, especially household, play. All over the world, for incomplete data, there are more than 10 million patients. In Ukraine, leprosaries are organized for isolation and complete cure of patients with Leproi with returning them to ordinary life.

What provokes / reasons for lepros:

Causative agent lepregesit is Bacillus, open in 1871 by the Norwegian physician G.hansen, the Mycobacteriacea family, named Mycobacterium Leprae Hominis. Bacillus lepros is a gram-positive alcohol and acid-resistant wand painting on cil-nielsen, erlihu and aniline dyes. In recent years, the bacterioscopic diagnosis of leprosy is used by the Martzinovsky method. In the course of the existence of mycobacterium, the leprosy forms A-forms, grainy and filtering forms. In biopsyttes, mycobacteria is found in a significant amount in the form of sticks with a slightly pointed ends, with a tendency to a parallel location in the form of "cigar packs" or clusters in the form of balls surrounded by a transparent gelatin-like shell. Mycobacterium Lepra does not have a capsule and does not form a dispute. Attempts to obtain a pure pathogenic culture of mycobacteria on an artificial nutrient medium, it was not yet possible, possibly vaccinated leprosh to battleships and some experimental animals (rats, mice), irradiated X-rays and prepared corticosteroid hormones.

Epidemiology. Socio-economic factors have the main importance than the particularly widespread dissemination of the disease among the poorest population of Asian countries.

A person is infected with a patient as a result of a long contact, which should accompany sensitization, progressing during repeated inoculations. The danger of infection in childhood is especially great, but even in this case, children inclined to allergic diseases have a greater degree of risk. Mycobacteria Lraprai is distinguished from the body of the patient through the mucous membranes of the respiratory tract or from the ulcerated lepros. Especially a lot of diaper mycobacteria is contained in the nasal mucus and separated by the mucous membranes of the pharynx, larynx. It is known that one patient even with a calm conversation for 10 minutes. A huge amount of leprosine sticks can be dispelled within a radius of 1-1.5 m. Mycobacteria Lrapra can also be detected in tears, urine, sperm, seals from urethra, breast milk and even blood during periods of reactivation of the leprine process.

There are no data on intrauterine infection of the fetus. Children born from parents who have leprosy, and immediately separated from them remain zadrop. It is known that with respect to the leprine infection there is a high natural resistance. This explains that not all persons having even a long contact with leprosant patients are ill, and individuals are lepreing in the form of a hidden infection. At the same time, people who had long-term contact with leprosant patients can be detected by mycobacteria leprosy in the density of lymph nodes or even re-find them in the scraping with a nose cavity shell in the absence of any signs of the disease. But at the same time, various factors that weaken the resistance of the body (insufficient and defective nutrition, alcoholism, colds, severe physical exertion), contribute to the infection or transition of the latent process in an automatic form. Given the possibility of more frequent injury to the skin of the lower extremities, it is believed that infection mainly occurs through the skin of the lower extremities. This assumption is based on a frequent detection of leprosh mycobacteria in increased femoral lymph nodes in the initial period of the disease. In this case, pathogenetic significance is attached to a violation of microcirculation, varicose syndrome and mikosam feet - especially epidermofitilation and candidias.

Pathogenesis (what happens?) During the leprosy:

The gates of infection is the skin and mucous membrane of the upper respiratory tract. From the moment of the introduction of microbes to the appearance of the first manifestations, it takes more often from 3 to 5 years, but sometimes several decades. The detailed picture of the disease develops far from all cases. Only 10-20% of infected persons develop poor signs of infection and only half of them (i.e., 5-10% of infected) are further formed by a detailed picture of the disease. The development of a certain clinical form is associated with the genetic features of the organism (in particular with HLA gaplotypes). In patients with leprosy, a defect of cellular immunity is detected, significantly different from the defects of cellular immunity in HIV-infected. Even with intense hematogenous dissemination of the pathogen, destructive processes are limited to the skin, peripheral nerves, front departments, testicles, upper and lower limbs. Especially often affected by the elbow nerve near the elbow bend. With lepromatose form, the leprosy mycobacteria is found in the liver, spleen, bone marrow.

Symptoms Lepros:

Incubation periodAccording to various authors, on average lasts from 4 to 6 years. However, the possibility of incubation both within 2-3 months and from 10-20 to 50 years have been established fairly reliably. Consequently, the duration and significant fluctuations in the rates of the incubation period are characteristic of the leisure.

Leper is considered to be a small-taigio disease, it is less inclous than tuberculosis. Children are much more sensitive than adults, and in conditions of long-term contact, they are faster and significantly more often than infection with leprosy.

Promotional phenomena are characterized by complaints of patients with indisposition, severe neuralgic pains, diseases in joints, increasing weakness, gastrointestinal disorders. Sometimes marked the paresthesia, hyperesthesia, fever. Already during this period on the mucous membrane, the nasal partition can be detected by ganzen sticks. In the future, clinical symptoms of the disease are developing, depending on the morphological manifestations of which three types of disease distinguish.

Classification. According to adopted in 1953, Madrid classifications isolated 2 polar types of leprosy: lepleromatous and tuberculoid and 2 intermediate groups: undifferentiated and border (dimorphic). Modern classification that develops in essence of Madrid reflects the immunological reactivity and data of immunobiological, histopathological, bacterioscopic studies. In practical activity, the following 3 types of lepros are distinguished: lepromatous, tuberculoid and undifferentiated or border. During each of these types of lepros, 4 stages are possible: progressive, stationary, regressive and residual phenomena. In progressive and inpatient stages, even when conducting rational therapy, leprine reactions are observed, manifested by the exacerbation of the basic foci of the disease and polymorphic secondary allergic rashes. The formation of the type of leprosy depends on the degree of immunobiological resistance of the patient's body. In persons with the agents of asthenization, immunodeficiency, accompanied by a negative leprosine breakdown, most often develops the most contagious type of leprosh - lepleromatous. In persons with high immunological reactivity, manifested by positive leprosine breakdown, there is a relatively favorable type - tuberculoid. Between these two opposite types, a peculiar intermediate form is often detected - an undifferentiated leprosy type. Such a variant of the formation of the disease is probably in persons with a non-defined character of immunobiological reactivity. Therefore, the undifferentiated type of layer in the future can be transformed or into tuberculoid (with a favorable flow), or in a lepleromatous.

Lepromatous type of lepros. With a lepromatous type of lepros, it first appears on the skin, unrearly outlined, unobtrusive reddish spots with a purple or cherry tint. Sensitivity (pain, temperature, tactile) in the region of these spots is not at first. Gradually, stains become dense. Powerful infiltrates are often formed. In the process, along with the actual skin, the subcutaneous fluid tissue is involved, nodes (leprosy) are formed. Such infiltrates and nodes are most often located on the extensitive surface of the limbs, on the face in the forehead, the abnormal arcs, cheeks, and the nose. The facial facial is violated or disfigured, taking the "fierce" expression ("Lion's Mord" - Fades Leonina).

Infiltration of abnormal arcs leads to a fairly resistant loss of hair in the region of the lateral part of the eyebrows. Infiltrative foci, in addition to the face and the extensive surface of the limbs, can be in separate areas of the skin of the body, as well as in the internal organs. In addition to stains and infiltrates, tuberculosions (lepregers) are observed with a measure from the matchhead to a pea, a semi-shaped or flattened form, dense consistency, a reddish-brown or reddish-purple color, which, in the future, due to the addition of the hemorrhagic component can take a rusty shade. In the area of \u200b\u200bthe uhoches of the oars, on the distal parts of the limbs, leprosy have a reddish-blue color. The surface of the tubercles is brilliant, smooth, often has a form of lubricated fat ("Song"). Bugorki can ulcerate.

The resulting ulcers are characterized by dense, sometimes rolunedly raised with rippled edges, the succinous separated, which contains a large number of leprine bacilli. According to Brazilian leprologists (Bekelli, Romberg), in 1 cm3 of the affected fabric, with a lepromatose type, contains about 1 biliona bacilli. The ulcers are gradually performed by granulations and make up. Nodes and deep infiltrates are also often ulcerated, less frequently resolved without ulceration (in this case, superficial logs remain). In the place of the ulcent nodes and deep infiltrates, extensive ulcers are formed; At the same time, muscles and bones can be involved in the process. In such cases, the destruction of the joints, small bones may be observed, and their deposit (mutilatio) followed by deforming and sharp deformation.

Most often in the process involves the mucous membrane of the nose, especially in the area of \u200b\u200bthe cartilage part of the partition. It is from here at the beginning of the disease in the scraping detect Hanzen sticks.

The lesion of the mucous membrane of the nose partition is characterized by erythema, infiltration, discharge from the nose, layers of crust, which causes the picture of chronic leprine rhinitis. As a result of the further development of leprine infiltrates in the field of the cartilage part of the nose partition, ulcers, destruction can be formed: in such cases, characteristic changes are arisen - the tip of the nose is raised upward.

Diffuse infiltrates and lepromes can be localized in the language in the solid and soft sky, spread to the mucous membrane of the larynx, voice ligaments. As a result, hoarseness may occur, up to Afony's resistant, which in such cases is caused by cutting changed changes in the mucous membrane of the nastestrian and voice ligaments.

In patients with lepromatous type, leproses can be observed conjunctivitis, irrit, episclerite and keratitis. As a result of infiltration, turbidity, ulceration and scarring of the cornea after leprine keratitis without treatment, loss of vision may occur.

Lymph nodes (especially femur and inguinal, less often cervical, occipital, submandibular, armpits) are increased to the size of the forest walnut, have a dense elastic consistency, painless, movable.

Often there is a damage to the nervous system. Calculated changes can be divided into general disorders of the central nervous system, manifested in various degrees of severe neurotic reactions to the neurosis and psychosis; Secondly, on the defeat of the peripheral nervous system, when neurites and polyneurite develop. Most often affected by NN. Ulnaris, Auricularis Magnus et peroneus. The affected nerve trunks are thickened and easily forgiven in the appropriate areas. As a result of the defeat of the central and, mainly peripheral nervous system, changes in sensitivity, trophic and motor disorders are developing.

Sensitivity disorders with lepromatose leprosy arise much later than with tuberculoid. Sensitive nerve endings are amazed again as a result of the comprehensive action of primary-emerging cell infiltrates. Initially, persistent, very agile neuralgia are noted, and then hyperesthesia, paresthesia, sensitivity perversion, inadequate reactions to stimuli appear at the corresponding areas of the skin (the cold is felt as warm and vice versa, lags the reaction to the unconditional stimulus). In the future, hyperesthesia and paresthesia are replaced by anesthesia, analgesia. The presence of thermal anesthesia and analgesia in the area of \u200b\u200bindividual segments of the limbs (more often of distal departments) and the torso leads to frequent burns that patients do not feel. On the place of these burns then the scar skin changes remain. Violation of tactile sensitivity in the leppomatous type is rare and only in a later period of the disease.

Trophic disorders in patients with Leprey lead to a violation of pigmentation, to severe complications - the development of mutilating brushes, stop. At the same time, due to significant trophic violations (and not as a result of infiltrative processes), there is a gradual separation of the bone skeleton of brushes or stop, destruction and deformation of the nails. Brush or stop becomes soft, reminding sealing paw or frog paw. Trophic disorders are due to the disorder of the functions of the sebaceous and sweat glands. Their hyperfunction is further replaced by hypofunction until the complete cessation of the flow and salo waste: the skin becomes dry, rough, cracks. In such patients, the minor sample turns out to be negative (starch, sprinkled on the skin, lubricated with an alcoholic solution of iodine, when placing patients in the thermal sucho-aggravated chamber does not show off due to the lack of functions of the sweat gland).

Due to the defeat of the peripheral nervous system, motor disorders arise. As a result of uneven atrophy of the extensors of muscles of muscles, stop, then the forearm and the legs prevailing the tone of the flexors. Fingers take a semi-covered position with an unequal degree of bending (clawing brush and horse stop). On the back of the brushes due to atrophy of small muscles, the interstitial intervals are marked. Because of the atrophy of the muscles of the Tenar and the hypothenary, the brush becomes flattened and resembles a paw monkey.

Atrophy of the circular muscles of the eye leads to incomplete closure of the eyelid (Lagofalm). These patients cannot spontaneously close the eyelids. In connection with the defeat of the facial nerve, atrophy of the mimic muscles comes and the face takes a sad, mask expression ("Mask of St. Anthony").

In patients with leprosy, it is possible to in different degrees a pronounced combination of the above-described sensitive, motor and trophic disorders with functional disorders of the central nervous system.

In patients with lepromatous type of leprosy, various internal organs can be amazed. First of all, the lungs, liver, spleen are increasing and become dense. However, the clinical picture of these violations is not characteristic precisely for leprosy. The clarification of the type of disease is carried out on the basis of the clinic of specific changes in the skin and mucous membranes, the data of bacterioscopic examination of the scarca from the mucous membrane of the nasal partition, scarification, a biopsyned piece of leather from the lesion focus, less frequently unrecognized lymph node.

Along with the lesion of the nervous system and internal organs during lepring, the function of some internal secretion glands is disturbed, which is expressed in premature aged, early menopause in women, a decrease in sexual function, up to impotence in men. As a result of some patients with leprine bilateral orchitis and epididimitis, azoospermia occurs, followed by the development of the sclerotic process. In such cases, women are infertility due to the lack of spermatozoa in her husband.

Tuberculoid type of layer. The tuberculoid type of lepros is characterized by a much more benign flow. Mainly affected skin cover, peripheral nerves. On the skin there are sharply defined depigmented vitiligo-like spots or bright, with clear borders of a reddish-stagnant color with a central pale stains, along the periphery of which in the form of a kind of border are located reminiscent red flat deck polygonal, flat and dense papules with a purple tint. The merging papulas form a reddish-purple or reddish-brown color, a variety of flat plaques, places having a ring-shaped configuration. In the central part of such plaques, depigmentation and atrophy are gradually developing.

It is very characteristic of the tuberculoid leprosy, early detection of pain disturbances, temperature, and a few later and tactile sensitivity. In patients with vitiligo, these types of lopera are preserved. In addition, when Introdially 0.1 ml of histamine in dilution 1: 1000, unlike vitiligo in the area of \u200b\u200bdepigmented spots during lepreing, reflex hyperemia around the blister does not occur (the absence of axon reflex). The affected peripheral nerves are thickened, they are tight in the form of tight heavy, places with clear thickening.
However, diseases of the nerve trunks with tuberculoid lepreges are much easier than lepleromatous neurites and polyneurite. This type of lepros is typical of the lesion of skin appendages (hair loss, a violation of the sweating on the affected areas, etc.).

The lepromine sample in patients is characterized by a positive slow reaction.

Untifferentiated type lepros. The undifferentiated lepros type is characterized by the absence of typical rashes.

A small number of inadvertent spots with unaware boundaries, of various sizes and outlines makes it difficult to diagnose. Remove the Hanzen wand in such patients it is rare. The pathogistic picture is manifested by banal nonspecific infiltrate, similar to that may be with various chronic dermatoses. Lepraine sticks in such an infiltrate are most often not found. These patients are small-catching, their general condition and well-being, as a rule, are good: in addition to the skin, the peripheral nervous system is involved in the process with an undefined type of leprosh. For a specific neuritis, the thickening of the Schvanna shell is characterized, the accumulation of round-flux infiltration in perinovevuria, the presence of single leprine bacills in the thickness of individual nerve beams.

The clinical picture of polyneurite is more reminded by a tuberculoid form, however, the associated motor trophic disorders and sensitivity disorders can be very pronounced (trophic ulcers, "clawing" brush, "horse" stop, etc.). In the past, this form of layer was called the "spotted anesthetic", or "nervous".

The lepromine reaction in patients with undifferentiated leprosy is different: it is negative, others have a positive one. In patients with a negative leprosine reaction, an indefinite type of layer can be transformed into a lepromatous form. A positive lepromine reaction testifies to a favorable forecast. Such patients have transformation only in tuberculoid type.

In children aged mainly from 3 years and older, much more often than in adults, a mixed or dimorphic leper is detected, when there are changes inherent in lepleromatous, tuberculoid and undifferentiated type of leprosy. In addition, in children lepreras can manifest itself in the form of a nodal erythema.

Diagnosis of leprosy:

Leper is not accidentally called the "great imitator" of various syndromes. At the time of the initial conversion of the patient to the doctor in patients, diffuse changes in the color of the skin, single or multiple spotted rashes, varying localization, shape, sizes and painting (erythematous, hypochegmented, hyperpigmented), limited or spilled skin infiltration, knots, tubercles, papules , rhinitis, loss of eyebrows, eyelashes, amyotrophy, nail fragility, ichthyosis, ulcers, paresthesia and violation of surface sensitivity. There are also signs of peripheral vegetative insufficiency and symptoms of reflex-vascular disorders (skin marbore, cyanosis, swelling of brushes and stop, impairment of powder and salo-waste, etc.). Thus, the initial manifestations of the leprosy are characteristic of symptoms characteristic of dermatosis: gendermatosis, sarcoidosis, tuberculosis, allergic, dischoma, etc. At the first appeals of patients in medical institutions, erroneous diagnoses: toxidermia, noded erythema, neurofibromatosis, dermatomyosis, pink deprich, micaosis Smooth skin, eczema, polyneurite, etc.

To the number of verification studies during lepregers include a detailed characteristic of the innervation state in the explored element (the temperature, pain and tactive sensitivity) is disturbed, the presence of thickening of the skin branches of nerves near rashes and larger regional nerve trunks, but the most important thing is to identify the pathogen in bacteriological research and Patomorphological study (painting on Cylu-Nielsen).

There are certain achievements in the development of test systems for specific serological diagnostics.

All types of lepros are diagnosed on the basis of the cardinal symptoms of the disease: the presence of spotted, tubercular-noded elements of peculiar brown-colored with greasy glitter, hair loss with a characteristic sensitivity impaired, existing neurological symptoms with thickening of nerve trunks determined by palpactoro. Diagnosis is confirmed by leprosy detection of leprine bacilli in tissue juice, smears from mucous membranes or histological preparations. It is more difficult to confirm the diagnosis of lepleromatous and undifferentiated types, when there are no leprosh mycobacteria. In these cases, the Combination Reaction (RSK) and the Preventation Reaction are used.

Extremely informative in the diagnosis of early spotted manifestations of the sample with nicotine acid. After intravenous infusion of 1.0 ml of 1% solution of nicotinic acid, spotted leprine rashes are blushing and swell (the phenomenon of ignition) after 1-3 minutes.

The differential diagnosis of lepromatose lepros is carried out with tertiary syphilians, leishmaniasis and skin tuberculosis (inductive erythema of the Basen, crofuloderma). Tuberculoid lepring is differentiated from red flat deprivation, vitiligo, chloasma. The main criteria are clinical and morphological symptoms, trophic and neurological symptoms, hypo-or anesthesia, microscopic studies. In patients with tuberculoid and undifferentiated types, the study of leprosh mycobacteria is better to produce after receiving patients within 1-2 days inside 5% of potassium iodide (1 tablespoon 3 times a day). This causes an aggravation of the process and can contribute to the easier and rapid detection of Ganzen's chopsticks in the scraping. Also important for the diagnosis is carefully assembled history, accommodation in endemic zones, indicating possible contact with sore leprosy.

Treatment of leprosy:

Use etiotropy therapy. The main drug is dapson (4,4-diaminodiphenylsulfone, diphenylsulfone). An adult patient is prescribed from 50 to 100 mg 1 time per day. Treatment is long. Although after 12 weeks most of the microbes die, but relapses are possible after the cessation of treatment (sometimes after 5-10 years). Sustainable to dapson mycobacteria is observed. A very active drug is rifampicin (after receiving 1500 mg of the drug, after 5 days, mycobacteria cannot be detected). The drug is prescribed 600 mg / day. Due to the high cost in developing countries, rifampicin is prescribed 600 mg 2 times a week and even 1 time per month. There are other drugs that are still not checked. The full course of therapy is 24 months.

Prevention Lrapra:

All family members are examined at least once a year. Newborns are immediately separated from patients with leprosy mothers and are transferred to artificial feeding, and more adult children are allowed to study in general schools, subject to their clinical and laboratory surveys at least 2 times a year. In places endemic by lepreing, mass surveys of the population are carried out. Persons who were in contact with patients conduct a lepromine sample.

Lepromine Sample (Mitsududa Reaction) is an intracutaneous administration of the leprosineauvoclaved suspension of mycobacterium leprosh.

In persons in contact with patients with leprosy, a rather high percentage of the Mitsuda reaction, which allows to judge the stability of the body to a leprine infection. Persons who do not respond to the sample with lepromine are a thorough examination, active immunoprophylaxis by re-administering the BCG vaccine. The immunoprophylaxis (immunization) of the population of the BCG vaccine is shown in localities with a relatively frequent morbidity of Leproi.
Members of the patient's family are subjected to preventive treatment, taking into account the results of the lepromine sample, if the patient found an active form of leprosy. Patients with Leprai is not allowed to work in the food industry and children's institutions. According to the international agreement, the relocation of patients with Leproi from one country to another. Personal prevention of leprosy in persons, by the nature of their activities in contact with patients, is strictly observing elementary sanitary and hygienic rules (frequent washing with soap, mandatory sanitation by microtrav).

What doctors should contact if you are lepreing:

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Pumplaze became known in the distant times, when people still did not know how to deal with this would whip. It is believed that the Phoenician navigators who visited Ancient Egypt brought this aid to Europe. But the peak of distribution began in the Middle Ages, when infected were so much that the authorities had to build special institutions for the isolation of lepers. Such insulators were built during monasteries where contaminated were sent to live their last years. Those people who have noticed ulcerative manifestations on the body were called lepers and expelled from society. The causative agent of Lepra, was described by Gansen in 1973

The lepreing was mentioned in the Bible, or rather in the Old Testament. Where can I find recommendations that make it with those people who are infected with a skin violation that you need to do with the housing and clothing of these infected. For example, where the leisure, housing and all the clothes were burned. And a person who is sick must wear a torn robe in order to demonstrate ulcers and thereby not to let the personalities of healthy.

It was believed that this ailment was moved to a healthy person through close contacts. Therefore, infected people were sent to special insulators or expelled. But this epidemic was trying to stop and used various oils. Such oils were Scholmogrovoye and watercraft, which prevented the ears, nose and fingers. But these oils had a negative impact on the kidneys due to poisons contained in them.

This half in past centuries grew at high speed due to the fact that the doctors did not fight against the amazed epidermis.

For this reason, patients suffered from purulent ulcers and deformation of the limbs and face. But medicine of the XXI century is already much developed, and this dermatological problem is successfully cured.

This disease arises due to the pathogen Mycobacterium Leprae. You can only infect from the source - the affected person. Infection occurs by the aerosol method - enters the air, breathing, entering saliva to a healthy person.

As it was found out, struck by this rash, when highlighting a sputum with a cough, approximately a million bacteria releases. Infection occurs during a chichany, passing, splashes the mucous discharges, which fall into the respiratory paths of a healthy person. It happened that the invasion took place through small wounds on the skin or mucous membrane.

People with a weak immunity, having chronic diseases living in bad conditions, make up a risk group.

Microorganisms fall into the circulatory system and find a favorable place in the human body. Mycobacteria begin to multiply and the nodules are formed. Such formations resemble tubercles that contain immune cells. Such a bugger appears on his face, while ugly and deforming the body.

Granulomas are growing not only on the face, but also on the internal organs of a person - liver, lungs, spleen, kidneys and others. Bone tissue that is amazed with granulomas becomes fragile and subsequently breaking often. And when such tubercles are located in the area of \u200b\u200bthe nerve paths, the paralysis is developed, the nutrition of the surrounding tissues near the lesion is stopped.

Symptoms of leprosy

From the moment of infection and before the manifestation, the corresponding signs of malaise can pass from three to five years on average, but there were cases when the incubation period lasted and up to twenty.

Inciable manifestations of the disease occurs from infected, for which, usually, few people pay attention.

• general weakness;
• malaise;
• i want to sleep constantly;
• man is in a sluggish condition;
• feeling breakdown.

Sometimes patients complain about numbness in the fingers, limbs and the formation of tubercles on the body, there is no harmony, making themselves quickly and brightly, therefore, taking into account such minor manifestations - to diagnose the disease in the early stages is very difficult.

When the disease is progressing, then the person gradually dies raids the fabric, the mucous membrane and places are affected, which were contaminated with infected. When progressing mycobacteria penetrate deep layers of epidermis, while the cells of the CNS are damage.

Microorganisms do not cause the destruction of bone tissue. The root cause is untimely therapy of infectious damage, while necrosis of tissues appears on the limbs.

The injured places are deprived of blood circulation and the wounds are badly healing, so the secondary infection and fingers or nails are gradually die away.

Depending on where ulcers are located, several types of disease are distinguished:

• Lepromatosny type is the hardest form that is difficult to treat and eventually leads to disability, and if not starting therapy, then to death. The first manifestations - the appearance on the skin of shiny spots without definitely clear contours. At a dark-skinned person, such pigmentation has a lighter color, and in white people - red. Infected skin sections retain their sensitivity. A few years in the area of \u200b\u200bthe lesion falls the hair cover, the tubercles are formed and drowned.

On the face systematically formed ulcers that affect infection. When such wounds are healing, the rude scars appear in their place, which will urge the face. The first sign of the lepleromatous form is that the nasal mucosa is affected and due to this is modified. With improper treatment, the mucous membrane of the throat suffers, which leads to a change in voice.

When the infection process is progressing, the sensitivity in the lower extremities begins to be lost. In the later stages of the lesion, the newly forming wounds do not heal for a long time. The lymph nodes begin to be inflamed, and men develop the process of suppuration in the ovarian zone. The patient most often amazed eyes, which leads to blindness. The knots are formed in the bones, especially in the field of cartilage compound, which ultimately leads to frequent fractures.

• Tuberculosis type - is a relatively light process of the disease, in which only the surface part of the epidermis is affected, and the normal operation of the internal organs is not violated. On the primary stage on the body, one source of infection is manifested or a few, on average - 5. Over time, single lesions are started to merge, form one large spot with burgundy contour, edges are raised, and the skin becomes thinner. The locations of the foci are insensitive, even at a distance of 2 cm. When the epidermis is injured, then with improper care of the wound, it is started to rotate.

The nervous system is affected, which is characteristic of a tuberculosis species. You can find seals near such a wound, which cause pain is the thickening of the nodules. The movement of the fingers is broken, while there are certain external signs - "bird foot", "hanging stop".

• The undifferentiated type is a light form that only leads to the damage to the skin and peripheral nerves. Flat spots appear on the surface of the body. If you do not start the correct treatment, then this type of lepros can go to tuberculosis form. When analyzing, the pathogen is often not found. Nervous endings thicken in the damage zone. The pain appears, there is such a symptom as the beaning of goosebumps, the face of infected is deformed and the hands are modified.

Diagnosis of the disease

When the patient appeals to the doctor with rashes on the skin, then at first glance, it is difficult to determine than the contamination caused. Therefore, it is not for nothing in vain the leper is called a "great simulator". With the first inspection, the body of the infected person is found in the color of the skin, the rash can be single or multiple, which are in different places, have different size and shape.

Along with such manifestations, a tuberculk can be found, the nodules, the hairs on the affected area fall out, the nails begin to break, the sensitivity of the epidermis decreases, where ulcers and other skin disorders are detected.

Diagnostics check changes in the body temperature, the presence of sensitivity and pain in the place of lesion, whether seals are available in the area of \u200b\u200bthe rash, but the most important thing to find out is in the patient's patient the pathogen with the help of bacteriological and pathological research.

All types of death are diagnosed when certain symptoms are detected - the appearance of tubercles, which have a brown and fat shine, the hair cover falls out, the sensitivity is broken, find thickened processes. With the help of smears in the patient, the presence of leprine bacteria at the site of infection. Diagnostics makes it difficult if with lipomatosis and undifferentiated types does not detect the causative agent of mycobacterium. To determine the appearance of the ailment, it is necessary to use the Complement Binding Reaction (RSK) and the response of the body to precipitate.

When the patient is detected, 1% solution of nicotinic acid is introduced, after which the rash begins to change the color to more red and swells.

How is the standard diagnosis of leprosh:

• the whole body of the infected is inspected, as well as the mucous membrane of the nose and oral cavity;
• check the lymphosystem, whether lymph nodes are watched;
• the bones of a person are investigated to identify changes in bone tissue;
• conducting various samples - to sweating, determining the level of sensitivity, introducing a nicotinic acid patient into the body;
• analysis for the presence of the pathogen;
• the study is a piece of leather that is taken from the focal zone.

Treatment of leprosy

For the treatment of the disease, many specialists are involved with different areas - orthopedist, dermatologist, ophthalmologist, surgeon, physiotherapists. Most often for treatment, Dapson is prescribed. Adults - daily rate of 50-100 mg of medication. Dapson decays in the body for a very long time, which allows you to apply even pregnant women.

There are also an adverse reaction that manifests infrequently - hemolysis, hepatitis and dermatitis.

The term of treatment with a lepromatous form occurs within 12 weeks, during this period a large number of pathogens die. But treatment must be carried out for 5-10 years. And if therapy is terminated, the risk of recurrence has appeared.

But as noted recently, mycobacteria has become more resistant to Dapson. Another means that is effectively struggling with the causative agent - rifampicin. For five days of reception at a daily dose of 1500 mg, the means of bacteria are not detected in the diseased disease.

Doctors also prescribe clophazimine - which is not yet sufficiently studied, but is prescribed at a dose of 50-200 mg per day. When using such a medication in white-skinned people, a red rash occurs, which prevents normal treatment. Side effect - diarrhea or spasm of intestines.

There are other medicines that help in the treatment of the disease: ethionamide, protionamide, tiamputozin, thioacetazine, etc.

Curacy should pass with the help of three medicines - dapson, rifampicin and clophazimine. Therapy continues until the analyzes show negative results.

Antipyretic and painkillers are added to symptomatic therapy. With a severe form of leprosy, high doses of prednisone 60-120 mg daily. At the same time, the fight against bacteria should continue. Talidomide helps perfectly in the formation of nodes. This means is contraindicated to women who are still going to give birth to children. With severe relapses, corticosteroids are used to prevent nerve damage.

In order to avoid disability, it is necessary to use shoes with a dense sole or removable prostheses, the deformation of the brush is possible to prevent special exercises or gypsum bandages. In some cases, it is recommended to seek help to a surgeon for transformation of tendons.

For the restoration of the face resort to plastic surgery. The psychologist's help is needed by the patients who have been isolated from society for a long time.

Epidemiologically dangerous terrain

Leproi was registered in 93 countries of the world, where 73% of victims comes to India, Nepal, Tanzania and Burma. Compared to the medieval, the incubation period has changed, has become longer.

According to doctors of immunologists, that most people have an immunity to this fear - 95%, but the remaining 5% is to fear this infection.

Therefore, those people who want to visit one of the listed countries where the disease occurs most often, should know that the vaccines from "leprosy" do not exist.

Conventional anti-tuberculosis vaccinations are excellent prevention. All familiar BCG vaccination is one of the methods of prevention, but the use of this vaccination is allowed only when traveling, where there are many infected. Tourists do not recommend entering contact with animals from the above countries.

Complications and forecast of life

Problems after the disease are significant - deformation of the limbs, facial zone, influence on human bodies. With incorrect churation, the fingers of the legs and hands die away. The damage to the nervous system leads to paralysis, and a long flow of infection can lead to blindness, the person becomes ugly due to the deformation of the facial bones and the cartilage tissue, which ultimately leads to disability.

Modern medicine can accurately say that the patient's life forecast inspires optimism, but the treatment lasts for quite a long time. It happens that a person just gives up and recovery does not occur. Under such circumstances, a high percentage of fatal outcome.

Lepra is not a deadly diagnosis that man isolate forever from society.

The cure and life expectancy is significantly higher than before. But it is worth remembering that with proper and timely treatment, a person can avoid disabilities and complications after infection.

But the effective medication from this disease is still not invented, so do not hinder with therapy, when the first symptoms appear. Mycobacteria is very poorly reacting to various antibiotics and antibacterial agents. But scientists continue to study this disease and seek to find an effective drug from leprosy.

Mention of lepreing are found in the most ancient sources. Over the course of centuries, the external manifestations of chronic granulomatous infection were called leprosy, a black night, lazy death and the Crimea. Now these names are outdated, modern synonyms are considered to be Hansen's disease, Hanseniaz, Hansenosis.

The patients were horrified on the inhabitants of cities, communication with the lepers was banned, so they were expelled from settlements. Later, for the isolation of such people began to create leprosaries.

The overwhelming majority of cases of lepros are detected in countries with hot and tropical climates. Every year, the number of such patients is reduced, but the lepreras is still distributed in South Asia (Nepal, Burma, India), in the countries of East Africa (Mozambique, Madagascar, Tanzania), in some areas of Brazil, in Latin America and the Western Pacific Islands. The natural reservoir for infection is armor, human-like primates, water bodies and soil, but this path of infection is not considered decisive when it spreads.

Disease able to develop in people any age categoriesBut more often is registered with adolescents and youth from 13 to 19-20 years, while severe lepromatous form is predominantly found in men. The incubation period, as a rule, is 3-5 years, but sometimes hesitates from six months to several decades. The early diagnosis of leprosh significantly makes it difficult for the nonspecific characteristics of the hidden period and their optional - any symptomatics can be completely absent.

Contrary to emerging opinion leprara is not a high disease. It is not inherited and during pregnancy from mother to the child. Such children after birth is isolated and transferred to artificial feeding. Lapra infection is possible after a long contact with the patient. In this process, immunological and genetic instability to mycobacteria plays a major role.

Even with many years of joint living with patients with leprosy, infection inside the family occurs only in 5-10% of cases. The episodes of the hidden flow of the disease were also recorded. When studying the puncture of lymph nodes and the scope taken from the shell of the nasal cavity, it was possible to identify mycobacteria lepros, but there were no signs of the disease. Despite these facts, there is a high risk of infection in children, especially when they are inclined to allergic reactions.

Most of all sick with a detailed clinical pattern of lepros fixed among people aged 30 to 50 Years, the men of the Negroid race are more susceptible to infection. Transition of the disease from latent active form contribute to the difficult conditions of life and labor, defective nutrition, infectious diseases and bad habits. All these reasons contribute to the resilience of the body, but one of the highest risk factors are accommodation in the endemic focus of infection.

Causes

The natural reservoir of infection, as well as the source of infection is the sick person. The transmission method is reliably studied. From the ulcers on the mucous membranes and from the surface of the skin, the causative agent is distributed in large numbers into the environment. In theory infection penetrates the body of a healthy person through skin damage And through the mucous upper respiratory tract. Mycobacteria in the reactivation of leprine infection is found in maternal milk, sperm, tears, blood and the selection of urethra. There were cases of infection after using the patient's things.

At the primary stages of the disease in the femoral lymph nodes, mycobacteria lepros are often detected. It is assumed that their penetration occurs through the skin of the lower extremities. This process contributes to varicose veins, copies of the feet and disruption of microcirculation in tissues.

Classification

According to the Madrid classification, adopted in 1953, two polar species and two intermediate forms of leprosy are distinguished.

Types of Lepry.

• Lepromatous type - This is the most serious variety, seriously dedicated therapy. Characteristic locations of the lesion: skin cover, eyes, the surface of the respiratory tract, peripheral nerves, lymph nodes and internal organs. The analysis taken from the outer sections of the scraps body shows the accumulation of mycobacteria, the inner skin test is negative.
• Tuberoid Type Leaves in easier form. The damage to the skin, peripheral nerves and lymph nodes occurs. In samples of scraps from mucous membranes and external covers, the pathogen is not detected, but the lepromine sample indicates the presence of mycobacteria.

Molds Lepry

• Undifferentiated- conditionally benign, the initial form flowing with the lesion of the skin and the peripheral nervous system. Externally manifested by flat red spots on the skin. When analyzing the scrapings, the bacilli-pathogens are often not detected. The result of the lepromine reaction depends on the intensity of the infectious process. Histological analyzes indicate the presence of lymphocytic infiltration in lesion foci.
• Dimorphic- This is a severe border and malignant shape, affecting the skin, mucous and nervous branches. In the scraps of the skin with bacteriological analysis, a huge accumulation of pathogens is found, and when analyzing samples from the nasal mucosa - not always. As a rule, the lepromine test shows a negative result. The study of the affected tissues may indicate the presence of cellular structures characteristic of two polar forms.

Along with Madrid, the classification of Ridley-jopling, which takes into account the clinical, immunological, bacteriological and histological criteria for analyzing the disease.

Symptoms

The severity of the disease and its manifestations depend on the severity of cellular immunity against the causative agent of lepros. In 75% of patients, a single lesion of the skin is observed, which spontaneously passes, the rest of the individuals develop typical clinical signs of lepros. The symptoms of the latent period are so blurred that diagnose leper at this stage is extremely difficult.

Early symptoms leprosy:

• weakness, indisposition, chlorinity;
• reduced sensitivity in the limbs;
• changing skin pigmentation;
• skin rash, skin marble;
• education of nodes, papules and buggers on the skin;
• nasal congestion, inflammation of mucosa and nose bleeding;
• rashes on mucous membranes;
• intensive fallout of a flush hair, eyebrows and eyelashes;
• neurogenic trophic ulcers;
• increase lymph nodes.

The described symptoms are mainly associated with external lesions. This is explained by the specific action of the pathogen, which mainly affects the tissues in contact with the external environment. In the absence of proper treatment, the disease progresses.

The spectrum of external signs is depending on the form of the disease. Lepromatous type of disease is characterized advantageous lesion of skinFor the tuberculoid target is the nervous system.

Diagnostics

To establish a faithful diagnosis of doctors, first of all, based on clinical manifestations of illness. Late and launched stages of the disease have pronounced diagnostic signs, while early symptoms are often lubricated and atypical.

Early manifestations of the leprine process are diverse, lepreing can imitate various syndromes. The initial symptoms of the lepros are characteristic of the signs of dermatosis, syphilis, exudative erythema, dischromy, vasculitis and various lesions of the nervous system, so erroneous diagnoses at this stage are not uncommon. Experienced professionals pay attention to the state of innervation of the affected area, since mycobacteria cause a violation of a tactile, pain and temperature sensitivity. It is noticeably thickening of peripheral and larger nerve branches near the plots of rashes.

Bacteriological and pathomorphological studies provide a more reliable result for the final diagnosis. In the course microscopic analysis of tissue fluid materialIn histological preparations and strokes taken from the nasal mucosa, leprosh bacillos can be detected. The lepromatous and undifferentiated type of disease is difficult to determine the absence of mycobacteria in samples of analyzes. To exclude such cases, the reaction of precipitation and binding of the complement is used.

With the help of leprosine, the type of leprosy is possible. The lepromine test with a tuberculoid type is positive, whereas with a leptomatous negative.

Informative method for diagnosing initial forms of lepros nicotinic acid sample. A few minutes after the intravenous infusion of the solution of nicotinic acid, the rashes of the leprosy are turned red color and swell.

Treatment

Until the middle of the XX century lepar was considered an incurable diseaseThe patients were isolated in leproseria in order to prevent the dissemination of the disease. The breakthrough in solving this problem was the opening of the preparations of the sulfonic group. After their active introduction to the treatment of lepros, most of the patients later several years of intensive therapy were recoverable.

In order to increase the effectiveness of treatment at the end of the 20th century, antibiotics began to apply in combination with sulfons. Complex and long-term therapy consists of several courses with simultaneous intake of 2-3 anti-preciprocers. To avoid the development of resistance to antibiotics, they are regularly changed and combined. Along with anti-collect drugs, adaptogens, vitamins, immunocormers and iron preparations are prescribed.

There are certain studies that prove that the BCG vaccination helps to increase the immunoreactivity of patients, but there are no reliable data on this issue yet.

This technique provides high chances of recovery Patients with initial layplus. In more launched cases, intensive therapy will help get rid of the illness, but the acquired pathological changes in the body of the patient often lead it to disability.

Complications

The diagnosis of lepros in the initial stages is difficult, so the patient often has to be treated for a long time from non-existent diagnoses, which ultimately leads to severe consequences:

• the appearance of a person and the outlines of his face change;
• neurotrophic ulcerations are formed;
• the nasopharyngeal mucosa is affected, perforation of a solid sky and a nasal partition;
• atrophy of the muscles of the limbs, especially the brushes;
• men develop infertility;
• the eye is defeated up to loss of vision;
• perhaps the defeat of visceral organs.

Mycobateria provoke paralyts, neuritis, stop contractures and brushes. Directly the causative agent of Lepry does not cause necrosis and loss of parts of the limbs, it leads to this development of secondary bacterial infection. Insensitive tissues are subject to injuries that remain without attention and become a favorable environment for infection.

Prevention

Special preventive measures to combat the spread of leprosy does not exist. The main importance in this process has timely detection of patients in the early stages of the disease, their treatment and, if necessary, isolation in the institution of the infectious profile.

Lepring is a littleness, so complete isolation in leprosaries is inexpedient. In the future, the members of the patient's family and people who have in contact with him must be held an annual survey for 3-10 years.

Patients with Leproi most often do not represent hazards for medical staff and loved ones, so any special rules, in addition to the usual compliance with the norms of hygiene, is not required when communicating with them.

Forecast

The level of modern medicine allowed transfer leper into the category of healing diseases. Prediction depends on the stage of development of the disease, its type and correctness of the prescription of drugs. After the invention of the drugs of the sulfonic series, the number of deaths from the leprosy approached the mortality rates from other diseases.

With early diagnosis of lepros, not more than 12 months from the moment of the first symptoms of the disease, regular and efficient treatment leads to the absence of severe lesions. If the treatment has begun 1-3 years after the detection of the disease, then the patient has neurotic changes associated with loss of sensitivity, contracture of fingers and amyotrophy. All this leads to loss of muscle strength and performance.

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It is estimated at 10-15 million people. About 5.5 million of them get antimicrobial therapy. Currently found in more than 70 countries, mainly in Africa and Asia, as well as in some countries of South and Central America. Caused by ugliness diseases are a source of serious psychological and social difficulties for suffering from leprosy and their families.
A feature of the modern flow of lepros is an increased risk of infection with leprosy HIV-infected patients, especially in countries with high incidence of both infections. Ukraine rarely register individual cases. Total registered several dozens of patients who are under the supervision of Odessa leproseria.
The source of infection is a patient leprosy. The main way of transmission of infection is air-drip, less often - through damaged skin. The causative agent of the leprosy stands out with Mother's Milk. The disease is distinguished by a long incubation period from 3 to 10 years. Contacts is insignificant, no more than 10% of contact persons are infected under long-term family contact. Infection is usually taken in children or youthful age, more often - in 10-20 years.

Pathogenesis . Mycobacterium Leprae is striking the skin, mucous, upper respiratory tracts and peripheral nerves, in particular, Schwann cells are sampled.

Classification . Based on clinical, bacteriological, histological and immunological data, lepreges is classified according to a specific spectrum. Its main forms are two stable polar opposite types: energetic, with a large amount of pathogens, lepromatose leprosh and allergic, with a small amount of pathogens, tuberculoid leprosh. There are differentiated and boundary (dimorphic) molds of leproshes between these two forms. A special way of confrontation between the pathogen and the owner leads to a respectively severe clinical picture. WHO classification distinguishes lepleromatous, tuberculoid, border and undifferentiated lepros.

Clinical manifestations . After an incubation period, a completely uncharacteristic early symptoms may occur lasting from 3 to 20 years.
The lepromatous form of leprosy develops in people with extremely low resistance of the body, is characterized by a large variety of skin manifestations, the mucous membranes are immediately involved, the internal organs, later - the nervous system. Initially, symmetric pigment stains appear on the skin, which are then converted into infiltrates or leprosy. They have a reddish-rusty color. More often such tubercles are localized on the face where they merge into single conglomerates. Over time, the patient is formed by the so-called "lion liquor" - wrinkles and folds deepen, the nose is thickened, cheeks, lips and chin have a loud look. Lapleroms are afraid after a while with the formation of deep ulcers with viscous contents, in which there is a large number of mycobacteria. Leproms during decay deform the nose. Fallen phalanges begin to fall off. Such a shape of the leproset occurs over the years, periodically exacerbating, which is accompanied by fever, severe intoxication, rash new leprom. Mycobacteria is always affixed by nervous trunks and destroy the end nerve receptors. Therefore, in the foci, the skin is lost thermal, painful and tactile sensitivity. This is a very characteristic symptom for which with 100% probability can be diagnosed. Formed foci are also completely lost and skin formations (sweat glands and hair follicles). The lepromatose variety of leprosy is the most severe and malignant form, resulting in a death faster than the rest.

Tuberculoid shape lepreges. A benign course of the disease in people with good organism resistance. It is amazed, mainly skin, peripheral nerves, less often - internal organs. In the affected areas, tuberculoid tuberculk are found, very similar to those with tuberculosis (contain epithelioid cells in the center, surrounded by a shaft of lymphocytes). The formation on the skin is usually asymmetrical, reddish brown, surrounded by roller, they also do not have sensitivity. The tuberculoid leprenel is 40 times less inward, compared with the leppomatosis form.

Untifferentiated lepreger -unstable clinical form, intermediate between tuberculoid and lepromatose type. Leather is also affected, stains are not sensitive to pain and temperature, the main feature is multiple nerves damage. It is also called "nervous leprosy". After a few years, this form moves either to tuberculoid, or in lepleromatous.

Dimorphic, or border, laying layoutit is quite rare, usually in people with reduced immunity. For it, it is characteristic of both types of lesions, characteristic of both tuberculoid and lep-diamatose leprosy. This form takes place hard, mycobacteria is highlighted in huge quantities.

Lesions of organs during lepreing.The defeat of the nerves is the most important component of the leprosy and occurs with all its forms. Only peripheral nerves are affected, and not the CNS. Neurrites when lepreing is defined as a multiple mononeurite, i.e. Simultaneous or consecutive disease of one, two or several peripheral nerves. This, therefore, is not about true polyneurite. The damage to the nerves during lepromatous lepreing is more often symmetrically, with tuberculosis - more often asymmetrically. Changing nerves include thickening, sensitivity disorders, motor and trophic lesions.

With lepromatous lepreing The nasal mucosa is very often amazed, but not in the initial stage. Therefore, the smear from the nose for the presence of mycobacteria lepros can not serve as an early diagnostic sign of lepros. Chronic nose bleeding (Epstiaxis), chronic cold (nasal obstruction), rhinitis (reminding vasomotor) are often not recognized, but very suspicious signs for leper. There are painless perforations of the nasal partition. A rich nasal secret is probably one of the main sources of infection at the open lepreing. Infiltrated may be the sky, tongue and nasophack.

Untreated lepromatose leprosh Almost inevitably leads to eye diseases caused directly by mycobacteriums of leprosy or indirectly - the defeat of the nerves. Pathognomonic is the perikoreapy painless congestive conjunctivitis, which forms a red-orange ring. There is a miliar projection of the leprosh in the scler and the iris ("Pearls on the Rainbow Shell"),
Iridoocykpit destroys the ciliary body. Acute Irit can develop with Erythema Zadosum Leprosum - threatening, eyes complication with the danger of blindness. Keratitis, ulcers and the formation of pannus lead to total scarring and blindness.
The liver and spleen in the lepromatose leprosy are amazed in a third of patients; Complications - non-infectious hepatitis, liver and amyloidosis cirrhosis. Approximately 75% of all patients with Leprai are affected by the kidneys: albuminuria, glomerulonephritis, nephrotic syndrome and amyloidosis. Uremia is the most common cause of death during lepreing. Inguinal lymph nodes are often painlessly enlarged and rich in bacteria. There is a damage to the genital organs.
Hair loss in the type of nest alopecia on the eyebrows, beard and scalp - early and important signs of leprosy. Nails stop in growth. The formation of sweat in anesthetized lepleratous foci is almost completely stopped.

Fig. one.The appearance of the patient with leprosy

Diagnosis of leprees it is based on the history of the anamnesis (accommodation in endemic zones, contact with leprosy patients), detecting the pathogen in the skin rashes in tissue juice when skin prick and in biopsytas, identifying DNA of mycobacteria leprosh with PCR.

Treatment. Principles: etiotropic antimicobacteria therapy; Prevention and treatment of reactive states (lepromatous reactions); Prevention and treatment of neurological complications; training patient tactics of behavior in the absence of sensitivity; Social adaptation.
The course of specific treatment is carried out in leprosaries. Currently, sulfones are used as a therapeutic selection tool with lepreing. They act bacteriostatically, but not bactericidal. The choice of dadps (DDS, Dapson). The usual dose is 25-50 mg DADPS daily for adults, but prescribed 100, and even a maximum of 200 mg. It should be started with low doses to avoid lepal reactions. The recommended WHO dose is 100 mg DADPS 6 times a week. Dapson can be administered intramuscularly by 225 mg; Its content in the blood is preserved quite high for 2 months.

Rifampicin - This is a bactericidal acting tuberculostatic. Dosage - 300-600 mg daily.

Clofacimine (LAMPLA) - a phenacine dye specifically operating on mycobacteria. In the treatment of leprosh, it is applied either in addition to Dapson, or as a replacement for resistance to sulfones, as well as in the treatment of lepromatous reactions (leprine-noded erythema). When pregnancy is also contraindicated, like rifampicin. As a rule, it is well tolerated, but it often occurs coloring of the skin from red to brown. It is also characterized by staining of the tear fluid, sweat, urine. Sometimes there are xerosis, ichthyosis, photosensitization and acneobodible rashes. It is often noted nausea, vomiting, abdominal pain, diarrhea, loss of appetite and weight, first of all, when using high doses for a long time (more than 3 months). For therapy, kidney and liver functions should be monitored (every 4 weeks).
In the event of a rare primary resistance to cluffachymin or rifampicin, etionamide and profionamide are used, as well as the second generation of quinolone, such drugs such as ciprofloxacin (cod).

Treatment of leprees Conduct courses duration up to 6 months. at intervals 1 month. The effectiveness of treatment is assessed by the results of bacterio-copy control and histological research. The duration of treatment, on average, is now reduced to 3-3.5 years. There is a rule: after the elimination of visible manifestations of the disease and the disappearance of Hansen chopsticks from the tissues in the lesions and in the scraps of the nasal mucosa, patients can be discharged on an outpatient truth. It should continue with a tuberculoid lepreing for another 1.5 years, with an undifferentiated lepreing - 3 years, with a lepromatous and dimorphic lepreing - another 10 years.
With a leprine nodular erythene with a severe form of flow and the Lucio reaction, glucocorticoid therapy is used - prednisone at 40-60 mg per day with a rapid decline in the dose.
For rehabilitation, physiotherapy is used, plastic reconstructive surgery (nasal plastic, ear plastic, artificial finger joints, transplantation of ligaments and nerves on legs and hands to eliminate perforing ulcerations, contractures and latoms of joints).

Prevention Lepry - individual and social. For family members of the patient and service personnel, there are no special rules of behavior. Sanitary isolation of patients in leprosaries lasts to bacterioscopic indemitations. They hold a regular examination of the family members of the patient and living in endemic regions, the chemoprophylaxis of anti-collections of persons who were in long-term family contact with patients excreted by leproser. In order to relative enhancement of antlegone immunity, the BCG vaccine is used.

Lepar or leprosy (outdated title), Hansenosis, Hanseniasis, is an infectious disease that is caused by Mycobacterium Lepromatosis and Mycobacterium Leprae mycobacterium and the preferential lesions of the skin, peripheral nerves, and, sometimes, the upper respiratory tract, the front chamber of the eyes, testicles, stop and brushes.

Currently, lepreras became healing disease, since antibiotics can destroy its pathogen. In this article we will acquaint you with the reasons, symptoms and modern methods of treating this disease.

Mentioning about this disease is still in the Bible, Hippocratic Manusing and Doctors of Ancient India, Egypt and China. The leper was called a sorrowful disease, since in those days she was inevitably led to death. In the Middle Ages for such doomed patients, the places of quarantine were opened - leprosaria. There they said goodbye to life. Relatives of the patient surrounding also avoided, since they were afraid to become infected with leprosy.

According to the decree of the king in France, patients with Leprai were subjected to "Religious Tribunal". They were given to the church in which everything was prepared for the burial. After that, the patient was laid in the coffin, fled and worn in the cemetery. After lowering in the grave, pronouncing words: "You are not alive, you are dead for all of us," and dropping to the coffin of several shovels of the land of the Deadyer again took out of the coffin and sent to leprosarium. After such a rite, he never returned to his home and did not see anyone from family members. Officially, he was considered the deceased.

Now the prevalence of leprosy decreased significantly, but the disease is still considered to be endemic (i.e. it is found in a certain area and renewing after some time independently, and not due to the coming from the outside). Usually it is detected among residents and tourists of tropical countries - Brazil, Nepal, India, the states of the western Pacific and East Africa. In Russia, the case of the disease was revealed in 2015 at the working from Tajikistan, who was employed at the construction site of the medical center.

Causes

The causative agent of Lrapra is mycobacterium Mycobacterium Lepromatosis and Mycobacterium Leprae. After infection, which comes from the patient to a healthy person through the selection from the nose and mouth or with frequent contacts, until the first signs of the disease passes for a long time. The incubation period of the leprosh can be from six months to several decades (usually 3-5 years).

After that, the patient begins no less long-lasting (latent) period, manifested in nonspecific symptoms, which cannot contribute to the early detection of the disease. This fact, as well as a long incubation period, predisposes its distribution.

Symptoms and types of disease

When diagram is contaminated, it is usually infected with the air of the body-skin, the mucous membranes of the upper respiratory tract and surface nerves. In the absence of timely and proper treatment, the disease causes severe skin infiltration and nerve destruction. In the future, these changes may cause complete deformation of the face, limbs and ugliness.

There are such changes as moving fingers on the limbs, they are provoked by non-mycobacterium-pathogens, but by secondary bacterial infections that are joined in injuries caused by the loss of sensitivity in the affected arms and legs. Such damage remain unnoticed, the patient does not appeal for medical care, and the infection leads to necrosis.

Lepra can flow in such forms:

• tuberculoid;
• lepleromatous;
• dimorphic (or border);
• mixed (or undifferentiated).

All molds of lepros have their own characteristics, but specialists also identify a number of general signs of this infectious disease:

• (to subfebrile);
• weakness;
• skin manifestations (light or dark spots with a sensitivity impairment);
• the emergence of skin infiltration sites;
• pain in the joints (especially during the movement);
• high columbs of the ears and the appearance of folds between eyebrows;
• loss of outdoor third eyebrows;
• the damage to the mucous membranes of the nose.

Tuberculoid leprosy

This shape of the layer is manifested in the form of a hypochegmented stain with clear contours. With any physical impact on it, the patient feels hyperesthesia, i.e. the increased sense of the stimulus.

Over time, the stain increases in size, its edges become raised (in the form of rollers), and the center is absorbed, turning atrophically. Its color can vary from bluing to stagnant red. A ring-shaped or spiral pattern appears on the edge.

Within such a stain there are no sweat and sebaceous glands, hair follicles and disappear all sensations. Near the focus, thickened nerves are tested. Their changes associated with the disease cause muscle atrophy, which is especially expressed in the defeat of the hands. Often, the disease leads to contractures not only with brushes, but also stop.

Any injuries and compresses in the foci (for example, wearing shoes, socks, clothes) lead to secondary infection and the appearance of neurotrophic ulcers. In some cases, this causes rejection (mutilating) Falling of fingers.

With the defeat of the face nerve, the leptra is accompanied by the defeat of the eyes. The patient can develop a logophlia (impossibility of full closure of the century). Such a consequence of the disease leads to the development of keratitis and ulcers at the cornea, which can further provoke the offensive of blindness.

Lepromatous leprosy

This shape of the lepros is more infected than tuberculoid. It is expressed in the form of extensive and symmetrical relative to the median axis of the body of lesions of the skin. The foci is manifested in the form of plaques, spots, papules, lepreger (knots). Their boundaries are blurred, and the center is convex and dense. The skin between the lesion foci is thickened.

Among the first symptoms of the disease, nasal bleeding and breathing difficulty are often observed. Subsequently, impassability of nasal moves, hoarseness and laryngitis can develop. And with perforation of the nasal partition, the patient is pressed the back of the nose ("saddle nose"). When infected with the pathogen of the anterior chamber, the patient develops iridocyclite and keratitis.

Most often, such changes in the skin are observed on the face, ears, elbows, wrists, knees and buttocks. At the same time, the patient feels weakness and numbness, which is caused by the defeat of the nerves. In addition to these characteristic symptoms, with a lepromatous leprosy, the outer third of the eyebrows occurs. Under the progression of the disease, the patient has the growing of the urstees of the ears and the "lion's face", caused by the thickening of the skin and expressing in the distortion of the facial expressions and the features of the face.

The disease is accompanied by a painless increase in axillary and inguinal lymph nodes. In the later stages of lepromatous leprosy, a decrease in the sensitivity in the legs appears.

In men, this form of lepros can lead to development (inflammation of the inflammation of the inflammation. In addition, the seal and sclerosis of the tissues of the testicles causes the development of infertility.

Dimorphic (or border) form

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

Mixed (or undifferentiated) form

This form of lepros is accompanied by severe nerve lesions, more often from such a process is the elbow, small -board and ear nerve. As a result, the loss of pain and tactile sensitivity develops. Violation of the trophic limbs leads to a gradual loss of disability and disability of the patient. With the defeat of the nerves responsible for the innervation of the person, the patient disrupts the diction and atrophy and paralysis of the face muscles.

In children, such a form layer can flow as. In such cases, red spots with ribbon edges appear on the body. They are not towering above the surface of the skin and are accompanied by weakness and increasing temperature to subfebrile.

Diagnostics

An important stage of diagnosis is a medical examination.

To diagnose leprees, the doctor can use several techniques. In this case, the mandatory part of the patient's survey is the establishment of sites and contacts over the past few years.

The patient's survey plan with suspicion of leper includes:

• inspection and survey;
• scraping oral mucosa or nose;
• minor's sample to identify reducing sweating in lesion foci;
• determination of skin sensitivity;
• nicotinic test to identify skin reaction to nicotine;
• leprominic sample (introduction of a special preparation in the skin of the forearm to identify the layout form).

The most affordable and rapid specific method of diagnosing leprosy is a lepromine sample. To perform the patient in the field of forearm, lepromine is intracodently introduced - the preparation based on the autoclaved homogenate of the skin lesions of patients with lepromatosepros. After 48 hours, there is a papule or a stain on the skin, and after 14-28 days - a tubercle (sometimes with a site of necrosis). The emergence of these signs is a positive result and indicates a tuberculoid form of leprosy, and under the negative result - on a lepromatous form or no disease.

Treatment

The treatment of patients with Lepra is always carried out in a specialized infectious hospital, and after discharge, they must regularly undergo dispensary inspections. Its effectiveness depends largely on timely start of therapy in the earliest stages of the disease, i.e. at the time of determining the fact of possible infection. However, in practice, patients are more likely to appeal for medical assistance already in those stages when the symptoms begin to progress. This fact can lead to the emergence of disease complications and its residual manifestations such as a change in appearance and disability.

For etiotropic therapy aimed at the destruction of the pathogen, a combination of several effective antimicrobial drugs is prescribed to the patient. In different countries, drug reception schemes may differ somewhat.

In the plan of medicinal etiotropic therapy, such funds may include:

• preparations of sulfonic group: dapson, diaminodiphenylsulfon, sulfetron, sulfatine, etc.;
• antibacterial agents: rifampicin (rifampin), offlsacin, minocycline, clophazimine, clarithromycin, etc.

The World Health Organization recommends combined therapy schemes for all formas of lepros. With tubroloid leproson - Dapson 1 time per day and Rifampine 1 time per month for six months, and with lepromatous - clophazamine and dapson 1 time per day and rifampin 1 time per month for 2 years to negative leather biopsy analyzes.

Ethiotropic treatment is complemented by the routine reception, vitamin C, group vitamins and antihistamine (suprastin, Loratadine, etc.).

In some cases, for the braking of the growth of mycobacteria and accelerating the regeneration of the skin, the patient is assigned to the reception of Hahulmughroy oil (from Chaulmugry seeds). This means should be taken in gelatin capsules that protect the gastric mucosa from an unwanted irritant effect.

Preparations for etiotropic treatment, lepros are accepted by long periods (from several months to 2 years), and this contributes to their negative effect on the composition of the blood. Patients decrease the level of red blood cells and hemoglobin. To eliminate these signs, anemia is a patient must organize regular intake of vitamins and rational food to replenish the lack of iron in the blood. In addition, it must take control of blood tests at least than 1 time per month.

To eliminate the development of complications by the authorities, the respiratory, nervous and musculoskeletal system, consultations of such specialists are recommended.