Leprosy (Greek lepra; a synonym leprosy) — the chronic generalized infectious disease caused by mycobacteria of a leprosy; it is characterized by damage of skin, mucous membranes, peripheral nervous system, internals.
Classification of a leprosy
On the Madrid classification accepted in 1953 allocate 2 polar types of a leprosy: lepromatous and tuberculoid and 2 intermediate groups: undifferentiated and boundary (dimorphous).
The modern classification developing in fact Madrid reflects immune responsiveness and data of immunobiological, histopathological, bakterioskopichesky researches. In practical activities distinguish the following 3 types of a leprosy: lepromatous, tuberculoid and undifferentiated or boundary. During each of these types of a leprosy there are 4 possible stages: progressing, stationary, regressive and the residual phenomena. In the progressing and stationary stages even when performing rational therapy the leprose reactions which are shown aggravation of the main focuses of the disease and polymorphic secondary allergic rashes are observed. Forming of type of a leprosy depends on degree of immunobiological resistance of an organism of the patient. At persons with the phenomena of astenisation, an immunodeficiency which are followed by negative leprominic test the most contagious type of a leprosy - lepromatous most often develops. At persons with high immune responsiveness, the shown positive leprominic test, rather favorable type - tuberculoid is observed. Between these two opposite types a peculiar intermediate form - undifferentiated type of a leprosy quite often comes to light. Such option of forming of a disease is probable at persons with yet not defined nature of immunobiological reactivity. Therefore the undifferentiated type of a leprosy can be transformed further or to tuberculoid (at a favorable course), or to lepromatous.
1. Early leprosy
The first symptoms of a leprosy usually are found on skin and are expressed by one or several hypopigmented or hyper pigmented plaques or spots. Frequent the first symptom to which draws the attention of the patient are podobyony plaques in the field of which the sensitivity completely is absent or paresthesia is noted. At thorough inspection of this site ustanavliyovat damage of skin. At inspection of the persons contacting with the patient at them, especially at children, often reveal the single skin center. Usually it is the site with hyposensitivity which can spontaneously ustrayonitsya within a year or two, but also in this case specific treatment is recommended. The sensitivity in the field of the early centers often remains, especially if they are located on face skin.
2. Tuberculoid leprosy
The early tuberculoid leprosy proyoyavlyatsya often by accurately delimited hypoxanthopathy spots with hyposensitivity. Later the centers increase in sizes, their edges pripodniyomatsya and rounded or get a ring-shaped form. The tenyodention to peripheral distribution and healing in the center is noted. Completely developed centers absolutely lose sensitivity and normal kozhyony formations (sweat glands and hair follicles). Centers, as a rule, single or not numerous and asymmetrical.
Nerves are early involved in pathological process, and the superficial, going from the center defeats, can increase in sizes. The increased peripheral nerves (especially lokteyovy, fibular and big ear) can be palpated and increase so that become visible, in particular those which are located in close proximity to the defeat centers on skin. Severe neurotic pains are noted. Damage of nerves conducts to an atrophy of muscles, especially small muscles of a brush. Often contractures of a brush and foot develop. Various injuries lead to consecutive infection of a brush and formation of bottom ulcers. Later the resorption and loss of phalanxes can develop in addition. When involving in process of facial nerves the lagophthalmia, a keratitis and a keratohelcosis leading to loss of sight can develop.
3. Lepromatous leprosy
The skin centers of defeat are shown in the form of spots, nodes, plaques or papules. Spots often gipopigmentirovana. GraniYotsa are outlined not clearly, and the central departments of the centers raised over poverkhnoyostyyu the skins condensed and convex, but not concave, as at a tuberculoid form of a disease. Between the centers reveal diffusion infiltration. Izlyub lenny sites of localization of the centers are a face (cheeks, a nose, eyebrows), ears, zapyayostya, elbow joints, buttocks and knees.
Involvement of any given site in pathological process with infiltration development, small nodulation or without it can progress so imperceptibly that the zaboleyovaniye proceeds imperceptibly. Eyebrows, especially side sites drop out. ZnachiYotelno becomes later face skin than thickened and shrivels (a lion's face), and ear lobes droop.
Very common early symptoms are "the congestion of a nose", nasal bleedings, the complicated breath. Often also full obstruction of the nasal courses, laryngitis and hoarseness of a voice are observed. Perforation of a nasal partition and formation of the hollow in a middle part of a back conduct to a razyovitiya of a saddle nose. As a result of defeat of front department of an eye the keratitis and an iridocyclitis razviyovatsya. The painless lymphadenopathy of inguinal and axillary lymph nodes is observed. Adult men have an infiltration and scarring of testicles result in sterility. A usual symptom is the gynecomastia.
Involvement in process of large nervous trunks at a lepromatous form of a disease is less known, but the diffusion hypesthesia extending to peripheral departments of extremities at the progressing course of the disease shiyoroko is widespread.
4. Boundary leprosy
The defeat centers on skin in a boundary and tuberculoid leprosy usually remind diseases, those at a tuberculoid form, however it is more of them by quantity and less outlined borders are inherent to them. More often than in a tuberculoid leprosy, multiple involvement in process of peripheral nervous trunks is observed. The increasing variability in characteristic of the skin centers is characteristic of a boundary leprosy that causes the name a "dimorphous" leprosy.
Papules and plaques can sosushchestyovovat with the spotty centers. Loss of sensitivity is significant less, than in a tuberculoid leprosy. The boundary and lepromatous form is characterized substantially by heterogeneous and rather symmetric skin centers. Lobes of ears can be slightly thickened, but eyebrows and area of a nose are changed a little.
Diagnosis of a leprosy
Diagnosis of a leprosy is based on direct identification of the activator. For this purpose apply a method of scraping excision of affected areas of skin in which the mycobacteria of a leprosy in a large number usually are found.
Causes of a leprosy
Infestant - mycobacteria of Mycobacterium leprae. The leprosy is transmitted through a discharge from a nose and a mouth during close and frequent contacts with the people who are not undergoing treatment. The incubation interval usually is three-five years, but can fluctuate from six months to several decades (the incubation interval lasting 40 years is described. It proceeds asymptomatically. Also not less long stage of latency, not specificity and non-obligation of antecedent signs (indisposition, weakness, drowsiness, paresthesia, feeling of chill) is characteristic of a leprosy that considerably complicates early diagnosis of a disease.
Treatment of a leprosy
Treatment is carried out by generally sulfonic drugs (Diafenilsulfon, Solusulfonum).
Diafenilsulfon appoint the first 2 weeks 50 mg (in powder or tablets) 2 times a day, the next 3 weeks — on 100 mg 2 times a day, a break — 2 weeks; the course of treatment consists of 4 such 5 weeks cycles. After 4 cycles of treatment take a break for 1-1.5 months and again carry out treatment.
Solusulfonum is entered intramusculary in the form of 50% of aqueous solution by 2 times a week. Appoint 50 injections with a break to a course 1-1.5 months. In the 1st week the drug is administered 2 times on 0.5 ml, in the next weeks add on 0.5 ml up to 3.5 ml (on the 7th week) and until the end of a course leave this dose. The course of treatment lasts 6 months.
Aethoksidum is accepted inside daily: the 1st week on 0.1 g 3 times a day, the 2nd — on 0.2 g 3 times a day, since the 3rd week on 0.3 g 3 times a day. The course of treatment makes 6 months.
Etioniamidum (Trecatorum) is accepted inside on 0.25 g a day, in 5 days the dose is increased to 0.5 g, from the 11th day it is increased to 0.75 g (0.25 g 3 times a day). A pill is taken in an hour after a meal. A course of treatment — 6 months.
Contraindications to use of sulfonic drugs are dekompensirovanny heart diseases, an acute gastroenteritis, organic diseases of nervous system, etc.
The leprosy, to be exact its skin elements, change appearance of the person, often spoiling to unrecognizability.
Damage of nerves is resulted by an atrophy of muscles that leads to loss of phalanxes, an ulceration of a cornea of an eye and contractures of foot and brushes.
Leprosy at children
At children aged mainly of 3 years is also more senior much more more often than at adults, detect the mixed or dimorphous leprosy when at the same time there are changes inherent to lepromatous, tuberculoid and undifferentiated types of a leprosy. Besides, at children the leprosy can be shown in the form of a knotty erythema.