Leprosy (leprosy): what is this disease?
Leprosy - what is this disease?
Leprosy(or leprosy) is a chronic infectious disease. It affects the skin and nerves located on the surface. Leprosy is caused by prolonged contact with the skin of a sick person. According to some experts, infection can also occur through the air. Contrary to existing myths about the disease, rarely touching the affected skin areas cannot cause leprosy. The idea of incurable leprosy and an unfavorable prognosis (death) can also be attributed to prejudices. It should also be noted the low threshold for the incidence of leprosy among people at risk for whom there is a real risk of infection. No more than 10% of people do not have sufficient immunity and cannot resist the penetration of the pathogen, therefore it is believed that the pathogenicity of microorganisms that cause leprosy is relatively low.
The disease is not too contagious. No more than 7% of people around the world suffer from it. The rest of the population (about 95%) is immune to this disease. It prevents infection from entering the body. Leprosy cannot be inherited, and the child does not get an infection from the mother.
The peak of leprosy was observed in the 12-16th centuries. Most of Europeans suffered from it. At that distant time, leprosy was considered a disease that could not be cured. The people affected by the infection were exiles. They were expelled from the city, forced to wear a goose foot around their necks, and also to ring a bell if they were going to approach a healthy person.
Now the peak incidence has subsided, but cases of leprosy infection are still being diagnosed. Therefore, doctors need to be attentive to patients with characteristic complaints. In Russia, the last time the disease was officially registered was in a migrant from Tajikistan. It happened in 2015. The man worked in the capital at a construction site.
Facts from history:
- The disease spread in past centuries during the Crusades. When sick warriors and knights became infected and infected the inhabitants of other countries.
- The plague stopped leprosy. During the epidemic, people with weak immune systems who suffered from leprosy were the first to get sick.
- In France, there was a decree. According to him, all people with leprosy were subjected to a "religious tribunal." They were taken to church, buried, and then laid in a coffin. When the coffin was lowered into the grave, they said the phrase: "You are dead to us, not alive." Then a few shovels of earth were thrown onto the coffin. After this, the person was taken out of the grave and sent to the leper colony. He was not allowed to return to the house. In a specialized institution, he remained until the end of his days. At the same time, his relatives considered him dead.
- People with leprosy were deprived of all social rights. They were not allowed to go to church, to entertainment establishments, to fairs. It was forbidden for the infected to swim in reservoirs, drink running water, eat with healthy people and even talk with them.
- Catholics allowed couples to divorce if one of the spouses was sick with leprosy, although the Catholic Church rejects divorce as such.
- In the Middle Ages, leprosy was called by various terms, including: Phoenician disease, black sickness, lazy or slow death, sorrowful illness. The name "leprosy" was coined in Russia. This word comes from the Old Russian "kazit", that is, disfigure or distort.
Content:
- Geography and features of the spread of leprosy
- Classification of leprosy
- Causes of leprosy
- Leprosy symptoms
- Diagnosis of leprosy
- Leprosy treatment
- Answers to popular questions
- What doctor treats leprosy?
Geography and features of the spread of leprosy
Today around the world there are no more than 2 million people with leprosy. The decrease in the number of infected people occurred in the nineties, until that time there were about 12 million. In Russia, as of 2007, 600 people were registered with leprosy, 35% of them received treatment in a hospital, and the rest underwent therapy at home.
Today, leprosy is practically not found in regions that are characterized by a cold climate, it is mainly common in the tropics and subtropics. The disease is noted in the countries of Asia and Africa (India, the countries of the former USSR, Japan, Korea and several others), as well as in Central and South America.
Leprosy is not a widespread disease, but, nevertheless, it affects approximately 11 million people worldwide (according to WHO). According to statistics, men are three times more likely to get leprosy, but if we take into account the age of the infected, then among children there is a higher susceptibility to microorganisms than among adults.
The infection is spread by a sick person. It can also be carried by armadillos and monkeys. Leprosy bacteria are found in soil and water, but the likelihood of infection through them is extremely low.
The bacteria that cause leprosy cannot exist outside the body. It quickly collapses in air. At the same time, bacteria can exist in human corpses for a long time.
The size of the population affected by leprosy largely depends on the economic status of the country. What matters is the level of sanitary and hygienic skills of people, their financial well-being.
The infection can spread in 2 ways:
- By airborne droplets. The bacteria are secreted when you cough, sneeze, or talk. At the same time, a lot of pathogenic microorganisms enter the air.
- In case of violation of the integrity of the skin. The infection can be brought in when performing tattoos, or when bitten by insects that feed on blood.
The longer contact with a sick person, the higher the risk of infection. So, the likelihood of infection increases if a person is in intimate proximity with a patient with leprosy, or lives with him in the neighborhood. Although statistics indicate that even if there is a patient with leprosy in the family, close relatives get sick no more often than in 12% of cases.
The incidence among children is high, since their protective forces are not yet fully formed. It has been established that black men suffer from leprosy more often than women. There is no such tendency among white-skinned people.
If a person with leprosy lived in the apartment, then after his departure, disinfection of the room is required.
Features of its implementation:
- First of all, linen and dishes are disinfected, as well as those places where mucus and sputum secreted by a person can be located.
- All objects are boiled in a 2% concentration soda solution. You can also soak them for an hour in a 1% strength chloramine solution.
- The walls and floors in the living area are sprayed with chloramine with a concentration of 0.5%, or with bleach, with a concentration of 0.2%.
Classification of leprosy
Depending on the type of disease, leprosy is distinguished:
- Tuberculoid.
- Lepromatous.
- Dimorphic (borderline) and undifferentiated.
Stages of development of the disease:
- Stationary;
- Progressive;
- Regressive;
- Residual.
Causes of leprosy
Hansen discovered the causative agents of leprosy Mycobacterium leprae in 1874. From the moment of infection until the first symptoms of leprosy appear, it can take from two to 20 years, on average 3-10 years.
Mycobacterium leprae, considered to be the cause of leprosy, have much in common with mycobacterium tuberculosis, but, unlike them, they are cultivated only on the skin of experimental animals and do not grow on artificial nutrient media.
Mycobacteria (Mycobacteriaceae) are a family of actinomycetes. The only genus is Mycobacterium. Some members of the genus Mycobacterium (e.g. M. tuberculosis, M. leprae) are pathogens for mammals
The bacterium looks like a stick, which has a straight or curved shape. Its ends are rounded. It does not exceed 7.0 microns in length and 0.5 microns in diameter. The bacterium is resistant to treatment with alcohol compounds. It is classified as an obligate intracellular parasite that is invaded by tissue macrophages.
The source of the spread of bacteria is humans. He releases it into the environment. Pathogenic flora is present in breast milk, saliva, nasal mucus, urine, feces and semen, and discharge from wounds. Mycobacterium enters the mucous membranes or damaged areas of the skin, and then reaches the nerve fibers, blood vessels. Together with blood and lymph, pathogens spread throughout the body.
If a person is healthy, then he has immunity to bacteria and infection will not happen. At risk are children, people who abuse alcohol, patients with chronic diseases and weak immunity.
Leprosy symptoms
The incubation period of the disease is quite long and ranges from 3 to 7 years, although sometimes it can be shortened to six months or stretched for 15-20 years. There is evidence that leprosy existed in the incubation period for 40 years. At the same time, no symptoms of the disease were observed in a person. Even after leprosy has left the incubation period, the patient may not have any symptoms of infection for a long time.
First of all, leprosy affects tissues that come into contact with air. Symptoms of leprosy are damage to the skin, mucous membranes of the mouth and sinuses, as well as the nerves located on the surface. In advanced cases, leprosy penetrates deeply located layers of the skin and becomes the cause of the destruction of nerve fibers, as a result of which deformities occur, the usual appearance of a person is distorted.
Leprosy pathogens are not directly responsible for the death of the toes. An infection that is not cured in a timely manner leads to tissue necrosis on the arms and legs. On the fingers deprived of blood supply, a secondary infection develops quite quickly, caused by bacteria that get on the injured skin, thus, it is due to the bacterial infection that the fingers and toes eventually die off.
There are two types of leprosy:
- Tuberculoid-type leprosy
- Lepromatous form
Leprosy tuberculoid form
This infection has the most favorable prognosis. In humans, the skin suffers, as well as nerve fibers passing along the periphery. Sometimes visceral internal organs are affected.
If the disease proceeds according to the tuberculin type, the symptoms of leprosy are flat spots with a red or white tint, or covered with scales. When the disease just started to develop, several spots resembling erythema are found on the dermis. Their boundaries are clearly delineated. They quickly grow and merge to form plaques that rise above the skin's surface. In the affected areas of the skin, the sheaths of nerve fibers become denser, their thickening gradually leads to a loss of sensitivity of individual tissues. Then the plaque in the middle becomes dense, the dermis begins to atrophy. Over time, its dimensions reach 15 mm in diameter. Multiple lesions, can be found on the chest, on the lower back, on the back.
With this form of the disease, the nail plates suffer, they lose their natural color, begin to break, exfoliate and collapse. The nails become gray, stripes appear on them.
Neurological symptoms develop early. In places where there are skin defects, sensitivity worsens, hair falls out, dermis changes color, glands responsible for the production of sebum and sweat are affected. The skin becomes dry, rough areas appear on them. When the disease has just begun to develop, skin sensitivity either diminishes or intensifies for a short period of time. Then it decreases and disappears completely.
In the case when pathogens penetrate the large nerve trunks, destructive changes in bones and joints occur, most often the limbs are affected. A person begins to move his fingers with difficulty, contractures appear. Trophic ulcerative defects form on the legs. Subsequently, the fingers, hands and nose atrophy and are rejected. This process is called mutation.
If the facial nerve suffers, then the facial muscles stop moving, the eyelids do not fully close.
In medicine, cases of spontaneous disappearance of symptoms of tuberculin-type leprosy are known.
Leprosy lepromatous form
In this form, mycobacteria multiply rapidly in the skin and cause the formation of nodes (leprosy) or plaques with a characteristic scaly structure. Over time, the skin becomes thicker, deep folds appear on it. Most often they can be seen on the patient's face, which resembles a lion's face - a symptom characteristic of leprosy.
This disease has a severe course. First of all, the patient's skin suffers, as well as the mucous membranes. After that, the pathological process spreads to the internal organs and the nervous system.
The main symptoms of lepromatous leprosy are:
- Skin lesions. Symmetrically located spots appear on the skin, which look like erythromatous rashes. Each such spot contains a huge amount of mycobacterium leprosy. The spots are not clear-cut. They can appear on the palms, face, legs, buttocks, and forearms. At first, the spots have a glossy sheen, they are smooth on top. As the pathology progresses, the spots turn from red to rusty or brown. At the same time, there is no deterioration in sensitivity in the area of their concentration. In this form, the spots can persist for many years. Sometimes they disappear, and sometimes they transform into lepromas and infiltrates. In the latter case, the spots look like plaques without a clear limitation. If vascular paresis occurs, then the spots acquire a brown color.
- Loss of function of the skin. If skin infiltration occurs, the sebaceous glands begin to work in an enhanced mode. Therefore, the dermis becomes greasy, becomes shiny. The follicles of the vellus hair and the ducts of the sweat glands become wider. Therefore, the skin resembles the appearance of an orange peel. As the pathology progresses in the area of infiltration formation, sweat stops secreting. At first, vellus hair stops growing, and then a person's mustache, beard and eyebrows begin to fall out.
- Facial affection. The face with infiltrates appearing on it begins to resemble a "lion's face". All skin folds and wrinkles deepen, the eyebrows protrude forward, the nose and cheeks become thicker, the lips and chin are divided into lobules.
- Formation of leprosy. When the disease has just begun to develop in the patient, infiltrates form on the skin. They are absent on the scalp, on the eyelids, in the elbows and in the armpits. Then, at the site of infiltrates, lepromas are formed, which can reach 3 cm in size. There are especially many of them on the face, ears, on the hands, in the forearms, on the legs, on the back and on the buttocks. Leproms do not hurt, have a smooth surface, and can peel off. Most often, over time, lepromas become soft, but sometimes, on the contrary, harden. It happens that they dissolve on their own. After them, a depigmented spot remains on the skin, which slightly sinks inward. If a person does not receive proper therapy, then ulcers form on the lepromas, which are very painful. After they disappear, scars remain on the skin.
- Damage to the mucous membranes. Especially often the nasal mucosa is affected. If the disease is severe, then the damage affects the mouth, lips and tongue. The patient has nosebleeds, nasal breathing worsens, as lepromas begin to grow in the nasal cavity. The organ itself is undergoing deformation. Sometimes a person loses the ability to speak. This happens when the disease affects the vocal cords.
- Other symptoms. In addition to the symptoms of the disease described above, the organs of vision may suffer in humans. Keratitis, blepharitis, iridocyclitis, lens opacity, conjunctivitis are often diagnosed. Nerve fibers, lymph nodes, blood vessels, testes and liver can be involved in the pathological process. As the disease progresses, a person develops paralysis and paresis, and trophic ulcers form. When the liver suffers, the patient is diagnosed with chronic hepatitis. Orchitis and orchiepididymitis may develop in men. In the future, the patient's mammary glands begin to increase in size according to the female type, symptoms of infantilism develop, which is associated with hormonal imbalance.
Dimorphic and undifferentiated lepra
If a patient develops a dimorphic type of leprosy, then the clinical picture will combine the symptoms of tuberculoid and lepromatous leprosy.
The undifferentiated form of the disease may be accompanied by damage to nerve fibers. First of all, the peroneal, ear and ulnar nerves are affected. On the skin of patients, areas with altered pigmentation appear, in these places sensitivity decreases or completely disappears, sweat glands stop working. The more damaged the nerve fibers, the more intense the symptoms of polyneuritis. Patients often have paralysis and paresis, and deformities of the arms and legs may occur. On them, areas of ulceration appear that do not heal for a long time.
Diagnosis of leprosy
The disease can be suspected based on its manifestations. When leprosy is at an advanced stage of development, the diagnosis will be obvious to the doctor. Patients have no eyebrows, lepromas form on the body and on the face, the limbs are paralyzed, fingers and hands may be missing, the nose is severely deformed, etc.
If the disease has just begun to develop, then the absence of obvious symptoms of leprosy can be difficult in terms of making the correct diagnosis. In this case, the patient may be referred for a consultation with a neurologist, dermatologist, infectious disease specialist or other narrow specialist, since the manifestations of the disease are quite diverse.
To confirm leprosy, it will be necessary to conduct a bacteriological examination of scrapings taken from the fingers, from the earlobes, from the nasal mucosa. For histological analysis, lepromas, the contents of the lymph nodes, or separated from the sites of ulceration can be taken. The collected materials will contain mycobacterium leprosy.
To clarify the degree of loss of skin sensitivity, functional tests are performed. They are carried out with Minor's reagent, with nicotinic acid, with mustard plaster and with histamine.
The lepromine test is also used. If his reaction is positive, then the patient develops leprosy according to the tuberculoid type, and if negative, then the lepromatous or borderline form can be diagnosed. When the test gives a weak positive reaction, an undifferentiated variant of the disease is suspected.
Leprosy treatment
For several centuries, leprosy was treated with haulmugr oil, which was replaced by sulfone drugs. Diaphenylsulfone (dapsone) has become the main treatment for leprosy since 1950. Its therapeutic effect can be seen only after a long period of time. Not being a specific treatment for leprosy, sulfone drugs inhibit the development of the disease. In mild cases, recovery occurs after two years; in more severe situations, the treatment of leprosy takes about eight years.
With the emergence in the 1980s of strains resistant to the main treatment for leprosy, dapsone, complex regimens have entered medical practice. Clofazimine is now widespread in the lepromatous type of leprosy.
Today, leprosy is a curable disease. At the same time, it is important to identify it at an early stage of development, before it leads to disability. A sick person is placed in a leper colony or treated at home.
Now only those people who have pronounced skin defects are hospitalized. Inpatient treatment for primary therapy is also indicated. Patients with recurrent leprosy are hospitalized. At home, people can be treated for whom a bacteriological study gave a negative result, and they have few skin rashes.
Patients are prescribed 2 or 3 drugs at once, which have pathological activity against leprosy bacteria. Be sure to carry out therapy aimed at increasing immunity. Medical correction can be implemented using drugs such as: Methyluracil, Dapsone, Rifampicin, Pyrogenal, gamma globulin. Patients are shown taking vitamin and mineral complexes.
The main directions of drug therapy:
- Sulfone preparations: Solusulfone, Diaphenylsulfone, Diucifon.
- Antibacterial agents: Rifampicin, Lampren, Clofazimine, Ofloxacin, Ethionamide.
The drugs are prescribed for up to six months. If a person tolerates treatment well, then there are no breaks between courses. The patient is prescribed one drug from the sulfone series and two antibiotics. To prevent bacteria from developing resistance, drugs must be alternated every 2 courses. In general, therapy should last at least a year, and sometimes it takes about 3 years. Some patients require lifelong treatment.
If a patient is diagnosed with multibacillary leprosy, then he is prescribed Rifampicin, Dapsone and Clofazamine. The drugs are dispensed to patients free of charge.
Treatment regimen:
- 600 mg Rifampicin + 300 mg Clofazimine orally 1 time per month under medical supervision. At home, a person should take Dapsone 100 mg + Clofazimine 50 mg once a day. The course of therapy lasts a year. Such recommendations are given by WHO.
- In America, the therapy is somewhat different. There, patients are offered 600 mg of Rifampicin + 100 mg of Dapsone + 100 mg of Clofazimine once a day. The course lasts a year. If a person is diagnosed with a borderline form of the disease, then he is prescribed Dapsone for 10 years. With lepromatous leprosy, this drug will need to be taken for life.
If a person is diagnosed with an oligobacillary form of leprosy, then WHO recommends that such patients take 600 mg of Rifampicin once a month and 100 mg of Dapsone every day. The course of treatment according to this scheme lasts 6 months. If the patient has a single skin formation, then he is offered a one-time intake of Ofloxacin 400 mg + Rifampicin 600 mg + Myocycline 100 mg.
In America, patients are prescribed 600 mg of Rifampicin + 100 mg of Dapsone 1 time per day. The course of therapy lasts a year. If the patient is diagnosed with an indefinite or tuberculoid form of leprosy, then he is prescribed Dapsone for 3 years. With a borderline form of the disease, the drug will need to be drunk for 5 years.
Dapsone is an inexpensive and safe drug used to treat leprosy. Occasionally, patients develop hemolysis and mild anemia, allergic dermatosis. The latter complication can be severe. Even less often, Dapson's syndrome develops.
Rifampicin is even more potent against leprosy bacteria than Dapsone. However, treatment with it is more expensive. Side effects include: liver damage, flu-like syndrome, thrombocytopenia, renal failure.
Clofazimine is a safe drug. Its only side effect is discoloration of the skin, but after the completion of the course of therapy, the color of the dermis is restored.
If the patient develops mild skin erythema (the first or second episode of inflammation), then patients are offered Aspirin. In severe erythema, prednisone 40-60 mg is prescribed once a day. Complement antibiotic treatment. When the skin lesion occurs again, then the patients are shown taking Thalidomide 100-300 mg 1 time per day. However, this drug is prohibited for women who are planning a pregnancy. Its side effects are leukopenia and constipation.
Antibacterial agents are able to stop the progression of the disease, then they do not allow to get rid of the already appeared deformities, or to correct the existing damage to the nerve fibers. Therefore, it is so important to start treatment precisely at the early stages of the development of the disease. The drugs are used in a complex scheme, since mycobacterium leprosy can quickly develop resistance to one antibiotic.
Answers to popular questions
- What is the prognosis for leprosy? If a person begins to receive treatment at an early stage of the development of the disease, then the prognosis is favorable. When leprosy has a neglected form, there is a high probability that the patient will become disabled.
- Are there leper colony in Russia? Yes, there are 4 leper colony in Russia, which are located in Astrakhan, in the Krasnodar Territory, in the Stavropol Territory and in Sergiev Posad. Sick people in leper colony have their own homes, they run the household. Doctors live next to the leper colony.
- After recovery, are already formed deformities reversible? No, if a person has lost his hands or fingers, then they will not grow back. Treatment aims to eliminate leprosy bacteria in the body. To cope with paralysis, paresis and contractures, the patient is recommended physiotherapy, exercise therapy, sometimes operations are performed.
- What are the complications of leprosy? The main complications include: trophic ulcers, damage to the organs of vision with the development of complete blindness, loss of voice, deformity of the nose, loss of fingers, paralysis. If there is no therapy, then the person dies from cachexia, asphyxia or amyloidosis.
- Can you get vaccinated against leprosy? What are the measures to prevent the disease? There is no vaccine for leprosy. There is evidence that the setting of BCG significantly reduces the likelihood of infection with mycobacterium leprosy. To prevent infection, you need to maintain the immune system, and also not contact sick people. If a person with leprosy lives in a family, then he should have his own personal belongings, starting from a comb and ending with dishes. All family members should be regularly examined for the detection of Mycobacterium leprosy in their body, and should carefully follow the rules of personal hygiene.
What doctor treats leprosy?
A phthisiatrician is involved in the treatment of prcoaza
Author of the article: Danilova Tatyana Vyacheslavovna | Infectionist
Education: in 2008 received a diploma in General Medicine (General Medicine) at the Pirogov Russian Research Medical University. Immediately passed an internship and received a diploma of a therapist
