Leprosy ( leprosy ) - Causes, Symptoms and Treatment .MF .
Leprosy - a disease caused by mycobacteria, characterized by prolonged chronic course, lesions of the nervous system, skin and mucous membranes, as well as the musculoskeletal system and internal organs.
disease is spread mainly in tropical countries.At the same time the highest number of cases were registered in Brazil, in second place is India, the third place is occupied Burma.According to the 2009 leprosy about two hundred thousand people in the world suffer from.In Russia of 2007, 600 people have been infected, and only 35% of them are hospitalized.So the "leprosy" is also known as leprosy, the disease is not so forgotten and there is a risk of falling ill.
Leprosy is caused by Mycobacterium Mycobacterium leprae.The source of leprosy is a sick man.The leading mechanism of infection is the aerosol.It was established that during the day leprosy patients with sputum allocates nearly one million bacteria.Infection occurs when the mucus droplets when coughing, sneezing by infected per
Mycobacteria enter the bloodstream and are deposited in various organs.Due to the active propagation of microorganisms formed granulomas.Granulomas are lumps composed of cells of the immune system.The granulomas are formed on the skin, leading to characteristic changes in facial deformities and development in the liver, lungs, spleen, kidney, lymph nodes, muscle.Granulomas in the bones causing depression of bone substance and lead to fractures, and location in the area of neural pathways granulomas contributes to the death of neurons and the development of paralysis, malnutrition surrounding tissues.
Symptoms of leprosy
from infection to the appearance of the characteristic symptoms of the disease takes on average 3-5 years, in some cases, this period shall be extended to 15-20 years.
disease begins quietly with the appearance of weakness, malaise, drowsiness, lethargy, weakness.Some people point to the emergence of numbness in the fingers, feet, solid bumps on the skin.Given lean symptoms, diagnosis at an early stage of leprosy usually difficult.
Depending on the leading symptoms of the following types of leprosy.
• tuberculoid type of leprosy .The most favorable variant of the disease.In tuberculoid type predominantly affects the skin and nervous system, there is no violation of the internal organs function.At the beginning of the skin disease appears a single center or multiple (2-5) of the elements that constitute the spot papule or plaque.They can be light or more reddish, compared with healthy skin.In the future, these elements merge with each other and formed with pockets fancy maroon circuit valikoobraznym raised edge and thinning of the skin in the central parts.
characteristic skin changes with tuberculoid type of leprosy
On the face and extremities may appear tumor formation.The skin in the affected area, as well as 1.5-2 cm in excess of the affected area becomes insensitive, numb.So often there are injuries, burns, which in non-compliance with the rules of hygiene very rapidly abscess.
defeat of the nervous system is a common symptom of tuberculoid type of leprosy.Near the centers of skin can be felt painful thickened nerve trunks.The most commonly affected radial, ulnar, parotid nerve and branches of the facial nerve.Violated the motor activity of the fingers, forming the characteristic symptoms, such as the "bird's foot", "hanging foot".
Deformation brush of the type "bird's foot" in the defeat of the ulnar nerve in leprosy
foot deformities of the type "hanging foot" in the defeat of the peroneal nerve in leprosy
Because eating disorders skinit becomes brittle and easily vulnerable, developing spontaneous amputation (spontaneous detachment of dead part of the body) of the limbs.
spontaneous amputation of fingers in leprosy
• lepromatous type of leprosy - the most severe form of the disease, in most cases leading to disability and, in some cases, to the patient's death.The disease begins with the appearance of the skin shiny spots without a clear demarcation from healthy skin.These spots in people with dark skin lighter, and in individuals with fair skin have a reddish color.It is noteworthy that the sensitivity of the skin in the affected area is preserved.After 3-5 years in the field of hair fall out spots, there are characteristic nodules and tumor formation.With the localization of tumor foci in the brow, chin and ears person acquires a peculiar species described in the literature as the "lion face".
Lion face as a characteristic feature of lepromatous type of leprosy
Very often these elements are formed ulcers, they are infected, after the healing of ulcers in place tough ugly scars are formed.A characteristic feature of lepromatous type of leprosy is the defeat of the nasal mucosa with perforation of the nasal septum, and changing the shape of the nose.Often pathological process extends to the mouth and throat, which leads to a change in voice.
Eventually disturbed sensitivity in the upper and lower limbs, and in the soles and palms sensitivity persists long enough.In the later stages of the disease are formed contracture of fingers, spontaneous amputation, and chronic nonhealing ulcers are formed.In patients experiencing inflammation of the lymph nodes.Men develop orchitis - inflammation of the testicles, followed by violation of their functions.In 80% of patients detected eye disease, eventually leading to blindness.Granuloma formation in the bones leading to fractures and dislocations.Often, granuloma formation in the kidneys, lungs, liver, spleen, which leads to dysfunction of these organs.
• Border types of leprosy combine the features of two main types and are characterized by a milder course.
The disease is most likely if one of the following features.
1. Identify specific cutaneous manifestations with sensitivity loss, regardless of the thickening of the nerve trunks.
2. Determination of mycobacteria in the study of the contents of cutaneous lesions.After a shallow incision is obtained from scraping region granuloma was examined under a microscope.In addition, a large number of disease pathogens may be detected by study of the nasal mucus and the oral cavity as well as the contents of the lymph nodes.
treatment of leprosy
Initially leprosy was considered a fatal disease.In the Middle Ages at the first sign of the disease unfortunate he was to appear at a religious court, which necessarily condemned him to death.The patient was taken to a church funeral service, then put in a coffin, attributed to the cemetery, they lowered into the grave and threw the earth with the words: "You're not living, you're dead to us all."After that they dug up and taken to the leprosarium.Home, he never returned.
Currently, with timely treatment may cure leprosy .Leprosy Treatment long, is aimed at the destruction of pathogens, prevention and treatment of complications.Patients hospitalized in specific institutions - a leper colony, their relatives undergo regular inspection.In the Hospital patients have at home, part-time farm, if desired, they can be engaged in various crafts.As a rule, medical and support staff living close to patients in isolated conventionally, for example, forest plantations, area.There are currently four leprosarium operated in Russia in Astrakhan, Sergiev Posad Branch in Stavrapolskom and the Krasnodar Territory.
As a rule, patients with newly diagnosed leprosy, as well as the return of the disease, on a mandatory basis are hospitalized in a specialized clinic, as these patients are contagious to others.For patients with lepromatous type of leprosy treatment duration is about 12 months, while tuberculoid type-6 months.
All patients demonstrated the use of antibiotics in a specific pattern.Type antibiotic, and the duration of treatment depends on the type and extent of disorders leprosy organs.The most common drugs such as rifampicin, dapsone, ofloxacin.In addition to the antibacterial treatment of patients is recommended anti-inflammatory therapy (acetylsalicylic acid, in some cases - prednisone).
If within 6-12 months after the course of treatment the patient is not determined by the mycobacterium, it can be transferred to outpatient treatment.At this time, a patient even in the presence of residual phenomena can not infect others.
for social adaptation of patients recommended psychotherapeutic treatment, as well as the use of orthopedic aids.In addition, to maintain immunity and prevent infectious complications patients should be nutrition, massage, physiotherapy, as well as physiotherapy.Given the violation of the sensitivity in the upper and lower extremities, all patients must be careful to prevent personal accidents.
Possible complications of leprosy
Injuries and infections can lead to deformation of the fingers, spontaneous amputation, the development of contractures.With the defeat of the nervous system are formed paralysis.Often, after prolonged illness within disturbed vision up to blindness.Granulomas on the face leads to the formation of deformities, and bone loss and joint promote disability of patients.Granulomas in viscera contribute to the development of hepatitis, pneumonia, lymphadenitis, nephritis and pyelonephritis.
Outlook for leprosy
itself leprosy is not a fatal disease.However, mortality in leprosy four times, compared with the general population.The cause of death are infectious complications and amyloidosis (abnormal protein deposition in inflammation) of the internal organs.Late seeking care in patients with preserved disabling deformation, which may require surgical and orthopedic treatment.
vaccines against leprosy no.In the literature there is a description efficacy against BCG tuberculosis vaccine, but objective evidence is received.
Preventive measures should be aimed at improving the quality of life, improvement of living conditions, immunity.
patient with leprosy should be a separate bed, dishes, personal hygiene items.It should be timely processing of ulcers, regularly changing the dressing.Patients even after treatment are not allowed to work in the children's and medical institutions, as well as food and utilities, since the possible return of the disease.Persons in contact with the sick, recommended personal hygiene (hand washing, use of gloves, masks when handling ulcers).
relatives of patients compulsorily carried leprominovaya sample.Leprominovaya sample - it intradermal attenuated Mycobacterium leprae.The appearance of spots on the injection site, and then turning it into a mound, often with ulceration, indicates a positive reaction.A positive reaction is typical for healthy individuals.Such persons are under the constant supervision of a doctor holding a non-specific treatment aimed at increasing immunity.In the absence of reaction is carried out a thorough examination and preventive treatment with antibacterial drugs in a specific pattern.
therapists Sirotkin EV