LEPROSY

Leprosy (syn .: leprosy) - malokontagioznaya chronic infectious disease characterized by lesions of the skin, visible mucous membranes, peripheral nervous system and internal organs.

Pathogen - acid-fast bacilli (Mycobacterium leprae) - Gram-positive rods, very similar to the causative agent of tuberculosis, an obligate intracellular parasite. Source pathogen - sick man. Infection occurs after prolonged and close contact with leprosy patients. The most susceptible are children.

The clinical picture. The incubation period - 3 - 7, sometimes up to 20 years. The disease lasts for many years, sometimes seriously exacerbated. There are lepromatous, tuberculoid and intermediate types of disease. In lepromatous type mainly on the skin of the limbs and face appear reddish-brown spots without clear boundaries, infiltration, bumps and knots; fall out eyelashes and eyebrows, earlobes thickened, deformed nose; the mucous membrane of the mouth and nose ulcers occur, the voice becomes hoarse, developed dyspnea , neuritis, visual disturbances including blindness, enlarged lymph nodes. When the diffuse infiltration of the skin, it acquires the characteristic form of the so-called lion's muzzle: the natural lines and wrinkles deepen, eyebrows bitterly opposed, thickened nose, cheeks, lips and chin have lobed appearance. The liver and spleen often are enlarged, dense, painless, bone phalanges leproma formed in long bones - osteoperiostity (inflammation of the bone, the periosteum exciting). Characterized by the development of symmetrical polyneuritis with sensitivity disorders and movement disorders.

When tuberculoid lighter type appear on the skin or pale red spots or plaques plaques increasing their flattened central portion, pigmentation reduced, which leads to a ring-shaped elements. The lesions are no surface sensitivity of the skin and sweating, hair fall out, developing atrophy of the skin. Often marked neuritis due to destruction of nerve trunks. This type is best to treat.

The intermediate (borderline) leprosy types are characterized by the presence of spots on the skin, usually annular. The spots are dry, have no surface sensitivity, there is pain along the nerve trunks (ulnar, peroneal, and others.); in the lesions develop atrophy and muscle contractures, trophic ulcers on the soles, lagophthalmos (nesmykanie century), dissolve bone phalanges of fingers, feet.

D and a g n o s is set on the basis of clinical, epidemiological history data (residence designation in the endemic area, the presence of relatives of patients with leprosy), and laboratory results. If you suspect a disease it is necessary to examine the entire skin, mucous membranes of the nose and mouth to explore scraping the mucous membrane of the nasal septum and tissue fluid from the skin rash. The presence of rash in the area of ​​anesthesia and distal extremities can be set using the sharp needle, tubes with hot and cold water. For the diagnosis can also be used in functional tests. Thus, in the absence of cutaneous manifestations of sample applied to a so-called inflammation, which consists in the intravenous administration of nicotinic acid; in the presence of leprosy process observed redness and swelling of the skin at the site of the lesion.

Treatment. If you suspect leprosy patients should explore the dermatologist. Once the diagnosis of leprosy patients is required to send to the leprosarium (private health care facility) where sulfonic provide treatment and other drugs. After the disappearance of bacteria in patients discharged to outpatient treatment in the community, as they are not dangerous to others.

Forecast. With early diagnosis and effective treatment of regular patients can not stay any debilitating effects of the disease. In late begun treatment may experience sensory disturbances, contractures of the fingers, paresis, etc .; the disease can lead to blindness and severe disability, and sometimes death occurs.

Prevention. Individual prevention lies mainly in personal hygiene measures. Health workers in the centers of leprosy should wear gloves when taking biopsies and surgery, gauze masks when examining the upper respiratory tract and taking scrapings from the nasal mucosa. Social prevention is early detection and treatment of leprosy cases, registration and accounting of all patients.

It is necessary to carry out preventive treatment of persons aged 2 to 60 years who had a long (eg, family) contact with leprosy patients: use one of sulfone drugs, treatment duration of 6 months to 3 years. For the organization and supervision of preventive treatment antileprosy responsible institutions and spend it as antileprosy institutions and STI clinics and local outpatient facilities.

To identify patients in areas endemic for leprosy, carried out preventive examinations of the population. For family members of leprosy patients are clinical observation - health checks, and where necessary laboratory tests on a quarterly basis. The duration of the observation from 3 to 10 years.