Who are lepers. Leprosy: a history of disease and medieval delusions. Complications and consequences

Leprosy or leprosy is one of the most ancient diseases in human history. Mentions of leprosy are found in the oldest medical manuscripts. ancient egypt(Papyrus Ebers), Biblical Old Testament, as well as the ancient Indian Vedas of the 15-10th century BC.

Previously, leprosy was considered absolutely incurable disease, patients with leprosy were expelled from society and were doomed to a slow and painful death. Since leprosy is a contagious disease, patients had to wear special bells, sound warning others about their approach, so that they had time to scatter. At that time, people did not know that the causative agent of leprosy is not transmitted by touch.

The superstitious fear that leprosy patients aroused in those around them caused such people to be considered "impure", cursed and "marked by the Devil" for their sins.

The patients were deprived of all social rights: they could not visit crowded places and churches, drink water from the river or wash in it, touch things healthy people and even just to be with them. Despite the church's negative attitude towards divorce, the presence of leprosy in one of the spouses was considered an absolutely legal and official reason for the immediate dissolution of the marriage.

A patient with leprosy during his lifetime was buried in a church, symbolically buried and driven out of the city, handing him a heavy hooded robe with bells ringing when walking.

By the end of the fourteenth century, leprosy was widespread in all European countries. In this regard, society began to think about more effective methods of isolating patients. Mentions of leper colonies, where leprosy patients could count on minimal medical care, food and a roof over their heads, date back to the sixteenth century AD (the first attempts to open leper colonies were noted in the 11 century). Such institutions were located on the territory of monasteries, where monks looked after lepers.

Thanks to the creation of leper colonies, by the end of the sixteenth century, leprosy had practically receded. On the this moment leprosy is found in Africa, Asia, South America. In Russia, leprosy occurs every 1-2 years. For patients with leprosy there are three leper colonies (there were sixteen leper colonies in the Soviet Union) in Stavropol, Krasnodar and Astrakhan.

The causative agent of leprosy was discovered and investigated in 1873 by the Norwegian physician Gerhard Hansen. He found in the tissues of patients with mycobacterium leprosy and established their similarity with mycobacterium tuberculosis.

In 1948, Raoul Follereau, a French public figure, writer, poet and journalist, founded the Order of Mercy for leprosy patients. In 1953, he also established World Leprosy Day, and in 1966 he founded the European Federation of Anti-Leprosy Associations.

Leprosy (leprosy) is a chronic infection, accompanied by damage to the skin, peripheral nervous system, eyes and mucous membranes of the upper respiratory tract.

The causative agent of leprosy is mycobacterium leprosy (Mycobacterium leprae). ICD 10 code - A30.

Is there a cure for leprosy now?

At the moment, patients are receiving specialized medical care. In cases where treatment was started on early stage, the disease does not lead to disability. Many patients with leprosy living on the territory of leper colonies are not contagious and can freely be in society, but they prefer to stay on the territory of the leper colony, being afraid to face leprophobia among others.

With adequate treatment, the disease does not lead to death.

Causes of leprosy

Leprosy (the disease is also called Hansen's disease, lazy or mournful disease), refers to a slightly contagious disease. Less than thirty percent of people are susceptible to leprosy.

The disease is often found in relatives (familial cases), suggesting a hereditary predisposition to the disease.

The famous doctor Danielsen, in the middle of the nineteenth century, studied the mechanism of transmission of leprosy and the pattern, as well as the staging of its development. To this end, he injected himself with the blood of patients infected with leprosy, but he did not manage to get sick himself.

How is leprosy (leprosy) transmitted?

The transmission of the pathogen is carried out by airborne droplets. The entry gates for infection are the mucous membranes of the upper respiratory tract (upper Airways). Isolated cases of infection during tattooing and after surgical interventions have been registered.

It is also possible to become infected with lengthy skin contacts.

The possibility of transmission of Mycobacterium leprosy through soil or water is being considered. In addition to humans, a nine-banded armadillo, a monkey or a buffalo can serve as a source of infection.

The incubation period of leprosy can last from six months to several decades. The literature describes a case where the incubation period of leprosy lasted almost forty years.

Generally, the incubation period for leprosy is three to nine years.

Is leprosy contagious?

Leprosy is contagious, however, it is a low contagious infection. Even out of thirty percent of patients with a predisposition to leprosy, only ten percent get sick

In men, the disease is recorded three times more often than in women. There is also a hereditary predisposition to the disease. Children get leprosy more easily and faster than adults.

Most people have high level immune protection from leprosy.

The indicator of immune protection and resistance also plays important role in the development of the form of the disease in infected patients.

In the development of leprosy and a decrease in the incubation period, the role of hormonal background. The first symptoms or exacerbation of old symptoms may be associated with the onset of puberty, pregnancy or childbirth.

It should be noted that leprosy produces cellular immunity. Its severity is minimal after the transferred lepromatous or diform type and maximum after tuberculoid leprosy (the tuberculoid form is forty times less infectious than the lepromatous form).

The development of tuberculoid leprosy is typical with a small infection of the patient. With a massive invasion of the pathogen, an almost complete suppression of the immune response occurs and lepromatous leprosy develops.

Leprosy classification

According to the classification of the World Health Organization, the course of leprosy can be:

• undifferentiated;
• lepromatous;
• subpolar lepromatous;
• borderline lepromatous;
• border;
• borderline tuberculoid;
• tuberculoid;
• unspecified.

Infection can also be:

• multibacterial;
• low bacterial.

Leprosy symptoms

After the end of a long incubation period, patients may have a long latent period of the disease. Symptoms of leprosy disease in prodromal period may present with discomfort neuralgic pains, soreness in the muscles and joints, muscle weakness, disorders of the gastrointestinal tract, periodic fever. Violation of skin sensitivity in the initial stage can be manifested by both a decrease and an increase in sensitivity.

In the future, the specific symptoms of leprosy join. The most commonly isolated lepromatous, undifferentiated and tuberculoid variant of the course of leprosy.

In the tuberculoid variant of the course of leprosy, lesions of the skin and peripheral nervous system are observed.

Photo of leprosy disease:

tuberculoid leprosy

Skin lesions are manifested by the appearance of vitiligo-like spots (spots have clear, sharply defined borders and do not have pigmentation) or bright red-violet spots with a pale area in the center.

These formations are arranged asymmetrically. The skin in these areas completely loses sensitivity. In children, the tuberculoid form of leprosy may progress through juvenile type, with the formation of several inconspicuous spots, which subsequently disappear.

The progression of the tuberculoid form of leprosy is accompanied by the appearance of flat and dense purple papules along the periphery of the spots. At the confluence of the papules, large or medium-sized plaques are formed, which have a bright purple hue. Some patients have an annular plaque configuration.

In the center of the plaques, the development of depigmented, atrophic foci is possible. Around them, foci of depigmentation and severe peeling can form.

A distinctive feature of this form of leprosy is that the temperature and pain sensitivity disappears first. Tactile sensitivity in patients for a long time persist.

Also, in patients with this form of leprosy, damage to the peripheral nervous system is noted, with the formation of compacted strands along the way. nerve fibers. It should be noted that damage to the nervous system in the tuberculoid type is much easier than in the development of lepromatous neuritis or polyneuritis.

In the future, these symptoms are joined complete absence sweating, impaired thermoregulation, fading and hair loss (including eyelashes and eyebrows).

Intermediate between the tuberculoid and lepromatous course of leprosy is the undifferentiated type. This variant occurs in patients with uncertain immune reactivity. Therefore, after some time, the undifferentiated type is transformed into another variant of the disease.

The lepromatous variant of leprosy is the most severe.

Photos of patients with leprosy:

This variant of leprosy is accompanied by specific lesions of the skin, as a result of which leprosy nodes are formed, in which the causative agent of leprosy multiplies intensively. Leproms lead to deformation superciliary arches and nose of the patient (with the destruction of the cartilaginous septum), contributing to the formation of a "lion" or "ferocious" face.

Leproms have a purple-cherry hue and fuzzy borders. In addition to the face, these nodes affect the skin of the limbs. In the initial stages, the bumps have a greasy greasy sheen. In the future, their surface may ulcerate, it is also possible to attach a hemorrhagic component, due to which they acquire a reddish-rusty tint. The appearance of sharply deep wrinkles on the face is noted (due to severe infiltration of the skin).

Violation of sensitivity occurs later than in the tuberculoid type. Lepromatous type of leprosy is accompanied by destruction and severe deformities small joints and falling off fingers.

This type of leprosy is also accompanied by severe eye damage (up to complete blindness), vocal cords, lymph nodes, damage to peripheral nerves and the development of motor disorders.

The progression of lepromatous leprosy is accompanied by delamination and destruction of bones, muscle atony and atrophy, cessation of sweat and sebaceous glands, severe disorders of the endocrine system.

The kidneys, spleen, liver, etc. are affected. Men may experience sclerosis prostate, severe epididymitis, orchiepididymitis.

Diagnosis of leprosy

The diagnosis may be suspected on the basis of specific skin lesions and sensory disturbances. Also, an important role is played by the presence of contact with a patient with leprosy.

If leprosy is suspected, a bacterioscopic examination of the material (scraping) from the nasal septum, skin, and biopsy specimens of the nodes is mandatory.

An important role is played by the implementation of specific functional tests(histamine, lepromine, morphine, nicotinic acid tests).

Differential diagnosis is carried out with syphilis and.

Leprosy treatment

Currently, leprosy is considered a curable disease. At timely handling per medical care and early start therapy, the disease does not lead to disability.

The main cures for leprosy are:

• Rifampicin ® ;
• Dapsone ® ;
• Lampren ® .

In multibacterial forms, a special regimen is prescribed that includes all three drugs. With low-bacterial leprosy, two drugs are prescribed. Treatment takes from six months (minimum) to several years.

Minocycline ® and ofloxacin ® are considered reserve drugs.

Additionally, the use of glucocorticosteroids, vitamins, drugs that improve nerve conduction and prevent the formation of atrophies, desensitizing agents is indicated.

How do you imagine a person suffering from such an ailment as leprosy? What kind of disease is this? It is also called leprosy. Few people know about her now. Most likely, this is because the disease is not particularly common in our time. However, everyone should have an idea about it, remember that it will help us to protect ourselves from it.

A bit of history

Since ancient times, leprosy has been known to mankind. "What kind of disease is this?" - guessed the ancient healers. Hippocrates wrote about this disease. However, he confused it with psoriasis. In medieval times, leprosy became the "plague of the century." Leprosariums began to appear everywhere, where they tried to treat the affected people. As a rule, these ancient medical institutions were near the monasteries. Patients with this terrible disease were encouraged to live in them. This gave a good preventive effect, made it possible to restrain the rapid spread of leprosy. In medieval France, there was even such a custom when a patient with leprosy was taken to a church, where they were placed in a coffin and covered with a lid. After that, his relatives went to the cemetery, lowered the coffin into the grave and threw a few lumps of earth on top, as if saying goodbye to the "deceased". Then the patient was taken out and taken to the leper colony, where he was to live the rest of his life. People did not know how to treat this disease. And only in 1873 in Norway G. Hansen discovered the causative agent of leprosy - Mycobacterium leprae. The situation with treatment immediately changed.

How can you get infected

Today, outbreaks of leprosy are observed mainly in tropical hot countries. The good news is that the number of patients continues to fall every year. However, in our time there are people who do not know what leprosy is. The disease, the photo of the sufferers of which can be seen here, is very common, as a rule, during close contact of people with each other, as well as through discharge from the mouth and nose.

Manifestations of the disease

Despite the fact that in our country the number of people suffering from the disease we are considering is small, there is still a risk of catching it. Leprosy is very insidious. What is the disease? How to recognize it? These questions are of interest to many of us. An infected person may initially experience weakness, lethargy, and drowsiness. He then notes that his arms and legs have bumps on his skin. it initial stage leprosy. Then come deep defeat skin and soft tissues, ulcers are formed.

How to protect yourself

Speaking about such an ailment as leprosy, a photo of the diseased of which is presented here, it is worth mentioning that it has a rather long incubation period - 15-20 years. This means that the causative agent of it is able to stay in your body for years and you may not even be aware of it. In order to activate it, you must comply certain conditions, such as severe hypothermia, poor nutrition, poor personal hygiene, secondary lesion infection. Therefore, it is important from childhood to strengthen your immunity and take care of the cleanliness around you. Treatment of the disease is long and requires the recommendations of many specialists. Typically, this is used antimicrobials. Haulmoogra oil is a remedy used by ancient healers for several centuries.

In this article, we have told you in an accessible way about such an ailment as leprosy. What kind of disease is leprosy? How to protect yourself from it? Now you know the answer to all these questions.

Leprosy (Hansen's disease, hansenosis, leprosy, leprosy) is a disease caused mainly by bacteria Mycobacterium leprae (Hansen's wand), which causes damage to the skin and peripheral nervous system. The disease develops slowly (from 6 months to 40 years) and leads to lesions and deformities of the skin, most often affecting cooler places on the body (eg, eyes, nose, earlobes, arms, legs, and testicles). The skin lesions and deformities can be very ugly and are the reason why infected people have historically been considered outcasts in many societies. Although human-to-human transmission is the main source of infection, three other species can carry and (rarely) transmit M. leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The disease is called chronic granulomatous disease, similar to tuberculosis, because over time it produces inflammatory nodules(granulomas) in the skin and nerves.

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Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. New health research shows that at least, as early as 4000 BC, people were infected with Hansen's wand, while the first known written reference to the disease was found in an Egyptian papyrus around 1550 BC. The disease was well known in Ancient China, Egypt and India, and there are several references to sickness in the Bible. Because the disease was poorly understood, very disfiguring, slowly showing symptoms, and had no famous treatment, many peoples believed that the disease is a curse or punishment from the gods. Consequently, the "cure" of leprosy was left to priests or holy men, not to physicians.

Since the disease often occurred in members of the same family, some people considered it to be hereditary. Other people noted that if contact with infected people was negligible or absent, the disease did not develop in others. Consequently, some peoples considered infected people (and sometimes their close relatives) to be "unclean" or "lepers" and decreed that they could not associate with uninfected people. Often sick people had to wear special clothes and bells so that non-infected people could avoid them.

Discovery of Hansen's wand

The Romans and Crusaders brought leprosy to Europe, and the Europeans brought it to America. In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting that leprosy is an infectious disease and not hereditary disease or punishment from the gods. However, patients with this disease were still ostracized by many societies and cared only for the missions of religious workers. Leprosy patients were encouraged or forced to live in seclusion until the 1940s, even in the United States (for example, the leprosy colony at Molokai, Hawaii, which was set up by a priest, Father Damien, and another colony founded in Carville), often because at that time there were no available and effective treatments.

Because of Dr. Hansen's discovery of bacteria Mycobacterium leprae, steps were taken to find a treatment that would stop or eliminate the leprosy. In the early 1900s-1940s, nut butter Chaulmoogra (Chaulmugra, Hydnocarpus Kurtz) was used with dubious effectiveness, the oil was injected into the patient's skin. At Carville in 1941, sulfone preparation showed efficacy in treatment, but required many painful injections. Dapsone tablets were considered effective in the 1950s, but soon (1960s-1970s) M. leprae bacteria developed Dapsone resistance (antimicrobial resistance). Fortunately, drug trials on the island of Malta in the 1970s showed that the combination of three drugs: Dapsone, Rifampicin(Rifadin) and Clofazimine(Lampren) is very effective against M. leprae. This multidrug therapy (MDT) was recommended by the World Health Organization (WHO) in 1981 and is still the treatment of leprosy with minor modifications. However, MLT does not reverse the damage done to leprosy patients prior to treatment.

There are currently several areas (India, East Timor) of the world where WHO and other agencies (eg the Leprosy Mission [eng. Leprosy Mission]) are working on reducing the number clinical cases leprosy and other diseases such as rabies and schistosomiasis. Although public health researchers hope to completely eliminate leprosy such as smallpox, endemic leprosy (that is, common or always present in a particular region) is unlikely to be completely eradicated.

Leprosy is often referred to as "Hansen's disease" by many physicians in an attempt to get patients to abandon the stigma associated with leprosy.

What causes Leprosy (leprosy)?

Leprosy is caused primarily by the rod-shaped bacteria Mycobacterium leprae, which is an obligate intracellular bacterium (it only grows inside certain human and animal cells). M. leprae is called the "acid fast" bacterium because of its chemical characteristics. When special dyes are used for microscopic analysis, it turns red on a blue background due to the content mycolic acid in its cell walls. The Ziehl-Neelsen staining method is an example of a special staining technique used to view acid-fast organisms under a microscope.

2006
Dr. Ray Butler; Janice Carr
This bacterium ranges in length between 2 - 4µm, and a width between 0.2 - 0.5µm.

Currently, organisms cannot be cultured (grown) on artificial media. Bacteria take a very long time to multiply inside cells (about 12-14 days compared to hours within hours for most bacteria). Bacteria grow best at 27-30°C, so colder areas of the body tend to develop infections. Bacteria grow very well in macrophages organism (cell type of the immune system) and Schwann cells(cells that cover and protect the axons of the nerve). M. leprae is genetically related to M. tuberculosis (a type of bacteria causing tuberculosis) and other mycobacteria that infect humans. As with malaria, leprosy patients produce anti-endothelial antibodies (antibodies against the tissues lining blood vessels), but the role of these antibodies in these diseases is still under investigation.

In 2009, researchers found the new kind mycobacterium, M. lepromatosis, which causes diffuse disease ( lepromatous leprosy). This new species (defined genetic analysis) has been found in patients living in Mexico and the Caribbean.

What are the risk factors for leprosy?

People at greatest risk are those who live in areas where leprosy is endemic (parts of India, China, Japan, Nepal, Egypt and other areas) and especially those people who are constantly in contact with infected people. In addition, there is some evidence that genetic defects in the immune system (area q25 on chromosome 6) can make some people more susceptible to infection. In addition, people who interact with certain animals known to carry the bacteria (such as armadillos, African chimpanzee, sooty mangabey, and cynomolgus macaque) are at risk of contracting leprosy from animals, especially if they do not wear gloves when handling animals.

What are the early signs and symptoms of leprosy?

Unfortunately, early signs and the symptoms of leprosy (leprosy) are very mild and develop slowly (usually over many years). The symptoms are similar to those that can occur with syphilis, tetanus, and leptospirosis. The following are the main signs and symptoms of leprosy:

• Numbness (among the initial symptoms);
• Loss of temperature sensation (among the initial symptoms);
• Decreased sensory sensation (among early symptoms);
• Stinging sensation in the limbs (among the first symptoms);
• Joint pain;
• Decrease or loss of deep sensations of pressure;
• Nerve damage;
• Weight loss;
• The appearance of a blister and / or rash;
• Ulcers, relatively painless;
• Skin lesions, the appearance of hypopigmented spots (flat, pale skin that has lost color);
• eye damage (dryness, decreased blinking);
• Large ulcers ( later symptoms and signs)
• hair loss (such as loss of eyebrows);
• Loss of fingers (later symptoms and signs)
• Facial deterioration (eg, loss of nose) ( later signs and symptoms).

This long-term, evolving sequence of events begins and continues in cooler areas of the body (eg, hands, feet, face, and knees).

Picture of a person with leprosy (Hansen's disease)

Are there different forms (classifications) of leprosy?

There are several forms of leprosy (leprosy) described in the literature. Forms of leprosy are based on the human immune response to M. leprae.

A good immune response can lead to the so-called tuberculous form of the disease, with limited skin lesions and some asymmetric nerve involvement. A poor immune response can lead to the lepromatous form, characterized by extensive skin lesions and symmetrical nerve involvement. Some patients may have aspects of both forms.

Currently in medical literature There are two classification systems: the WHO system and the Ridley-Jopling system.

Ridley-Jopling system

The Ridley-Jopling system consists of six forms or classifications, listed below according to the increasing severity of the symptoms:

Indefinite leprosy: several hypopigmented spots; can self-heal, this form persists or advances to other forms.

tuberculous leprosy: several hypopigmented spots, some large, and some lose their sensation of pain. Slight nerve involvement in which the nerves become enlarged; spontaneous healing after a few years, persists or passes to other forms.

Borderline tuberculous leprosy: Lesions similar to tuberculous leprosy, but smaller and more numerous, with less nerve enlargement. This form may persist, revert to tuberculous leprosy, or change to other forms.

Central border leprosy: many reddish plaques that are asymmetrically distributed, moderately lose sensation of pain, with local adenopathy (swollen lymph nodes). The form may persist, regress, or progress to another form.

Borderline lepromatous leprosy: many skin lesions with patches (flat lesions) papules (raised bumps), plaques and nodules, sometimes with or without anesthesia; the form may persist, regress, or progress to lepromatous leprosy.

Lepromatous leprosy: Early lesions are pale maculae (flat areas) that are diffuse and symmetrical. Later, many M. leprae organisms can be found in them. It is called alopecia (hair loss). Often patients do not have eyebrows or eyelashes. As the disease progresses, nerve involvement leads to anesthesia and weakness in the sense of touch of the extremities. progression leads to aseptic necrosis(tissue death from lack of blood to the area), leprosy (skin knots) and disfigurement of many areas, including the face. The lepromate form does not regress to others less severe forms. Hyproid leprosy is a clinical variant of lepromatous leprosy that presents with clusters of histiocytes (a type of cell involved in the inflammatory response) and a gruntz zone (an area of ​​collagen separating the lesion from normal tissue) observed in microscopic sections of tissue.

The Ridley-Jopling classification is used worldwide to evaluate patients in clinical trials.

WHO classification of leprosy

The WHO classification system is more widely used. It has only two forms or classifications of leprosy. The 2009 WHO classifications are based only on the number of skin lesions as follows:

Small bacillary leprosy: skin lesions without bacilli (M. leprae) seen on skin smear
Multibacillary leprosy: skin lesion with bacilli (M. leprae) seen on a skin smear

However, WHO further modifies these two classifications with clinical criteria because “Due to the lack or unreliability of skin smear tests. The clinical classification system for the purpose of treatment includes the use of the number of lesions of the skin and nerves, participating as the basis for grouping patients with leprosy into multibacillary (MnB) and small bacillary (MaB) leprosy." The researchers state that up to four to five skin lesions are classified as low bacillary leprosy, with five or more lesions representing multibacillary leprosy.

Multidrug therapy (MLT) with three antibiotics (dapsone, rifampicin, and clofazimine) is used for the treatment of multibacillary leprosy, and modified MLT with two antibiotics (dapsone and rifampicin) is recommended for the treatment of small bacillary leprosy and constitutes the majority of current treatments (see Treatment section below) . Small bacillary leprosy usually includes indeterminate, tuberculosis and borderline tuberculous leprosy from the Ridley-Jopling classification, while multibacillary leprosy usually includes central borderline leprosy, borderline lepromatous leprosy and lepromatous leprosy.

How is leprosy transmitted? Is leprosy contagious?

Researchers speculate that M. leprae is spread to humans through nasal secretions or droplets. However, the disease is not highly contagious like the flu. They suggest that infected droplets reach other people's nasal passages and become infected there. Some researchers speculate that infected droplets can infect others when they enter skin breaks. M. leprae does not appear to be able to penetrate and infect intact skin. Rarely, people get leprosy from several of the animal species mentioned above. The presence of the disease in animals makes it difficult to eradicate leprosy from endemic areas. Ways of transmission of leprosy are still being investigated. Recent genetic studies have shown that several genes (about seven) are associated with increased susceptibility to leprosy. Some researchers are now concluding that susceptibility to leprosy may be partly heritable.

How do medical professionals diagnose leprosy?

Most cases of leprosy are diagnosed by clinical indications especially since most of the current cases are diagnosed in areas that have limited or no laboratory equipment.

Hypopigmented patches of skin or reddish patches of skin with loss of sensation, thickened peripheral nerves or both are clues to the diagnosis of leprosy. Skin smears or biopsy (biopsy) materials that show acid-fast bacilli with a Siehl-Neelsen spot or a beautiful spot may diagnose multibacillary leprosy, or if bacteria are absent, diagnose small-bacillary leprosy. Other tests may also be performed, but most are performed by specialized laboratories and can help a doctor diagnose an illness in a patient more quickly. detailed classification Ridley-Jopling, but usually not performed (test for lepromine, phenolic glycolipid-1 test, PCR, studies of the degree of inhibition of leukocyte migration). Other tests may be done, such as general blood analysis, liver function tests, creatinine test, or nerve biopsy to help determine if other organ systems have been affected.

What types of doctors treat leprosy?

While pediatricians and primary care physicians health care care for patients with leprosy, initial diagnosis and treatment is often done in consultation with infectious disease specialists, dermatologists, neurologists, and/or immunologists. Some patients may require a consultation with a surgeon to restore some movement function and/or for cosmetic restoration.

What is the treatment for leprosy?

Most cases of leprosy (mostly clinically diagnosed) are treated with antibiotics. Recommended antibiotics, their dosages and duration of therapy are based on the form or classification of the disease. In general, small bacillary leprosy is treated with two antibiotics, dapsone and rifampicin, while multi-bacillary leprosy is treated with the same two plus a third antibiotic, clofazimine. Typically, antibiotics are given for at least 6 to 12 months or more to completely cure the disease.

Antibiotics can treat small bacillary leprosy with little or no side effects. It is possible to stop the development of multibacillary leprosy, and live M. leprae bacteria can be practically eradicated from a person with antibiotics, but the damage done before the introduction of antibiotics is usually not reversible. The WHO recently suggested that a single treatment of patients with a single skin lesion with rifampicin, minocycline (Minocin), or ofloxacin (Floxin) is effective. Research into other antibiotics is ongoing. Each patient, depending on the above criteria, has an individual treatment schedule, therefore, treatment regimens should be planned by a doctor who is well aware of the initial diagnostic classification of this patient.

Steroid medications are used to minimize pain and acute inflammation in leprosy; however, controlled studies have not shown significant long-term effects on nerve damage.

The role of surgery in the treatment of leprosy occurs after treatment (with antibiotics) has been completed with negative skin smears (no detectable acid-fast bacilli) and is often required only in modern cases. Surgery is individualized for each patient with the goal of attempting cosmetic improvements and, if possible, restoring limb function and some of the neural function that was lost in the disease.

As is the case with many diseases, household medicines can be found in the literature. For example, a plant paste has been proposed him a, Hydrocotyle, also known as centella asiatica, and even aromatherapy with frankincense. Patients are strongly advised to discuss any home treatments for leprosy with their physician prior to use.

What are the complications of leprosy?

Complications of leprosy depend on how quickly the disease is diagnosed and treated effectively. Very few complications occur if the disease is treated early enough, but the following is a list of complications that can occur when diagnosis and treatment are either delayed or started late in the disease process:

• Sensory loss (usually starts in the limbs)
• Permanent nerve damage (usually in the limbs);
• muscle weakness;
• Progressive disfigurement (eg, loss of eyebrows, distortion of toes, fingers, and nose).

In addition, sensory loss causes people to injure body parts unless the person feels there is an injury. This may lead to additional issues, such as wet gangrene.

Can leprosy be prevented?

Avoiding contact with nasal droplets and other secretions from patients with untreated M. leprae infection is currently the most effective way to avoid the disease. Treating patients with appropriate antibiotics stops the person from spreading the disease. People who live with people who have not been treated are about 8 times more likely to develop the disease because investigators assume family members have close contact with infectious droplets. Leprosy is not hereditary disease, but recent evidence suggests that susceptibility to the disease may have a genetic basis.

Many people are exposed to leprosy around the world, but the disease is not highly contagious. Researchers suggest that most exposures do not lead to any disease. Most cases of leprosy occur in the tropics or subtropics (eg Brazil, India and Indonesia). WHO reports 500,000 to 700,000 new cases each year worldwide, with about 14 million cases cured since 1985.

There are no commercially available vaccines to prevent leprosy. However, there are reports that the use of BCG vaccine and BCG vaccine along with killed high temperature M. leprae and other drugs may protect against disease, help clear an infection, or possibly shorten the duration of treatment.

Animals (chimpanzees, mangabey monkeys, and nine-banded armadillos) rarely transmit M. leprae to humans. However, the treatment of such animals in wild nature Not recommended. These animals are a source of endemic infections.

What is the prognosis for leprosy?

The prognosis of leprosy varies depending on the stage of the disease at first diagnosis and treatment. For example, early diagnosis and treatment limit or prevent tissue damage, so the person has a good prognosis. However, if the patient's infection progresses to a later disease, the complications listed above can markedly affect the patient's lifestyle.

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Leprosy is an outdated name for the disease, today the term "leprosy" is more relevant, or Hansen's disease, hansenosis, hanseniaz. This is an infectious disease that affects skin and the peripheral nervous system of man, has been known to mankind since ancient times.

"Cursed" outcasts

Leprosy has already been sufficiently studied, and it is known that the disease is not transmitted by a simple touch of the patient and does not always lead to death. But in Medieval Europe leprosy feared more than modern people afraid of AIDS or cancer.

Photo: www.globallookpress.com

The first mention of the disease is found in written monuments dating back to the 15th-10th centuries BC. e. It is likely that in ancient times leprosy was confused with other skin diseases such as psoriasis.

Leprosy inspired fear and disgust, as it was incurable for a long time, leading to inevitable disability and death. This is what became the basis of prejudices, leprophobia and discriminatory attitudes towards patients.

The treatments of the time, such as stomach cleansing and bloodletting, were powerless.

The peak incidence of leprosy falls on the period from the 12th to the 14th centuries, when the infection affected the population of almost all European countries.

The fate of the sick was unambiguous - they inevitably became outcasts, the leper was considered "damned". The sick were deprived of all social rights, they were forbidden to enter the church, attend markets and fairs, wash in running water or drink it, touch other people's things, eat next to or even talk with uninfected people, standing against the wind.

Leprosy in one of the spouses was considered a legitimate reason for divorce, when the first signs of leprosy appeared, a person was buried in the church as if dead, and a symbolic funeral was held, after which the patient was given special clothes - a heavy hooded hoodie. Lepers were obliged to warn of their appearance with the help of a horn, a rattle, a bell or shouts: “Unclean, unclean!”.

With the advent of the first leper colonies, the life of leprosy patients acquired a more civilized appearance. The places where the sick lived became leper colonies, usually they were located near monasteries.
By the end of the 16th century, leprosy had disappeared from most European countries. Why exactly leprosy receded is not completely clear, but many see the cause in the plague epidemic, which first of all struck the weakened bodies of people already suffering from leprosy.

Gerhard Hansen and Raoul Follero

Two people in the history of this disease played a prominent role. Gerhard Hansen, a Norwegian physician, is famous for discovering the causative agent of leprosy in 1873. He announced the discovery of Mycobacterium leprae in the tissues of all patients, but he did not recognize them as bacteria and received little support from his colleagues. Later it turned out that mycobacteria of leprosy are close in their properties to tuberculosis, but are not capable of growing on artificial nutrient media, which made it difficult to study leprosy.

“Saint Francis of the 20th century” was the name of Raoul Follero, a French poet, writer and journalist who devoted his life to the fight against leprosy and the discrimination against those who suffer from it. In 1948 he founded the Order of Mercy, and in 1966 the Federation of European Antileprosy Associations.

It is thanks to him that since 1953, January 30 is celebrated as World Leprosy Day. In another way, this date is called "Day of the rights of patients with leprosy."

In addition, there are cases when doctors infected themselves in order to find out the patterns of development of this disease. terrible disease. So, in the middle of the 19th century, the doctor Daniel Cornelius Danielsen experimented for 15 years, injecting himself with the blood and pus of lepers, but he did not succeed in becoming a leper.

Contrary to prejudice

Leprosy is not transmitted by a simple touch of the patient and is not always fatal. Only about 10% of people exposed to the risk of infection actually get sick with it. Most people have the necessary level of immunological protection against the pathogen.

Basically, infection occurs due to prolonged direct skin contact, less often - by inhalation of bacteria that enter the air from the nasal cavity or mouth of the patient. There are versions that only 30% of people are clinically susceptible to leprosy and that the disease itself is genetically determined. But, despite the fact that some features of the disease are still the subject of a dispute among scientists, two main types of leprosy are known:

The face of a 24-year-old patient with leprosy. 1886 Photo: wikipedia.org

Lepromatous- affects the skin where mycobacteria multiply, causing the formation of nodes called leprosy. Gradually formed large folds, and the patient's "lion's face" is formed. With the collapse of the leprosy, the nose is deformed, the phalanges of the fingers begin to fall off. This is the heaviest and malignant form illness.

Tuberculoid- mainly the skin, peripheral nerves, and sometimes internal organs are affected. Lesions on the skin are insensitive, asymmetrical, reddish-brown in color. Tuberculoid leprosy is 40 times less infectious than leprosy.

There is also a borderline form of the disease, which usually develops into one of two main types. The juvenile form of leprosy occurs in children and is expressed in many subtle spots on the skin. The indefinite form is the most favorable - a few spots appear on the skin, but after a few months the spots disappear, as if the disease goes away by itself.

For staging accurate diagnosis on the background clinical signs bacterioscopic and histological studies are always carried out.

Treatment and personal prevention

Prevention of leprosy is the careful observance of the rules of personal hygiene. According to Gerhard Hansen himself, cleanliness and soap are the main enemies of leprosy.

Today, leprosy does not belong to mass diseases, but, according to WHO, about 11 million people suffer from it in the world. On the one hand, the problem of mortality and the spread of leprosy has been solved, on the other hand, it is important to remember the existence of this disease. And today the problem of late diagnosis is relevant due to the fact that doctors have begun to forget about the possibility of the appearance of individual cases of leprosy. At the same time, the disease in 42% of cases leads to severe disability, and in the absence of treatment, patients severe form diseases die in 5-10 years.