Leprosy (leprosy): etiology, pathogenesis, symptoms and features of treatment

The word "leper" even in our time is endowed with a sharply negative connotation. The concept of "leprosy" for many is, although not entirely understandable, but very unpleasant, but before all it has been horrifying and horrifying at all. In this article, we will tell you what kind of ailment it is - leprosy, what are its symptoms, etiology, epidemiology, pathogenesis, what kind of treatment exists, and most importantly, whether you need to be afraid of leprosy people and how you can get them.

Leprosy or leprosy?

There is a disease in which the face becomes incredibly repulsive, and the hands and feet are made ugly due to loss of fingers. She has about ten names. There are exotic - mournful illness, Phoenician disease, lazy death. There are sophisticated, for example, hansenosis or chronic granulomatosis, but there are widely known, such as leprosy or leprosy, which gave rise to the terrible word "leper". Each name emphasizes one or another feature of the ailment. For example, "hansenosis" appeared in honor of the scientist Hansen, who first discovered the causative agent of the disease, and "lepra" originated from the ancient Greek lepras, that is, "scales". Apparently, it reminded the ancient Greeks of growths and terrible scabs on the faces of the sick. The ancient Slavs, on the basis of the words "pro" and "kaz", that is, to change the appearance, called the sore "leprosy". Etiology, pathogenesis, and even more so the treatment of ailment still cause controversy and disagreement, and before people knew absolutely nothing about it, so they were afraid. The Church declared the disease a punishment for the sins of God, and the believers did not dare to doubt it. That's the only method of treatment for the concealment of sins.

A few historical facts

Scientists have conducted a series of analyzes of ancient remains and found that for more than 6 thousand years, mankind has known a horror by the name of leprosy. Etiology, the pathogenesis of the disease described by Hippocrates, but he mistakenly included the same and psoriasis. The homeland of leprosy is considered to be Africa (according to other sources, Asia, hence the Phoenician disease), the "brave" crusaders brought to Europe the infamy, and to America its pioneers and their followers. Having received a huge number of fresh victims and not encountering obstacles, the disease easily conquered the sex of the world. No one had no idea, leprosy - what is it? The etiology and pathogenesis of leprosy was reduced to the fact that a person suddenly became a freak, his fingers fell to his feet, and then he himself rotted alive. People were in panic terror and got rid of leprosy by all means. At best, they were simply expelled. There was a ritual of "burial" of the unfortunate, during which he was put in a coffin, pinned, dropped into a pit and even sprinkled with earth. After, however, got, but for all man among the living no longer existed. In the worst case, the sick person was killed for real. Whatever it ends, it is unknown, but it happened incredible - Europe was attacked by another deadly infection that displaced the first. After the pandemic of plague, leprosy here became a rare phenomenon.

Leprosy these days

Even in the Middle Ages, monasteries created houses for lepers, where they lived until their death. They were called leprosariums. In 1873, the scientist Hansen, who worked in one of these institutions, managed to find in the material taken from the patient, unprecedented bacteria. They were called Hansen chopsticks. But many more years passed before they found out their connection with such a disease as leprosy. Etiology, pathogenesis and methods of treatment have now become more understandable. Once in the world there were thousands of leprosariums, because lepers then were more than 20 million. Only in Russia there were 19 leprosoria. Thanks to the medicine found, by the end of the 20th century the number of patients in the world had dropped to 12 million, and at the moment there are about 1.5 million. However, statistics for 2015 again showed a slight increase in the number of patients. In Russia, leprosariums now only 4, and leprosy patients 600 people. Most of the "lepers" are now concentrated in India, China, other countries of South Asia, almost throughout Africa, including Madagascar, in South America, the Arabian Peninsula, the Philippines, the Caribbean.

Portrait of the pathogen

The pathogenesis of leprosy begins with the penetration of Hansen's wand into the human body. It is a microscopic bacterium with a length of up to 8 μm, and a diameter of only up to 0.5 μm. The sticks have sharpened or thickened edges and are covered with four layers of very dense membranes, which protect them from external stimuli. They are immovable, do not form spores, multiply incredibly slowly. The division of one bacterium lasts approximately 14 days. Hold the sticks in groups, then they resemble scattered cigarettes. Sometimes parasites can be found and one by one. They live exclusively in the cells of the victims, therefore, hitting the external environment, quickly die. Hansen's sticks parasitize only in humans, but there is an opinion that they can infect mice, armadillos, chipmunks and some kinds of monkeys. The etiology and pathogenesis of leprosy is difficult to study, because the colonies of Hansen sticks on the nutrient medium in laboratories grow unusually poorly and slowly - from 6 weeks, against several hours in other bacteria. Another difficulty is that outside the cell they become non-pathogenic, and in experimental animals they practically do not get accustomed. Nevertheless, it was possible to learn that the Hansen and Koch sticks (cause tuberculosis) originated from one bacterium, but in the course of evolution they somewhat modified their structures. And in 2009, another species of this bacterium was discovered, which causes diffuse lepromatous leprosy.

Ways of infection

The source of the leprosy microbe can only be a person suffering from this ailment in an active form. But according to some reports, sometimes the cause of infection is the work without gloves with animals, which affects Hansen's bacterium. How is the pathogenesis of leprosy? Infections transmitted by airborne droplets are always the most virulent and capable of infecting many. But in the case of leprosy this does not happen for as yet unknown reasons. It is known only that Hansen's sticks are actively multiplying in areas of the body that can cool the air, namely, on the mucous membranes of the mouth. From sick to healthy, they are transmitted by sneezing, kissing, coughing, emotional conversation. In addition, the microbe can be transmitted with the blood of the patient or when his exudates, saturated with parasites, directly onto the injured skin of the new victim.

Risk groups

A high probability of getting infected with those in whose families there is a patient with leprosy. First, due to the fact that it is difficult to avoid long-term contacts between family members, and secondly, because there is a genetic predisposition to this disease. Family couples are forbidden to have heirs. But in sick mothers, children are born healthy. If such babies are immediately isolated, they are not affected at all by leprosy (leprosy). The etiology of the disease has not yet been clarified with respect to other risk categories among the population. While it is precisely established, that the ailment actively develops in persons with weakened immunity. There are cases when people caring for lepers remained healthy, but their relatives fell ill, did not take part in the care. The doctor Daniel Danielson for many years injected the blood of the lepers, placed in his wounds the exudate from the tubercles on their body, but was never infected. In general, the disease is most likely where there is a low standard of living.

The pathogenesis of leprosy

Presumably, because of the slow multiplication of Hansen bacteria, the leprosy caused by them is developing too long. Etiology, pathogenesis of the disease are as follows: the causative agent, having got on the mucous or in the wound, seeps into the blood and lymph, and with these fluids into the nervous system and other internal organs. There, the bacteria form granulomas containing many macrophages. Once infected, a person can live for decades and not suspect about his illness. The incubation period for some lasts six months, more often about 5 years, and in some cases 20 and even 40 years. In addition to the incubation, there is a latent period (the time from which an infected person is able to infect others). For leprosy, it is somewhat less incubative. The patient at this time may not have symptoms at all, or slight malaise, loss of appetite, inexplicably fast fatigue, but he does not suggest a serious disease, although he is already contagious.

Symptoms

The microbe affects not only the mucous in the mouth, but also in the lungs, as well as the cells in the nerve endings (Schwann's). With the progression of the disease, bacteria are found in the eyes, in the liver, even in the brain. The first sign of ailment is heavily tolerated pain in the extremities, in the back. At the same time, patients can complain of weakness, drowsiness, loss of appetite, intestinal disorders. In the future, pain is replaced by a sensation of tingling, and then a person generally loses sensitivity in the affected areas. This often causes injuries, infection with another infection and, ultimately, loss of fingers, irreversible hand and foot defects. Hansen's wands themselves do not deprive the diseased limbs themselves. Leprosy is distinguished by two main types - tuberculoid leprosy and lepromatous. Their symptoms are different, so consider each in more detail.

Tuberculoid leprosy, etiology, symptoms, treatment

This type of disease is diagnosed in three forms:

• Polar;
• Border crossing point;
• Undifferentiated.

The main symptom of tuberculoid leprosy is the appearance on the skin of a clear hypopigmented (light) patch. The undifferentiated form is able to heal on its own, or to move to heavier ones. Initially, the skin in place of the pigmentation is very sensitive, but soon the spot starts to increase, its edges protrude, and the central part, on the contrary, sinks. There are no sweat glands, hair disappears, the skin loses sensitivity. Outside the spot, nerves thicken, as Hansen's sticks, growing, inflate the affected cells. Infection of the nerves causes muscle atrophy, contracture of the feet and hands. When bacteria attack the facial nerve, patients develop eye diseases that eventually lead to blindness.

Lepromatous leprosy

This type of disease is more severe and more dangerous for people in the environment of the patient. There are two forms:

• Polar;
• Frontier.

One of the primary symptoms of the disease is also the spots, but they have a slightly different picture - they are vast, symmetrical in relation to the conditional midline of the human body, with fuzzy boundaries and a dense convex center. In addition to spots, the rashes may look like nodules, blips or papules. All of them are called leproms and contain thousands of Hansen sticks in the infiltration. It is very characteristic that occurs during leprosy with the faces of patients. They drop eyelashes and eyebrows, the nose (late stages) fails, the shape of the ears is distorted (thickened), the skin on the face ("lion's muzzle"), mimicry is broken. Other symptoms:

• Problems with the nose (stuffiness, difficulty breathing, sometimes from the nose goes the blood);
• Change of voice (becomes hoarse);
• Problems with eyesight (keratitis, iridocyclitis);
• Enlarged lymph nodes in the groin;
• Infiltration of tissue in the testicles;
• Formation on a place of the disfigured leprom of disfiguring ulcers;
• Weakness of extremities, atrophy, and further necrosis.

There is a mixed form of leprosy, in which symptoms of tuberculoid and lepromatous forms are simultaneously observed.

Diagnostics

Leprosy disease, the etiology and pathogenesis of which are still being studied, is diagnosed by several methods.

1. Clinical. It consists of a visual examination of the patient's skin, revealing insensitive mucous membranes and skin areas.
2. Microscopic. In the nasopharynx do a fairly intense (until the blood) scraping, take the material from the lymph nodes. The microscope shows the patient the presence of characteristic oval or round leprosy cells. The smears are stained using the Ziehl-Nielsen method, as a result Hansen's old sticks turn red, and the young ones are mostly blue.
3. Allergic test (Mit-court). Under the skin inject lepromine (prepared from tissues taken from patients with leprosy). If the subject is infected, in less than a day his skin swells and turns red.
4. The serological method.

Treatment

Procave is treated for a very long time, up to 12 months, and sometimes several years. Therapy is only complex with the participation of ophthalmologists, orthopedists, neuropathologists. Antibacterial drugs are also used in the complex. This is "Dapson" in tandem with "Clofazimine" and "Rifampicin". For each patient, the doses and the algorithm for taking medication are individual. Some forms of the disease can be treated with the use of only two of the three antibiotics given, which is determined by the doctor. Now trials of drugs "Minocycline", "Clarithromycin", "Ofloxacin" as medicines against leprosy are being conducted. As a result, all the leprosy bacteria are killed in the patients, but the damage they have caused to the organs and skin (if it has already reached) remains.

Forecast

If treatment is started on time, the outcome is quite favorable. Patients may not even remain on the skin. In the neglected stages, the health can not be restored, the person remains an invalid for life, but it can restore the internal organs, which allows him to prolong his life.

Prevention of the disease includes:

• Hygiene, especially when located in regions where leprosy thrives;
• Early diagnosis and treatment;
• Preventive control of all those who are in long contact with sick leprosy (doctors, family).