What kind of disease is leprosy?

What is leprosy Leprosy is a chronic infectious disease caused by Leprosy Bacillus. It mainly invades skin, mucosa and peripheral nerves, and can also invade deep tissues and organs. The disease is very popular all over the world. It is estimated that there are about 1 million leprosy patients in the world, mainly distributed in Asia, Africa and Latin America. What causes leprosy? Lepers are natural reservoir of Leprosy Bacillus. Leprosy bacilli are widely distributed in patients, mainly in some cells of reticular endothelial system such as skin, mucosa, peripheral nerves, lymph nodes, liver and spleen. Leprosy bacilli are mainly excreted from the body through broken skin and mucous membrane. Others are also found in milk, tears, semen and vaginal secretions, but the amount of bacteria is very small. What are the symptoms of leprosy? It is generally believed that the average incubation period is 2 ~ 5 years, ranging from a few months to more than ten years for the elderly. (1) Tuberculosis-like leprosy: This type of patient has strong immunity, and the leprosy bacilli are confined to the skin and nerves. (2) Boundary-like tuberculosis-like leprosy: This type is similar to tuberculosis-like leprosy, and it is macula and patch, with reddish, purplish red or brownish yellow color, neat and clear boundaries, and some patches have "blank areas" or "hole-punched areas" in the center, forming annular lesions with clear inner and outer edges, and the skin within the hole area seems normal. (3) Leprosy in the middle boundary: This type of lesions is characterized by pleomorphism and polychromatic. (4) Boundary-like neoplasia leprosy: This type of skin damage includes macula, papule, nodule, plaque and diffuse infiltration. (5) Tumorous leprosy: This type of patient lacks immunity to Leprosy Bacillus, which spreads all over the body through lymph and blood. (6) Undetermined leprosy: This type is the early manifestation of leprosy, is primary, is not included in the five-level classification, is unstable in nature, and can fade away or change to other types. What inspection test methods and results are needed to judge leprosy? Inject .1 ml of crude leprechin into the skin of forearm flexion to form a white bulge with a diameter of about 6 ~ 8 mm, and then observe the reaction results. Early reaction: 48 hours after injection, the results showed that those with invasive erythema with a diameter greater than 2 mm at the injection site were strongly positive (++), those with a diameter of 15-2 mm were moderately positive (++), those with a diameter of 1-15 mm were weakly positive (+), those with a diameter of 5-1 mm were suspicious (+), and those with no response below 5 mm were negative (-); Late reaction: 21 days after injection, the results showed that the patients with red infiltrating nodules and ulceration at the injection site were strongly positive (++), those with nodule infiltration diameter greater than 5 mm were moderately positive, those with nodule infiltration diameter of 3 ~ 5 mm were weakly positive (+), those with slight nodule infiltration or below 3 mm were suspicious (+), and those with local unresponsiveness were negative (1). How to treat 1, chemical drugs. (1) Aminobenzene alum (DDS) is the first choice. (2) Chlorophenazine (B633) can not only inhibit Leprosy Bacillus, but also resist type II leprosy reaction. 1--2mg//day, orally. (3) Rifampicin can kill Leprosy quickly. 2. Immunotherapy. The specific immunotherapy of live BCG plus dead leprosy bacteria under study can be carried out simultaneously with combined chemotherapy. Pathological changes of leprosy Due to the different cellular immunity of patients infected with Leprosy Bacillus, the diseased tissues have different tissue reactions. According to this, leprosy lesions are divided into the following two types: 1. Tuberculous leprosy is the most common type, accounting for about 7% of leprosy patients. Because its lesions are similar to tuberculous granuloma, it is called tuberculous leprosy. The characteristic of this type is that patients have strong cellular immunity, so the lesions are localized, and the bacteria contained in the lesions are rare or even difficult to find. The lesion develops slowly and has low infectivity. It mainly invades skin and nerves, and rarely invades internal organs. (1) Skin: Lesions mostly occur on the skin of face, limbs, shoulders, back and buttocks, showing a macula with clear boundary and irregular shape or a papule with slightly sunken center and slightly raised edge. Microscopically, the focus is granuloma similar to tuberculosis, scattered in the superficial dermis, and sometimes the focus contacts the epidermis. Granuloma is mainly composed of epithelioid cells, occasionally Langhans giant cells, surrounded by lymphocyte infiltration (Figure 1). There is little caseous necrosis in the center of the lesion, and acid-fast bacteria are generally not seen in acid-fast staining. Because the lesions mostly surround the dermal nerve and skin appendages, it causes local hypoesthesia and sweating. When the lesion subsides, only a few lymphocytes or fibrosis remain locally, and finally, inflammatory cells can disappear completely. Fig. 1 There are nodular lesions mainly composed of epithelioid cells in the dermis of tuberculoid leprosy, in which Langhans cells can be seen, which are similar to tuberculosis nodules, but there is no caseous necrosis in the center. (2) Peripheral nerves: the greater auricular nerve, ulnar nerve, radial nerve, peroneal nerve and tibial nerve are most commonly invaded, and most of them are accompanied by skin lesions. It is rare to see pure nerve leprosy without skin lesions. Nerve thickening, tuberculosis-like lesions and lymphocyte infiltration under microscope. Different from skin lesions, tuberculous lesions of nerves often have caseous necrosis, which can liquefy to form a so-called "nerve abscess". When the lesion heals, the epithelioid cells disappear, the lesion becomes fibrotic, and the texture of the nerve becomes hard. Neuropathy not only causes superficial sensory disturbance, but also is accompanied by movement and nutrition disturbance. In severe cases, talons hand (caused by ulnar neuropathy which paralyzes palmar vermiform muscle, excessively bends finger joints and excessively straightens metacarpophalangeal joints), wrist hanging, foot hanging, muscle atrophy, plantar ulcer and even toe atrophy or absorption and disappearance occur. Under effective prevention and treatment measures, the above-mentioned limb changes are no longer seen. 2. lepromatous leprosy accounts for about 2% of leprosy patients. Because skin lesions often bulge on the skin surface, it is called lepromatous leprosy. The characteristic of this type is that the patient's cellular immunity to Leprosy Bacillus is deficient, and there are a large number of Leprosy Bacillus in the focus, which is highly contagious and often invades the nasal mucosa, lymph nodes, liver, spleen and testis in addition to skin and nerves. The lesion developed rapidly. (1) Skin: The initial lesion is a red macula, and later it develops into a nodular lesion with unclear nodule boundary, which can be scattered or aggregated into lumps and often ulcerated to form ulcers. Most of them occur on the face, limbs and back. The facial nodules are symmetrical, and the skin nodules on the earlobe, nose and eyebrow arch change the face and form facies leontina. Microscopically, the lesion is a granuloma composed of a large number of foamy cell, mixed with a small number of lymphocytes. Foam cells are derived from macrophages. After phagocytosis of Leprosy, the lipid of Leprosy accumulates in the cytoplasm of macrophages, which makes the latter foam-like. Acid-fast staining showed that the foam cells contained a large number of leprosy bacilli, and even gathered in piles to form the so-called globus leprosus. The lesion is surrounded by small blood vessels and appendages, which will fuse into pieces with the development of the lesion, but there is a layer of cell-free infiltration area between the epidermis and the infiltrating lesion (Figure 2), which is not found in tuberculous leprosy. Due to the cellular immune deficiency of patients with leprosy, there are no epithelioid cells and few lymphocytes in the lesions. When the lesion subsided after treatment, the number of leprosy bacilli decreased, and the morphology changed from rod-shaped to granular, foam cells decreased or merged into vacuoles, and fibrous tissue proliferated. Finally, the lesion subsided, leaving only scars. Fig. 2 Epidermis of leprosy with tumor is atrophied and thinned, and there is diffuse infiltration of foam cells in the dermis, which is separated from the epidermis by a thin layer of cell-free infiltration area. (2) Peripheral nerves: the involved nerves are also thickened. Microscopically, there are foam cells and lymphocytes infiltration in the nerve bundles between nerve fibers. Acid-fast staining can detect a large number of leprosy bacilli in foam cells and Schwann cells. In the late stage, nerve fibers disappear and are replaced by fibrous scars. The clinical manifestations of neuropathy are similar to those of tuberculosis. (3) Mucosa: Mucosa of nose, mouth, even throat and vagina can be involved, especially nasal mucosa. (4) Organs: Liver, spleen, lymph nodes and testicles are often affected by tumor leprosy, and may be accompanied by enlargement of liver, spleen and lymph nodes. Microscopically, foam cells were infiltrated. If there is foam cell infiltration in the seminiferous tubule of testis, it can make semen contain leprosy bacteria and infect others through sexual intercourse. 3. The immune response of patients with borderline leprosy is between tumor type and tuberculosis type, and there are both tumor type and tuberculosis type lesions in the lesions. Because the immune response of different patients is different, sometimes the lesions are more inclined to tuberculosis type or tumor type. There are foam cells and leprosy bacteria in the neoplastic lesions. 4. Undetermined leprosy is an early change of leprosy, with nonspecific lesions and focal lymphocyte infiltration only around skin blood vessels or small nerves. Acid-fast staining is not easy to find leprosy bacteria. Most cases later turned into tuberculosis-like type. A few turn into tumor type. In 1954, in order to widely publicize leprosy knowledge, eliminate people's misunderstanding about leprosy, improve the living conditions of leprosy patients, promote the development of the great cause of eliminating leprosy, and benefit the people, the World Health Organization decided to designate the last Sunday of January every year as "International Leprosy Prevention and Control Day". I hope to remind the public of leprosy patients, and treat them like other general diseases. At the same time, it also makes the whole society respect, care and support the work of drug control, and understand that drug control is a great and civilized cause. 1. What is leprosy? Leprosy is a chronic infectious disease caused by Leprosy Bacillus, which mainly invades the skin and peripheral nerves. Leprosy Bacillus was first discovered by Norwegian scholar Han Sen in 1874, so leprosy is also called Hansen's disease. Untreated leprosy patients are the only known source of infection. The incubation period of leprosy can be as long as several years, usually 3 to 5 years, and some even longer; Leprosy is distributed all over the world, with the heaviest number of registered patients in 25 countries. There are about 5, newly discovered patients in the world every year; At present, there are only more than 5, patients in China, but as many as 12, patients with disabilities have been cured. These patients are mainly distributed in ethnic minority areas and remote mountainous areas such as Yunnan, Guizhou, Sichuan and Guangdong. 2. Leprosy bacilli: generally small, straight, strong or slightly bent at both ends, with a length of 1 to 8 microns and a width of .2 to .5 microns. After acid-resistant dyeing, it can be seen as rod-shaped, drum-hammered, dumbbell-shaped, beaded and granular. Bacteria with complete staining are generally considered as living bacteria, while those with incomplete staining are dead bacteria. Leprosy Bacillus is not easy to survive without human body, so the culture has not been successful yet. Leprosy bacilli can live for 2 weeks at ℃ and die immediately above 6℃, which can be killed by general disinfection. 3. What are the early symptoms and main signs of leprosy? The clinical manifestations of leprosy are diverse, which can be divided into three parts for the convenience of description: A. "Primary" damage refers to all kinds of skin lesions and peripheral nerve injuries directly caused by leprosy bacteria. Skin lesions can be one or more, usually lighter than the surrounding normal skin, and sometimes these lesions can be reddish or copper. Spot diagnosis, mound diagnosis, plaque, diffuse infiltration, nodules and ulcers are common. Nerve injury such as claw hand, wrist drop and foot drop. Most leprosy lesions occur and develop slowly, but those who take the form of reaction as the first symptom are also divided into tuberculous leprosy and borderline leprosy because of the different immunity of leprosy patients and different clinical manifestations after onset. Most skin lesions are numb and sweatless, but a few have itching or strange itching. Accompanied by sensory impairment: sensory loss is a typical feature of leprosy, and skin lesions can show different degrees of sensory impairment such as temperature and pain. B. Immune reactive damage induced by leprosy antigen means that leprosy bacteria will release antigen after death in vivo, which will induce immune response and tissue damage, such as erythema nodosum, iridocyclitis and neuritis. These manifestations usually appear before skin and peripheral nerve damage, but sometimes they can occur earlier and become the first and prominent manifestations, which often lead to misdiagnosis. Please pay attention to the examination of skin and peripheral nerves. If you are suspicious, please refer to the relevant specialist for diagnosis. C. Nerve injury is mainly seen in peripheral nerve trunks, which is characterized by sensory disturbance of skin and weakness of muscles dominated by injured nerves. Complications after peripheral nerve injury: such as numbness and anhidrosis of hands and feet, chapping, ulcer and even bone and tissue absorption may occur in the late stage. The above manifestations can overlap and cross each other. Generally, the shorter the illness period, the less likely the nerve damage is. Therefore, early diagnosis and treatment are of great significance to prevent deformity. 4. How is leprosy spread? At present, the survival situation and transmission route of leprosy bacteria in vitro are not very clear, but there is evidence that respiratory tract is an important way of transmission of leprosy bacteria besides direct and close contact. Whether leprosy patients will get sick or not depends on the body's natural immunity. It has been scientifically proved that most healthy people (more than 95%-99%) have natural immunity to leprosy patients, even if they are infected with leprosy patients, they will not get sick, and only those who are susceptible will get sick. It is a chronic infectious disease, but it is very contagious and will not be inherited. And couples rarely infect each other. 5. What should I do if I suspect that I have leprosy? At present, the classification of leprosy is as follows: those with or without bacteria, but with more than 5 lesions, belong to multi-bacterial type (MB); No bacteria were found, and the skin lesions were less than 5 pieces, which belonged to less bacteria type (PB). If you suspect that your symptoms are leprosy-like, you should go to the local dermatology station or epidemic prevention station as soon as possible, and don't be afraid of medical treatment, so as not to delay your illness and lose the opportunity of early diagnosis, early treatment and early recovery. Leprosy is generally not fatal, but it can damage nerves and is irreversible. If you delay the treatment, you will leave yourself with a lifelong disability! 6. Can leprosy be cured? The era when leprosy was an "incurable disease" has long since become history. Leprosy, like other chronic diseases, can be completely cured. With the development of science, there are more and more drugs to treat leprosy. In the 194s, dapsone has achieved good results in the treatment of leprosy, and many drugs such as rifampicin, rifampicin and chlorphenazine have been developed. Now combined chemotherapy is more effective. As long as you take the medicine for a week, the bacteria in your body can kill more than 95%. As long as you insist on taking medicine, you can take medicine for half a year for less bacteria leprosy and two years for more bacteria leprosy, and leprosy will be cured and you will be a healthy person. Combination chemotherapy is to treat leprosy with two or more drugs with different mechanisms. For the effect of combined chemotherapy, leprosy experts and relevant scholars all over the world agree that the best scheme for leprosy treatment. The drugs used in combination chemotherapy are rifampicin, dapsone and chlorphenazine. 7. Do leprosy patients need isolation treatment? Leprosy patients should not be isolated from their families and society, and treatment should be carried out at home. After taking the medicine for a week, the patients will basically lose their infectivity. Patients treated at home can not only live with their families, but also do what they should do. 8. Which medical departments are responsible for leprosy control? When you suspect that you have leprosy, you should first get in touch with the local anti-leprosy institutions. In some counties and cities with different situations in China, there are professional organizations for leprosy prevention and control (usually called dermatosis prevention stations or anti-leprosy stations). In areas without professional organizations, you can contact the local health and anti-epidemic stations or health bureaus, and the grassroots health centers can contact the township hospitals. You can also contact dermatology institutes in various provinces or get in touch with our association directly. I believe we can give you a satisfactory answer! 9. The characteristics of leprosy: long-term sores, anodyne; Erythema and leukoplakia, numbness and sweating; Eyebrows are thin and seemingly drunk; The earlobe is hypertrophy and there are insects crawling on the face; Dry skin and numbness of extremities; Thick limbs and unbearable pain; There is no skin in the tiger's mouth and the fingers are bent; Thigh thinning