leprosy
Introduction
Introduction to leprosy Leprosy is an extremely chronic and less contagious disease caused by M. leprae, which mainly affects the skin and peripheral nerves. In severe cases, it can cause damage and limb disability. Due to the high attention paid by the Chinese government to the prevention and treatment of leprosy, the goal of eliminating leprosy has basically been achieved at the end of the last century. In addition to a small number of remaining patients in the western and coastal areas, there are basically no new infections in the country. Leprosy has been popular in the world for nearly 3,000 years. India, Egypt and China are considered to be the world's three major epidemics. The source, of which India is the earliest source of epidemic, has gradually spread to all parts of the world. The leprosy in China has been popular for more than 2,000 years. It began in the Spring and Autumn Period and the Warring States Period. It was called the hurricane, the wind and the evil. The word leprosy comes from the Hebrew zarrath in the Bible, meaning untouchable, later translated into Greek lepra, then translated into English called leprosy (leprosy), and M. leprosy was discovered by Norwegian scholar Hansen in 1873. Therefore, foreign scholars still call leprosy Hansen disease. basic knowledge The proportion of illness: the incidence rate is about 0.0052% Susceptible people: no special people Mode of infection: respiratory transmission Complications: malformation osteitis
Cause
Cause of leprosy
Virus infection (55%)
The closeness of contact is related to the pathogenesis of infection through skin or mucosal damage containing M. leprae and the contact of damaged healthy human skin or mucous membrane, which is an important way traditionally considered to be the spread of leprosy. At present, it is believed that the droplets and hanging droplets of the bacteria in the cough and sneezing enter the human body through the upper respiratory tract mucosa of healthy people, which is the main way for the spread of M. leprae.
Poor hygiene (40%)
Healthy people and infectious leprosy patients are infected through certain media. For example, contact with clothes, bedding, hand towels, food utensils, etc. used by infected patients. The possibility of indirect contact infection is small. The body's resistance is undoubtedly the leading factor in the infection process. The pathogenesis and performance of M. leprae after entering the human body depends mainly on the resistance of the infected person, that is, the immune status of the body. In recent years, many people believe that leprosy, like many other infectious diseases, has subclinical infections. Most of the contacts have established specific immunity against leprosy after infection, and terminated infection by subclinical infection. .
Pathogenesis
Mycobacterium leprae is not strong in pathogenicity, and most healthy people are resistant to it. Therefore, there are many infected people and few cases, and Mycobacterium leprae is an intracellular parasite. Therefore, its pathogenesis is more related to cellular immunity. The immune status and response of Mycobacterium leprae and its antigenic substances are directly reflected in the state of bacteria in the tissues after onset.
Immunopathological changes and clinical manifestations of patients, the general humoral immunity of patients with leprosy is basically normal, can produce leprosy antibodies, but this antibody does not have anti-infective effect, tumor leprosy patients can also produce excessive leprosy antibodies, due to this antibody corresponding The main component of the antigen is phospholipid, which has a common antigenicity with the phospholipid component in human tissue cells, and becomes the basic cause of skin, joint and nerve damage when causing clinical leprosy erythema reaction. On the contrary, leprosy patients Cellular immunity often has varying degrees of defects. According to the degree of its defects, it appears on the clinical pathology as a spectrum-like continuous change of disease spectrum, such as extremely low cellular immune function, lack of immune response to Mycobacterium leprae, pathological manifestations of extensive skin damage and a large number of leprosy Bacillus, which is a clinical pathological type of leprosy, such as cellular immune damage is only mild to moderate, and there is still sufficient immune response to leprosy, the clinical manifestations of lesions are limited but more obvious, less bacteria or sterility in the tissue With limited and obvious peripheral neuritis, it is the characteristic of tuberculosis-like leprosy at the other extreme of the clinic. There are several intervening continuous variations between the two extreme types, two extreme patients. It is usually more stable, and the intermediate type may evolve in two extreme directions due to changes in the immune status of the body or changes in the condition. Some of the early undetermined leprosy patients can heal themselves, and most of them gradually change to other clinical types.
After being invaded into human body, Mycobacterium leprae is first swallowed by macrophages. After treatment, some antigenic components are expressed on the surface of macrophage membrane, and cooperate with HLA class II antigens DR, DP, DQ on macrophage membrane, and are recognized by T cells. Causes an immune response, such as immune response, normal T cells are activated to produce lymphokines, promote macrophage clearance of M. leprae, form epithelioid cells and Langerhans cells (Langerhan's cell), such as immune function defects, or HLA-DR antigen The expression site is altered by M. leprae infection, and even the expression disorder causes T cells to be unrecognizable. The immune response is weak, and the leprosy cannot be cleared. The lesions are widespread, but the immune damage is mild, and the leprosy containing a large amount of leprosy is formed in the lesion. Cells, or foam cells, are caused by macrophage infection of a large number of lipid-containing M. leprae. From the above, the immune status and histocompatibility of the body are directly related to the type of onset and onset of leprosy infection. related.
The pathological features of leprosy mainly reflect the different immune damage of patients, the early type of leprosy, the histopathological features of non-specific inflammatory infiltration of lesions, no special granuloma formation, few colonies in the tissue or sterile. However, if the acid-fast bacilli have important diagnostic value, the pathological changes of tuberculosis-like leprosy are a large number of lymphocytes infiltrating, and the granuloma formation is obvious. A large number of epithelioid cells and Langhans cells can be seen, and the epidermis is thickened by obvious cell infiltration, but destroyed. Lighter, peripheral nerve involvement has lymphocytic infiltration and neurolemma cell infiltration, nerve bundles and nerve plates are destroyed, few leprosy bacteria are found in the tissue, leprosy skin test is positive, borderline type tuberculosis The pathological damage characteristics of the sample are basically similar to those of the tuberculosis type. Only the extent of skin damage increases and the weight is increased, while the lymphocyte infiltration and granuloma reaction are alleviated, the number of bacteria increases, and the leprosy skin test is weakly positive, and the leprosy pathology is The anatomical feature is that there is a clear "no infiltration zone" under the epidermis of the skin, so the lymphocyte infiltration is less, only Layer collagen formation, another atypical foamy leprosy cells, the amount of bacteria in the tissue increased significantly, the leprosy reaction was negative, the lymphoid infiltration of the tumor lesions in the tumor type leprosy, but there are more typical leprosy Foam cells, containing a large number of leprosy, small and diffuse lesions, extensive nerve damage, usually pathological damage of internal organs, such as eye, bone, testicular and other leprosy inflammatory cell infiltration or granuloma formation, leprosy skin test negative The pathology of the off-line type leprosy is similar to that of the tumor type, but to a lesser degree, especially the nerve damage is lighter and appears later.
Although the invasiveness of M. leprae is low, it can quickly change the immune response status of the infected tissue to M. leprae, leading to the exacerbation and deterioration of clinical symptoms, especially called "leprosy reaction", in patients with polychaete leprosy (tumor type and The borderline metamorphosis type) contains a large amount of leprosy, which is relatively normal due to humoral immunity. The circulation contains high levels of leprosy antibodies. When effective chemotherapy is applied, a large amount of soluble antigen is released outside the cell and reacts with antibodies in the blood. In about half of the patients, an acute leprosy erythematous erythema reaction (erythema nodosum leprosy (ENL), also known as type II leprosy reaction, ENL is mainly caused by a large number of immune complex formation deposition caused by type III immune response For example, Arthu's phenomenon occurs when there is too much antibody, and serum-like reaction occurs when there is too much antigen. The main clinical manifestations of ENL are skin pain nodular erythema, iridocyclitis, neuritis, glomerulus Nephritis and systemic vasculitis.
The other type is tuberculosis-like and borderline leprosy. When various external or internal factors change, affecting the increase or decrease of immune response, there may be delayed hypersensitivity caused by cellular immune response. It is called type I leprosy reaction. When cell immunity is enhanced or effective chemotherapy is performed, the condition is often extremely transformed into tuberculosis type, called escalation or reverse reaction. In this case, although the enhanced immune response can further clear and reduce the tissue The number of leprosy bacteria, but immune damage can cause the original lesions and nerve damage to be further aggravated, and even cause permanent disability, and when the cellular immune response is further reduced or effective chemotherapy is not available, the condition can be advanced to the tumor type leprosy The evolution, called the degraded response, thus, regardless of the leprosy reaction, can increase the pathological damage of patients, and even cause serious consequences, the clinical should pay attention to and strengthen the prevention and treatment of leprosy response.
Prevention
Leprosy prevention
So far, there is no fully mature leprosy vaccine. The incidence of leprosy infection is low, and the incubation period is long. It is very difficult to evaluate the effect of the vaccine. On the spot, the leprosy vaccine and BCG are tried to prevent leprosy, which initially shows that the incidence can be reduced. However, the results reported by different regions are quite different, and it is difficult to evaluate its true preventive value. It is expected that the research on leprosy vaccine will take a long time to strengthen the publicity and education of people in the epidemic areas, including knowledge of leprosy transmission and early clinical manifestations. And leprosy is widely available through the combination of chemotherapy and other aspects of knowledge, is extremely important to prevent leprosy, patients with suspected leprosy in close family history, especially children under the age of 16 should take preventive use of dapsone .
Complication
Leprosy complications Complications deformity osteitis
Causes deformity or disability.
Symptom
Leprosy symptoms Common symptoms Conjunctival hyperemia, muscle atrophy, lymph nodes, papules, joint pain, splenomegaly, sensory disorder, maculopathy
1. Classification Leprosy classification is very important in leprosy prevention and scientific research. According to clinical, immunology, bacteriology and histopathology, and the practice for many years, the classification has been continuously improved and gradually reasonable.
(1) Madrid classification: In 1953, the sixth international leprosy conference in Madrid proposed a two-category classification method (also known as the Madrid classification method). After more than 20 years of clinical and on-site practice, although it is more practical but not ideal, the Madrid classification divides leprosy into Two types and two types, two types are relatively stable, namely tuberculoid (T) and lepromatous (L), two types of instability, namely, indeterminate (I) and boundary line (Borderline, B) .
(2) Five-level classification: According to the leprosy test, the strong positive gradual shift behavior is negative, and the leprosy is from less to more. The histopathological manifestation is epithelioid cell granuloma migration behavior foam cell granuloma, much like different wavelengths in the spectrum. The sequence is the same, therefore, using the spectral phenomenon of physics to form the concept of leprosy immunospectral, Ridley and Jopling proposed the grading five-level classification based on the concept of spectroscopy (also known as spectral immunological classification) in 1966, and Recommended after discussion at the 10th International Leprosy Conference, the leprosy is divided into tuberculoid leprosy (TT), borderline tuberculoid leprosy (BT), midborde1 leprosy (BB) , borderline lepromatous leprosy (BL), 1epromatous leprosy (LL), indeterminate leprosy (IL) is regarded as the early stage of leprosy, not included in the classification, this is A continuous spectrum of disease, patients can move to any aspect due to host response and treatment, TT-end cell immunity is the strongest, generally not detected in tissues M. leprae, LL end lacks cellular immunity to M. leprae antigen, no macrophage activation, a large number of M. leprae can be detected in tissues, TT and LL are the most stable, the former can heal itself, and the latter will continue without proper treatment. Aggravated infection, BT if untreated, often downgraded to BL, BB is the most unstable, if not treated, most of them are downgraded to LL, although the unclassified class is not included in the spectral classification, some self-healing later, some to clinical Development, this classification is more practical and can reflect the whole process of leprosy, which has been widely adopted around the world.
(3) On-site management classification: In 1981, the WHO leprosy chemotherapy research group was based on the needs of leprosy on-site management, and facilitated the observation of epidemiological investigation and combined chemotherapy. The leprosy examination was the main basis, and leprosy was classified as multi-bacterial and There are two types of less bacteria type, paucidacillary is the skin smear of any part, and the bacterial density is below , including undetermined, tuberculosis and boundary type tuberculosis type, multi-bacterial leprosy. (multibacillary, MB) is the density of bacteria in any part of the "" or above, including the middle boundary line, the boundary line type of tumor type, tumor type, 1988 also stipulates that all cases of skin-positive bacteria are according to the multi-bacterial type Combined chemotherapy.
2. After invasive into the body, the leprosy enters the body for a long incubation period. It is generally considered that the incubation period is 2 to 5 years on average, the short period is several months, and the elder is more than 10 years. If the disease occurs, it is carried out unconsciously. Before the onset of typical symptoms, there may be pre-existing symptoms such as general malaise, muscle, joint pain, and limb paresthesia. These manifestations are not specific. As the disease progresses, the clinical manifestations develop according to the strength of the immunity. The typical symptoms gradually become apparent. Those with stronger immunity develop to the end of the tuberculosis type, those with weak immunity develop to the end of the tumor type, or develop to the boundary line with unstable immunity. The clinical manifestations of various types of leprosy are described as follows.
(1) Tuberculosis-like leprosy (TT): This type of immunity is strong, the immunopathological response of local tissues is strong, the damage is limited to peripheral nerves and skin, skin lesions have rashes and plaques, and plaques are more common than rashes. (Improved immune response), often round or oval, the number is 1-3, the edge of the lesion is neat and clear, which is a clinical feature of tuberculosis-like leprosy, except for the face, the skin lesions are often obvious Feeling disorder, but not itching, asymmetric distribution, hair loss in the skin lesions, occurs in the limbs, face, shoulders, buttocks and other parts susceptible to friction, the rash is light, red or red, smooth surface, The plaque is often dark red or purple, with a clear outline, high edges, some inwardly inclined, gradually moving to the center of flattening or atrophy, the surface is dry and scaly, and sometimes the lesions of most small papules are visible. Large or small cutaneous nerves may be touched under or near the skin lesions, sometimes the nearby lymph nodes become larger, and the eyebrows do not fall off. The peripheral nerves of this type (such as the auricular nerve, ulnar nerve, median nerve, phrenic nerve, iliac crest) Nerve, etc.) becomes thicker and harder after being affected. It is fusiform, nodular or beaded, only 1 or 2, tender, mostly unilateral. In severe cases, it may form abscess or fistula due to delayed hypersensitivity reaction. Some patients have only symptoms of nerve involvement. No skin damage, known as pure neuritis, clinical manifestations of large nerves, skin sensation and muscle weakness in the corresponding parts, this patient for leprosy test, to help classification, if the late reaction is strongly positive, for TT Or BT, the rest is negative, after the nerve is involved, the nerve nutrition, exercise and other functions occur in varying degrees of obstacles, manifested as large, small fish muscles and interosseous muscle atrophy, forming a "claw hand" (ulnar nerve), "" (median nerve), "wresting wrist" ( nerve), "foot" ( nerve), "rabbit eye" (face nerve), "ulcer", "finger bone absorption" and other manifestations, distortion Residual occurs earlier, this type generally does not involve mucosa, eye and internal organs, bacterial density index of skin lesions (logarithmic classification method) is "0" ~ 1 "", leprosy test positive, cellular immune function Normal or near normal, this type is relatively stable, slow progress, and some Self-healing, leprosy reactions occur less opportunity, if occurred, compared with Type leprosy reaction, short treatment period, the prognosis is good.
(2) Boundary line type tuberculosis type leprosy (BT): The lesions in this type are rash and plaque, similar to tuberculosis, with reddish color, purple or brownish yellow, neat edges, and some plaques in the center. There are blank areas or drilling areas (also known as non-infiltration areas, immunization areas), which form clear circular damage inside and outside. The skin inside the cave area looks normal, the damage surface is mostly smooth, and some have a little scale. The number of damages is more than three, the size is different, some are scattered, with the trunk, limbs, face more, widely distributed, but asymmetrical, common satellite-like damage, although there are sensory disturbances, but lighter and later than TT Eyebrow eyelashes generally do not fall off, nerve involvement is coarse and asymmetrical, not as good as TT, mucous membrane, lymph nodes, testicles, eye and internal organs are less involved and lighter, skin lesions are generally negative for bacterial examination, bacterial density index of skin lesions For 1 "" to 3 "", the leprosy test is weakly positive or suspected positive, and the cellular immune function test is lower than that of normal people. This type is unstable, and can be "degraded" when not treated, that is, the immunity is weakened. To BB or BL, send When the leprosy reacts, it is the type I reaction. When the reaction condition is improved, the immune system can be "upgraded" when it is enhanced, and it can be transformed into a tuberculosis type. However, sometimes the nerve damage is aggravated by the reaction, and severe deformity can be generated.
(3) Middle boundary leprosy (BB): This type of skin lesion is characterized by pleomorphism and pleochroism. There are rashes in the skin lesions, plaques and infiltrates. The number is large, the size is different, and the distribution is different. Wide, asymmetrical, smooth surface, soft touch, color is wine, orange, brown, red, tan, etc. Sometimes it is two colors on a piece of skin lesion, the edge of the skin lesion is clear, part is not Clear, its shape is banded, serpentine or irregular. If it is strip-shaped, one side is clear, one side is infiltrated, if it is plaque, some center is "drilling area", the inner ring is clear It rises upwards and gradually tilts outwards, so that the outer edge is gradually immersed, showing an "inverted dish" appearance. Some skin lesions are red or white and ring-shaped or multi-ring shaped, resembling a target or a badge. "Spot" or "badge-like spot", the skin lesions that occur on the face are sometimes bat-like wings, color grayish brown, called "bat-like face", sometimes visible "satellite" damage, common in a different part of a patient There are approximate tumor and tuberculosis lesions on the skin, sometimes in the elbow and knee joints. The face and hip are composed of nodular thick cushions. The nerves are multiple, but asymmetrical. The thickness is between the two poles. The medium is soft, the eyebrows often do not fall off, or fall off and are asymmetrical. Mucosa Lymph nodes, eyes, testicles and internal organs can be affected. The bacterial density index of skin lesions is 2" to 4", the leprosy test is negative, and the cell immune function test is between the two poles. Unstable, when a type I leprosy reaction occurs, the "upgrade reaction" changes to BT, and the "degraded reaction" changes to BL or LL.
(4) Boundary line type of metastatic leprosy (BL): This type of skin damage has rash, papules, nodules, plaques and diffuse infiltration, etc., most of which are lesions like tumor type lesions, the number is large, large and small, Smaller, more unclear borders, brighter surface, reddish color, red or orange-red, skin lesions tend to yellow, widely distributed, but asymmetrical, skin lesions are less sensitive, appear later, in large damage The "drilling area" is still visible inside. The inner edge is clear, the outer edge is blurred, and sometimes scattered nodular damage can occur. A large diffuse infiltration can occur in the face and limbs. Some skin lesions have sensory disturbances, eyebrows, eyelashes, and hair. Can fall off, often asymmetrical, diffuse infiltration of the face of the late stage can also form a "lion face", in the middle and late stage patients with mucosal congestion, infiltration, swelling, lymph nodes, epididymis and testicular swelling can be seen, the conjunctiva can occur in the eye Inflammation, keratitis, iritis, etc., the nerve involvement tends to be bilateral, more uniform, soft to the touch, the deformity appears later, the bacterial density index of the lesions is 4 "" ~ 5 "", leprosy The statin test is negative in the late stage, fine Immune function tests show defective immune system when it is enhanced, to BB, BT upgrading, when it is reduced immunity, LL to change, this type of reaction may type leprosy.
(5) Tumor-type leprosy (LL): This type of patient is not reactive to M. leprae, its tissue is conducive to the propagation of M. leprae, and the leprosy is spread throughout the body through the lymphocytes. Most of the body tissues can be found in the body, which is persistent. Bacteremia, therefore, tissue and organ damage is more extensive, skin lesions have rash, infiltration, nodules and diffuse damage are characterized by a large number, wide distribution and symmetry, blurred edges, tend to fuse, the surface is greasy and smooth In addition to the light spots, the color of the skin lesions mostly consists of light red, red to yellowish red, orange color, and the sensory disturbance occurs later. The eyebrows are thinner in the early stage, and the eyelashes are thin. It begins to fall off and the eyelashes also fall off at the same time. This is a clinical feature of lepromatous leprosy. The plaque lesions are distributed throughout the body at an early stage, and are more common in the face, chest, back and abdomen, but warm parts such as armpits, groin, perineum and The middle part of the back is rarely affected, the color is reddish or light, the border is unclear, tends to fuse, and must be carefully examined under good light. It is identifiable. Later, the rash continues to increase. In addition, the formation of shallow diffuse infiltration, etc., nodular damage occurred on the basis of rash and invasive damage, starting very little, gradually increasing, varying in size, the characteristics of the distribution in the extremities of the extremities Many other parts are more common in the face, shoulders, buttocks, scrotum and other prominent parts. In the face, because the blood vessels are rich, the potential infiltration can occur in the early stage, the facial appearance is mildly red and swollen, and the infiltration then develops deep into the skin, making the skin diffuse. Thickening, deeper skin, thicker nose, larger earlobe, thinning of eyebrows, thin hair or large pieces falling off, nodules and deep infiltration, conjunctival congestion, forming a "lion face" appearance, more Late, due to partial absorption of diffuse infiltration, and obvious sensory disturbances in the limbs forming "gloves" or "socks" like numbness and occlusion, the skin visible in the calf is slightly hardened, smooth and shiny, and fish scales or snake skin appear. The damage is long-lasting. Some patients have almost all the hair removed, and the remaining hair is distributed along the blood vessels or remains in pieces. The peripheral nerves of this type are invaded at an early stage, and the nerve trunks are mostly thickened. Uniform, symmetrical, soft touch, tender, but the sensory disturbance is more obvious in the later stage, muscle atrophy, deformity and disability, nasal mucosal damage appear earlier, mucosal congestion and swelling, nasal secretions with blood or The nasal passages are blocked, and nodules, infiltration and ulcers occur later. In some cases, there are nasal septal perforations. If the nasal bridge collapses, a "saddle nose" can be formed. The oral and throat mucosa can be seen with congestion, infiltration, nodules, soft palate perforation, and uvula. Skewed or detached, the tongue is more fatty, the groove is deeper and nodules, the lymph nodes are obvious, generally not red, not hot, no adhesion, no pain, more common in the groin, thigh, neck, elbow, armpit Lymph nodes, which have been invaded at an early stage, mildly swollen, with enlarged swelling at the end of the period, and tenderness. The epididymis and testicles are swollen and atrophied, and there is tenderness. In the advanced stage, breast enlargement and impotence can be seen. The first half of the eyeball Partial involvement may occur with conjunctivitis, keratitis, iridocyclitis, etc., other internal organs are involved at the same time, visible liver, splenomegaly, etc., in addition to the upper respiratory tract, the lungs have not seen the performance after lung involvement, Although the bacterium can directly invade the muscle, the clinical skeletal muscle atrophy, sputum and other symptoms are often secondary to the damage of the peripheral nerve. The bacteria density index of the skin lesions is 5 "" to 6 "", and there are a large number of bacteria balls. The leprosy test is negative, and the cell immune function test has obvious defects. This type is very stable and cannot heal itself. Only a small number of patients can change to BL when the immunity is enhanced, but it is rare. This type often occurs II. Type leprosy reaction.
(6) Undetermined leprosy (IL): It is considered to be an early manifestation of various types of leprosy. It is not included in the five-level classification. It is primary, not secondary, and has mild clinical manifestations. Only skin damage or mild The neurological symptoms, non-discriminatory, mucous membrane, lymph nodes, testicles, eyes and internal organs are not involved, clinically easy to ignore, skin lesions are simple, only rash, occurs in the extremities of the extremities, chest, back and buttocks, etc. , rare in the armpits, groin, perineum and scalp, pale red or light color, the number is one or several, the surface is smooth and no infiltration, no shrinkage, generally no scales, the spotted mane can be sparse, the spot is round , elliptical or irregular, with unclear or partially unclear edges, asymmetrical distribution, normal or mild dysfunction in the plaque, some with sweating disorders, lighter nerve involvement, lighter, thicker, lower hardness Most of the lesions were negative, and a small number of acid-fast bacilli were found. Most of the leprosy tests were positive, a few were negative, the cellular immune function test was normal or near normal, and some were defective. This type was unstable and self-healing. , can also change to other types (about 30%), evolve Depending on the type of patient's immunity, most evolved into tuberculosis, with a few being transformed into tumors and boundaries.
Tissue-like leprosy (HL): also known as tissue-like leprosy (histoid leprosy), occurs in tumor-type and borderline type of lepromatous leprosy, the pathological image of skin tissue is special, the lesion can be primary, but also In the case of drug-resistant cases in which sulfone drugs are treated to worsen or recur, the clinical features are that nodules of different sizes occur on the basis of diffuse infiltration, which are more common in the face, limbs and trunk, and are tough or soft. Brownish brown, smooth surface, can ulcerate and form a thick cushion in the oppressed area. Histopathological examination has a large number of dense fusiform or polygonal tissue cells infiltrating, arranged in a spiral shape, similar to skin fibers. The tissue image of a tumor or a neurofibroma contains a large number of elongated leprosy, arranged in clusters, and surrounded by connective tissue to form a pseudo-envelope, which is called "tissue-like leprosy."
(7) The symptoms of leprosy: After the leprosy is cured or self-healed, the original active skin symptoms have completely disappeared, but some residual symptoms may remain, which will remain unchanged for a long time, or cause some long-term damage due to nerve damage. Unrecoverable deformities, familiar with these symptoms, have practical significance for the judgment of leprosy cure, post-healing monitoring and differential diagnosis. These residual symptoms can have fixed light spots, white spots, atrophy and pigmentation on the skin. Spot, eyebrow, eyelash, hair loss, secondary ichthyosis, scar, ulcer, etc.; can have localized sensory disturbance or no sweat in the nerve, claw hand, hanging wrist, foot, rabbit eye, Mouth, muscle atrophy, lack of fingertips, etc., other such as nasal septum perforation, saddle nose, blindness, male breast enlargement, testicular atrophy, etc., although patients have these symptoms, but can not be considered that leprosy has no cure or recurrence, It should be distinguished. Those without disabilities should be treated as normal people, those with disabilities should be treated as normal disabled people, and they should not be discriminated against.
(8) Leprosy reaction: lepra reaction is an immune response to leprosy antigen in the chronic process of leprosy, whether active or not, causing the condition to be suddenly active, manifesting as acute or subacute aggravation. The original skin damage and nerve damage are intensified, or new skin damage or nerve damage may occur, which may be accompanied by arthritis and nodular erythema. The cause may be drug, secondary infection, anemia, mental, climate, trauma, Preventive injection or vaccination, malnutrition, alcoholism, excessive fatigue, irregular menstruation, pregnancy, childbirth, breastfeeding, etc., type I response is related to sensitized lymphocytes, is a delayed type hypersensitivity reaction, also known as cellular immune type metamorphosis Reaction, general antibody and complement do not participate in the reaction, the occurrence and disappearance of the reaction is relatively slow, so called delayed type allergic reaction, type I reaction is common in the boundary line leprosy, divided into upgrade (reverse) and degraded reaction, escalation reaction occurs mostly in anti-leprosy In patients with drug therapy, the clinical manifestations are that the original skin lesions are exacerbated in whole or in part, with acute inflammation, pain, congestion, and water. , flushing, appearance similar to erysipelas, can be broken when severe, edema can be seen in the hands, feet and face, iritis can occur in the eye, and new erythema, plaque and nodules appear; the original lesion is more clear, the skin lesions are investigated Reduce or turn negative; if the transition to the tuberculosis-like end, the lesions disappeared when visible desquamation; nerve trunk swelling and thickening, accompanied by pain and tenderness, especially in the night, severe cases, a small number of patients can form nerves Abscess, the original numb area on the skin is enlarged, and a new numb area appears. The original deformity is aggravated, and new deformities and disability can occur. The degrading reaction mostly occurs in untreated patients, and the clinical manifestations are almost the same as the escalation response. The edge of the original lesion becomes more blurred, and there may be many new lesions similar to the tumor type. The lesions are increased, or the original is negative, and if the transformation can be changed to the tumor type; the blood image There is no obvious change in the examination; this type of reaction occurs slowly and disappears slowly. The type II reaction is an antigen, and the antibody complex is allergic. It is a humoral immune reaction, also known as vasculitis type reaction, which mainly occurs in cured or untreated. bacteria In patients with type, the reaction occurs faster and the tissue damage is more serious.
Examine
Leprosy check
1 ELISA detection of serum PGI-1 IgM antibody in patients, is valuable for monitoring the treatment of patients with multiple bacteria, but the detection rate of antibodies in patients with low bacterial type is very low.
Two human neuron antibody assays have reference value for early diagnosis of leprosy.
3 The use of PGI-1 monoclonal antibody to detect specific antigens in pathological sections of patients may become a new specific diagnostic method.
Histopathological examination revealed characteristic epithelioid cells, Langhansian cell granulomas, or leprosy cells.
Diagnosis
Diagnosis of leprosy
diagnosis
When leprosy patients have typical skin lesions with neurological symptoms, combined with a clear epidemiological history, diagnosis is easier. When early symptoms are atypical and light, they are often misdiagnosed or missed.
The diagnosis of leprosy is mainly based on:
1 special clinical rash, peripheral nerve swelling and sensory impairment.
2 skin scrapings to find acid-fast bacteria.
3 biopsy histopathological examination.
4 The exact history of leprosy exposure and other aspects of the data, after comprehensive analysis to make a judgment.
The diagnosis requires two of the above four items to be diagnosed, and the most reliable basis for the detection of leprosy in the skin.
When collecting medical history, patients may conceal their condition because of fear. The doctor should fully obtain the trust and cooperation of the patient, focusing on the history of the symptoms and the history of contact with the family. When examining your body, you should pay attention to local sensory disturbances and large nerves with diagnostic value. If the sensory disorder occurs in the lesion area and the numbness and sweat area, it is more diagnostic value.
Examination of leprosy from the skin tissue is important for diagnosis, but leprosy cannot be ruled out when the bacteria are negative, especially in tuberculous leprosy. When the bacteria are positive, attention should also be paid to the identification of other acid-fast bacilli.
The clinically used bacterial index BI and the morphological index MI indicate the presence of M. leprae in tissues. The bacterial index, or bacterial density index, is the sum of the bacterial densities of each part according to the Ridely logarithmic classification method, and divided by the number of parts examined. The Ridely counting method is 10 times worse between each level. The morphological index is the ratio of intact leprosy (live bacteria) in the total bacterial amount. It is difficult to standardize in practical applications, so only the morphology of the bacteria is reported. In addition to reflecting the content and morphology of M. leprae, the two indices can also be used as indicators for drug efficacy evaluation.
Differential diagnosis
1. Leprosy has sensory disturbances and large nerves in the clinic.
2. Patients with multiple bacteria can detect leprosy.
3. Each type of leprosy has its own histopathological changes and tissue investigation results.
