Diagnosis of eye leprosy

Leprosy is diagnosed only if there are clinical signs of the disease. As indicated above, the clinical symptoms of lesion in the eyes of leprosy patients are only found many years after the onset of the disease. Consequently, the basis for establishing the leprosy etiology of eye disease is primarily clinical manifestations of the disease, expressed mainly in a variety of dermatological and neurological symptoms and characterized by a chronic course with periodic exacerbations.

The diagnosis is facilitated by epidemiological, radiologic, functional and laboratory data.

The main radiographic features are focal specific inflammatory destruction of bone tissue (leprom), observed with lepromatous type of leprosy, and periostitis, hyperostosis and trophic changes (oophorosis and osteolysis) that occur in all types of leprosy.

As is known, leprosy mono-and polyneuritis is accompanied not only sensory and motor, but also vasomotor, secretory and trophic disorders. For the diagnosis of the latter, functional and pharmacodynamic tests are used: with histamine (or morphine, dionine), nicotinic acid, mustard, and Minor.

A sample with histamine reveals a lesion of the peripheral nervous system. On the affected area and on the externally unchanged skin, one drop of 0.1% histamine solution (or 1% morphine solution, 2% dionine solution) is applied and a superficial skin incision is made. Three phases of the reaction (the Lewis triad) are normally observed: small sizes of erythema appear in the place of the incision of the skin, after 1 to 2 minutes the erythema reflex erythema (a few centimeters in diameter) develops considerably, arising as an axon-reflex, after a few more minutes in its center is formed by a papule or vesicle. On the rashes of leprosy etiology (sometimes on externally unchanged skin) due to the defeat of nerve endings in the skin, reflex erythema does not develop.

Using a sample with nicotinic acid, proposed by NF Pavlov (1949), vasomotor disturbances are revealed. The patient is injected intravenously with 3-8 ml of a 1% aqueous solution of nicotinic acid. Normally there is erythema of the entire skin, completely disappearing in 10-15 minutes. On leprosy lesions, sometimes in some areas of externally unchanged skin due to the paresis of capillaries, hyperemia persists for a long time (a symptom of "inflammation").

A sample with a mustard plaster is used in patients with hypopigmented spots of the skin, in the area of which erythema does not appear due to vasomotor disorders.

The sweating test (Minor) is as follows. The test area of the skin is lubricated with iodine-containing Minor reagent or 2-5% alcoholic iodine solution and powdered with starch. Then they stimulate sweating. In areas of healthy skin with normal sweating, a blue staining appears. On leprosy lesions of the skin due to anhidrosis, the blue color does not appear.

The examination of the eye in leprosy patients should include external examination of the eye and its auxiliary organs, determination of the mobility of the eyeballs, examination of pupillary responses to light, accommodation and convergence, examination of refractive media in transmitted light, ophthalmoscopy, biomicroscopy, gonioscopy, biomicrophthalmoscopy, sensitivity study of bulbar conjunctiva and cornea, the definition of visual acuity, perimetry, campimetry, adaptometry and tonometry.

For early detection of fatigue of the circular muscle of the eyelid, Yu. I. Garus (1959) proposed a blinking test. The patient is offered a continuous blinking eyelid movement within 5 minutes. Normally, these movements stop after 5 minutes. With the defeat of the circular muscle of the eyelids, its fatigue, expressed in incomplete closure of the eyelids, occurs 2-3 minutes later.

When examining patients with suspected leprosy, use of bacterioscopic, histological and immunological methods of investigation.

Bacterioscopic examination is subjected to scrapings from the mucosa of the septum of the nose, scarifications from the affected areas of the skin and puncture of the lymph nodes. With lesions of the organ of vision, the detachable from the conjunctival sac is examined, the scrapes from the conjunctiva of the eyeball and eyelids, from the cornea, the moisture of the anterior chamber of the eye. Smears stained by Tsilyu-Nielsen. The results of bacterioscopy studies depend on the type and stage of leprosy, exacerbations and the effectiveness of treatment of leprosy infection.

The material for histological studies is usually biopsied pieces of skin. In the case of enucleation of the eyeball, examine its membranes. Histological sections are stained by Romanovsky-Giemsa and Tsiol-Nielsen. The results of histological studies (most often biopsied skin pieces) are important for the classification of lepra type, the study of the dynamics of the leprosy process, the evaluation of the effectiveness of treatment, the determination of the timing of inpatient treatment and dispensary observation.

Serological diagnosis of leprosy using the reaction of RSK, RIGA, RNIF, etc. Is under study.

In order to determine the resistance of the organism to mycobacteria, lepra put a lepromine sample, proposed by K. Mitsuda in 1919. The reaction uses Lepromin-antigope Mitsuda (obtained from leproma autoclavrocytic suspension of mycobacterium leprosy). This is the so-called integral antigen, used most often. Other antigens are also proposed. 0.1 ml of lepromine is injected into the skin of the shoulder or forearm of the patient. With a positive result, at the site of antigen administration, after 48 hours, hyperemia and papula are determined. This is an early reaction to lepromine (Fernandez reaction). After 2-4 weeks, a tubercle develops, sometimes a ulcerous knot. This is a late reaction to lepromine (Mitsuda's reaction). Within 3-4 months a scar is formed, usually hypopigmented, which persists for many years.

The positive result of Mitsuda's reaction testifies to the expressed ability of the organism to develop a response to the introduction of mycobacteria leprosy, which is observed in the majority of healthy people.

The negative result of Mitsuda's reaction testifies to the inhibition of cellular immunity reactions.

In patients with lepromatous leprosy, the test with lepromine is negative, with tuberculoid type positive, undifferentiated - positive in about 50% of cases, with borderline - usually negative. In children under 3 years, Mitsuda's reaction is negative.

Thus, lepromine sample is important for determining the type of leprosy, the prognosis of the disease and the state of resistance of the organism. Cellular immunity with leprosy is also studied in in vitro reactions (the reaction of blasttransformation of lymphocytes., Etc.).

The clinical manifestations of leprosy are diverse and require careful differentiation from many skin diseases, the mucous membrane of the upper respiratory tract, the peripheral nervous system, lymph nodes and the organ of vision, which have a number of input features with manifestations of leprosy (erythema nodosum, tubercular syphilis, syphilitic gums, tuberculosis, sarcoidosis , syringomyelia, myelodysplasia, disseminated and amyotrophic lateral sclerosis, inflammatory diseases of the nasal and laryngeal mucosa, lymph nodes, organ of vision tuberculosis and syphilis etiology et al.).

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