Symptoms of leprosy

The incubation period with leprosy is long: an average of 3-7 years, in some cases from 1 year to 15-20 years or more. In the initial period of the disease may be subfebrile body temperature, malaise, drowsiness, loss of appetite and weight loss, arthralgia, neuralgia, paresthesia of the extremities, rhinitis and frequent nasal bleeding. Then there are clinical signs of one of the forms of the disease.

With lepromatous type of leprosy, skin lesions are extremely diverse: spots, infiltrates, nodes. At the beginning of the disease, symmetrically located erythematous and erythematous-pigmented spots with a smooth, shiny surface appear on the skin of the face, extensor surfaces of the forearms, shins and buttocks. Their size is small, the color is red at first, then yellowish-brown (copper, rusty shade), the boundaries are fuzzy.

After months and years, skin spots may disappear, but more often they are transformed into diffuse or limited infiltrates with a greasy shiny surface. The skin in the field of infiltrates resembles an orange peel due to the expansion of the follicles of the cuff hair and the excretory ducts of the sweat glands. Subsequently, anhidrosis, hypo- and anesthesia of all types of surface sensitivity, loss of hair, eyelashes, eyebrows, hair of the beard and mustache are noted in the lesions. The face of the patient due to diffuse infiltration of the skin, deepening of natural folds and wrinkles reminds facies leonina.

In the field of infiltrates there are single or multiple leproms (dermal and hypodermal tubercles and nodes) with a diameter from 1-2 mm to 2-3 cm. Lepromes are painless, their boundaries are clear. Over time, leproms can resolve, undergo fibrous degeneration; often painful, long-lasting healing ulcers. On the site of resorpted infiltrates and leprom remain pigmented spots, after healing ulcers - hypopigmental scars.

A permanent and early clinical sign of the disease is the damage to the mucous membranes of the nose, and in far-reaching cases - the mucous membranes of the lips, mouth, pharynx and larynx (hyperemia, edema, diffuse infiltration and leproms). Due to their defeat, perforation of the septum of the nose, deformation of its back, difficulty in nasal breathing and swallowing, stenosis of the larynx, dysphonia, aphonia can be observed.

With lepromatous leprosy, chronically occurring lymphadenitis of the femoral, inguinal, axillary, ulnar, submandibular, cervical and other nodes is relatively early. Liver, spleen, kidney, testicles, ovaries can be affected. There are also periostitis and hyperostosis of the bones of the upper and lower extremities.

Specific lesions of the organ of vision develop, as a rule, many years after the onset of the disease and are expressed in the appearance of inflammatory changes mainly in the anterior part of the eyeball and its auxiliary organs: blepharitis, conjunctivitis, keratitis, episcleritis, scleritis, iritis, iridocyclitis.

The defeat of the peripheral nervous system manifests itself late and proceeds according to the type of symmetrical polyneuritis leading to sensory, and in later stages to trophic, secretory, vasomotor and motor disorders. A detailed description of the clinical symptoms of peripheral nervous system damage is given in the presentation of the clinic of an undifferentiated type of leprosy, in which they are more pronounced and observed most often.

In the tuberculoid type of leprosy, skin rashes (spots, papules, plaques) are asymmetric and can be found in any part of the body, usually in the chest, back, lumbar region. In the early stages of the disease, single hypopigment or erythematous spots with distinct edges are observed. Then on the edges of the spots appear flat papules of a reddish-cyanotic color, which merge into several solid plaques rising above the level of the skin. Such a gradually increasing erythematous plaque has a sharply contoured, roll-like, raised margin with scalloped contours. Over time, the central part of the plaque is flattened and depigmented. The resulting ring-shaped elements, also called curbs, merge into a figured tuberculoid of various shapes and sizes.

Thus, tuberculoid rashes are small papules and tubercles of reddish-brown color, merging into plaques, which have an annular structure and scalloped edges. Individual plaques (usually 10-15 mm in diameter) merge into larger rashes. At the point of regression of all elements of the skin lesions are hypopigmentation spots or develop skin atrophy and areas of scarring atrophy with secondary pigmentation.

Very early lesions of peripheral nerves, proceeding according to the type of polyneuritis, leading to sensory, motor, secretory, vasomotor and trophic disorders (see the description of the undifferentiated type of leprosy) are detected very early.

With an undifferentiated type of leprosy, flat erythematous and hypopigmental patches of various shapes and sizes with indistinct edges are observed on the skin of the buttocks, lumbar region, hips and shoulders. In the lesions of the skin gradually develop hypo- and anesthesia (temperature, pain and tactile), anhidrosis, hair loss of hair.

Then, lesions of peripheral nerves, proceeding according to the type of mono- and polyneuritis and accompanied by sensory, motor, vasomotor and trophic disorders are detected. Most often the following nerve trunks are affected: nn. Ulnaris, radialis, medialis, peroneus communis, tibialis, auricularis magnus, etc. Nerve trunks, in the innervation zone of which there are skin rashes, thicken, become dense and painful on palpation. Thickening of nerves can be diffuse and uneven (crisp). Similar changes are observed in the superficial nerves of the skin around the tuberculoid rash. In the lesions of the skin and often in the distal parts of the limbs paresthesia, decrease, and then complete loss of all kinds of surface sensitivity (temperature, pain, tactile) are noted.

As a result of neuritis, paresis, paralysis, atrophy and contracture of many facial muscles and limbs gradually develop. As a result of paresis, paralysis and atrophy of the circular muscle of the eyelids, a lagophthalmus develops. When the mimic and chewing musculature is affected, immobility, the masculinity of the face is observed. Atrophy of the muscles of the hands leads to the development of the so-called "monkey brush", and the flexion contracture of the fingers - to the "clawed brush" ("paw of the fretboard"). Amyotrophy of the lower extremities leads to the development of a hanging foot that assumes the position of pes varus equinus, and the appearance of a step like "steppe".

Trophic, secretory and vasomotor disorders are as follows. In the area of skin rashes, hair loss, anhidrosis, increased secretion of sebaceous glands and telangiectasia are noted. There are persistent loss of eyelashes, eyebrows, hair of mustaches and beard, dystrophy of nail plates, trophic ulcers of feet (often perforating). There are mutations of phalanges of fingers and hands - their shortening and deformation due to resorption of the phalanx bone substance.

After 2-4 years, the undifferentiated type of leprosy can evolve (transform) into a lepromatous or tuberculoid form.

With the borderline type of leprosy (dimorphic leprosy), skin rashes in appearance and location are similar to skin lesions observed in both lepromatous and tuberculoid types of the disease. The defeat of the peripheral nerves proceeds according to the type of polyneuritis with sensory, motor, secretory, vasomotor and trophic disorders (see the description of the undifferentiated type of leprosy).

The course of leprosy is chronic with periodic exacerbations, the so-called leprosy reactions. Activation of the process in all forms of the disease is due to the weakening of the factors of specific and nonspecific defense of the organism. Exacerbation of the process may be accompanied by an increase in body temperature, the formation of new skin rashes, the emergence or exacerbation of neuritis, lymphadenitis, increased inflammation in the tissues of the eye and internal organs, ulceration of old leprom, the appearance of mycobacteria leprosy in the lesions of the skin and in the mucous membrane of the nose. Reaction exacerbation can lead to the transition of one clinical form of the disease to another, with the exception of lepromatous leprosy, which does not transform into another type of disease. Such reactions can last several weeks, months, sometimes years.

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