Symptoms of lepra

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

In the lepromatous type of leprosy, skin lesions are extremely varied: spots, infiltrates, nodes. At the onset 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 initially red, then yellowish-brown (copper, rusty shade), the boundaries are unclear.

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

In the area of infiltrates, single or multiple lepromas (dermal and hypodermal tubercles and nodes) with a diameter of 1-2 mm to 2-3 cm appear. Lepromas are painless, their boundaries are clear. Over time, lepromas can resolve, undergo fibrous degeneration; more often, painful, long-term non-healing ulcers are formed. In place of resolved infiltrates and lepromas, pigment spots remain, after the ulcers heal - hypopigmented scars.

A constant and early clinical sign of the disease is damage to the mucous membranes of the nose, and in advanced cases - the mucous membranes of the lips, oral cavity, pharynx and larynx (hyperemia, edema, diffuse infiltration and leprosy). As a result of their damage, perforation of the nasal septum, deformation of its back, difficulty in nasal breathing and swallowing, stenosis of the larynx, dysphonia, aphonia can be observed.

In lepromatous leprosy, chronic lymphadenitis of the femoral, inguinal, axillary, elbow, submandibular, cervical and other nodes is also observed relatively early. The liver, spleen, kidneys, testicles, and ovaries may be affected. Periostitis and hyperostosis of the bones of the upper and lower extremities are also observed.

Specific lesions of the visual organ 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 accessory organs: blepharitis, conjunctivitis, keratitis, episcleritis, scleritis, iritis, iridocyclitis.

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

In tuberculoid leprosy, skin rashes (spots, papules, plaques) are asymmetrical and can be found on any part of the body, usually in the chest, back, and lumbar region. In the early stages of the disease, single hypopigmented or erythematous spots with clear edges are observed. Then, flat reddish-bluish papules appear along the edges of the spots, which merge into solid plaques that are slightly elevated above the skin level. Such a gradually increasing erythematous plaque has a sharply defined, ridge-like, raised edge with scalloped outlines. Over time, the central part of the plaque flattens and becomes depigmented. The resulting ring-shaped elements, also called border elements, merge into a figured tuberculoid of varying shape and size.

Thus, tuberculoid rashes are small papules and tubercles of a reddish-brown color, merging into plaques that have a ring-shaped structure and scalloped edges. Individual plaques (usually 10-15 mm in diameter) merge into larger rashes. At the site of regression of all elements of skin damage, hypopigmented spots remain or skin atrophy and areas of cicatricial atrophy with secondary pigmentation develop.

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

In the undifferentiated type of leprosy, flat erythematous and hypopigmented spots of various shapes and sizes with indistinct edges are observed on the skin of the buttocks, lumbar region, thighs and shoulders. Hypo- and anesthesia (temperature, pain and tactile), anhidrosis, and loss of vellus hair gradually develop in the lesions of the skin.

Then lesions of the peripheral nerves are detected, occurring as mono- and polyneuritis and accompanied by sensory, motor, vasomotor and trophic disorders. The following nerve trunks are most often affected: nn. ulnaris, radialis, medialis, peroneus communis, tibialis, auricularis magnus, etc. The nerve trunks, in the innervation zone of which there are skin rashes, thicken, become dense and painful upon palpation. Nerve thickenings can be diffuse and uneven (bead-like). Similar changes are observed in the superficial nerves of the skin around tuberculoid rashes. In the foci of skin lesions and often in the distal parts of the extremities, paresthesia, a decrease, and then a complete loss of all types of superficial sensitivity (temperature, pain, tactile) are noted.

As a result of neuritis, paresis, paralysis, atrophy and contractures of many muscles of the face and limbs gradually develop. As a result of paresis, paralysis and atrophy of the orbicularis oculi muscle, lagophthalmos develops. When the facial and masticatory muscles are affected, immobility and a mask-like appearance of the face are observed. Atrophy of the hand muscles leads to the development of the so-called "monkey hand", and flexion contracture of the fingers - to the "claw hand" ("vulture's paw"). Amyotrophy of the lower limbs leads to the development of a drooping foot, taking the position of pes varus equinus, and the appearance of a "steppage" type gait.

Trophic, secretory and vasomotor disorders are as follows. In the area of skin rashes, loss of vellus hair, anhidrosis, increased secretion of the sebaceous glands and telangiectasia are observed. Persistent loss of eyelashes, eyebrows, moustache and beard hair, dystrophy of the nail plates, trophic ulcers of the feet (often perforating) are observed. Mutilations of the phalanges of the fingers and toes appear - their shortening and deformation due to resorption of the bone substance of the phalanges.

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

In the borderline type of leprosy (dimorphic leprosy), skin rashes are similar in appearance and location to skin lesions observed in both the lepromatous and tuberculoid types of the disease. Peripheral nerve damage occurs as polyneuritis with sensory, motor, secretory, vasomotor and trophic disorders (see 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 caused by weakening of the factors of specific and non-specific protection of the body. Exacerbation of the process may be accompanied by an increase in body temperature, formation of new skin rashes, occurrence or exacerbation of neuritis, lymphadenitis, increased inflammation in the tissues of the eye and internal organs, ulceration of old leprosy, appearance of leprosy mycobacteria in the lesions of the skin and in the mucous membrane of the nose. Exacerbation reactions 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 for several weeks, months, sometimes years.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]