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Leprosy eyes: general information
Last reviewed: 23.04.2024
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[Causes of leprosy
The causative agent of human leprosy - Mycobacterium leprae (M. Leprae hominis, M. Hanseni), described in 1874 by G. Hansen, belongs to the genus Mycobacterium.
Morphology of the causative agent of leprosy has been studied on fixed preparations in light and electron microscopes. A typical form of mycobacteria leprosy is straight or slightly curved sticks with rounded ends, from 1 to 4-7 microns in length and 0.2-0.5 microns in width. Grain, branched, and other forms of the pathogen are also observed. They are immovable, spores and capsules do not form, acid and alcohol resistant, gram-positive, are colored according to Tsil-Nielsen in red. They are intra- and extracellular, they tend to group together, being parallel to each other ("cigarette packs"). They can be in the form of globular clusters (globi), with a diameter of 10-100 microns, and sometimes - about 200 microns. According to morphology, tinctorial and antigenic properties, the causative agent of human leprosy has a great similarity with mycobacterium tuberculosis.
Immunity with leprosy
The majority of healthy people develop relative natural immunity to mycobacteria leprosy, which is characterized by a rather high intensity. The state of the immunological reactivity of the macroorganism in relation to the causative agent of leprosy is determined mainly by the reactions of cellular immunity. To this end, the most commonly used intradermal lepromine sample. Positive results of this test indicate a pronounced ability of the body to develop a response to the introduction of mycobacteria leprosy, ie, a high degree of natural immunity. A negative answer indicates the inhibition of cellular immunity reactions, in other words, the lack of natural immunity.
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.
Symptoms of leprosy eye organ
Prior to the widespread use of sulfonamides, damage to the organ of vision in leprosy occurred in a large percentage of cases: 77.4% in each case. No other infectious disease had such a high incidence of eye damage. Currently, in connection with the success of therapy and prevention of leprosy, the disease of the organ of vision is observed much less frequently: according to U. Ticho, J. Sira (1970) - 6.3%, A. Patel and J. Khatri (1973) - 25 , 6% of cases. However, among the untreated patients, the specific inflammation of the eyes and its subsidiary organs, according to the observations of A. Patel, J. Khatri (1973), is 74.4%.
The organ of vision in leprosy patients is involved in the pathological process only a few years after the onset of the disease. Inflammation of the eyes and its subsidiary organs is observed with all types of leprosy, most often with lepromatous. In this case, changes in the eye's auxiliary organs (eyebrows, eyelids, eyeballs, teardrop, conjunctiva), fibrous, vascular and reticular membranes of the eyeball and optic nerve are detected.
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Classification of leprosy
According to the classification adopted at the 6th International Congress on Leprosy in Madrid in 1953, the following forms of leprosy are distinguished: lepromatous, tuberculoid, undifferentiated and borderline (dimorphic). The first two types of leprosy are recognized as polar.
Lepromatous type - the most severe form of the disease, highly contagious, difficult to treat. The skin, mucous membranes, lymph nodes, visceral organs, eyes, peripheral nerves are affected. A typical lesion of the skin is diffuse and limited infiltration (lepromatous infiltration and leprom). A bacterioscopic examination of scrapings from skin lesions and nasal mucosa reveals a large number of pathogens. In the outline the lepromine sample is negative. When histological examination of lesions is determined lepromatous granuloma, the main cellular elements of which are leprous Virkhov cells - macrophages with a "foamy" cytoplasm, containing mycobacteria leprosy.
Diagnosis of leprosy eye
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.
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Treatment and prevention of leprosy eye
In the treatment of leprosy damage to the organ of vision, the main thing is to conduct general specific therapy.
The total duration of treatment of patients with lepromatous and borderline type of leprosy is 5-10 years, with tuberculoid and undifferentiated - at least 3-5 years. In some cases, the treatment of patients with lepromatous leprosy continues throughout their life. Initially, the treatment is performed in the hospital of leprosarium. The disappearance of clinical signs of the activity of the leprosy process, multiple negative results of bacterioscopic and histological examinations of various parts of the skin and mucous membrane of the patient's nasal septum is transferred to outpatient treatment in the leprosarium or dermatovenerologic dispensary at the place of residence. Treatment is carried out according to the prescription of the leprologist. At the end of outpatient treatment, the patient remains under follow-up care throughout life. All patients prescribed for out-patient treatment receive specialized care (including ophthalmology) in the medical institutions of the general medical network.
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