Leprosy (leprosy): symptoms

Leprosy has an extremely long and indefinite incubation period (from several months to 20 years and more, an average of 3-7 years); the symptoms of leprosy are very diverse. Leprosy has no clear signs of flow.

According to the modern classification of Ridley-Jopling, lepromatous (LL), tuberculoid (TT) and three borderline types of disease are distinguished: borderline leprosy (BB), borderline lepromatosis (BL) and border tuberculoid (BT). According to this classification, four main diagnostic criteria are taken into account in the diagnosis of leprosy: the symptoms of leprosy, the bacterioscopic index indicating the amount of the pathogen in the body, the immunological reactivity of the patient, evaluated with the lepromine test, and the histological examination data.

The prodromal symptoms of leprosy are signs of peripheral vegetative insufficiency and reflex-vascular disorders (marbling of the skin, cyanosis, edema of the hands and feet, disturbances of the flow and salinity), as well as weakness, aches, paresthesia, nosebleeds. At the beginning of development of manifest forms of the disease, as a rule, diffuse changes in the color of the skin, single or multiple spotted rashes, varying in location, shape, size and color (erythematous, hypopigmental, hyperpigment, cyanotic, with brownish tinge), intensifying paresthesia. In later stages of the disease, there are limited or diffuse skin infiltrates, papules, tubercles, knots, rhinitis and eruptions on the mucous membranes of the upper respiratory tract, leprosy pemphigus, eyebrows and eyelashes dropping (madarose), amyotrophy, nail brittleness, ichthyosiform signs, ulcers and others. Trophic disorders, gross violations of surface types of sensitivity.

Skin symptoms of lepra tuberculoid type (TT-lepra), depending on the stage of the disease, look like single or multiple spots with clear edges, as well as papular elements, plaques, sarcoid and annular curbs with a clearly outlined elevated margin.

A characteristic sign of tuberculoid leprosy eruptions on the skin is an early detectable decrease in pain, temperature and tactile sensitivity on them, usually extending 0.5 cm beyond the visible boundaries of lesions, impaired sweating and hair loss. When regression of eruptions of the tuberculoid type of leprosy, hypopigmental spots remain in their place, and in case of deeper infiltration, skin atrophy remains.

[1], [2], [3], [4], [5],

Lepromatous type

The most severe and contagious (multi-bacillary) type of disease. It is characterized by the prevalence of the pathological process. Skin symptoms of leprosy are localized on the face, back of hands, legs and are represented by limited tubercles (leproms) and diffuse infiltrates. Color leprom varies from pink to cyanotic red, their surface is smooth and shiny, sometimes covered with otrigious scales. Lepromy hemispherically rise above the surface of the skin and, closely adjacent to each other, often form a continuous bumpy infiltration. When the face of the leprom is affected, it is strongly disfigured, giving the appearance of a lion's face - facies leonine. The flow of leprom is torpid, sometimes they can disintegrate, forming ulcers.

Simultaneously with skin changes, the mucous membranes of the nose, oral cavity, larynx are often affected. Patients complain of dryness in the mouth, nose, soup discharge, frequent nasal bleeding, shortness of breath, hoarseness of voice. Ulceration of leprom and infiltrates of the cartilaginous septum of the nose leads to its perforation followed by deformation of the nose.

Eye damage is observed in the form of keratitis, iridocyclitis, episcleritis, which can lead to impaired visual function and even complete blindness.

Lymph nodes (femoral, inguinal, axillary, ulnar, etc.) increase, and during an exacerbation the diseases can melt. In the punctata they are found mycobacteria leprosy. From the internal organs are affected liver, spleen, lungs, kidneys, etc. In the bone system, periostitis, leproms develop.

As a result of the defeat of the nerves along the way they appear sharp pains, all kinds of skin sensitivity (temperature, pain and tactile) are broken, especially on the hands and feet. Patients without feeling warmth and cold, without feeling pain, often suffer severe burns, injuries, in some patients, in connection with nerve damage, the muscles of the face and limbs are weakened and depleted, and sometimes the destruction and rejection of the fingers and toes (mutations), on feet appear deep ulcers, difficult to treat. All this leads the patients to a deep disability.

Usually a dull, chronic course of this type of lepra can sometimes be replaced by periods of exacerbation, the so-called leprosy reactions, during which the general condition of patients deteriorates sharply, the existing lesions become worse, and new rashes appear. The old leproms are melted and ulcerated, neuritis, lesions of the eyes, lymph nodes and internal organs become worse, the symptoms of "leprosy erythema nodosum" develop.

The initial eruptions with lepromatous type of lepra (LL-lepra) most often have the appearance of numerous erythematous, erythematous-pigmental or erythematous-hypopigmental spots, the characteristic features of which are small size, symmetrical arrangement and absence of clear boundaries. More often spots appear on the face, extensor surfaces of hands and forearms, legs and buttocks. Their surface is usually smooth and shiny. Over time, the initial red color of the spots becomes a brown or yellowish tinge. Sensitivity and sweating within the spots are not violated, pushrod hair is preserved. In the future, infiltration of the skin increases, accompanied by a strengthened function of sebaceous glands, and the skin becomes shiny and shiny in the spot area. Extended follicles of fleece hair give the skin the look of an "orange peel". With increasing infiltration of the facial skin, natural wrinkles and folds deepen, the superciliary arches protrude sharply, the dorsum of the nose widens, the cheeks, the chin, and often the lips are lobed ( facies leonina). Infiltration of the facial skin with lepromatous type of leprosy, as a rule, does not pass to the scalp. In most patients, infiltrates are also absent on the skin of the ulnar and popliteal flexural surfaces, axillae and along the spine (immune zones).

Often already in the early stages of the disease in the field of infiltrates, single or multiple tubercles and nodes (leproms) arise, the sizes of which vary from millet grain to 2-3 cm in diameter. Lepromy sharply delimited from the surrounding skin, painless. The most frequent outcome of their development, if there is no anti-leprosy treatment, is ulceration. In all cases of lepromatous leprosy, lesions of the mucous membrane of the nasopharynx are noted. It looks hyperemic, juicy, covered with small erosions. Later on, there are leproms and infiltration, massive crusts are formed, sharply hindering breathing. Decay leprom on the cartilaginous septum of the nose leads to its perforation and deformation of the nose ("collapsed" the back of the nose). In very neglected cases of the disease, ulceration of leprom on the palate mucosa can be observed. The defeat of the vocal cords can cause a sharp narrowing of the glottis, aphonia. If generalization of the lepromatous type of leprosy has occurred before puberty, it is often noted underdevelopment of secondary sexual characteristics, in men - gynecomastia. The peripheral nervous system is involved in the process in the late stages of the lepromatous type of leprosy, therefore, for a long time, skin sensitivity disorders can be absent.

In patients with lepromatous leprosy, the lepromine test (Mitsuda reaction) is usually negative, which indicates the lack of any ability of the body to recognize and resist the causative agent of the disease. From a pathogenetic point of view, this explains the severity and unfavorable prognosis of clinical manifestations of lepromatous leprosy.

The bacteriographic index in lepromatous patients is usually high, and this is called multibacillarity. Because of this, patients with lepromatous type are the main source of infection and spreading leprosy and with prolonged contact are a great danger to others.

Tuberculoid type of leprosy

It is polar lepromatous and is characterized by a more benign course and is more amenable to treatment. The main elements of skin rash with tuberculoid type of lepra are small reddish-cyanotic color flat polygonal papules. They often, merging, form figured elements in the form of disks, rings, semirings. The roller encircling the periphery of the tuberculoid is very characteristic: the outer margin of them is somewhat elevated, clearly delineated, and is distinguished by a reddish-cyanotic color and a testy consistency; the inner edge, on the contrary, is smeared and imperceptibly passes into the central pale part of the lesion focus. When regression rashes remains depigmentation or atrophy of the skin. Due to the dominant lesion of peripheral nerve trunks, a typical violation of skin sensitivity and sweating in lesions is typical. The specific leprosy lesion of the peripheral nerves leads to a decrease in the area of their innervation of superficial skin sensitivity - first the temperature, then the pain and finally the tactile, with the inevitable subsequent formation of severe trophic disorders in the form of miatrophies, mutations and trophic ulcers.

With the tuberculoid type of leprosy, mycobacteria are rarely found in the mucosal scraping, and there are very few in the lesions. In connection with this, patients with tuberculoid leprosy are usually called malaccial. The chronic course of tuberculoid leprosy may also be interrupted by exacerbations, during which lesions are often found in the lesions.

Boundary types of leprosy

Unite in themselves with less severity the symptoms of lepra of the polar types - lepromatous and tuberculoid leprosy and can be transitional. They are characterized mainly by neurologic symptoms and erythematous hyperpigmented and depigmented spots with clear boundaries, varying in size and shape. Hair on the lesions fall out, sensitivity gradually disappears and sweating is disturbed. After a few months and even years, muscle atrophy develops, leading to deformations of the upper and lower extremities. The face becomes masklike, facial expression disappears, incomplete closure of the eyelids (lagophthalmus) appears. Paralysis and paresis, contractures develop, mutations are possible. On the soles of the feet, deep ulcers are formed that are difficult to treat. Trophic disorders can be various: hair loss, acrocyanosis, atrophy of nails, etc.

A separate diagnosis, but not an independent type, is undifferentiated leprosy. The possibility of setting such a diagnosis appears when the leprosy is treated early by the doctor and timely recognition of the initial, debut manifestations of the leprosy process on the skin, which at this initial stage has not yet formed into any independent type of leprosy. The debut symptoms of leprosy of the undifferentiated type are of low specificity and are more often represented by subtle hypopigment spots at first small dimensions, within which skin sensitivity quickly disappears, which can serve as a basis for early and timely diagnosis of leprosy.

Symptoms of leprosy of other varieties are expressed in a different ratio (borderline states).

The lesions of the peripheral nervous system are detected sooner or later in all forms of leprosy. The peculiarity of leprosy neuritis is their ascending character and islet (ramuscular) type of sensitivity disorder, which is caused by the destruction of nerve endings in the foci of rashes, the defeat of cutaneous branches of nerves and individual nerve trunks. More often, it is the defeat of the peripheral nervous system that leads to disability (absence of cutaneous sensitivities, amyotrophy, contractures, paralyzes, neurotrophic ulcers, osteomyelitis, mutations, lagophthalmus).

After introduction of effective anti-prosthetic drugs in practice, leprosy ceased to figure as the cause of death, and the indices of the average life expectancy in leprosy patients exceed those in the rest of the population.

[6], [7], [8], [9]