Leprosy

Lepra is known to mankind since ancient times. This disease is also mentioned in the Bible ( Leviticus , Chronicles, and others), and probably also in Ebers papyrus . Hippocrates wrote about it, apparently confusing leprosy with psoriasis . They knew about leprosy in ancient India . It has been suggested that by leprosy, indicated in the sources of antiquity and antiquity, one should understand various diseases, which "were milder in nature, having their own etiology " ^[5] . The reason for this confusion, apparently, was that leprosy was interpreted as God's punishment for sins, as a "sickness of the soul," and it was the clergy, not the doctors, who handed down the verdict about who should be considered a leper ^{[6] [5]} .

In the Middle Ages, the disease became widespread, there were numerous leprosoria . There is a theory ^[7] that the Vikings , namely, the fur brought by them, caused a more widespread spread of the disease. One of the possible causes of the prevalence of leprosy in medieval Europe is the transfer of its pathogens by gray meat flies , the fact of which is the subject of discussion.

In the Middle Ages in Europe, a special liturgical rite (perhaps not having a widespread and universal character) ritual burial of a patient with leprosy ( Latin separatio leprosórum) , according to which a leper, whose disease was certified by a special council, consisting usually of doctors, priests and other patients, passed into the status of "dead" - a symbolic funeral ceremony was performed on him, after which the patient was isolated from people ^{[8] [9]} . Thus, he received special leper clothing that hides the face and the whole body, as well as a ratchet or a bell. In 1179, at the Third Lateran Council , a formal procedure was developed and approved for excluding lepers from the community with a long list of prohibitions aimed at isolating the patient from society ^[10] . Michel Foucault called such and similar measures the “exception of lepers” ^[11] :

Matthew of Paris established at the beginning of the XIII century the number of leprosiums in Europe was 19 thousand. The number of leprosariums in France in 1226 was about two thousand ^[12] . The first known leprosarium was the hospital of St. Nicholas in Harbledown in Kent in England, founded in 1084. These institutions were located within the monasteries, and while patients with leprosy were encouraged to live in them, the leprosariums contributed to the prevention of the spread of the disease, acting as quarantine.

The causative agent of leprosy (Mycobacterium leprae) was discovered in 1873 in Norway by Gerhard Hansen , who worked in the hospital of St. Jorges based in the 15th century in Bergen . Now it is a museum, perhaps the best preserved leper colony in Northern Europe. The bacterium discovered by Hansen became the first known pathogen to humanity.

Lepra is transmitted through the discharge from the nose and mouth, during close and frequent contact with people who are not undergoing treatment ^[13] .

During the 1990s, the number of leprosy patients in the world decreased from 10–12 million to 1.8 million. Most of the leprosy is common in tropical countries. But although the number of cases of morbidity in the world continues to fall, the disease is still widespread in some parts of Brazil , South Asia ( India , Nepal ), East Africa ( Tanzania , Madagascar , Mozambique ) and the Western Pacific . India ranks first, Brazil second, and Burma third. In 2000, WHO listed 91 countries with endemic leprosy foci. India, Burma and Nepal together accounted for 70% of the incidence of diseases.

Residents of areas with an endemic prevalence of leprosy with poor living conditions, such as polluted water, no bed linen, and adequate food, are among the groups at high risk of morbidity. Persons suffering from diseases that weaken the immune function (eg, AIDS ) also fall into the high-risk group.

In 1995, WHO estimated the number of people with disabilities due to leprosy at 2 million.

In 1999, the number of leprosy cases in the world was estimated at 640 thousand people, in 2000 - 738,000 people, in 2001 - a maximum of 775,000 people.

The number of new cases reported globally in 2015 was 211,973 ^[13] .

In the United States, according to the Centers for Disease Control and Prevention, in 2015, 178 new cases were reported.

The maximum value - 2505 people - the number of registered patients with leprosy in Russia reached in the early 1960s. As of 2007, about 600 patients with leprosy are officially in Russia, 35% of them have been hospitalized, the rest are on outpatient treatment and under dispensary observation. In 1996–2007, 43 new cases of the disease were observed in Russia ^[14] .

The incubation period is usually three to five years, but can vary from six months to several decades (an incubation period of 40 years is described) ^[15] . It is asymptomatic. Also, leprosy is characterized by a not less long latent period , non-specificity and non-binding prodromal signs (malaise, weakness, drowsiness, paresthesia , feeling of coldness), which makes it difficult to diagnose the disease early.

Basically, leprosy affects the body's air-cooled tissues: the skin, the mucous membrane of the upper respiratory tract and superficial nerves. If untreated, skin infiltration and nerve destruction can lead to severe deformity and deformity. However, the mycobacterium leprosy itself is not capable of causing the dying of the fingers of the hand or the foot. Secondary bacterial infection leads to the loss of body parts as a result of tissue necrosis in cases where the desensitized tissues are exposed to injuries that go unnoticed and are not treated.

There are two polar types of disease (tuberculoid and lepromatous), as well as indefinite and borderline types.

Undefined leprosy usually begins with skin lesions. Foci are almost invisible. The first symptom is usually paresthesia or hyperesthesia in any part of the skin. On closer inspection, you can find a hypo-or hyperpigmented spot, one or more. Rashes can resolve themselves after one or two years.

Tuberculoid leprosy

Tuberculoid leprosy usually begins with the appearance of a well-defined hypopigmented spot, within which hyperesthesia is noted. Further the stain increases, its edges rise, become roller-shaped with a ring-shaped or spiral-shaped pattern. The central part of the spot undergoes atrophy and sinks. Within this focus, the skin is deprived of sensitivity, there are no sweat glands and hair follicles . Near the spot are usually palpated thickened nerves innervating the affected areas. Nerve damage leads to muscle atrophy; especially the muscles of the hand are affected. Frequent contractures of the hands and feet. Injuries and compression lead to an infection of the hands and feet, and neurotrophic ulcers form on the soles. Further mutation of phalanxes is possible. With the defeat of the facial nerve lagophthalmos and keratitis caused by it, as well as corneal ulcer, leading to blindness, are found.

Lepromatous leprosy

Lepromatous leprosy is usually accompanied by extensive and symmetrical skin lesions with respect to the median line of the body. Lesions can be represented by spots, plaques, papules , nodes (lepromas). They have blurred borders, dense and convex center. The skin between the elements is thickened. The face, auricles, wrists, elbows, buttocks and knees are most often affected. A characteristic sign - loss of the outer third of the eyebrows. For the later stages of the disease are characterized by " lion's face " (distortion of facial features and impaired facial expression due to thickening of the skin), growth of earlobes. The first symptoms of the disease are often nasal congestion, nasal bleeding, and difficulty breathing. Possible complete obstruction of the nasal passages, laryngitis , hoarseness. Perforation of the nasal septum and deformation of the cartilage leads to a collapse of the nasal dorsum ( saddle nose ). The penetration of the pathogen into the anterior chamber of the eye leads to keratitis and iridocyclitis . The inguinal and axillary lymph nodes are enlarged, but not painful. In men, infiltration and sclerosis of the testicular tissue leads to infertility. Often develops gynecomastia . Hypoesthesia of peripheral parts of the limbs is characteristic of the later stages of the disease. Biopsy of the skin reveals diffuse granulomatous inflammation.

Border types of leprosy in their manifestations are between the polar types.

Leprosy treatment requires the participation of many specialists. In addition to antimicrobial therapy , counseling and treatment of an orthopedist , an ophthalmologist , a neuropathologist , a physiotherapist may be needed. Anti-leprosy therapy is carried out using the following means: dapsone , rifampicin , clofazimina ; Recently, the anti-leprosy activity of minocycline , ofloxacin , thalidomide and clarithromycin has been detected .

With timely diagnosis, leprosy is completely curable ^[13] . With delayed treatment, the disease leads to persistent morphological changes and disability of the patient.

There is no reliably proven specific prophylaxis of leprosy with vaccines, sera or immunostimulants .

The main measures for the prevention of leprosy are early detection of patients and sources of infection, isolation of patients with active forms of leprosy, timely start of treatment of leprosy with effective antibiotics, combination therapy; rehabilitation of patients undergoing treatment. Persons who are at the dispensary should regularly be examined by a leprologist or dermatologist.

Family members and persons who have been in close contact with a patient with leprosy are examined at least once a year. According to the testimony, taking into account the leprome sample, he is given preventive treatment. Children in mothers with leprosy are usually born healthy, so they are separated from mothers by newborns and transferred to artificial feeding. Patients who completed the treatment, are contraindicated in rest in balneological sanatoriums, work in the food industry and child care facilities. According to some international agreements, it is forbidden to move patients from one country to another.

In places endemic for leprosy, mass surveys of the population, sanitary-educational work among the population and doctors are carried out. In addition to the epidemiological situation, socio-economic factors are of great importance, which explains the wide spread of the disease among the poorest people in Asia and Africa. In the health systems of these countries, the priority is to expand the activities of services for the identification and treatment of patients with leprosy and ensure the availability of modern treatment for all patients.

Prevention of leprosy in medical personnel and other persons who, by the nature of their activities, are in contact with patients, consists in strict observance of sanitary and hygienic rules (frequent washing of hands with soap, obligatory rehabilitation of micro injuries, etc.). Cases of infection of medical personnel are rare.

• Leperosarium
• Order of St. Lazarus
• Osarsif

• Infectious diseases: national leadership / Ed. N. D. Yushchuk , Yu. Ya. Vengerov. - M .: GEOTAR-Media, 2009. - 1056 p. - (National guidelines). - 2000 copies - ISBN 978-5-9704-1000-4 .

• Lepra (Neopr.) . Newsletter number 101 . World Health Organization (October 2016).
• Artem Korsun. The most ancient diseases of mankind (Unsolved) . Polit.ru (December 7, 2013). The appeal date is July 31, 2015.
• Victoria Kuzmenko. India could not defeat leprosy (Undefeated) (inaccessible link) . Russian planet (September 17, 2013). The appeal date is August 15, 2015. Archived January 22, 2015.