leprosy

Leprosy: description

What is leprosy?

Leprosy (leprosy) a bacterial infectious disease caused by Mycobacterium leprae; it occurs worldwide. The bacteria destroy the skin and mucous membranes and infect the nerve cells. The time between leprosy and the onset of the disease (incubation period) may be up to 20 years.

Leprosy occurs mainly in tropical and subtropical regions with high population density and low hygienic standards. Particularly affected countries include India, Nepal, Brazil, the Republic of Congo, Mozambique and Tanzania. In general, the number of cases in Africa, America, Southeast Asia and the southeastern Mediterranean since 2003 go back.

Yet, every year around the world, there are still around 220,000 new cases of leprosy – many of them children. However, only a few cases of leprosy have been recorded in Germany in recent years; the disease was introduced.

Normally, leprosy patients do not need to be isolated. However, many sufferers are socially expelled in the countries where the leprosy is widespread. The risk of infection is low, if one has only short contact with the patient. Mostly, the infection takes place via bacteria-containing secretions from wounds or the nose.

Leprosy in the Middle Ages

Leprosy was also very widespread in Europe in the Middle Ages. It was considered the “punishment of God”: the original name “Leprosy” probably comes from the fact that infected people outside human settlements (exposed) had to live.

Leprosy: symptoms

The leprosy primarily affects the skin and the nervous system. It can also affect the eyes, upper respiratory tract, bone marrow or testicles. There are different forms of leprosy, which are manifested by different symptoms. The time from infection to the onset of the disease (incubation period) can be months to years.

Physicians distinguish the following forms of leprosy:

The Leprosy indeterminata is a very mild form of the disease in which there are isolated, slightly pigmented (hypopigmented) skin spots. In 75 percent of cases, these heal spontaneously.

The tuberculoid leprosy or neuralgia is the easier form of the disease. Skin lesions occur only sporadically and sharply limited. The areas are less pigmented (hypopigmented) or reddened and itchy. In this form, the nerve damage as typical leprosy symptoms in the foreground.

The tactile sensation (temperature, touch and pain sensation) is lost. Since those affected do not feel pain early enough, they often injure themselves. The muscles atrophy, it leads to paralysis and sometimes to severe deformations. The skin lesions can heal on their own. The risk of infection is low in this manifestation and the prognosis with appropriate treatment is good.

The lepromatous leprosy is a severe form of infectious disease that occurs in poor immune system. Numerous nodular nodules appear on the skin, giving the face the appearance of a lion’s head (“Facies leontina”). The nasal and oral mucous membranes as well as the eyes may be affected. There are often mutilations of the face, hands, feet and back. The emotional loss of the affected areas occur only in the later course of the disease. In the terminal stage, the lepromatous leprosy spreads to the entire organism.

The Borderline forms of leprosy are mixed forms, which unite different symptoms of the other courses.

Leprosy: causes and risk factors

The cause of leprosy is the bacterium Mycobacterium leprae. The bacterium was discovered in 1873 by the Norwegian physician Armauer Hansen as the cause of the infectious disease. Mycobacterium leprae is a slightly aggressive bacterium that, like the tuberculosis virus, lives obligately in infected host cells. As a result, the immune system can only combat the pathogen directly with defense cells (“cellular defense”), and a defense reaction via antibodies (“humoral defense”) almost does not take place. Only in massive and prolonged exposure to the bacterium it comes to leprosy.

The exact infection route is not yet clear. However, long-term, close contact with untreated leprosy patients seems to play an important role. The infected excrete larger amounts of the leprosy pathogen with the nasal secretions or the resulting skin ulcers. The bacteria are then probably transmitted via small skin wounds or the respiratory tract as a droplet infection from person to person. IIn contrast to the widespread view, the leprosy is not a highly contagious disease! Isolation of people with leprosy is therefore usually not necessary.

Leprosy: examinations and diagnosis

One Institute for Infection and tropical medicine is the right place to go if leprosy is suspected. For the diagnosis is the medical history (Anamnese) very important. Crucial is the question of staying in leprosy risk areas in recent years, as leprosy has been eradicated in industrialized countries. In the physical examination The doctor pays attention to typical skin changes, nerve changes and emotional disorders.

Further investigations:

Cultivation (cultivation) of the leprosy pathogen is extremely difficult and is therefore not carried out. However, one can detect the bacterium in smears of the skin or mucosa or in tissue samples in microscope after special staining detect (proof “acid-resistant sticks”).

Another possibility for diagnosis are so-called molecular biological detection methods, for example the detection of the genome of Mycobacterium leprae by a polymerase chain reaction (PCR), This makes it possible to diagnose early leprosy disease. The procedure also serves to secure the diagnosis.

Of the Lepromintest (Mitsuda reaction) is an antibody screening test that examines the body’s immune system. This test makes it possible to distinguish between tuberculoid and lepromatous leprosy.

Leprosy: treatment

The therapy of leprosy depends on the amount of the pathogens. A combination of different antibiotics is used. In tuberculoid leprosy it is usually the active substances dapsone and rifampicin, in lepromatous leprosy additionally clofazimine.

The World Health Organization (WHO) recommends treatment for six months with paucibacillary leprosy (leucorrhoea). Multibacillary leprosy (pathogen-rich leprosy) should be treated with appropriate antibiotics over a two-year period. In some cases, the treatment must be continued even longer and, if necessary, to resort to replacement medicines (“reserve leprosy”).

To really completely cure the leprosy, several years of therapy are often necessary. Supportive exercise therapy can help prevent paralysis due to leprosy. In addition, wound treatment is important. If the lesions on the skin of the leprosy have healed after successful treatment, rehabilitation should take place.

Leprosy: disease course and prognosis

Leprosy is a chronic disease of the skin, mucous membranes and nerve cells. Timely diagnosis and treatment is the prognosis Cheap, However, if the disease is not treated at an early stage, it increases the likelihood of a lepromatous course. Closer contact persons should be tested for infection every six months, if possible.

However, damage that has already occurred, such as mutilation or paralysis, can not be reversed. Worldwide, about two to three million people are through Leprosy (leprosy) permanently impaired.