Lecture of Leprosy (leprosy)

2021-02-05 12:00 AM

Stick-shaped bacilli, resistant to alcohol, resistant to acidosis in terms of staining, size 1.5 to 6 microns, dyed bright red according to Ziehl Neelsen method

Define

A disease caused by the Hansen bacillus, the disease has a long-lasting and contagious nature, has systemic manifestations but the most prominent and frequent symptoms are skin and some nerves.

Nouns: leprosy, leprosy, leprosy, Hansen disease is now uniformly called leprosy.

The concept of leprosy

The old is said to be sick, incurable, afraid, brutally treating the sick.

New: suppose the disease is contagious, can be controlled, cut the spread, can be cured, and treated the patient humane.

The current world trend is to cut off the spread with rifampicin, treat leprosy with chemotherapy, treat at home, at the hospital like other diseases to eradicate leprosy.

Epidemiology

Bacillus Hansen (BH) scientific name Mycobacterium Leprae discovered by the Norwegian scientist Armeuer Hansen in 1873.

Stick-shaped bacillus, resistant to alcohol, resistant to acid in terms of staining, size 1.5 - 6 microns, dyed bright red according to Ziehl - Neelsen method.
On the leprosy bacillus skin specimens mainly located in the shallow and middle mesoderm, scattered or amas, in clusters (globe), 14-day generation time, 7 days outside the body (according to Rees 1974) It can be boiled to kill insurance, infusion to animals, but it is difficult, not yet cultured on artificial media.

It is a contagious disease, (the hereditary theory has been rejected), is a contagious disease but less contagious, the rate of spread between husband and wife is 3-6%, spread slowly, incubated for 2-3 years, it is difficult to spread.

Transmission route: bacteria penetrates mainly through the skin, the patient often excretes bacteria mainly through nose and throat lesions in the late stage, mainly leprosy (L) and leprosy patients. space (body B).

L leprosy is more contagious than tuberous leprosy (T-type), indirectly spread through water, soil, and objects is common, direct transmission must be in prolonged living conditions.

Clinical symptoms

Incubation period: an average of 2-3 years (6 months to 32 years), not exactly determined.

Early symptoms: low fever, drowsiness, feeling entangled in arachnoid, less valuable, difficult to detect. Full-play period:

Skin symptoms:

Red and pink stains are common, sometimes white inlaid with faded colour or less than a dark inlaid, the condition is long-lasting and reduced, loss of sensation.

Red sap, clearly defined or unknown, with no elevation on the skin.

Root plaque: red, well-defined plaque, with high hilly banks, small tubers or large tubers dotted with toothpicks, beans, corn kernels leaving scars. Common in the tuberous (LT) form.

Plaque (leprosy), dark red masses high on the skin, shiny, unknown limits, pressed on the clump, or eaten on the eyebrows, forehead, called the face like a lion, found in the form LL).

Neurological symptoms:

Reduction, loss of pain and heat sensation on lesions, maculopapular or popular plaque, leprosy or loss of pain sensation in the forearms of the hands and feet, detection by needling and cold water, hot water pressure.
The deep sense of pressure and pressure often remains.

Inflammation and swelling of certain nerves such as the cylindrical nerve, the neck, the hips, and nerves that are slightly swollen or swollen and lumpy like beads.

Muscle symptoms:

Head and limb muscle atrophy, helminth muscle atrophy, the musculoskeletal muscle of hands and feet, possibly the calf muscles, the forearm Outward dislocated hip nerve paralysis leads to walking and needing. Paralysis causes cylindrical claw.

Symptoms of nutritional disorders:

Broken nails, sagging skin.

Pothole ulcers are usually on the feet of compression due to nutritional disorders, painless trauma, persistent deep ulcers, and difficult to heal.

Eyebrow loss is a common and valuable symptom.

Cut off fingers and toes.

Disorders of excretion:

Dry skin or excess fat. It produces sweat; fatty skin due to endocrine disorders.

Symptoms of the viscera and five organs:

Eye damage (50%), keratitis (30%) can lead to blindness and disability.

Rhinitis, hoarseness pharyngitis, swollen lymph nodes.

Testicular inflammation, osteomyelitis, liver, spleen, can damage all organs because it is a whole disease.

Classification of the styles according to Madrid

According to the international anti-leprosy conference (1953) in Madrid, leprosy was divided into the following categories:

Type I: ie indeterminate, is the early stage of the disease.

Body T: ie root.

Body B: intermediate form.

The L: the tumor (formerly known as the malignant form).

A summary of the individual characteristics of each species is as follows:

Characteristics

I (uncertain)

T (tuberous form)

B (intermediate)

L (room u)

clinical

Give

Root array

Array infiltration

U, Department

Virus

Negative or slightly positive

Negative

Positive

Strong positive

Mitsuda response

Negative or positive

Strong positive

Negative or slightly positive

Negative

Histopathology

Nonspecific

Specialized style

Disseminated infection includes semiaphoid, tissue

Diffuse infection includes cellular, foam cells.

Grouped by bacteria

To facilitate the application of multi-chemotherapy, divide leprosy into 2 groups, low-bacteria group (Pauci Bacilary - PB) and group of many bacteria (MultiBacilary-MB), each group has its own treatment regimen. .

Low bacteria group (PB), in this group negative bacteria, are usually patients with type I, T.

Group of many bacteria (MB), from 1-6 (+), this group is usually patients with B, L type.

Classification table of leprosy according to the immunological mechanism of Ridley and Jopling (1966)

Classification basis: based on cell-mediated immunity (CMI).

Leprosy is divided into many forms, located between two TT poles (tuberous leprosy, strong cell mediated immunity) and LL (weak CMI leprosy) which are intermediate tuberous leprosy, BB intermediate, Intermediate form BL - U, LLS subpolar tumour, LLp polar tumour.

ENL (erythema nodosa lepro sum) leprosy erythema nodosum is common in leprosy (LL) on specific drug therapy.

RR (reverse reaction) level of reverse reaction - transforms closer to the tuberous leprosy when the immune system becomes stronger, and the immune response increases.

Progression and complications

Prolonged disease is sometimes like standing still, regressing, causing little death but damage is causing disability.

Pain, neuritis, paralysis, muscle atrophy, loss of sensation easily burned, rubbing infections, corneal ulcers causing blindness, flare-ups.

Diagnose

There are skin colour changes accompanied by loss of pain, indistinguishable from heat or cold.

Swelling of some nerves (cylindrical nerves) shallow cervical branch, hips.

The skin is inlaid, tuber, and plaque, lasting for a long time, losing sensation.

Chiropractic atrophy.

Test for the Hansen bacillus in nasal fluid, on the skin.

To diagnose leprosy, people do a test to find the Hansen bacillus on the skin and nasal mucosa called Slit skin smear the following way: disinfect the suspected lesion area, lightly stretch the skin, use 1-line light slitting knife about 0.5 - 0.7 mm deep to the dermis, using the blade to gently brush the thin layer to organize the spread on the glass slide, fix, dye ziehl, read microscope for Hansen bacillus, tape wound back.

Mitxuda reaction helps prognosis of tuberous form, tumour type. Evaluate disease prognosis is usually (+) in leprosy, (-) in leprosy.

Patients accept the news of leprosy as a kind of shock, despair, and suffering, so they must carefully announce, slowly from the point of view of modern medicine and art to give the patient a hope, determination to believe. it is possible to cure the disease.

Differential diagnosis

Lesions are erythematous plaques usually on the face of the nose, forehead, and ears that can be confused with drug allergies, diagnosis should think of pain leprosy and Hansen bacillus test.

Tuberous leprosy needs to be differentially diagnosed with ringworm fungus because of the same red plaque, with a border, clearly limited, but in leprosy, the red patch on the shore is small papules, loss of pain and examination. Hansen bacteria are positive, while in ringworm, red plaques have a polygonal shape with clear edges, blisters, itchy edges. fungal test (+) calculation.

Preventive treatment

General path:

The purpose of treatment is to cure the patient, but the important thing is to avoid disability and limit spread.

Cut off the spread with rifampicin. Using rifampicin after 5 to 27 days, the patient ceases to spread to others, although treatment must continue.

The world trend is to eliminate leprosy treatment zones.

Treat like other patients at the hospital.

Vietnam's anti-leprosy approach is "home treatment", eliminating leprosy in each region.

Multidrug therapy replaces single-therapy
(DDS) therapy to avoid oily, drug resistance.

Disability prevention, functional rehabilitation with guided skin care exercises to avoid disability, early treatment with physical therapy, footwear program for leprosy patients.

Propaganda work to improve people's understanding of leprosy, eliminate prejudice against leprosy, and management of medical records.

Multi-therapy is the policy of the world health organization to replace the toxic therapy DDS that produces drug resistance, to ensure cure. World Health Organization Protocol 1982.

Multiple bacteria (MB):

Rifampicin 300 mg x 2 tablets (600 mg / month, with control).

Clofazimine 100 mg x 3 tablets (300 mg / month checked once).

Clofazimine 50 mg / day by mouth.

DDS 100 mg / day.

Time 24 months or until testing negative bacteria BI = 0, then discontinue follow-up drug for 5 years.

Less bacteria (PB):

Rifampicin 300 mg x 2 tablets = (600 mg once a month, with control).

DDS 100 mg / day by mouth.

Time of 6 months after that, follow up drug for 3 years.

DDS Dapsone (Diamino diphenyl sulfone) is inexpensive, has bactericidal effect, is taken by mouth, and is easy to use. Rifampicin (Rimactan, rifadin) kills bacteria quickly, cuts off the spread quickly.

Clofazimine (lampern B663) has antibacterial effects, the side effect is to darken the skin in the light area.

Ethionamide and protionamide.

Other treatments:

Function rehabilitation, disability prevention, orthopaedic and surgical treatment, pothole surgery curettage, tendon transfer treatment of nerve paralysis.

Footwear program incorporates a unique type of footwear suitable for each patient to avoid disabilities.

Guide patients to prevent disability, avoid rubbing infection in the loss of sensation and prevent eye complications.

Preventive:

Tracking, early detection and treatment.

Has not produced successfully leprosy vaccines.