Ramos-e-Silva M, Rebello P F
Sector of Dermatology, School of Medicine, HUCFF-UFRJ, Universidade Federal do Rio de Janeiro, State of Rio de Janeiro, Brazil.
Am J Clin Dermatol. 2001;2(4):203-11. doi: 10.2165/00128071-200102040-00001.
Leprosy is a slowly progressive, chronic infectious disease caused by the bacillus Mycobacterium leprae. It is a very serious, multilating and stigmatizing disease in many parts of the world and early diagnosis and therapy is the most important strategy for its control. The skin and peripheral nerves are the most affected organs. It is highly infective, but has low pathogenicity and low virulence with a long incubation period. The geographical distribution of leprosy has varied greatly with time and it is now endemic only in tropical and subtropical regions such as India and Brazil. The diagnosis of leprosy is made from the clinical picture, but must be complimented by skin bacilloscopy and histopathology. Leprosy has a number of distinct clinical presentations. Indeterminate leprosy is frequently the initial form consisting of a few lesions that either evolves into the other forms or resolves spontaneously. Lepromatous leprosy is the more contagious form and affects mainly the skin. In addition, some peripheral nerves may be thickened and other symptoms maybe present. The tuberculid form affects the skin and nerves, although usually there are few lesions. There is also a form borderline between the lepromatous and tuberculoid forms. Current treatment of leprosy involves use of 3 drugs: rifampicin (rifampin); clofazimine; and dapsone. Multidrug therapy aims to effectively eliminate M. leprae in the shortest possible time to prevent resistance from occurring. The duration of therapy was recently reduced from 24 to 12 months. Other treatment options are under evaluation in both preclinical and clinical trials and a number show promise. The combination of rifampicin, ofloxacin and minocycline given as a single dose has been recommended for the treatment of paucibacillar leprosy. Only when physicians, other health workers, and the population in endemic countries become fully aware of, and able to recognize, the disease in its initial phase, will it be possible for therapy to be instituted at the very beginning with either the standard scheme or the newer ones. Intervention at such an early stage will avoid the onset of the more serious signs and symptoms, meaning that leprosy will eventually become a less important public health problem. Therefore, efforts must be made to alert populations at risk and all health workers of the importance of an early diagnosis and treatment in leprosy infection.
麻风病是一种由麻风分枝杆菌引起的缓慢进展的慢性传染病。在世界许多地区，它是一种非常严重、致残且带来污名化的疾病，早期诊断和治疗是控制该病的最重要策略。皮肤和周围神经是受影响最严重的器官。它具有高度传染性，但致病性和毒力较低，潜伏期较长。麻风病的地理分布随时间变化很大，现在仅在印度和巴西等热带和亚热带地区呈地方性流行。麻风病的诊断基于临床表现，但必须辅以皮肤涂片镜检和组织病理学检查。麻风病有多种不同的临床表现。未定类麻风通常是初始形式，表现为少数皮损，这些皮损要么发展为其他类型，要么自行消退。瘤型麻风是传染性更强的类型，主要影响皮肤。此外，一些周围神经可能会变粗，还可能出现其他症状。结核样型麻风影响皮肤和神经，不过通常皮损较少。还有一种介于瘤型和结核样型之间的界线类。目前麻风病的治疗使用三种药物：利福平；氯法齐明；以及氨苯砜。多药联合疗法旨在尽可能在最短时间内有效清除麻风分枝杆菌，以防止产生耐药性。治疗疗程最近从24个月缩短至12个月。其他治疗方案正在临床前和临床试验中进行评估，一些方案显示出前景。已推荐单剂量给予利福平、氧氟沙星和米诺环素联合用于少菌型麻风病的治疗。只有当医生、其他卫生工作者以及流行国家的民众充分认识并能够在疾病初期识别该病时，才有可能一开始就采用标准方案或新方案进行治疗。在如此早期阶段进行干预将避免出现更严重的体征和症状，这意味着麻风病最终将成为一个不那么重要的公共卫生问题。因此，必须努力提醒高危人群和所有卫生工作者注意早期诊断和治疗麻风感染的重要性。
