Chimenos Küstner Eduardo, Pascual Cruz Montserrat, Pinol Dansis Cristina, Vinals Iglesias Helena, Rodríguez de Rivera Campillo Maria Eugenia, López López José
Facultad de Odontología, Universidad de Barcelona.
Med Oral Patol Oral Cir Bucal. 2006 Nov 1;11(6):E474-9.
Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen s bacillus). It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the multibacillary lepromatous leprosy and the paucibacillary tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularly for less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence.
麻风病是由麻风分枝杆菌（汉森氏杆菌）引起的一种具有传染性的慢性全身性肉芽肿疾病。它通过人与人之间传播，潜伏期较长（两到六年）。该疾病呈现出两极临床类型（多菌型瘤型麻风病和少菌型结核样型麻风病）以及其他具有混合特征的中间类型。口腔表现通常出现在瘤型麻风病中，发生率为20%至60%。它们可能表现为多个结节（麻风瘤），进而发展为坏死和溃疡。溃疡愈合缓慢，会产生萎缩性瘢痕甚至组织破坏。病变通常位于硬腭和软腭、悬雍垂、舌腹面以及嘴唇和牙龈。也可能出现上颌前部破坏和牙齿脱落。基于临床怀疑的诊断通过细菌学和组织病理学分析以及麻风菌素试验（皮内反应，通常在瘤型麻风病形式中为阴性，在结核样型中为阳性）得以确诊。鉴别诊断包括系统性红斑狼疮、结节病、皮肤利什曼病和其他皮肤病、三期梅毒、淋巴瘤、系统性真菌病、创伤性病变和恶性肿瘤等其他疾病。治疗困难，因为必须长期持续进行，需要几种有副作用的药物，而且成本非常高，特别是对欠发达国家而言。最常用的药物是氨苯砜、利福平和氯法齐明。喹诺酮类药物，如氧氟沙星和培氟沙星，以及一些大环内酯类药物，如克拉霉素和米诺环素，也有效。本病例报告描述了一名在童年和青少年时期于有传染性的家庭环境中感染瘤型麻风病的患者。
