Meyers W M, Marty A M
Department of Infectious and Parasitic Diseases Pathology, Armed Forces Institute of Pathology, Washington, DC.
Drugs. 1991 Jun;41(6):832-56. doi: 10.2165/00003495-199141060-00003.
In recent years there have been notable advances in the laboratory investigation and field management of leprosy. Progress, however, continues to be hindered by the lack of efficient methods for early diagnosis and implementation of control and treatment measures. Diagnosis is still made on the same principles as a century ago (clinical and histopathological findings), and only 1 in 3 known patients worldwide receives optimal chemotherapy. In 1988, nearly 1 in 10 newly diagnosed patients already had debilitating deformities. Contributing factors are operational, administrative and financial difficulties in implementing multidrug therapeutic regimens, inadequately trained personnel, and lack of priority and political commitment to leprosy control. The formulation and implementation of multidrug therapy is the most important development in leprosy in the past 10 years. Dapsone monotherapy was the mainstay for treatment and control for approximately 40 years, but secondary dapsone-resistant strains, first noted in 1964, now infect as many as 50% of all new patients. Multidrug regimens recommended by the WHO consist of various combinations of therapy using dapsone, rifampicin, clofazimine and a thionamide. Duration of therapy is limited to 6 months for paucibacillary and 2 years or more for multibacillary patients; relapse rates thus far are low. The average cost of treatment worldwide, including the cost of drugs, is estimated at $US150 per patient. The recent annual drop of nearly 8% in newly registered patients may be due to the implementation of these therapeutic regimens. Newer drugs that may be introduced into these regimens include fluoroquinolones, minocycline and clarithromycin. While knowledge of the microbiology of the leprosy bacillus and host response has advanced remarkably, there is little improvement in the understanding or amelioration of social aspects of leprosy. Better treatment and control reduces the stigma, but improvements in the attitudes of patients and society towards leprosy are as important as advances in medical science in achieving ultimate eradication of the disease.
近年来，麻风病的实验室研究和现场管理取得了显著进展。然而，由于缺乏早期诊断以及实施控制和治疗措施的有效方法，进展仍然受到阻碍。诊断仍然基于与一个世纪前相同的原则（临床和组织病理学发现），全球已知患者中只有三分之一接受了最佳化疗。1988年，近十分之一的新诊断患者已经出现使人衰弱的畸形。促成因素包括实施多药治疗方案时的操作、行政和财政困难、人员培训不足以及对麻风病控制缺乏重视和政治承诺。多药疗法的制定和实施是过去十年中麻风病领域最重要的进展。氨苯砜单药治疗是大约40年来治疗和控制的主要手段，但1964年首次发现的继发性氨苯砜耐药菌株，现在感染了多达50%的所有新患者。世界卫生组织推荐的多药治疗方案由氨苯砜、利福平、氯法齐明和一种硫酰胺的各种治疗组合组成。少菌型患者的治疗疗程限制为6个月，多菌型患者为2年或更长时间；迄今为止复发率较低。全球治疗的平均成本，包括药物成本，估计为每位患者150美元。最近新登记患者每年近8%的下降可能归因于这些治疗方案的实施。可能引入这些方案的新药包括氟喹诺酮类、米诺环素和克拉霉素。虽然对麻风杆菌微生物学和宿主反应的了解有了显著进展，但在对麻风病社会方面的理解或改善方面几乎没有进展。更好的治疗和控制减少了耻辱感，但患者和社会对麻风病态度的改善与医学科学进展对于最终根除该疾病同样重要。
