Waters M F, Jacobs J M
Hospital for Tropical Diseases, London, UK.
Baillieres Clin Neurol. 1996 Mar;5(1):171-97.
Once a terrifying disease, leprosy today has a very hopeful prognosis, provided that it is diagnosed early and treated with modern multidrug chemotherapy, any immunological reactions being recognized quickly and controlled well to prevent (further) peripheral nerve damage after commencing treatment. The diagnosis should be considered in all patients who present with peripheral neuropathy and/or anaesthetic skin lesions who come from or have lived in the tropics and subtropics. Although M. leprae cannot yet be grown in vitro, it is readily grown in experimental animals. A complete gene library has been developed, much of the genome mapped and a number species-specific and common mycobacterial antigens identified. The intricacies of the host-parasite relationship, especially of cell-mediated immunity, and of the important immunological reactions of ENL and reversal reaction have been widely investigated. Modern MDT has caused a dramatic fall in prevalence, although the world annual case detection rate remains at around 600,000 new patients, many being at an early stage of the disease. WHO has launched a campaign to eliminate leprosy as a significant public health risk by the 2000 (with a prevalence of less than 1:10 000 population), which may well be achieved in some endemic countries. Leprosy will, however, remain an important cause of peripheral neuropathy for at least several more decades.
麻风病曾是一种可怕的疾病，如今只要能早期诊断并用现代联合化疗进行治疗，且能迅速识别并有效控制任何免疫反应以防止开始治疗后出现（进一步的）周围神经损伤，其预后就很乐观。对于所有来自热带和亚热带地区或曾在这些地区生活、出现周围神经病变和/或皮肤感觉缺失性病变的患者，都应考虑麻风病的诊断。虽然麻风分枝杆菌尚不能在体外培养，但很容易在实验动物体内生长。现已构建了完整的基因文库，绘制了大部分基因组图谱，并鉴定出了许多种属特异性和常见的分枝杆菌抗原。宿主与寄生虫的关系，特别是细胞介导免疫的复杂情况，以及麻风结节性红斑和反应性增生的重要免疫反应都已得到广泛研究。现代联合化疗使麻风病的患病率大幅下降，尽管全球每年的新病例检出率仍约为60万例，其中许多患者处于疾病早期。世界卫生组织发起了一项运动，目标是到2000年将麻风病作为重大公共卫生风险消除（患病率低于万分之一），一些流行国家很可能实现这一目标。然而，至少在今后几十年里，麻风病仍将是周围神经病变的一个重要病因。
