麻风的诊断与治疗

易感人群：
取决于人体的免疫反应与功能 正常成人一般感染后不发病

Leprosy is asymmetrically distributed globally, with the greatest incidence and prevalence in the developing world. Globally, the incidence has fallen by 70% and the prevalence has fallen by 90% since 2000 thanks to aggressive eradication efforts with multidrug treatment regimens.
Multiple dermatofibroma-like (histoid) lesions, which are solitary and confluent, in a patient with subpolar lepromatous leprosy. Their uniformly sharp margins and erythema are in contrast to most of the lesions in borderline lepromatous leprosy.
出汗障碍 可找到麻风杆菌
Leprosy: tuberculoid type Welldefined, hypopigmented, slightly scaling, anesthetic macules and plaques on the posterior trunk.
A
B Leprosy: borderline-type A 31-year old Vietnamese female. A. Geographic shaped plaque on the buttock with raised red indurated margins and central clearing. There is extension of the infection indicated by the erythematous papules beyond the margins. B. Similar geographic plaque on the legs with raised red margins and central clearing.
One of several lesions of borderline tuberculoid leprosy, which had an incompletely annular configuration with satellite papules. Compared to the polar tuberculoid lesion, there is less erythema, no evident scales, but sharp margination.
临床表现

眼部症状：由于麻风反应、麻风本身、三叉神经 受累所致，表现为慢性结膜炎、角膜炎、巩膜炎、 泪囊炎、虹膜睫状体炎等。 鼻部症状：鼻黏膜充血、肿胀、糜烂、结痂、结 节、浸润、肥厚等。 其他：咽喉不适，淋巴结肿大、骨骼和内脏受累。


麻风反应

为机体免疫系统对感染的免疫学反应发生变化所致， 常导致神经损伤，但并不意味着疾病进展或治疗失 败。
The facial nerve is another commonly damaged nerve in leprosy. The patient shown has both a facial nerve palsy and contractures of the hand from leprosy.
In the United States, armadillos(南美犰狳) are a major reservoir of leprosy infection. They are one of the few animals known to become infected and are used in research efforts to study the disease. They have an unusually low body temperature of around 34°C, which is hospitable to M 关，又称迟发型超敏反应。
Long-standing neuropathy in the feet can lead to nonhealing ulcers, abscess formation, and osteomyelitis. If untreated early in the disease course, deformities may occur. The image shown is of an individual with advanced lepromatous leprosy with amputation of the toes and trophic ulceration.
Characteristic borderline or dimorphic lesion is an indurated and elevated annular plaque
It has a well-defined “tuberculoid” interior margin but a poorly defined “lepromatous” exterior margin. Having both morphologies, it is termed “dimorphic.”
病因与发病机制

麻风杆菌（Mycobacterium leprae）
革兰染色阳性，抗酸染色阳性 形态多样，与病人治疗情况密切相关 迄今体外培养未成功
病因与发病机制

发病机制
主要分布于皮肤（主要位于真皮层的末梢神经、
巨噬细胞、立毛肌、毛囊与皮脂腺）、黏膜（主 要是鼻黏膜）、周围神经（不侵入中枢神经）， 引起相应病理反应。
临床表现

平均潜伏期2~5年。

发病率约15%。
因患者免疫力不同，临床表现差异较大， 几乎涉及临床各个学科。

临床表现

皮肤表现：
皮损形态多样：有斑疹、丘疹、结节、斑块、
浸润、水疱、溃疡等
皮肤附属器侵犯：表现为头发、眉毛脱落，闭
汗、皮肤干燥
临床表现

与其他皮肤病不同在于：
局部感觉障碍
麻风的诊断与治疗
概念

麻风（leprosy）又称Hansen病。由麻风分枝 杆菌（Mycobacterium leprae）引起的一种慢 性传染性疾病，主要侵犯皮肤、黏膜和周围 神经，少数情况下可侵犯深部组织和内脏器 官。
Dr. GH Armauer Hansen( Norway) and his Patient
临床表现

周围神经症状：
发生于几乎所有患者，表现为神经粗大
侵犯神经：尺神经、耳大神经、正中神经、腓
总神经、眶上神经、面神经、桡神经、胫神经
临床表现

周围神经症状：
功能障碍：
浅感觉障碍：最早最常见，温觉最早，痛觉次之，
触觉最后 运动障碍：肌肉萎缩或瘫痪所致，表现为爪形手、 足下垂、面瘫等 营养性障碍：皮肤干燥、萎缩、脱毛，易形成水疱 或溃疡 循环障碍：手足发绀、温度降低、肿胀 出汗障碍：
Leprosy: borderline-type A 26-year-old Vietnamese male. A. Well-demarcated, infiltrated,erythematous plaques on the face. B. Identical red plaques on the lower back.
破损皮肤和鼻黏膜排出大量麻风杆菌，为麻风主
要传染源。
Mycobacterium leprae is an acid-fast, rod-shaped bacillus. It is an obligate, intracellular organism that preferentially proliferates in tissues with cooler temperatures. The organism exhibits the longest reproduction time among all bacteria, requiring 13 days to double in experimentally infected mice, and with an incubation time of up to 50 years in humans.
A solitary, anesthetic, and annular lesion of polar tuberculoid leprosy, which had been present for 3 months. Its sharp margins, erythema, and scale are more evident than its elevation.
The Louisiana Leper Home was established in 1894 to provide "a place of refuge, not reproach; a place of treatment and research, not detention."
流行病学
Multiple lesions in a patient with borderline lepromatous leprosy. The annular lesions vary in size and are asymmetrically distributed. In contrast, the poorly defined papular and nodular lesions are roughly symmetric. Impairment of sensation was present in most lesions.