麻风的诊断与治疗课件

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1、麻风的诊断与治疗概念麻风（leprosy）又称Hansen病。由麻风分枝杆菌（Mycobacteriumleprae）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.GHArmauerHansen(Norway)andhisPatientTheLouisianaLeperHomewasestablishedin1894toprovide"aplaceofrefuge,notreproach;aplaceoftreatmentandresearch,notdetent

2、ion."流行病学流行区域：世界性：非洲、东南亚、拉丁美洲和西太平洋地区中国：沿海与长江流域发病情况：青壮年男女之比3:1家庭聚集性社会因素影响：贫穷、居住环境、伴有HIV感染等流行病学传染源：人是唯一传染源，特别是未经治疗的多菌型麻风病人是主要传染源传播途径：传统观点：与麻风病人长期接触新近观点：与肺结核类似的空气传播易感人群：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Leprosyisasymmetricallydistributedglobally,withthegreatestincidencean

3、dprevalenceinthedevelopingworld.Globally,theincidencehasfallenby70%andtheprevalencehasfallenby90%since2000thankstoaggressiveeradicationeffortswithmultidrugtreatmentregimens.病因与发病机制麻风杆菌（Mycobacteriumleprae）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

4、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。破损皮肤和鼻黏膜排出大量麻风杆菌，为麻风主要传染源。Mycobacteriumlepraeisanacid-fast,rod-shapedbacillus.Itisanobligate,intracellularorganismthatpreferentiallyproliferatesintissueswithcoolertemperatures.Theorganismexhibit

5、sthelongestreproductiontimeamongallbacteria,requiring13daystodoubleinexperimentallyinfectedmice,andwithanincubationtimeofupto50yearsinhumans.IntheUnitedStates,armadillos(南美犰狳)areamajorreservoirofleprosyinfection.Theyareoneofthefewanimalsknowntobecomeinfectedan

6、dareusedinresearcheffortstostudythedisease.Theyhaveanunusuallylowbodytemperatureofaround34°C,whichishospitabletoMlepraegrowth.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

7、障碍出汗障碍可找到麻风杆菌Leprosy:tuberculoidtypeWell-defined,hypopigmented,slightlyscaling,anestheticmaculesandplaquesontheposteriortrunk.Leprosy:borderline-typeA31-yearoldVietnamesefemale.A.Geographicshapedplaqueonthebuttockwithraisedredinduratedmarginsandcentralclearing

8、.Thereisextensionoftheinfectionindicatedbytheerythematouspapulesbeyondthemargins.B.Similargeographicplaqueonthelegswithraisedredmarginsandcentralclearing.ABLeprosy:borderline-typeA