GB 15973-1995 Diagnostic criteria and treatment principles for leprosy
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and management of leprosy
Diagnostic criteria and management of leprosyGB15973—1995
This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Measures for the Implementation of the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases. Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which mainly invades the skin and peripheral nerves. If not treated in time, it may cause disability of the eyes, face, hands and feet. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles of leprosy. This standard is applicable to the diagnosis, reporting and treatment of leprosy by medical and health care institutions and health and epidemic prevention institutions at all levels across the country. 2 Diagnostic principles
Leprosy can be diagnosed based on the symptoms and signs caused by leprosy invading the skin, upper respiratory tract mucosa and peripheral nerves, combined with bacteriological examination of skin lesion tissue fluid smears and/or specific pathological changes in skin lesion biopsy. 3 Diagnostic criteria and classification
3.1 Diagnostic criteria
3.1.1 Chronic rash.
3.1.2 Localized numbness (temperature, pain, tactile disturbances). 3.1.3 Enlarged peripheral nerves.
3.1.4 Positive bacteria detection in acid-fast staining of tissue scraping smears. 3.1.5 Specific pathological changes or nonspecific inflammation invading the cutaneous nerves in skin lesion biopsy. Suspected cases: meet any two of 3.1.1, 3.1.2, 3.1.3. Confirmed cases: meet three of 3.1.1, 3.1.2, 3.1.3 or suspected cases plus 3.1, 4 or 3.1.5. See Appendix A for bacteria detection and biopsy methods.
3.2 Classification
Leprosy can be divided into five gradually transitioning types: from the tuberculoid type (TT) with strong immunity to the tumor type (LL) with low cellular immunity, with the borderline tuberculoid type (BT) with unstable immunity, the intermediate borderline type (BB) and the borderline tumor type (BL) in between. In addition, the early leprosy lesions have no specific pathological changes and are called the indeterminate type (I). The World Health Organization Technical Report (WHOTRS675, 1982) summarizes the five-level classification into multibacterial type (MB, including IL, BI., BB and some BT) with positive skin smear bacteria and paucibacillary type (PB, including I, TT and some BT) with negative bacteria. The clinical manifestations and pathological characteristics of various types of leprosy are shown in Appendix B. 4 Treatment Principles
In order to quickly eliminate the infectiousness, shorten the course of treatment, and prevent drug resistance and recurrence, it is necessary to use a combination of multiple bactericidal drugs and chemotherapy (MDT, Multidrug therapy). The treatment plan is shown in Appendix F. Some patients may experience immune changes before, during, and after treatment, which is clinically called leprosy reaction. Anti-inflammatory treatment should be given in time for leprosy reaction to prevent deformity, but MDT cannot be stopped. See Appendix G for the symptoms and treatment of leprosy reaction. 5 Monitoring after drug withdrawal, clinical cure criteria, and relapse judgment 5.1 Monitoring after drug withdrawal After completing the MDT course, all types of leprosy should undergo clinical (including the contents of Appendix D) and bacterial examinations at least once a year; MB for 10 consecutive years, PB for 5 years. When stopping the drug, patients should be advised to seek medical attention as soon as possible when new skin lesions appear or the original skin lesions are red and swollen, peripheral nerve pain or numbness area expands, so as to promptly determine whether leprosy reaction or relapse has occurred and give appropriate treatment. 5.2 Clinical cure (inactivity) criteria
After completing the MB course of treatment, the active symptoms (redness and swelling of the skin lesions, enlarged peripheral nerves, and pain) disappear during the monitoring period, the bacterial index continues to decline, and after turning negative, the bacteria are checked every three months, that is, three consecutive negatives within 6 months; after PB treatment, the active lesions disappear and the skin bacteria are still negative, which can be judged as clinically cured. For clinically inactive patients, clinical and bacterial examinations should still be completed once a year to detect leprosy reactions or relapses in time.
5.3 Determination of relapse
After the patient reaches clinical inactivity after treatment, if the active symptoms of leprosy reappear and/or the skin lesion bacteria are positive again (the skin lesion bacteria in a certain part increases by ≥2 compared with the time of drug withdrawal), or the skin lesion biopsy reappears specific leprosy pathological changes, it is considered a relapse. When relapse is suspected, it is necessary to verify whether the medication is regular, and attention should be paid to the reaction with type I leprosy (see Appendix C) or to distinguish it from other skin diseases. When clinically inactive cases test negative and then test positive again, the results of the previous and subsequent tests must be carefully verified. The diagnosis of recurrence must be confirmed by a provincial skin disease prevention and treatment institute through clinical, bacterial and histopathological examinations. If it is indeed a recurrence, a biopsy should be performed before repeating MDT (MB repeats triple, PB changes from two-drug to three-drug), and the mouse foot pad should be inoculated by a designated laboratory to determine whether the strain is resistant to a drug in the MDT, and then decide whether to change the treatment plan. MDT should be started immediately after the biopsy, and only one biopsy should be performed before and after the recurrence.
6 Clinical classification of leprosy disability
When peripheral nerves are damaged, leprosy patients may experience skin numbness and muscle numbness in the corresponding parts. For nerve function examination and disability classification, please see the appendix (. All leprosy patients should receive health guidance on self-protection of eyes, face, hands and feet, as well as muscle function exercises in the corresponding parts of damaged nerves.
7 Prevention and treatment management
In order to detect patients in the early stage and avoid disability, leprosy examination should be included in various physical examinations, that is, carefully check the skin of the whole body for numbness rash and peripheral nerve enlargement under natural light conditions indoors. If there are suspicious signs, a dermatologist should be consulted. Tissue fluid should be scraped from the edge of suspicious skin lesions, and smears should be taken for acid-fast bacteria examination and/or Perform pathological examination of skin lesions. Prefectures and counties without specialized leprosy institutions should designate a person in the epidemic prevention station to be responsible for daily leprosy prevention and control work (clinical, bacterial examination, tissue biopsy, treatment, post-treatment monitoring, and regular physical examinations of contacts, etc.), and report epidemiological statistics to the province or prefecture/state, carry out publicity and education work at the grassroots level, and conduct annual physical examinations of patients' family members/contacts during the treatment and monitoring period. See Appendix E for my country's leprosy prevention and control indicators. 8 Disinfection methods
Leprosy bacteria cannot be cultured in vitro, and their growth activity is lower than that of tuberculosis bacteria, so no special protection and disinfection are required. After examining the patient, only wash your hands with soap and running water; dirt can be boiled (30 minutes) and exposed to the sun (2 hours), and routine disinfection can be similar to tuberculosis bacteria (using 75% alcohol or 3% bleaching powder clarified solution). Soak for 1-2 hours). As long as the patient is found as early as possible and combined chemotherapy is given, the infection can be immediately blocked. 208
A Bacteria examination
A1.1 Specimen preparation
GB15973-1995
Leprosy examination method and submission of leprosy pathology specimens for examination (supplement)
In addition to conventional sites such as earlobes, supraorbital and submandibular, samples should be taken from the edges of 2-3 active skin lesions, a total of 5-6 sites; after wiping the skin with a 75% alcohol cotton ball, use the middle finger and index finger of the left hand to hold the skin tightly to make it pale, hold the sterilized scalpel in the right hand, and use the tip of the knife to make an incision of 5mm long and 2-3mm deep, then turn the knife handle 90°, scrape the tissue fluid from the edge and bottom of the incision back and forth, and then evenly place it on a clean glass slide in order. The sample is coated on the slide to form a thin film with a diameter of 5 to 7 mm. When scraping, care should be taken to prevent blood. After each scraping, the tip of the knife should be wiped clean and disinfected with an alcohol flame. A new blade should be used for each patient to avoid cross contamination and infection. After taking the specimen from a patient, the reverse side of the slide should be placed on the alcohol flame and shaken back and forth 2 to 3 times to fix it. Then, the medical record number and the date of specimen collection should be marked and placed in a slide box. It should be protected from moisture, dust and sunlight. Within three days, it should be sent to the laboratory for acid-fast staining together with the inspection form. A1.2 Acid-fast staining
A1.2.1 Add carbolic acid fuchsin dye solution to the film on the slide, heat it on the flame of an alcohol lamp until steam comes out, pause for a while, and heat it again three times for a total of 3 to 5 minutes, and then rinse slowly with clean water. Be careful not to let the dye solution boil or dry out. A1.2.2 Add 1% hydrochloric acid ethanol solution to decolorize for 1/2~1min, until no red color comes off, then rinse slowly with running water; do not rinse directly on the film. A1.2.3 Re-stain with 0.3% methylene blue aqueous solution for 1~3min, then rinse slowly with running water from the end of the slide, dry, and examine under a microscope. A1.3 Bacterial density index (BI)
Under oil immersion lens (10×100 times), leprosy bacteria are bright red and the background is light blue. At least 200 fields of view should be checked for negative smears. The bacterial base in each smear is expressed by the bacterial index:
1+ There are 1 to 10 bacteria per 100 fields of view on average 2+ There are 1 to 10 bacteria per 10 fields of view on average 3+ There are 1 to 10 bacteria per field of view on average 10 to 100 bacteria per field of view on average 4+
There are 100 to 1000 bacteria per field of view on average 5+
6+ There are more than 1000 bacteria per field of view on average, and there are bacterial balls. At least 100 visual fields should be examined
At least 100 visual fields should be examined
At least 50 visual fields should be examined
At least 50 visual fields should be examined
At least 25 visual fields should be examined
Each patient should select at least 5 sites each time and make a smear on each site. The sum of the plus numbers obtained from the 5 smears divided by 5 is the patient's bacterial index.
Pathological specimens
Examining the pathology of leprosy lesions is very important for diagnosis and typing, evaluation of efficacy and judgment of cure. The specimens should be fixed with 10% neutral formalin and sent to the local central laboratory (state or provincial level) for HE and acid-fast staining; the laboratory should also issue a report within one month. The biopsy should be performed at the raised edge of the active lesion. The operation should be performed aseptically under local anesthesia to avoid squeezing. A 12mm×6mm skin flap should be cut along the skin grain, deep into the subcutaneous fat tissue. After fixation, it should be sent to the pathology department of the state or provincial skin disease prevention and control institute with a submission form. Neutral formalin fixation can better preserve the original morphology of tissues and the acid resistance of leprosy bacteria. Preparation method: Formalin (40% formaldehyde aqueous solution)
Sodium dihydrogen phosphate (NaH,P0·2H,O)
Sodium hydrogen phosphate (Na2HPO,·12H,O)
Distilled water
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Appendix B
Classification of leprosy
(Supplement)
In order to facilitate the implementation of combined chemotherapy at the grassroots level, the World Health Organization recommends that the Madrid or Ridley-Jopling leprosy classification method be summarized into two types, namely multibacillary leprosy (MB) and paucibacillary leprosy (PB). cibacillary leprosy) Leprosy:
Madrid
(1953)
Reedley-Joplin
(1966)
The number of
bacteria (ten) in any part
tumorous (L))
multibacillary (MB)
borderline (B)
borderline-tumorous (BL)
intermediate-border (BB)
paucibacillary (PB)
tuberculoid (T)
indeterminate (I)
tuberculoid
borderline-tuberculoid (BT)
indeterminate (I)
The body's immune response to leprosy varies, resulting in different clinical and histopathological manifestations. According to the strength of cellular immunity, leprosy can be roughly divided into five gradually transitioning types: B1 Undetermined type (I)
Mostly early manifestations of leprosy, with one or several light-colored spots or light red spots, with clear or unclear edges, sensory impairment, commonly seen in exposed parts of the skin; smear examination is often negative. Histopathology: Lymphocyte infiltration may be found around the dermal attachments, blood vessels, and cutaneous nerves, and a few leprosy bacteria may sometimes be seen in the nerves and arrector pili muscles.
B2 Tuberculoid type (TT)
There are one or several macules, plaques or papular lesions with clear edges, slightly higher than the skin. Some lesions have a normal or atrophic appearance in the center, dry and scaly surface, hair loss and sweating, loss of sensation, and enlarged cutaneous nerve branches near the lesions. There are 1 to 2 thick and hard peripheral nerve trunks. Histopathology: There are epithelioid cell granulomas in the dermis, which may invade the basal layer of the epidermis, with dense lymphocytes on the periphery and Langhans cells in the central area. Leprosy bacteria are not seen in the skin appendages and nerves. B3 borderline tuberculoid type (BT)
Leprosy is less, asymmetrically distributed, mostly reddish brown or hypopigmented spots, which may be higher than the skin surface, with a "blank area" with strong immunity in the center, clear edges, and the surface is often rough and scaly. The cutaneous nerves near the lesions can be touched, and there may be 1 to 3 thick and tender peripheral nerves; satellite-like lesions are often near large lesions. Leprosy bacteria are rarely or absent in the skin lesion smear. Histopathology: No infiltration zone can be seen under the epidermis, and there are epithelioid cell granulomas in the dermis with more lymphocyte infiltration on the periphery. Leprosy bacteria may or may not be seen in the skin appendages and nerves. B4 Intermediate borderline type (BB)
The skin lesions vary in size and are generally asymmetrical. They are polymorphic lesions such as macules, plaques or nodules, and are often yellow-red or dark red. The immune zone is often seen in the middle of the lesions, with a clear inner edge and an unclear outer edge. The surface of the lesions is smooth and scaleless, with sensory impairment, and positive bacteria examination. Histopathology: True 210
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There are epithelioid cell granulomas in the skin, which are diffusely distributed, with only a few lymphocytes and no Langhans cells; the nerves may be partially involved, the perineurium is layered, and there are moderate numbers of leprosy bacteria (3-4+). B5 Borderline hemitumor type (BL)
The skin lesions are smaller, diverse in shape, more extensive, more symmetrical, smooth in surface, unclear edges, sensory impairment, and multiple thick peripheral nerves, soft texture, and a large number of bacteria. Histopathology: There are infiltration zones and macrophage granulomas under the epidermis. Some of the cells in the latter are vacuolated, with lymphocytes in between. The perineurium is layered and infiltrated. There are more leprosy bacteria (4-5+). B6 tumor type (LI.)）
Early skin lesions are small and numerous, widely distributed and symmetrical, and are red or brown or pigmented macules, often with diffuse infiltration, smooth and shiny surface, and unclear boundaries; in the late stage, there are plaques, nodules or wrinkles; the nerves are thick and soft. There is symmetrical numbness in the hands and feet, and there are many bacteria in the routine parts, which can be accumulated into clusters. Histopathology: There is no diffuse zone under the epidermis, macrophage granulomas in the dermis, few lymphocytes, and tissue cells are foamy in HE staining; the perineurium is a layered structure; there are many leprosy bacteria, which are in clusters (5-6+). Appendix C
Differentiation between leprosy relapse and leprosy reaction
(Supplement)
Relapse is when the symptoms of leprosy appear again during the monitoring period after the completion of combined chemotherapy or thereafter. Clinical signs of relapse:
a. The original skin lesions are enlarged, thickened, and the edges are red; b. New lesions appear in the area without skin lesions; c. Leprosy bacteria appear in the area with negative bacteria, or the bacteria in a certain area (lesion) increase by 20% compared with the time of drug withdrawal, especially the appearance of complete bacteria. If the bacterial index increases during the re-examination, it must be carefully verified by comparing with the medical records; d. The peripheral nerve that was not painful before is obviously painful when touched. After completing the MDT course, type 1 leprosy reaction may occur, which is often misdiagnosed as relapse. The characteristics of the two are shown in Table C1: Differentiation between leprosy reaction and relapse:
Time of occurrence
Characteristics of attack
Systemic symptoms
Characteristics of lesions:
Original lesions
New lesions
Peripheral nerves
Type 1 reaction
During treatment or within 1/2 to 1 year after drug withdrawal, but also after 1 year of drug withdrawal
Can occur after 1 year of drug withdrawal
Sudden attack
Fever, fatigue, joint pain
Several or all old lesions are red, swollen and shiny
The lesions often break down
There is desquamation after the lesions subside
The previously affected nerves are invaded, and the movement disorder develops quickly
The edges of some original lesions are red and infiltrated
Mainly new lesions appear
No desquamation
The previously affected or unaffected nerves are invaded, and the movement disorder develops slowly
Effect of hormones
D1 Examination of nerve damage
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Continued Table C1Www.bzxZ.net
Type I reaction
Short-term (4 weeks) prednisone treatment (40 mg/day) is effective, and then it is reduced by 10-5 mg/day every month until it is completely reduced in 6 months. After using prednisone 40 mg/day for 4 weeks to distinguish it from relapse, repeat the MBMDT regimen and use hormone treatment at the same time. MDT is not stopped when using hormones. Appendix D
Prednisone treatment is ineffective. After 1 month of treatment with 40 mg/day of hormone, if there is no clinical improvement, the stimulation cord is stopped and the MBMDT regimen is repeated
Neurological function examination and clinical classification of disability in leprosy (supplement)
Morphological examination: Perform in sequence along the nerve route. Touch each pair of nerves and compare the thickness, hardness, uniformity, tenderness and radiating pain of the nerves bilaterally. Pay attention to the presence of neuromas and nerve abscesses. It is necessary to compare the auricular nerve, ulnar nerve, common peroneal nerve, posterior tibial nerve, supraorbital nerve, median nerve, radial nerve, and whether there is enlargement of the cutaneous nerve near the skin lesion or numbness area bilaterally. D2 Sensory function examination
Check whether the pain, touch and temperature sense are dull, reduced or lost. Before the examination, explain the examination method and requirements to the patient first, and then conduct the test after obtaining the patient's understanding and cooperation. Ask the patient to point out and say how the tested part feels with his eyes closed or covered with an object. Pay attention to the patient's expression and reaction to judge the reliability of the results. D2.1 Pain: Use the tip of a needle to lightly prick the normal skin and skin lesions and ask the patient to answer "pain" or "no pain", and observe his/her expression. Do not prick too lightly or too hard.
D2.2 Touch: Use a soft feather or cotton wool at the end of a cotton swab to lightly touch the normal skin and skin lesions, and ask the patient to point out the part touched each time or the number of touch attempts.
D2.3 Temperature: Use two test tubes, one with cold water and the other with hot water (about 40C) to alternately test the tested parts, and compare the normal and skin lesions to understand whether the patient can sense cold and heat. Generally, the pain test can be done first, and then the touch and temperature sense can be tested. For those who have lost the touch and pain sense, there is no need to test the temperature sense. If the touch and pain sense are normal, the temperature sense should be tested.
D3 Motor function test
It is necessary to record whether the muscle strength of the affected nerve is normal, and whether there is paralysis or atrophy. D3.1 Face: Observe for facial nerve paralysis by raising the forehead, frowning, closing the eyes and whistling. Note whether the patient has normal eye movements, and then ask the patient to close his eyes to see if the upper and lower eyelids can close completely. If they cannot close, estimate the distance of the palpebral fissure (mm). D3.2 Hand: Ask the patient to abduct the little finger, measure its muscle strength, and observe the situation and strength of thumb palm abduction, finger abduction, adduction, palm opposition, fist clenching, wrist dorsiflexion and other movements.
D3.3 Foot: Check whether the affected foot can be turned inward and outward, as well as the situation and strength of foot dorsiflexion. D4 Basic record and classification of leprosy deformity (attached with basic record form and classification form) During and after treatment and during the monitoring period, the neurological function of the hands, feet and eyes should be checked at each physical examination of leprosy patients. If there are abnormalities, timely measures should be taken to avoid aggravation of the original neurological dysfunction or the emergence of new disabilities. During the examination, the patient's hand or foot can be supported, and a ballpoint pen can be used to lightly press the corresponding parts of the fingers, palms and soles of the feet on both sides vertically (11 points on one hand and 12 points on the foot) to form a depression with a diameter of about 1 cm. The patient is asked to point out the pressure point without looking. If there is a feeling, record "V", otherwise record "×" (see Table D1 Basic Record of Leprosy Disability). Examination and Record of Neuritis
Each physical examination during treatment and the post-treatment monitoring period should include a neurological function examination. D5.1 Whether there has been any change in skin sensation and muscle strength in the past six months. D5.2 Whether there is neuralgia and tenderness.
If "yes", record its location, degree, date of occurrence and examination date, etc. (see Table D1 Basic Record of Leprosy Disability and Table D2 Leprosy Disability Clinical Grading Registration Form).
Basic record of leprosy disability
1. Sensory examination:
Medical record number
Lightly touch the skin at the position marked in the figure. If the patient can point out the touched point (within a range of no more than 3cm), it means there is sensation, record "\√", otherwise record "×". 2. Other examinations:
Claw-shaped fingers (toes): record "\C" on the outside of the finger () end, and record "S" if there is stiffness. For chapped fingers, wounds, and ulcers, mark the affected area. Shortening of fingers (toes): record ",,
Indicates the level of shortening.
3. Motor function examination:
Examination items
Panoptic movement
Facial fissure width (when eyes are slightly closed)
Little finger adduction
Thumb palmar abduction
Wrist dorsiflexion
Foot dorsiflexion
Note: N
Normal muscle strength; W
4. Examination of neuritis:
Weakened muscle strength; P
1. Has the skin sensation changed in the past six months: No 2. Has the muscle strength changed in the past six months: No 3. Nerve pain; No
4. Nerve tenderness: No
: Location
Muscle paralysis.
: Location
: Location
If the answer to the above four items is "yes",The location, time and degree of occurrence of the disease are further recorded. Left
Corneal sensory disturbance
Conjunctivitis
Incomplete eyelid closure
Exposure keratitis
Iridocyclitis
Vision loss
Severe vision loss
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Clinical classification registration form for leprosy deformity
Protective sensory disturbance
Joints with movable hooks
Skin keratinization, chapped and injured
Mild bone resorption
Ankylosis
Shortened or missing fingers
Protective sensory impairment
Skin cracks and wounds
Simple plantar ulcer
Mild bone resorption
Melon-shaped toes
Equus foot
(or combined with inversion)
Complex plantar ulcer
Shortened foot
Note: WHOTRS768 combines grade 1 and grade 2 deformities into grade I, which means disability. Eyebrow loss is a symptom of multibacillary leprosy and should not be classified as disability. Facial paralysis and collapsed nose should be classified as grade II. Ask the patient to cover one eye with his hand at a distance of 1m and count the fingers with the other eye. If the fingers cannot be counted clearly, it means visual impairment, and if there is no light perception, it means blindness. Inspector;
Appendix E
Prevention and control indicators and evaluation indicators of leprosy
(Supplement)
Leprosy prevention and control indicators (in cities and counties)E1
Prevalence
Basically controlled
Basically eliminated
<0.05/1000
0.01/1000
Incidence rate
(Average in the past five years)
<2.0/100,000
<1.0 /100,000
<0.5/100,000
Province (city, district)
Standards to be achieved
More than 95% of counties (cities) have achieved basic control, and the rest have a prevalence rate below 1%. More than 95% of counties (cities) have achieved control targets, and the rest have basic control. More than 95% of counties (cities) have achieved basic elimination targets, and the rest have achieved control targets.
my country has a vast territory, and leprosy is unevenly distributed, so my country's leprosy prevention and control targets are formulated based on counties (cities). In 1991, the World Health Organization General Assembly resolved to eliminate leprosy by the end of this century based on countries, and the target is that countries should reduce the prevalence of leprosy to <1/10 000 by the end of this century.
E2 Evaluation indicators for leprosy prevention and control (based on provinces or counties) WH () At the Jakarta Leprosy Epidemiology Conference held from June 17 to 21, 1991, it was recommended that countries use the following table to report the annual leprosy 214
basic indicators:
Prevalence rate:
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Country/Region/Province/County
Number of registered patients at the end of the year
Number of registered patients this year
Number of population in the middle of this year
Number of newly discovered patients this year
Morbidity rate:
Number of population in the middle of this year
, population
Newly discovered patients this year
With deformity
Without deformity
That is, the total population in the middle of the year
b+c+f+g
That is, the total number of people in Mouzhong
E2.3MIT Coverage rate, among the patients registered this year, at least 8 months of MDT should be avoided. Number of patients registered this year who should receive MDT
Number of patients who started using
MDT this year
That is: a+b+c+e+f+g
According to WHO1988TRS768, MB completed 24 months within 36 months, and PB completed 6 months of MDT within 9 months, which is not included in the prevalence rate.
E2.4 Completion rate of MDT: Li Niannianli completed the number of MDT courses. Number of patients who completed the MDT course this year
MB and PB can be calculated separately: PB 6. Month course, completed within 9 months, excluding the number of people who moved out and died; MB 24 Month course, completed within 36 months, excluding the number of people who moved out and died. E2.5 Among the newly discovered patients
Disability rate, among the patients discovered this year! ～1st level disability Total number of new patients found this year
E2.6 Number of patients who refused treatment (did not take MDT) MB, PB Appendix F
Combined chemotherapy treatment plan for leprosy
(reference)
F1 Side effects of combined chemotherapy drugs for leprosy
i.e. b+f+c+g
F1.1 Nitrophenylsulfone: The side effects of conventional doses are few and mild. The main side effects are: digestive tract discomfort, fatigue, insomnia, etc., which can disappear on their own soon without stopping the drug. Some patients may have anemia, granulocytopenia, hepatitis, drug rash and mental symptoms. In severe cases, the drug must be stopped and symptomatic treatment should be given. F1.2 Rifampicin: Good efficacy, 99.9% of leprosy bacteria can be killed in a few days, stopping transmission. Its main side effects are: reddening of various secretions. There may be rash and mild gastrointestinal reactions. But it is rare in combined chemotherapy regimens. Occasionally, anemia, purpura, and renal failure are also seen, and the drug should be discontinued at this time. F1.3 Fluphenazine.
The bactericidal effect is similar to that of dapsone. In addition, the drug has an anti-inflammatory effect. When used in combination therapy, it can reduce type 1 leprosy reactions. Side effects include gastrointestinal reactions, pigmentation, dry skin, itching, etc., and there is no need to stop the drug. After taking the drug for 1 to 3 months, the exposed parts of the skin and the leprosy infiltration and nodules gradually turn brown-red, and then turn purple-brown. It gradually subsides after 9-12 months of discontinuation of the drug. During the medication period, the urine may be light brown-red. Taking large doses (300 mg/day) may cause severe gastrointestinal reactions and even intestinal obstruction. According to the clinical and bacterial examination results, the patients were treated with MB or PB regimens (Table F1). For PB(BT), if any part of the body was positive for bacteria215
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（+）or there were ≥5 skin lesions or ≥2 affected nerves, MB regimen should also be used. Table F1
Rifampicin
Chlorophenazine
Chlorophenazine
Azophenone
Regular treatment:
MB regimen
600mg×1/month monitored
300mg×1/month
50mg×1/day self-administered
100mg×1/day
PB regimen
600mg×1/month monitored
100mg×1/day self-administered
At least 24 months, can be completed within 36 months, 6 months, can be completed within 9 months or until bacteria turn negative
Monitored service means taking the medicine under the supervision of medical staff, once a month; self-administered service means that the patient takes the medicine every day, at least 20 days a month, otherwise this month will not be counted as the treatment course; no interruption for 3 months each year. During the monthly monitoring service, the medical staff will issue a self-administered medication for one month. When delivering the medication for the next month, check the number of self-administered tablets used in the previous month to see if there are any unused tablets. The 24-month course of multibacillary MDT should be completed within 36 months. The 6-month course of paucibacillary MDT should be completed within 9 months.
Appendix G
Leprosy reaction and treatment
(reference)
In the chronic process of leprosy, the body can react to leprosy antigens and develop acute allergic symptoms, which are called leprosy reactions. According to the immune characteristics and clinical manifestations, it can be divided into type 1 reaction and type Ⅱ reaction. G1I type leprosy reaction: It can occur in patients with tuberculoid type and borderline type (BB, BT, BL). When the body's immunity decreases (such as acute infection, pregnancy, childbirth, mental trauma, excessive fatigue, etc.), the condition will transform to the tumor type after the reaction, which is called downgrading reaction. It often occurs in the case of insufficient treatment or no treatment, and is rare in clinical practice. If the patient's body immunity is enhanced and the condition transforms to the tuberculoid type, it is called an upgrading reaction or a retrograde reaction. It often occurs during or after treatment. The two have essential differences in pathogenesis, but the clinical symptoms in the skin and peripheral nerves are very similar, so they are collectively called type I reactions. Type 1 leprosy reaction can occur before treatment, during treatment, and within half to one year after short-term MDT treatment, but it can also occur 3 to 4 years after treatment. G2I type leprosy reaction: Also known as erythema nodosum leprosum reaction (ENL, Erythema nodosum leprosum),It can be seen in treated or untreated multibacillary leprosy (LL, BL, and a few BB); it mainly occurs on the skin of the face, limbs, etc., sometimes presenting as annular multiforme erythema lesions, often accompanied by obvious systemic symptoms, such as fever, fatigue, limb pain, and severe cases may have iridocyclitis, orchitis, neuritis, arthritis, and lymphadenopathy. The above symptoms may occur one after another, or only one or two of them may appear. Type II leprosy reactions may occur before and during treatment, but the number of reactions gradually decreases in short-term MDT and disappears completely within 1 to 2 years of drug withdrawal. The clinical symptoms and treatment methods of type II and type I leprosy reactions are shown in Table G1: 216
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Table G1 Symptoms and treatment precautions of type I and type I leprosy reactions Type I reaction (retrograde reaction)
The original skin lesions are enlarged, red, and edematous, and new skin lesions may appear. The affected nerves are thick and painful. In severe cases, systemic symptoms such as fatigue, low fever, and swelling of the face, hands, and feet may occur. Skin lesions and edema may break or ulcerate, or scar. If there is neuralgia and muscle weakness, it should be treated in time, otherwise it may cause permanent disability
1. Mild or moderate skin reactions can be treated at home. Leprosy specialists should follow up weekly and treat symptoms. Severe cases should be hospitalized. 2. Those with neuralgia should rest and keep the affected limb warm, and can take oral decoctions or tablets of Tripterygium wilfordii or Begonia kunmingensis and analgesics such as aspirin. 3. Hormone treatment: For moderate reactions, prednisone 40~60mg/day, which can be gradually reduced after the reaction is controlled, and can be completely discontinued after 6 months. For severe reactions, 100-300 mg of hydrocortisone + 1500 ml of 5% glucose saline + 100 mg of Vit.C per day can be used for intravenous drip for 2-3 days, and then 40-60 mg of prednisone can be used for daily administration. The dosage can be gradually reduced after the reaction is controlled, and the drug can be discontinued after 6 months.
4. Continue MDT
Additional notes:
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard is drafted by the Institute of Tropical Medicine of Beijing Friendship Hospital. The main drafter of this standard is Li Huanying.
【Type reaction (erythema nodosum reaction)
Nodular erythema appears scattered or in batches on the limbs, face, buttocks, etc.; in severe cases, nodules can form pustules and ulcers, which can be accompanied by high fever, joint pain, fatigue, and lymphadenopathy, iridocyclitis, orchitis, hepatosplenomegaly, etc. Often accompanied by peripheral neuralgia 1. Mild or moderate reactions can be treated at home. Leprosy specialists should follow up weekly and treat symptoms. Severe cases should be hospitalized. 2. Use the following drugs in combination:
2. 1 Mild: Those with neuralgia should rest and keep the affected limb warm, and can take decoction or tablets of Tripterygium wilfordii or Kunming Mountain Begonia and analgesics such as aspirin or the like.
2.2 Moderate reactions can use the following treatment plan: 1) Thalidomide 100mg×4/day, gradually reduce to 100mg/day after 4-6 weeks, and maintain for 1-2 months. It is forbidden for early pregnancy and should be used with caution by women of childbearing age.
2) Chlorophenazine 100mg×3/day, reduce by 100mg/day to 50mg/day every month after 2-3 months.
3) Use aspirin as an adjuvant.
2.3 For severe reactions, 100-300mg of nitrated cortisone + 1500ml of 5% glucose saline + 100mg of Vit.C per day can be used for intravenous drip for 2-3 days, and then 40-60mg of prednisone can be used per day. After the reaction is controlled, the dosage can be gradually reduced and the drug can be discontinued after 6 months.
2.4 If there is iridocyclitis, drip irritant and atropine eye drops several times a day and consult an ophthalmologist.
3. Do not stop MDT
This standard is interpreted by the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health. 217
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