1 (Skin tuberculosis, leprosy, leishmaniasis)Tashkent Medical Academy Department of Skin and Venereal Diseases Papulose dermatoses (Skin tuberculosis, leprosy, leishmaniasis) Professor Vaisov Adham Shavkatovich Tashkent

2 Tuberculoderma Pathogen - Mycobacterium tuberculosis. There are three types: human bull avian Tuberculous lesions of the skin and oral mucosa are common symptoms of TB disease, and are the result of:    a) internal superinfection when the agent in the body of an existing tuberculous focus blood flow recorded in the skin    b) there may be cases of superinfection inside when the agent on the skin and mucous gets outside.

3 There are the following forms of tuberculosis of the skin:localized:      1) vulgar erythematosus      2) verrucous lupus      3) kollikvativny (skrofuloderma)      4) Ulcerative tuberculosis of the skin and mucous      5) tuberculous chancre           disseminated:      1) papules necrotizing tuberculosis      2) indurativnyy erythema Bazin      3) lichen lichenoid scrofulous      4) disseminated miliary lupus      5) acute disseminated miliary tuberculosis of the skin.

4 Vulgar erythematosus - facial skin, mucous membrane of the mouth, nose, legs, buttocks and neck.     Tubercle - lyupoma, soft, yellowish-rusty color. Peripheral growth merges.      Vitropression yellow-brown spots - a symptom of apple jelly.       Symptom of falling through the probe. Tubercle - scar skin atrophy, thin, folded, bleeds.   Ulcer - soft edges, rough-grained view, sero-purulent discharge, and sometimes bleed.       New items on the scars.

5 Tuberculosis cutis luposa exedensThe disease began 25 years ago Condition after treatment

6 Tuberculosis cutis papulonecrotica

7 clinical manifestations Tertiary syphilis papulosetuberculous lupus Tertiary syphilis papulose primary element tubercle color tubercle Stagnant-red with a yellow tint Copper, ham, red consistency soft Density elastic peripheral growth + - symptom probe positive negative Яблочное желе The nature of the scar Surface, smooth, delicate, drawing "lace" Mosaic by varying depth, size and age of the tubercle histopathology Granuloma, giant cells, epithelioid cells around Endomezoperi Vasculitis, infiltration of plasma cells tuberculin skin test start Often in childhood At any time course For many years, months DAC

8 Skrofuloderma - localized, dense knot, increasing to a walnut, softSkrofuloderma - localized, dense knot, increasing to a walnut, soft. When nodes are opened, there fistulas - reddish pus. The ulcer is covered sluggish granulations, edge saped has pockets. Tissue loose, easily broken. There may be scars, uneven, rough, for torpid. The presence of bridges.           Diff. Diagnostics - performed with gummy syphilides.

9 Diagnosis: Tuberculin skin test (Pirquet, Mantoux).Microscopy to detect acid-BK and sticks. Microscopy of biopsies material. Crops on nutrient media and the resulting culture of mycobacteria. The positive results of vaccination pathological material guinea pigs. Detection of other foci of tuberculosis in a patient. Epidemiological data. Positive results of a specific therapy.

10 TREATMENT (GENERAL): Specific anti-TB drugs in the degree of antibacterial activity can be divided into three groups: most effective prepparaty-isoniazid, rifampicin; high-performance drugs streptomycin, ethambutol, protionamid, kanamycin, tsikloseril, florimitsin, viomitsin; The drug is moderately effective- Pasco, tibon. appropriate co-administration of 2.3 drugs.

11 leprosy Is the causative agent of leprosy bacillus, discovered in 1871 by the Norwegian physician Ganzen. Since 1931, according to the decision of the Manila International Conference on Leprosy, Hansen bacillus was related to the family of Mycobacteria and is called Mycobacterium leprae hominis. The causative agent of leprosy is apparently somewhat similar to Mycobacterium tuberculosis Gram + alcohol-and acid-fast bacilli with microns and a width of microns.

12 Dispensaries. watching.Information on the number of leprosy patients in the Republic of Uzbekistan for 1998. № What city. reg. At AMB. treatment Readiness. Dep. Dispensaries. watching. In other leprosarium only 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11 12 13 14 15 16 Tashkent Tashkent region. Syrdarya Dzhizak Samarkand Surkhandarya Kashkadarya Ferghana Namangan Andijan Navoi Bukhara Khorezm Of the Republic. Kara-Kalpak Of the Republic. Tajikistan On Res. Karakalpakstan 6 1 2 7 3 - 26 236 96 254 40 29 626 in total 311 107 44 716

13 In hospital: 107 patients Of those with disabilities: I-group - 85                                          II-group - 22 Abatsillyarnyh of      inpatients - 99 Bacillary - 8 Under medical observation (ex-patients) In other CIS leprosarium - 44 Outpatients - 311

14 Timing of the incubation period, in leprosy can be quite variable and range from years or more. Some authors have noted the presence of prodromal phenomena, which are expressed in fatigue, general weakness with a little physical activity in rheumatic pains in the joints, sometimes hypersthesia and paresthesias. Prodromal period can last months, and sometimes more. Currently, there are three main types of leprosy - lepromatous, tuberculoid, nedifferintsirovanny.

15 Lepromatous type of leprosyThe most severe form of leprosy is characterized by polymorphism of clinical manifestations.   The process begins with the appearance of the skin round erythematous patches with a distinctive shiny surface.   Often infiltrated spots are unique, rusty color. Sometimes the spots may be somewhat discolored contrary, have the form of rings or half rings.   In the initial stage of the sensitivity of the spots can be maintained or even howl determined hyperesthesia. Over time, the sensitivity of the first down, and then disappears.

16 If it affects the face, typical image of the patient - the general puffy, shiny and somewhat hyperemic background define the set of nodes, which gives a person a kind, stern look. The lips are turned out, hang down, the nose is increased, especially in the swollen part of the wings of the nose, the eyebrows are thinning and almost completely lost. A similar syndrome has long been called the face of defeats - facies leonina «lion face" - Hence synonym leprosy - leontiazis.8

17 leprosy

18 lepromatous type

19 Contracture and spontaneous amputation of fingers, residual stagelepromatous type Contracture and spontaneous amputation of fingers, residual stage

20 tuberculoid type

21 Multiple shaped pocketstuberculoid type Atrophy of the small muscles of the hand, finger contractures, telangiectasia Multiple shaped pockets

22 Leprosy before and after treatment

23 For the diagnosis of leprosy, but a typical clinical picture, as well as the medical history of the patient stay in endemic foci are also important special methods: Bacterioscopy - scraping from the nasal mucosa, lymph node puncture. Determine the sensitivity of the skin. Checking the temperature of the reaction - test with cold water. histamine test - no redness. Minor sample for perspiration - grease a 10% solution of iodine, after drying pripudrivayut starch, human sweat plus iodine stains the skin chernofioletovym color. Sample to ultraviolet radiation - no tan. Leprominovaya test - special antigen (lepromin), which is made from leprosy.

24 treatment So far, specific treatments for this severe suffering there. Of the most currently used treatments for leprosy can point to a number of sulfone drugs DDS (4 - 4 diaminodifenilsulfon) sulfone - 3 sulfetron leprosan PROMIN diazonium promatsetin   and thiourea derivatives Ciba-1906 haulmugrovoe oil mugrol etc.

25 Cutaneous leishmaniasisCutaneous leishmaniasis - (Bolezan Borovsky) endemic, infectious disease caused by a protozoan Leischmania tropica, enter the body through the bite of a mosquito - a vector of infection from wild animals and the sick person and manifested in papulose nodular or ulcerated skin lesions.

26 переносчик

27 seldom frequently synonyms Late ulcerate, ashhabadka, Kokand, yearlingAcute ulcerate, pendinka, Murgab ulcer, leishmaniasis. incubation Long, usually 2-3 months, often 1-2 years Short, usually 1-4 weeks primary element Small pimple-bump Significant acute inflammatory infiltrate often similar Boils The development process slowly fast Time of onset of ulceration After 3-6 months or more After a week lymphangitis seldom frequently tubercles contamination relatively rare localization Usually on the face than on the extremities More often in the lower extremities The processing time for epithelialization Year or more 4-6 months Seasonality Primary disease may all year Only in the summer and autumn months

28 Late ulcerate, ashhabadka, Kokand, yearling synonyms Late ulcerate, ashhabadka, Kokand, yearling Acute ulcer, pendinka, Murgab ulcer, leishmaniasis. endemic outbreak frequently observed frequently keepers of infection human rodents Occurrence Towns Rural areas of the desert, the edge of town Number of Leishmania in leyshmaniome many few Virulence for mice Most cross-immunity no resistant exciter L.tropica minor. L.tropica major.

29 leishmaniasis

30 leishmaniasis

31 leishmaniasis

32 leishmaniasis

33 leishmaniasis

34 Prevention of leishmaniasisShould be carried out simultaneously in several directions, and include measures to break the epidemiological chain, that is, measures of the source of infection (people with type anthroponotic, rodents - with zoonotic) and vector (mosquito). It is also important observance of personal prevention measures. More important is the early detection and treatment of patients. Recommendation on imposing plaster on Leishmania. Destroying rodent burrows seed chloropicrin, cyanides. Destruction of mosquitoes - insecticides (DDT thiophos, geksohloran, etc) application repillentov - dimethyl phthalate, kerosene, some essential oils (clove oil, cream, "Taiga") Inoculation of the living culture of zoonotic type that provides rapid development of immunity. Protect humans from the bite. By means of personal antique mechanical prophylaxis is the canopy.

35 treatment chemotherapy:  1. preparations of antimony, arsenic, gold, sulfonamides, bismuth, quinacrine.   2. Physiotherapy - diathermocoagulation, cryotherapy, X-ray Local treatment: 1. Surgical treatment. 2. Destructive means - sodium hydroxide, zinc chloride, acetic acid, sodium nitride, KMnO4. 3. Disinfectants - 0.1% mercuric chloride, xeroform, dermatological, iodine, protorgolovaya ointment rivanol (secondary flora). 4. Herbal remedies - juices, extracts, ointments - aylantus, McClure, castor. 5. Leyshmitsin Treatment for today: 1. Solyusurmin in / -5% ml per day of 2. Obkalyvanie 4 - 5% of quinacrine in 1% solution - re novocaine 3. Aminohinol by 0,2 x 3p, a course of grams. 4. Monomitsin 250 tys.h 3 r.den, rate million (checked out) 5. Methacycline - rondomitsin