1

- ( )

L( Leprosy )

1873

( 10 %) 90 %

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:541

2

WHO

1930 195

3429

49

65

88

919194

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:542

3

LEPROSY (Hansen's Disease)

90 %

Mycobacterium Leprae1873 Hansen

Hansen's

11~13

Dr. ArmauerHansen (1841-1912)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:543

4

2 5 2.5 40

90 %

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:544

5

-destroglycan laminin-2 receptor

( )

Classification

TT BT

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:545

6

TTBT I

1 ( )

23

PGL-1(Epitope)

LAM-B(LL type)

30%

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:546

7

1. (Ziehl-Neelsen Stain )

2. (Kinyoun Stain )Kinyoun's carbolfuchsin

5 Methylene blue(Ziehl-Neelsen Stain carbolfuchsin )

3. (Fite's Stain)xylene/peanut oil 2 10

4. (Auramine-rhodamine fluorochrome stain)auramine-rhodamine mycolic acids

250Ziehl-Neelsen (

(+))

5.PCR( )DNA

DNADNA ( )

6. (Microtiter Particle Agglutination Test)

Colored Polyacrolein Latex Microparticles (PAMP) comjugated 3,6-Di-O-Methyl-D-

Glucose (DMG) (DMG)

7. (Leprosy Test)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:547

8

8. (Lepromin Skin Test)

1 9 1 8

(T type)

(L type)

(B type )

(I type)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:548

9

solid

fragmented

granular

MI ( morphological index ) ( )

BI ( bacteriological index ):

/

6+ 00 >1,000 / 1

5+ 100~1000 / 1

4+ 0010~100 / 1

3+ 00001~10 / 1

2+ 00001~10 / 10

1+ 00001~10 / 100 0+ 00000 / 100

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:559

10

BI 2 MB Type( )

BI 1 100 1-10

BI 2 100 10 1-10

BI 3 25 1-10

BI 4 25 10-100

BI 5 25 100-1000

BI 6 25 1000

(Multidrug therapy, MDT)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5510

11

(Rifampin 300 mg)(Clofazimine 100mg) (Dapsone 100mg)

27(Dapsone 100mg) (Clofazimine 50mg)28

:(1) (2) (3)

30-50 %

(Type I reactions or reversal reactions) (Type IIreactions or ENL, erythema nodosum leprosum) Lucio

type IV6 (

BB BL BT) 1/4

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5511

12

(1)

(2)

(3) 6

type III3

(BL LL BB)50%

(1)

(ENL) (2) (3)

(4)

Luciotype III

(LL)

(1) (2) (3)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5512

13

I( ): aspirin

chloroquine 2# hs (250 mg/#) ( )

prednisolone 40-60 mg 12 24Clofazimine ( 300mg 100mg)

II( ) prednisolone

60 mgThalidomide: 100 mg 100mg 1. 2.

Clofazimine ( 300mg 100mg)

Thalidomide

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5513

14

:

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5514

15

( )( ) 1.

2.

3.

( ) X ()

( )(Multidrug therapy, MDT)

1.

2. 1

2

3 4

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5515

16

5 P216 P2213.

4.

39

5. 1

B

26.

1

2

1.

2.

(1)a.

(a)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5516

17

(b)(c)

40(d)

30

(e) b .

(2)

( )( ) 1.

(1)(2)

(3)

(4)

(5) 30

(6)

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5517

18

(7) " "

(8)( 1.5 )

2.

(MDT)

12

12

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5518

19

Q&AQ1A

Q2A

Q3 A

Q4A

Q5 A

Q6A

Q7A

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5519

20

0Q80A

0Q90A

Q10A

Q11A

Q12A

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5520

21

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5521

22

794

08 30~11 3013 30~16 00

•�ƒÀ-02-B.p65 2007/1/29, §U§» 01:5522