ABSTRACT
The clinical course of leprosy is often interrupted by reactions, which are acute inflammatory episodes that can be classified as type I or type II. Type II reactions can present as cutaneous lesions that resemble erythema multiforme (EM). EM is classically associated with drug allergies or pre-existing viral infections. However, the differential diagnostic criteria of the diverse causative agents remain controversial. The aim of this study was to determine both the clinical relevance and the morphological and immunohistochemical characteristics of the EM-like lesions during the course of type II leprosy reactions. Twenty-seven skin biopsies were taken from typical EM-like lesions of multibacillary patients and reviewed; their histological features were correlated to their clinical aspects. Then, a computer-assisted morphometric analysis was performed to measure the extent of angiogenesis during these acute episodes. The histopathological and immunohistochemical analysis of the EM lesions revealed that they shared the same features that have been previously described for ENL, including immunopositivity in the identical cell-mediated immune markers. Our results point to leprosy as the cause of the EM-like lesions in our patients. Therefore, leprosy should be considered in the differential diagnosis of EM.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Erythema Multiforme/pathology , Leprosy, Lepromatous/pathology , Biopsy , Diagnosis, Differential , ImmunohistochemistryABSTRACT
Contact surveillance is an important strategy to ensure effective early diagnosis and control of leprosy; passive detection may not be as efficient because it is directly tied to the ready availability of heath care services and health education campaigns. The aim of this study was to reinforce that contact surveillance is the most effective strategy for the control of leprosy. The analysed data were obtained from a cohort of contacts and cases diagnosed through a national referral service for leprosy. We analysed data from patients diagnosed between 1987-2010 at the Souza Araújo Ambulatory in Rio de Janeiro. Epidemiological characteristics of leprosy cases diagnosed through contact surveillance and characteristics of passively detected index cases were compared using a conditional logistic regression model. Cases diagnosed by contact surveillance were found earlier in the progression of the disease, resulting in less severe clinical presentations, lower levels of initial and final disability grades, lower initial and final bacterial indices and a lower prevalence of disease reaction. In this respect, contact surveillance proved to be an effective tertiary prevention strategy, indicating that active surveillance is especially important in areas of high endemicity, such as Brazil.
Subject(s)
Female , Humans , Male , Contact Tracing/statistics & numerical data , Leprosy/epidemiology , Population Surveillance , Brazil/epidemiology , Cohort Studies , Leprosy/transmission , PrevalenceABSTRACT
O objetivo deste trabalho foi comparar dados epidemiológicos de pacientes de hanseníase residentes em dois municípios com perfil socioeconômico e nível de endemicidade diferentes e que foram acompanhados em um mesmo centro de referência. Foi realizado um estudo descritivo dos dados de pacientes tratados no ambulatório Souza Araújo, 1986 a 2008, residentes nos municípios do Rio de Janeiro (n = 1353) e Duque de Caxias (n = 336). Entre os pacientes desta cidade, em comparação com os da outra, observou-se maior proporção de casos: com idade inferior a 15 anos, multibalicares, com maior índice baciloscópico (IB) inicial, e detectados através da vigilância de contatos. Os pacientes de Duque de Caxias apresentaram menor renda média e nível de escolaridade. Não foram observadas diferenças estatisticamente significativas quanto ao sexo, grau de incapacidade inicial, reação no diagnóstico, IB final, abandono e regularidade do tratamento. As diferenças encontradas entre os pacientes acompanhados em um mesmo centro de referência poderiam estar, em parte, relacionadas a diferenças contextuais existentes entre os municípios. Por outro lado, observou-se que a oferta de tratamento e acompanhamento podem minimizar o efeito que os fatores contextuais apresentam sobre os desfechos de saúde.
The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). Results: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.
Subject(s)
Adolescent , Female , Humans , Leprosy/epidemiology , Brazil/epidemiology , Referral and Consultation , Urban HealthABSTRACT
Em estudo aberto, näo comparativo, avaliou-se a eficácia e tolerabilidade do trioconazol creme a 1%, em dose única diária, durante 4 semanas, em 30 pacientes portadores de tinea corporis ou cruris. O agente etiológico predominante foi o T. rubrum (60%), e os pacientes foram avaliados clínica e micologicamente no pré-tratamento, na 1ª, 2ª e 4ª semanas após o início do tratamento. Ao final da 2ª semana de tratamento, 28 (93%) pacientes evidenciaram cura micológica e ao término da terapêutica, a avaliaçäo clínica final mostrou ser excelente em 100% dos pacientes, sendo que nesta ocasiäo todos encontravam-se micologicamente curados. Todos os pacientes consideraram o tioconazol creme 1% de fácil aplicaçäo, e que este näo manchava a pele nem a roupa. Apenas um paciente apresentou reaçäo adversa (prurido), de intensidade leve e transitória. Conclue-se que o tioconazol creme é um grande avanço na terapia antimicótica por ser bastante eficaz e seguro, apresentando como vantagem adicional a comodidade de poder ser utilizado, em dose única diária
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Imidazoles/therapeutic use , Mycoses/therapyABSTRACT
Apresenta-se um trabalho de investigaçäo retrospectiva sobre a ocorrência de doenças sexualmente transmissíveis nos últimos nove anos numa clínica dermatológica privada, tecendo consideraçöes sobre aspectos clínicos e epidemiológicos dos resultados encontrados, os quais assumem características peculiares em funçäo da especialidade clínica e da populaçäo nela atendida