ABSTRACT
Multidrug therapy (MDT), with rifampicin, dapsone, and clofazimine, treats leprosy infection but is insufficient in arresting or preventing the nerve damage that causes impairments and disabilities. This case-series study evaluates the benefits of the combined use of steroids and MDT in preventing nerve damage in patients with pure neural leprosy (PNL). In addition to MDT, 24 patients (88 percent male aged 20-79 years, median=41) received a daily morning dose of 60 mg prednisone (PDN) that was gradually reduced by 10 mg during each of the following 5 months. PNL was clinically diagnosed and confirmed by nerve histopathology or PCR. A low prevalence (8.3 percent) of reaction was observed after release from treatment. However, most of the clinical parameters showed significant improvement; and a reduction of nerve conduction block was observed in 42 percent of the patients. The administration of full-dose PDN improved the clinical and electrophysiological condition of the PNL patients, contributing to the prevention of further neurological damage.
A poliquimioterapia (PQT), com rifampicina, dapsona, e clofazimina, trata a infecção na hanseníase, mas é insuficiente para interromper ou prevenir o comprometimento neurológico que causa as incapacidades e desabilidades, nesta enfermidade. Este estudo de série de casos avalia o benefício do uso combinado de prednisona e PQT na prevenção do dano neurológico em pacientes com a forma neural pura da hanseníase (FNP). Além do PQT, 24 pacientes (88 por cento homens, com idade variando entre 20-79, mediana=41) receberam uma dose diária de 60 mg prednisona que foi reduzida gradualmente na dose de 10 mg durante cada um dos 5 meses subseqüentes. FNP foi diagnosticada clinicamente e confirmada através do estudo histopatológico ou PCR. Baixa prevalência de reação (8,3 por cento) foi observada apenas após o final do tratamento. A maioria dos parâmetros clínicos mostrou melhora significativa e redução do bloqueio de condução foi observada em 42 por cento dos pacientes. A administração de doses altas de prednisona melhora a evolução clínica e eletrofisiológica de pacientes com a FNP de hanseníase, contribuindo na prevenção de novos comprometimentos neurológicos.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Glucocorticoids/administration & dosage , Leprostatic Agents/administration & dosage , Leprosy, Tuberculoid/drug therapy , Peripheral Nervous System Diseases/prevention & control , Prednisone/administration & dosage , Clofazimine/administration & dosage , Drug Therapy, Combination , Dapsone/administration & dosage , Electrophysiology , Follow-Up Studies , Longitudinal Studies , Prospective Studies , Rifampin/administration & dosage , Treatment OutcomeABSTRACT
The production of interferon gamma (IFNgamma) guarantees effective T cell-mediated immunity against Mycobacterium tuberculosis infection. In the present study, we simply compare the in vitro immune responses to Mycobacterium antigens in terms of IFNg production in a total of 10 healthy Brazilian volunteers. Whole blood and mononuclear cells were cultivated in parallel with PPD, Ag85B, and M. bovis hsp65, and five-days supernatants were harvested for cytokine detection by ELISA. The inter-assay result was that the overall profile of agreement in response to antigens was highly correlated (r² = 0.9266; p = 0.0102). Potential analysis is in current progress to dictate the usefulness of this method to access the immune responses also in tuberculosis patients and its contacts.
Subject(s)
Humans , Male , Female , Adult , Interferon-gamma , Mycobacterium tuberculosis , T-Lymphocytes , Tuberculosis , Cell Culture Techniques , Enzyme-Linked Immunosorbent Assay , Interferon-gamma , Tuberculin Test , TuberculosisABSTRACT
The phenotypic features acquired subsequent to antigen-specific stimulation in vitro were evaluated by means of the kinetic expressions of CD69 and CD25 activation molecules on T lymphocytes and assayed by flow cytometry in response to PPD, Ag85B, and ferritin in PPD-positive healthy control individuals. In response to PHA, CD69 staining on both CD4+ and CD8+ T cells became initially marked after 4 h, peaked at 24 h, and quickly decreased after 120 h. For CD25, a latter expression was detected around 8 h, having increased after 96 h. As expected, the response rate to the mycobacterial antigens was much lower than that to the mitogen. Positive staining was high after 96 h for CD25 and after 24 h for CD69. CD69 expression was significantly enhanced (p < 0.05) on CD8+ as compared to CD4+ T cells. High levels were also found between 96-120 h. Regarding Ag85B, CD25+ cells were mostly CD4+ instead of CD8+ T cells. Moreover, in response to ferritin, a lower CD25 expression was noted. The present data will allow further characterization of the immune response to new mycobacterial-specific antigens and their evaluation for possible inclusion in developing new diagnostic techniques for tuberculosis as well in a new vaccine to prevent the disease
Subject(s)
Antigens, Bacterial , Antigens, CD , Antigens, Differentiation, T-Lymphocyte , CD4-Positive T-Lymphocytes , CD8-Positive T-Lymphocytes , Lymphocyte Activation/immunology , Mycobacterium tuberculosis , Receptors, Interleukin-2 , Acyltransferases , Bacterial Proteins , Ferritins , Flow Cytometry , TuberculinABSTRACT
The study of the relationship between Mycobacterium leprae and its human host, by investigating the bacterial components and the host immune response, will certainly provide the basis for a better treatment and control of leprosy. In addition, leprosy represents an attractive model from where important aspects regarding pathogen survival strategies, and the basic mechanisms involved in the regulation of the immune system can be learned. This review describes the definition of a major protein of the leprosy bacillus with a potential role in its virulence. The involvement of key cytokines and leukocyte subsets in protection and pathophysiology of this disease is also presented.