Respuesta inmune en pacientes con diagnóstico de lepra

Introducción: La lepra es una entidad de expresión florida con afectación frecuente en el tegumento cutáneo y los nervios periféricos, por la predisposición que presenta el Mycobacterium leprae a estas estructuras. Las reacciones leprosas pueden aparecer en el curso de la enfermedad. Estas interrumpen la evolución crónica usual y la estabilidad clínica de los pacientes que la padecen. Objetivo: Caracterizar los estados reaccionales de la lepra. Materiales y métodos: Se realizó un estudio descriptivo en el período de enero de 2019 a septiembre de 2022, en pacientes que acudieron a la Consulta Provincial de Lepra en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. El universo estuvo constituido por 8 pacientes que presentaron estados reaccionales en la etapa mencionada. Se recogieron de las historias clínicas variables como: edad, sexo, clasificación de la lepra según Ridley-Jopling, tipo de estado reaccional, forma clínica y momento de aparición. Resultados: La mayor frecuencia estuvo entre el rango de 50 a 64 años, con un 50 %. El sexo masculino representa el 62,5 %. Se mostró prevalencia de la lepra lepromatosa en el 62,5 %. La reacción tipo II y las formas graves fueron las más frecuentes, con un 62,5 % y 75 % respectivamente. Existió predominio de las reacciones leprosas durante y después del tratamiento, sin diferencias entre estas, con un 37,5 %. Conclusiones: La reacción tipo II y las formas graves de presentación fueron las predominantes en pacientes masculinos, representados en el grupo etario de 50 a 64 años. La forma clínica preponderante en estos eventos fue la lepromatosa.

Introduction: Leprosy is a floridly expressed entity with frequent involvement of the cutaneous integument and peripheral nerves due to the predisposition of Mycobacterium leprae to these structures. Leprosy reactions may appear during the course of the disease. These interrupt the usual chronic course and the clinical stability of patients suffering from the disease. Objective: To characterize the reactional states of leprosy. Materials and methods: A descriptive study was carried out from January 2019 to September 2022 in patients who attended the Provincial Leprosy Clinic at the Clinical Surgical University Hospital Comandante Faustino Pérez Hernández, in Matanzas. The universe consisted of 8 patients who presented reactional states in the aforementioned stage. The variables, collected from the clinical records, were: age, sex; classification of leprosy according to Ridley-Jopling, type of reactional state, clinical form and time of onset. Results: The highest frequency was between 50 and 64 years, with 50%. The male sex represents 62.5%. Lepromatous leprosy prevalence was shown in 62.5%. The type II reaction and severe forms were the most frequent with 62.5% and 75% respectively. There was predominance of leprosy reactions during and after treatment without differences between them, with 37.5%. Conclusions: The type II reaction with severe forms of presentation was predominant in male patients represented in the age group of 50 to 64 years. The predominant clinical form in these events was the lepromatous one.

Caracterización clinicoepidemiológica de pacientes con estados reaccionales de lepra / Clinical and epidemiological characterization of patients with leprosy reactional states

Se realizó un estudio observacional y descriptivo de 50 pacientes con estados reaccionales de lepra, ingresados en el servicio de dermatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba durante el quinquenio 2009-2013, a fin de caracterizarles según algunas variables clinicoepidemiológicas, para lo cual además se empleó el cálculo porcentual y el test de correlación de Pearson. En la serie predominaron el sexo masculino (56,0 %), el grupo etario de 30-49 años (48,0 %) y la variedad clínica dimorfa lepromatosa (40,0 %); asimismo se observó que los estados reaccionales aparecieron principalmente después del tratamiento (64,0 %), por lo general con un único episodio (58,0 %), y que la reacción de reversión resultara más común (32,0 %), con una mayor frecuencia de la forma grave (69,0 %).

An observational and descriptive study of 50 patients with reactional states of leprosy, admitted in the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the five year period 2009-2013, in order to characterize them according to some clinical and epidemiological variables, for which the calculation percentage and the Pearson correlation test were also used. The male sex (56.0%), the age group 30-49 (48.0%) and the clinical variety dimorpha lepromatous (40.0%) prevailed in the series; it was also observed that the reactional states appeared mainly after the treatment (64.0%), in general with just one episode (58.0%), and that the reversion reaction was more common (32.0%), with a higher frequency in the severe type (69.0%).

Reações hansênicas em pacientes em alta por cura pela poliquimioterapia / Leprosy reactions in discharged patients following cure by multidrug therapy

INTRODUÇÃO: Reações hansênicas são a principal causa de lesões dos nervos e incapacidades provocadas pela hanseníase. MÉTODOS: Estudo retrospectivo com objetivo de verificar a frequência de reações hansênicas em pacientes com alta por cura pela poliquimioterapia (PQT). RESULTADOS: Pacientes que apresentaram reações durante o tratamento, 35,5 por cento continuaram pós-PQT; aqueles que não apresentaram no tratamento, somente 12,7 por cento tiveram pós-PQT; 63,4 por cento multibacilares apresentaram durante e 31,7 por cento após; paucibacilares 27,7 por cento durante e 8,3 por cento após. CONCLUSÕES: Existe relação diretamente proporcional entre presença de reações durante e após o tratamento. Formas clínicas multibacilares apresentam maior frequência de reações durante e após a cura.

INTRODUCTION: Reactional states are the main cause of nerve lesions and incapacities provoked by leprosy. METHODS: Retrospective study aimed at verifying the frequency of leprosy reactions in discharged patients following cure by multidrug therapy (MDT). RESULTS: Among patients who presented reactions during treatment, 35.5 percent continued after MDT; of those that did not present during treatment, only 12.7 percent presented after discharge; 63.4 percent multibacillary patients presented during and 31.7 percent after; 27.7 percent paucibacillary patients presented during and 8.3 percent after. CONCLUSIONS: A direct proportional relation exists between the presence of reactions during and after treatment. Multibacillary clinical forms present a greater frequency of reactions during and after cure.