ABSTRACT
Resumen Objetivo: Describir la frecuencia, las características clínico-demográficas y los factores relacionados con el retraso diagnóstico, con tratamientos incompletos y con el desarrollo de discapacidad entre el ingreso y el egreso de pacientes inscritos en el "Programa de Control de la Enfermedad de Hansen del Valle del Cauca", de 2010 a 2016. Metodología: Se realizó un estudio observacional descriptivo de una cohorte retrospectiva de pacientes con lepra. Resultados: La incidencia promedio fue de 0,99 casos / 100 000 habitantes. La mediana de edad fue 54 años (rango intercuartílico: 39-65); el 58,82 % fueron hombres, el 49,73 % pertenecía al régimen subsidiado. El 83,68 % fueron casos nuevos, de los cuales, el 76,47 % eran multibacilares (47,9 % con lepra lepromatosa). El 59,54 % manifestó discapacidad y el 10,54 % tuvo leprorreacciones. El 50% presentó retraso diagnóstico, y el 9,09 %, abandonó tratamiento. Se encontró dependencia significativa entre retraso diagnóstico y discapacidad al ingreso (or: 2,09, ic 95 %: 1,28-3,41, p= 0,003), y entre la no finalización del tratamiento y ser previamente tratado (or: 2,82, ic 95 %: 1,28-6,18, p= 0,009). Conclusión: La lepra continúa siendo frecuente en el Valle del Cauca. El retraso diagnóstico y el ingreso con alguna discapacidad connotan captación tardía de los pacientes y en estadios avanzados. El abandono y la discapacidad al egreso se suman a la complejidad de la situación. Se evidencia la necesidad de fortalecer las intervenciones actuales dirigidas hacia el paciente, sus contactos domiciliarios, el personal de salud y la comunidad en general.
Abstract Objective: To describe the frequency, clinical-demographic characteristics and factors related to delayed diagnosis, incomplete treatments, and development of disability from admission to discharge of patients enrolled in the "Hansen's Disease Control Program of Valle del Cauca", from 2010 to 2016. Methodology: A descriptive observational study of a retrospective cohort of patients with leprosy was conducted. Results: The average incidence was 0.99 cases / 100 000 inhabitants. The median age was 54 years (interquartile range: 39-65); 58.82% were men, 49.73 % belonged to the subsidized regime. 83.68% were new cases, of which 76.47% were multibacillary (47.9% with lepromatous leprosy). 59.54% were disabled, and 10.54% experienced leprotic reactions. 50% had a delayed diagnosis, and 9.09 % abandoned treatment. Significant dependence was found between delayed diagnosis and disability at admission (OR: 2.09, CI 95 %: 1.28-3.41, p = 0.003), and between non-completion of treatment and prior treatment (OR: 2.82, CI 95 %: 1.28-6.18, p = 0.009). Conclusion: Leprosy continues to be frequent in Valle del Cauca. Delayed diagnosis and disability at admission imply late identification of patients in advanced stages. Abandonment and disability are additional factors in this complex situation. It is evident the need to strengthen current interventions aimed at the patient, their home contacts, healthcare workers, and the community.
Resumo Objetivo: Descrever a frequência, as características clínico-demográficas e os fatores relacionados com o atraso do diagnóstico, com tratamentos incompletos e com o desenvolvimento de incapacidade entre a ingresso e o egresso de pacientes inscritos no "Programa de Controle da Enfermidade de Hansen do Valle del Cauca", de 2010 a 2016. Metodologia: Foi realizado um estudo observacional descritivo de uma coorte retrospectiva de pacientes com lepra. Resultados: A incidência média foi de 0,99 casos/100000 habitantes. A média de idade foi de 54 anos (intervalo interquartil: 39-65); 58,82% foram homens, 49,73% pertenciam ao regime subsidiado. Um total de 83,68% foram de novos casos, dos quais, 76,47% eram multibacilares (47,9% com lepra lepromatosa). Um 59,54% manifestaram incapacidade e 10,54% tiveram lepro-reações. Um 50% apresentaram atraso no diagnóstico e 9,09% abandonaram o tratamento. Encontrou-se significativa dependência entre atraso no diagnóstico e incapacidade no ingresso (OR: 2,09, IC95%: 1,28-3,41, p= 0,003), e entre a não-finalização do tratamento e ser previamente tratado (OR: 2,82, IC95%: 1,28-6,18, p= 0,009). Conclusão: A lepra continua sendo frequente no Valle del Cauca. O atraso no diagnóstico e o ingresso com alguma incapacidade indicam captação tardia dos pacientes e em estágios avançados. O abandono e a incapacidade ao ingresso são somados à complexidade da situação. É evidente a necessidade de fortalecer as intervenções atuais dirigidas ao paciente, seus contatos domiciliares o pessoal de saúde e a comunidade em geral.
ABSTRACT
Mycobacterium leprae and Mycobacterium lepromatosis are gram-positive bacterial pathogens and the causative agents of leprosy in humans across the world. The elimination of leprosy cannot be achieved by multidrug therapy alone, and highlights the need for new tools and drugs to prevent the emergence of new resistant strains. Methods In this study, our contribution includes the prediction of vaccine targets and new putative drugs against leprosy, using reverse vaccinology and subtractive genomics. Six strains of Mycobacterium leprae and Mycobacterium lepromatosis (4 and 2 strains, respectively) were used for comparison taking Mycobacterium leprae strain TN as the reference genome. Briefly, we used a combined reverse vaccinology and subtractive genomics approach. Results As a result, we identified 12 common putative antigenic proteins as vaccine targets and three common drug targets against Mycobacterium leprae and Mycobacterium lepromatosis. Furthermore, the docking analysis using 28 natural compounds with three drug targets was done. Conclusions The bis-naphthoquinone compound Diospyrin (CID 308140) obtained from indigenous plant Diospyros spp. showed the most favored binding affinity against predicted drug targets, which can be a candidate therapeutic target in the future against leprosy.(AU)
Subject(s)
Gram-Positive Rods/pathogenicity , Vaccinology , Mycobacterium leprae/pathogenicity , Mycobacterium lepraemurium/pathogenicityABSTRACT
RESUMEN La lepra es una enfermedad causada por Mycobacterium leprae. Su evolución crónica a veces se ve interrumpida por cuadros inmunológicos llamados reacción leprosa en pacientes con alta carga bacilar. Estos cuadros inmunológicos incrementan la morbilidad y pueden complicarse, volviéndose potencialmente mortales. En el espectro de estas reacciones, se han descrito algunas caracterizadas por lesiones vasculo necróticas, como el Fenómeno de Lucio y el eritema nodoso lepromatoso necrosante, que son asociadas a la lepra lepromatosa difusa y a la especie de bacilos recién descripta, Mycobacterium lepromatosis. Presentamos un paciente de sexo femenino de 21 años de edad, que duranteel tratamiento específico para lepra multibacilar presentó cuadros recidivantes de eritema nudoso que evolucionó a la forma necrosante. En este paciente se precisó a través de la biología molecular la presencia simultánea de M. leprae y M. lepromatosis como causantes de la enfermedad. Este caso representa la primera comunicación de M. lepromatosis en el Paraguay, y también la primera infección dual como agente causante de lepra, en asociación con el M. leprae.
ABSTRACT Leprosy is a disease caused by Mycobacterium leprae. Its chronic evolution is sometimes interrupted by immunological conditions called leprosy reaction in patients with high bacillary load. These immunological conditions increase morbidity and can be complicated, becoming life threatening. In the spectrum of these reactions, some characterized by vasculonecrotic lesions have been described, such as Lucio's Phenomenon and Necrotizing Lepromatous Nodus Erythem, which are associated with diffuse lepromatous leprosy and the species of bacilli just described, Mycobacterium lepromatosis. We present a 21-year-old female patient, who during specific treatment for multibacillary leprosy presented recurrent pictures of erythema nodosum that evolved to the necrotizing form. In this patient, the simultaneous presence of M. leprae and M. lepromatosis as the cause of the disease was determined through molecular biology. This case represents the first communication of M. lepromatosis in Paraguay, and also the first dual infection as a causative agent of leprosy, in association with M. leprae.
ABSTRACT
La lepra es una enfermedad causada por Mycobacterium leprae. Su evolución crónica a veces se ve interrumpida por cuadros inmunológicos llamados reacción leprosa en pacientes con alta carga bacilar. Estos cuadros inmunológicos incrementan la morbilidad y pueden complicarse, volviéndose potencialmente mortales. En el espectro de estas reacciones, se han descrito algunas caracterizadas por lesiones vasculo necróticas, como el Fenómeno de Lucio y el eritema nodoso lepromatoso necrosante, que son asociadas a la lepra lepromatosa difusa y a la especie de bacilos recién descripta, Mycobacterium lepromatosis. Presentamos un paciente de sexo femenino de 21 años de edad, que durante el tratamiento específico para lepra multibacilar presentó cuadros recidivantes de eritema nudoso que evolucionó a la forma necrosante. En este paciente se precisó a través de la biología molecular la presencia simultánea de M. leprae y M. lepromatosis como causantes de la enfermedad. Este caso representa la primera comunicación de M. lepromatosis en el Paraguay, y también la primera infección dual como agente causante de lepra, en asociación con el M. leprae.
Leprosy is a disease caused by Mycobacterium leprae. Its chronic evolution is sometimes interrupted by immunological conditions called leprosy reaction in patients with high bacillary load. These immunological conditions increase morbidity and can be complicated, becoming life threatening. In the spectrum of these reactions, some characterized by vasculonecrotic lesions have been described, such as Lucio's Phenomenon and Necrotizing Lepromatous Nodus Erythem, which are associated with diffuse lepromatous leprosy and the species of bacilli just described, Mycobacterium lepromatosis. We present a 21-year-old female patient, who during specific treatment for multibacillary leprosy presented recurrent pictures of erythema nodosum that evolved to the necrotizing form. In this patient, the simultaneous presence of M. leprae and M. lepromatosis as the cause of the disease was determined through molecular biology. This case represents the first communication of M. lepromatosis in Paraguay, and also the first dual infection as a causative agent of leprosy, in association with M. leprae.
ABSTRACT
BACKGROUND: The causative agents of leprosy are the well-known Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. This agent was found in 2008, and it was found to be the cause of diffuse lepromatous leprosy in two Mexican patients. OBJECTIVE: The objective of this work was to determine if M. leprae and M. lepromatosis were present in formalin-fixed and paraffin-embedded skin samples from cases from different regions in Mexico. METHODS: A total of 41 skin samples were obtained from 11 states of Mexico. All patients' samples were diagnosed by clinical and histopathological analyses. Total DNA was isolated using a Qiagen-DNeasy blood and tissue kit and molecular identification was achieved by two semi-nested polymerase chain reactions. RESULTS: The 41 patient included 33 samples from men and 8 samples from women; 29 samples were polymerase chain reaction (PCR)-positive to Mycobacterium and 12 samples were PCR-negative. From those 29 samples, 13 were PCR-positive to M. leprae, 8 to M. lepromatosis and 8 were positive to both species. The histopathological diagnosis included; Nodular lepromatous leprosy (NLL); Diffuse lepromatous leprosy (DLL); and Borderline leprosy (BL). The 29 PCR-positive samples were classified as follow: 14 NLL, 4 DLL, and 11 BL. In the 12 samples negative to Mycobacterium, 7 showed the NLL, 2 DLL and 3 BL. CONCLUSION: These findings add evidence to the M. leprae and M. lepromatous distribution, clinical forms and participation of dual infections in Mexico.
Subject(s)
Female , Humans , Male , Diagnosis , DNA , Hospital Distribution Systems , Leprosy , Leprosy, Borderline , Leprosy, Lepromatous , Mexico , Mycobacterium leprae , Mycobacterium , Polymerase Chain Reaction , SkinABSTRACT
Diffuse lepromatous leprosy (DLL) is a severe clinical outcome of lepromatous leprosy (LL). The aetiologic cause is believed to be different from Mycobacterium leprae. A new species, Mycobacterium lepromatosis, was identified from a group of Mexican patients with DLL, and severe leprosy reactional state type 3 (Lucio's phenomenon). However, a total sequencing of its genome is necessary to prove the existence of this new species. This is a report on a non-typical Colombian case of leprosy - HIV coinfection, associated with an immune reconstitution inflammatory syndrome clinically compatible with a leprosy reaction type 3 or Lucio's phenomenon.
La lepra difusa (LLD) es una variedad de la lepra lepromatosa (LL), frecuente enMéxico. El agente etiológico se cree que es diferente a Mycobacterium leprae y se considerauna especie nueva denominada Mycobacterium lepromatosis, hecho que no se ha comprobado.El reporte de este caso se realiza para dar a conocer el cuadro clínico atípico que presentóuna paciente colombiana con coinfección VIH---LL variedad difusa (LLD), asociado a síndromede reconstitución inmunológica, compatible clínicamente con una leprorreacción tipo 3 o fenó-meno de Lucio.