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1.
An. Fac. Cienc. Méd. (Asunción) ; 55(2): 88-91, 20220801.
Article in Spanish | LILACS | ID: biblio-1380445

ABSTRACT

El fenómeno de Lucio es un estado reaccional grave, poco frecuente, mediado por inmunocomplejos que se observa típicamente en los casos de lepra lepromatosa difusa. En Paraguay, corresponde aproximadamente al 2% de los casos de lepra diagnosticados en la mayoría de los casos, se presenta como debut de la enfermedad. Se manifiesta con lesiones en la piel de tipo máculas y placas purpúricas poligonales, generalmente sin compromiso visceral. El diagnóstico lo confirma el estudio histopatológico y es fundamental realizar el diagnóstico diferencial con vasculitis de otras etiologías.


Lucio's phenomenon is a rare and severe reactional state mediated by immune complexes that is commonly seen in cases of diffuse lepromatous leprosy. In Paraguay, it represents approximately 2% of leprosy diagnosed cases, mainly as a debut of the disease. It manifests with macule-type skin lesions and polygonal purpuric plaques, generally without visceral involvement. The diagnosis is confirmed by the histopathological study and it is essential to consider differential diagnosis such as vasculitis of other etiologies.


Subject(s)
Leprosy , Leprosy, Lepromatous
2.
J. pediatr. (Rio J.) ; 98(4): 431-437, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1386105

ABSTRACT

Abstract Objective: To analyze the prevalence of Mycobacterium leprae detection and the associated factors among social contacts in the school environment of multibacillary cases living in a hyperendemic municipality of the state of Mato Grosso. Methods: Cross-sectional study with 236 social contacts of multibacillary leprosy from public schools and residents in Cuiabá (Mato Grosso) in 2018. The sources of information were interviews and nasal swab tests for molecular analysis by polymerase chain reaction - PCR. For the prevalence ratio estimates, crude and adjusted analyses were performed using robust Poisson regression and their respective confidence intervals (95% CI). The ArcGIS 9.1 software was used for the geographic distribution analyses. Results: The prevalence of detection of M. leprae in social contacts was 14%. A total of 63.6% of the schools surveyed had 5.1% to 50% of the social contacts of leprosy with positive PCR. The analysis of the geographic distribution in the neighborhoods showed a high prevalence of infection, being higher than 50% in some localities. The highest proportion of positive results occurred in the northern region of the city and from a precarious socioeconomic class. Conclusion: The results showed a high prevalence of detection of M. leprae among social contacts in areas with poor socioeconomic conditions. In these regions, there is a greater risk of

3.
Ciênc. Saúde Colet. (Impr.) ; 27(6): 2255-2258, jun. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1375007

ABSTRACT

Resumo A hanseníase é uma doença dermato-neurológica, infecciosa, sistêmica ou localizada, debilitante, causada por Mycobacterium leprae. No Brasil, a magnitude e o alto poder incapacitante mantêm a doença como um problema de saúde pública. Mancha na pele e dormência são sinais e sintomas patognomônicos na hanseníase. A Pesquisa Nacional de Saúde de 2019 (PNS-2019), do Instituto Brasileiro de Geografia e Estatística (IBGE), considerou a seguinte pergunta como proxy para estimar sua magnitude no país. "O(a) sr(a). tem mancha com dormência ou parte da pele com dormência?". No Brasil, 1.921.289 adultos referiram ter mancha ou parte da pele com dormência, sem diferenças regionais. Com relação ao grupo etário, quanto mais velho, maior a prevalência. Por exemplo, entre os de 18 a 29 anos (235.445) e de 30 a 39 anos (236.485), 0,7% possuía a condição, entre 40 e 59 anos (827.887), 1,5%, e entre os idosos, 1,8% (621.472). Poder estimar, em pesquisas de base populacional, com representatividade estatística, uma morbidade referida tal como a hanseníase é fundamental para apoiar a formulação de políticas públicas, notadamente as relativas às ações da atenção primária à saúde. Dessa forma, o IBGE cumpre seu papel constitucional de retratar a realidade da população brasileira e hoje é o principal avaliador externo do Sistema Único de Saúde (SUS) e das políticas públicas instituídas no âmbito federal.


Abstract Leprosy is a debilitating, infectious, systemic or localized dermato-neurological disease caused by Mycobacterium lepra. In Brazil, the magnitude and high disabling power keep the disease as a public health problem. Skin spotting and numbness are pathognomonic signs and symptoms in leprosy. The Instituto Brasileiro de Geografia e Estatística (IBGE) 2019 National Health Survey (PNS-2019) considered the following question as a proxy to estimate its magnitude in the country. "Do you have a spot with numbness or part of the skin with numbness?". In Brazil, 1,921,289 adults reported having a patch or part of the skin with numbness, with no regional differences. As for the age group, the older, the higher the prevalence, for example, between 18 to 29 years old (235,445) and 30 to 39 years old (236,485), 0.7% had the condition, between 40 to 59 years old (827,887), 1.5% and among the elderly, 1.8% (621,472). Being able to estimate, in population-based surveys, with statistical representativeness, a reported morbidity such as leprosy is essential to support the formulation of public policies, notably those related to primary health care actions. In this way, the IBGE fulfills its constitutional role of portraying the reality of the Brazilian population and today it is the main external evaluator of the Unified Health System (SUS) and of public policies developed by the federal level.

4.
Cogit. Enferm. (Online) ; 27: e82221, Curitiba: UFPR, 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1394307

ABSTRACT

RESUMO Objetivo: analisar o perfil sociodemográfico e clínico dos casos notificados de hanseníase em menores de 15 anos, no município de São Luís - Maranhão - Brasil. Método: estudo descritivo realizado com 826 casos notificados no Sistema de Informação de Agravos de Notificação, em São Luís - Maranhão, no período de 2010 a 2019. Os dados foram analisados por meio de estatística descritiva e foram expressos em frequências absolutas e relativas. Resultados: faixa etária entre 10 e 14 anos (60,29%), masculino (51,09%), cor parda (69,59%), ensino fundamental incompleto (39,58%), multibacilar (62,71%), forma clínica dimorfa (54,24%), até cinco lesões (74,45%), zero a dois nervos afetados (83,23%), sem baciloscopia (46,28%), casos novos (93,70%), demanda espontânea (46,38%) e grau zero de incapacidade no diagnóstico (78,98%). Conclusão: foram demostrados parâmetros hiperendêmicos com elevado risco para a doença. Destaca-se a importância de criar estratégias de controle e prevenção para reduzir a transmissão da hanseníase em crianças.


ABSTRACT Objective: to analyze the sociodemographic and clinical profile of reported cases of Hansen´s disease in children under 15 years old in the municipality of São Luís - Maranhão - Brazil. Method: descriptive study conducted with 826 cases reported in the Notifiable Diseases Information System, in São Luís - Maranhão, in the period from 2010 to 2019. Data were analyzed using descriptive statistics and were expressed in absolute and relative frequencies. Results: age group between 10 and 14 years (60.29%), male (51.09%), brown (69.59%), incomplete elementary education (39.58%), multibacillary (62.71%), dimorphic clinical form (54.24%), up to five lesions (74.45%), zero to two nerves affected (83.23%), no bacilloscopic (46.28%), new cases (93.70%), spontaneous demand (46.38%) and zero degree of disability at diagnosis (78.98%). Conclusion: hyper-endemic parameters with high risk for the disease were demonstrated. It is important to create control and prevention strategies to reduce Hansen´s disease transmission in children.


RESUMEN Objetivo: analizar el perfil sociodemográfico y clínico de los casos notificados de lepra en niños menores de 15 años, en el municipio de São Luís - Maranhão - Brasil. Método: estudio descriptivo realizado con 826 casos notificados en el Sistema de Información de Enfermedades de Declaración Obligatoria, en São Luís - Maranhão, en el período de 2010 a 2019. Los datos se analizaron mediante estadísticas descriptivas y se expresaron en frecuencias absolutas y relativas. Resultados: edad entre 10 y 14 años (60,29%), sexo masculino (51,09%), color marrón (69,59%), educación elemental incompleta (39,58%), multibacilar (62,71%), forma clínica dimórfica (54,24%), hasta cinco lesiones (74,45%), de cero a dos nervios afectados (83,23%), sin baciloscopia (46,28%), casos nuevos (93,70%), demanda espontánea (46,38%) y cero grado de discapacidad en el momento del diagnóstico (78,98%). Conclusión: se demostraron parámetros hiperendémicos con alto riesgo de enfermedad. Destaca la importancia de crear estrategias de control y prevención para reducir la transmisión de la lepra en los niños.

5.
Ciênc. Saúde Colet. (Impr.) ; 27(4): 1641-1652, abr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374937

ABSTRACT

Abstract This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.


Resumo O objetivo deste estudo foi analisar o padrão de distribuição espacial de novos casos de hanseníase em menores de 15 anos e seus contatos. Estudo transversal, descritivo, abrangendo características sociodemográficas e análise espacial. Os participantes eram de Sobral, Ceará e o estudo foi realizado entre agosto de 2014 e setembro de 2015. Os contatos foram identificados pelos responsáveis pelas crianças. A soropositividade foi determinada com o antígeno NDO-LID e os casos positivos foram plotados em polígonos de Voronoi. Nove novos casos de hanseníase em menores de 15 anos foram encontrados. O número médio de pessoas que conviviam com os casos foi superior ao número de pessoas que conviviam com contatos não domiciliares. Todos os contatos domiciliares sabiam de outros casos de hanseníase e apresentaram maior taxa de testes soropositivos do que os contatos não domiciliares. Os casos índice residiam nas regiões mais pobres do município e em áreas hiperendêmicas. A análise espacial revelou um agrupamento de infecção subclínica em um raio de 102 metros, sugerindo que a transmissão não domiciliar está relacionada à proximidade com indivíduos soropositivos. Concluindo, a busca por novos casos de hanseníase não pode se restringir aos contatos domiciliares.

6.
An. bras. dermatol ; 97(2): 231-235, Mar.-Apr. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374231

ABSTRACT

Abstract Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.

7.
Nursing (Säo Paulo) ; 25(287): 7553-7567, abr.2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1372473

ABSTRACT

Objetivo: identificar a prevalência de pacientes notificados com hanseníase em São Luís, Maranhão, durante 2010-2020. Método: estudo descritivo, exploratório, retrospectivo, transversal, quantitativo, realizado no Banco de Dados público do DATASUS cuja coleta ocorreu em agosto de 2021. A amostra foi composta por 9.387 pacientes notificados com Hanseníase. Resultados: observa-se prevalência amostral em maio de 2012, sexo masculino, faixa etária entre 30-39 anos, Ensino Médio completo, pardos, casos multibacilares, avaliação de incapacidade física e de cura no estágio Grau 0, apresentaram mais que cinco lesões, baciloscopia negativa, episódios sem reação,sendo abordados como casos novos cuja forma prevalente foi a dimorfa, tendo como esquema terapêutico mais prescrito a poliquimioterapia durante 12 meses e prevalência de cura. Conclusão: houve uma prevalência dos casos de hanseníase em homens jovens com bom grau de instrução escolar. Apesar da alta prevalência de casos novos, o tratamento foi efetivo de modo a levá-los à cura.(AU)


Objective: to identify the prevalence of patients notified with leprosy in São Luís, Maranhão, during 2010-2020. Method: descriptive, exploratory, retrospective, cross-sectional, quantitative study, conducted in the public database of the DATASUS whose collection occurred in August 2021. The sample was composed of 9,387 patients notified with Leprosy. Results: sample prevalence was observed in May 2012, male gender, age range 30-39 years, complete High School, brown, multibacillary cases, evaluation of physical disability and cure in Grade 0 stage, presented more than five lesions, negative bacilloscopy, episodes without reaction, being addressed as new cases whose prevalent form was the dimorphic, having as the most prescribed therapeutic scheme the polychemotherapy for 12 months and prevalence of cure. Conclusion: there was a prevalence of leprosy cases in young men with good schooling. Despite the high prevalence of new cases, the treatment was effective in order to lead them to cure(AU)


Objetivo: identificar la prevalencia de pacientes con lepra notificados en São Luís, Maranhão, durante 2010-2020. Método: estudio descriptivo, exploratorio, retrospectivo, transversal, cuantitativo, realizado en la base de datos pública DATASUS, la cual fue recolectada en agosto de 2021. La muestra estuvo conformada por 9.387 pacientes reportados con lepra. Resultados: se tiene una muestra de prevalencia en mayo de 2012, sexo masculino, grupo etario entre 30-39 años, bachillerato completo, pardos, casos multibacilares, valoración de incapacidad física y curación en la etapa Grado 0, presentaba más de cinco lesiones, baciloscopía negativa , episodios sin reacción, siendo abordados como casos nuevos cuya forma prevalente fue borderline, siendo el régimen terapéutico más prescrito la polimedicación durante 12 meses y prevalencia de cura.Conclusión: había una prevalencia de casos de lepra en hombres jóvenes con buena escolaridad. A pesar de la alta prevalencia de casos nuevos, el trataminto fue eficaz de manera que los curará(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Disease Notification , Leprosy/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Health Information Systems , Sociodemographic Factors
8.
J. health sci. (Londrina) ; 24(1): 06-11, 20220322.
Article in English | LILACS-Express | LILACS | ID: biblio-1362801

ABSTRACT

The individuals with Hansen's disease experience situations of prejudice that, together with stigma and discrimination, culminate in social isolation and restrictions in social relationships. The aim of this study was to assess the perception of leprosy patients about their quality of life. This is a cross-sectional, quantitative study, whose convenience sample consisted of 94 leprosy patients, undergoing treatment, who attended health units in the city of Cuiabá, MT, Brazil. A structured questionnaire with sociodemographic data and information about the patient's knowledge about leprosy, prejudice, self-esteem and quality of life, was applied between April and August 2018.The results showed in the investigated population a predominance of males (55.3%), individuals with high school education (28.7%) and with an income ranging from 1 to 3 minimum wages (67%).The interviewees pointed out the side effects (44.7%) and the duration period (28.7%) as the greatest difficulty in the treatment. Most of the investigated (72.3%) had great knowledge about the disease, among which 26.6% had already suffered the leprosy reaction.40.4% of individuals were depressed and sad, and 69.1% had problems in employment after the diagnosis of the disease. When the quality of life was investigated, 45.7% of leprosy patients classified the domains evaluated between bad and very bad. Physical pain was associated with 43.7% of the individuals being unable to perform daily tasks. It can be concluded that leprosy causes suffering beyond pain and discomfort, with great social and psychological impact. (AU)


Os pacientes com hanseníase vivenciam situações de preconceito que, com o estigma e a discriminação, culminam para o isolamento social e a restrição dos relacionamentos sociais. O objetivo do presente estudo foi avaliar a percepção do paciente com hanseníase sobre sua qualidade de vida. Trata-se de um estudo transversal, quantitativo, cuja amostra de conveniência foi composta por 94 pacientes hansenianos, em fase de tratamento, que frequentavam as Unidades de Saúde do município de Cuiabá/MT, Brasil. Um questionário estruturado com dados sociodemográficos e informações sobre o conhecimento do paciente sobre a hanseníase, preconceito, autoestima e qualidade de vida, foi aplicado entre abril e agosto de 2018. Os resultados mostraram, na população investigada, um predomínio de indivíduos do sexo masculino (55,3%), com ensino médio completo (28,7%) e com renda entre 1 e 3 salários mínimos (67%). Os entrevistados apontaram como maior dificuldade do tratamento os efeitos colaterais (44,7%) e o período de duração (28,7%). A maioria dos investigados (72,3%) apresentava grande conhecimento sobre a doença, dentre os quais 26,6% já haviam sofrido a reação hansênica. 40,4% dos indivíduos encontravam-se deprimidos e tristes e 69,1%, tiveram problemas no emprego após o diagnóstico da doença. Quando a qualidade de vida foi investigada, 45,7% dos hansenianos classificaram os domínios avaliados entre ruim e muito ruim. A dor física foi associada ao impedimento do desempenho das tarefas diárias por 43,7% dos indivíduos. Pode-se concluir que a hanseníase causa sofrimento aos indivíduos que ultrapassa a dor e o mal-estar estritamente vinculados ao prejuízo físico, com grande impacto social e psicológico. (AU)

9.
RECIIS (Online) ; 16(1): 28-47, jan.-mar. 2022. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1366518

ABSTRACT

A colaboração científica entre pesquisadores, instituições e países tem despertado o interesse de estudiosos da ciência da informação que desejam conhecer as relações estabelecidas entre os atores envolvidos, a dinâmica e a evolução dos padrões sociais na comunicação científica. Por meio de análise bibliométrica, este estudo objetiva visualizar a rede de colaboração científica entre a comunidade discursiva que conduz pesquisas sobre hanseníase no Brasil, por meio das relações de coautoria institucional. As características da colaboração foram estudadas a partir da coautoria de 498 artigos indexados na base de dados Web of Science no período de 2016 a 2020. As análises revelam que parte significativa dos artigos foi publicada por um grupo reduzido de instituições e que as universidades, apesar de maior número, possuem publicações mais pulverizadas e não ocupam a centralidade da rede, que é dominada por institutos de pesquisa, que concentram grande número de publicações em poucas unidades.


Scientific collaboration between researchers, institutions and countries has aroused the interest of Information Science scholars who want to know the relationships established between the actors involved, the dynamics and evolution of social standards in scientific communication. Through bibliometric analysis, this study aims to visualize the network of scientific collaboration between the discursive community that conducts research on leprosy in Brazil through institutional co-authoring relationships. Collaboration characteristics were studied based on the co-authorship of 498 articles indexed in the Web of Science database in the period 2016-2020. The analyzes reveal that a significant part of the articles was published by a small group of institutions and that, despite the greater number, the universities have more widely distributed publications and don't occupy the centrality of the network, which is dominated by research institutes, which concentrate a large number of publications in a few units.


La colaboración científica entre investigadores, instituciones y países ha despertado el interés de los estudiosos de las Ciencias de la Información que quieren conocer las relaciones que se establecen entre los actores involucrados, la dinámica y evolución de los estándares sociales en la comunicación científica. A través del análisis bibliométrico, este estudio tiene como objetivo visualizar la red de colaboración científica entre la comunidad discursiva que realiza investigaciones sobre la lepra en Brasil a través de relaciones institucionales de coautoría. Las características de la colaboración fueran estudiadas a partir de la coautoría de 498 artículos indexados en la base de datos de Web of Science en el período de 2016 hasta 2020. Los análisis revelan que una parte importante de los artículos fue publicada por un grupo reducido de instituciones y que las universidades, aunque en mayor número, tienen publicaciones más dispersas y no ocupan la centralidad de la red, que es dominada por institutos de investigación, que concentran un gran número de publicaciones en pocas unidades.


Subject(s)
Humans , Scientific and Technical Activities , Authorship and Co-Authorship in Scientific Publications , Social Networking , Leprosy , Bibliometrics , Information Science , Database , Scientific Communication and Diffusion
10.
Rev. chil. infectol ; 39(1): 80-85, feb. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388336

ABSTRACT

Resumen La enfermedad de Hansen o lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, y que afecta principalmente la piel y nervios periféricos. En los últimos años, se ha logrado un mejor control de la enfermedad en forma global. Sin embargo, en Chile la incidencia de la lepra ha ido en aumento. Presentamos el caso clínico de un paciente de 40 años, haitiano, con lesiones e histopatología compatibles con una lepra tuberculoide. Se discute la importancia en la educación sobre enfermedades menos prevalentes en Chile y se hace una revisión sobre la fisiopatología, clínica y clasificación de la enfermedad de Hansen.


Abstract Hansen's disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae, mainly affecting the skin and peripheral nerves. In recent years, a better control of the disease has been achieved globally. However, in Chile the incidence of leprosy has continued to increase. We present a case of a 40-year-old patient Haitian nationality with lesions and histopathology compatible with tuberculoid leprosy. We discuss the importance of education on less prevalent diseases in Chile, in conjunction with a review of the pathophysiology, clinic, and classification of Hansen's disease.


Subject(s)
Humans , Male , Adult , Leprosy, Tuberculoid/diagnosis , Leprosy, Tuberculoid/drug therapy , Chile , Haiti , Leprosy , Mycobacterium leprae
11.
An. bras. dermatol ; 97(1): 54-57, Jan.-Feb. 2022. graf
Article in English | LILACS | ID: biblio-1360092

ABSTRACT

Abstract Leprosy presents a varied clinical spectrum. Lucius phenomenon is a rare leprosy reaction characterized by erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration. This case report describes a patient whose diagnosis of leprosy occurred in the presence of Lucius phenomenon. Late diagnosis and delay in the implementation of specific therapy contributed to an unfavorable outcome, highlighting the importance of early identification and treatment of this disease, as well as its complications.


Subject(s)
Leprosy
12.
An. bras. dermatol ; 97(1): 49-53, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360079

ABSTRACT

Abstract Erythema nodosum leprosum is a severe immune reaction that complicates the usual course of multibacillary leprosy. There is increased activation of T-cells in erythema nodosum leprosum. Treatment modalities available to date for the management are systemic steroids, thalidomide, methotrexate, cyclophosphamide, azathioprine, minocycline, and apremilast but none of them is promising and safe. Mycobacterium indicus pranii is an atypical mycobacterium possessing strong immunomodulatory properties. The vaccine for this mycobacterium has been shown to have both immunotherapeutic and immunoprophylactic effects in multibacillary leprosy patients. We report a case of chronic recalcitrant erythema nodosum Leprosum which responded to Mycobacterium indicus pranii vaccine without any adverse effects, thereby suggesting its role as a novel therapeutic option in this reaction.


Subject(s)
Humans , Vaccines , Leprosy, Lepromatous/drug therapy , Erythema Nodosum/drug therapy , Leprosy, Multibacillary , Mycobacterium
13.
Mem. Inst. Oswaldo Cruz ; 117: e220014, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1386344

ABSTRACT

BACKGROUND Leprosy, caused by Mycobacterium leprae, is a public health problem in Brazil that affects peripheral nerves, resulting in physical disabilities. During host-pathogen interactions, the immune response determines leprosy outcomes from a localised (paucibacillary) form to a disseminated (multibacillary) form. The recognition of M. leprae involves the DC-SIGN receptor, which is present on the dendritic cells (DCs) and participates in immune activation. OBJECTIVES To evaluate the association of polymorphisms in the promoter region of the gene encoding DC-SIGN (CD209) and the clinical form of leprosy, and to investigate its functional effects. METHODS The study population included 406 leprosy patients from an endemic area in Brazil [310 multibacillary (MB); 96 paucibacillary (PB)]. A functional evaluation based on the effects of the single nucleotide variant (SNV) associated with PB leprosy on the specific immune response was also performed. RESULTS The GA genotype and the presence of the A allele of rs735240 (-939G>A) were associated with PB leprosy [OR: 2.09 (1.18-3.69) and 1.84 (1.07-3.14), respectively]. Carriers of the A allele showed reduced expression of CD209 and TGF-β1 in leprosy lesions in comparison with individuals with GG genotype, in addition to a higher response to the Mitsuda test. CONCLUSION These data suggest that rs735240 influences the immune response against M. leprae and clinical presentation of leprosy.

14.
Mem. Inst. Oswaldo Cruz ; 117: e220025, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1386354

ABSTRACT

BACKGROUND Mycobacterium leprae, the causative agent of Hansen's disease, causes neural damage through the specific interaction between the external phenolic glycolipid-1 (PGL-1) and laminin subunit alpha-2 (LAMA2) from Schwann cells. OBJECTIVE To design a LAMA2-based peptide that targets PGL-1 from M. leprae. METHODS We retrieved the protein sequence of human LAMA2 and designed a specific peptide using the Antimicrobial Peptide Database and physicochemical parameters for antimycobacterial peptide-lipid interactions. We used the AlphaFold2 server to predict its three-dimensional structure, AUTODOCK-VINA for docking, and GROMACS programs for molecular dynamics simulations. FINDINGS We analysed 52 candidate peptides from LAMA2, and subsequent screening resulted in a single 60-mer peptide. The mapped peptide comprises four β-sheets and a random coiled region. This peptide exhibits a 45% hydrophobic ratio, in which one-third covers the same surface. Molecular dynamics simulations show that our predicted peptide is stable in aqueous solution and remains stable upon interaction with PGL-1 binding. In addition, we found that PGL-1 has a preference for one of the two faces of the predicted peptide, which could act as the preferential binding site of PGL-1. MAIN CONCLUSIONS Our LAMA2-based peptide targeting PGL-1 might have the potential to specifically block this key molecule, suggesting that the preferential region of the peptide is involved in the initial contact during the attachment of leprosy bacilli to Schwann cells.

15.
Article in English | LILACS-Express | LILACS | ID: biblio-1387334

ABSTRACT

ABSTRACT This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

16.
Article in English | LILACS-Express | LILACS | ID: biblio-1360789

ABSTRACT

ABSTRACT As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselaein this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.

17.
Article in Chinese | WPRIM | ID: wpr-924177

ABSTRACT

ObjectiveTo investigate the clinical characteristics of leprosy-related neuritis with bullous pemphigoid after treatment of paucibacillary leprosy. MethodsThe treatment of leprosy reaction combined with bullous pemphigoid of a cured case of leprosy was analysed. ResultsFive years after standard treatment for leprosy, erythema and vesicles appeared in the limbs without obvious inducement, and the disease became more and more severe. With clinical diagnosis and pathological examination, pemphigoid was confirmed, and the patients were given hormone treatment for leprosy reaction and anti-immunotherapy, as well as symptomatic supportive treatment. ConclusionLeprosy reaction and pemphigoid are both related to immunity, but the occurrence of both at the same time is relatively rare, so in the clinical process we should attach great importance to early detection, early diagnosis and prompt treatment to prevent further harm to the patient.

18.
Esc. Anna Nery Rev. Enferm ; 26: e20210114, 2022. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1350749

ABSTRACT

Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.


Resumen Objetivo evaluar la descentralización del Programa de Control de la Lepra (PCL) en Governador Valadares. Método el marco teórico-metodológico fue la Evaluación de Cuarta Generación, con un enfoque cualitativo-participativo. El estudio involucró a 30 sujetos, divididos en cuatro grupos: gerentes del PCL; profesionales del Centro de Referencia (CR); profesionales de atención primaria y usuarios. Los datos fueron recolectados a través de entrevistas, utilizando la técnica del Círculo Hermenéutico-Dialéctico. Posteriormente se realizaron tres talleres de validación y negociación de los datos. Para el análisis se utilizó el Método Comparativo Constante. Resultados se evidenció el mantenimiento del modelo vertical de atención a la lepra, sustentado en determinantes socio-histórico-culturales que se expresan en la permanencia del ingreso a la demanda espontánea en el CR; en la derivación rutinaria del usuario a atención secundaria; en la ineficiencia de la contrarreferencia; en la centralización de la poliquimioterapia; en la creencia en la necesidad de atención especializada y en el estigma. Se evidenciaron debilidades en el vínculo con la atención primaria. Conclusión la descentralización del PCH involucra la tensión entre los actores en cada punto de la atención en salud, generando disputas sobre conocimientos y prácticas de salud. Implicaciones para la práctica la sostenibilidad de la descentralización requiere de una participación política e institucional, enfocada en el fortalecimiento de la atención primaria, reorientando el rol de los servicios en la red de atención a la lepra y en la educación para la salud.


Abstract Objective to evaluate the decentralization of the Leprosy Control Program (LCP) in Governador Valadares. Method the theoretical and methodological framework was the Fourth Generation Evaluation, with a qualitative-participatory approach. The study involved 30 subjects divided into four groups: managers of the LCP; professionals of the Reference Center (RC); primary care professionals and users. Data were collected through interviews, using the Hermeneutic-Dialectic Circle technique. Subsequently, three workshops were held for data validation and negotiation. The Constant Comparative Method was used for the analysis. Results the maintenance of the vertical model of leprosy care was evidenced, sustained by social-historical-cultural determinants that are expressed in: the permanence of the gateway to spontaneous demand in the RC; the routine referral of the user to secondary care; the inefficiency of counter-reference; the centralization of multidrug therapy; the belief in the need for specialized care, and stigma. Weaknesses in the link with primary care were evidenced. Conclusion and implications for practice The sustainability of decentralization requires political and institutional involvement focused on strengthening primary care, reorienting the role of the services in the leprosy care network, and health education. The decentralization of the LCP involves tension between the actors of each health care point, generating disputes of knowledge and health practices.


Subject(s)
Humans , Primary Health Care , Health Evaluation , Leprosy/prevention & control , National Health Programs , Referral and Consultation , Secondary Care , Brazil , Health Personnel , Qualitative Research , Social Stigma
19.
Acta ortop. bras ; 30(3): e244354, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1374153

ABSTRACT

ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.


RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.

20.
Epidemiol. serv. saúde ; 31(1): e2021951, 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1375389

ABSTRACT

Resumo Objetivo Analisar a distribuição espacial e temporal da hanseníase em cenário de baixa endemicidade no estado de São Paulo, Brasil. Métodos Estudo ecológico, sobre casos de hanseníase notificados no município de Ribeirão Preto, entre 2006 e 2016. A tendência temporal da taxa de detecção de hanseníase foi verificada mediante decomposição de séries temporais, e identificadas as áreas de alta e de baixa ocorrência da doença utilizando-se a técnica Getis-Ord Gi*. Resultados Foram registrados 890 casos, e a taxa de detecção apresentou uma tendência crescente no período analisado, com crescimento médio de 1% ao mês. Identificaram-se áreas de alta ocorrência da doença na região norte do município (99% e 95% de confiança). Conclusão A taxa de detecção de hanseníase apresentou tendência temporal crescente, e a análise espacial permitiu visualizar que a região do município com maior ocorrência da doença se caracteriza por apresentar as maiores desigualdades sociais.


Resumen Objetivo Analizar la distribución espacial y temporal de la lepra en un escenario de baja endemicidad en el estado de São Paulo, Brasil. Métodos Estudio ecológico con casos de lepra en Ribeirão Preto, entre 2006 y 2016. La tendencia temporal de la detección de la lepra se verificó a través de la descomposición de series de tiempo e identificaron áreas de alta y baja ocurrencia utilizando la técnica Getis-Ord Gi*. Resultados Fueron 890 casos y la tasa de detección mostró una tendencia creciente en el período de 2011 a 2015, con un crecimiento promedio de 1% mensual. Se identificaron áreas de alta ocurrencia de la enfermedad en la región norte de la ciudad (99% y 95% de confianza). Conclusión El análisis temporal mostró que la tasa de detección de lepra presentó una tendencia creciente y el análisis espacial mostró que la región de la ciudad con mayor ocurrencia de la enfermedad se caracteriza por presentar las mayores desigualdades sociales.


Abstract Objective To analyze the spatial and temporal distribution of leprosy in a scenario of low endemicity in the state of São Paulo, Brazil. Methods Ecological study with leprosy cases in Ribeirão Preto, between 2006 to 2016. The temporal trend of leprosy detection was verified through the decomposition of time series and identified areas of high and low occurrence of the disease using the Getis-Ord Gi* technique. Results There were 890 cases, and the detection rate showed an increasing trend in the period from 2011 to 2015, with an average growth of 1% per month. Areas of high occurrence of the disease were identified in the northern region of the city (99% and 95% confidence). Conclusion The temporal analysis showed that the rate of detection of leprosy presented an increasing trend, and the spatial analysis showed that the region of the municipality with the highest occurrence of the disease is characterized by presenting the greatest social inequalities.

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