Hanseníase: aspectos clínicos, imunológicos e terapêuticos / Leprosy: clinical, immunological and therapeutical aspects

Considerando a complexidade das manifestaçöes clínicas da hanseníase e sua correlaçäo com as alteraçöes imunológicas encontradas dentro do espectro clínico da doença, e, ainda, a importância do tratamento específico no controle do quadro clínico, imunológico e epidemiológico, säo relatados os aspectos de maior relevância, incluindo resultados de investigaçäo imunológica para a melhor compreensäo dos mecanismos fisiopatológicos envolvidos na evoluçäo da hanseníase. Nas consideraçöes sobre terapêutica, säo apresentados esquemas práticos para controle dos surtos reacionais e a eficácia da poliquimioterapia no controle e na baixa freqência de recidivas da doença

Diagnostic value of gene probes and its correlation with clinical profile of leprosy in children.

Clinico-bacteriological profile of 73 leprosy patients below 16 years of age was studied. Majority of the patients were males and fell in 11-16 years age group (p < 0.05). Skin lesions were present in all cases on both exposed as well as unexposed areas and their number increased with advancing age. Cutaneous sensations were affected in most of the patients while nerve thickening was observed in 41. As age increased, the disease moved from the tuberculoid end of spectrum towards the lepromatous end (p < 0.05) and the positivity of the skin smears increased (p < 0.05). Majority of the paucibacillary cases were lepromin positive while most multibacillary cases were lepromin negative (p < 0.01). Two M. leprae specific gene probes were applied in 42 cases to assess their diagnostic value. Eighty one per cent cases were picked up by the probes indicating presence of active bacilli. These included all lepromin positive cases, all smear positive cases, and most of smear negative cases (p < 0.05). Seven children with inconclusive histology were also positive. Drug treatment and inadequate size of biopsy sample could explain the negative probe results in 19% cases. This study highlights the immense potential of gene probes in diagnosing leprosy in children.