Manual de diagnóstico laboratorial de lepra / Laboratory diagnosis manual for leprosy

Las enfermedades causadas por las micobacterias, en la actualidad aquejan a millones de personas en el mundo, siendo la Lepra o Mal de Hansen, una de las enfermedades más antiguas, y en nuestro país de interés en Salud Pública. Desde el punto de vista epidemiológico llama la atención que el descenso mundial de la prevalencia de la Lepra no se ha acompañado de un descenso de su incidencia, o sea que no se haya podido prevenir la transmisión de la enfermedad, pese a que se ha adoptado la poliquimioterapia en los Programas, con un seguimiento muy estricto. Una parte importante de la vigilancia y diagnóstico de los casos de lepra lo constituye el Laboratorio que sirve como apoyo para la confirmación y clasificación de los casos, al monitoreo del tratamiento, la vigilancia a la resistencia antimicrobiana, y al control de los contactos, entre otros. El objetivo de este Manual es que el mismo sirva como un instrumento de orientación, que ayude a todo el personal de laboratorio.

La lepra y el testículo / Leprosy and the testis

Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.

Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Perfil clinico-epidemiológico dos casos de hanseníase atentidos no Hospital Universitário em Campo Grande, Mato Grosso do Sul, de janeiro de 1994 a julho de 2005 / Clinical-epidemiological profile of leprosy patients assisted at the University Hospital of Mato Grosso do Sul Federal University, Campo Grande, MS, from January 1994 to July2005

Estudo descritivo, realizado a partir da coleta de dados de 192 fichas de notificação e controle da hanseníase, do total de pacientes atendidos no período de janeiro de 1994 a julho de 2005, no Ambulatório do Hospital Universitário da Universidade Federal de Mato Grosso do Sul, com o objetivo de traçar o perfil epidemiológico da hanseníase no grupo de pacientes estudados e gerar subsídios à política de controle da hanseníase. As variáveis estudadas constam da ficha de notificação e controle da hanseníase. Observou-se a predominância de casos no sexo masculino (62,5%); na faixa etária de 40 a 59 anos (45,8%); multibacilares (67,2%); da forma clinica dimorfa (35,9%) e virchowiana (27,6%). Setenta e três (73%) por cento dos casos foram avaliados em relação à incapacidade ao inicio do tratamento, encontrando-se 66,7% desses casos sem nenhum problema com as mãos, pés ou olhos e 33,3% com incapacidade ou deformidade ao início do tratamento.

An evaluation of clinical and histopathological status in paucibacillary leprosy patients after completion of fixed duration therapy.

The present study was carried out involving 25 patients with paucibacillary leprosy who attended the outpatient department of dermatology of Father Muller's Medical College Hospital during the period January 2001 to March 2002. All the patients were examined clinically and histopathologically at the beginning and at the end of six months of MDT and relevant data recorded. Clinicopathological correlation with histopathological classification before MDT was 72% and 68% at the end of MDT in our study. At the end of treatment 4 (16%) cases were clinically active and 8 (32%) were histopathologlcally active. The study showed that active cases were significantly reduced as a result of MDT, both clinically and histopathologically. The histopathological activity that outlasts MDT may be due to the bacillary fragments that persist; but clinical activity coupled with histopathological activity seen in 2 patients at the end of 6 months of MDT was possibly an indicator of relapse and these patients and similar others need to be followed up for a longer duration. In this study, resolution of granuloma and clinical activity after completion of MDT were assessed.

Leprosy among inmates of a prison.

A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.