Examining ERBB2 as a candidate gene for susceptibility to leprosy (Hansen’s disease) in Brazil

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.

Relato de três casos novos de hanseníase em menores de quinze anos no município de Itaguaí, Rio de Janeiro: evento de alerta para investigação epidemiológica / Report of three new leprosy cases in children under fifteen in the municipality of Itaguai, Rio de Janeiro: event alert for epidemiological investigation

A hanseníase é uma doença infectocontagiosa, com período de incubação médio de dois a cinco anos, causada pelo Mycobacterium leprae, o qual possui tropismo para a pele, as mucosas e os nervos periféricos. Quando manifestada em crianças abaixo de quinze anos, reflete a intensidade e longo período de exposição à grande carga bacilar. Representa, então, um importante evento de alerta que aponta para uma dificuldade no controle da doença. Os autores relatam três casos de hanseníase, em menores de quinze anos, provenientes do Município de Itaguaí, Rio de Janeiro. Discutem-se as implicações epidemiológicas da detecção de novos casos nessa faixa etária e o papel fundamental do exame de contatos e da busca do caso fonte no controle da Hanseníase.

Leprosy is an infectious disease with an average incubation period of two to five years. It is caused by Mycobacterium leprae, mainly affecting skin, mucous membranes and peripheral nerves. When it occurs in children under fifteen, it reflects an intense and long contact period, with a high bacillary load. Therefore, it is considered an important alert sign that points to the challenge of controlling the disease. The authors report three cases of leprosy in children under fifteen that occurred in the Itaguaí district, Rio de Janeiro. The epidemiologic implications of new cases detected at this age and the fundamental role of examining the patients' close contacts and the possible identification of source cases as an effort for leprosy control are discussed.

Caracterización del comportamiento de casos de lepra en la ciudad de La Habana. 2004-2008 / Characterization of the behavior of cases of lepros in Havana city. 2004-2008

Estudio descriptivo, retrospectivo, de corte transversal, para determinar el comportamiento de la lepra en ciudad de la Habana entre los años 2004 y 2008. De un universo de 97 casos notificados en este quinquenio, se estudiaron 94 pacientes que tenían encuesta epidemiológica. Se analizaron variables sociodemográficas y clínicas para caracterizar los casos notificados. Se determinó que más de la mitad de los casos estudiados estuvo en el grupo de edad de 45 y más años (64.9%) y fue más frecuente en el sexo masculino (65.9%). El mayor número de los casos diagnosticados (79.7%) clasificaron con lepra multibacilar, correspondiendo un 54.2% de ellos a lepromatosa. El síntoma más frecuente corresponde a la presencia de máculas con un 49.2%. Considerando el resultado de la investigación realizada, se presentará una propuesta al Departamento Provincial de este programa, para capacitar al personal que trabaja en las diferentes áreas de salud.

Descriptive, retrospective, cross-sectional study, to determine the behavior of leprosy in Havana City between 2004 and 2008. In a universe of 97 cases reported in the five years, 94 patients who had an epidemiological survey were studied. Sociodemographic and clinical variables were analyzed to characterize the reported cases. It was determined that more than half of the cases studied were in the age group 45 and over (64.9%), and was more frequent in males (65.9%). The highest number of diagnosed cases (79.7%) classified as multibacillary leprosy, corresponding a 54.2% of them to Lepromatous. The most common symptom is the presence of macules in 49.2%, Considering the outcomne of the investigation, a proposal will be presented to the Provincial Department of this program to train staff working in different health areas. .

Manifestaçoes fonoaudiologicas em um grupo de doentes de Hanseniase / Manifestations fonoaudiologicas in a group of patients from leprosy

A Hansenise, doença cronica infecto-contagiosa e de nofificaçao compulsoria, e causada pelo bacilo de Hansen (Mycobacterium leprae), e pode apresentar multiplas lesoes em qualquer local do corpo...

Primary neuritic leprosy: a reappraisal at a tertiary care hospital.

AIM: To study the clinico-epidemiological profile of primary neuritic leprosy. METHODS: Retrospective analysis of the leprosy records of clinically diagnosed patients of PNL who attended the Leprosy Clinic from 2000 to 2004 was carried out for details of presenting complaints, age and sex distribution, duration, number of nerves involved and pattern of nerve enlargement, BI (skin), nerve abscess, and deformities. RESULTS: There were 32 (4.6%) patients of PNL out of a total of 686. Majority (56.2%) had complaints for less than a year. There were 29 (90.6%) males, and 3 (9.4%) females, with 15-30 years as the commonest age-group (65.6%) involved. Paraesthesia and numbness were the presenting complaints in 20 (62.5%), and motor deficit (paresis) in 11 (34.4%); deformities (claw hand, foot drop, trophic changes) were seen in 16 (50%) cases. Polyneuritic pattern was noted in 21 (63.56%) patients and mononeuritic in 11 (16.5%) with ulnar nerve as the most commonly enlarged nerve (63.6%). Nerve abscess was noted in 4 (12.5%) cases. Slit-skin smear was positive in 2 (6.2%) cases only. DISCUSSION: PNL continues to be common in India. Sensory complaints are early and more common. The disease is more common in males. Polyneuritic pattern was predominant, and the ulnar nerve was the most commonly involved nerve. Majority of the cases belong to the tuberculoid spectrum. Early diagnosis depends on complete neurological examination in order to reduce the sequelae of the disease.

Incidence of leprosy in school-children and their family members in Berhampur.

A school survey, followed by a contact survey, was carried out in Berhampur, a city in southern Orissa. In a study of 8,870 school-children, leprosy was detected in 15, giving a prevalence rate of 16.91 per 10,000 with a male:female ratio of 8:7. Of these, 14 (93.99%) had paucibacillary leprosy. More cases [11 (73.33%)] were seen in the age-group of 10-15 years. Exposed parts, such as lower limbs, upper limbs and head and neck in that order, were the sites of predilection, accounting for 85.71% of total lesions. Nerve involvement was found in 2 (13.33%) girls with deformity (ulnar claw) in one of them (6.66%). BCG scar was present in 11 (73.33%) cases. Among the vaccinated cases, tuberculoid type was the most common, followed by indeterminate, pure neuritic and borderline, in that order. A contact survey detected 2 multibacillary cases in two families (13.33%). In each case, the father was the index source. The study revealed that a maximum number of students, 8 (53.3%), belonged to the middle socioeconomic class. Of the 15 affected, 60% were undernourished and the rest well nourished. No other systemic disease was found clinically associated with leprosy.

Prevalencia de olho seco em portadores de hanseniase do Hospital de Dermatologia Sanitaria de Goiania / ?

Objetico: Determinar a prevalencia de olho seco em portadores de hanseniase do Hospital de Dermatologia Sanitaria de Goiania, comparando-se a um grupo controle. Desenho: Estudo de prevalencia. Material e metodos: A amostra do presente estudo inclui 70 portadores de hanseniase, do Hospital de Dermatologia Sanitaria de Goiania, e 30 individuos no grupo controle, da Fundacao Banco de Olhos de Goias, ambos localizados em Goiania-GO. Foram realizados exeme oftalmologico e testes de Schirmer I, break-up time (BUT) e rosa bengala em todos estes individuos em uma unica avaliacao. Resultados: Quarenta e quatro (63,0%) portadores de hanseniase eram do sexo masculino e 22 73,3%) individuos do grupo controle, do sexo feminino (p=0,001). A idade medica dos hansenianos foi de 61,1+-12,5 anos e no grupo controle, 55,7+-9,6 anos. Quinze (21,4%) hansenianos e quatro (13,3%) individuos deo grupo controle apresentaram diagnostico de olho seco (p=0,429) A forma virchowiana (74,2%) da hanseniase foi a mais prevalente e o olho seco (66,7%) foi mais frequente nesta forma clinica da doenca. Conclusao: A prevalencia de olho seco nos portadores de hanseniase foi semelhante a encontrada nos individuos do grupo controle

Hanseníase e migração no município de Maringá - Paraná: 1957-1997 / ?

Este trabalho é um estudo histórico-descritivo de natureza qualitativa, cujo o objetivo é estabelecer a relação entre a doença e o movimento migratório da hanseníase no município de Maringá. Foram entrevistadas 11 pessoas entre portadores, ex-portadores da doença e profissionais de saúde que compartilharam do mesmo problema de forma singular, e vivenciaram a doença no período de 1957-1997. As histórias de vida relatadas foram analisadas segundo os seguintes aspectos da hanseníase: os serviços de saúde oferecidos, as duas faces da doença, tratamento, e hanseníase e migração. Através deste estudo, percebemos que um dos motivos da vinda de hansenianos para a região foi a tentativa de manter a união de sua família, no que iam de encontro à política de controle da época, do isolamento compulsório. Outro motivo decorre das incapacidades físicas instaladas que o impossibilitava de trabalhar no campo. Concorreram, além disso, a busca da melhoria das condições de vida e recentemente, motivados pela qualidade do atendimento oferecido pela rede do município de Maringá.

Hepatitis B antigen and antibody in patients with leprosy: a study of three resettlement villages in Thailand.

It remains uncertain whether the cellular immune abnormalities of patients with lepromatous leprosy interfere with resolution of hepatitis B virus (HBV) infections. To investigate this question in an area coendemic for the two diseases, we determined the prevalence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) in: 1) 204 leprosy patients living in three leprosy resettlement villages; 2) 198 contacts living in the same villages; and 3) 44 newly diagnosed leprosy patients in Thailand. Within the villages, the prevalence of HBsAg positivity was inversely related to age, tended to be more frequent in patients with tuberculoid than lepromatous leprosy, and was similar after age adjustment among persons with and without leprosy. The prevalence of HBV markers found in newly diagnosed patients was similar to that in the villagers. We conclude that extensive HBV transmission had occurred in the resettlement villages and that the natural history of HBV infection was similar in persons with, whether tuberculoid or lepromatous, and without leprosy.

Leprosy in low endemic areas of India: an appraisal and suggested measures for control.

Prevalence of leprosy in the low endemic areas of India is described based on the observations of patients attending an Urban Leprosy Centre in the Union Territory of Delhi from the neighbouring states. The rising incidence in these so-called low to moderate endemic places is closely linked to factors related to urbanisation, movement of people in search of employment, etc., which necessitate fresh surveys in these areas. A significant number of leprosy patients attending the Centre were irregular (37.7%) in therapy and many absconded after the initial visit (35.3%), the reasons for which are discussed. These figures are compared to that from similar low endemic areas and known high endemic parts of the country. Suitable modifications to the control programme in these areas are suggested under the purview of the National Leprosy Eradication Programme.

Leprosy survey in industries in Bombay.

Population surveys for leprosy in industrial cities like Bombay revealed that about 60% of adult subjects especially males could be examined. The fact that the prevalence rate of leprosy particularly multibacillary type is much higher in this segment of population as compared to other groups indicates the importance of examining this population at their workspot like industries. 22287 industrial workers were examined for leprosy by paramedical auxiliaries in their establishments and 270 leprosy cases were detected (P.R. 12/1000). However, only 13 multibacillary cases (P.R. 0.5/1000) could be unearthed. 12 patients were with grade II and above. 184 (83%) were untreated. 161 (60%) patients reported for treatment. With available resources, case holding of patients who are not within the control area of the project becomes a challenging job for paramedical workers though large number of leprosy cases are detected amongst industrial workers. If industrial management arranges treatment for leprosy patients without dislocating them from their service, the pool of infection in the urban community will be reduced and can contribute tremendously towards urban leprosy control programme.

Tendência secular da detecçäo da hanseníase no município de Maringá, PR, 1977/1986 / Temporal tendency in the detection of Hansen's disease in the municipality of Maringá, PR, 1977/1986

Estudo dedicado a analisar o comportamento da hanseníase no município de Maringá - PR. Foram estudadas 348 fichas clínico-epidemiológicas de pacientes portadores de hanseníase no período compreendido entre 1977 e 1986. Verificou-se um maior percentual das formas clínicas Virchowiana + Dimorfa, prevalecendo na faixa etária economicamente ativa, o que näo difere de estudos anteriormente realizados por Belda & Lombardi, por Asseis et al. Säo Apresentadas tabelas e figuras da distribuiçäo da doença segundo sexo, naturalidade, ano de detecçäo, forma clínica, idade na ocasiäo do diagnóstico, tempo do início dos sintomas até diagnóstico com breves comentários, e sua importância para a avaliaçäo epidemiológica da hanseníase neste município

Aspectos epidemiológicos da hanseníase no 10§ Departamento Regional de Saúde (DRS/10) de Presidente Prudente, Estado de Säo Paulo, em dezembro de 1984 / Epidemiologic aspects of Hansen's disease in the 10th Departamento Regional de Saúde (DRS/10) of Presidente Prudente, State of Säo Paulo, Brazil, in december, 1984

O autor relata dados referentes a situaçäo epidemiológica da hanseníase no décimo Departamento Regional de Saúde de Presidente, Estado de Säo Paulo (DRS/10). A partir de 1974 chama a atençäo o fato de que se tem diagnosticado pecentuais elevados de formas precoces da doença, formas indeterminadas (I). Em 1984 foram diagnosticados 132 pacientes, sendo forma Virchowiana (V) e forma Dimorta (D) = 36 (27.28%), forma I = 62(46,96) e forma Tuberculóide (T) = 34(25,75%). A taxa de incidência em 1984 foi de 0,19% e a de prevalência de 1,83%