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1.
An. bras. dermatol ; 96(5): 598-601, Sept.-Oct. 2021. graf
Article in English | LILACS | ID: biblio-1345144

ABSTRACT

Abstract Histoid leprosy is considered a rare form of lepromatous leprosy. Its peculiar clinical picture makes its diagnosis a challenging one, which can delay starting treatment and perpetuate the disease as endemic. In addition to representing a reservoir of bacilli, and being an important means of contamination, these patients have greater resistance to standard treatment. This is a report of a typical case of this rare presentation, aiming to share the knowledge and favor earlier diagnosis of the disease.


Subject(s)
Humans , Leprosy, Lepromatous/diagnosis , Leprosy, Lepromatous/drug therapy , Leprosy , Mycobacterium leprae
4.
Arq. ciências saúde UNIPAR ; 25(1): 79-85, jan-abr. 2021.
Article in Portuguese | LILACS | ID: biblio-1151426

ABSTRACT

Introdução: O diagnóstico da hanseníase possui números significativos que causam preocupação à saúde pública. Os casos de resistência medicamentosa nessa doença se iniciaram em meados dos anos 60 e diante do problema, a Organização Mundial da Saúde instituiu em 1981 a poliquimioterapia, associação dos antibióticos rifampicina, dapsona e clofazimina, tratamento atual de escolha. A resistência aos fármacos na hanseníase é reportada pela literatura, desvelando um obstáculo à sua eliminação. Apresentamos nessa revisão os principais aspectos da resistência medicamentosa no tratamento para hanseníase e seus impactos. Metodologia: Revisão sistemática sobre os aspectos da resistência medicamentosa utilizando a pesquisa exploratória como metodologia de abordagem. Foram pesquisados os termos resistência medicamentosa, hanseníase, recidiva, alterações genéticas e os operadores booleanos "and" e "or" na busca. Resultados e discussão: A dificuldade de tomar a medicação corretamente foi um dos principais fatores que acarretaram resistência do bacilo Mycobacterium leprae aos fármacos. Homens de países norte e sul-americanos e asiáticos foram os mais atingidos por episódios de resistência. A resistência medicamentosa é uma das principais causas de recidivas em hanseníase. O principal fármaco causador de resistência medicamentosa descrito nos trabalhos foi a dapsona (46,6%) e a maioria das alterações genéticas encontradas estão no gene rpoB; 23,2% dos registros relatados foram de resistência secundária aos fármacos e, também, sete casos de resistência múltipla a esses medicamentos. Conclusão: Os principais aspectos da resistência medicamentosa na hanseníase são os equívocos ao ingerir os medicamentos e as alterações genéticas na bactéria. Os impactos causados estão na dificuldade de refazer o tratamento, a possibilidade de nova transmissão e o aparecimento de sintomas mais graves.


Introduction: The diagnosis of leprosy has significant numbers causing public health concern. Reports of drug resistance in this disease begun in the mid-1960s and due to this problem, the World Health Organization instituted a multidrug therapy with rifampicin, dapsone, and clofazimine antibiotic association in 1981, which is currently the first-choice treatment for leprosy. Cases of drug resistance have been reported in literature, revealing an obstacle to the eradication of the disease. This paper has the purpose of presenting the key aspects and impacts of drug resistance in the treatment for leprosy. Methods: Systematic review of the drug resistance aspects using exploratory research as an approach methodology. The authors searched the terms drug resistance, leprosy, recurrence, genetic alterations, and the Boolean operators "and" and "or" between them. Results and discussion: The difficulty in taking the medication correctly was one of the key factors that led to drug resistance for Mycobacterium leprae. Men from North and South American, as well as from Asian countries, were the most affected by episodes of resistance. Drug resistance is one of the main causes of leprosy recurrences. Dapsone was the most frequently identified drug resistance in the studies (46.6%), while most of the genetic alterations were found in the rpoB gene; 23.2% of the cases were from secondary resistance episodes, and seven cases of multiple resistance were reported. Conclusion: The misconceptions when taking the treatment and the Mycobacterium leprae genetic alterations have been described as the key aspects of drugs resistance in leprosy and the impacts caused are the difficulty in redoing the treatment, the possibility of new transmission, and the appearance of more severe symptoms.


Subject(s)
Drug Resistance/drug effects , Drug Resistance, Bacterial/drug effects , Mycobacterium leprae/drug effects , Rifampin/adverse effects , Bacteria/genetics , Pharmaceutical Preparations , Clofazimine/adverse effects , Fluoroquinolones/adverse effects , Dapsone/adverse effects , Drug Therapy, Combination/adverse effects , Leprosy/drug therapy , Anti-Bacterial Agents/adverse effects
5.
An. bras. dermatol ; 96(1): 97-99, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1152798

ABSTRACT

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.


Subject(s)
Humans , Male , Leprosy, Borderline/drug therapy , Leprosy/drug therapy , Drug Therapy, Combination , Leprostatic Agents/therapeutic use , Middle Aged , Mycobacterium leprae
6.
Medisan ; 25(1)ene.-feb. 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1154843

ABSTRACT

Introducción: La lepra es una enfermedad infectocontagiosa crónica, producida por el Mycobacterium leprae, y constituye uno de los males más antiguos de la humanidad. Objetivo: Describir algunas características clínicas y epidemiológicas de los pacientes con lepra pertenecientes al Policlínico Docente Ramón López Peña de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 11 pacientes diagnosticados con la enfermedad de Hansen en la mencionada área de salud en el período 2005-2019. Para el procesamiento de la información se creó una base de datos mediante el sistema SPSS, versión 11.5 para Windows, donde se tabularon los datos de las encuestas. El análisis de los resultados se expresó en números absolutos y porcentajes para su mejor interpretación. Resultados: Predominaron el grupo etario de 35-44 años (54,5 %), el sexo masculino (54,6 %) y la lepra dimorfa, en su forma clínica multibacilar. La mayoría de los pacientes fueron diagnosticados precozmente y solo se observó algún grado de discapacidad en los diagnósticos tardíos; asimismo, las condiciones higiénicas desfavorables y el hacinamiento fueron los factores de riesgo de mayor relevancia. Conclusiones: A pesar de la existencia de pacientes con lepra en dicha área de salud, se observó un período de silencio epidemiológico, que unido a los factores de riesgo presentes, aumenta la posibilidad de contagio y pone en peligro los objetivos establecidos para su erradicación.


Introduction: Leprosy is an infectious chronic disease, produced by the Mycobacterium leprae, and constitutes one of the oldest ills of humanity. Objective: To describe some clinical and epidemiological characteristics of the patients with leprosy belonging to Ramón López Peña Teaching Polyclinic in Santiago de Cuba. Methods: A descriptive and retrospective study of the 11 patients diagnosed with Hansen disease in the mentioned health area during 2005-2019 was carried out. A database was created by means of the SPSS system, version 11.5 for Windows, for processing the information, where the data of the surveys were tabulated. The analysis of the results was expressed in absolute numbers and percentages for its best interpretation. Results: There was a prevalence of the 35-44 age group (54.5 %), the male sex (54.6 %) and the borderline lepromatous leprosy, in its multibacilar clinical form. Most of the patients were early diagnosed and certain degree of disability was just observed in the late diagnoses; also, the unfavorable hygienic conditions and overcrowding were the risk factors of more relevance. Conclusions: In spite of the existence of patients with leprosy in this health area, a period of epidemiological silence was observed that along with the existing risk factors, increases the infection possibility and puts in danger the established objectives for its eradication.


Subject(s)
Communicable Diseases , Leprosy/epidemiology , Primary Health Care , Mycobacterium leprae
7.
Rev. bras. oftalmol ; 80(1): 21-26, jan.-fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1251319

ABSTRACT

RESUMO Objetivo: O presente trabalho teve por objetivo caracterizar o perfil epidemiológico e clínico de pacientes com lagoftalmo associado à hanseníase, atendidos no ambulatório de oftalmologia da Fundação Alfredo da Matta, Manaus, Amazonas. Métodos: Trata-se de estudo retrospectivo realizado por meio da análise dos prontuários clínicos dos pacientes incluídos no estudo. Sexo, idade, forma clínica, grau de incapacidade no diagnóstico e desfecho foram obtidos dos prontuários. Início, tipo de comprometimento (unilateral ou bilateral), grau de intensidade do lagoftalmo e alterações oculares associadas também foram compilados. Resultados: Foram incluídos 65 pacientes; 66,1% eram do sexo masculino e 53,8% tinham idade superior a 60 anos. Em relação à classificação operacional da hanseníase, a maioria dos pacientes (81,5%) era multibacilar: 33,8% na forma de hanseníase borderline e 47% virchowiana. 36,9% casos apresentavam sequelas oculares associadas ao lagoftalmo: opacidade corneana, epífora, ceratopatia em faixa, e neovascularização corneana.41,6% evoluíram para a cegueira. O lagoftalmo foi conduzido de forma clínica em 23 pacientes e a abordagem cirúrgica foi indicada em 42. Em relação ao tratamento cirúrgico consistiu principalmente no implante de peso de ouro e na cantoplastia de Tessier. Discussão: O lagoftalmo nessa casuística acometeu mais homens idosos, esteve relacionado à forma multibacilar, com hanseníase do tipo virchowiano como relatado na literatura. O diagnóstico de lagoftalmo foi tardio na maioria dos casos, explicando o grande número de sequelas incluindo a cegueira. Conclusão: O presente estudo reforça a necessidade de acompanhamento oftalmológico precoce para que as potenciais e graves sequelas associadas a essa condição sejam evitadas.


ABSTRACT Objective: The present study aimed to characterize the epidemiological and clinical profile of patients with lagophthalmos associated with leprosy, seen at the ophthalmology outpatient clinic of Fundação Alfredo da Matta, Manaus, Amazonas. Methods: This is a retrospective study carried out by analyzing the medical records of the patients included in the study. Sex, age, clinical form, degree of disability in diagnosis and outcome were obtained from medical records. Onset, type of impairment (unilateral or bilateral), degree of intensity of lagophthalmos and associated eye changes were also compiled. Results: 65 patients were included; 66.1% were male and 53.8% were older than 60 years. Regarding the operational classification of leprosy, most patients (81.5%) were multibacillary: 33.8% in the form of borderline leprosy and 47% virchowian. 36.9% of cases had ocular sequelae associated with lagophthalmos: corneal opacity, epiphora, band keratopathy, and corneal neovascularization.41.6% progressed to blindness. Lagophthalmos was performed clinically in 23 patients and the surgical approach was indicated in 42. Regarding surgical treatment, it consisted mainly of gold weight implantation and Tessier's canthoplasty. Discussion: Lagophthalmos in this sample affected more elderly men, was related to the multibacillary form, with leprosy-like leprosy as reported in the literature. The diagnosis of lagophthalmos was delayed in most cases, explaining the large number of sequelae including blindness. Conclusion: The present study reinforces the need for early eye care so that the potential and serious sequelae associated with this condition are avoided.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Blindness/complications , Eye Diseases/epidemiology , Leprosy/epidemiology , Mycobacterium leprae , Oculomotor Muscles/abnormalities , Brazil , Epidemiology, Descriptive , Retrospective Studies
8.
Ciênc. cuid. saúde ; 20: e58386, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1356130

ABSTRACT

RESUMO Introdução: a hanseníase é uma doença infectocontagiosa que prevalece como problema de saúde pública no Brasil. Objetivo: descrever o perfil sociodemográfico, de tratamento e clínico de pacientes que concluíram o tratamento poliquimioterápico para a hanseníase. Método: estudo transversal, desenvolvido de novembro de 2017 a fevereiro de 2018 no município de Natal. A população-alvo foi constituída por 113 indivíduos cadastrados no Sistema de Informação de Agravos de Notificação e a amostra por 90, que foram notificados para a hanseníase e concluíram o tratamento poliquimioterápico, selecionados por sorteio. Os dados foram coletados por formulário, tabulados e analisados pelo SPSS 21. Quanto ao teste de Kolmogorov-Smirnov, não se observou uma distribuição de normalidade dos achados, optando-se por trabalhar com testes não paramétricos: qui-quadrado de Pearson (ou exato de Fisher) e o teste de Mann-Whitney. Resultados: predominaram indivíduos do sexo feminino, até 59 anos, com baixa renda, baixo grau de escolaridade, tratados nos centros de referência e classificados como paucibacilares. Conclusão: as condições de vulnerabilidade associada à predominância de casos tratados nos centros de referência reforçam a necessidade de organização da atenção básica para acompanhamento dos casos de hanseníase.


RESUMEN Introducción: la lepra es una enfermedad infectocontagiosa que prevalece como problema de salud pública en Brasil. Objetivo: describir el perfil sociodemográfico, de tratamiento y clínico de pacientes que concluyeron el tratamiento poliquimioterapéutico para la lepra. Método: estudio transversal, desarrollado de noviembre de 2017 a febrero de 2018 en el municipio de Natal. La población objetivo fue constituida por 113 individuos registrados en el Sistema de Información de Agravios de Notificación y la muestra por 90, que fueron notificados para la lepra y concluyeron el tratamiento poliquimioterapéutico, seleccionados por sorteo. Los datos fueron recogidos por formulario, tabulados y analizados por el SPSS 21. En cuanto a la prueba de Kolmogorov-Smirnov, no se observó una distribución de normalidad de los hallazgos, optándose por trabajar con pruebas no paramétricas: chi-cuadrado de Pearson (o exacta de Fisher) y la prueba de Mann-Whitney. Resultados: predominaron individuos del sexo femenino, hasta 59 años, con bajos ingresos, bajo grado de escolaridad, tratados en los centros de referencia y clasificados como paucibacilares. Conclusión: las condiciones de vulnerabilidad asociadas al predominio de casos tratados en los centros de referencia refuerzan la necesidad de organizar la atención básica para el seguimiento de los casos de lepra.


ABSTRACT Introduction: leprosy is an infectious and contagious disease that persists as a public health problem in Brazil. Objective: to describe the sociodemographic, treatment and clinical profile of patients who completed polychemotherapy treatment for leprosy. Method: cross-sectional study developed from November 2017 to February 2018 in the city of Natal. The target population consisted of 113 individuals registered in the Information System for Notifiable Diseases, and the sample consisted of 90, who were reported for leprosy and completed the multidrug therapy, selected by drawing lots. Data were collected using a form, tabulated and analyzed using SPSS 21. In the Kolmogorov-Smirnov test, non-normal distribution of the findings was found, and thus non-parametric tests were used, namely, Pearson's chi-square (or exact Fisher test) and the Mann-Whitney test. Results: there was a predominance of female individuals, up to 59 years old, with low income, low level of education, treated in reference centers and cases classified as paucibacillary. Conclusion: the conditions of vulnerability associated with the predominance of cases treated in reference centers reinforce the need to organize primary care in order to monitor leprosy cases.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Patient Discharge/statistics & numerical data , Drug Therapy, Combination , Leprosy/nursing , Primary Health Care , Health Profile , Leprosy, Tuberculoid/nursing , Chronic Disease/drug therapy , Communicable Diseases/classification , Diagnosis , Health Services Needs and Demand , Mycobacterium leprae
9.
Braz. arch. biol. technol ; 64: e21210030, 2021. graf
Article in English | LILACS | ID: biblio-1339317

ABSTRACT

Abstract Nowadays, a prompt and reliable diagnosis is one of the most critical measures for leprosy control. The current diagnostic is based on clinical exams by a health care professional, and it may not recognize early signs of the disease. Therefore, other leprosy diagnosis methods are needed that are sensitive, disease-specific, and easy to deliver to the end-user. This study describes the construction of an electrochemical DNA biosensor to detect PCR products of Mycobacterium leprae using methylene blue as an indicator of the hybridization. The capture probe was immobilized on the graphite electrode modified with poly(4-aminophenol). The electrode surface was morphologically characterized by atomic force microscopy. Linear voltammetry was used to monitor the concentration of methylene blue on the DNA biosensor, which indicated a limit detection of 1 x 10-10 mol/L. The biosensor showed selective when placed to hybridize with a non-complementary sequence. This study suggests that the electrochemical DNA biosensor developed is promising for detecting DNA of Mycobacterium leprae.


Subject(s)
Biosensing Techniques , Aminophenols , Methylene Blue , Mycobacterium leprae
10.
J. venom. anim. toxins incl. trop. dis ; 27: e20200027, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1287091

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/pathogenicity
11.
An. bras. dermatol ; 95(5): 652-654, Sept.-Oct. 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130942

ABSTRACT

Abstract Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.


Subject(s)
Humans , Female , Leprosy, Borderline/drug therapy , Leprosy, Lepromatous/diagnosis , Leprosy, Lepromatous/drug therapy , Leprosy/drug therapy , Drug Therapy, Combination , Leprostatic Agents/therapeutic use , Middle Aged , Mycobacterium leprae
12.
Article in Portuguese | LILACS | ID: biblio-1359195

ABSTRACT

RESUMO: Modelo do Estudo: Relato de caso. Importância do problema: No mundo, mais de três milhões de pessoas estão vivendo com deficiência física devido à hanseníase. O Brasil é o segundo país com o maior número de casos novos registrados.A magnitude e o alto risco de incapacidade mantêm a doença como problema de saúde pública. O diagnóstico de hanseníase em geral é simples. Porém, quadros com ausência de lesões cutâneas características, somente com alterações neurais, representam um desafio para o diagnóstico diferencial com outras doenças neurológicas. Comentários: Relatamos o caso de um paciente encaminhado ao serviço de neurologia com história clínica e eletroneuromiografia compatíveis com polineuropatia desmielinizante, sem qualquer lesão cutânea ao exame de admissão. O raciocínio clínico inicial foi direcionado para o diagnóstico das polineuropatias desmielinizantes inflamatórias adquiridas como Polineuropatia Desmielinizante Inflamatória Crônica (CIDP) e suas variantes. No entanto, após anamnese e exame físico detalhados, chamou a atenção a ausência do componente atáxico e a presença predominante de alterações sensitivas de fibra fina, espessamento de nervo e importante fator epidemiológico para hanseníase, motivando a suspeita e a in-vestigação desta enfermidade por meio da biópsia de nervo que foi sugestiva de hanseníase. Após três meses, em novo exame do paciente para biopsiar áreas de anestesia para reforçar o diagnóstico, observou-se o surgimento de extensas lesões levemente hipocrômicas no tronco e membros inferiores, cuja biópsia definiu o diagnóstico de hanseníase. (AU)


ABSTRACT: Study: Case report. Importance: Worldwide over three million people are living with disabilities due to leprosy. Brazil is the second country with the highest number of new cases registered. The magnitude and high risk of disability make the disease a public health problem. The diagnosis of leprosy can be simple. However, in the absence of skin lesions and with many possibilities of neurological impairment, diagnosis can become a challenge. Comments: We report the case of a patient referred to the neurology service with a clinical history and electrophysiological tests compatible with demyelinating polyneuropathy, without any skin lesion at admission examination. The initial clinical research was directed to the diagnosis of acquired inflammatory demyelinating polyneuropathies such as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)and its variants. However, after anamnesis and detailed physical examination, the absence of the ataxic component and the predominant presence of sensory alterations of fine fiber, nerve thickening and important epidemiological factor for leprosy,led to the suspicion and investigation of this disease by nerve biopsy that was suggestive of leprosy. After three months, in a new patient examination "to perform a biopsy in areas of anesthesia" to reinforce the diagnosis, there was the appearance of extensive slightly hypochromic lesions in the trunk and lower limbs, whose biopsy defined the diagnosis of leprosy.(AU)


Subject(s)
Humans , Male , Adult , Polyneuropathies , Mononeuropathies , Diagnosis, Differential , Leprosy/diagnosis , Leprosy/therapy , Mycobacterium Infections , Mycobacterium leprae
13.
Rev. enferm. UFPI ; 9: e10152, mar.-dez. 2020.
Article in Portuguese | LILACS, BDENF | ID: biblio-1368736

ABSTRACT

Objetivo: caracterizar o perfil clínico e epidemiológico dos casos de hanseníase no município hiperendêmico de São Luís do Maranhão, Brasil. Metodologia: estudo epidemiológico, retrospectivo, descritivo e quantitativo. Utilizaram-se dados de pacientes com hanseníase, referentes ao período de 2014 a 2017, obtidos a partir da base de dados do Sistema de Informação de Agravos de Notificação, disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Resultados: no período analisado, notificaram-se 2.166 casos de hanseníase. Observou-se maior frequência no sexo feminino (53,4%) e na faixa etária de 15-59 anos (69,4%). Quanto aos aspectos clínicos, 62,1% eram da forma dimorfa, 77,8% classificados como multibacilar e 61,8% sem incapacidades físicas. Apresentaram algum grau de incapacidade 694 casos (32,0%). O diagnóstico da hanseníase ainda é realizado tardiamente devido à detecção da classificação multibacilar e forma clínica dimorfa, além da presença de incapacidade física no momento do diagnóstico. Conclusão: os resultados deste estudo sugerem a realização de novas pesquisas que explorem a necessidade de intensificação de estratégias de prevenção e controle da doença visando à eliminação da hanseníase como problema de saúde pública no município.


Objective: to characterize the clinical and epidemiological profile of leprosy cases in the hyperendemic municipality of São Luís do Maranhão, Brazil. Methodology: This is an epidemiological, retrospective, descriptive, and quantitative study. We used data from leprosy patients from 2014 to 2017 obtained from the database of the Information System for Notifiable Diseases, available by the Informatics Department of the Unified Health System. Results: In the analyzed period, we notified 2,166 leprosy cases. A higher frequency was observed in females (53.4%) and the 15-59 age group (69.4%). Regarding the clinical aspects, 62.1% were of the dimorphic form, 77.8% were classified as multibacillary and 61.8% without physical disabilities. In 694 cases (32.0%), there was some degree of disability. The diagnosis of leprosy is still made late, due to the detection of the multibacillary classification and the dimorphic clinical form, and to the presence of a physical disability at the time of diagnosis. Conclusion: the results of this study suggest new research that explores the need to intensify strategies for prevention and control of the disease aiming at the elimination of leprosy as a public health problem in the municipality.


Subject(s)
Health Profile , Public Health , Epidemiology , Leprosy , Mycobacterium leprae
14.
Rio de Janeiro; s.n; 2020. xix,97 p. ilus.
Thesis in Portuguese | LILACS | ID: biblio-1342099

ABSTRACT

A hanseníase é uma doença crônica transmissível causada pelo bacilo Mycobacterium leprae, que acomete sobretudo a pele e os nervos periféricos, podendo provocar perda das funções sensitiva e motora, usualmente evoluindo com deformidades e estigma. Apesar de estratégias mundiais e nacionais visando a eliminação da doença, a mesma persiste como relevante problema de saúde pública em diversos países, incluindo o Brasil, que apresenta elevado número absoluto de casos da doença e indicadores de transmissão ativa, traduzidos pelas taxas de detecção em menores de 15 anos. As crianças representam um grupo vulnerável à infecção, principalmente pela maior exposição a indivíduos doentes dentro da família, especialmente quando estes apresentam a classificação operacional multibacilar (MB) da hanseníase. O diagnóstico precoce seguido de tratamento dos casos é de grande importância, tanto para a redução da carga da hanseníase, quanto para a prevenção de incapacidades físicas nos pacientes. Nesse sentido, o exame de contatos é apontado como relevante ferramenta estratégica. Pretendendo avaliar o perfil epidemiológico, a evolução clínica e a magnitude da associação entre a classificação operacional para fins de tratamento e o modo de detecção em crianças diagnosticadas com hanseníase em um serviço de referência no Rio de Janeiro, foi realizado um estudo retrospectivo com dados de 335 pacientes menores de 15 anos diagnosticados com hanseníase e registrados no Ambulatório Souza Araújo, Laboratório de Hanseníase­ IOC ­ FIOCRUZRJ, no período de janeiro de 1987 a dezembro de 2018. Como limitações podemos mencionar dificuldades no levantamento e no recrutamento de todos os contatos, tratar-se estudo retrospectivo e o fato de ser realizado em um serviço de referência. Foram realizadas análises univariadas e bivariadas para verificar as distribuições dos pacientes com relação a todas as variáveis do estudo, e o modelo de regressão logística foi aplicado, considerando como variável dependente a classificação operacional MB, para avaliar a associação entre esta classificação e o modo de detecção (encaminhamento ou exame de contato) nos pacientes estudados. Para esta análise foram incluídos os pacientes diagnosticados através de encaminhamentos e apenas os casos coprevalentes do grupo diagnosticado através do exame de contato. As crianças detectadas através de encaminhamentos apresentaram chance duas vezes maior [OR 2,00 (IC95% 1,02 ­ 3,92)] de serem diagnosticadas com a hanseníase MB, quando comparadas àquelas detectadas através do exame de contato. Nos pacientes do sexo masculino foi observada chance 2,16 vezes maior (IC95% 1,13 ­ 4,14) de apresentarem a classificação operacional MB quando comparados aos do sexo feminino. Nos pacientes com idade entre 10 e 14 anos, a chance para apresentarem hanseníase MB foi 3,57 vezes maior (IC95% 1,84 ­ 6,90) em relação àqueles com idade entre 0 a 9 anos. A presença cicatriz de BCG, indicando imunização recebida após o nascimento, apresentou redução de chance de apresentarem classificação operacional MB [OR 0,45 (IC95% 0,24 ­ 0,84)]. Esses dados confirmam a importância da realização do exame dos contatos de casos novos registrados para tratamento poliquimioterápico como estratégia para o diagnóstico precoce da doença, principalmente em menores de 15 anos.


Leprosy is a chronic transmissible disease caused by the bacillus Mycobacterium leprae, which mainly affects the skin and peripheral nerves, and can cause loss of sensory and motor functions, usually progressing with deformities and stigma. Despite global and national strategies to eliminate the disease, it persists as a relevant public health problem in several countries, including Brazil, which has a high absolute number of cases of the disease and indicators of active transmission, translated by detection rates in children under 15 years. Children represent a vulnerable group to infection, mainly due to the greater exposure to sick individuals within the family, especially when they present the multibacillary operational classification (MB) of leprosy. Early diagnosis followed by treatment of cases is of great importance, both for reducing the burden of leprosy and for preventing physical disabilities. In this sense, the examination of contacts is identified as a relevant strategic tool. In order to assess the epidemiological profile, clinical evolution and the magnitude of the association between the operational classification for treatment purposes and the mode of detection in children diagnosed with leprosy in a reference service in Rio de Janeiro, a retrospective study was conducted with data from 335 patients under 15 years of age diagnosed with leprosy and registered at the Souza Araújo Ambulatory, Leprosy Laboratory - IOC - FIOCRUZ- RJ, from January 1987 to December 2018. As limitations, we can mention difficulties in the survey and recruitment of all contacts, a retrospective study and the fact that it was carried out in a reference service. Univariate and bivariate analyzes were performed to verify the distribution of patients in relation to all study variables, and the logistic regression model was applied, considering the MB operational classification as a dependent variable, to assess the association between this classification and the mode of detection (referral or contact examination) in the studied patients. For this analysis, patients diagnosed through referrals and only co-prevalent cases in the group diagnosed through contact examination were included. Children detected through referrals were twice as likely [RC 2.00 (95% CI 1.02 - 3.92)] to be diagnosed with MB leprosy, when compared to those detected through contact examination. Male patients were 2.16 times more likely (95% CI 1.13 - 4.14) to have the MB classification when compared to females. In patients aged 10 to 14 years, the chance of having a MB classification was 3.57 times greater (95% CI 1.84 - 6.90) compared to those aged 0 to 9 years. The presence of BCG scar, indicating immunization received after birth, presented a reduced chance of having an MB operational classification [OR 0.45 (95% CI 0.24 - 0.84)]. These data confirm the importance of examining the contacts of new cases registered for polychemotherapy treatment as a strategy for the early diagnosis of the disease, especially in children under 15 years of age.


Subject(s)
Logistic Models , Clinical Evolution , Leprosy, Multibacillary , Leprosy , Mycobacterium leprae
15.
Mem. Inst. Oswaldo Cruz ; 115: e190324, 2020. tab, graf
Article in English | LILACS | ID: biblio-1091245

ABSTRACT

BACKGROUND Leprosy is an infectious-contagious disease caused by Mycobacterium leprae that remain endemic in 105 countries. This neglected disease has a wide range of clinical and histopathological manifestations that are related to the host inflammatory and immune responses. More recently, the inflammasome has assumed a relevant role in the inflammatory response against microbiological agents. However, the involvement of inflammasome in leprosy remains poorly understood. OBJECTIVES The aim is to associate biomarkers of inflammasome with the different immunopathological forms of leprosy. METHODS We performed an observational, cross-sectional, and comparative study of the immunophenotypic expression of inflammasome-associated proteins in immunopathological forms of leprosy of 99 skin lesion samples by immunohistochemistry. The intensity and percentage of NLRP3, Caspase-1, Caspases-4/5, interleukin-1β and interleukin-18 immunoreactivities in the inflammatory infiltrate of skin biopsies were evaluated. FINDINGS Strong expression of NLRP3 and inflammatory Caspases-4/5 were observed in lepromatous leprosy (lepromatous pole). In addition, were observed low expression of caspase-1, interleukin-1β, and interleukin-18 in tuberculoid and lepromatous leprosy. The interpolar or borderline form showed immunophenotype predominantly similar to the lepromatous pole. MAIN CONCLUSIONS Our results demonstrate that the NLRP3 inflammasome is inactive in leprosy, suggesting immune evasion of M. leprae.


Subject(s)
Humans , Immune Evasion/immunology , Inflammasomes/metabolism , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Leprosy/immunology , Leprosy/metabolism , Mycobacterium leprae/immunology , Immunohistochemistry , Cross-Sectional Studies , Leprosy/pathology
16.
Rio de Janeiro; s.n; 2020. xii, 79 p. ilus.
Thesis in Portuguese | LILACS | ID: biblio-1129385

ABSTRACT

A hanseníase é uma doença infecciosa, desmielinizante, que pode levar à incapacidades e deformidades físicas permanentes. Dados anteriores demonstraram que Mycobacterium leprae, o agente etiológico da doença, consegue modular a biologia das células de Schwann. Um ponto ainda não elucidado é se o dano neural na hanseníase é causado diretamente pelo bacilo ou se é dependente do infiltrado inflamatório. Sabe-se que durante os episódios reacionais, o aumento de citocinas pró-inflamatórias, como IFN-γ, pode contribuir para o incremento do dano neural por um mecanismo ainda desconhecido e, uma correlação positiva entre concentrações séricas de TNF-α e desmielinização em pacientes com hanseníase já foi demonstrada. IFN-γ e TNF-α são citocinas capazes de induzir a expressão de Indoleamina 2,3 dioxigenase (IDO1), enzima chave na regulação da via das quinureninas, em diversos tipos celulares como monócitos, macrófagos e células dendríticas. Diversos estudos envolvendo patologias do sistema nervoso central apontam que as quinureninas produzidas pela degradação do triptofano podem ter uma função neurotóxica, mas pouco se sabe sobre o envolvimento de IDO1 e seus metabólitos na patogênese de doenças do sistema nervoso periférico. O presente estudo teve como objetivo avaliar a possível contribuição de IDO1 e seus metabólitos na neuropatia hanseniana. Inicialmente foi demonstrado que M. leprae aumenta a expressão de IDO1 em células de Schwann primárias e da linhagem ST88-14. No entanto, o bacilo não é capaz de aumentar a atividade de IDO1 em células de Schwann da linhagem ST88-14.


Foi observado que as citocinas pró-inflamatórias IFN-γ e TNF-α isoladamente não são capazes de induzir a expressão proteica de IDO1, mas aumentam significativamente sua atividade em células ST88-14. Em associação com M. leprae, IFN-γ exerce um forte estímulo na indução da atividade enzimática de IDO1. A infecção com M. leprae diminui a expressão gênica de Quinurenina aminotransferase II (AADAT), sugerindo que o mesmo possa estar direcionando a via para a produção de metabólitos neurotóxicos como o ácido quinolínico (QUINA), 3-hidroxiquinurenina (3-HK) e ácido 3-hidroxiantranílico (3HAA). A análise de viabilidade celular demonstrou que 3-HAA é capaz de induzir apoptose em células ST88-14 e, a análise por ELISA, dos sobrenadantes de 24h de cultura, demonstrou que M. leprae viável induz aumento na concentração do metabólito ácido quinurênico (KYNA) que é significativamente reduzida na presença de IFN-γ, enquanto IFN-γ aumenta significativamente a concentração de QUINA, principalmente quando associado à M. leprae morto. Foi observado um aumento na atividade de IDO1 em soro de pacientes com neuropatia hanseniana em relação a pacientes com outras neuropatias periféricas. Uma correlação positiva foi observada entre a atividade de IDO1 e a gravidade do dano neural, conforme avaliado pelo exame de eletroneuromiografia. Em conjunto, os dados apresentados sugerem o envolvimento da via das quinureninas no dano neural na hanseníase. (AU)


Subject(s)
Humans , Schwann Cells , Indoleamine-Pyrrole 2,3,-Dioxygenase , Kynurenine , Leprosy , Mycobacterium leprae
17.
Mem. Inst. Oswaldo Cruz ; 115: e200075, 2020. graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1135240

ABSTRACT

BACKGROUND Although Mycobacterium leprae (ML) is well characterised as the causative agent of leprosy, the pathophysiological mechanisms underlying peripheral nerve damage still need further understanding. In vitro and in vivo studies have yielded insights into molecular mechanisms of ML interaction with Schwann cells (SC), indicating the regulation of genes and proteins crucial to neural plasticity. OBJECTIVES We aimed to investigate the effect of ML on neurotrophins expression in human SC (hSC) and mice sciatic nerves to better understand their role in leprosy neuropathy, and aiming to contribute to future therapeutic approaches. METHODS We evaluated mRNA and protein expression of BDNF, NGF, NT-3, NT-4 in hSC from amputation nerve fragments, as well as in athymic nude mice, infected by ML for eight months. FINDINGS and MAIN CONCLUSIONS Our in vitro results showed a trend to decline in NGF and BDNF mRNA in ML-treated hSC, compared to controls. The immunodetection of BDNF and NT-4 was significantly downregulated in ML-treated hSC. Conversely, ML-infected mice demonstrated upregulation of NT-3, compared to non-infected animals. Our findings indicate that ML may be involved in neurotrophins regulation, suggesting that a pathogen-related imbalance of these growth factors may have a role in the neural impairment of leprosy.


Subject(s)
Humans , Animals , Mice , Schwann Cells/metabolism , Sciatic Nerve/metabolism , Mycobacterium leprae , Nerve Growth Factors/metabolism , Mice, Nude
18.
Rev. Soc. Bras. Med. Trop ; 53: e20200277, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1143873

ABSTRACT

Abstract INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.


Subject(s)
Humans , Leprosy, Lepromatous , Annexin A1 , Leprosy , Lymphocytes , Mycobacterium leprae
19.
Rev. Soc. Bras. Med. Trop ; 53: e20200197, 2020.
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1143857

ABSTRACT

Abstract Slit skin smear and histopathological examinations are currently the main laboratory tools used to aid the diagnosis of leprosy. However, their sensitivity is low, and many cases are not detected. New methodologies have been studied to develop more accurate tests. This narrative review aims to raise attention to the results of molecular (polymerase chain reaction) and serological (Enzyme-Linked Immunosorbent Assay) tests applied to the diagnosis of leprosy, and to summarize the available information about the former. Original scientific articles published in indexed international journals, whose study involved aspects of the diagnosis and classification of leprosy cases or home contacts, were selected. The data were extracted independently using a standardized method that dictated the inclusion of the following information: diagnosis in Paucibacillary and Multibacillary cases and in household contacts; sample number; sample type; study design; studied variables; statistical analysis employed; main results; and limitations identified. In clinical practice, the results from molecular and serological tests are assessed separately, with moderate sensitivity and specificity. However, an integrated study of these methodologies has been suggested for greater accuracy in diagnosis.


Subject(s)
Humans , Leprosy/diagnosis , Mycobacterium leprae/genetics , Enzyme-Linked Immunosorbent Assay , Serologic Tests , Polymerase Chain Reaction , Sensitivity and Specificity
20.
Rev. Soc. Bras. Med. Trop ; 53: e20200246, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136821

ABSTRACT

Abstract INTRODUCTION: Leprosy is a chronic infectious disease caused by Mycobacterium leprae.This study aimed to analyze the epidemiological, temporal, and spatial dynamics ofleprosy in a municipality in northeastern Brazil. METHODS: This is an ecological study on new leprosy cases in the population of Arapiraca (Alagoas, Northeast Region, Brazil), from 2008 to 2017. Data extracted from a national database were analyzed forepidemiological indicators, factors associated with physical disabilities, and spatialanalysis in the neighborhoods of Arapiraca. RESULTS: A total of 292 new cases of leprosy were recorded, particularly occurring among the following groups: women, the age group of 46-59 years, brown-skinned individuals, people with less than eight years of schooling, and urban residents; the new cases were also predominantly the tuberculoid form and were of the paucibacillary classification of the disease. Almost 1/3 of the people had some degree of physical disability, which was mainly associated with the group 60 years of age and older, black ethnicity, and the multibacillary clinical form of leprosy. The joinpoint regression showed a stationary temporal behavior of indicators. There was a heterogeneous spatial distribution with active transmission areas, especially in the neighborhoods Primavera, Baixão, Ouro Preto, and downtown. CONCLUSIONS: The epidemiological indicators revealed complexity in the process of leprosy development. These spatial and temporal studies are relevant to help in the planning, monitoring, and guidance of interventions in the municipality. The spatial analysis showed heterogeneous distribution in the analyzed neighborhoods.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Leprosy/epidemiology , Brazil/epidemiology , Disabled Persons , Spatial Analysis , Middle Aged , Mycobacterium leprae
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