The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy

Abstract Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.

Lepra dimorfa en estado reaccional tipo 1 y 2 / Multibacillary borderline leprosy with leprosy reaction type 1 and 2

El enfoque de los pacientes con lepra se ha modificado de forma positiva en los últimos años; sin embargo, las reacciones lepróticas siguen siendo un problema clínico importante. Se reporta el caso de un paciente con lepra dimorfa multibacilar que presentó reacción leprótica tipo 1 y 2. Se discute la dificultad de su manejo.

Leprosy reaction and immune reconstitution syndrome in Aids / Reação hansênica e síndrome de reconstituição imunológica na Aids

The authors report seven cases of borderline leprosyin AIDS patients whose presentation form was of a typeI reaction diagnosed soon HAART introduction, whichled to the discussion of the immunological aspects involved in the reaction to leprosy and the immune reconstitution syndrome. The patients were in frank AIDS-induced immune deterioration, which was the reason they met the criteria to initiate HAART treatment. It is likely that due to this fact, the amount of CD4 cells increased at the same time that a reduction of the viral load occurred, allowing the installation of a basically Th1 immunological profile. Therefore, the leprosy infection, which was dormant and unable to express itself was exteriorized in the form of a reverse reaction.

Hanseniase: episodio reacional tuberculoide desencadeado preconcemente apos instalaçao de poliquimioterapia, em individuo inicialmente diagnosticado como multibacilar / Leprosy: tuberculoid reactional episode developed early after multidrugtherapy was initiated in patient initially diagnosed as multibacillary

Um homem de cor parda, 66 anos de idade, refere ha 10 anos disturbio de sensibilidade na regiao dorsal do halux direito, e ha 6 meses placa eritematosa no braço direito co diagnostico histopatologico de hanseniase multibacilar. Quinze dias apos instalaçao de poliquimioterapia, a lesao inicial se tumefaz, ulcera e aparecem novas lesoes eritemato-edematosas disserminadas na pele. A biopsia de uma dessas novas lesoes demonstra hanseniase reacionla na faixatuberculoide com baciloscopia de 3+/6. O aparecimento da lesao inicial coincidiu com diagnostico recente de diabetes mellitus, e durante o episodio reacional o paciente apresentou mal-estado geral, febre e leve ictiricia Os autores discutem a patogenese destes eventos, surgerindo uma fase previa de degradaçao (downgrading) devido a progressiva proliferaçao bacilar, com consequente inibiçao da imunidade celular pela açao dos antigenos capsulares produzidos pela fraçao de bacilos integros e viaveis...

Leprosy and herpes zoster; an association or dissociation?

Nerve involvement is common to the pathogenesis of both leprosy and herpes zoster. We report two cases of borderline leprosy in which the skin lesions characteristically spared the healed zoster scar. Possible mechanisms and relationship are discussed.

Thyroid functional status in leprosy patients in Sudan

We studied 45 adult patients with untreated lepromatous leprosy and borderline leprosy, presenting at clinics in Khartoum and Omdurman, to assess clinical and biochemical effects of the disease on thyroid function. A matching control group of 30 subjects, without symptoms or signs of thyroid disease, were included for comparison. Thyroxine, triiodothyronine and thyrotrophin levels were within normal range. Mean serum thyroxine was low in both groups [significant in lepromatous leprosy patients only]. Mean serum triiodothyronine was high in both groups [significant in neither group]. Mean thyrotrophin was significantly higher in both groups compared with controls

Hanseníase dimorfa e infecçäo pelo HIV (Aids) / Borderline leprosy and HIV infection

Uma paciente jovem, de cor branca apresentando dor na perna esquerda e uma placa no membro superior esquerdo com distúrbios de sensibilidade, baciloscopia + e com diagnóstico de hanseníase DT, iniciou tratamento com a PQT/OMS para MB. Três meses após o início do tratamento, apresentou surto reacional (Reaçäo tipo 1) com acentuaçäo da infiltraçäo e do edema na lesäo inicial e o aparecimento de várias outras placas, também eritematosas, disseminadas por todo o tegumento. Nessa ocasiäo, a dor na perna continuava e näo parecia relacionada com a hanseníase. Pelo fato de eletroneuromiografia ter sido inconclusiva, foi realizada uma ressonância magnética que acusou um neurinoma no nível da 4ª vértebra lombar que a histopatologia mostrou tratar-se de um schwanoma benigno. O tumor foi retirado cirugicamente e a dor desapareceu

Reaçao hansenica tipo 1 ulcerada / Ulcerated type 1 leprosy reaction

Os autores estudaram15 casos de hanseniase tuberculoide reacional (13) e dimorfa reacional (2) que ulceraram (12 mulheres e 3 homens, entre 30 e 76 anos). Chamam a atençao para a escassez de trabalhos na literatura sobre esse tema e descreveram os aspectos clinicos desses casos, os resultados da baciloscopia, histopatologia e do teste de Mitsuda, Eles enfatizaram a predominancia de pacientes com imunidade mais alta, ou seja, aqueles que exibiam baciloscopia negativa e a reaçao de Mitsuda igual a 6 mm ou mais. As ulceraçoes apareceram, na maioria das vezes, durante o 2º ou 3º surto reacional. A opiniao dos autores e de que as reaçoes hansenicas tipo 1 sao manifestaçoes de hipersensibilidade que ocoreram devido a multiplicaçao, bacilar, seguida de sua destruiçao pelas defesa organicas ou pela terapeutica e a consequente liberaçao de epitopos, que desencadeariam o fenomeno reacional. Eles surgeriram para explicar o aparecimento de ulceraçoes em seus pacientes duas possibilidades. A primeira seria uma estimulaçao continua dos macrofagos, podendo levar ao dano tecidual atraves da produçao de intermediarios reativos do oxigenio e hidrolases, que e devida ao aumento na produçao de TNFalfa....

Audiovestibular involvement in leprosy.

100 leprosy patients were studied for audiovestibular involvement. Conductive hearing loss was detected in 6 cases of BT leprosy, all of them having coincidental chronic middle ear infection. Sensori-neural hearing loss was detected in 10 cases, of which 6 had LL, 2 BT and 2 pure neuritic type of disease respectively. All the cases of lepromatous leprosy having sensorineural hearing loss had evidence of ENL reaction. Vestibular involvement was not detected in any of the cases. Evaluation of audiovestibular function was also carried out in 50 fresh cases of leprosy and after 3 months, 6 months and 1 year of multidrug therapy to ascertain any ototoxic side effects of antileprosy drugs. No audiovestibular dysfunction was detected in these patients at any time during follow-up.