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1.
Int J Infect Dis ; 118: 44-51, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838840

ABSTRACT

OBJECTIVES: We aimed to characterize the profile of patients diagnosed with leprosy relapse and understand the influence of different multidrug therapy (MDT) treatments and initial disease presentation. METHODS: This retrospective study included patients diagnosed with leprosy relapse at a referral center in Brazil from 2013 to 2018. We analyzed their clinico-epidemiologic characteristics, laboratory data, and bacilloscopic tests. Survival analysis was used to determine the time elapsed until relapse according to the previous treatment and clinical forms of the disease. RESULTS: A total of 126 cases of relapse were analyzed, which comprised 11.89% (126/1059) of the cases. The median time elapsed until a relapse was 10 years, and most patients had previously undergone 12 doses of MDT (40.48%; 51/126). Undergoing 24 doses of MDT was associated with a better prognosis regarding relapse over time compared with 6 or 12 doses of MDT therapy. Most cases of relapse were classified as multibacillary (96.03%; 121/126). CONCLUSION: The incidence of relapse was greater than observed in other studies. The high percentage of multibacillary patients who had negative bacillary indices demonstrated that the bacillary index cannot be considered to be an essential criterion for relapse, especially concerning making an early diagnosis.


Subject(s)
Leprostatic Agents , Leprosy , Brazil/epidemiology , Chronic Disease , Drug Therapy, Combination , Humans , Leprostatic Agents/therapeutic use , Leprosy/drug therapy , Recurrence , Referral and Consultation , Retrospective Studies
3.
BMJ Open ; 11(8): e046125, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1376488

ABSTRACT

INTRODUCTION: Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS: PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION: Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER: NL7294 (NTR7503).


Subject(s)
Leprosy , Ethiopia , Feasibility Studies , Humans , Leprosy/diagnosis , Leprosy/drug therapy , Leprosy/prevention & control , Mozambique , Tanzania
4.
PLoS Negl Trop Dis ; 15(7): e0009635, 2021 07.
Article in English | MEDLINE | ID: covidwho-1329131

ABSTRACT

BACKGROUND: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Leprosy/drug therapy , Leprosy/epidemiology , Adrenal Cortex Hormones/therapeutic use , BCG Vaccine/administration & dosage , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19 Testing , Clofazimine/therapeutic use , Cohort Studies , Dapsone/therapeutic use , Humans , Pentoxifylline/therapeutic use , Prospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Survival Analysis , Thalidomide/therapeutic use
5.
Clin Dermatol ; 39(1): 133-138, 2021.
Article in English | MEDLINE | ID: covidwho-1300682

ABSTRACT

Wanda Blenska (1911-2014), a Polish physician, established a leprosy treatment center in the village of Buluba in Uganda in 1951, which lasted until 1993. Through her efforts, the village for lepers in Buluba, established in 1934, which had previously been a place of isolation conducted by the Little Sisters of St. Francis in Uganda, became such an important leprosy treatment and research center that eventually the facility was able to cooperate with similar centers in India and South Africa. It then became affiliated with research institutes in London and Amsterdam; the Borstel Research Institute near Hamburg, Germany; and the World Health Organization. Blenska developed a working relationship with the government of Uganda and contributed to changes in the government provision of health care for lepers by creating a network of leprosy treatment stations throughout the country. Through her efforts, public health education and leprosy prophylaxis became available for thousands of people, effectively changing the national attitude toward this disease. In 1994, one of the buildings of the St. Francis hospital complex in Buluba was named in her honor (The Wanda Blenska Training Centre).


Subject(s)
Leprosy , Delivery of Health Care , Female , Government , Humans , India , Leprosy/drug therapy , Leprosy/epidemiology , Leprosy/prevention & control , Uganda/epidemiology
7.
Trans R Soc Trop Med Hyg ; 115(12): 1456-1461, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1254842

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. METHODS: We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. RESULTS: Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. DISCUSSION: This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.


Subject(s)
COVID-19 , Leprosy , Cross-Sectional Studies , Drug Therapy, Combination , Humans , Leprostatic Agents , Leprosy/diagnosis , Leprosy/drug therapy , Leprosy/epidemiology , Pandemics/prevention & control , Referral and Consultation , SARS-CoV-2 , Surveys and Questionnaires
8.
PLoS Negl Trop Dis ; 14(10): e0008819, 2020 10.
Article in English | MEDLINE | ID: covidwho-958088
10.
Int J Mol Sci ; 21(17)2020 Aug 19.
Article in English | MEDLINE | ID: covidwho-724888

ABSTRACT

The aim of this study is to examine the use of an inflammasome competitor as a preventative agent. Coronaviruses have zoonotic potential due to the adaptability of their S protein to bind receptors of other species, most notably demonstrated by SARS-CoV. The binding of SARS-CoV-2 to TLR (Toll-like receptor) causes the release of pro-IL-1ß, which is cleaved by caspase-1, followed by the formation and activation of the inflammasome, which is a mediator of lung inflammation, fever, and fibrosis. The NLRP3 (NACHT, LRR and PYD domains-containing protein 3) inflammasome is implicated in a variety of human diseases including Alzheimer's disease (AD), prion diseases, type 2 diabetes, and numerous infectious diseases. By examining the use of 4,4'-diaminodiphenyl sulfone (DDS) in the treatment of patients with Hansen's disease, also diagnosed as Alzheimer's disease, this study demonstrates the diverse mechanisms involved in the activation of inflammasomes. TLRs, due to genetic polymorphisms, can alter the immune response to a wide variety of microbial ligands, including viruses. In particular, TLR2Arg677Trp was reported to be exclusively present in Korean patients with lepromatous leprosy (LL). Previously, mutation of the intracellular domain of TLR2 has demonstrated its role in determining the susceptibility to LL, though LL was successfully treated using a combination of DDS with rifampicin and clofazimine. Of the three tested antibiotics, DDS was effective in the molecular regulation of NLRP3 inflammasome activators that are important in mild cognitive impairment (MCI), Parkinson's disease (PD), and AD. The specific targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by DDS may be responsible for its observed preventive effects, functioning as a competitor.


Subject(s)
Coronavirus Infections/drug therapy , Dapsone/pharmacology , Inflammasomes/metabolism , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Pneumonia, Viral/drug therapy , Alzheimer Disease/pathology , COVID-19 , Clofazimine/pharmacology , Cognitive Dysfunction/pathology , Humans , Interleukin-1beta/metabolism , Leprosy/drug therapy , Leprosy/genetics , Pandemics , Parkinsonian Disorders/pathology , Rifampin/pharmacology , Spike Glycoprotein, Coronavirus/metabolism , Toll-Like Receptor 2/genetics
11.
Dermatol Ther ; 33(6): e14052, 2020 11.
Article in English | MEDLINE | ID: covidwho-670820
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