ABSTRACT
BACKGROUND: Leprosy has been treated with multidrug therapy, which has been distributed for free across the globe and regarded as highly efficient. However, the impossibility of growing Mycobacterium leprae in axenic media has historically impaired assessments of M. leprae resistance, a parameter only recently detectable through molecular methods. METHODS: A systematic, population-based search for M. leprae resistance in suspected leprosy relapse cases and contacts was performed in Prata Village, an isolated, hyperendemic, former leprosy colony located in the Brazilian Amazon. Results led to an extended active search involving the entire Prata population. Confirmed leprosy cases were investigated for bacterial resistance using a combination of in vivo testing and direct sequencing of resistance genes folP1, rpoB, and gyrA. A molecular epidemiology analysis was performed using data from 17 variable number tandem repeats (VNTR). RESULTS: Mycobacterium leprae was obtained from biopsies of 37 leprosy cases (18 relapses and 19 new cases): 16 (43.24%) displayed drug-resistance variants. Multidrug resistance to rifampicin and dapsone was observed in 8 relapses and 4 new cases. Single resistance to rifampicin was detected in 1 new case. Resistance to dapsone was present in 2 relapses and 1 new case. Combined molecular resistance and VNTR data revealed evidence of intra-familial primary transmission of resistant M. leprae. CONCLUSIONS: A comprehensive, population-based systematic approach to investigate M. leprae resistance in a unique population revealed an alarming scenario of the emergence and transmission of resistant strains. These findings may be used for the development of new strategies for surveillance of drug resistance in other populations.
Subject(s)
Leprosy , Pharmaceutical Preparations , Brazil/epidemiology , Drug Resistance, Bacterial , Drug Therapy, Combination , Humans , Leprostatic Agents/pharmacology , Leprostatic Agents/therapeutic use , Leprosy/drug therapy , Leprosy/epidemiology , Microbial Sensitivity Tests , Mycobacterium leprae/geneticsABSTRACT
BACKGROUND: Leprosy has been treated with multidrug therapy (MDT) distributed for free across the globe and regarded as highly efficient. However, the impossibility to grow M. leprae in axenic media has historically impaired assessment of M. leprae resistance, a parameter only recently detectable through molecular methods. METHODS: A systematic, population-based search for M. leprae resistance in suspected leprosy relapse cases and contacts was performed in Prata Village, an isolated, hyper-endemic former leprosy colony located in the Brazilian Amazon. Results led to an extended active search involving the entire Prata population. Confirmed leprosy cases were investigated for bacterial resistance using a combination of in vivo testing and direct sequencing of resistance genes folP1, rpoB and gyrA. Molecular epidemiology analysis was performed using data from 17 variable number tandem repeats (VNTR). RESULTS: M. leprae was obtained from biopsies of 37 leprosy cases (18 relapses and 19 new); 16 (43.24%) displayed drug-resistance variants. Multi-drug resistance to rifampicin and dapsone was observed in 8 relapses and 4 new cases. Single resistance to rifampicin was detected in one new case. Resistance to dapsone was present in two relapses and one new case. Combined molecular resistance and VNTR data revealed evidence of intra-familial primary transmission of resistant M. leprae. CONCLUSIONS: A comprehensive, population-based systematic approach to investigate M. leprae resistance in a unique population revealed an alarming scenario of emergence and transmission of resistant strains. These findings may be used for the development of new strategies for surveillance of drug resistance in other populations.
Subject(s)
Drug Resistance, Bacterial/genetics , Leprosy/transmission , Mycobacterium leprae/drug effects , BrazilABSTRACT
O suporte básico da vida, em sua essência, visa ao atendimento imediato da parada cardiorespiratória. O reconhecimento da parada cardiorespiratória, a realização de manobras de ressuscitação cardiopulmonar e de desfibrilação precoce assim como a chegada do suporte avançado estão diretamente relacionados com a sobrevida. A participação da população leiga no atendimento da parada cardiorespiratória é de fundamental importância, assim como a participação médica. As cidades e comunidades, em nosso país, precisam se empenhar para desenvolver métodos populacionais de esclarecimento e incentivo à busca por informações precisas do tratamento da parada cardiorespiratória. O mesmo deve ser observado na atividadae desportiva. Ressaltam-se as principais modificações nas novas diretrizes em emergências e ressuscitação em suporte básico de vida.
