Casos inusuales de lepra en la provincial de Camagüey, Cuba, 2015 / No disponible

La lepra es una enfermedad común y aunque ya no constituye un problema de salud en el país ni en la provincia, sí se notifican casos todos los años. Este año notificamos casos con características clínicas inusuales, pues la lepra de Lucio es una forma de lepra lepromatosa que se observa fundamentalmente en México, siendo excepcional su presentación en nuestro medio. Es la denominada lepra difusa o moteada, no tiene nódulos sino que se caracteriza por presentar zonas de vasculitis múltiples en la que se produce necrosis dermoepidérmica y la aparición de úlceras planas que se unen entre sí y curan dejando cicatriz. Se caracteriza por presentar una infiltración difusa generalizada de la piel. Además, se presentó un segundo caso con lepra tuberculoide de lesión única, con engrosamiento de nervios cubitales de 10 años de evolución, sin tratamiento y sin ningún tipo de discapacidad. El tercer caso se presentó con manifestaciones clínicas muy floridas de una lepra dimorfa sin anestesia táctil, térmica ni dolorosa con un año de evolución sin tratamiento

Leprosy is a common illness in our area and although it no longer represents a public health problem in the state or at country level new cases are notified every year. This year we have diagnosed cases with unusual clinical characteristics, one with Lucio’s Leprosy is a form of lepromatous leprosy that is observed fundamentally in Mexico and unusual in our area. It is also defined as diffuse or spotted leprosy and the patient doesn’t have nodules but presents areas of multiple vasculitis in which dermoepidermal necrosis together with the appearance of plane ulcers that unite takes place and it cures leaving a scar. This type of leprosy is mainly characterized by a disseminated diffuse infiltration of the skin. We also had a second case with single lesion tuberculoid leprosy, presenting affectation of the ulnar nerve, without treatment, no visible deformities and diagnosed 10 years ago of the disease. And a third case with very florid clinical manifestations of dimorphous leprosy without tactile, thermal nor pain anesthesia with a year of evolution and without treatment is also presented

Epidemiología de la lepra en la región del norte araguaia, mt, Brasil en el período entre 2001 y 2012, Parte I / No disponible

No disponible

Caso familiar intradomiciliario de lepra tuberculoide e índice lepromatoso / No disponible

La lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, que tiene especial tropismo por la piel, las membranas mucosas y los nervios periféricos. En general, cuando se manifiesta en los niños menores de quince años refleja la intensidad y la larga exposición a una gran carga bacteriana.1 En Paraguay, según datos del Programa Nacional de Control de Lepra, en el año 2013 se reportaron 408 casos nuevos, lo que corresponde a una tasa de 6,11 casos por 100.000 habitantes, 394 casos (96,6%) en pacientes mayores de 15 años y 14 casos (3,4%) en pacientes menores de 15 años.2 Presentamos un caso de Lepra familiar, donde el diagnóstico de un hombre con Lepra Lepromatosa condujo a la investigación de sus contactos intra-domiciliarios, en quienes se diagnosticaron casos de Lepra Tuberculoide (en dos de sus tres hijos). Este reporte demuestra la importancia de la realización de una pesquisa activa entre los contactos de los pacientes, constituyéndose así en una herramienta imprescindible, tanto para el diagnóstico y el tratamiento tempranos, así como para prevenir secuelas y eliminar la enfermedad como problema de salud pública

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which has special tropism for the skin, mucous membranes and peripheral nerves. In general, when it manifests in children under fifteen years old, reflects the intensity and long exposure to a high bacterial load.1 In Paraguay, according to the National Leprosy Control Programme, in the year 2013, 408 new cases were diagnosed, which corresponds to a rate of 6,11 cases per 100,000, 394 cases (96,6%) in patients older than 15 years old were reported, and 14 cases (3,4%) in patientsyounger than 15 years old.2 We present a case of family Leprosy, where the diagnosis of a man with Lepromatous Leprosy, led to the investigation of their household contacts, in which cases of Tuberculoid Leprosy were diagnosed in two of their three children. This report demonstrates the importance of conducting an active investigation between patient contacts, thus becoming an indispensable tool for both, the early diagnosis and treatment, as well as to prevent damage and eliminate the disease as a public health problem

Leprosy: a review of laboratory and therapeutic aspects--part 2.

Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Leprosy: a review of laboratory and therapeutic aspects - Part 2

Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Epidemiological situation of leprosy in Salvador from 2001 to 2009.

Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.

Epidemiological situation of leprosy in Salvador from 2001 to 2009

Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil.

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil / Aspectos epidemiológicos, clínicos e operacionais de portadores de hanseníase atendidos em um serviço de referência no estado do Maranhão

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7 percent were male participants, and 60 percent were brown. Concerning the age, 54.8 percent of women were between 35 and 49 years, and 57.6 percent of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3 percent of cases, and the multibacillary form was found in 72.9 percent. The skin smear was positive in 42.3 percent. The occurrence of reaction was found in 43.5 percent of cases, and 83.5 percent had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7 percent of the patients. Most of the individuals (96.4 percent) lived in houses made of brick with more than three rooms (72.6 percent) and two persons per room (65.1 percent). Concerning the level of education, 41.4 percent of women and 34.1 percent of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5 percent), and that in the end was the age group of 20 to 34 (29.9 percent) with Grade 0, 30.7 percent Grade 1, and 11.5 percent Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

INTRODUÇÃO: A hanseníase é uma doença infecto-contagiosa causada pelo Mycobacterium leprae. Este estudo descreve os aspectos epidemiológicos, clínicos e operacionais de portadores de hanseníase. MÉTODOS: Estudo transversal, realizado no município de São Luis, MA. RESULTADOS: Foram analisados 85 casos, sendo 51,7 por cento, do sexo masculino e cor parda (60 por cento). As mulheres tinham entre 35 a 49 anos de idade (54,8 por cento) e os homens entre 20 a 34 (57,6 por cento). A forma virchowiana foi mais frequente (42,3 por cento), a classe operacional a multibacilar (72,9 por cento) e baciloscopia positiva em 42,3 por cento. Houve ocorrência de reação em 43,5 por cento, e ausência da cicatriz da Bacillus Calmette-Guérin (BCG) em 83,5 por cento. Hanseníase na família foi referida por 44,7 por cento. As casas eram de alvenaria (96,4 por cento), tinham mais de 3 cômodos (72,6 por cento), dormindo duas pessoas por cômodo (65,1 por cento). Quanto aos anos de estudo, 41,4 por cento de mulheres e 34 por cento de homens tinham de um a três anos. A faixa etária entre 35 e 49 anos foi a mais avaliada com Grau 0 de incapacidade, no início do tratamento (64,5 por cento) e no final, foi entre 20 e 34 e destes 29,9 por cento tinham Grau 0, 30,7 por cento Grau 1 e 11,5 por cento Grau 2. CONCLUSÕES: A frequência das formas multibacilares e casos em familiares indicam diagnósticos tardios, reforçando a importância do diagnóstico precoce e tratamento adequado, para a redução do aparecimento de incapacidades.

Use of the ML-Flow test as a tool in classifying and treating leprosy.

BACKGROUND: The treatment of leprosy is defined by the classification of patients as paucibacillary (PB) or multibacillary (MB). The WHO (World Health Organization) classifies patients according to the number of lesions, but Ridley-Jopling (R & J) also uses complementary exams, which are difficult to use outside reference services. In 2003, a test called ML-Flow, an alternative to Elisa serology, was developed to help classify patients as PB or MB and decide about their treatment. OBJECTIVES: To assess the agreement between the ML-Flow test and slit skin smears, already largely used for MB detection, and to observe the efficacy of the ML-Flow test in the field. MATERIAL AND METHODS: A retrospective study evaluating the medical records of 55 patients who had not undergone previous treatment, diagnosed as PB or MB according to R & J and subjected to slit skin smears and the ML- Flow test. RESULTS: In MB patients, slit skin smears were positive in 80% of the cases, the ML-flow was positive in 82.5%. Among PB patients, the ML-Flow was positive in 37.5% and slit skin smears were negative in 100% of the cases. The agreement between skin smear and ML-Flow results was 87.5%, with a kappa value of 0.59, p <0.001. CONCLUSION: No laboratory test is 100% sensitive and specific for the correct classification of all forms of leprosy. The ML-Flow test is faster, easier to use, and less invasive than slit skin smears and therefore may be useful when making therapeutic decisions in areas of difficult access to reference services.

Uso do teste ML-Flow como auxiliar na classificação e tratamento da hanseníase / Use of the ML-Flow test as a tool in classifying and treating leprosy

FUNDAMENTOS: O tratamento da hanseníase é definido pela classificação de pacientes em paucibacilares (PB) e multibacilares (MB). A OMS (Organização Mundial de Saúde) classifica os doentes de acordo com o número de lesões, mas Ridley-Jopling (R&J) utiliza também exames complementares, porém é de difícil utilização fora dos serviços de referência. Em 2003 foi desenvolvido um teste denominado ML-Flow, uma alternativa à sorologia por ELISA para auxiliar na classificação de pacientes em PB e MB e auxiliar na decisão terapêutica. OBJETIVOS: Observar a concordância entre o teste de ML-Flow e baciloscopia de linfa, exame já consagrado para detecção de MB. Analisar a utilidade do teste de ML-Flow em campo. MATERIAL E MÉTODOS: Estudo retrospectivo avaliando prontuário de 55 pacientes virgens de tratamento, diagnosticados como PB ou MB por R&J. Submetidos à baciloscopia e ao teste de ML-Flow. RESULTADOS: Nos MB, a baciloscopia foi positiva em 80 por cento dos casos, o ML-flow foi positivo em 82,5 por cento. Entre os PB, o ML-Flow foi positivo em 37,5 por cento e a baciloscopia do esfregaço foi negativa em 100 por cento dos casos. A concordância entre os resultados da baciloscopia do esfregaço e ML-Flow foi de 87,5 por cento, kappa=0,59, p<0,001. CONCLUSÃO: Nenhum teste laboratorial é 100 por cento sensível e específico para a correta classificação de todas as formas de hanseníase. O ML-Flow é um teste rápido, de fácil manuseio em campo, menos invasivo que a baciloscopia podendo ser útil para auxiliar na decisão terapêutica em locais de difícil acesso a serviços de referência.

BACKGROUND: The treatment of leprosy is defined by the classification of patients as paucibacillary (PB) or multibacillary (MB). The WHO (World Health Organization) classifies patients according to the number of lesions, but Ridley-Jopling (R & J) also uses complementary exams, which are difficult to use outside reference services. In 2003, a test called ML-Flow, an alternative to Elisa serology, was developed to help classify patients as PB or MB and decide about their treatment. OBJECTIVES: To assess the agreement between the ML-Flow test and slit skin smears, already largely used for MB detection, and to observe the efficacy of the ML-Flow test in the field. MATERIAL AND METHODS: A retrospective study evaluating the medical records of 55 patients who had not undergone previous treatment, diagnosed as PB or MB according to R & J and subjected to slit skin smears and the ML- Flow test. RESULTS: In MB patients, slit skin smears were positive in 80 percent of the cases, the ML-flow was positive in 82.5 percent. Among PB patients, the ML-Flow was positive in 37.5 percent and slit skin smears were negative in 100 percent of the cases. The agreement between skin smear and ML-Flow results was 87.5 percent, with a kappa value of 0.59, p <0.001. CONCLUSION: No laboratory test is 100 percent sensitive and specific for the correct classification of all forms of leprosy. The ML-Flow test is faster, easier to use, and less invasive than slit skin smears and therefore may be useful when making therapeutic decisions in areas of difficult access to reference services.

Hanseníase paucibacilar: estudo retrospectivo da evolução clínica e laboratorial durante a poliquimioterapia dose fixa (PQT/OMS) / Paucibacillary leprosy: a retrospective study of clinical and laboratory during the fixed dose multidrug therapy (WHO / MDT)

Foram estudados retrospectivamente 185 pacientes hansenianos do Centro de Referência em Hanseníase do Ministério da Saúde da Fundação Oswaldo Cruz, classificados como paubacilares, que seguindo as recomendações da Organização Mundial de Saúde em 1982, receberam tratamento poliquimioterápico (PQT/OMS) com dose fixa...Através das correlações entre as variações podemos observar que não houve correlação entre o número de lesões cutâneas iniciais e o número de troncos neurais espessados (inicial) e qu eo número de troncos neurais espessados (inicial) não interferiu no grau de incapacidade inicial e final. A evolução clínica das lesões cutâneas e a evolução das lesões neurológicas não sofreram interferência das variáveis estudadas.