Enfermedad de Hansen y ginecomastia / No disponible

La lepra es una de las causas de ginecotelia, sin embargo poco se ha publicado sobre este signo común y generalmente ignorado. La prevalencia de ginecomastia, una complicación bien conocida de la lepra en pacientes varones adultos, es poco reportada. El tratamiento temprano tiene un efecto notable en la reducción de la misma. Presentamos el caso de un varón con lepra multibacilar con ginecotelia y ginecomastia, en el curso de la enfermedad

Leprosy is one of the causes of gynaecothelia, however little has been published on this common and generally ignored sign. The prevalence of gynecomastia, a well known leprosy complication in adult male patients, is little reported. Early treatment has a marked effect in reducing it. Here we present the case of a man with multibacillary leprosy who had been associated gynaecothelia and gynecomastia in the course of the disease

Risk factores for developing leprosy -A population-based cohort study in Indonesia

This study identified risk factors for developing leprosy through yearly incidence rates in five island populations. Personal factors, like age, sex, household size and the presence of M.leprae-specific antibodies as well as contact were studied. Of the 94 index patients (patients diagnosed in 2000) 43 (46%) were classified as multibacillary (MB), 17 (19%) were seropositive and 6 (7%) presented M.leprae DNA in nasal swabs as determined by polumerase chain reaction (PCR). All PCR positive patients were also seropositive. Forty-four of the 4903 persons initially without symptoms of leprosy developed leprosy in almost four years follow-up, giving an incidence rate of 2.98 per 1000 person-years. Men had a 2.2 times higher risk (95% Confidence Interval [CI]: 1.2-4.1) to developd leprosy than women. Persons living in households of more than 7 household members. Persons who were seropositive in 2000 had a 3.7 times higher risk (95% CI:1.1-12.4) than seronegative persons. Household contacts of MB patients had an adjusted hazard ratio (aHR) of 4.6 (95% CI:1.6-12.9) and household contacts of PCR positive patients an aHR of 9.36 (95% CI: 2.5-34.9) compared to non-contacts. Patients with PCR positive nasal swabs, suggesting nasal excretion of M.leprae, are probably the patients with the highest transmission patential. Since all index patients who were PCR positive were also seropositive, serology semms an adequate tool to identify these patients. Preventing seropositive persons to become seropositive patients and thus the main source of infection may break the chain of transmission

An historical and clinical review of the interaction of leprosy and pregnancy: a cycle to be broken.

Since earliest history the person with leprosy has been shut out from society. Laws have prohibited marriage and allowed divorce of those with leprosy. Segregation of the sufferer from the rest of society has been followed by separation of the sexes, and of leprous parents from their children. With the advent of antileprotic drugs, first dapsone then multidrug therapy (MDT), infection can be treated, individuals made non-infectious, and the pool of infection in the community reduced. The clinical signs of leprosy are due not to the degree of infection but to the immunological status of the host. Hormonal changes at puberty and in pregnancy can cause variation of the host's immune status. Pregnancy in women with leprosy is a hazardous undertaking. First appearance of leprosy, reactivation of the disease and relapse in 'cured' patients is likely to occur particularly in the third trimester of pregnancy. Leprosy reactions caused by variation in cell mediated and humoral immunity are triggered off by pregnancy: type 1 reaction (reversal reaction, RR) occurs post partum, while type 2 reaction (erythema nodosum leprosum, ENL) peaks in late pregnancy. Both types of reaction continue long into lactation. Neuritis with loss of both sensory and motor function is associated with relapse and reaction. Relapse, reaction and nerve damage, especially 'silent neuritis', with subsequent deformity and disability, occur not only in women on apparently effective treatment but also in those who have received MDT and have been released from treatment (RFT). To prevent disability, research is urgently needed into the mechanisms of early and late reaction and neuritis. Pregnancy is not only a trigger factor for reaction but an ideal in vivo model for research. Up to 20% of children born to mothers with leprosy may develop leprosy by puberty. While early leprosy in young children is self-healing, when marriage and childbearing take place at an early age the daughters of mothers with leprosy are likely to run the risk of experiencing the adverse effects of pregnancy on leprosy. Increased awareness and health education, as well as long term surveillance of 'cured' leprosy patients, are essential to break a potentially vicious cycle of leprosy and pregnancy. Women with cured leprosy could play an important role in screening for and detection of both early leprosy in children and late, post-MDT RFT, nerve damage in their mothers.

Lepromatous placentitis and intrauterine fetal infection in lepromatous nine-banded armadillos (Dasypus novemcinctus).

Three pregnant lepromatous armadillos along with the three sets of four fetuses and their placentae were studied histopathologically. Mycobacterium leprae were present in the decidual tissue, trophoblastic cells which line the chorionic villi, and in the cells that form the internal structure of the villi. Acid-fast organisms were also seen in the spleens of three fetuses. Congenital infection is clearly possible in leprosy in the armadillo and may also occur in humans.

Ações da enfermagem nos comprometimentos oculares na hanseniase

O trabalho realizado pela equipe com aplicação das tecnicas simples de tratamento e prevenções dos problemas oculares, mostrou-se de grande validade visto que em reavaliações posteriores pode-se constatar grande melhora no ressecamento da cornea e menor frequencia de irritações oculares. Valeu tambem pela conscientização dos pacientes que passaram a procurar sistematicamente o serviço aos menores sinais de problemas percebidos e para remoçãodos cilios na triquiase. Os proprios pacientes passaram a procurar o serviço para obtenção dos colirios lubrificantes dos olhos ressecados e dos portadores de lagoftalmo conseguiu-se que usassem o protetor ocular noturno fornecido. Ofereceu tambem aos profissionais oportunidade para aprofundar os conhecimentos na area de oftalmologia na hanseniase e perceber o quanto po ser feitocom medidas silples. Ampliou o campo de atuação do enfermeiro e aumentou a conficança do paciente e do corpo clinico no trabalho da equipe de enfermagem oftalmologica.

Papel de la herencia em la lepra

Aún cuando se ha comprobado en forma satisfactoria la contagiosidad de la lepra (producida por un mycobacterium), el papel que la herencia juega en su adquisición es motivo de controvérsias. Una breve revisión de lalepra recuerda, como datos básicos, su classificacion actual, basada en hechos imunológicos, en dos tipos; polares: L y T y dos grupos: I y D, con cuadros clínicos, bacteriológicos e histopatológicos definidos en los tipos e inestables en los grupos. Se exponen los hechos que afirman la transmission de la lepra negando la existencia de vectores y formites y abogando por uma transmissión directa de hombre a hombre, merced a una convivencia íntima y prolongada con un caso lepromatoso (único transmisible)

Histological study of an early case of leprosy in a young child of leprous parents: report of a case, with autopsy

1- An autopsied case of very early leprosy in a 17-months-old child of leprous parents is reported. 2- The single, isolated, heavily bacillated lesions discovered two months before death, no longer identifiable clinically two days before death, was found in histological sections after a systematic search for it. 3- Histologically the lesion was a very young leproma with beginning formation of foamy cells and numerous bacilli, in close association with three scars that presumably were due to scabies. 4- Evidence is presented which tends to corroborate the belief that the early skin lesions of leprosy is the primary inoculation lesion. This conclusion is based on the finding of bacilli in considerable numbers only in the corresponding reagional lymphatic nodes of drainage, with none in the other groups of lymph nodes, the nerves, or the other organs examined. 5- The spread of the infection in this case of early leprosy by way of the lymphatics is discussed.

A infecção leprosa congenita em face da reacção leprotica durante a gravidez

Os autores tecem considerações sobre as transmissões hereditarias, germinativa e congenita ou por via placentaria na lepra, negando a possibilidade das duas primeiras, como soé acontecer, em geral, com todas as molestias infecciosas. Baseadas nas poucas obervações de lepra congenita publicadas na literatura e nos achados bacillares em recem-nascidos, admitem a possibilidade, se bem que rara, da infecção leprosa congenita ou por via placentaria nos fetos. A raridade da transmissão congenita, confirmada pelas observações prolongadas, feitas em recem-nascidos filhos de hansenianos, que rarissimamente se tornam leprosos, quando afastados logo ao nascer do meio em que deveriam viver, mostra a pouca importancia que tem na propagação da molestia. Pelo estudo bacteriologico e histo-pathologico de cinco placentas, sete cordões umbilicaes, tres autopsias de recem-nascidos e uma de feto de quatro mezes, relatam ter encontrado bacillos alcool-acido resistentes de Hansen no chorion das villosidades placentarias num caso e no cordão umbilical de outro caso. não observando nunca a presença de lesões histo-pathologicas de natureza leprosa. Além de não observarem nos recem-nascidos e feto a presença de lesões macroscopicas e microscopicas que justifiquem a lepra congenita, não encontraram a presença de bacillos alcool-acido resistentes de Hansen quer no sangue e nos órgãos do fero e das creanças autopsiadas. Chamam a attenção para o facto que, nos dois casos em que constataram a presença de bacilos de Hansen na placenta ou no cordão umbilical, as parturientes tiveram reacção leprotica durante a gravidez, admittindo que a infecção da placenta, do cordão e do feto, se faça mais communmmente durante a gestação quando acompanhada de r~eacção leprotica. Justificam finalmente, a necessidade de um tratamento pré-natal, orientando de modo a se afastar não só as molestias intercorrentes, como tambem a medicação chaulmoogrica deverá ser administrada habilmente, associada á therapeutica desensibilizante e desintoxicante, procurando evitar todas as causas possiveis, desencadeadoras do surto eruptivo, quer mesmo lançando mão com grande frequencia da hemo-sedimentação, annunciadora, ás vezes, com certa precocidade, de um futuro surto de racção leprotica.