[Outbreaks of human rabies transmitted by vampire bats in Alto Baudó and Bajo Baudó municipalities, department of chocó, Colombia, 2004-2005]. / Brotes de rabia humana transmitida por vampiros en los municipios de Bajo y Alto Baudó, departamento del Chocó, Colombia 2004-2005.

INTRODUCTION: During months May to July 2004, a rabies outbreak in the Embera community of Birrinchao, in the Purricha river basin department of Choc6 was reported with 14 human deaths. Another rabies outbreak was reported in January 2005 in the black communities of Pató and Nauca in the neighboring municipality of Alto Baudó with 3 human deaths. OBJECTIVES: To describe the largest outbreaks of human rabies transmitted by vampire bats reported in Colombia to date. To describe the diagnostic laboratory techniques used, and the activities undertaken for the control of rabies in the area. To discuss the epidemiologic significance and public health implications of these rabies outbreaks. MATERIALS AND METHODS: Rabies diagnosis was achieved by direct immunofluorescence, inoculation of mice and immunohistochemistry. Typing of the virus was achieved by indirect immunofluorescence using monoclonal antibodies. Rabies control activities were undertaken in Bajo Baudó consisting in a population census, human vaccination and application of antirabies sera, vaccination of dogs and cats, and application of anticoagulant to bats. RESULTS: Four human cases were confirmed as positive for rabies in both rabies outbreaks. Another 13 rabies cases in humans were inferred by strong epidemiological links. Rabies antigenic variant 3 was identified in the samples studied. Rabies control activities were conducted for a human rabies outbreak caused by vampire bats. CONCLUSIONS: The human rabies outbreak in Bajo Baudó has been the largest reported in Colombia. It was caused by vampire bats, showing that these animals are a threat for human health. The implementation of control strategies for this kind of epizootic outbreaks is needed in South America. It remains unknown whether there is a link between this outbreak and one reported 6 months later in the neighboring municipality of Alto Baudó.

[Relapses after multibacillary leprosy treatment]. / Recidivas postratamiento de la lepra multibacilar.

Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS) monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL), diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years. Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983. Five patients received only DDS, and presented relapses 13-20 years after the treatment was stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of 20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment uncompliance, and inadequate relationship between the patient and the health staff. Inspections for relapse in leprosy is recommended for in all multibacillary patients that were treated with DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and skin biopsy, used together, are effective in establishing the presence of relapses.

Recidivas postratamiento de la lepra multibacilar / Relapses after multibacillary leprosy treatment

La persistencia de bacilos viables y la monoterapia con diamino-difenil-sulfona (DDS) son los principales factores que favorecen las recidivas de la lepra. Presentamos 33 pacientes con lepra lepromatosa (LL) diagnosticada 7 a 48 años antes de la recidiva, que recibieron monoterapia con DDS durante 4 a 38 años. Veintiocho fueron tratados, además, con poliquimioterapia (PQT) irregular, no supervisada, desde 1983. Cinco sólo recibieron DDS. Éstos presentaron la recidiva entre 13 y 20 años después de suspenderla. Las recidivas se diagnosticaron por reaparición de las lesiones clínicas o por la presencia de nuevas zonas anestésicas; todas se confirmaron con la baciloscopia y, en 20 casos, por la biopsia de piel. Cuatro pacientes presentaron en la biopsia de la recidiva, lepra indeterminada (LI) y uno lepra dimorfa tuberculoide (LDT), todos con presencia de bacilos intraneurales; los demás fueron LL. Dos pacientes recidivaron, aun con PQT razonablemente supervisada. Los demás curaron con PQT supervisada. Los factores predisponentes para la recidiva fueron: monoterapia con DDS por varios años; PQT irregular con dosis inadecuadas, sin supervisión del tratamiento; abandono de la PQT, y relación inadecuada entre el paciente y el personal de salud. Las recidivas de la lepra se deben buscar en todos los pacientes colombianos con lepra multibacilar que fueron tratados con DDS solo durante años. La clínica, la baciloscopia y la biopsia individualmente o en conjunto son métodos confiables para establecer las recidivas.

Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS) monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL), diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years. Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983. Five patients received only DDS, and presented relapses 13-20 years after the treatment was stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of 20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment uncompliance, and inadequate relationship between the patient and the health staff. Inspections for relapse in leprosy is recommended for in all multibacillary patients that were treated with DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and skin biopsy, used together, are effective in establishing the presence of relapses.