Detection of Mycobacterium leprae in saliva and the evaluation of oral sensitivity in patients with leprosy.

The aim of this study was to investigate sensitivity disorders in the oral cavity related to the presence of Mycobacterium leprae in the saliva of treatment-naïve patients with leprosy in the state of Amazonas, Brazil. A cross-sectional study was conducted involving 45 subjects with leprosy. The subjects were interviewed to evaluate the sensitivity of the oral cavity. For the detection of M. leprae, saliva and slit-skin smear samples were collected. The samples were analysed using a bacteriological index (BI) protocol and the real-time quantitative polymerase chain reaction (qPCR). The results indicated that 15 of the 45 (33.3%) subjects with leprosy showed decreased oral sensitivity, which confirmed the importance of the oral cavity sensitivity evaluation. There was not a direct relationship between the presence of M. leprae in saliva and changes in oral sensitivity. Positive saliva qPCR results from six (31.6%) of 19 paucibacillary (PB) patients suggested the possibility of a new site for sample collection. Positive results using these diagnostic techniques (BI, slit-skin smear and saliva qPCR) increased to 55.5%, thus opening the possibility of combining these different techniques to increase the rate of positive diagnoses, especially in PB patients.

Detection of Mycobacterium leprae in saliva and the evaluation of oral sensitivity in patients with leprosy

The aim of this study was to investigate sensitivity disorders in the oral cavity related to the presence of Mycobacterium leprae in the saliva of treatment-naïve patients with leprosy in the state of Amazonas, Brazil. A cross-sectional study was conducted involving 45 subjects with leprosy. The subjects were interviewed to evaluate the sensitivity of the oral cavity. For the detection of M. leprae, saliva and slit-skin smear samples were collected. The samples were analysed using a bacteriological index (BI) protocol and the real-time quantitative polymerase chain reaction (qPCR). The results indicated that 15 of the 45 (33.3%) subjects with leprosy showed decreased oral sensitivity, which confirmed the importance of the oral cavity sensitivity evaluation. There was not a direct relationship between the presence of M. leprae in saliva and changes in oral sensitivity. Positive saliva qPCR results from six (31.6%) of 19 paucibacillary (PB) patients suggested the possibility of a new site for sample collection. Positive results using these diagnostic techniques (BI, slit-skin smear and saliva qPCR) increased to 55.5%, thus opening the possibility of combining these different techniques to increase the rate of positive diagnoses, especially in PB patients.

Adverse effects of alternative therapy (minocycline, ofloxacin, and clofazimine) in multibacillary leprosy patients in a recognized health care unit in Manaus, Amazonas, Brazil.

BACKGROUND: After the introduction of the multidrug therapy, there was a decline in the coefficients of prevalence and detection of new cases of leprosy. However, the records of drug resistance and relapses are threatening factors in leprosy control. Hence, new alternative schemes and monitoring of adverse effects to avoid treatment abandonment are important considerations. OBJECTIVE: Describe the side effects of a multidrug regimen containing minocycline, ofloxacin, and clofazimine in multibacillary leprosy patients. METHODS: We conducted a prospective, descriptive, and observational study with multibacillary patients, including cases of intolerance to standard MDT and relapses. The study was carried out at Fundação Alfredo da Matta (Alfredo da Matta Foundation), in Manaus, Amazonas, from April 2010 to January 2012. The patients received alternative therapy, which consisted of daily self-administered doses of 100mg of minocycline, 400 mg of ofloxacin, and 50mg of clofazimine and a supervised monthly dose of 300mg of clofazimine for six months, followed by eighteen months of daily doses of ofloxacin 400mg, clofazimine 50mg, and a supervised monthly dose of clofazimine 300mg. RESULTS: Twenty-one cases were included. Mild and transitory side effects occurred in 33.3% of patients. Of the total episodes, 45.9% were attributed to ofloxacin and they included abdominal pain, nausea, vomiting, headache, and insomnia; 21.6% were due to clofazimine, with 100% of patients presenting skin pigmentation. The mean time for the development of adverse effects after beginning the therapy was 15.2 days. CONCLUSION: All patients tolerated the drugs well, and compliance was satisfactory, with no serious events. Unlike other standard MDT studies had shown, no treatment was stopped due to side effects. Nevertheless, patient follow-up and studies with bigger samples are necessary to guarantee the efficacy and safety of the alternative regimen as a second-line scheme in multi-drug therapy.

Adverse effects of alternative therapy (minocycline, ofloxacin, and clofazimine) in multibacillary leprosy patients in a recognized health care unit in Manaus, Amazonas, Brazil / Efeitos adversos das drogas (minociclina, ofloxacina e clofazimina) utilizadas no esquema alternativo para pacientes com hanseníase multibacilar, em unidade de referência, Manaus, Amazonas, Brasil

BACKGROUND: After the introduction of the multidrug therapy, there was a decline in the coefficients of prevalence and detection of new cases of leprosy. However, the records of drug resistance and relapses are threatening factors in leprosy control. Hence, new alternative schemes and monitoring of adverse effects to avoid treatment abandonment are important considerations. OBJECTIVE: Describe the side effects of a multidrug regimen containing minocycline, ofloxacin, and clofazimine in multibacillary leprosy patients. METHODS: We conducted a prospective, descriptive, and observational study with multibacillary patients, including cases of intolerance to standard MDT and relapses. The study was carried out at Fundação Alfredo da Matta (Alfredo da Matta Foundation), in Manaus, Amazonas, from April 2010 to January 2012. The patients received alternative therapy, which consisted of daily self-administered doses of 100mg of minocycline, 400 mg of ofloxacin, and 50mg of clofazimine and a supervised monthly dose of 300mg of clofazimine for six months, followed by eighteen months of daily doses of ofloxacin 400mg, clofazimine 50mg, and a supervised monthly dose of clofazimine 300mg. Results: Twenty-one cases were included. Mild and transitory side effects occurred in 33.3% of patients. Of the total episodes, 45.9% were attributed to ofloxacin and they included abdominal pain, nausea, vomiting, headache, and insomnia; 21.6% were due to clofazimine, with 100% of patients presenting skin pigmentation. The mean time for the development of adverse effects after beginning the therapy was 15.2 days. CONCLUSION: All patients tolerated the drugs well, and compliance was satisfactory, with no serious events. Unlike other standard MDT studies ...

FUNDAMENTOS: Após introdução do esquema poliquimioterápico padrão, houve declínio nos coeficientes de prevalência e detecção de casos novos; entretanto, os registros de resistência medicamentosa e recidivas representam ameaça para o controle da hanseníase. Dessa forma, a proposição de novos esquemas alternativos e a necessidade de monitorar efeitos adversos são importantes para evitar o abandono do tratamento. OBJETIVO: Descrever efeitos adversos do esquema alternativo contendo clofazimina, ofloxacina e minociclina em pacientes com hanseníase multibacilar. MÉTODOS: Estudo prospectivo, descritivo e observacional de casos multibacilares, incluindo recidivas ou intolerância à poliquimioterapia padrão, realizado na Fundação Alfredo da Matta, Manaus, Amazonas, de abril de 2010 a janeiro de 2012. Os indivíduos receberam a terapia composta de doses diárias auto-administradas de 100mg de minociclina, 400mg de ofloxacina e 50mg de clofazimina e mensais supervisionadas de 300mg de clofazimina por seis meses, seguidas de 18 meses de doses diárias de ofloxacina 400mg, clofazimina 50 mg e supervisionadas mensais de clofazimina 300mg. Resultados: 21 pacientes foram incluídos. Efeitos adversos leves e transitórios foram observados em 33,3% dos pacientes; 45,9% foram atribuídos à ofloxacina, como dor abdominal, náuseas, vômitos, cefaléia e insônia; 21,6% foram associados à clofazimina, com relatos e observação em 100% dos pacientes de hiperpigmentação cutânea. O tempo médio de desenvolvimento das reações adversas a partir do início do esquema foi de 15,2 dias. ...

The profile of the dermatoses in children with the HIV virus at the Fundação de Medicina Tropical do Amazonas.

BACKGROUND: The Acquired Immunodeficiency Syndrome (AIDS) constitutes a sub-epidemic in Brazil. Due to the increasing number of women infected by the virus, the vertical transmission increased substantially, and due to the lack of adequate prophylactic treatment, many children are infected and show manifestations of the disease in early ages. Multiple systems are affected by the HIV virus, and the skin is often the first organ to be involved. OBJECTIVES: The objective of this study is to analyze the clinic, dermatological and epidemiological profiles of children carriers of the virus in the City of Manaus aiming at identifying the most frequent dermatoses that affect these children and try to relate these dermatoses to the immunologic deterioration. METHODS: A study was conducted where children carriers of the HIV virus from the Fundação Alfredo da Matta and Fundação de Medicina Tropical were studied from March 2007 to July 2008. These children were submitted to dermatological and laboratorial exams such as viral load dosage and CD4+ and CD8+ counts. RESULTS: During the study period, 70 HIV + children were examined; all of them had AIDS and had been contaminated by vertical transmission. The average number of dermatoses by children was 1.73, and 95.5% had at least one dermatosis during the study period. The most frequent manifestations were atopic dermatitis (22.9%), childhood prurigo (20%) and warts (18,6%). CONCLUSIONS: Children with HIV/AIDS have more skin disorders than children without HIV/AIDS. There was no statistical difference between the children in the group using ARVT and the group that wasn't using it.

The profile of the dermatoses in children with the HIV virus at the Fundação de Medicina Tropical do Amazonas / Perfil das dermatoses em crianças portadoras do vírus HIV na Fundação de Medicina Tropical do Amazonas

BACKGROUND: The Acquired Immunodeficiency Syndrome (AIDS) constitutes a sub-epidemic in Brazil. Due to the increasing number of women infected by the virus, the vertical transmission increased substantially, and due to the lack of adequate prophylactic treatment, many children are infected and show manifestations of the disease in early ages. Multiple systems are affected by the HIV virus, and the skin is often the first organ to be involved. OBJECTIVES: The objective of this study is to analyze the clinic, dermatological and epidemiological profiles of children carriers of the virus in the City of Manaus aiming at identifying the most frequent dermatoses that affect these children and try to relate these dermatoses to the immunologic deterioration. METHODS: A study was conducted where children carriers of the HIV virus from the Fundação Alfredo da Matta and Fundação de Medicina Tropical were studied from March 2007 to July 2008. These children were submitted to dermatological and laboratorial exams such as viral load dosage and CD4+ and CD8+ counts. RESULTS: During the study period, 70 HIV + children were examined; all of them had AIDS and had been contaminated by vertical transmission. The average number of dermatoses by children was 1.73, and 95.5% had at least one dermatosis during the study period. The most frequent manifestations were atopic dermatitis (22.9%), childhood prurigo (20%) and warts (18,6%). CONCLUSIONS: Children with HIV/AIDS have more skin disorders than children without HIV/AIDS. There was no statistical difference between the children in the group using ARVT and the group that wasn't using it.

FUNDAMENTOS: A Síndrome da Imunodeficiência Adquirida (AIDS) tem se configurado como uma sub-epidemia no Brasil, devido ao crescente número de mulheres infectadas pelo vírus, a transmissão vertical aumentou significativamente, e devido à falta de tratamento profilático adequado, muitas crianças são infectadas e convivem com as manifestações da doença precocemente. Múltiplos são os sistemas acometidos pelo vírus HIV, sendo a pele muitas vezes o primeiro órgão acometido. OBJETIVOS: O estudo teve por objetivo analisar o perfil clínico-dermatológico e imunológico das crianças portadoras do vírus HIV na cidade de Manaus com a finalidade de identificar as dermatoses mais freqüentes que as acometem e relacioná-las com a deterioração de seu sistema imunológico. MÉTODOS: Realizou-se um estudo onde foram acompanhadas entre março de 2007 a julho de 2008, crianças portadoras do vírus HIV atendidas na Fundação de Medicina Tropical do Amazonas. Estas foram submetidas a exame dermatológico e a exames laboratoriais como dosagem de carga viral, CD4+, CD8+. RESULTADOS: Durante o período estudado, foram atendidas 70 crianças HIV+, todas já apresentavam AIDS e tinham sido contaminadas por transmissão vertical. A média de dermatose por criança foi de 1,73 sendo que 95,5% apresentaram pelo menos uma dermatose. As manifestações mais freqüentes foram: dermatite atópica (22,9%), prurigo estrófulo (20%) e verruga (18,6%). CONCLUSÃO: As crianças com HIV/AIDS apresentaram mais dermatoses do que as crianças sem HIV/AIDS. Não houve diferença estatística em relação às dermatoses entre o grupo de crianças que estava em uso de Terapia antiretroviral (TARV) e o que não estava.

OFLOXACIN multicentre trial in MB leprosy FUAM-Manaus and ILSL-Bauru, Brazil.

UNLABELLED: Recently antimicrobials of the fluoroquinolone class (pefloxacin and ofloxacin) were found far more effective against Mycobacterium leprae in studies with both mice and patients than dapsone and clofazimine. As multicentre trial participants, we evaluated the therapeutic efficacy, in terms of rate of relapse, of two new multidrug regimens containing ofloxacin, comparing them to 1 year and 2 years of standard WHO-MDT regimen in multibacillary (MB) leprosy patients. A total of 198MB patients were recruited to participate in a randomized, double-blind trial. Among those, 53 patients were treated with 1 year of WHO-MDT (a regimen including dapsone, clofazimine, and rifampin), 55 patients received 1 year of WHO-MDT plus an initial 1 month of daily ofloxacin, 63 patients were treated with 1 month of daily rifampin and daily ofloxacin, whereas 27 were treated with 2 years of WHO-MDT. Patients were regularly monitored for signs of relapse, in at least 7 years follow-up after being released from treatment. RESULTS: Relapse occurred in those treated with 1-month regimen alone at a significant higher rate (P < 0.001): 388%, whereas in the other three regimens that included WHO-MDT it ranged from 0 to 5%. This study found that a short-course treatment for MB patients with rifampicin-ofloxacin combination had a higher failure rate. The addition of one month of daily ofloxacin to 12 months MB WHO-MDT did not increase its efficacy.

Clinical and epidemiological profile of sexually transmitted diseases in children attending a referral center in the city of Manaus, Amazonas, Brazil.

BACKGROUND: Sexually transmitted diseases in children remain a public health concern that is relatively ignored. Further data are required on the management of these diseases and their association with child sexual abuse. OBJECTIVES: To describe the clinical and epidemiological profile of sexually transmitted diseases in children receiving care at a referral center in the city of Manaus, Amazonas, Brazil. METHODS: A descriptive, exploratory study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in children who received care at this clinic between January 2003 and December 2007. RESULTS: A total of 182 children with STDs were included in the study. The majority were female (65.4%), dark-skinned and with a mean age of 8.5 years. Furthermore, 89% were from the city of Manaus and their parents were usually responsible for having brought them to the clinic. Genital warts constituted the principal diagnosis in children of both sexes and 90.1% of the children had only one STD. CONCLUSIONS: The frequencies and clinical characteristics of the STDs in the children in this study were similar to data reported in the literature. Although the signs and symptoms of the STDs found in these children do not, in themselves, constitute reliable parameters by which to confirm abuse, professionals should always be alert to this possibility, since these diseases may represent a sign of sexual offenses that may be dissimulated and repetitive.

Perfil clínico-epidemiológico das doenças sexualmente transmissíveis em crianças atendidas em um centro de referência na cidade de Manaus, Amazonas, Brasil / Clinical and epidemiological profile of sexually transmitted diseases in children attending a referral center in the city of Manaus, Amazonas, Brazil

FUNDAMENTOS: Doenças Sexualmente Transmissíveis em crianças permanecem um problema de saúde pública pouco estudado, sendo ainda necessários esclarecimentos sobre seu manejo e a relação destas com o abuso sexual infantil. OBJETIVOS: Descrever o perfil clínico-epidemiológico das Doenças Sexualmente Transmissíveis em crianças atendidas em centro de referência na cidade de Manaus. MÉTODOS: Realizou-se estudo descritivo exploratório para verificar características clínicas, epidemiológicas e laboratoriais das Doenças Sexualmente Transmissíveis em crianças atendidas durante o período de janeiro/2003 a dezembro/2007. RESULTADOS: Foram incluídas no estudo 182 crianças que apresentavam DST. A maioria era do sexo feminino (65,4 por cento) e de cor parda; a média de idade foi de 8,5 anos; 89 por cento eram procedentes da cidade de Manaus; os pais foram os principais acompanhantes na consulta; verruga genital foi o principal diagnóstico em ambos os sexos; e, 90,1 por cento apresentavam apenas uma DST. CONCLUSÃO: As frequências e características clínicas das DST nas crianças do estudo não diferiram do encontrado na literatura. Embora, com base em sinais e sintomas referentes tão somente às DST nas crianças, não se tenham parâmetros fidedignos de confirmação de abuso, deve-se sempre estar alerta para esta possibilidade, visto que estas doenças podem ser sinalizadoras de ofensas sexuais, por vezes, dissimuladas e repetidas.

BACKGROUND: Sexually transmitted diseases in children remain a public health concern that is relatively ignored. Further data are required on the management of these diseases and their association with child sexual abuse. OBJECTIVES: To describe the clinical and epidemiological profile of sexually transmitted diseases in children receiving care at a referral center in the city of Manaus, Amazonas, Brazil. METHODS: A descriptive, exploratory study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in children who received care at this clinic between January 2003 and December 2007. RESULTS: A total of 182 children with STDs were included in the study. The majority were female (65.4 percent), dark-skinned and with a mean age of 8.5 years. Furthermore, 89 percent were from the city of Manaus and their parents were usually responsible for having brought them to the clinic. Genital warts constituted the principal diagnosis in children of both sexes and 90.1 percent of the children had only one STD. CONCLUSIONS: The frequencies and clinical characteristics of the STDs in the children in this study were similar to data reported in the literature. Although the signs and symptoms of the STDs found in these children do not, in themselves, constitute reliable parameters by which to confirm abuse, professionals should always be alert to this possibility, since these diseases may represent a sign of sexual offenses that may be dissimulated and repetitive.

Aspectos clínicos de pacientes com pitiríase versicolor atendidos em um centro de referência em dermatologia tropical na cidade de Manaus (AM), Brasil / Clinical aspects of patients with pityriasis versicolor seen at a referral center for tropical dermatology in Manaus, Amazonas, Brazil

FUNDAMENTOS: A pitiríase versicolor (tinha versicolor) é uma micose superficial crônica, causada por leveduras do gênero Malassezia spp. comensais das camadas queratinizadas da pele e que, sob determinadas condições ainda não esclarecidas, se torna patogênica, determinando as manifestações clínicas da doença. É uma dermatose recidivante e, mesmo após tratamento, pode deixar hipopigmentação persistente, causando problemas sociais aos indivíduos acometidos. OBJETIVO: Descrever as características clínicas e epidemiológicas de pacientes com diagnóstico de tinha versicolor atendidos em uma unidade de referência em Dermatologia (Fundação Alfredo da Matta). MÉTODOS: Estudo de série de casos em que foram detalhadas as manifestações cutâneas e as características epidemiológicas de pacientes atendidos na Fundação Alfredo da Matta com diagnóstico de tinha versicolor. RESULTADOS: Cento e dezesseis pacientes foram incluídos no estudo no período de janeiro a agosto de 2008. A maioria dos indivíduos é do sexo masculino, de cor parda, da faixa etária jovem e formada por estudantes, que apresentavam fatores predisponentes ao surgimento das manchas. Também a maioria apresentava lesões extensas e história passada da doença. CONCLUSÃO: O estudo mostrou alta proporção de indivíduos com quadros extensos e de longa duração da doença.

BACKGROUND: Pityriasis versicolor (tinea versicolor) is a chronic superficial mycosis caused by yeasts of the Malassezia spp. genus commensal of the keratinized layers of the skin. Under conditions not yet understood, it becomes pathogenic determining the clinical manifestations of the disease. It is a recurrent skin condition and persistent hypopigmentation may remain after treatment, causing social problems to those affected. OBJECTIVE: To describe the clinical and epidemiological features of patients diagnosed with tinea versicolor treated at a referral center for dermatology (Alfredo da Matta Foundation). METHODS: Case-studies in which cutaneous manifestations and epidemiological characteristics of patients diagnosed with tinea versicolor treated at Alfredo da Matta Foundation were detailed. RESULTS: One hundred and sixteen patients were included in the study from January to August 2008. Most subjects were male, of mixed ethnicity and young age. Most were students who were predisposed to the development of macules. The majority had extensive injuries and past history of the disease. CONCLUSION: The results revealed a high proportion of individuals with extensive clinical manifestations and duration of the disease.

Agreement between dermatological diagnoses made by live examination compared to analysis of digital images.

BACKGROUND: Teledermatology is seldom used in Brazil, although some incipient initiatives have been implemented in the state of Amazonas. Further studies are still required to confirm the feasibility and efficacy of this diagnostic tool. OBJECTIVES: To evaluate the efficacy of an asynchronous method of teledermatology using simple, inexpensive technological resources. METHODS: One hundred and seventy-four patients were examined by four dermatologists, two clinic-based dermatologists, who diagnosed the patients following live examination (A1 and A2), and two consultant specialists in image dermatology, who reached diagnoses by examining images of the lesions and the patients' clinical histories (B1 and B2). The agreement between live examination and examination of images was evaluated. RESULTS: Agreement between the two live examiners (A1 and A2) with respect to the principal diagnosis was 83.3% compared to 81.0% between the physicians who diagnosed by examining images (B1 and B2). Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2% to 83.9%, CONCLUSION: Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent.

Concordância entre diagnósticos dermatológicos obtidos por consulta presencial e por análise de imagens digitais / Agreement between dermatological diagnoses made by live examination compared to analysis of digital images

FUNDAMENTOS: A teledermatologia, pouco utilizada no Brasil e com iniciativas incipientes no Amazonas, necessita de estudos para demonstrar sua factibilidade e eficácia. OBJETIVOS: Avaliar a eficácia de um método assíncrono de teledermatologia, utilizando recursos tecnológicos simples e de baixo custo. MÉTODOS: Cento e setenta e quatro pacientes foram examinados por quatro dermatologistas; dois efetuaram diagnóstico presencial (A1 e A2) e dois por meio de imagens das lesões e história clínica (B1 e B2). Foi investigada a concordância entre as avaliações presenciais e por imagens. RESULTADOS: A concordância do diagnóstico principal entre os examinadores presenciais (A1 e A2) foi de 83,3 por cento e entre os de imagens (B1 e B2), de 81 por cento. A concordância entre o diagnóstico principal estabelecido pelo método presencial e o obtido por meio de imagens variou de 78,2 por cento a 83,9 por cento. CONCLUSÃO: O diagnóstico de doenças dermatológicas realizado por imagens digitais demonstrou concordância ótima quando comparado àquele realizado com a presença física do paciente.

BACKGROUND: Teledermatology is seldom used in Brazil, although some incipient initiatives have been implemented in the state of Amazonas. Further studies are still required to confirm the feasibility and efficacy of this diagnostic tool. OBJECTIVES: To evaluate the efficacy of an asynchronous method of teledermatology using simple, inexpensive technological resources. METHODS: One hundred and seventy-four patients were examined by four dermatologists, two clinic-based dermatologists, who diagnosed the patients following live examination (A1 and A2), and two consultant specialists in image dermatology, who reached diagnoses by examining images of the lesions and the patients' clinical histories (B1 and B2). The agreement between live examination and examination of images was evaluated. RESULTS: Agreement between the two live examiners (A1 and A2) with respect to the principal diagnosis was 83.3 percent compared to 81.0 percent between the physicians who diagnosed by examining images (B1 and B2). Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2 percent to 83.9 percent, CONCLUSION: Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent.

Clinical aspects of patients with pityriasis versicolor seen at a referral center for tropical dermatology in Manaus, Amazonas, Brazil.

BACKGROUND: Pityriasis versicolor (tinea versicolor) is a chronic superficial mycosis caused by yeasts of the Malassezia spp. genus commensal of the keratinized layers of the skin. Under conditions not yet understood, it becomes pathogenic determining the clinical manifestations of the disease. It is a recurrent skin condition and persistent hypopigmentation may remain after treatment, causing social problems to those affected. OBJECTIVE: To describe the clinical and epidemiological features of patients diagnosed with tinea versicolor treated at a referral center for dermatology (Alfredo da Matta Foundation). METHODS: Case-studies in which cutaneous manifestations and epidemiological characteristics of patients diagnosed with tinea versicolor treated at Alfredo da Matta Foundation were detailed. RESULTS: One hundred and sixteen patients were included in the study from January to August 2008. Most subjects were male, of mixed ethnicity and young age. Most were students who were predisposed to the development of macules. The majority had extensive injuries and past history of the disease. CONCLUSION: The results revealed a high proportion of individuals with extensive clinical manifestations and duration of the disease.

Mycobacterium leprae in the periodontium, saliva and skin smears of leprosy patients / Mycobacterium leprae no periodonto, saliva e raspados intradérmicos de sujeitos com hanseníase

Purpose: To verify the presence of M. leprae in the periodontium, saliva and skin slit smears of leprosy patients. To correlate bacteriological and molecular findings with clinical data and compare laboratory techniques. Methods: A cross-sectional study was designed to use bacteriological (baciloscopy) and molecular (PCR) parameters to detect M. leprae in exudates of the gingival sulcus/periodontium pocket, saliva and skin slit smears from multiple clinical forms of leprosy patients without previous treatment. Results: The study included 48 leprosy patients with 15 multibacillary (MB) cases and 33 paucibacillary (PB) cases. The diagnosis of MB was confirmed through bacteriological examination and PCR results from skin slit smears. A total of 16 (48.5%) PB patients were PCR positive only. Four PB patients with negative PCR skin smears were PCR positive for the periodontium and saliva, with 2 cases and 1 case, respectively. No periodontium or saliva samples had positive bacteriological results. Conclusion: There was no correlation between periodontal disease and the presence of M. leprae. Bacteriological examination did not prove to be an efficient technique for the analysis of saliva and periodontium samples. PCR analysis of skin smears was more efficient at diagnosing PB patients than bacteriological examination. PCR positive results for the detection of M. leprae in PB patients can be increased by collecting slit skin smears, periodontium and saliva samples.

Objetivo: verificar através da baciloscopia e da reação em cadeia da polimerase (PCR) a presença do M. leprae no periodonto, saliva e raspados intradérmicos de pacientes com hanseníase. Metodologia: Realizou-se um estudo transversal do tipo detecção de casos numa instituição referência de hanseníase no Amazonas. Resultados: Foram avaliados 48 pacientes, sendo 15 multibacilares (MB) e 33 paucibacilares (PB). Os pacientes MB tiveram o diagnóstico confirmado pela baciloscopia e PCR dos raspados intradérmicos, enquanto que 16 (48,5%) dos PB foram positivos apenas na PCR. Quatro pacientes PB negativos na PCR de raspados intradérmicos foram positivos no periodonto e na saliva, 1 positivo na saliva e 2 no periodonto. Nenhuma amostra do periodonto e da saliva foi positiva na baciloscopia. Conclusão: Não houve relação entre a doença periodontal e a presença do M. leprae; a baciloscopia não mostrou ser uma técnica eficiente para análise da saliva e periodonto; a técnica de PCR de raspado dérmico mostrou ser um método mais eficaz no diagnóstico dos PB do que a baciloscopia; a positividade da PCR para detecção do M. leprae nos PB pode ser aumentada coletando raspado intradérmico, periodonto e saliva.

Avaliação neurofuncional no pré e pós-operatório de neurólise no dano neural devido à hanseníase / Pre and post operative neurofunctional assessment of neurolysis surgery in nerve damage in leprosy patients

O presente estudo teve como objetivo analisar, por meio do exame neurofuncional, a eficácia da cirurgia de neurólise em pacientes com neurite hansênica. Tratou-se de um estudo prospectivo, do tipo descritivo. Teve como universo de estudo a população portadora de neurite hansênica do Estado do Amazonas, tratada na FUAM-AM. Foram selecionados 27 participantes os quais foram triados para cirurgia eletiva de neurólise no período de outubro de 2004 a janeiro de 2005, correspondendo a 64 cirurgias eletivas. Foi realizada uma avaliação neurofuncional pré-operatória compreendendo o teste de força muscular manual, teste de sensibilidade pelos estesiômetros de Semmes-Weinstein, avaliação da dor por meio de escala analógica visual e classificação do grau de incapacidade.A mesma avaliação foi repetida um mês após a cirurgia. Os principais nervos operados foram, em ordem decrescente, medial e ulnar, fibular comum e tibial posterior. A forma clínica mais comum entre os mesmos foi a virchowiana (67 por cento), seguida da dimorfa-virchoviana (19 por cento), tuberculóide (7 por cento) e dimorfa-tuberculóide (7 por cento). Setenta e quatro por cento dos pacientes operados encontravam-se em alta clínica e 26 por cento ainda realizavam tratamento por poliquimioterapia. A principal queixa apresentada foi dor (55 por cento). Em relação ao grau de incapacidade, 70 por cento apresentaram grau I e 30 por cento apresentaram grau II. No pós-operatório, foi relatada melhora da dor em 64 por cento das cirurgias, 30 por cento não apresentaram alteração e 6 por cento apresentaram piora. Cinqüenta e seis por cento dos nervos com comprometimento motor não apresentaram melhora, 32 por cento melhoraram em até um grau e 12 por cento apresentaram piora em até um grau. Trinta e quatro por cento dos pacientes apresentaram melhora da sensibilidade, e 66 por cento se mostraram com quadro inalterado.

The aim of this study was to analyze, through neurofunctional assessment, the effectiveness of the neurolysis surgery in patients with neuritis due to leprosy. It was a prospective and descriptive study. The subjects of this study were the population with neuritis due to leprosy of Amazon state, treated in Fundação Alfredo da Matta (FUAM-AM). 27 participants were selected for elective surgery of neurolysis from October 2004 to January 2005, corresponding to 64 elective surgeries. A preoperative neurofunctional assessment was carried out including manual muscle strength testing, sensibility test using Semmes-Weinstein nylon filaments, pain assessment using a visual analogical scale and classification of rate disability. The same assessment was repeated one month after surgery. The main nerves that underwent surgery were, in decreasing order, medial and ulnar, fibular and posterior tibial. The clinical form more frequently was the lepromatous form (67 percent), following by the lepromatous-borderline (19 percent), tuberculoid (7 percent) and tuberculoid-borderline (7 percent). Seventy four percent of patients had already finished clinical treatment and 26 percent were still using multidrug therapy. Fifty five percent referred pain complaint. Concerning rate disability, 70 percent had level I and 30 percent level II. During the postoperative, patients referred to get better pain sensation in 64 percent of surgeries, 30 percent did not have alteration and 6 percent were worst. Fifty six percent of motor nerves degeneration did not improve, 32 percent improved one level and 12 percent have become worse one level. Thirty four percent of patients referred improvement of sensibility and 66 percent referred no improvement.

Hanseníase históide de localização restrita / Histoid leprosy of restricted location

A hanseníase permanece importante problema de saúde pública, e os técnicos de unidades básicas de saúde devem estar capacitados para reconhecer as diversas formas de apresentação clínica da doença. Relata-se caso de paciente com lesões pouco habituais, cujo diagnóstico foi importante por se tratar de doente multibacilar, principal elo da cadeia de transmissão da doença. O diagnóstico e tratamento oportuno desses casos contribuem para atingir as metas de eliminação da doença no país.

Leprosy remains a public health problem in Brazil. Every health professional at the primary health care level should be able to detect all presentation forms of leprosy. We report the case of a multibacillary patient with unusual lesions, whose diagnosis was important to interfere in the transmission chain. Diagnosis and adequate treatment contribute to reach the leprosy elimination goal in our country.

Episodios reacionais e relacao com recidiva em doentes com hanseniase multibacilar tratados com diferentes esquemas terapeuticos / ?

Para avaliar fatores relacionados com a presenca e tipos de reacao e as recidivas, foram acompanhados, por um periodo de 72 meses, apos o inicio do tratamento, 90 doentes com hanseniase multibacilar (MB). Os pacientes foram tratados com esquemas poliquimioterapicos, seguindo protocolo de estudo randomizado e duplo cego. Foram relizadas, avaliacoes clinicas e laboratoriais, atraves da quantificacao do indice baciloscopico, de anticorpos anti PGL-1, anti gangliosideos e das citocinas IL-10, IFN y e TNFa, em diferentes periodos. As quantificacoes de citocinas e anticorpos foram feitas atraves de ELISA, sendo encontrado resultados que conduziram as sequintes conclusoes: Durante o curso evolutivo da hanseniase, os episodios reacionais, compreendendo

Experimental porphyria cutanea tarda and photosensitivity

FUNDAMENTOS - A porfiria cutânea tardia é uma doença metabólica da via porfirina-heme, resultante da deficiência da enzina uroporfirinogênio descarboxilase, que induz ao acúmulo de porfirinas, principalmente no fígado e na pele, responsáveis por lesöes cutâneas em áreas expostas ao sol. OBJETIVOS - Determinar a espécie animal que melhor corresponda ao modelo experimental da PCT, para o estudo de lesöes cutâneas relacionadas à fotossensibilidade. MÉTODO - Ratos, cobaias e camundongos foram submetidos a uma dieta contendo um dos fatores desencadeantes da PCT, o hexaclorobenzeno (HCB), na concentraçäo de 0,25 porcento. Após o surgimento da PCT, os animais foram expostos à radiaçäo ultravioleta, as porfirinas uninárias dosadas e as manifestaçöes cutâneas de fotossensibilidade anotadas, e, comparadas ao grupo controle. RESULTADOS - Somente os ratos apresentaram aumento da excreçäo de porfirinas urinárias, principalmente de uroporfirinas: 60,81ug/24h, comparados aos controles: 0,9ug/24h, neurotoxicidade e lesöes cutâneas em àreas fotoexpostas. CONCLUSÄO - Considerando-se as três espécies de animais estudadas, os ratos apresentaram quadro semelhante à PCT encontrada no homem. Em relaçäo às cobaias, sugere-se administrar dieta contendo menor concentraçäo de HCB e prolongar o tempo do experimento. Os camundongos näo se adequaram ao modelo experimental

Niveis de anti-PGL-1 no soro de pacientes com hanseniase tratados com quinolona e poliquimioterapia / ?

Foram quantificados os niveis de anticorpos anti PGL-1 no soro de pacientes com hanseniase multibacilar, paucibacilar e em individuos doadores de sangue. Os pacientes foram tratados segundo protocolo de estudo prospectivo, randomizado e duplo cego, com regimes contendo quinolona de ultima geracao, a ofloxacina tendo como grupo controle pacientes tratados com regime poliquimioterapico padrao. Todos os 242 pacientes, exceto um, nao haviam feito uso previo de medicacao especifica, no momento de inclusao no estudo. Nos individuos multibacilares, a deteccao dos niveis de anti PGL-1 foi feita no momento de entrada no estudo, ao final do tratamento e apos 24 a 36 meses de seguimento dos casos. A finalidade dessas determinacoes foi a monitorizacao da resposta terapeutica aos diferentes esquemas avaliados