ABSTRACT
We report the clinical and histopathological features of hydroa vacciniforme-like lymphoproliferative disorder in five indigenous and Mestizo children. All the children resided at higher altitudes, experiencing maximal solar exposure. All cases presented with prurigo along with Epstein-Barr virus infection. Histopathologic examination showed an atypical, CD30 + lymphocytic infiltrate with angiocentricity in all, while three cases demonstrated panniculitis-like infiltrate.
Subject(s)
Epstein-Barr Virus Infections , Hydroa Vacciniforme , Lymphoproliferative Disorders , Humans , Child , Hydroa Vacciniforme/diagnosis , Hydroa Vacciniforme/epidemiology , Hydroa Vacciniforme/pathology , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/epidemiology , Herpesvirus 4, Human , Ecuador/epidemiology , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/epidemiology , Lymphoproliferative Disorders/pathologyABSTRACT
The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.
Subject(s)
Extremities/innervation , Leprosy , Nerve Compression Syndromes , Neurologic Examination , Neurosurgical Procedures/methods , Adult , Aged, 80 and over , Algorithms , Child , Cross-Sectional Studies , Early Diagnosis , Ecuador/epidemiology , Female , Humans , Leprosy/complications , Leprosy/epidemiology , Male , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/physiopathology , Neurologic Examination/instrumentation , Neurologic Examination/methods , Patient Selection , Sensory Thresholds , TouchABSTRACT
Por recomendación de la OMS/OPS y el apoyo financeiro de la Ayuda Alemana a los Enfermos de Lepra (AYU), el segundo semestre de 1983 se introdujo en el Ecuador la poliquimioterapia para el tratamiento de todos los pacientes de lepra conocidos en el país. A partir de ese año la prevalencia presenta un descenso progresivo, de 2.399 casos, tasa 0.27 x 1.000 habitantes en 1983, baja a 839 pacientes, tasa de 0.08 x 1.000 habitantes em 1990. Igualmente la incidencia disminuye desde 1986 de una tasa de 1.7 x 100.000 habitantes a 1.01 por 100.000 habitantes en 1990. El tratamiento con poliquimioterapia es del 100 por ciento desde 1987, hay predominio de las formas lepromatosas por su mayor período de incubación y tratamiento más prolongado. La incidencia en menores de 15 años es mínima por lo que se puede interpretar que existe una disminución del riesgo de infección en la comunidad. Por último la proporción de casos multibacilares en relación a los casos detectados es en promedio el 48.15 por ciento en 6 años de control de lepra en el Ecuador, menor a las formas paucibacilares, indicando que la endemia es todavía activa en el país