Cenário epidemiológico da hanseníase e diferenças por sexo / Epidemiological scenario of leprosy and sex differences

Objetivo: Descrever o cenário epidemiológico da hanseníase segundo as características clínicas e demográficas entre indivíduos dos sexos feminino e masculino. Métodos: Trata-se de um estudo ecológico de série temporal. Avaliaram-se dados de pacientes notificados no Sistema de Informações de Agravos de Notificação (Sinan) durante o período de 2014 a 2017 no município de Paulo Afonso, na Bahia. Resultados: Foram notificados 130 casos novos, com taxa de detecção média nas mulheres de 14,7±5,6 por 100 mil habitantes, ou seja, valores bem acima da média estadual e nacional (p=0,011). Além disso, observou-se predominância de casos multibacilares em homens e paucibacilares em mulheres (p>0,0001). A faixa etária mais acometida foi entre 35 e 64 anos (53,1%), independentemente do sexo. Conclusão: A hanseníase apresentou-se com grau de endemicidade muito alto e acometendo prioritariamente as mulheres. Portanto, há necessidade urgente de elaboração de políticas públicas mais direcionadas ao enfrentamento da doença no município. (AU)

Objective: To describe the epidemiological scenario of leprosy according to the clinical and demographic characteristic among men and women. Methods: This is an ecological time-series study. Data from patients notified in the Sistema de Informações de Agravos de Notificação (Sinan) were evaluated from 2014 to 2017 in the municipality of Paulo Afonso, in Bahia. Results: A total of 130 new cases were reported, with an average detection rate in women of 14.7±5.6 per 100 thousand inhabitants, that is, values well above the state and national average (p=0.011). In addition, there is a predominance of multibacillary cases in men and paucibacillary cases in women (p>0.0001). The most affected age group was between 35 and 64 years old (53.1%), regardless of sex. Conclusion: Leprosy had a very high degree of endemicity affecting primarily women. Therefore, there is an urgent need to develop public policies that are more focused on coping with the disease in the municipality. (AU)

O ensino sobre hanseníase na graduação em saúde: limites e desafios para um cuidado integral / Teaching about leprosy in undergraduate health courses: limits and challenges for integral care / La enseñanza sobre lepra en los cursos de pregrado en salud: los límites y los desafíos para un cuidado integral

A hanseníase representa um preocupante problema de saúde pública no Brasil, com altas taxas endêmicas e grande impacto na vida do indivíduo e sua família. Um importante instrumento para alcançar o seu controle efetivo é o amplo conhecimento sobre a doença. No entanto, existem lacunas na formação dos profissionais de saúde quanto à sua abordagem no processo de ensino-aprendizagem, o que influencia na prática profissional. A integralidade no cuidado às pessoas com hanseníase precisa orientar o processo de formação dos profissionais de saúde. Objetiva-se apresentar reflexões sobre o ensino da hanseníase em cursos de Graduação em saúde, apontando limites e desafios para um cuidado integral. Trata-se de uma revisão narrativa da literatura que pretende conhecer o estado da arte sobre o ensino da hanseníase na Graduação em saúde. O ensino sobre a hanseníase e sua integração nos currículos dos cursos da área da saúde ainda não contempla uma perspectiva integral para a abordagem do tema. Existe um distanciamento entre teoria e prática, um enfoque centrado nos aspectos clínicos e um grau elevado de desinformação sobre diagnóstico, tratamento, cura e aspectos sociais que envolvem o processo de adoecimento e tratamento. A hanseníase precisa ser abordada de forma integral nos cursos da área da saúde desde os primeiros semestres. Dessa forma, deve-se considerar um olhar ampliado para aspectos sociais e culturais que envolvem o processo de adoecimento e tratamento, tanto a nível individual quanto familiar.

Leprosy represents a public health issue in Brazil, having high endemic rates and great impact on the life of the individual and his family. An important tool for achieving effective control is extensive knowledge about the disease. However, there are gaps in health professional training regarding their approach in the teaching-learning process, which influences professional practice. Integral care for people with leprosy needs to guide the training process of health professionals. This study presents reflections on the teaching of leprosy in undergraduate courses in Health, indicating the limits and challenges for integral care, verifying the state of the art on the teaching of leprosy in undergraduate health by means of literature review. Teaching about leprosy and its integration in curricula of the courses of the health area has not yet reached an integral perspective to the approach of the subject. There is still a gap between theory and practice, a focus on clinical aspects, and a high degree of misinformation about diagnosis, treatment, cure, and social aspects that involve the process of illness and treatment. Leprosy needs to be addressed in a comprehensive manner in courses of the health field since the first semesters. Thus, an expanded view must be considered for social and cultural aspects that involve the process of illness and treatment, both individually and in the family.

La lepra es un gran problema de salud pública en Brasil, con altos índices endémicos y gran impacto en la vida del individuo y su familia. Para alcanzar su control efectivo, un importante instrumento es el amplio conocimiento sobre la enfermedad. Sin embargo, existen deficiencias en la formación de los profesionales de la salud con relación a su enfoque en el proceso de enseñanzaaprendizaje, lo que influye en la práctica profesional. La integralidad del cuidado a las personas con lepra necesita orientar el proceso de formación de los profesionales de la salud. Se pretende presentar reflexiones sobre la enseñanza de la lepra en cursos de graduación en salud, apuntando límites y desafíos para un cuidado integral. Esta es una revisión narrativa de la literatura que tiene como objetivo conocer el estado del arte en la enseñanza de la lepra en los cursos de graduación. La enseñanza sobre la lepra y su integración en los planes de estudios de los cursos del área aún no ha alcanzado una perspectiva integral para el abordaje del tema. Hay un distanciamiento entre teoría y práctica, enfocándose en los aspectos clínicos y un alto grado de desinformación sobre el diagnóstico, tratamiento, cura y aspectos sociales que comprende el proceso de enfermedad y tratamiento. La lepra necesita ser abordada de forma integral en los cursos del área de la salud desde los primeros semestres. De esta forma, se debe ampliar la mirada hacia los aspectos sociales y culturales que comprende el proceso de enfermedad y tratamiento, tanto a nivel individual como familiar.

ELISA-based assay of immunoglobulin G antibodies against mammalian cell entry 1A (Mce1A) protein: a novel diagnostic approach for leprosy.

BACKGROUND: Leprosy is a chronic infectious disease caused by the obligate intracellular bacillus Mycobacterium leprae. Because leprosy diagnosis is complex and requires professional expertise, new tools and methodologies are needed to detect cases in early stages and prevent transmission. The M. leprae genome contains mce1A, which encodes a putative mammalian cell entry protein (Mce1A). We hypothesised that the presence of Mce1A on the cell surface could be detected by the host's immune system. OBJECTIVE: The aim of this study was to evaluate antibody responses against the Mce1A protein in leprosy patients, household contacts of patients, and the general population to present an addition tool for leprosy diagnosis. METHODS: A cross-sectional study involving 89 volunteers [55 leprosy cases, 12 household contacts (HHC) and 22 endemic controls (EC)] was conducted at Couto Maia Hospital, in Salvador, Bahia (BA), Brazil. RESULTS: The median anti-Mce1A IgA was significantly higher in multibacillary (MB) and paucibacillary (PB) cases than in EC (p < 0.0001). A similar trend was observed in IgM levels, which were significantly higher in both MB (p < 0.0001) and PB (p = 0.0006) groups compared to in EC individuals. The greatest differences were observed for IgG class-specific antibodies against Mce1A. The median levels of MB and PB were significantly higher compared to both controls HHC and EC (MB or PB vs EC, MB vs HHC p < 0.0001; PB vs HHC, p = 0.0013). Among leprosy cases, IgG enzyme-linked immunosorbent assay sensitivity and specificity were 92.7% and 97.1%, respectively. IgG positivity was confirmed in 92.1% and 94.1% of MB and PB patients, respectively. CONCLUSION: This novel diagnostic approach presents an easy, non-invasive, and inexpensive method for leprosy screening, which may be applicable in endemic areas.

ELISA-based assay of immunoglobulin G antibodies against mammalian cell entry 1A (Mce1A) protein: a novel diagnostic approach for leprosy

BACKGROUND Leprosy is a chronic infectious disease caused by the obligate intracellular bacillus Mycobacterium leprae. Because leprosy diagnosis is complex and requires professional expertise, new tools and methodologies are needed to detect cases in early stages and prevent transmission. The M. leprae genome contains mce1A, which encodes a putative mammalian cell entry protein (Mce1A). We hypothesised that the presence of Mce1A on the cell surface could be detected by the host's immune system. OBJECTIVE The aim of this study was to evaluate antibody responses against the Mce1A protein in leprosy patients, household contacts of patients, and the general population to present an addition tool for leprosy diagnosis. METHODS A cross-sectional study involving 89 volunteers [55 leprosy cases, 12 household contacts (HHC) and 22 endemic controls (EC)] was conducted at Couto Maia Hospital, in Salvador, Bahia (BA), Brazil. RESULTS The median anti-Mce1A IgA was significantly higher in multibacillary (MB) and paucibacillary (PB) cases than in EC (p < 0.0001). A similar trend was observed in IgM levels, which were significantly higher in both MB (p < 0.0001) and PB (p = 0.0006) groups compared to in EC individuals. The greatest differences were observed for IgG class-specific antibodies against Mce1A. The median levels of MB and PB were significantly higher compared to both controls HHC and EC (MB or PB vs EC, MB vs HHC p < 0.0001; PB vs HHC, p = 0.0013). Among leprosy cases, IgG enzyme-linked immunosorbent assay sensitivity and specificity were 92.7% and 97.1%, respectively. IgG positivity was confirmed in 92.1% and 94.1% of MB and PB patients, respectively. CONCLUSION This novel diagnostic approach presents an easy, non-invasive, and inexpensive method for leprosy screening, which may be applicable in endemic areas.

Immunoglobulin G response to mammalian cell entry 1A (Mce1A) protein as biomarker of active tuberculosis.

Cell wall components are major determinants of virulence of Mycobacterium tuberculosis and they contribute to the induction of both humoral and cell-mediated immune response. The mammalian cell entry protein 1A (Mce1A), in the cell wall of M. tuberculosis, mediates entry of the pathogen into mammalian cells. Here, we examined serum immunoglobulin levels (IgA, IgM and total IgG) against Mce1A as a potential biomarker for diagnosis and monitoring tuberculosis (TB) treatment response. Serum samples of 39 pulmonary TB patients and 65 controls (15 healthy household contacts, 19 latently infected household contacts, 13 non-TB and 18 leprosy patients) were screened by ELISA. The median levels of all immunoglobulin classes were significantly higher in TB patients when compared with control groups. The positive test results for IgA, IgM and total IgG were 62, 54 and 82%, respectively. For comparison, routine sputum smear examination diagnosed only 26 (67%) of 39 TB cases. Sensitivities of IgA, IgM and IgG test were 59, 51.3 and 79.5%, respectively, while the specificities observed were 77.3, 83.3 and 84.4%, respectively. A significant decrease compared with baseline was also shown after TB treatment. These results suggest that circulating total IgG antibody to Mce1A could be a complementary tool to diagnosis pulmonary TB.