Nova lei garante sigilo a pessoas vivendo com HIV, hepatites crônicas, tuberculose e hanseníase

Foi sancionada, nesta terça-feira (4) a Lei nº 14.289, que obriga o sigilo sobre a condição de pessoas infectadas pelo vírus HIV e hepatites crônicas. A medida também abrange pessoas com hanseníase ou tuberculose. O sigilo é obrigatório no âmbito dos serviços de saúde, estabelecimentos de ensino, locais de trabalho, administração pública, segurança pública, processos judiciais e mídias escrita e audiovisual. O texto foi publicado no Diário Oficial da União.

Hepatotoxicidad por talidomida: caso clínico y revisión de la literatura / Hepatotoxicity by thalidomide: case report and literature review

La talidomida fue desarrollada e introducida al mercado por los laboratorios Grünenthal en 1953, siendo usada principalmente como sedante y también para el tratamiento de las náuseas durante el embarazo. Los informes dan cuenta de aproximadamente 10.000 niños que nacieron con focomelia, dando lugar a la denominada "tragedia de la talidomida", que obligó a su retiro del mercado en 1962. Luego de casi 60 años, es nuevamente utilizada en otros campos de la medicina, entre ellos, para el tratamiento de la lepra y del mieloma múltiple, debido a sus propiedades antinflamatorias, inmunomoduladoras y antiangiogénicas, con expresas advertencias sobre su utilización durante el embarazo; no obstante, con su nuevo uso han sido reportados múltiples efectos adversos, entre los que se encuentra la hepatitis aguda o crónica inducida por este fármaco. Se presenta el caso de una paciente de 34 años con lepra, que estaba en tratamiento con talidomida desde hacía 4 años para combatir las lesiones de piel asociadas a esta enfermedad. Presentó malestar general, vómito, pérdida de peso, artralgias, ictericia, edemas de miembros inferiores, ascitis, coluria y acolia. Se sospechó toxicidad por talidomida, por lo que se suspendió su uso, y se trató con ácido ursodesoxicólico y N-acetilcisteína con mejoría sintomática y de laboratorio, desde la primera semana hasta los 41 días de seguimiento. Las entidades clínicas para las cuales se aprobó talidomida en 1998, pueden traer nuevos problemas y desafíos clínicos. Este caso muestra hepatotoxicidad crónica por talidomida, situación que hasta el momento no se había reportado en la literatura.

Thalidomide was developed and introduced to the market by Grünenthal laboratories in 1953, being used mainly as a sedative and also for the treatment of nausea during pregnancy. Reports give account of approximately 10,000 children who were born with phocomelia, giving rise to the so-called "thalidomide tragedy", which forced its withdrawal from the market in 1962. After almost 60 years, it is usedagain in other fields of medicine, including the treatment of leprosy and multiple myeloma, due to its anti-inflammatory, immunomodulatory and anti-angiogenic properties, with clear warnings about its use during pregnancy; however, multiple adverse effects have been reported in patients with leprosy and multiple myeloma, including acute or chronic hepatitis. We present the case of a 34-year-old patient with leprosy, who had been on thalidomide therapy for 4 years to treat skin lesions associated with this disease. She presented general malaise, vomiting, weight loss, arthralgia, jaundice, lower limb edema, ascites, choluria and acholia. Thalidomide toxicity was suspected, so its use was suspended, and treatment with ursodeoxycholic acid and N-acetylcysteine was initiated, with symptomatic and laboratory improvement from the first week up until 41 days of follow-up. The new range of medical conditions for which thalidomide was approved for in 1998 may bring clinical challenges. This case shows chronic hepatotoxicity due to thalidomide, a situation that had not been reported previously in the literature.

Lepra visceral: presentación de un caso / Visceral leprosy: a case report

La lepra es una enfermedad infectocontagiosa crónica que puede presentarse con afectación cutánea, nerviosa y/o visceral según el perfil inmunológico del paciente. El Mycobacterium leprae puede producir afectación visceral de forma directa y/o indirecta. El compromiso hepático es más frecuente en los casos multibacilares. Presentamos un paciente de sexo masculino de 52 años con lepra lepromatosa y compromiso hepático

Leprosy is a chronic infectious disease that may present with skin, nervous and /or visceral involvement, according to immune profiles of patients. Mycobacterium leprae may cause visceral affection in a direct or indirect way. Liver involvement is more common in multibacillary cases. A case of lepromatous leprosy with liver compromise in a 52-year-old male patient is presented.

Human genetic susceptibility to intracellular pathogens.

Intracellular pathogens contribute to a significant proportion of infectious disease morbidity and mortality worldwide. Increasing evidence points to a major role for host genetics in explaining inter-individual variation in susceptibility to infectious diseases. A number of monogenic disorders predisposing to infectious disease have been reported, including susceptibility to intracellular pathogens in association with mutations in genes of the interleukin-12/interleukin-23/interferon-γ axis. Common genetic variants have also been demonstrated to regulate susceptibility to intracellular infection, for example the CCR5Δ32 polymorphism that modulates human immunodeficiency virus-1 (HIV-1) disease progression. Genome-wide association study approaches are being increasingly utilized to define genetic variants underlying susceptibility to major infectious diseases. This review focuses on the current state-of-the-art in genetics and genomics as pertains to understanding the genetic contribution to human susceptibility to infectious diseases caused by intracellular pathogens such as tuberculosis, leprosy, HIV-1, hepatitis, and malaria, with a particular emphasis on insights from recent genome-wide approaches. The results from these studies implicate common genetic variants in novel molecular pathways involved in human immunity to specific pathogens.

Corticosteroid pulse therapy for leprosy complicated by a severe type 1 reaction.

A 24-year-old Vietnamese woman presented with a 3-month history of non-itchy erythematous plaques on the face, trunk and limbs. Borderline lepromatous leprosy was confirmed by clinical findings, acid-fast bacilli on skin biopsy specimen and skin smear and a history of exposure. Around the twentieth day of World Health Organization (WHO) multibacillary standard treatment (rifampin 600 mg per month, dapsone 100 mg per day, clofazimine 300 mg per month and 50 mg per day for 1 year), she developed fever, general malaise, blurred vision, cough, nausea, epigastric pain, and arthralgia. The skin lesions also became swollen. During hospitalization, her illness was complicated by retrobulbar optic neuritis, secondary bacterial pneumonia, pleuritis, ascites, hepatitis, antral gastritis, progressive normocytic anemia, and peripheral sensory loss. The patient recovered after receiving systemic steroid pulse therapy (prednisolone equivalent dose 1250 mg) with systemic antibiotics (cefuroxime), adjustment of her anti-lepromatous therapy, and supportive care. She resumed the WHO multibacillary regimen uneventfully. This patient presented with a diverse type 1 reaction, which is a complex immune response in leprosy. We found that the judicious use of high dose steroids followed by a slow tapering course is beneficial in managing patients with a severe type 1 reaction. At the 1-year follow up, the patient had generalized skin hyperpigmentation resulted from long-term clofazamine use and numbness on feet without other systemic sequelae.

Epidemiological Bulletin, v. 23, n.2, Jun. 2002

IN THIS ISSUE: Health Analysis: Situational Analysis of Mortality in Bolivia | The Global Youth Tobacco Survey: Results in the Americas | A Glossary for Social Epidemiology (Part II) (Dr. Nancy Krieger) | Norms and Standards in Epidemiology: Case Definitions: acute viral hepatitis and leprosy

Boletín Epidemiológico, v. 23, n.2, Jun. 2002 

EN ESTE NÚMERO: Análisis de Salud: Análisis Coyuntural de la Mortalidad en Bolivia | Encuesta Mundial sobre tabaquismo en la Juventud: Resultados en las Américas | Glosario de Epidemiología Social (Parte II) (Dra. Nancy Krieger) | Normas y Estándares en Epidemiología: Definiciones de Caso: hepatitis vírica aguda y lepra

Síndrome sulfônica: relato de um caso / Sulfonic syndrome: a case report

Durante o tratamento da hanseníase, o uso da dapsona e da rifampicina pode levar a transtornos cutâneos e hepáticos significativos. Relata-se o caso de paciente leucodérmica, com 12 anos de idade, portadora de hanseníase indeterminada, que desenvolveu eritrodermia, hepatite e colecistite no curso da segunda semana de tratamento com esquema para paucibacilar (600mg/mês de rifampicina e 100mg/dia de dapsona). O quadro foi diagnosticado como síndrome sulfônica

Granulomatous hepatitis: a retrospective study.

51 cases of granulomatous hepatitis were seen among 1234 liver biopsies over a 10 year period. Tuberculosis was the commonest cause seen in 55 percent of cases. Other causes included leprosy, sarcoidosis, histoplasmosis, brucellosis, amoebic liver abscess, lymphoma and malignant granuloma. 12 percent of cases remained undiagnosed. Clinically these patients presented with pyrexia and hepatosplenomegaly. Jaundice was uncommon. Many showed elevated alkaline phosphatase levels, anaemia and raised ESR Granulomatous hepatitis of unknown aetiology with FUO was seen in 6 percent cases only.

Perfil epidemiológico no município de Olinda, 1990 / Epidemiologic pattern in the city of Olinda, 1990

A pesquisa foi realizada com objetivo de avaliar o perfil epidemiológico das doenças transmissíveis nas 5 áreas programáticas do município de Olinda. Os dados foram coletados dos serviços de saúde municipais, estaduais e conveniados que enviavam o relatório semanal de notificaçao para o nível regional, cujo registro era feito pelos médicos clínicos, pediatras e ginecologistas. Destaca-se a hanseníase como a doença mais notificada na área II nao havendo referência dos casos para os serviços especializados, tendo sido caracterizada como de baixa endemicidade (0,15/1000 hab.). A hepatite foi a patologia mais notificada em todas as áreas do município, atingindo mais o grupo de 5 a 14 anos. A tuberculose mostrou-se mais ou menos semelhante nas áreas programáticas, sendo mais atingido o grupo de 15 a 49 anos, com baixo coeficiente de incidência. A coqueluche foi mais registrada nas áreas III e V e o grupo de maior risco os menores de 1 ano. A meningite atingiu mais os menores de 1 ano. No sarampo o grupo mais atingido foi de 1 a 4 anos com maior risco para os menores de 1 ano. A leptospirose foi mais frequente entre 5 a 14 anos. Quanto à sífilis congênita os casos foram notificados na fase precoce. A difteria ocorreu nas crianças de 1 a 4 e 5 a 14 anos com igual frequencia. Dos 279 casos notificados apenas 28 por cento foram confirmados