Identification of primary drug resistance to rifampin in Mycobacterium leprae strains from leprosy patients in Amazonas State, Brazil.

The aim of this study was to identify polymorphisms in the folp1, gyrA, and rpoB genes in leprosy patients treated in Amazonas State, Brazil. Among 197 slit-skin smear samples from untreated or relapsed patients, we found three cases of primary resistance to rifampin and one confirmed case of multidrug resistance.

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. ...

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.

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.

Desigualdade social, crescimento urbano e hanseníase em Manaus: abordagem espacial / Desigualdad social, crecimiento urbano y hanseníasis en Manaus (Norte de Brasil): abordaje espacial / Social inequality, urban growth and leprosy in Manaus: a spatial approach

OBJETIVO: Analisar a epidemiologia de hanseníase segundo a distribuição espacial e condições de vida da população. MÉTODOS: Estudo ecológico baseado na espacialização da hanseníase em Manaus (AM), entre 1998 e 2004. Os 4.104 casos obtidos do Sistema de Informações de Agravos de Notificação foram georreferenciados de acordo com a localização dos endereços em 1.536 setores censitários urbanos, por meio de quatro técnicas: correios (73,7 por cento dos endereços encontrados); Programa de Cadastro de Logradouros (7,3 por cento); Programa Saúde da Família (2,1 por cento) e folhas de coleta do Instituto Brasileiro de Geografia e Estatística (1,5 por cento). Para cálculo do coeficiente de detecção utilizou a população de 2001. Na análise espacial foi aplicado o método bayesiano empírico local para produzir uma estimativa do risco da hanseníase, suavizando o efeito da flutuação das taxas, quando calculadas para pequenas áreas. Para análise da associação entre espacialização e fatores de risco empregou-se a regressão logística, tendo como variáveis explicativas a ocorrência de casos em menores de 15 anos (indicador de gravidade) e o Índice de Carência Social construído a partir das variáveis do Censo 2000. RESULTADOS: O coeficiente de detecção apresentou-se hiperendêmico em 34,0 por cento dos setores e muito alto em 26,7 por cento. A medida de associação (odds ratio) referente às variáveis explicativas foi significativa. A combinação de baixa condição de vida e ocorrência em menores de 15 anos foi adotada para identificar as áreas prioritárias para intervenção. CONCLUSÕES: A análise espacial da hanseníase mostrou que a distribuição da doença é heterogênea, atingindo mais intensamente as regiões habitadas por grupos em situação de maior vulnerabilidade.

Social inequality, urban growth and leprosy in Manaus: a spatial approach.

OBJECTIVE: To analyze the epidemiology of leprosy according to spatial distribution and living conditions of the population. METHODS: Ecological study based on the spatial distribution of leprosy in the municipality of Manaus, Northern Brazil, from 1998 to 2004. The 4,104 cases identified in the Sistema de Informações de Agravos de Notificação (Sinan -National Notification System) were georeferenced according to the addresses in the 1,536 urban census tracts through four different sources: postal service (73.7% of addresses found), Property Registration Program (7.3%), Family Health Program (2.1%), and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics) data sheet (1.5%). Calculation of detection coefficient was performed based on the 2001 population. Local empirical Bayesian method was used for the spatial distribution analysis, in order to estimate leprosy risk, making rate variation shorter when they were calculated for small areas. Logistic regression was employed to analyze the association between geographical distribution and risk factors. The incidence of cases in children under 15 (severity indicator) and Social Need Index built from variables of the 2000 census were adopted as explicative variables. RESULTS: The mean coefficient of detection was hyperendemic in 34.0% of the census tracts, and very high in 26.7%. Odds ratio was obtained for explicative variables and proved to be significant. Low-income and incidence in children under 15 were combined to identify priority areas for intervention. CONCLUSIONS: Spatial analysis of leprosy showed that the distribution of the disease is heterogeneous and is more strongly present in regions inhabited by more vulnerable groups.

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.

Perfil epidemiológico da hanseníase em menores de quinze anos de idade, Manaus (AM), 1998-2005 / Perfil epidemiológico de la hanseniasis en menores de quince años de edad, Manaus (Norte de Brasil), 1998-2005 / Epidemiological profile of leprosy in children under 15 in Manaus (Northern Brazil), 1998-2005

OBJETIVO: Analisar a situação epidemiológica da hanseníase em crianças, em zona urbana. MÉTODOS: Foram estudados 474 casos de hanseníase, em menores de 15 anos, detectados na zona urbana de Manaus (AM), de 1998 a 2005. A partir dos dados do Sistema de Informações de Agravos de Notificação foram analisados o perfil da endemia e a qualidade do atendimento nos serviços de saúde, utilizando os indicadores epidemiológicos e operacionais Programa Nacional de Eliminação da Hanseníase. RESULTADOS: Os casos de hanseníase em menores de 15 anos corresponderam a 10,4 por cento do total de casos detectados no período. O coeficiente de detecção nessa faixa etária manteve-se no nível hiperendêmico entre 1998 e 2003, reduzindo a partir do ano de 2004 mas mantendo endemicidade muito alta. A forma clínica mais freqüente foi a tuberculóide, seguida da dimorfa. As formas paucibacilares corresponderam a 70,7 por cento dos casos e no momento do diagnóstico, o grau de incapacidades foi avaliado em 94,7 por cento dos pacientes, dos quais 2,9 por cento apresentaram incapacidades físicas. A maioria dos casos (99,4 por cento) foi tratada com o esquema poliquimioterápico da Organização Mundial da Saúde. CONCLUSÕES: Apesar de seu decréscimo, o coeficiente de detecção da hanseníase nas crianças em Manaus mantém nível de endemicidade muito alto.

Epidemiological profile of leprosy in children under 15 in Manaus (Northern Brazil), 1998-2005.

OBJECTIVE: To describe the epidemiological status of leprosy in children living in a metropolitan area. METHODS: There were studied 474 leprosy cases detected in children under 15 living in the metropolitan area of the city of Manaus, Northern Brazil, between 1998 and 2005. The endemic profile and quality of care services were assessed based on data from the Notifiable Diseases Information System using epidemiological and operational indicators of the National Leprosy Elimination Program. RESULTS: Of all leprosy cases detected in the period studied, 10.4% were found in children under 15. The detection rates in this age group remained at hyperendemic levels between 1998 and 2003, and decreased from 2004 onwards but keeping on very high endemic levels. The most common clinical form was tuberculoid followed by dimorphous. Paucibacillary forms were seen in 70.7% of the cases. The level of disability at the time of diagnosis was assessed in 94.7% of patients and 2.9% of them had physical disabilities. Most children (99.4%) were treated with the multiple drug regimen recommended by the World Health Organization. CONCLUSIONS: Despite its decrease, detection rate of leprosy in children in the city of Manaus remains at a very high endemic level.

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

Campaña para la eliminación de la lepra Amazonas-Brasil. 1997

Se llevó a cabo una campaña para la eliminación de la lepra (LEC) en 15 áreas endémicas del Estado de Amazonas, Brasil, en 1997. La LEC concentró sus esfuerzos en la detección de lepra durante una campaña nacional de multivacunación de otros problemas sanitarios graves, como polio, difteria, hepatitis, sarampión, etc. La campanã nacional exigió una movilización de población muy intensa, proporcionando una valiosa oprotunidad para, al mismo tiempo, detectar nuevos casos de lepra. El personal de la LEC incluye 2.964 individuos (trabajadores sanitarios municipales y estatales y voluntarios de la comunidad), distribuidos en 688 unidades sanitarias y 53 centros sanitarios de referencia. Como resultado de la LEC se dieron 74.814 contactos directos persona a persona, 10.297 exámenes dermatológicos y se detectaron 40 nuevos casos de lepra el día de campaña en las z/onas urbanas de los municipios. Este resultado comparado con otros estados de Brasil es bajo, posiblemente debido al desarrollo de actividades educacionais sanitarias y servicios comunitarios en el estado de Amazonas desde 1987 y a la implantación de la multiterapia (MDT) de la OMS desde 1982. A pesar del hecho de que la LEC se llevó a cabo solamente en áreas urbanas de los municipios, al no encontrar casos de lepra en 7 de 15 municipios resultó sorprendente y puede indicar que la prevalencia de los casos ocultos no sea tan elevado, al menos en estas zonas del Estado de Amazonas.

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