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1.
Nihon Hansenbyo Gakkai Zasshi ; 83(1): 14-9, 2014 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-25076761

RESUMO

In 2012 the WHO Expert Committee on Leprosy published its 8th report, 14 years after the publication of its 7th report in 1998. This report, the first since the leprosy reduction goal was met in 2000, highlights key points such as improvements in the quality of various services available to patients and the efforts of individuals and societies, in addition to medical progress in diagnosis and treatment. This review will mainly describe the changes made since the 7th report. Some of the main modifications are the deletion of single lesion paucibacillary type, elongated treatment of patients with high bacterial indices, the introduction of promising new drugs, and a shift from reducing the statistical number of patients to a new target for disability prevention.


Assuntos
Comitês Consultivos/organização & administração , Hanseníase , Relatório de Pesquisa/tendências , Organização Mundial da Saúde/organização & administração , Pessoas com Deficiência , Humanos , Hanseníase/diagnóstico , Hanseníase/prevenção & controle , Hanseníase/terapia , Fatores de Tempo
2.
Nihon Hansenbyo Gakkai Zasshi ; 82(3): 143-84, 2013 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-24579462

RESUMO

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.


Assuntos
Hansenostáticos/administração & dosagem , Hanseníase/diagnóstico , Hanseníase/terapia , Assistência Integral à Saúde , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/prevenção & controle , Quimioterapia Combinada , Diagnóstico Precoce , Humanos , Japão , Hanseníase/classificação , Hanseníase/microbiologia , Quimioterapia de Manutenção/métodos , Quimioterapia de Manutenção/normas , Fatores de Tempo
3.
J Neuropathol Exp Neurol ; 66(4): 284-94, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17413319

RESUMO

Peripheral neuropathy has been extensively studied in leprosy, a chronic disease caused by Mycobacterium leprae, but the central nervous system (CNS) is thought to be free from bacilli. Involvement of the CNS was explored in autopsy cases of clinically cured lepromatous leprosy (n = 67) and in non-leprosy cases (n = 15). Paraffin sections of the medulla oblongata and spinal cord were subjected to hematoxylin and eosin staining, Fite acid-fast staining, and anti-phenolic glycolipid-I (PGL-I) immunostaining. PGL-I-positive areas were microdissected from selected cases and nested polymerase chain reaction (PCR) targeting the M. leprae-specific repetitive sequence was performed. Of the 67 cases of leprosy, 44 (67%) had vacuolar changes of motor neurons either in medulla oblongata (nucleus ambiguous or hypoglossal nucleus) or spinal cord. Fite staining was negative, but PGL-I was positive in vacuolated areas. PCR revealed M. leprae-specific genomic DNA in 18 of 19 cases (95%) with vacuolated changes and 5 of 8 (63%) without vacuolated changes. All of above findings were negative in control cases. Terminal deoxynucleotidyl transferase dUTP nick-end labeling staining did not show a significant increase of apoptosis in the neurons. The PCR positivity had a significant correlation with PGL-I immunostaining (p < 0.05). The presence of vacuolar changes in the spinal cord was correlated with hand and feet deformity grades (p = 0.04). This study provides significant additional evidence to indicate that M. leprae is present in the CNS in a subset of patients. Further investigation is required to correlate this finding to motor dysfunction and silent neuropathy in leprosy.


Assuntos
Hanseníase/patologia , Bulbo/patologia , Mycobacterium leprae/isolamento & purificação , Neurônios/microbiologia , Medula Espinal/patologia , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/metabolismo , Feminino , Glicolipídeos/metabolismo , Humanos , Imuno-Histoquímica/métodos , Marcação In Situ das Extremidades Cortadas/métodos , Hanseníase/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Estatística como Assunto
4.
Am J Pathol ; 168(3): 805-11, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16507896

RESUMO

Buruli ulcer is an emerging chronic painless skin disease found in the tropics and caused by Mycobacterium ulcerans; however, it remains unknown why the large and deep ulcers associated with this disease remain painless. To answer this question, we examined the pathology of BALB/c mice inoculated in the footpads with M. ulcerans African strain 97-107. On days 54 to 70 after inoculation, extensive dermal ulcers, subcutaneous edema, and numerous acid-fast bacilli were noted at the inoculate region. Nerve invasion occurred in the perineurium and extended to the endoneurium, and some nerve bundles were swollen and massively invaded by acid-fast bacilli. However, Schwann cell invasion, a characteristic of leprosy, was not observed. Vacuolar degeneration of myelin-forming Schwann cells was noted in some nerves which may be induced by mycolactone, a toxic lipid produced by M. ulcerans. Polymerase chain reaction analysis of microdissected nerve tissue sections showed positive amplification of M. ulcerans-specific genomic sequences but not of Mycobacterium leprae-specific sequences. Behavioral tests showed decrease of pain until edematous stage, but markedly ulcerated animals showed ordinary response against stimulation. Our study suggests that the painlessness of the disease may be partly due to intraneural invasion of bacilli. Further studies of nerve invasion in clinical samples are urgently needed.


Assuntos
Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium ulcerans , Nervos Periféricos/patologia , Dermatopatias Bacterianas/patologia , Úlcera Cutânea/patologia , Pele/inervação , Animais , Comportamento Animal , DNA Bacteriano/análise , Camundongos , Camundongos Endogâmicos BALB C , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/fisiopatologia , Medição da Dor , Nervos Periféricos/microbiologia , Nervos Periféricos/fisiopatologia , Pele/microbiologia , Pele/patologia , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/fisiopatologia , Úlcera Cutânea/microbiologia , Úlcera Cutânea/fisiopatologia
5.
Nihon Hansenbyo Gakkai Zasshi ; 74(3): 191-8, 2005 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-16248355

RESUMO

In the developing countries where leprosy is prevalent, diagnosis of leprosy is made from clinical signs and symptoms. However, when difficult and doubtful cases increase after the advance of leprosy control programs, definitive diagnosis of leprosy by histopathology become necessary. This report describes our experience of technical support to re-establish histopathology service and introduction of immunohistochemistry in the leprosy referral center of Myanmar, and we discuss the ideal way of international technical support. This activity was performed as a part of leprosy control and basic health services project of Japan International Cooperation Agency (JICA) since 2000 to 2005.


Assuntos
Técnicas de Laboratório Clínico , Países em Desenvolvimento , Hanseníase/diagnóstico , Hanseníase/patologia , Patologia Clínica , Educação Médica , Humanos , Cooperação Internacional , Japão , Hanseníase/prevenção & controle , Mianmar , Programas Nacionais de Saúde , Patologia Clínica/educação , Coloração e Rotulagem
6.
Int J Lepr Other Mycobact Dis ; 71(3): 240-3, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14608820

RESUMO

Emergence of drug resistant strains of Mycobacterium leprae was reported soon after the introduction of dapsone (diamino-diphenyl sulphone, DDS) for leprosy treatment (6, 10, 11). Three cases of multidrug-resistant strains of M. leprae have been reported recently (2, 8, 9, 13). In order to prevent multiple drug resistant strains of M. leprae from developing, current leprosy control strategies are based on early detection of cases and treatment with multidrug therapy (MDT) as recommended by the World Health Organization (WHO). We report here the identification of a multidrug-resistant strain of M. leprae from a patient who received inadequate therapy for leprosy. The drug resistant profile of the isolated strain was confirmed by the mouse footpad method and the identification of mutations in genes previously shown to be associated with resistance to each drug was made.


Assuntos
Farmacorresistência Bacteriana Múltipla , Hansenostáticos/farmacologia , Hanseníase Virchowiana/microbiologia , Mycobacterium leprae/efeitos dos fármacos , Idoso , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Farmacorresistência Bacteriana Múltipla/genética , Pé/microbiologia , Humanos , Japão , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Mutação , Recidiva , Análise de Sequência de DNA
7.
Int J Lepr Other Mycobact Dis ; 71(2): 106-12, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12914133

RESUMO

Leprosy patients lack specific cellular immunity against Mycobacterium leprae, but other immunological functions are thought to be preserved. However, in a leprosy sanatorium in South Japan between 1982 and 2000, we found that the average age at death of cured lepromatous leprosy patients was about 5 yrs younger than that of cured tuberculoid patients; [male/lepromatous, 76.0 +/- 10.0 yrs old vs. male/tuberculoid, 79.7 +/- 9.4 yrs old, p = 0.026], and [female/lepromatous, 78.0 +/- 10.5 vs. female/tuberculoid, 85.3 +/- 9.8, p = 0.0001]. This trend was also observed in autopsy records of two other leprosy sanatoria in Japan. In a prospective study based on their age in 1982, among females in the age group between 60 and 69, lepromatous patients (75.3 +/- 6.0 yrs) died earlier than tuberculoid patients (81.0 +/- 5.1 yrs) (p < 0.01). These findings suggest that lepromatous patients have higher risk of death even in a post-chemotherapy era.


Assuntos
Hanseníase Virchowiana/mortalidade , Hanseníase Tuberculoide/mortalidade , Expectativa de Vida , Idoso , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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