A luta contra a tuberculose e a hanseniase. Apreciacao geral da analogia epidemiologica das micobacterioses de Koch e de Hansen / The fight against the tuberculosis and leprosy. General appreciation of the analogy epidemiologist of mycobacterium infections of Koch and Hansen

A receptividade da infância e adolescência, registrada no ambiente familiar dos focos poli-infectantes, constitui o ponto vulnerável da luta contra ambas as endemias; pela imunização preventiva e tratamento dos casos precoces, diminui-se e estanca-se a infectuosidade do doente foco, com os recursos atuais da vacina de Calmette Guerin e da quimioterapia específica pelas medicações antimicrobianas biostáticas, de acordo com os esquemas de tratamento mistos estabelecidos pela prática para uma e outra das infecções irmãs. Dentro da moderna estrutura sanitária de controle da saúde da comunidade pelos Centros de Saúde de ação dispensarial integralizada por equipes de médicos sanitaristas, visitadoras e técnicos de laboratório, impõe-se paralelamente a formação de Unidades Móveis de atuação emmeio familiar, para vigilância sanitária periódica de contatos e doentes contagiantes, segundo os preceitos da Medicina Preventiva, harmonizando-se com os Médicos de Família, obedecendo-se ao critério formulado pelos Hansenólogos e Tisiólogos

Controle da hanseníase endêmica pela vigilância domiciliar dos focos polinfectantes (V+D) / Control of endemic leprosy by home surveillance of multiple infective foci (V+D)

Os casos de hanseníase tipo Virchow e do grupo dimorfo, pela resistência ao tratamento biostático, entrecortada pelas reações alérgicas (Lepra-reaction) e pelo caráter polinfectante de suas lesões tegumentares, representam o fulcro da ação sanitária pelo seu alto nível de incurabilidade, tornando respectivos focos familiared o verdadeiro campo de ação reincidente e periódico no ciclo quinquenal de controle da endemia.

Lepra familiar (influência da lepromatose cumulativa na expansão endêmica) / Familial lepra (influence of cumulative lepra on the endemic expansion

In spit of the liberal regime instituted by the Belo Horizonte Seminar (1958), our sanatoria shall preceed for many years to come with their humanitarian and social purposes, taking in socially maladjusted patients, invalids (blind, paralytic, and mental), provinding medical and surgical care for needy patients with acute intercurrent diseases, or requiring physical rehabilitation; these institutions are indispensable for therapeutic investigations in the field of new drugs or trying to perfect the existing methods of treatment. The high fugure of 85% represents patients interned in our State Institutions for leprosy, poly-infectious and incurable form, of chronic evolution and low mortality, invading the organism slowly and progressively during decades, causing social maladjustment and physical inability; this irreversible residue of leprosy hides behing the weight of mystic and millenary popularbeliefs, making it thus a plumbeoum onus sanatorium. This lepromatous population, the result of deficient control of the endemic disease in 40 years, is even more serious in view of the influence of cumulative leprosy on the expansion of the endemic disease, acting through a contagious chain, perpetuating itself throughout the decades of intra-familiar contagion (occult cases). James A. Doull, the noted American epidemiologist, after amny years of study of leprosy in the Philippines (Cebu) thus concludes: "It is thus evident that a great proportion of lepromatous ulcers of the nasal septum and the skin are cured within 48 weeks of treatment. The inference that leprosy coud not subsist but for the infectivity, spread over long periods of time, of the lepromatous cases discharging large numbers of bacilli, seems to be justified". Since the present prophylactic program is based on the figures of undetermined cases and correlated breach of the chain of familiar contagion, the preventive medicine program for leprosy views the endemic control by preventing leprosy: this i...

Importância dos focos lepromatosos no contrôle domiciliar da endemia de lepra - prevenção da lepromatose pela cura da lepra indeterminada

The importance of lepromatous foci for the domestic control of endemic lepra the prevention of leprosy by the cure of indeterminate lepra. Starning from the traditional concept established by Armauer Hansen in 1886 that lepra is a disease spreal through contagion within the family, the author suggests a prophylaxis system in accordance with irrefutable epidemiologic arguments and with an ecologic basis in the field of preventive medicine, to work as follows: a) periodic inspection of domestic foci by mobile Sanatary Units. b)Intensive treatment of the indeterminate group cases, so as to break the cycle of contagion and avoid their development into the lepromatous type, the majority of which evolve from the indeterminate type, the most frequent among Lepra incipiens. c) Higher efficiency and more facilities for sulfone therapy is diagnosed in its initial form. avoiding highly infective open lesions through intensive treatment. d) Extinction of compulsory isolation which, besides being extremely expensive for the campaing, brings about the hiding of foci; to assist advanced cases of the disease, the existing sanitaria should be maintained with an open door regime, the only condition compatible with selective isolation advocated by the VII International Lepra Congress (Tokyo - 1958). e) Transformation of preventories into polyvalent educational and assistential institutions for needy minors, so as to protect descendants of Lepra patients from the stigma of millenary tradition. f) Integration of lepra prophylaxy within the Public Health Service, to be coordinated as a specific unit in polyvalent organizations with sanitary, assistential and scientific aims, of official, state, or private institutions; thus, a close collaboration between clinicians, pathologists, and sanitarists specialized in leprology and the technical personnel of the Public Health Organization is obtained. In consequence, specific standards are raised and stigmas and anathemas, among which pop...