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1.
Int J Lepr Other Mycobact Dis ; 67(1): 1-5, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10407622

RESUMO

Since Mycobacterium leprae are rarely demonstrable in the tuberculoid spectrum of leprosy, a confirmatory diagnosis of leprosy can be made on the basis of finding active destruction of cutaneous nerves by granulomatous inflammation in a skin biopsy. Immunoperoxidase staining for S-100 protein, which is a marker for Schwann cells, was used to delineate nerves in lesional skin biopsies of 25 patients with tuberculoid and borderline tuberculoid leprosy as well as 15 controls with nonleprous granulomatous inflammation. Four different patterns of nerve damage were observed: infiltrated, fragmented, absent, and intact. All of the nonleprous granulomatous dermatoses showed only intact nerves, either inside or outside the granuloma, and so S-100 staining can be used to rule out leprosy.


Assuntos
Hanseníase Tuberculoide/diagnóstico , Mycobacterium leprae/isolamento & purificação , Proteínas S100 , Células de Schwann/patologia , Diagnóstico Diferencial , Granuloma/patologia , Humanos , Imuno-Histoquímica , Hanseníase Tuberculoide/patologia , Sarcoidose/patologia , Pele/patologia , Tuberculose Cutânea/patologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-20921654

RESUMO

A case of pyoderma gangrenosum with ulcerative colitis from Nepal is reported. The patient responded well to a combination of oral steroids, clofazimine. dapsone and salazopyrine within a period of 3 months.

4.
Lepr Rev ; 68(1): 10-5, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9121326

RESUMO

New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.


Assuntos
Hansenostáticos/efeitos adversos , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Tuberculoide/tratamento farmacológico , Leucopenia/induzido quimicamente , Ofloxacino/efeitos adversos , Rifampina/efeitos adversos , Adolescente , Adulto , Idoso , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hansenostáticos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Ofloxacino/administração & dosagem , Rifampina/administração & dosagem
5.
6.
Int J Lepr Other Mycobact Dis ; 64(4): 392-5, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9030104

RESUMO

During a period of 9 years, four male patients with HIV and Hansen's disease were detected in Tamil Nadu, South India. The sequence as to which infection came first is not known. All had high-risk sexual behavior with commercial sex workers and a past history of genital ulcer disease. Their spectrum of leprosy was multibacillary. Patient no. 1 had pure neural leprosy of the lepromatous type, which is rare. He also had a single episode of type 1 reaction which did not require steroid therapy. Despite having taken inadequate treatment, patient no. 2 remained clinically and bacteriologically quiescent after 4 years of follow up. He had a low CD4 count of 330 cells/mm3. The third patient completed a full course of multibacillary multidrug therapy, and a year later is clinically and bacteriologically inactive. The fourth patient died of AIDS within 2 months of the dual diagnosis.


PIP: Since the detection of HIV infection in the Christian Medical College and Hospital, Tamil Nadu, in 1986, patients attending the sexually transmitted disease (STD) clinic are counselled and screened for HIV antibodies using ELISA. Over the course of 9 years, 4 males, all from Tamil Nadu, were identified at the clinic with concurrent HIV infection and leprosy. The men were aged 20-27 years and had had multiple heterosexual contacts with prostitutes and a past history of genital ulcer disease. They were in the multibacillary (MB) spectrum of the disease as evidenced by the presence of numerous acid-fast bacilli in the nerve biopsy in 1 case and positive skin smears in the other 3 cases. Mitsuda tests conducted in 3 patients were negative, consistent with the MB spectrum of Hansen's disease (HD). The patients had concurrent infections, but it is unclear which infection occurred first. One patient developed a type 1 reaction which rapidly recovered with nonsteroidal antiinflammatory drugs. Observation of the patient over 3 years revealed no further episodes of reaction. No patient developed an erythema nodosum leprosum (ENL) reaction. One patient died 2 months after being diagnosed with HIV and HD. The other patients were followed for 3-5 years after the diagnosis of dual infection. Over that period, neither their leprosy worsened nor did their HIV infection progress to clinical AIDS. HIV infection therefore does not appear to influence an infection with Mycobacterium leprae.


Assuntos
Infecções por HIV/complicações , Hanseníase/complicações , Adulto , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Incidência , Índia/epidemiologia , Masculino , Neurite (Inflamação)/complicações , Neurite (Inflamação)/epidemiologia , Fatores de Risco , Comportamento Sexual , Doenças Sexualmente Transmissíveis/complicações , Doenças Sexualmente Transmissíveis/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-20952997

RESUMO

A 70-year old Indian lady with a two year history of a blistering eruption is described. This eruption clinically resembled dermatitis herepetiformis and responded to dapsone, however, histological and immunological investigations showed features of pemphigus herepetiformis.

9.
Lepr Rev ; 65(3): 272-8, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8942158

RESUMO

A health education study utilizing a homework assignment was carried out in a private secondary school in Bangalore, South India, to determine whether health information about leprosy would be transferred from children to their families. After a pre-test questionnaire on knowledge and attitude about leprosy was administered to 3 Standard VII classes and their family members, a different comprehensive health education session was given to each class: (i) leprosy plus a homework assignment; (ii) leprosy alone; and (iii) tuberculosis alone. A post-test questionnaire was administered to all participants 1 month later. Of the 118 children and 229 family members who entered the study, almost 80% of the participants completed it. The children in the leprosy-educated groups showed significant improvement in knowledge compared with controls, but no change in their attitude towards leprosy. Although post-test responses of household members showed modest improvement in knowledge about leprosy, attitudes remained the same or worsened. The homework assignment did not appear to improve the transmission of health information to household members. This study showed that the knowledge level of family members in South India could be improved modestly by educating their children about leprosy. However, attitudes towards leprosy were unaffected or worsened.


Assuntos
Países em Desenvolvimento , Educação em Saúde/métodos , Hanseníase , Adolescente , Adulto , Criança , Família , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Hanseníase/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , População Urbana
10.
Int J Lepr Other Mycobact Dis ; 61(4): 550-5, 1993 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8151185

RESUMO

A hospital-based study was done from 1968 to 1991 to determine the risk and extent of intrafamilial transmission of leprosy in relation to the characteristics of the index cases and contacts in urban areas in India. Families were examined by doctors annually. Skin smears were done for contacts of multibacillary (MB) leprosy patients. Person years of follow up were computed for each contact and used as the denominator for computation of incidence rates. Specific rates were computed by age, sex, type of leprosy, smear in index cases, age at registration, and sex of contacts. Of the 120 index cases (81 males, 39 females) 44% were MB; 410 contacts (186 males, 224 females) and 14 co-prevalent cases were registered. The cumulative years of follow up was 2725 years. Fourteen contacts developed the disease (9 TT, 3 indeterminate, and 2 BT); 85.7% were in the 0-14 age group; 12 of 14 patients were detected to have leprosy during the first 5 years. The incidence rate (IR) was 5.1/1000 (males 5.15, females 5.12). The IR was 7.3/1000 and 2.3/1000 among contacts of MB and paucibacillary leprosy patients (p < 0.05). The IR in multiple-case families was 1.8. The importance of active surveillance by a hospital-based survey is emphasized. It should be designed to focus on children younger than 15 years and should be limited to 5 years of follow up.


Assuntos
Família , Hanseníase/transmissão , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Escolaridade , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Lactente , Recém-Nascido , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Pele/microbiologia
11.
Int J Lepr Other Mycobact Dis ; 59(2): 237-41, 1991 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2071980

RESUMO

The World Health Organization (WHO) has recommended a fixed duration of multidrug therapy (MDT) for paucibacillary leprosy which is currently widely implemented in India. A clinico-pathological study was initiated in 1984 to assess the efficacy of this regimen. The clinical and histological responses of the patients to MDT were assessed at the end of 6 months, when their treatment was stopped, and at 2 1/2 years, when they were released from surveillance, and compared with the responses of a matched patient group to conventional dapsone (DDS) monotherapy during the same period. Of 28 patients who completed the MDT schedule, there was less than 60% improvement in 33% of them when treatment was stopped at the end of 6 months and in 20% of them at the end of 2 1/2 years. Of 26 patients receiving DDS monotherapy, 37% showed less than 60% improvement at the end of 6 months but only 8.8% had less than 60% improvement at 2 1/2 years. It is concluded that MDT for paucibacillary leprosy as recommended by WHO may not have a major advantage over DDS monotherapy, since about 20% of those patients on MDT continue to have evidence of active disease when discharged from surveillance.


Assuntos
Dapsona/uso terapêutico , Hanseníase/tratamento farmacológico , Rifampina/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Dapsona/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Tuberculoide/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Rifampina/administração & dosagem , Fatores de Tempo
12.
Int J Lepr Other Mycobact Dis ; 56(1): 56-60, 1988 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3373086

RESUMO

The role of nerve biopsy in the diagnosis of primary neuritic leprosy was evaluated in a study of 77 patients who had symptoms of peripheral neuropathy without hypopigmented patches, positive skin smears, or a skin biopsy consistent with leprosy. A biopsy of a representative cutaneous nerve near the site of the neurological deficit was taken for histopathological examination and acid-fast staining. Nearly half of the patients had leprosy confirmed by nerve biopsy, and the entire spectrum of leprosy was represented. No significant relationship was seen by age or sex or type of neuropathy. The duration of symptoms did not correlate with the severity of nerve damage as seen histologically. The probability of false-positive or false-negative results is discussed in light of clinical management. Being a relatively simple office procedure, a cutaneous nerve biopsy is strongly recommended as an important diagnostic tool, particularly for primary neuritic leprosy.


Assuntos
Hanseníase/diagnóstico , Neurite (Inflamação)/diagnóstico , Nervos Periféricos/patologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Feminino , Humanos , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Neurite (Inflamação)/patologia , Nervo Fibular/patologia , Nervo Radial/patologia , Pele/inervação
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