Hanseníase em gêmeos de 3 anos em Mato Grosso, Brasil: a importância da baciloscopia no diagnóstico / Leprosy in 3-year-old twin children in Mato Grosso, Brazil: the importance of bacilloscopy in the diagnosis

Introdução: o diagnóstico clínico da hanseníase em crianças é particularmente difícil. Relato de Caso: crianças gêmeas bivitelinas, com três anos de idade, eram contactantes de pai com hanseníase Virchowiana. Os dois pacientes têm lesões cutâneas bem definidas e irregulares, anteriormente tratadas como micoses e uma cicatriz de BCG. Foram confirmados positivos para Mycobacterium por análise histopatológica da pele. Discussão: especialmente, com menos de cinco anos, os diagnósticos de hanseníase são raros e difíceis porque simulam outras doenças. Esses diagnósticos são alarmes epidemiológicos para áreas endêmicas e mostram a importância dos sintomas em crianças e o rastreamento nos contactantes dos pacientes.

Introduction: the clinical diagnosis of leprosy in children is particularly difficult. Case Report: fraternal twins, three years old, were in contact with a father with Virchowian leprosy. Both patients have well-defined and irregular skin lesions previously treated as mycoses and a BCG scar. They were confirmed positive for Mycobacterium by histopathological analysis of the skin. Discussion:especially, with less than five years, leprosy diagnoses are rare and difficult because they simulate other diseases. These diagnoses are epidemiological alarms for endemic areas and show the importance of symptoms in children and tracking of patients' contacts.

Análise de tendência histórica da evolução da hanseníase em Santa Catarina no período de 2001-2015 / Analysis of the histórical trend of leprosy evolution in a state in southern Brazil in the period 2001-2015

Introdução: A Hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, também chamado de bacilo de Hansen. Em Santa Catarina, atualmente há baixos índices de morbidade decorrente de ações efetivas de combate à doença nos últimos vinte anos. Porém existem poucos estudos publicados que avaliem esses indicadores no estado em geral. Objetivos: Avaliar aspectos sociodemográficos e epidemiológicos da evolução da hanseníase no Estado de Santa Catarina, entre os anos de 2001 e 2015. Métodos: Estudo observacional do tipo ecológico, descritivo e analítico. Foram estudadas as características clínicas e epidemiológicas dos pacientes diagnosticados e notificados com hanseníase em Santa Catarina no período de 2001 a 2015. Resultados: No período avaliado, 3605 casos da doença foram notificados no estado. Dentre esses, a maior taxa de incidência da doença ocorreu em 2004, de 5,03/100.000 hab, e a menor em 2015, de 2,42/100.000 hab. A macrorregião que apresentou maior número de casos novos foi o Extremo Oeste, seguida do Planalto Norte. A maioria dos pacientes era do sexo masculino, correspondendo 57,82% dos casos e a faixa etária mais acometida foi dos 40 aos 59 anos de idade. Conclusão: É fundamental que medidas como a implementação de programas e estratégias de educação em saúde, sejam mantidas e aperfeiçoadas afim de reduzir cada vez mais as taxas de incidência da doença no Brasil e preconizar o seu diagnóstico precoce para se evitar o surgimento de possíveis sequelas e complicações.

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, also called Hansen's bacillus. In Santa Catarina, there are currently low morbidity rates due to effective actions to combat the disease in the last twenty years. However, there are few published studies that evaluate these indicators in the state in general. Objectives: To evaluate sociodemographic and epidemiological aspects of leprosy evolution in the State of Santa Catarina, between 2001 and 2015. Methods: Observational ecological, descriptive and analytical study. The clinical and epidemiological characteristics of the patients diagnosed and reported with leprosy in Santa Catarina from 2001 to 2015 were studied. Results: During the period evaluated, 3605 cases of the disease were reported in the state. Among these, the highest incidence rate of the disease occurred in 2004, from 5.03 / 100,000 inhabitants, and the lowest in 2015, from 2.42 / 100,000 inhabitants. The macro-region that presented the highest number of new cases was the Far West, followed by the North Plateau. The majority of the patients were male, 57.82% of the cases and the most affected age group was 40 to 59 years of age. Conclusion: It is fundamental that measures such as the implementation of health education programs and strategies be maintained and improved in order to reduce the incidence rates of the disease in Brazil and recommend its early diagnosis to avoid the appearance of possible sequelae and complications.

Importancia del control de la calidad de la baciloscopia en los laboratorios de diagnóstico de tuberculosis / Importance of quality control of baciloscopy in laboratories that perform diagnosis of tuberculosis

Introducción: La baciloscopia es la herramienta primaria en el diagnóstico de la tuberculosis (TBC) pulmonar activa, siendo esta la técnica más utilizada internacionalmente en la búsqueda de casos infecciosos. El control de calidad consiste en la relectura de las láminas por un observador altamente calificado. Objetivo: Evaluar y destacar la importancia del control de la calidad de la baciloscopia en los laboratorios provinciales encargados del diagnóstico de TBC en Cuba. Material y Métodos: Este estudio fue realizado en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias del Instituto de Medicina Tropical "Pedro Kourí", La Habana, Cuba. Fueron evaluadas 2.676 láminas recibidas en el período de enero de 2013-diciembre de 2014, procedentes de los diferentes Centros Provinciales de Higiene, Epidemiología y Microbiología de Cuba, incluido el Municipio Especial Isla de la Juventud. Resultados: Hubo 2.664 (99,5%) láminas concordantes, la concordancia obtenida para las láminas positivas fue 96,5% y las negativas 99,8%. Se identificaron 12 errores de lectura: 7 (3,5%) falsos positivos, 5 (0,2%) falsos negativos. Se calificaron láminas con calidad de la muestra adecuada en 2.039 (76,2%), presentaron deficiencias en la realización de la extensión 1.464 (54,7%), y la tinción fue adecuada en 2.343 (87,6%). El índice de kappa fue de 0.9674. Conclusión: Aunque hubo una adecuada concordancia entre las observaciones realizadas, se recomienda mejorar la calidad del extendido, mantener programa de entrenamiento al personal que realiza esta actividad, al igual que las supervisiones periódicas por parte de especialistas, para continuar mejorando la calidad del diagnóstico.

Background: Baciloscopy is the primary tool for pulmonary tuberculosis diagnosis, being this technique the most used internationally in the search for infectious cases. Quality control is the process of the rechecking smears by a highly qualified observer. Aim: To evaluate and highlight the importance of quality control of smear microscopy in the Provincial Laboratories diagnosticians of Tuberculosis in Cuba. Methods: This study was conducted at the National Reference Laboratory and Research in Tuberculosis, Leprosy and Mycobacteria in the Institute of Tropical Medicine "Pedro Kouri", Havana, Cuba, Were evaluated 2676 smears received from January 2013 to December 2014, from Provincial Centers of Hygiene, Epidemiology and Microbiology of Cuba, including the special municipality Isla de la Juventud. Results: 2,664 (99.5%) were concordant smears, the correlation obtained for the positive smears were 96.5% and 99.8% for negative. Were identified12 reading errors: 7 (3.5%) false positive and 5 (0.2%) false negatives. Slides were classified with adequate quality of smears in 2039 (76.2%), showed difficulties in realizing the extension in 1464 (54.7%) and staining were adequate in 2343 (87.6%). The kappa index was 0.9674. Conclusion: Although there was good agreement between observations it is recommended to improve the quality of extended, maintain staff training program that performs this activity, like regular supervision by specialists, to further improve the quality of diagnosis.

Evaluación de diferentes muestras para la detección molecular de Mycobacterium leprae en Cuba / Evaluation of different samples for Mycobacterium leprae molecular detection in Cuba

Introducción: en la actualidad, la principal estrategia para controlar la infección por Mycobacterium leprae es la detección precoz y la multiterapia. El objetivo del presente estudio fue evaluar la utilidad del empleo de diferentes muestras clínicas en el diagnóstico molecular de la infección por M. leprae. Métodos: se evaluaron 22 pacientes con clínica sugestiva de lepra. Se tomaron muestras de linfa de cuatro puntos (ambos lóbulos auriculares y ambos codos) recogidas en una lámina porta objetos (lámina de baciloscopía) y en un hisopo, además muestra de hisopado nasal, muestra de sangre total y de tejido de la lesión. Las muestras se analizaron mediante baciloscopía, histología y PCR según correspondió en cada caso. Por otro lado, para determinar la sensibilidad y especificidad del método, se realizó un estudio de casos y controles en el que se emplearon 40 láminas de baciloscopías negativas de pacientes con lepra paucibacilar y 40 láminas negativas de personas sin lepra. Resultados: el 54,5 por ciento de los pacientes resultó positivo por baciloscopía. Solo en el 41 por ciento de los pacientes la histología tuvo resultados concluyentes de lepra. En el 100 por ciento de los pacientes se detectó la presencia de ADN de M. leprae a partir de la lámina de baciloscopía y el hisopado de linfa. En el 95,45 por ciento de los pacientes se pudo amplificar la secuencia diana a partir de la sangre total y solo en el 31,8 por ciento de los pacientes el hisopado nasal resultó positivo. El estudio de casos y controles mostró que la sensibilidad y especificidad de la PCR respecto al diagnóstico convencional fue de 100 por ciento. Conclusión: el diagnóstico de M. leprae mediante PCR, es de gran utilidad cuando las técnicas convencionales no son concluyentes. La lámina de baciloscopía y el hisopado de linfa constituyen las muestras clínicas más útiles para la confirmación molecular de la infección por M. leprae(AU)

Introduction: Currently, the early detection and treatment with multitherapy are the main strategy to control the infection by Mycobacterium leprae. The objective of the present study was to evaluate the usefulness of different clinical samples for molecular diagnosis of M. leprae infection. Methods: Twenty two patients with suggestive clinical leprosy were analyzed. Different clinical samples were taken by slit skin smear, histopathology and PCR. To determine the sensitivity and specificity of the PCR method, a case-control study was also performed using 40 slides from negative smears of patients with leprosy paucibacillary and 40 from individuals without leprosy. Results: From all patient studied fifty-four percent were positive by slit skin smear and 41 percent were conclusive of leprosy by histopathology. M. leprae DNA was detected in slit skin smears and lymph swabs in 100 percent of patients. In 95,45 percent of patients were detected M. leprae DNA in whole blood and in 31,8 percent of them in nasal swab. The sensitivity of PCR respect to conventional diagnostic was 100 percent, the specificity was 97.5 percent, and the positive predictive value was 97.56 and the negative predictive value was100 percent. Conclusion: The diagnosis of M. leprae by PCR is very useful when conventional techniques are inconclusive. The slit skin smears and lymph swabs are the most useful clinical samples for molecular confirmation of infection with M. leprae(AU)

Evaluación de diferentes muestras para la detección molecular de Mycobacterium leprae en Cuba / Evaluation of different samples for Mycobacterium leprae molecular detection in Cuba

Introducción: en la actualidad, la principal estrategia para controlar la infección por Mycobacterium leprae es la detección precoz y la multiterapia. El objetivo del presente estudio fue evaluar la utilidad del empleo de diferentes muestras clínicas en el diagnóstico molecular de la infección por M. leprae. Métodos: se evaluaron 22 pacientes con clínica sugestiva de lepra. Se tomaron muestras de linfa de cuatro puntos (ambos lóbulos auriculares y ambos codos) recogidas en una lámina porta objetos (lámina de baciloscopía) y en un hisopo, además muestra de hisopado nasal, muestra de sangre total y de tejido de la lesión. Las muestras se analizaron mediante baciloscopía, histología y PCR según correspondió en cada caso. Por otro lado, para determinar la sensibilidad y especificidad del método, se realizó un estudio de casos y controles en el que se emplearon 40 láminas de baciloscopías negativas de pacientes con lepra paucibacilar y 40 láminas negativas de personas sin lepra. Resultados: el 54,5 por ciento de los pacientes resultó positivo por baciloscopía. Solo en el 41 por ciento de los pacientes la histología tuvo resultados concluyentes de lepra. En el 100 por ciento de los pacientes se detectó la presencia de ADN de M. leprae a partir de la lámina de baciloscopía y el hisopado de linfa. En el 95,45 por ciento de los pacientes se pudo amplificar la secuencia diana a partir de la sangre total y solo en el 31,8 por ciento de los pacientes el hisopado nasal resultó positivo. El estudio de casos y controles mostró que la sensibilidad y especificidad de la PCR respecto al diagnóstico convencional fue de 100 por ciento. Conclusión: el diagnóstico de M. leprae mediante PCR, es de gran utilidad cuando las técnicas convencionales no son concluyentes. La lámina de baciloscopía y el hisopado de linfa constituyen las muestras clínicas más útiles para la confirmación molecular de la infección por M. leprae(AU)

Introduction: currently, the early detection and treatment with multitherapy are the main strategy to control the infection by Mycobacterium leprae. The objective of the present study was to evaluate the usefulness of different clinical samples for molecular diagnosis of M. leprae infection. Methods: twenty two patients with suggestive clinical leprosy were analyzed. Different clinical samples were taken by slit skin smear, histopathology and PCR. To determine the sensitivity and specificity of the PCR method, a case-control study was also performed using 40 slides from negative smears of patients with leprosy paucibacillary and 40 from individuals without leprosy. Results: from all patient studied fifty-four percent were positive by slit skin smear and 41 percent were conclusive of leprosy by histopathology. M. leprae DNA was detected in slit skin smears and lymph swabs in 100 percent of patients. In 95,45 percent of patients were detected M. leprae DNA in whole blood and in 31,8 percent of them in nasal swab. The sensitivity of PCR respect to conventional diagnostic was 100 percent, the specificity was 97.5 percent, and the positive predictive value was 97.56 and the negative predictive value was100 percent. Conclusion: the diagnosis of M. leprae by PCR is very useful when conventional techniques are inconclusive. The slit skin smears and lymph swabs are the most useful clinical samples for molecular confirmation of infection with M. leprae(AU)

Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

Associação do teste sorológico ML Flow com a baciloscopia / Association of the ML Flow serologic test to slit skin smear

Realizou-se estudo descritivo e exploratório relacionando as covariáveis aos resultados do teste sorológico ML Flow e baciloscopia. Foram estudados 60 casos novos de hanseníase diagnosticados no Centro de Referência em Dermatologia Sanitária. Para a baciloscopia, foi utilizada a coleta de esfregaço dérmico em quatro sítios, sendo o resultado expresso pelo índice bacilocópico. O ML Flow foi registrado de modo qualitativo e semi-quantitativo. Para o estudo da concordância, foi utilizado o índice de Kappa e, para sua interpretação, os critérios de Landis e Koch. Para análise estatística foram realizados a regressão logística e o teste de Kruskal-Wallis. O ML Flow mostrou forte associação com a baciloscopia, observou-se que o aumento gradativo do índice baciloscópico foi acompanhado pelo aumento semi-quantitativo dos níveis de anticorpos medidos pelo ML Flow, tendo sido positivo em 100% dos casos com baciloscopia positiva. Os resultados deste estudo evidenciaram que o ML Flow, por estar fortemente correlacionado à bacilocopia, poderá tornar-se um valioso instrumento auxiliar na classificação e alocação dos pacientes para fins de tratamento.

A descriptive, exploratory study was conducted analyzing the association of covariables in the results of the ML Flow serological test and slit skin smear. A total of 60 leprosy cases diagnosed at the state Sanitary Dermatology Referral Center were investigated. Slit skin smear samples were collected from four sites and the results were expressed by the bacillary index. ML Flow was registered in both qualitative and semi-quantitative terms. Cohen's kappa coefficient was used to study the agreement with Landis and Koch's observer criteria for interpretation. For statistical analysis, the logistic regression model and Kruskal-Wallis test were used. ML Flow showed a strong association with slit skin smear results, since a gradual increase in BI was accompanied by a semi-quantitative rise in antibody levels measured by ML Flow, with 100% positivity in cases presenting a positive slit skin smear. Given its strong correlation to slit skin smear, the results of this study provide evidence that the ML Flow test could be a valuable auxiliary tool in the classification and treatment of leprosy patients.

A influência do teste sorológico ML Flow na classificação da hanseníase / The influence of ML Flow test in leprosy classification

Estudo descritivo e exploratório correlacionando o ML Flow, a baciloscopia e a classificação em paucibacilar (PB) e multibacilar (MB), envolveu 1.041 casos novos com hanseníase em 13 municípios de Minas Gerais, de outubro de 2002 a março de 2004. A concordância entre o ML Flow e a classificação pelo número de lesões cutâneas e a baciloscopia foi moderada (Kappa:0,51 e 0,48, respectivamente) e, substancial (Kappa:0,77) com a classificação final. De janeiro de 2000 a março de 2004, a proporção de casos novos MB no Estado, passou de 78,1 para 65,8%. A queda no percentual de MB foi maior nos serviços participantes da pesquisa ML Flow (73,1 para 53,3%). A diferença de PB e MB nos serviços participantes e não participantes, de janeiro a março de 2004, foi estatisticamente significativa, indicando implicação direta e benéfica no tratamento e no controle da endemia em Minas Gerais.

This is a descriptive, exploratory study correlating ML Flow, bacilloscopy and classification of paucibacillary (PB) and multibacillary (MB), involving 1,041 new leprosy cases in 13 municipalities of Minas Gerais State, from October 2002 to March 2004. Agreement between ML Flow and the classification of the number of skin lesions and bacilloscopy was moderate (K:0.51 and K:0.48, respectively); and substantial for final classification (K:0.77). From January 2000 to March 2004, the proportion of new MB cases in Minas Gerais decreased from 78.1 to 65.8%. The reduction in the percentage of MB cases was higher in health centers that participated in the ML Flow study (73.1% to 53.3%). The difference between PB and MB in the participating and non-participating health centers from January to March 2004 was statistically significant. Implementation of the ML Flow test influenced the classification of patients, suggesting a direct and beneficial impact on patient treatment and the control of the leprosy endemic in Minas Gerais, Brazil.

Fatores de risco para a soropositividade do ML Flow em pacientes com hanseníase / Risk factors for ML Flow seropositivity in leprosy patients

O diagnóstico precoce da hanseníase, a correta classificação e o estudo dos fatores de risco relacionados à soropositividade, tornam-se importantes para o tratamento do doente e controle da endemia, especialmente, quando a responsabilidade pelo atendimento desses pacientes está sendo absorvida pelos serviços de atenção básica. Estudo descritivo e exploratório utilizando regressão logística avaliou a associação das variáveis: sexo, idade, modo de detecção, número de lesões cutâneas e de nervos acometidos, grau de incapacidade, baciloscopia, com o resultado do teste sorológico ML Flow, em 1.072 casos novos com hanseníase em 13 municípios de Minas Gerais. A soropositividade (50,7%) estava estatisticamente associada aos pacientes com 15 anos ou mais de idade (OR:2,6), mais de cinco lesões cutâneas (OR:7,5), mais de um nervo acometido (OR:2,4) e com baciloscopia positiva (OR:5,5 para IB<2 e OR:191,2 para IB>2), colaborando, assim, com a classificação e o tratamento adequados dos doentes.

The early diagnosis of leprosy, its correct classification and the risk factors related to seropositivity have become important for patient treatment and disease control, especially where the responsibility for treatment has been transferred to basic health care centers. This descriptive, exploratory study using logistic regression was undertaken to evaluate the association between the variables of sex, age, mode of detection, number of skin lesions and affected nerves, disability grade and bacilloscopy with the results of the ML Flow serological test in 1,072 new leprosy cases in 13 municipalities in Minas Gerais State. Seropositivity (50.7%) was statistically associated with patients 15 years-old or over (OR:2.6) and those with more than five skin lesions (OR:7.5), more than one affected nerve (OR:2.4) and a positive bacilloscopic index (OR:5.5 for 02), thus contributing to the appropriate classification and treatment of patients.