RESUMO
PURPOSE: To report the prevalence of ocular morbidity in patients with treated multibacillary Hansen's disease (HD) using modern ophthalmic diagnostic techniques in a rural community endemic for HD. DESIGN: Cross-sectional, observation study. PARTICIPANTS: All patients with multibacillary HD who had completed their multidrug therapy and who resided in 4 defined geographical areas in Vellore, Tamil Nadu, India. METHODS: All participants underwent a complete eye examination that included slit-lamp examination, esthesiometry, gonioscopy, applanation tonometry, and dilated fundus examination, including a stereobiomicroscopic examination of the fundus at an ophthalmic center set up for that purpose. Glaucoma suspects underwent automated perimetry using a Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA). MAIN OUTCOME MEASURES: The prevalence of various ocular disease parameters were reported as mean value with 95% confidence interval. The difference of disease prevalence between various leprosy groups was compared using an unpaired t test. The association between eye symptoms and potentially sight-threatening complications was analyzed using the chi-square test. RESULTS: Three hundred eighty-six of the 446 patients with multibacillary HD residing in the defined areas were evaluated. Four patients (1.04%; 95% confidence interval [CI], 0.0%-2.0%) were bilaterally blind; 33 (8.55%; 95% CI, 5.8%-11.3%) had unilateral blindness. Mean intraocular pressure was 12 mmHg (standard deviation, 4.1 mmHg), and prevalence of glaucoma was 3.6% (95% CI, 1.8%-5.5%). Potentially sight-threatening (PST) pathologic features (corneal anesthesia, lagophthalmos, uveitis, scleritis, and advanced glaucoma) were present in 10.4% (95% CI, 7.4%-13.4%) of patients. Significant cataracts occurred 3 times more frequently in those with polar lepromatous leprosy. The odds ratio for PST pathology in the presence of patient-reported symptoms (pain, redness, inability to close eye, burning, and irritation) was 2.9 (95% CI, 1.34-6.26). CONCLUSIONS: Patients who have completed treatment for multibacillary HD continue to have significant ocular morbidity. A history of specific eye symptoms can be the basis for referral by field staff.
Assuntos
Infecções Oculares Bacterianas/epidemiologia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/epidemiologia , Catarata/epidemiologia , Criança , Cloroquina/uso terapêutico , Doenças da Córnea/epidemiologia , Estudos Transversais , Quimioterapia Combinada , Doenças Endêmicas , Feminino , Glaucoma/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Índia/epidemiologia , Pressão Intraocular , Hansenostáticos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prevalência , Refração Ocular/fisiologia , População Rural/estatística & dados numéricos , Uveíte/epidemiologia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
Protozoan infections of the skin, particularly cutaneous amoebiasis, are rare in HIV-positive patients. We report a case of amoebiasis cutis in an HIV-positive truck driver with a history of frequent unprotected sexual exposures. He presented with multiple painful ulcers and sinuses with purulent discharge, necrotic slough and scarring in the perianal and gluteal region for the last 2 years. He was positive for HIV-1 and -2. Cutaneous biopsy revealed numerous Entamoeba histolytica in the trophozoite form, in addition to an inflammatory infiltrate and necrotic debris. He responded well to oral metronidazole and chloroquine. Amoebiasis cutis should be considered in the differential diagnosis of perianal ulcers, particularly in HIV-positive patients.
Assuntos
Amebíase/tratamento farmacológico , Amebíase/parasitologia , Doenças do Ânus/patologia , Doenças do Ânus/parasitologia , Adulto , Amebíase/patologia , Amebicidas/uso terapêutico , Animais , Antiprotozoários/uso terapêutico , Doenças do Ânus/tratamento farmacológico , Cloroquina/uso terapêutico , Entamoeba histolytica/patogenicidade , Entamebíase/tratamento farmacológico , Entamebíase/parasitologia , Entamebíase/patologia , Humanos , Masculino , Metronidazol/uso terapêutico , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/parasitologia , Úlcera/patologiaRESUMO
PURPOSE: To determine the prevalence of glaucoma in a population of patients with multibacillary Hansen disease who had completed treatment. PATIENTS AND METHODS: The authors examined 386 of 446 patients with treated multibacillary Hansen disease residing in a geographically limited area. A complete ophthalmic examination including slit-lamp, applanation tonometry, gonioscopy, ophthalmoscopy, and stereobiomicroscopic examination of the optic disc was performed in all subjects. Glaucoma suspects were invited to the base hospital for further examination including automated perimetry. RESULTS: The overall prevalence of glaucoma was 3.6% (CI 1.9-5.3); 1.3% had primary open-angle glaucoma, 7% were primary angle-closure suspects (occludable angles), 1.8% had primary angle-closure glaucoma, and 0.5% had secondary glaucoma. CONCLUSION: The prevalence of primary glaucoma in patients with treated multibacillary Hansen disease was similar to that in the general population, and secondary glaucoma was rare.
Assuntos
Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cloroquina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Gonioscopia , Humanos , Índia/epidemiologia , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Disco Óptico/patologia , Prevalência , Tonometria OcularRESUMO
PURPOSE: To determine the prevalence of glaucoma in a population of patients with multibacillary Hansen disease who had completed treatment. PATIENTS AND METHODS: The authors examined 386 of 446 patients with treated multibacillary Hansen disease residing in a geographically limited area. A complete ophthalmic examination including slit-lamp, applanation tonometry, gonioscopy, ophthalmoscopy, and stereobiomicroscopic examination of the optic disc was performed in all subjects. Glaucoma suspects were invited to the base hospital for further examination including automated perimetry. RESULTS: The overall prevalence of glaucoma was 3.6 per cent (CI 1.9-5.3); 1.3 per cent had primary open-angle glaucoma, 7 per cent were primary angle-closure suspects (occludable angles), 1.8 per cent had primary angle-closure glaucoma, and 0.5 per cent had secondary glaucoma. CONCLUSION: The prevalence of primary glaucoma in patients with treated multibacillary Hansen disease was similar to that in the general population, and secondary glaucoma was rare.
Assuntos
Masculino , Feminino , Humanos , Criança , Adulto , Pessoa de Meia-Idade , Idoso , Adolescente , Idoso de 80 Anos ou mais , Cloroquina/uso terapêutico , Disco Óptico/patologia , Glaucoma de Ângulo Aberto/epidemiologia , Glaucoma de Ângulo Fechado/epidemiologia , Glucocorticoides/uso terapêutico , Gonioscopia , Hanseníase/epidemiologia , Hanseníase/tratamento farmacológico , Manometria , Oftalmoscopia , Índia/epidemiologia , PrevalênciaRESUMO
Objetivo: realizar un análisis retrospectivo de los datos obtenidos en pacientes con porfiria cutánea tarda (PCT); establecer pautas de manejo diagnóstico y de seguimiento; evaluar enfermedades asociadas y/o vinculadas a PCT. Material y métodos: pacientes provenientes de la Sección Dermatología del Hospital J. B. Iturraspe de la ciudad de Santa Fe (1985-1997) y del Servicio de Gastroenterología del Sanatorio Allende de la ciudad de Córdoba (1997). Resultados: del total de 14 pacientes, 11 se diagnosticaron en Santa Fe y 3 en Córdoba; rango etario: 36-63; edad promedio 53,2; 11 hombres y 3 mujeres. Signos dermatológicos más frecuentes: lesiones ampollares, hiperpigmentación y fotosensibilidad. Signos oculares encontrados: fotofobias e inyección conjuntival. Factores precipitantes: tóxicos: etilismo (10), alcohol metílico (1), agroquímicos (1). Farmacológicos: estrógenos (1); psicofármacos (1). Enfermedades asociadas: lepra (2), carcinoma testicular y enfermedad de von Recklinghausen, psoriasis, diabetes, anemia hemolítica autoinmune. Determinación de marcadores virales: total de pacientes: 5; resultados: VIH (-) 3/3; VHB (-) 5/5; VHC (+) 4/5. Conclusión: se enfatiza la importancia de la asociación de PCT y hepatopatía crónica, en especial por virus C
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Porfiria Cutânea Tardia/complicações , Alcoolismo/complicações , Carcinoma Hepatocelular/complicações , Cloroquina/uso terapêutico , Congêneres do Estradiol/efeitos adversos , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Hipertricose/etiologia , Flebotomia/estatística & dados numéricos , Porfiria Cutânea Tardia/diagnóstico , Porfiria Cutânea Tardia/terapia , Fatores Desencadeantes , Estudos Prospectivos , S-Adenosilmetionina/uso terapêutico , Luz Solar/efeitos adversos , Vitamina E/uso terapêuticoRESUMO
Objetivo: realizar un análisis retrospectivo de los datos obtenidos en pacientes con porfiria cutánea tarda (PCT); establecer pautas de manejo diagnóstico y de seguimiento; evaluar enfermedades asociadas y/o vinculadas a PCT. Material y métodos: pacientes provenientes de la Sección Dermatología del Hospital J. B. Iturraspe de la ciudad de Santa Fe (1985-1997) y del Servicio de Gastroenterología del Sanatorio Allende de la ciudad de Córdoba (1997). Resultados: del total de 14 pacientes, 11 se diagnosticaron en Santa Fe y 3 en Córdoba; rango etario: 36-63; edad promedio 53,2; 11 hombres y 3 mujeres. Signos dermatológicos más frecuentes: lesiones ampollares, hiperpigmentación y fotosensibilidad. Signos oculares encontrados: fotofobias e inyección conjuntival. Factores precipitantes: tóxicos: etilismo (10), alcohol metílico (1), agroquímicos (1). Farmacológicos: estrógenos (1); psicofármacos (1). Enfermedades asociadas: lepra (2), carcinoma testicular y enfermedad de von Recklinghausen, psoriasis, diabetes, anemia hemolítica autoinmune. Determinación de marcadores virales: total de pacientes: 5; resultados: VIH (-) 3/3; VHB (-) 5/5; VHC (+) 4/5. Conclusión: se enfatiza la importancia de la asociación de PCT y hepatopatía crónica, en especial por virus C (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Porfiria Cutânea Tardia/complicações , Alcoolismo/complicações , Hipertricose/etiologia , Luz Solar/efeitos adversos , Fatores Desencadeantes , Hepatite C Crônica/complicações , Carcinoma Hepatocelular/complicações , S-Adenosilmetionina/uso terapêutico , Hepatite B Crônica/complicações , Cloroquina/uso terapêutico , Estudos Prospectivos , Vitamina E/uso terapêutico , Congêneres do Estradiol/efeitos adversos , Porfiria Cutânea Tardia/terapia , Porfiria Cutânea Tardia/diagnóstico , Flebotomia/estatística & dados numéricosRESUMO
BACKGROUND: Tumor necrosis factor-alpha (TNF) is an important mediator of immunologic responses to chronic infections. METHOD: Sera from 25 patients with acute reactions (6 with type 1 upgrading, 8 with type 1 downgrading, and 11 with type 2 reaction) were assayed for TNF before treatment and after clinical remission of the acute episode. The results were compared with serum TNF levels in healthy controls and fresh pauci- and multibacillary leprosy patients. RESULTS: TNF levels in acute reactions were higher than in the control groups (significant only in upgrading reaction). In type 1 reaction, serum TNF concentrations fell to approximately the levels of the control patients following treatment and clinical remission. In type 2 reaction, however, levels of TNF were seen to rise further (became statistically significant) as a result of therapy induced clinical remission. CONCLUSIONS: The rise in TNF-alpha level in reactions in leprosy is significant and indicates its active role in immunopathogenesis. The corresponding decline in TNF-alpha levels seen following regression of type 1 (lepra) reactions was not observed in the case of type 2 (ENL) reaction. This probably reflects the enhancement of cellular immunity in such cases and/or an attempt by the immunologic process to overcome specific inhibitors.
Assuntos
Eritema Nodoso/sangue , Hipersensibilidade Tardia/sangue , Hanseníase Dimorfa/sangue , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Tuberculoide/sangue , Hanseníase Tuberculoide/tratamento farmacológico , Fator de Necrose Tumoral alfa/análise , Administração Oral , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Cloroquina/administração & dosagem , Cloroquina/análogos & derivados , Cloroquina/uso terapêutico , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Eritema Nodoso/tratamento farmacológico , Feminino , Humanos , Hipersensibilidade Tardia/tratamento farmacológico , Hansenostáticos/uso terapêutico , Masculino , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , ComprimidosAssuntos
Administração Oral , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Cloroquina/administração & dosagem , Cloroquina/análogos & derivados , Cloroquina/uso terapêutico , Comprimidos , Eritema Nodoso/sangue , Eritema Nodoso/tratamento farmacológico , Fator de Necrose Tumoral alfa/análise , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/sangue , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Tuberculoide/sangue , Hanseníase Tuberculoide/tratamento farmacológico , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/tratamento farmacológico , Hipersensibilidade Tardia/sangue , Hipersensibilidade Tardia/tratamento farmacológico , Prednisolona/administração & dosagem , Prednisolona/uso terapêuticoRESUMO
Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.
Assuntos
Malária/epidemiologia , Programas Nacionais de Saúde/organização & administração , Tuberculose/epidemiologia , Adolescente , Anemia/epidemiologia , Animais , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Cloroquina/uso terapêutico , Resistência a Medicamentos , Humanos , Incidência , Lactente , Recém-Nascido , Hanseníase/epidemiologia , Malária/tratamento farmacológico , Malária/prevenção & controle , Masculino , Neoplasias/epidemiologia , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/isolamento & purificação , Viagem , VanuatuRESUMO
Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.
Assuntos
Masculino , Humanos , Animais , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Anemia/epidemiologia , Cloroquina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Hanseníase/epidemiologia , Malária/epidemiologia , Malária/prevenção & controle , Malária/tratamento farmacológico , Neoplasias/epidemiologia , Plasmodium falciparum , Plasmodium falciparum/isolamento & purificação , Programas Nacionais de Saúde/organização & administração , Resistência a Medicamentos , Tuberculose/epidemiologia , Vanuatu , Incidência , ViagemRESUMO
Reaction and the subsequent development of neuritis is the basis for the majority of the disabilities and deformities that occur in leprosy. All possible means to prevent, to treat, and to reverse every reaction should be employed in all-out effort to ultimately effect as ideal a functional status for the patient as can be attained.
Assuntos
Hanseníase/imunologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Formação de Anticorpos , Aspirina/uso terapêutico , Benzenossulfonatos/uso terapêutico , Cloroquina/uso terapêutico , Clofazimina/uso terapêutico , Citotoxicidade Imunológica , Humanos , Imunidade Celular , Inflamação/etiologia , Hanseníase/microbiologia , Hanseníase/terapia , Contenções , Procedimentos Cirúrgicos Operatórios , Talidomida/uso terapêuticoRESUMO
Seventeen patients with the type II (erythema nodosum leprosum) (ENL) reaction were studied. They received multidrug therapy and also the anti-reactional drugs prednisolone clofazimine or chloroquin, and we measured serum levels of complement components before treatment and after the reaction had subsided. Factor B was significantly elevated after treatment with each of the three drugs. C3 levels were significantly increased after treatment, the largest change being in patients treated with clofazimine. In these patients there was also a concomitant decrease in C3d levels. This suggests that clofazimine has complement modulating activity and we would recommend it as the drug of choice in treatment of the ENL reaction.
Assuntos
Proteínas do Sistema Complemento/análise , Eritema Nodoso/tratamento farmacológico , Hanseníase/tratamento farmacológico , Cloroquina/uso terapêutico , Clofazimina/uso terapêutico , Complemento C3/análise , Fator B do Complemento/análise , Eritema Nodoso/imunologia , Humanos , Hanseníase/imunologia , Prednisolona/uso terapêuticoRESUMO
Vast travelling nowadays into warm subtropical and tropical regions demands more knowledge about infectious diseases outside our temperate climate. A leishmaniasis infection in Europeans is no rarity today because of its vast distribution in Africa. Cutaneous leishmaniasis is now considered a spectral and polar disease not unlike leprosy, caused by the leishmania parasite but also influenced by the host's immune response and intolerance. Therefore, diagnosis and treatment of a cutaneous leishmaniasis request an immunopathohistological view of the case.