RESUMO
Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.
Assuntos
Doenças do Pé/cirurgia , Hanseníase/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Doenças do Pé/diagnóstico , Doenças do Pé/tratamento farmacológico , Doenças do Pé/microbiologia , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Transferência de Nervo , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/etiologiaRESUMO
Conventional techniques, such as plain radiography and bone-scintigraphy, were used in the past to evaluate skeletal changes in patients with leprosy. More recent publications focus on radiological imaging of affected nerves, and involve advanced modalities such as Computed Tomography (CT-scan), Ultrasonography (US), and Magnetic Resonance Imaging (MRI). US and MRI can play an especially important role in the evaluation of nerve involvement in newly diagnosed patients, and also during leprosy reactions. This is important, because when nerve involvement is diagnosed in time, it may be reversible with adequate treatment. Radiological modalities can also play an important role during the followup of patients with leprosy with nerve function impairment. Skeletal and soft-tissue abnormalities occur, even after treatment. The so-called neuropathic foot is a well known consequence. Because of nerve function impairment, there is a constant risk of developing ulcers and subsequent osteomyelitis, or neuro-osteoarthropathy (Charcot foot or tarsal disintegration), which can lead to the amputation of the affected limb. Different radiological modalities can be used during the evaluation and follow-up of patients with leprosy with a neuropathic foot. With this up-to-date review, we highlight the importance and potential role of radiological imaging techniques in leprosy.
Assuntos
Doenças Ósseas Infecciosas/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Hanseníase/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Feminino , Seguimentos , Pé/diagnóstico por imagem , Doenças do Pé/microbiologia , Humanos , Hanseníase/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Doenças do Sistema Nervoso Periférico/etiologia , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: An MRI study done in 2000 on 10 leprosy patients with neuropathic feet, without clinical complications such as ulcerations, osteomyelitis or Charcot deformities revealed abnormalities in nine patients, with degradation, interruption of subcutaneous fat and effusion/synovitis, all located in the first metatarsophalangeal (MTP) region. Since these MRI abnormalities may precede clinical complications of the foot, a follow-up study was performed. DESIGN: A new evaluation was based on a clinical examination and an MRI of the same patients who participated in the initial study. RESULTS: Four patients were lost to follow-up. Average follow-up period was 4-6 years. MRI abnormalities in the MTP 1 region in the first study were no longer visible in three patients, but were still present in two patients. In six patients new MRI findings were found, without clinical evidence of ulceration, osteomyelitis or Charcot deformity. No relationship was found between MRI findings in the MTP 1 region at the start of the study and the development of foot ulcers, callus or skin fissures in the MTP 1 region during follow-up. CONCLUSION: MRI findings of interruption and infiltration of the subcutaneous fat in leprosy patients with uncomplicated neuropathic feet do not necessarily have any clinical implication for the development of future foot problems.
Assuntos
Doenças do Pé/patologia , Hanseníase/complicações , Hanseníase/patologia , Imageamento por Ressonância Magnética , Doenças do Sistema Nervoso Periférico/complicações , Feminino , Seguimentos , Doenças do Pé/diagnóstico , Doenças do Pé/microbiologia , Humanos , Hanseníase/diagnóstico , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Masculino , Osteomielite/diagnóstico , Ossos do Tarso/patologiaRESUMO
This study was undertaken to analyze the magnetic resonance imaging (MRI) findings in the clinically asymptomatic neuropathic feet of leprosy patients. Since in the literature no MRI data are available concerning the asymptomatic neuropathic foot in leprosy, the interpretation of MRI examinations in clinically suspected neuropathic feet in leprosy is difficult. We examined 10 adult leprosy patients with clinically asymptomatic neuropathic feet. Inclusion criteria were a normal or near normal neuropathic foot, without signs of inflammation. All patients underwent an MRI protocol with the inclusion of two-point Dixon chemical shift imaging as fat suppression sequence. We found MRI changes in almost all patients. The most striking were the changes located in the region of the first metacarpophalangeal (MTP) joint. These changes ranged from degradation and interruption of the subcutaneous fat to effusion/synovitis in the first MTP joint. This study reveals significant MRI changes in clinically asymptomatic neuropathic feet in patients with leprosy. These changes may relate to the development of ulcerations. MRI may play an important role in detecting feet at risk and may influence clinical decision making.
Assuntos
Doenças do Pé/patologia , Hanseníase/patologia , Adulto , Idoso , Medula Óssea/patologia , Feminino , Doenças do Pé/diagnóstico , Doenças do Pé/microbiologia , Humanos , Hanseníase/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Articulações Tarsianas/patologiaAssuntos
Doenças do Pé/diagnóstico , Hiperemia/diagnóstico , Hanseníase/diagnóstico , Temperatura Cutânea , Feminino , Doenças do Pé/complicações , Doenças do Pé/microbiologia , Humanos , Hiperemia/complicações , Hiperemia/microbiologia , Hanseníase/complicações , Hanseníase/microbiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Palpação/métodos , Estatísticas não Paramétricas , TermografiaRESUMO
Effect of three types of dressings on bacterial flora in ulcers is presented. Debrisan seemed to be more effective than Zinc tape and collagen sheet in reducing the number of bacterial pathogens.
Assuntos
Bandagens/normas , Doenças do Pé/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Úlcera Cutânea/microbiologia , Colágeno/uso terapêutico , Dextranos/uso terapêutico , Humanos , Zinco/uso terapêuticoAssuntos
Doenças do Pé/etiologia , Hanseníase/complicações , Síndromes de Compressão Nervosa/etiologia , Nervo Tibial/cirurgia , Adulto , Idoso , Feminino , Doenças do Pé/microbiologia , Doenças do Pé/cirurgia , Humanos , Hanseníase/cirurgia , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/microbiologia , Síndromes de Compressão Nervosa/cirurgiaRESUMO
Out of 25 cases of trophic ulcers of the foot, 10 (40%) were both aerobic and anaerobic, 14 (56%) only aerobic and one (4%) showed no growth of bacteria. With the exception of two cases (8%) in the aerobic group, all others showed mixed infections. A wide range of bacteria is reported. Topical application of gentamicin and chloramphenicol is recommended, based on the results of in vitro sensitivity.
Assuntos
Doenças do Pé/microbiologia , Hanseníase/microbiologia , Úlcera Cutânea/microbiologia , Bactérias Aeróbias/efeitos dos fármacos , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/efeitos dos fármacos , Bactérias Anaeróbias/isolamento & purificação , Humanos , Testes de Sensibilidade MicrobianaRESUMO
Material from 108 trophic ulcers from leprosy cases were studied bacteriologically. 4 cases showed growth of pure anaerobes and 69 showed mixed growth of aerobic and anaerobic bacteria. The predominant anaerobes were Fusobacteria (41), anaerobic cocci (30) and Bacteroides (25). Clostridia were isolated only in 10 cases. Metronidazole, chloramphenicol, penicillin and ampicillin were found effective against anaerobes in in-vitro studies.
Assuntos
Bactérias Anaeróbias/isolamento & purificação , Doenças do Pé/microbiologia , Hanseníase/microbiologia , Úlcera Cutânea/microbiologia , Antibacterianos/farmacologia , Bactérias Anaeróbias/efeitos dos fármacos , Bacteroides/efeitos dos fármacos , Bacteroides/isolamento & purificação , Doenças do Pé/complicações , Fusobacterium/efeitos dos fármacos , Fusobacterium/isolamento & purificação , Humanos , Hanseníase/complicações , Testes de Sensibilidade Microbiana , Úlcera Cutânea/complicaçõesRESUMO
Swabs from trophic ulcers from 108 cases were studied by culture. 37 cases yielded single organism (Ps. aeruginosa, 18, Proteus species 11, Staph. pyogenes 4, Others 4). 71 cases yielded mixed growth with two or more organisms. Ps. aeruginosa, Proteus species and Diphtheroids were the predominant organisms in these cultures. Ps. aeruginosa was sensitive to Gentamycin (96.6%), Streptomycin (62.7%) and Chloramphenicol (33.9%). Other organisms although comparatively more sensitive showed a similar pattern.
Assuntos
Doenças do Pé/microbiologia , Hanseníase/complicações , Úlcera Cutânea/microbiologia , Actinomycetales/isolamento & purificação , Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Doenças do Pé/etiologia , Humanos , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Úlcera Cutânea/etiologia , Staphylococcus/efeitos dos fármacos , Staphylococcus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
39 consecutive cases of plantar ulcers with underlying chronic osteomyelitis admitted in the Sacred Heart Hospital during 1975/1976 were studied for the infecting organisms and their sensitivity to easily available antibiotics. Single organism was iasolated in only 10 cases, the infection in the rest being a mixed one. The commonest organisms were Staphylococcus, Streptococcus and Proteus mirabilis. In a few cases Pseudomonas and E-Coli were also isolated. Chloramphenicol was the most effective antibiotic in general and Streptomycin the least. 70% of the staphylococcus strains isolated were found to be resistant to Penicillin. Empirical use of antibiotics especially Penicillin and Streptomycin is hence deprecated.
Assuntos
Doenças do Pé/microbiologia , Hanseníase/complicações , Osteomielite/etiologia , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Criança , Escherichia coli/efeitos dos fármacos , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Osteomielite/microbiologia , Proteus mirabilis/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Staphylococcus/efeitos dos fármacos , Streptococcus/efeitos dos fármacos , Úlcera/etiologia , Úlcera/microbiologiaRESUMO
Ultrastructural changes in cells of the mouse footpad are described which occurred during the log phase of multiplication, the plateau, and the stationary phase of growth of Mycobacterium leprae.BALB/c mice were inoculated in the right hind footpad with 5 x 10(3) organisms and sacrificed in pairs at 86 to 173 days after inoculation. Tissue samples were prepared for electron microscopy by standard techniques. During the early growth phase of M. leprae in the mouse footpad, few organisms can be detected. Those present are in macrophages and are bound by a single membrane. The cytoplasm of the macrophage is less dense around the organism. There are few lysosomes, and the bacteria do not appear to be degenerating. At the peak of the growth phase, the organisms within a macrophage are bound by either a single or double membrane. There is an increased number of vacuoles, which are also bound by a double membrane, and lysosomes. During the stationary phase, most of the macrophages have taken on a vacuolar appearance and contain lysosomes. The vacuoles are bound by a double membrane, as are most of the organisms within the macrophage. Many of these organisms appear to be degenerating. Occasionally, organisms are encountered in the sarcoplasm of striated muscle. They are usually bound by a single membrane and do not appear to be degenerating.