Assuntos
Dermatoses da Mão/diagnóstico , Hansenostáticos/uso terapêutico , Hanseníase Tuberculoide/diagnóstico , Adulto , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Mãos/patologia , Dermatoses da Mão/tratamento farmacológico , Humanos , Hiperpigmentação/etiologia , Hipestesia/etiologia , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/tratamento farmacológico , Rifampina/uso terapêuticoAssuntos
Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Hanseníase Virchowiana/diagnóstico , Mycobacterium leprae/isolamento & purificação , Biópsia , Dermatoses do Pé/complicações , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Dermatoses da Mão/complicações , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Humanos , Hipestesia/etiologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Masculino , Pessoa de Meia-Idade , Coloração e Rotulagem , TunísiaAssuntos
Emigrantes e Imigrantes , Hipestesia/diagnóstico , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/diagnóstico , Pele/patologia , Adulto , Austrália , Humanos , Hipestesia/etiologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Nepal/etnologiaRESUMO
Hansen Disease (leprosy) is an infectious disease that targets macrophages and Schwann cells, caused by the acid fast intracellular organism, Mycobacterium leprae. Clinically, it presents with a spectrum of findings that may include hypopigmented macules, erythematous plaques and nodules, and thickened or tender peripheral nerves. The most feared complication is mutilating damage to facial structures or digits resulting from loss of sensation in affected skin. In non-endemic areas, the diagnosis of leprosy is frequently delayed because it may mimic other more common skin conditions. We present a case of borderline/lepromatous leprosy in an otherwise healthy young Brazilian man that was initially diagnosed as tinea versicolor, but did not respond to appropriate treatment. This case highlights the importance of having a high index of suspicion for leprosy in patients from endemic areas who present with lesions that could be consistent with this disease.
Assuntos
Erros de Diagnóstico , Hanseníase Dimorfa/diagnóstico , Hanseníase Virchowiana/diagnóstico , Tinha Versicolor/diagnóstico , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Contraindicações , Dapsona , Diagnóstico Tardio , Humanos , Hipestesia/etiologia , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/complicações , Hanseníase Dimorfa/microbiologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Masculino , Minociclina/administração & dosagem , Minociclina/uso terapêutico , Mycobacterium leprae/isolamento & purificação , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Adulto JovemAssuntos
Exame de Medula Óssea , Medula Óssea/microbiologia , Febre de Causa Desconhecida/etiologia , Hanseníase Virchowiana/diagnóstico , Mycobacterium leprae/isolamento & purificação , Adulto , Animais , Medula Óssea/patologia , Feminino , Úlcera do Pé/etiologia , Histiócitos/patologia , Humanos , Hipestesia/etiologia , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Paniculite/microbiologia , Paniculite/patologia , Paraguai/etnologiaAssuntos
Hanseníase Tuberculoide/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Brasil/etnologia , Dapsona/uso terapêutico , Diagnóstico Tardio , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Dermatoses Faciais/imunologia , Dermatoses Faciais/microbiologia , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/imunologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/imunologia , Dermatoses da Mão/microbiologia , Humanos , Hipestesia/etiologia , Imunidade Celular , Hanseníase Tuberculoide/tratamento farmacológico , Hanseníase Tuberculoide/imunologia , Hanseníase Tuberculoide/microbiologia , Exposição Ocupacional , Prednisona/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Rifampina/uso terapêutico , EspanhaRESUMO
OBJECTIVE: To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone injection in patients with carpal tunnel syndrome (CTS) over a 6-months period. METHODS: Twenty one patients, of whom 7 were lost for follow-up (mean age 57.9 +/- 8.4) with clinical and electrophysiological evidence of CTS were treated by injection of depo-methylprednisolone 40 mg proximal to the carpal tunnel. Severity of pain (VAS), rates of numbness/paresthesias and nocturnal awakening, motor and sensory nerve conduction studies were used as outcomes. All tests were performed before, 1, 3 and 6 months after the injection. RESULTS: Severity of pain was significantly reduced at all follow-up time points (p < 0.001). Prior to injection all patients complained of night pain and awakening. On the first, third and sixth months, 0(0%), 4 (29%) and 7 (50%) of the patients, respectively, had night awakening. All patients complained of numbness before the treatment. This symptom disappeared in 81% of the patients after one month and reappeared in all after three months. Significant improvement was shown in the mean distal motor latency (DML) of the median nerve: 5.2 +/- 0.9 msec. before, 4.6 +/- 0.6 msec. and 4.7 +/- 0.6 msec. 1 and 3 months after the injection, respectively (p < 0.05). Mean values of motor muscle potential amplitudes, sensory latency and sensory amplitude did not change significantly after the treatment. CONCLUSIONS: Local corticosteroid injection for the treatment of CTS provides significant symptom improvement for three months. No electrophysiological parameters were improved after injection, except the improvement in distal motor latency of the median nerve.
Assuntos
Síndrome do Túnel Carpal/tratamento farmacológico , Hansenostáticos/administração & dosagem , Metilprednisolona/administração & dosagem , Idoso , Eletromiografia , Feminino , Humanos , Hipestesia/tratamento farmacológico , Hipestesia/etiologia , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Estudos ProspectivosRESUMO
Lepromatous leprosy is a form of chronic granulomatous disease that is caused by infection with Mycobacterium leprae. Early involvement is marked by widespread, ill-defined, erythematous papules and plaques. With early intervention, leprosy is a curable disease; however, if not recognized and treated promptly, permanent sequelae and disability result. We present a patient with long-standing lepromatous leprosy who exhibits many of these sequelae.
Assuntos
Hanseníase Virchowiana/patologia , Contratura/etiologia , Progressão da Doença , Sobrancelhas/patologia , Úlcera do Pé/etiologia , Deformidades Adquiridas da Mão/etiologia , Hepatite B Crônica/complicações , Humanos , Hipestesia/etiologia , Hanseníase Virchowiana/complicações , Masculino , Pessoa de Meia-Idade , Mianmar/etnologia , Deformidades Adquiridas Nasais/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Tuberculose/complicaçõesRESUMO
No disponible
Assuntos
Masculino , Idoso , Humanos , Exantema/etiologia , Hanseníase/diagnóstico , Clofazimina/uso terapêutico , Dapsona/uso terapêutico , Hipestesia/etiologia , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Rifampina/uso terapêutico , Espanha , VenezuelaAssuntos
Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/fisiopatologia , Doenças do Sistema Nervoso Periférico/etiologia , Biópsia , Diagnóstico Diferencial , Pé/patologia , Mãos/patologia , Humanos , Hipestesia/etiologia , Arcada Osseodentária/patologia , Hanseníase Virchowiana/patologia , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Doenças do Sistema Nervoso Periférico/patologia , Sensação , Nervo Sural/patologiaRESUMO
Thirty patients presenting with circumscribed areas of clearly demonstrable hypoesthesia were chosen from amongst those attending this Institute. Their history and clinical features were recorded, lepromin test was done for reading at four weeks, and peripheral part of the hypoesthetic area was biopsied for histopathology and immunostaining. The subjects were predominantly adult males with the symptomatic sites limited to the extremities. On routine histopathological examination of the symptomatic sites, the diagnosis of leprosy, using defined criteria, could be made in six cases (20%). Immunostaining of the remaining sections showing either no pathology or a nonspecific pathology revealed the presence of mycobacterial antigen in five of the 24 cases (20.83%). Overall, leprosy could be diagnosed in 11 of the 30 cases studied (36.66%). This study shows that leprosy may be an important cause of circumscribed areas of sensory deficit.
Assuntos
Hipestesia/patologia , Hanseníase/patologia , Adolescente , Adulto , Distribuição por Idade , Antígenos de Bactérias/isolamento & purificação , Feminino , Humanos , Hipestesia/etiologia , Hanseníase/complicações , Hanseníase/diagnóstico , Masculino , Pessoa de Meia-Idade , Distribuição por SexoRESUMO
The trigeminal and great auricular nerves which supply sensation to the face are affected in leprosy. No objective sensory testing methods have been devised for testing sensation in the face. Testing for corneal sensation to ascertain trigeminal nerve or visualization and palpation of the great auricular nerve alone may not be enough to establish the involvement of these nerves. In a sample of leprosy patients, face sensation threshold measurements were done using a set of three Semmes-Weinstein (SW) monofilaments that gave a force of 0.05-0.07, 0.2 and 2 g. Sensation was tested by three examiners and intra- and inter-observer testing was used as a means to validate the findings. Within the limitations of this study, the results indicate that use of SW monofilaments is a fairly reliable and repeatable method for sensory testing in the face. During follow up, a single filament with a force of 0.5-0.7 g (2.83 marking number in SW filament or any other filament with a corresponding gram force) could be used to assess sensation. A simple procedure of quantifying sensation in these nerves is suggested. A method to incorporate trigeminal or great auricular nerve sensory testing into the existing sensory assessment charts is also discussed.
Assuntos
Face/inervação , Hipestesia/diagnóstico , Hanseníase/fisiopatologia , Nervo Trigêmeo/fisiopatologia , Face/fisiopatologia , Feminino , Humanos , Hipestesia/etiologia , Hanseníase/complicações , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos TestesRESUMO
This report describes two atypical cases of leprosy. A 48 year old male patient presented laryngeal dyspnea with adhesions of the oropharynx of which the biopsies were inconclusive. The patient was cachectic with hyperesthesia of the extremities and two subcutaneous nodules. The biopsy of one nodule evoked thesaurismosis or dyslipoidosis while the bacilloscopy was positive in nasal smears. A 14 year old female patient suffered from bullae which appeared spontaneously on erythematous skin on the legs and upper arms. Upon examination those areas were found to be hypoaesthetic, as was a very large hamartoma on the left half of the body. A biopsy of healthy skin evoked the diagnosis of leprosy. The patient then developed BT leprosy and episodes of hysteria. The first observation led to several diagnoses: while laryngeal dyspnea is unusual in LL and while cutaneous histology of regressive LL contrasted with the abundance of the bacilloscopy. The diagnosis of the second case is that of indeterminate leprosy with premonitory neurological signs associated with pathomania and evolution to a multibacillary form.
Assuntos
Vesícula/etiologia , Dispneia/etiologia , Laringite/etiologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Tuberculoide/diagnóstico , Adolescente , Biópsia , Caquexia/etiologia , Diagnóstico Diferencial , Eritema/etiologia , Feminino , Humanos , Hiperestesia/etiologia , Hipestesia/etiologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/microbiologia , Hanseníase Tuberculoide/patologia , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/isolamento & purificação , Orofaringe/microbiologia , Orofaringe/patologia , Pele/microbiologia , Pele/patologiaRESUMO
Median nerve decompression was performed in 29 leprosy patients of which 20 were followed up for varying periods. It has been observed that the decompression was beneficial, sensory recovery was seen in 90% cases and in 45% cases the muscle strength improved and the process of deterioration was arrested in another 25% cases.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Hipestesia/etiologia , Hanseníase Tuberculoide/complicações , Nervo Mediano/cirurgia , Debilidade Muscular/etiologia , Adolescente , Adulto , Idoso , Síndrome do Túnel Carpal/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
One hundred fifty-one patients (125 males and 26 females) of multibacillary leprosy (LL 88, BL 40, BB 23), registered during 1986-1992 for multidrug therapy (MDT), were analysed with reference to their disabilities before, during and after MDT. At induction 48 (31.7%) had no disability (Gr 0), 59 (39.0%) had only peripheral anaesthesia (Gr 1) and 44 (29.1%) had Gr 2 and 3 deformities with or without anaesthesia. The parallel analysis of the three groups, with nearly equal duration of symptoms, revealed that new deformities developed in only a few cases during and after MDT, least in the Gr 0 group. The crude fresh deformity incidence was 59.2 per 1,000 person years of observation. The rate of recovery from anaesthesia was higher (64%) in Gr 1 group than that (44%) in group with Gr 2, 3 deformities. No significant difference was observed between the incidence of Gr 2 deformities developed before, during and after MDT (incidence of claw-hands 9.2% before and 7.9% during and after MDT, trophic ulcers 13.9% before and 17.8% during and after MDT). Out of 19 cases which developed motor weakness during MDT and follow-up, 10 (52.6%) were instances of quite nerve paralysis. Occupational factors influenced the development of deformities but not the sex and bacterial load. Generally, the lower the Grade of disability at induction of patient for MDT, the lower the chances of new disability development and higher the chances of recovery from sensory impairments.