Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study.

OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.

El Proyecto de la fundación fotilles en la región del norte araguaia: desde 1996 a 2013 / No disponible

No disponible

[Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana]. / Réponses et réactions paradoxales au cours du traitement médicamenteux de l'infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française.

BACKGROUND: In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. PATIENTS AND METHODS: We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. DISCUSSION: In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.

A imagem corporal nas ações educativas em autocuidado para pessoas que tiveram hanseníase / Body image in educational actions in self-care for people who had leprosy

Os comprometimentos físicos ocasionados pela hanseníase são pactuados nas ações do Plano Nacional de Controle da Hanseníase e são considerados um grave problema de saúde pública. Como forma de prevenir o avanço de incapacidades, o Ministério da Saúde propõe ações educativas em autocuidado. No entanto, apesar da enfática importância da realização do autocuidado, observa-se a não aderência dos pacientes ao programa, que pode ser justificada, dentre outros motivos, pela desestruturação de sua imagem corporal e pelo estigma advindo das representações sociais do corpo "leproso". Sendo assim, acredita-se na importância de ampliar o discurso tecnicista nas ações educativas em autocuidado, considerando a imagem corporal como aspecto importante nas estratégias de tratamento da doença. Objetiva-se conhecer a imagem corporal de pessoas que tiveram hanseníase e que desenvolveram incapacidades físicas. Para tanto, aplicou-se o teste psicológico Desenho da Figura Humana (DFH), com ênfase na análise interpretativa das mãos e dos pés, locais mais afetados pela hanseníase, em cinco mulheres cadastradas e em acompanhamento no Programa de Autocuidado em Hanseníase de um Ambulatório Regional de Especialidades de um município do Vale do Paraíba Paulista. O teste foi realizado no período de março a dezembro de 2009. Os resultados revelaram a não inclusão ou a desfiguração de mãos e pés. Existe uma falta de integração dessas regiões à consciência, acarretando desestruturação da imagem corporal, que pode decorrer tanto da perda de sensibilidade cutânea como da deformidade advindas da doença. Infere-se que essa desestruturação da imagem corporal dificulta a aderência ao autocuidado e a sociabilização dessas pessoas, aumentando o estigma da hanseníase...

Physical impairment caused by leprosy are agreed in the National Plan for Leprosy Control and are considered a serious public health problem. In order to prevent the advance of disabilities, the Ministry of Health proposes educational actions in self-care. However, despite the emphatic importance of performing self-care, we observe non-adherence of patients to the program, which may be explained, among other reasons, by the destruction of their body image and the stigma arising from the social representations of the "leprous" body. Thus, we believe in the importance of increasing the technicist discourse in educational actions in self-care, considering body image as an important aspect in the treatment strategies of the disease. We aim to meet the body image of people who had leprosy and developed disabilities. For this, we applied the psychological test Human Figure Drawing (HFD), with emphasis on interpretive bnalysis of the hands and feet, the most affected by leprosy, in five women registered and monitored by the Self-Care Program in Leprosy, in a Regional Outpatient Clinic in the district of Vale do Paraíba Paulista. The test was conducted from March to December 2009. Results revealed the inclusion or disfigurement of hands and feet. There is a lack of integration between these regions and awareness, causing disruption of body image, which may result from both loss of cutaneous sensibility and the resulting deformity disease. It is inferred that this disruption of body image hinders adherence to self-care and socialization of these people, increasing the stigma of leprosy...

The wide range of clinical manifestations in leprous neuropathy: two case reports.

The present report describes two patients with leprous neuropathy diagnosed in Japan and manifesting with different clinical features. A 78-year-old Japanese man presented with a 3-year history of numbness and weakness affecting the upper and lower extremities. Although he did not have skin eruptions, nerve biopsy revealed acid-fast bacilli. Another patient, a 41-year-old Japanese-Brazilian man, presented with a 1-month history of numbness in the right fourth and fifth fingers and whole-body erythema. These cases highlight the fact that, as a result of worldwide travel and immigration, leprosy should still be considered in the differential diagnosis of neuropathy in developed countries.

Leprosy and stigma in the context of international migration.

If it can be argued that no single attribute or condition (leprosy included) is inherently or universally considered to be 'deeply discrediting,' to quote Goffman, then we must consider how external factors shape stigma associated with that condition in different cultural and socioeconomic contexts. Often, an analysis of what is perceived to be stigma towards people affected by leprosy uncovers other prejudices or stigmatising attitudes associated with class, gender, and/or ethnic inequalities in that society. The movement of people across international borders adds new dimensions to the experience of leprosy, as affected individuals confront different sets of understandings of the disease among healthcare professionals, friends, family, and employers in host and sending countries. Preconceptions of the immigrant 'other' in host countries may be bound up with notions of disease and danger, further complicating the experience of leprosy treatment for immigrants. Drawing on the work of others and on early stage qualitative research on leprosy among Brazilian immigrants to the United States, this paper will consider the ways in which immigration and transnational processes could affect the experience of stigma among immigrants affected by leprosy.

Isolamento social, sociabilidades e redes sociais de cuidados / Social isolation, sociability and social care networks

Este trabalho examina, em caráter exploratório, experiências de isolamento social vividas por indivíduos portadores de hanseníase, internados na ex-colônia Tavares de Macedo, em Itaboraí, onde foram mantidas da década de 1930 até os dias de hoje, para problematizar noções sobre segregação e discriminação social presentes nesse meio. Para tanto, examina sociabilidades e redes sociais de cuidados estabelecidas na vida em comum nessa "ex-colônia de leprosos", quase sempre como alternativas às condições oferecidas pelos sistemas públicos de proteção social. Faz isso com base em narrativas de alguns desses sujeitos, vistos em suas diferenças - nas interseções das relações por sexos, classes, raças/etnias, gerações, e também por religiões e graus de escolaridade. Recorre à história oral, modo de oferecer novas interpretações qualitativas de processos histórico-sociais evidenciados nessas sociabilidades e redes, nem sempre visíveis como formas singulares de proteção social da vida em comum.

This exploratory work examines the social isolation experienced by individuals with leprosy admitted to the former colony Tavares de Macedo, Itaboraí, where they were kept from the 1930s until the present day, to question notions of segregation and social discrimination present in this environment. So it analyzes sociabilities and social care networks established in the common life in this "ex-leper colony," usually as alternatives to the conditions offered by the public systems of social protection. The work is based on stories of some of the subjects, seen in their differences - at intersection of gender relations, classes, races/ethnicities, generations and also by religions and educational backgrouns. It adopts the oral history, so as to offer new qualitative interpretations of social and historical processes shown in these networks and sociability, not always visible as unique forms of social protection of life in groups.

[Leprosy in children: A diagnosis that must not be missed]. / Lèpre de l'enfant : un diagnostic à ne pas méconnaître.

BACKGROUND: With 254,525 new cases reported in 2007, leprosy is the worlds' second most widespread form of mycobacteriosis. According to the WHO, eradication of leprosy as a public health problem (defined by less than one case per 10,000 people) has been globally achieved. High endemic zones, however, still subsist. Leprosy rates among children, which reflect a country's endemic level, ranged from 0.55 to 19.2 % in 2006. Due to world population migrations, cases of leprosy are now seen in mainland France, in both children and adults. PATIENTS AND METHODS: We describe three leprosy patients aged under 15 years treated at the Dermatology Unit of Saint Louis Hospital between 1st January 2002 and 31st December 2008. The three cases described account for 3 % of new patients treated for leprosy at Saint Louis Hospital over this 7-year period. All were born in an endemic country. Lesions appeared 18 months after arrival in France in two cases and clinical diagnosis was made in only one case. Due to absence of sensory loss in the lesions, diagnosis was reliant upon histopathological examination in two cases. CONCLUSION: Leprosy should be suspected in children from endemic countries presenting skin lesions, particularly hypochromic lesions, even if there is no sensory loss, regardless of how long they have been living in France.

Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil.

In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called 'United-States-of-Sobral', in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A 'contextualized semantic interpretation' revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. 'Skin Spot Day' discriminates more than educates. Patients' 'non-compliance' with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. 'Social leprosy' in Northeast Brazil deforms patients' moral reputations and personal dignity.

Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil / Estigma, metáforas deformadoras e experiência moral de pacientes com hanseníase multibacilar em Sobral, Ceará, Brasil

In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called "United-States-of-Sobral", in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30 percent increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A "contextualized semantic interpretation" revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. "Skin Spot Day" discriminates more than educates. Patients' "non-compliance" with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. "Social leprosy" in Northeast Brazil deforms patients' moral reputations and personal dignity.

No intuito de criar uma Ciência do Estigma, este estudo antropológico investiga a experiência moral de pacientes diagnosticados com a hanseníase multibacilar. De 2003 a 2006, a pesquisa foi conduzida nos "Estados Unidos do Sobral", Estado do Ceará, Brasil, altamente endêmico para hanseníase apesar da intensificação de erradicação e o aumento de 30 por cento na cobertura de saúde desde 1999. Entre 329 casos de hanseníase, 279 foram identificados como multibacilar e seis casos "ricos em informação" foram selecionados para aprofundamento. Narrativas da enfermidade, entrevistas etnográficas, visitas domiciliares, observação-participante de consultas clínicas e entrevistas semi-estruturadas com médicos foram realizadas. A "interpretação semântica contextualizada" revelou quatro metáforas de "lepra" - uma repulsiva doença de rato, uma infecção de pele com conotações racistas, uma praga bíblica, e uma leucemia letal. Essas metáforas "multivocálicas" contestam o discurso biomédico. A lepra é repleta de significados morais. O "Dia da Mancha" descrimina mais do que educa. A falta de aderência à eficaz poliquimoterapia é causada mais pelo estigma desmoralizante do que pela rejeição ao tratamento em si. A "lepra social" no nordeste brasileiro deforma a reputação moral e a dignidade do paciente.

4º Conferência Nacional de Saúde Indígena: relatório final / 4th national conference on indigenous health: final report

A 4ª Conferência Nacional de Saúde Indígena (4ª CNSI), convocada pela Portaria Ministerial nº 963, de 23 de julho de 2005 e publicada no Diário Oficial da União no 120, de 24 de junho de 2005, é parte integrante da 12ª Conferência Nacional de Saúde. A 4ª CNSI ocorreu no período de 27 a 31 de março de 2006, no município de Rio Quente, Goiás e teve por finalidade avaliar a situação de saúde nos Distritos Sanitários Especiais Indígenas e do Subsistema Indígena no âmbito do Sistema Único de Saúde e propor diretrizes e ações para promover a saúde dos povos indígenas, com controle social. O tema central da 4ª CNSI que orientou as discussões nas distintas etapas da sua realização, foi: "Distrito Sanitário Especial Indígena: território de produção de saúde, proteção da vida e valorização das tradições" e teve cinco eixos temáticos: I. Direito à Saúde; II. Controle Social e Gestão Participativa; III. Desafios Indígenas Atuais; IV. Trabalhadores indígenas e não indígenas em saúde; V. Segurança Alimentar, Nutricional e Desenvolvimento Sustentável.

[Survey of newly diagnosed leprosy patients in Japan (1993-2000)].

We analyzed the medical and social problems of newly registered leprosy patients in the past 8 years from 1993 to 2000 in a low endemic country, Japan. There were 56 registered Japanese patients (males, 32; females, 24), and 76 registered foreign patients (males, 56; females, 20). The number of Japanese patients in each year was between 5 and 9, and 2/3 of them were from Okinawa Prefecture, located in subtropical zone. But the number of foreign patients in each year was between 5 and 18, and 2/5 of them were from Brazil. The number of foreign patients was greater than that of Japanese patients. Male/female ratio has decreased among the Japanese.

Tendencia temporal de la detección de la lepra en el Estado de São Paulo (Brasil) 1934-1983

A partir de una muestra de casos de lepra detectados en el Estado de São Paulo, Brasil, entre 1943 y 1983, se describe y se avalúa la tendencia temporal de la endemis en el Estado. La tendencia de las tasas de detección ha sido estudiada por sexo y grupo de edad,. así como también las proporciones de las distintas formas clínicas, incluso por comparación con otros países de tendencia secular parecida. En el período estudiado, la tendencia global de las tasas de detección es decreciente; sin embargo, solamente las dos décadas subsiguientes a la introdución de la sulfonoterapia podrían considerarse como de caída real la incidencia. Dado que el lapso abarcado incluye límites importantes en la terapéutica y el enfoque de las políticas de control de la lepra, se intenta una interpretación del fenómeno epidemiológico observado en función de las características organizativas y estratégicas del programa de control en las diferentes etapas consideradas.

Two sisters with leprosy.

Leprosy is a rare entity in Japan, but remains quite common in developing countries. We report two sisters with leprosy from Brazil but currently working in Japan who presented to our clinic. The younger sister was infected with the BB type with HLA-A2, A24, B51, Bw52, DR2, DRw8, DRw52, DQw1, and DQw3. The elder sister had the TT type with HLA-A2, A31, B51, Cw3, DRw6, DRw8, DRw52, DQw1, and DQw3. Immunohistochemical findings revealed that CD4+, 4B4+ helper/inducer T-cells were dominant in the granulomas of both cases. Bacilli were not detectable in the biopsy specimens. However, Mycobacterium leprae-specific DNA fragments were found in their peripheral blood and biopsy specimens by polymerase chain reaction.