Lepra Lepromatosa con incio neural puro. A propósito de un caso / No disponible

En la lepra lepromatosa, cuando los troncos nerviosos periféricos son invadidos producen lesiones en la medida en que la enfermedad progresa de manera simétrica y dejan graves secuelas en etapas avanzadas de la enfermedad. Se trata de un paciente masculino, de 56 años de edad, con antecedentes de haber sido tratado por la especialidad de neurología por más de 20 años, debido a que tenía trastornos de la sensibilidad en miembros inferiores, en forma de calcetín que había sido diagnosticado como neuropatía sin causa aparente que acude a consulta de cuerpo de guardia del Hospital Manuel Ascunce de Camagüey, refiriendo que desde hacía unos años presentaba lesiones en forma de manchas por todo el cuerpo, que no le picaban. Al examen dermatológico se constata cuadro cutáneo diseminado constituido por placas infiltradas eritematosas, de bordes mal definidos, en número de más de una veintena, acompañadas de trastornos de la sensibilidad y disminución del vello a ese nivel. Además, con infiltraciones difusas de cara y pabellones auriculares, trastorno de la sensibilidad en miembros inferiores y troncos nerviosos engrosados. La variedad neurítica pura es muy discutida y se cree que los casos que fueron diagnosticados como tales presentaron lesiones cutáneas que pasaron inadvertidas y no dejaron secuelas

In lepromatous leprosy, when the peripheral nervous trunks are invaded they produce lesions to the extent that the disease progresses symmetrically and leave serious sequelae in advanced stages of the disease. This is a 56-year-old male patient with a history of having been treated by the specialty of neurology for more than 20 years, because he had sensory disorders in the lower limbs, in the form of a sock that had been diagnosed as a neuropathy without apparent cause, he went to the on call unit at the Manuel Ascunce Hospital in Camagüey, saying that for some years he had had lesions in the form of spots all over his body that did not itch. The dermatological examination revealed a disseminated cutaneous plaque composed of infiltrated erythematous plaques with poorly defined edges, in a number of more than twenty, accompanied by disorders of sensitivity and hair loss at that level. Also with diffuse infiltration of the face and ears, sensory disturbance in the lower limbs and thickened nerve trunks. The pure neuritic variety is very controversial and it is believed that the cases that were diagnosed as such presented cutaneous lesions that went unnoticed and did not leave sequels

Generalized granulomatous dermatitis following Mycobacterium w (Mw) immunotherapy in lepromatous leprosy.

Mycobacterium w (Mw) vaccine is a heat-killed suspension derived from a nonpathogenic, cultivable, atypical mycobacterium named Mycobacterium indicus pranii. Mw immunotherapy has been reported to be efficacious as an adjunct to multidrug therapy multibacillary regimen in leprosy patients with high bacillary index. Cutaneous reactions are predominant adverse effects associated with the administration of vaccines. Cutaneous adverse effects ascribed to Mw vaccine are generally limited to the site of injection. We herein describe two cases of lepromatous leprosy who developed an unusual generalized cutaneous reaction following Mw immunotherapy. A high index of suspicion is needed to identify such manifestations in leprosy cases to avoid misdiagnosis of a relapse or a reaction and for appropriate treatment.

Casos inusuales de lepra en la provincial de Camagüey, Cuba, 2015 / No disponible

La lepra es una enfermedad común y aunque ya no constituye un problema de salud en el país ni en la provincia, sí se notifican casos todos los años. Este año notificamos casos con características clínicas inusuales, pues la lepra de Lucio es una forma de lepra lepromatosa que se observa fundamentalmente en México, siendo excepcional su presentación en nuestro medio. Es la denominada lepra difusa o moteada, no tiene nódulos sino que se caracteriza por presentar zonas de vasculitis múltiples en la que se produce necrosis dermoepidérmica y la aparición de úlceras planas que se unen entre sí y curan dejando cicatriz. Se caracteriza por presentar una infiltración difusa generalizada de la piel. Además, se presentó un segundo caso con lepra tuberculoide de lesión única, con engrosamiento de nervios cubitales de 10 años de evolución, sin tratamiento y sin ningún tipo de discapacidad. El tercer caso se presentó con manifestaciones clínicas muy floridas de una lepra dimorfa sin anestesia táctil, térmica ni dolorosa con un año de evolución sin tratamiento

Leprosy is a common illness in our area and although it no longer represents a public health problem in the state or at country level new cases are notified every year. This year we have diagnosed cases with unusual clinical characteristics, one with Lucio’s Leprosy is a form of lepromatous leprosy that is observed fundamentally in Mexico and unusual in our area. It is also defined as diffuse or spotted leprosy and the patient doesn’t have nodules but presents areas of multiple vasculitis in which dermoepidermal necrosis together with the appearance of plane ulcers that unite takes place and it cures leaving a scar. This type of leprosy is mainly characterized by a disseminated diffuse infiltration of the skin. We also had a second case with single lesion tuberculoid leprosy, presenting affectation of the ulnar nerve, without treatment, no visible deformities and diagnosed 10 years ago of the disease. And a third case with very florid clinical manifestations of dimorphous leprosy without tactile, thermal nor pain anesthesia with a year of evolution and without treatment is also presented

Fenómeno de Lucio reaccional y anticuerpos antifosfolípidos en pacientes con lepra lepromatosa difusa. Reporte del primer caso descrito en el Paraguay / No disponible

El Fenómeno de Lucio es un episodio reaccional de necrosis cutánea que ocurre en la Lepra de Lucio. Ocurre en el curso de la enfermedad tras tres o cuatro años, sobre todo en aquellos pacientes no tratados o que han recibido tratamiento pero de forma irregular. Se manifiestan con máculas purpúricas que progresan a lesiones ulcerosas superficiales, poligonales o anguladas, a veces con ampollas, con sensación quemante, en un paciente sin fiebre, síntomas generales ni daño visceral. El cuadro dura no más de 15 días. Presentamos el caso de un varón adulto, quien presentó un cuadro con necrosis traumática del dedo medio del pie izquierdo, con su posterior amputación y tratamiento antibiótico, tras lo cual desarrolla Fenómeno de Lucio reaccional, con positividad de anticuerpos antifosfolípidos, sin fenómeno trombótico coexistente

Lucio’s Phenomenon is a skin necrotizing reactional condition that occurs in Lucio’s Leprosy. It generally occurs three or four years after the illness has begun, especially in patients who had not been treated or have had an irregular treatment. The condition manifests with purpuric macules that progress to superficial ulcers, with polygonal or angled shapes, some of them with blisters accompanied by a burning sensation. Lucio’s Phenomenon is usually afebrile, and shows no general symptoms of being ill or visceral damage. It typically resolves within 15 days. We report the case of an adult male, who presents with traumatic necrosis of the middle finger of the left foot. The patient is subjected to amputation and antibiotics. After that, he develops Lucio’s Phenomenon with Antiphospholipid antibodies, without a thrombotic episode

Prevenção de incapacidades em hanseníase: relato de caso / Prevention of disability in leprosy: case report

Introdução: a hanseníase é uma doença que afeta o ser humano como um todo. O Mycobacterium leprae (ML) é o responsável pelo desenvolvimento dessa doença dermatoneurológica crônica e por ser uma doença de evolução lenta, na maioria dos casos, pode gerar um alto grau de incapacidades e deformidades em indivíduos não tratados ou tratados inadequadamente devido a diagnósticos tardios,ocasionando limitações na vida social e laborativa. O homem é considerado a única fonte de infecção e de transmissão da hanseníase os nervos mais frequentemente acometidos são o ulnar, mediano, radial, tibial posterior e fibular. Com a evolução da hanseníase, dois outros fenômenos estão relacionados ao processo inflamatório intenso provocado pelos bacilos acometem os nervos, prejudicando-os em graus variados: as neurites e as reações. Para prevenir incapacidades em hanseníase são necessárias medidas que visem à manutenção física, emocional e socioeconômica do indivíduo e que evitem complicações nos casos onde os danos já estão presentes. Objetivo: este estudo tem como objetivo descrever um caso clínico e focar nas questões de avaliação de força muscular e sensibilidade (monitoração da função neural), diagnóstico e prevenção de incapacidades, mesmo quando já existem sequelas instaladas, visando evitar as complicações e melhorar a qualidade de vida do paciente nestas condições. Resultados e discussão: Como descrito na literatura consultada, a maior frequência de lesões ocorre em pés, seguida das lesões em mãos. Geralmente os nervos afetados são mistos, isto é, possuem fibras sensitivas, motoras e autonômicas. As alterações acontecem em todos esses aspectos, e foram observadas no paciente deste estudo, comprovando a necessidade da intervenção fisioterapêutica. Considerações finais: Pôde-se observar a necessidade de uma avaliação fisioterapêutica ampla, que considere o indivíduo como um todo, para se traçar os objetivos e condutas adequados de acordo com as particularidades existentes.

Introduction: leprosy is a disease that affects the human being as awhole. Mycobacterium leprae (ML) is responsible for the developmentof this disease the dermatological-neurological chronic disease to be a slow evolution, in most cases, can generate a high degree of disability and deformity in untreated or inadequately treated because of late diagnosis, causing limitations in social life and labors. The man is considered the only source of infection and transmission of leprosy nerves most often affected are the ulnar, median, radial, posterior tibial and fibular. With the evolution of leprosy, two other phenomena are related to the intense inflammation caused by bacilli affect the nerves, damaging them in varying degrees: neuritis and reactions. To prevent disability in leprosy are necessary measures to maintain the physical, emotional and socio-economic of the individual and to avoid complications in cases where the damage is already present. Objective: this study aims to describe a clinical case and focus on issues of assessment of muscle strength and sensitivity (monitoring of nerve function), diagnosis and prevention of disabilities, even when there are sequels already installed in order to avoid complications and improve quality of life the patient in this condition. Results and discussion: as described in the literature, the highest frequency of injuries occur in feet, followed by lesions on the hand. Usually the affected nerves are mixed, ie they have sensory fibers, motor and autonomic. Changes occur in all these respects, and were observed in this study patient, demonstrating the need for physiotherapy intervention. Conclusion: it might be noted the need for a comprehensive physical therapy evaluation, which considers the individual as a whole, to outline the objectives and conduct appropriate according to the specific ones.

[Diagnosis and treatment of leprous neuropathy in practice]. / Diagnostic et traitement de la neuropathie lépreuse en pratique.

Leprosy still affects 240,000 persons every year in the world. It is a particularly common cause of neuropathy and severe disabilities in developing countries. With increasing migration, new cases of leprosy are regularly diagnosed in developed countries, where it still remains rare and so underestimated. Cutaneo-nevritic leprosy is the most frequent form of leprosy. It may be diagnosed by the clinical features and the cutaneous histology and bacteriology. Neuritic leprosy without obvious skin lesions is reported in 5 to 15% of leprosy patients. It must be suspected in persons from areas of endemic disease presenting with nerve thickening and associated nerve deficit. Nerve biopsy is essential for diagnosis. However search for bacilli in cutaneous samples may be of great help and avoid nerve biopsy. Acute and severe neuritis occurs during reactional states, reversal reaction (Type 1) and erythema nodosum leprosum (Type 2). Multidrug therapy is advocated. The treatment of acute neuropathy needs a supplementary medical and sometimes surgical treatment.

Self care groups and ulcer prevention in Okegbala, Nigeria.

OBJECTIVE: To assess the impact of the three self-care Groups on ulcer prevalence and readmission rates in Okegbala hospital. DESIGN: A retrospective, descriptive study. The evaluation combined four data collection methods namely (i) records survey, (ii) semi-structured interviews of individual members of self-care groups, (iii) group discussions and (iv) key informant interviews. RESULTS: Record surveys show that the ulcer prevalence has decreased by almost 75% since the adoption of the self-care group; admissions to hospital for ulcer care have reduced, and the mean interval between admissions has increased by 7 months. Semi structured interviews and group discussions show that all members have a greater sense of control of their ulcers and general health; and that self-care groups have a potential of catalysing community solidarity and development. CONCLUSIONS: This small study shows that self-care groups are valuable for reducing ulcers and giving members a greater sense of control of their ulcers and general health resulting in fewer hospital admissions. We recommend a multi-centre, controlled, prospective study incorporating different settings (e.g. urban, rural, near hospitals, within field leprosy programmes) to test these findings. Such a study has the potential of influencing policy and health-service reorientation of ulcer care in future.

[Nasal leprosy: impact of multitherapy in the morphology and physiology of the nose]. / Lepra nasal: impacto de la multiterapia en la morfología y la fisiología nasal.

INTRODUCTION: The multi-drug therapy protocol has allowed leprosy patients following this strategy to achieve complete recovery without developing neurotrophic sequelae or deformities. OBJECTIVES: To assess the impact of multi-drug therapy on the development of nasal deformities and nasal airway patency. PATIENTS AND METHOD: In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug and 22 were treated with multi-drug while 24 subjects formed a control group. Nose morphology was determined by anterior rhinoscopy. Nasal patency and flow resistances were measured by anterior rhinomanometry. The results were compared by using the Anova test for a single variable. RESULTS: The nasal structures in the group with therapy based on a single drug underwent resorption of bone and cartilage in the structures of the nose and increased flow resistance. In the group receiving the multi-drug protocol, there were no significant morphological alterations and nasal patency and flow resistance remained within normal levels. CONCLUSIONS: The multi-drug therapy is effective in preventing the development of nasal deformities and maintains normal nasal airflow.

A case of feline leprosy caused by Mycobacterium lepraemurium originating from the island of Kythira (Greece): diagnosis and treatment.

A 2-year-old, 4 kg, healthy, domestic shorthair female cat presented with ulcerated subcutaneous nodules on the commissures of its mouth. The cat was negative for feline leukaemia virus and feline immunodeficiency virus. Skin mycobacteriosis was diagnosed after detection of numerous acid-fast bacilli in Ziehl Neelsen-stained smears from the ulcers. Feline leprosy was suspected following preliminary polymerase chain reaction results: positive for Mycobacterium genus but negative for Mycobacterium tuberculosis and Mycobacterium avium complexes. Mycobacterium lepraemurium was later identified following DNA sequence analysis of the 5' end of the 16S rRNA gene and the 16S-23S internal transcribed spacer region. Microscopic lesions consisted of pyogranulomas containing mainly large foamy macrophages with 10-100 intra-cellular acid-fast bacilli per field. The cat was cured after surgery and a 14-week course of clofazimine (30 mg daily) and clarithromycin (50 mg twice daily).

Estudo terapêutico comparando a associação de rifampicina, ofloxacina e minociclina com a associação rifampicina, clofazimina e dapsona em pacientes com hanseniase multibacilar / Therapeutical study comparing the association of rifampin, ofloxacine e minocycline with a association rifampin, clofazimine e dapsone in patients with bacillus leprosy

O presente trabalho comparou dois esquemas terapêuticos em pacientes com hanseniase multibacilar. O grupo l, que recebeu o tratamento convencional (PQT-MB), foi denominado grupo de controle. O grupo 2, denominado de grupo teste, recebeu a associação de rifampicina 600mg, mais ofloxacina 400mg, mais minociclina 100mg (ROM), administrado sob supervisão, uma vez por mês. A duração total do tratamento nos dois grupos foi de dois anos. Na avaliação inicial foram realizados: exame clinico, baciloscopio e histologico. A baciloscopia e a biopsia foram repetidas no final do primeiro ano e novamente no final do segundo ano de tratamento. A avaliação clinica foi realizada mensalmente por ocasião da administração da dose supervisionada. No grupo 1 foram avaliados 14 pacientes. O indice baciloscopio (IB) antes do tratamento variou de 2 a 4,8. No grupo 2 foram estudados 12 pacientes. O IB antes do tratamento nesse grupo variou de m1,6 a 4,8. Ambos os grupos apresentavam lesões cutâneas que os caracterizavam como pertencentes ao pólo vichoviano. Histologicamente apresentavam quadro de hanseniase virchoviana ativa, exceto um paciente do grupo 2. Ao final do primeiro ano de tratamento estavam todos clinicamente melhorados, o indice baciloscopio diminuido e com quadro histologico em regressão. Essa tendencia de melhora se mantinha e na avaliação do finanl do segundo ano todos estavam clinicamente, baciloscopidamente e histologicamente ainda melhores. A análise estatistica dos parametros, baciloscopio e histologico, mostrou que não houve diferença estatisticamente significativa entre os grupos estudados, sendo, portanto os dois esquemas equivalentes. A ocorrência de reação tipo 2(eritema nodoso hansenico-ENH) foi igual nos dois grupos. no primeiro grupo 1, todos apresentaram pigmentação cutânea devido a clofazimina. Os resultados, portanto, demonstraram que o esquema com administração mensal de rifampicina, mais ofloxacina, mais minociclina tem eficácia e segurança equivalenteao esquema convencional. Além disso, tem a vantagem de não acarretar pigmentação cutânes, ser totalmente supervisionado, podendo ser utilizado como esquema alternativo.

Pápulas eritemato-parduscas en tronco y extremidades / Brown erythematous papules on trunk and limbs

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Hanseníase: a doença secular do mundo subdesenvolvido / Hanseniase: the secular disease of the underdeveloped world

A finalidade deste artigo é relatar um caso de hanseníase,em sua forma virchowiana, fazendo também uma revisão sobre a doença, desconhecida não só por leigos, como também pelos profissionais de saúde. Mostra que a doença tem tratamento e cura, bastando para tanto precocidade de diagnóstico e de terapêutica

Lichen scrofulosorum in a patient with lepromatous leprosy after BCG immunotherapy.

Lichen scrofulosorum is a rare form of tuberculid seen in children and young adults. The cutaneous lesions are typically symptomless papular eruptions, associated with a strong Mantoux reaction, tuberculosis of lymph nodes and/or other organs or rarely following BCG vaccination. We describe an unusual case of occurrence of lichen scrofulosorum following BCG immunotherapy in a patient with lepromatous leprosy.

Guillain-Barre syndrome 1N leprosy patients.

Leprosy commonly affects the peripheral and cranial nerves. This involvement often manifests with peripheral neuropathy, occurring as a result of direct invasion of the nerves by lepra bacilli. Immune-mediated neuropathy occurring in leprosy, as part of lepra reaction, has been described earlier. We report here two cases of Guillain-Barre syndrome occurring in patients with leprosy who did not have any obvious evidence of lepra reaction.

Dos casos de lepra en Valladolid / Two cases of leprosy in Valladolid

La lepra continúa siendo un importante problema de salud en todo el mundo y aunque en nuestro continente no alcanza cifras de endemia, parece existir una tendencia al alza debido al número de casos importados diagnosticados cada año. Se describen 2 casos de lepra lepromatosa diagnosticados en Valladolid en un periodo de 5 meses. El último caso declarado de esta enfermedad en nuestra comunidad data de hace más de 20 años

Leprosy is still a major health problem on a worldwide level, and although it does not reach endemic levels on our continent, it seems that there is an upward trend due to the number of imported cases diagnosed each year. We present two cases of lepromatous leprosy diagnosed in Valladolid within a five-month period. The last reported case of this disease in our community was over 20 years ago

10-12 years follow-up of highly bacillated BL/LL leprosy patients on combined chemotherapy and immunotherapy.

This study reports the follow-up results of 36 highly bacillated untreated BL/LL cases who were serially allocated to three treatment groups. Group I patients received a modified WHO regimen (Rifampicin 600 mg once a month supervised, 50 mg of Clofazimine and 100 mg of Dapsone daily unsupervised) and BCG 0.1 mg per dose 6 monthly; group II patients received the same multi-drug treatment (MDT) and Mw (2 x 10(8) killed bacilli per dose) 6 monthly: group III patients received the same MDT with 0.1 ml of distilled water 6 monthly and acted as a control. Treatment was continued till smear negativity. All these three groups were comparable by their initial clinical score, bacteriological index (BI), viable bacilli as assessed by the mouse foot pad (MFP), bacillary adenosine triphosphate (ATP) content and also histologically at the time of starting treatment. All these parameters were evaluated every 6 months. The vaccines were well tolerated. All the patients in group I became smear negative by 3.5 years, in group II in 3 years whereas those in group III took 5 years. The incidence of reactions was the same in all the groups during the first 2 years, however, patients of group III (MDT + placebo) continued to have reactions up to 3 years. No viable bacilli could be detected in the local and distal sites as estimated by MFP and bacillary ATP after 12 months in both the immunotherapy groups. These could be detected in patients on MDT alone up to 24 months of therapy. Histologically patients in both the immunotherapy groups (groups I and II) showed accelerated granuloma clearance, histological upgrading and non-specific healing without granuloma formation both at the local and distal sites and this was achieved much earlier compared to the MDT + placebo group. Thus, by the addition of immunotherapy the effective treatment period of achieving bacteriological negativity could be reduced by about 40%, time period of reactions reduced by 33% and there were no reactions and/or relapses in the 10-12 years post-treatment follow-up.

Evolución de las lesiones óseas en enfermos de Hansen en alta terapéutica: a propósito de 3 casos

En el presente artículo los autores intentan explicar cómo a pesar de que la lepra en la actualidad es una enfermedad que, con un diagnóstico precoz y con un tratamiento adecuado, tiene cura sin dejar ninguna secuela, para aquellos enfermos en los que ya existe una afectación neurológica, van a quedar unas lesiones tróficas que les van a acompañar durante el resto de su vida. Sin embargo, y a pesar de los grandes avances realizados en los últimos veinte años, estas lesiones óseas en miembros inferiores en enfermos en alta terapéutica siguen constituyendo un gran problema en el control de la enfermedad (AU)