2020 Impact report

GPZL 2020 impact report highlights work on COVID-19 response, research on leprosy and partnerships with countries

LIVE - Impactos da pandemia para as doenças tropicais negligenciadas

Conversa com Alexandre Menezes, diretor da NHR Brasil, Eloan Pinheiro, ex-diretora do Instituto de Tecnologia em Fármacos (Farmanguinhos/Fiocruz), e Francilene Mesquita, voluntária do Movimento de Reintegração das Pessoas Atingidas pela Hanseníase (Morhan) no Piauí. Moderação: Thaís Brito

The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy.

Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.

Bacillus Calmette-Guérin (BCG) vaccine generates immunoregulatory cells in the cervical lymph nodes in guinea pigs injected intra dermally.

This work demonstrates the presence of immune regulatory cells in the cervical lymph nodes draining Bacillus Calmette-Guérin (BCG) vaccinated site on the dorsum of the ear in guinea pigs. It is shown that whole cervical lymph node cells did not proliferate in vitro in the presence of soluble mycobacterial antigens (PPD or leprosin) despite being responsive to whole mycobacteria. Besides, T cells from these lymph nodes separated as a non-adherent fraction on a nylon wool column, proliferated to PPD in the presence of autologous antigen presenting cells. Interestingly, addition of as low as 20% nylon wool adherent cells to these, sharply decreased the proliferation by 83%. Looking into what cells in the adherent fraction suppressed the proliferation, it was found that neither the T cell nor the macrophage enriched cell fractions of this population individually showed suppressive effect, indicating that their co-presence was necessary for the suppression. Since BCG induced granulomas resolve much faster than granulomas induced by other mycobacteria such as Mycobacterium leprae the present experimental findings add to the existing evidence that intradermal BCG vaccination influences subsequent immune responses in the host and may further stress upon its beneficial role seen in Covid-19 patients.

Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

A brief introduction of Xiangya's anti-epidemic history in a century. / ç™¾å¹´æ¹˜é› æŠ—ç–«ç®€å².

Based on archival materials, the Xiangya's anti-epidemic history in a century from its establishment to 2020 is divided into 4 stages. The first stage (1906-1926), Edward Hicks Hume and YAN Fuqing, the founders of Xiangya, prevented and controlled smallpox and plague. The second stage (1929-1953), during the resumption of Xiangya, students prevented and controlled cholera, plague, dysentery, typhus, and other infectious diseases. In the third stage (1953-1999), in a peacetime, Xiangya actively fought against schistosomiasis, hydatidosis, malaria, leprosy, tuberculosis and other epidemics. The fourth stage (2000-2020), the era of Central South University. Medical staff in Xiangya fight SARS, influenza A (H1N1) flu, Ebola hemorrhagic fever, coronavirus disease 2019, etc. Over the past hundred years, Xiangya people joined together to spread benevolence and love, apply medical knowledge and skills, combat the epidemic and rescue people in difficulties, which made a great contribution to the motherland and the people.

A Situação da Hanseníase no Contexto da Pandemia de Covid-19 - iH Entrevista Alice Cruz

Nessa entrevista com Drª. Alice Cruz, Relatora Especial das Nações Unidas para Eliminação da Discriminação contra as Pessoas Afetadas pela Hanseníase, ela explana e debate a situação dos países e seus programas em relação à hanseníase frente a pandemia de Covid-19.

Avoiding COVID-19 complications with diabetic patients could be achieved by multi-dose Bacillus Calmette-Guérin vaccine: a case study of beta cells regeneration.

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.

4,4'-Diaminodiphenyl Sulfone (DDS) as an Inflammasome Competitor.

The aim of this study is to examine the use of an inflammasome competitor as a preventative agent. Coronaviruses have zoonotic potential due to the adaptability of their S protein to bind receptors of other species, most notably demonstrated by SARS-CoV. The binding of SARS-CoV-2 to TLR (Toll-like receptor) causes the release of pro-IL-1ß, which is cleaved by caspase-1, followed by the formation and activation of the inflammasome, which is a mediator of lung inflammation, fever, and fibrosis. The NLRP3 (NACHT, LRR and PYD domains-containing protein 3) inflammasome is implicated in a variety of human diseases including Alzheimer's disease (AD), prion diseases, type 2 diabetes, and numerous infectious diseases. By examining the use of 4,4'-diaminodiphenyl sulfone (DDS) in the treatment of patients with Hansen's disease, also diagnosed as Alzheimer's disease, this study demonstrates the diverse mechanisms involved in the activation of inflammasomes. TLRs, due to genetic polymorphisms, can alter the immune response to a wide variety of microbial ligands, including viruses. In particular, TLR2Arg677Trp was reported to be exclusively present in Korean patients with lepromatous leprosy (LL). Previously, mutation of the intracellular domain of TLR2 has demonstrated its role in determining the susceptibility to LL, though LL was successfully treated using a combination of DDS with rifampicin and clofazimine. Of the three tested antibiotics, DDS was effective in the molecular regulation of NLRP3 inflammasome activators that are important in mild cognitive impairment (MCI), Parkinson's disease (PD), and AD. The specific targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by DDS may be responsible for its observed preventive effects, functioning as a competitor.

Thalidomide-Revisited: Are COVID-19 Patients Going to Be the Latest Victims of Yet Another Theoretical Drug-Repurposing?

The coronavirus disease 2019 (COVID-19) pandemic is a worldwide threatening health issue. The progression of this viral infection occurs in the airways of the lungs with an exaggerated inflammatory response referred to as the "cytokine storm" that can lead to lethal lung injuries. In the absence of an effective anti-viral molecule and until the formulation of a successful vaccine, anti-inflammatory drugs might offer a complementary tool for controlling the associated complications of COVID-19 and thus decreasing the subsequent fatalities. Drug repurposing for several molecules has emerged as a rapid temporary solution for COVID-19. Among these drugs is Thalidomide; a historically emblematic controversial molecule that harbors an FDA approval for treating erythema nodosum leprosum (ENL) and multiple myeloma (MM). Based on just one-case report that presented positive outcomes in a patient treated amongst others with Thalidomide, two clinical trials on the efficacy and safety of Thalidomide in treating severe respiratory complications in COVID-19 patients were registered. Yet, the absence of substantial evidence on Thalidomide usage in that context along with the discontinued studies on the efficiency of this drug in similar pulmonary diseases, might cause a significant obstacle for carrying out further clinical evaluations. Herein, we will discuss the theoretical effectiveness of Thalidomide in attenuating inflammatory complications that are encountered in COVID-19 patients while pinpointing the lack of the needed evidences to move forward with this drug.

Orientações para pessoas atingidas pela hanseníase durante a pandemia Covid-19 / Guidelines for persons affected by Hansen's disease (leprosy) during the Covid-19 pandemic / Pautas para las personas afectadas con la lepra durante la pandemia de Covid-19

Documento desenvolvido pela Sociedade Brasileira de Hansenologia com orientações às pessoas atingidas pela hanseníase sobre a prevenção e tratamento do Covid-19. O trabalho foi feito por um grupo de hansenologistas da Sociedade Brasileira de Hansenologia (SBH) em versões em português, espanhol e inglês e mostra como os médicos acreditam que a doença de Hansen e a COVID-19 podem interagir

Document developed by the Brazilian Society of Hansenology with guidance to people affected by leprosy on the prevention and treatment of Covid-19. The work was done by a group of Hansenologists from the Brazilian Society of Hansenology (SBH) in Portuguese, Spanish and English versions and shows how doctors believe that Hansen's disease and COVID-19 can interact

Documento desarrollado por la Sociedad Brasileña de Hansenología con orientación a las personas afectadas por la lepra sobre la prevención y el tratamiento de Covid-19. El trabajo fue realizado por un grupo de hansenólogos de la Sociedad Brasileña de Hansenología (SBH) en versiones en portugués, español e inglés y muestra cómo los médicos creen que la enfermedad de Hansen y COVID-19 pueden interactuar

Imported Infections in Rural Mid-West United States - A Report from a Tertiary Care Center.

BACKGROUND: There is lack of specific data on imported infections in the mid-west United States (U.S.). METHODS: Retrospective data on demographic and geographic data of imported infections seen by the infectious diseases clinics and consultation service from 2001-2018 was collected. RESULTS: Of the 64 infections, tuberculosis(TB) was most common [20(31.3%); pulmonary(11,55%), lymphadenopathy(8,40%), gastrointestinal(4,20%), disseminated(2,10%), and 1(5%) each of genitourinary and vertebral spine infection, 4 Human immune-deficiency virus infection and 1 echinococcosis)] followed by malaria(11,17.2%). Other infections: Cysticercosis [7,10.9%], giardiasis (4,6.3%), 3 each (4.7%) Human T-lymphotrophic Virus infection and schistosomiasis, 2 each (3.1%) leprosy, strongyloidiasis, and typhoid fever, one each (1.6%) of ascariasis, brucellosis, Chagas disease, Chikungunya virus, hepatitis A virus, echinococcosis, Japanese encephalitis virus, loiasis, paratyphoid fever, Q fever, and unspecified parasitosis. Geographic origins: Africa(26,40.6%), Asia(16,25%), Central America(11,17.2%), Europe(2,3.1%), Oceania(2,3.1%), South America(2,3.1%), and Unknown(5). More cases were seen after 2015. CONCLUSIONS: With increasing tourism, it is important to educate rural mid-west healthcare professionals on travel medicine. The current COVID-19 pandemic illustrates the importance of this type of education and data accumulation now and in the future.

Orientações sobre o manejo e controle da hanseníase durante a pandemia da COVID-19 / Guidelines on leprosy management and control during the Covid-19 pandemic

Orientações para a unidade de tratamento seguir a reorganização dos seus fluxos de processos de trabalho de forma a melhor atender a demanda dos usuários do SUS, diminuindo a exposição ao Coronavírus, e ao mesmo tempo, assegurando o acesso às ações de manejo da hanseníase com efetividade

Advice on leprosy and COVID-19 / Adivice on leprosy and COVID-19 / Conseils sur la lèpre et le COVID-19

The ILEP Technical Commission and the Global Leprosy Programme have issued the following advice on leprosy and COVID-19(AU)

La Commission Technique de l'ILEP et le Programme mondial de lutte contre la lèpre ont publié les conseils suivants sur la lèpre et COVID-19(AU)

The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy

Abstract Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.