Assuntos
Hanseníase , Mycobacterium leprae/fisiologia , Neuritos/microbiologia , Neurite (Inflamação) , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/microbiologia , Hanseníase/terapia , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/epidemiologia , Neurite (Inflamação)/microbiologia , Neurite (Inflamação)/terapiaRESUMO
Leprosy remains an important health problem wordwide. The disease in caused by a chronic granulomatous infection of the skin and peripheral nerves with Mycobacterium leprae. The clinical range from tuberculoid to lepromatous leprosy is a result of variation in the cellular immune response to the mycobacterium. The resulting impairment of nerve fuinction causes be disabilities associated with leprosy. This review summarises recent advances in understanding of the biology of leprosy, clinical features of the disease, the current diagnostic criteria, and the new approaches to treatment of the infection and the immune-mediated complications. Supervesed multi-drug therapy (MDT) for fixed durations is highly effective for all forms of the disease. The widespread implemantation of MDT has been associated with a fall in the prevalence of the leprosy but as yet no reduction in the case-detection rate globally. Thus, leprosy control activities must be maintained for decades to interrupt transmission of infection
Assuntos
Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Hanseníase/terapia , Hanseníase/transmissão , Mycobacterium leprae/citologia , Mycobacterium leprae/imunologia , Mycobacterium leprae/patogenicidade , Mycobacterium leprae/química , Quimioterapia Combinada , Educação em Saúde/tendências , Interações Hospedeiro-Parasita/imunologia , Neuritos/etiologia , Neuritos/imunologia , Neuritos/microbiologiaAssuntos
Animais , Endotélio Vascular/cirurgia , Endotélio Vascular/microbiologia , Hanseníase/história , Hanseníase/microbiologia , História do Século XIX , História do Século XX , Mycobacterium leprae/isolamento & purificação , Nervos Periféricos/irrigação sanguínea , Nervos Periféricos/microbiologia , Neuritos/história , Neuritos/microbiologiaAssuntos
Biópsia por Agulha , Diagnóstico Diferencial , Fibras Nervosas/microbiologia , Fibras Nervosas/patologia , Granuloma/patologia , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/microbiologia , Histiócitos/microbiologia , Histiócitos/patologia , Linfadenite/diagnóstico , Linfadenite/microbiologia , Linfonodos/inervação , Mycobacterium leprae/isolamento & purificação , Neuritos/diagnóstico , Neuritos/microbiologia , Pescoço/patologia , Sistema Nervoso Periférico/patologiaRESUMO
Recent electrophysiological studies on peripheral autonomic dysfunction in leprosy patients show a high prevalence of autonomic dysfunction as measured by abnormal vasomotor reflexes (VMR) and absent sympathetic skin response (SSR). Nothing is known about the reversibility of these autonomic parameters with treatment. Since there is evidence that small fiber function may be the most reversible component in neuropathies, we measured the effect of steroid treatment on autonomic parameters together with motor and sensory functions in leprosy patients with acute neuritis. Control subjects were investigated for repeatability testing of autonomic function. Due to a relatively high variability on repeat VMR testing in the controls, we defined a change in VMR testing as a change of > 30%. With this definition, the VMR of 14.8% of the patients improved, 75% remained unchanged, and 10.2% worsened. Absent SSR became positive in 16.6% and remained unchanged in 83.4%. Improvement in sensory motor functions was seen in 21.2% and 1.3% of the patients, respectively.