Imunopatologia da Hanseníase - Professora Ana Paula Vieira

Aula sobre Imunopatologia da Hanseníase com a biomédica Ana Paula Vieira, Professora da Uniasselvi (SC)

Características de la enfermedad de Hansen y contagio a familiares en El Oro. Estudio descriptivo / Characteristics of Hansen's disease and contagion to relatives in El Oro Province. Descriptive study

Introducción:La incidencia de la Enfermedad de Hansen registrada en Ecuador es de 0.71 por 10,000 habitantes en 2006, se encuentra dentro del parámetro mundial de eliminación. La provincia de El Oro aún presenta casos positivos para la enfermedad. Objetivo:Determinar las características de la enfermedad de Hansen en pacientes de la Provincia de el Oro y el diagnóstico del contagio a familia-res.Material y métodos:El estudio es de tipo cuantitativo descriptivo, en la provincia de El Oro en personas con diagnóstico de la enfermedad de Hansen registrados en el Centro de Epidemiologia de esta provincia en el periodo Julio 2012 ­ Junio 2013 y sus familiares que convivan con estos.Se realizó la toma de muestra de la linfa del pabellón auricular e hisopadonasal para el diagnóstico mediante la tinción de Ziehl Neelsen y llenado de un formulario. En el análisis de la información se aplicó estadística descriptiva utilizando el sofware SPSS. Resultados:Se registró 32 pacientes con enfermedad de Hansen, un 59.4% correspondía al tipo lepromatoso, el 81.3% de individuos presentan lesiones cutáneas, representando las manchas un 50% y los nódulos el12.5% de los casos. La localización preferente de las lesiones fue las extremidades. El 53.1% de los pacientes presentaron perdida de la sensibilidad en extremidades. El 15.6% presentan deformidad y un 9.4% presentan discapacidad debido a la enfermedad. El 11.8% de los familiares presento un test positivo de baciloscopía, de quienes el 60% correspondía al subtipo lepromatoso. Conclusiones:Aún se encuentran casos de Hansen en la provincia del Oro y persiste el contagio a familiares que conviven con los pacientes.

Introduction:The incidence of Hansen's disease re-gistered in Ecuador is 0.71 per 10,000 inhabitants in2006; it is within the global elimination parameter.The Province of El Oro still presents positive cases forthe disease. Objective:To determine the characteristics of Hansen'sdisease in the Province of El Oro and diagnosis of thecontagion to relatives.Material and Methods:It is a quantitative descriptivestudy which was carried out in the Province of El Oroin people who were diagnosed with Hansen's diseaseregistered in the Epidemiology Center of this provincein the period July 2012 to June 2013 and theirrelatives who were living with them. The sample ofthe lymph of the auricular pavilion and nasal swabfor the diagnosis was made by means of the stainingof Ziehl Neelsen and filling out a form. In the analysisof the information, a descriptive statistics wereapplied using the SPSS software.Results:A total of 32 patients with Hansen's diseasewere registered, 59.4% were lepromatous, 81.3%had skin lesions, the spots were 50% and the noduleswere 12.5%. The preferred location of the lesionswas the extremities. The 53.1% of the patients hadloss of sensation in extremities. The 15.6% presenteddeformity and 9.4% presented disability due to illness.The 11.8% of the relatives presented a positivesputum smear test, of which 60% corresponded tothe lepromatous subtype.Conclusions:There are still cases of Hansen in theprovince of El Oro and the contagion persists torelatives who live with the patients.

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Leprosy is a chronic granulomatous infectious disease and is still endemic in many parts of the world. It causes disabilities which are the consequence of nerve damage. This damage is in most cases the result of immunological reactions...

Leproma conjuntival que simula tumor benigno / Conjunctival leproma which simulates benign neoplasm

La lepra es una patología infecto-contagiosa ocasionada por el Mycobacterium leprae, este alcanza el ojo por medio de diseminación hematógena o propagación por lesiones adyacentes. El 21 a 24% de los pacientes con la enfermedad pueden tener compromiso de la visión, el cual es más frecuente en la lepra multibacilar y 5% padecen ceguera. Las complicaciones más frecuentes son hipoestesia corneal (53%), cataratas (12,6%), opacidad corneal (10,5%), precipitados oculares (4,62%), paresia del músculo orbicular (4,62%), lagoftalmos (4,20%), degeneración del nervio corneal (1,68%), triquiasis (0,84%) y ectropión (0,42%), con pocos datos de incidencia de leproma ocular en estos estudios. En la literatura existen escasos reportes de lesiones oculares de presentación que simulan tumor, sin embargo se han reportado algunos casos de leproma ocular en diferentes localizaciones, corneal, escleral, cuerpo ciliar y limbo esclero-corneal; en el presente reporte se describe un caso de leproma conjuntival diagnosticado en Latinoamérica - Colombia. (MÉD.UIS. 2014;27(2):97-103).

Leprosy is an infectious pathology caused by Mycobacterium leprae and this reaches the eyes through haematogenous spread, or via adjacent injuries. Among 21-24% of the patients with the disease might develop visual injuries, which are more frequent in multibacillary leprosy and 5% suffer blindness. The most frequent complications of this condition are corneal hypoesthesia (53%), cataracts (12.6%), corneal opacity (10.5%), keratic precipitates (4.62%), orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), corneal nerve beading (1.68%), trichiasis (0.84%) and ectropion (0.42%), with few data on the incidence of ocular leproma in these studies. There are few reports in ocular injuries that present tumor, nevertheless cases of ocular leproma have been reported in different sites (corneal , scleral, and limbo scleral); provided below a case of ocular leproma is described, this case was diagnose in Colombia in the south American region. (MÉD.UIS. 2014;27(2):97-103).

Semi-automated protocol for purification of Mycobacterium leprae from tissues using the gentleMACS™ Octo Dissociator.

Mycobacterium leprae, etiologic agent of leprosy, is propagated in athymic nude mouse footpads (FPs). The current purification protocol is tedious and physically demanding. A simpler, semi-automated protocol was developed using gentleMACS™ Octo Dissociator. The gentleMACS protocol provided a very effective means for purification of highly viable M. leprae from tissue.

Dermatopathology practice in ethiopia.

CONTEXT: Dermatologic diseases are extremely common among the Ethiopian population and are a significant cause of morbidity. However, few studies exist in the literature that describe the incidence and clinical and histologic features of biopsied cutaneous lesions. OBJECTIVES: To categorize the cutaneous diseases observed in skin biopsies at the All African Leprosy Rehabilitation and Training Center (ALERT) in Addis Ababa, Ethiopia, and to describe the clinical and histologic features of dermatopathologic diagnoses most frequently encountered in this practice setting. DATA SOURCES: Pathology reports of 2342 cutaneous specimens received at ALERT in Addis Ababa, Ethiopia, were reviewed to determine the range and frequency of cutaneous diseases and dermatoses diagnosed from January 2007 through December 2010. CONCLUSIONS: The range of cutaneous diseases observed in skin biopsies at ALERT was varied and included inflammatory dermatoses (27%), infectious diseases (24%), and malignant and benign cutaneous neoplasms (22% and 20%, respectively). The most common conditions observed in this study were squamous cell carcinoma (8% of total cases), eczema (6% of total cases), leishmaniasis (6% of total cases), tuberculosis (6% of total cases), and benign nevi (4% of total cases).

[A Brazilian medical collection: Central Brazil in Arthur Neiva and Belisário Penna's scientific expedition and Julio Paternostro's voyage to Tocantins]. / Uma brasiliana médica: o Brasil Central na expedição científica de Arthur Neiva e Belisário Penna e na viagem ao Tocantins de Julio Paternostro.

The article addresses the role played within the social imaginary of Brazil by the scientific voyages of physicians in the first half of the twentieth century. Two texts are analyzed: a report by Arthur Neiva and Belisário Penna published in Memórias do Instituto Oswaldo Cruz and another by Julio Paternostro, released in 1945 in Viagem ao Tocantins. The former contributed to singling out pathology as defining mark of national identity during the First Republic (1899-1930), a fact that had repercussions in the following decades, as apparent in Paternostro's book, which at the time of its publication was presented as an indictment of national problems. These portraits of Brazil highlight as attributes of the country not only disease but also the geographic and, primarily, cultural distance separating the coast from the sertão.

Uma brasiliana médica: o Brasil Central na expedição científica de Arthur Neiva e Belisário Penna e na viagem ao Tocantins de Julio Paternostro / A Brazilian medical collection: Central Brazil in Arthur Neiva and Belisário Penna's scientific expedition and Julio Paternostro's voyage to Tocantins

Aborda o papel das viagens científicas realizadas por médicos, durante a primeira metade do século XX, na imaginação social sobre o Brasil. Com esse objetivo, são analisados dois textos: o relatório de Arthur Neiva e Belisário Penna, publicado em Memórias do Instituto Oswaldo Cruz, e o de Julio Paternostro, que veio a público em 1945 no livro Viagem ao Tocantins. O primeiro contribuiu para que se apontasse a patologia como marca definidora da identidade nacional durante a Primeira República (1899-1930). Esse fato teria repercussões nas décadas seguintes, como se verificou com relação ao livro de Paternostro, apresentado na época de sua publicação como obra de denúncia dos problemas nacionais. Além das doenças, a distância não apenas geográfica, mas sobretudo cultural entre litoral e sertão são os atributos ressaltados nesses retratos do Brasil.

The article addresses the role played within the social imaginary of Brazil by the scientific voyages of physicians in the first half of the twentieth century. Two texts are analyzed: a report by Arthur Neiva and Belisário Penna published in Memórias do Instituto Oswaldo Cruz and another, by Julio Paternostro, released in 1945 in Viagem ao Tocantins. The former contributed to singling out pathology as the defining mark of national identity during the First Republic (1899-1930), a fact that had repercussions in the following decades, as apparent in Paternostro's book, which at the time of its publication was presented as an indictment of national problems. These portraits of Brazil highlight as attributes of the country not only disease but also the geographic and, primarily, cultural distance separating the coast from the sertão.

www.derm101.com: a growing online resource for learning dermatology and dermatopathology.

The internet is increasingly being used to distribute knowledge in medicine in novel and unconventional ways. In this article, we give a brief introduction into the website www.derm101.com, which was founded by A. B. Ackerman for the purpose of teaching dermatology and dermatopathology. A clinical atlas, online books such as the 3rd edition of his volume "Histologic diagnosis of inflammatory skin diseases", works on clues and differential diagnoses in dermatopathology, a resource on therapeutic strategies in dermatology, a video lecture library on controversial issues in dermatology, the quarterly online journal Dermatopathology: Practical and Conceptual and much more can be found on derm101.com. The site is enriched with new contents biweekly and offers several interactive teaching devices. Currently, www.derm101.com is the most comprehensive online library of dermatology resources.

V.R. Khanolkar: father of pathology and medical research in India.

Vasant Ramji Khanolkar was the first pathologist in India. He made major contributions to the epidemiology and understanding of cancer, blood groups, and leprosy. He was the first to show the existence of dhoti cancers, and was among the earliest to demonstrate the carcinogenicity of tobacco and the use of needle aspiration cytology for the diagnosis of neoplasms. He was an acclaimed teacher and was on the boards of numerous international organizations. He was a bibliophile and his writings are Oslerian in style. He serves as a role model to the few in India who are aware of him. He deserves to be called the "Father of pathology and medical research in India."

V.R. Khanolkar: father of patology and medical research in India

Vasant Ramji Khanolkar was the first pathologist in India. He made major contributions to the epidemiology and understanding of cancer, blood groups, and leprosy. He was the first to show the existence of dhoti cancers, and was among the earliest to demonstrate the carcinogenicity of tobacco and the use of needle aspiration cytology for the diagnosis of neoplasms. He was an acclaimed teacher and was on the boards of numerous international organizations. He was a bibliophile and his writings are Oslerian in style. He serves as a role model to the few in India who are aware of him. He deserves to be called the "Father of pathology and medical research in India."

Imunopatologia da doença de Jorge Lobo: composição celular do infiltrado inflamatório e quantificação de citocinas em sobrenadante de cultura de células mononucleares e soro sanguíneo / Immunopathology of Jorge Lobo's disease: cellular composition of inflammatory infiltrate and quantification of cytokines in mononuclear cell and blood serum culture supernatant

A doença de Jorge Lobo é micose cutânea-Subcutânea de evolução crônica causada pelo fungo Lacazia loboi. Esta micose é predominante na regiمo Amazônica e afeta, principalmente, trabalhadores rurais que vivem em contato constante com a vegetaçمo e o solo, como é o caso dos seringueiros dessa regiمo. Os estudos abordando os aspectos imunopatológicos desta micose sمo ainda muito escassos. Até o momento nمo se tem conhecimento da composição celular do granuloma induzido pelo L.loboi, bem como da participação da resposta imune na gênese e desenvolvimento desse granuloma. Deste modo, o presente estudo foi realizado com a finalidade de identificar a população de células mononucleares presentes nas lesُes cutâneas e quantificar algumas citoconas macrofágicas e linfocitلrias em sobrenadante de cultura de células no soro sangüيneo

Valoración sobre terreno de la patología dermatológica en Guinea Ecuatorial

Como continiación del trabajo expuesto en el número anterior sobre la situación de la lepra en Guinea Ecuatorial, exponemos el trabjo desarrollado sobre el terreno con el fin de valorar la patología dermatológica más frecuentemente existentes entre los probladores de las zonas rurales de este país. Este trabajo en el campo servió también para confirmar sobre el terreno la situación de lepra en Guinea Ecuatorial. Fueron elegidos los distritos de Niefang (alta incidencia en 1999), Micomeseng y Nsok-Nsomo (nula incidencia en 1999 e importante casuística de discapacitados). en estos distritos fueron elegidos 25 poblados (Anexo I). en todos elles se realizó una exploración dermatológica completa a todos os habitantes que voluntariamente se presentaron a la consulta. El trabajo se desarrolló durante 10 días y la valoración fue realizada por Santiago Elé Eboa, coordinador regional de lepra, Juan Manuel Rod´riguez, miembro de CIDOC y asesor del Programa de Tuberculosis en Guinea Ecuatorial y el Dr. José Ramón Gómez, Director Médico Lepra de Fontilles y Fátima Moll, fisioterapeuta de Fontilles. Con el fin de estimular la participación de la población, la Asociación Fontilles otorgó tratamientos tópicos básicos (clotrimazol, neomicina, hidrocortisona, benzoato de benzilo...) que se distribiyeron gratuitamente entre los pacientes que sufrían las diferentes patologías dermatológicas. La participación de la población fue muy alta, valorándose 975 (2'4 0/00) personas de las que posteriormente y de forma detallada explicamos las caracterísitcas y patología detectada.

[Historiography of diseases in Finland]. / "Ovatko taudit itsenäisiä, eläväisiä olentoja?" - eli voimmeko kirjoittaa niiden historian.

The 19th century was a period of comprehensive, "big" histories of diseases. German historiographers of diseases were especially prominent. World-famous is August Hirsch's Handbuch der historisch-geographischen Pathologie (the second edition appeared in three volumes in 1881-1886). The first volume of the Finn Immanuel Ilmoni's (1797-1856) Bidrag till Nordens sjukdoms-historia (A History of Diseases in the Nordic Countries) was published in 1846, the second volume in 1849 and the third in 1853. In this book Ilmoni treated the history of disease up to the year 1800. He planned a fourth volume, dealing with the 19th century, but this book was never published. Ilmoni was strongly influenced by the ideas of Thomas Sydenham and the German exponents of Naturphilosophie. Ilmoni's "ontological" concept of disease was rejected by Erik Alexander Ingman, a contemporary Finnish representative of "modern" medical ideas. After Ilmoni, nobody has attempted to write a comprehensive history of diseases in Finland, but histories of cholera (Carl Qvist, 1872) lepra (Lars Fagerlund, 1886), malaria (Richard Sievers, 1891) and pulmonary tuberculosis (Woldemar Backman and Severi Savonen, 1934) have been published. Diseases in Finland received very little attention in the "world histories" of diseases. After Hirsch only one comprehensive "world history" of diseases has been published (1993).

Agreement between histopathological results in clinically diagnosed cases of indeterminate leprosy in São Paulo, Brazil.

Histopathological slides from skin biopsies of fifty-seven self-reporting patients diagnosed as indeterminate leprosy by the Leprosy Control Programme in São Paulo, were sent to three independent histopathologists. Agreement between the reports were based on the following diagnosis: "indeterminate leprosy", "suggestive leprosy" or "no leprosy". A great variation was observed in the interpretation of the histopathological examination. The three pathologists reported "indeterminate leprosy" respectively in 7.0%, 54.4% and 84.2%, of the cases studied. A kappa index of agreement between any two pathologists ranged from 0.08 to 0.32, showing poor agreement between observers. Agreement improved by pooling together the reports "suggestive leprosy" and "indeterminate leprosy". The three pathologists agreed in the results of 24 biopsies of the 27 classified as leprosy by any one of the three observers. Eight cases were considered as "no leprosy" by all pathologists. Higher agreement indices were obtained for positive and negative proportionate concordance between any two examiners. The implications of the variation in the diagnosis of indeterminate leprosy and early leprosy are discussed in the context of public health and case-management.

Estudo imuno-histoquímico e ultra-estrutural da inervação de lesões cutâneas de hanseníase em fase inicial / ?

A inervação cutanea das lesões da hanseníase em fase inicial foi estudada através da expressão imuno-histoquímica das proteinas neuronais NGER ("nerve growth factor receptor"). PGP 9.5 ("protein gene product 9.5") ENE (enolase neurônio-específica") e também através do estudo ultra-estrutural com microscopia eletronica de transmissão. Observamos uma redução do numero de fibras nervosas PGP 9.5- e ENE-positivas não estava relacionada topograficamente com o infiltrado inflamatório. No estudo ultra-estrutural, a maioria dos nervos examinados mostrava-se sem envolvimento inflamatório e sem alterações morfológicas. O infiltrado inflamatório estava presente em sete nervos e em seis deles, situava-se em torno do perincuro. Em apenas um nervo permeava as lamelas perineurais e invadia o endoneuro. Mesmo alcançando o endoneuro, as células inflamatórias não mostravam interação de contacto com a fibra nervosa. Não encontramos alterações morfológicas das fibras ocasionadas pela inflamação. A existência de redução do número de fibras nervosas e de fibrose endoneural independentes do evento inflamatorio foi suspeitada. Existe portanto, nas fases iniciais da hanseniase, uma alteração seletiva na expressão de proteinas neuronais não relacionada com o incipiente infiltrado específico. A nivel ultra-estrutural, não detectamos lesões das fibras nervosas diretamente causadas pelo infiltrado inflamatório, este comprometia mais o componente mesenquimatoso do nervo (perineuro). O infiltrado hanseniano inicial não deve ser implicado como o unico responsavel pelos distúrbios neurológicos exibidos pelos pacientes hansenianos. A existência de um processo patogênico distinto da inflamação e intrinseco à fibra nervosa, foi cogitada para explicar os mecanismos de lesão neural da neuropatia hanseniana.