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1.
BMC Infect Dis ; 21(1): 347, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849463

RESUMO

BACKGROUND: Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases. METHODS: We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression. RESULTS: The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000-0.00266; I2 = 0%, p = 0.55). CONCLUSION: Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions. TRIAL REGISTRATION: This review is registered in PROSPERO with the registry number CRD42018116275 .


Assuntos
Gastroenteropatias/tratamento farmacológico , Imunossupressores/uso terapêutico , Hanseníase/diagnóstico , Doenças Reumáticas/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Gastroenteropatias/patologia , Humanos , Imunossupressores/efeitos adversos , Hanseníase/etiologia , Estudos Longitudinais , Doenças Reumáticas/patologia , Dermatopatias/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia
2.
Microb Pathog ; 150: 104725, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33400985

RESUMO

Leprosy, also known as Hansen's disease, is a long-term infection by the bacteria Mycobacterium leprae, and actually still persists as a serious public health problem. The clinical parameters are used for diagnosis, however, some studies have indicated the selection of a set of biomarkers of subclinical infection, both serological and cellular, that allow the early diagnosis. Some cytokines and chemokines have been differentially expressed in index cases (paucibacillary and multibacillary patients) and household contacts (HHC), and may present a potential biomarker of M. leprae subclinical infection. Thus, the aim of this study was to analyze the variations in the profile of cytokines and chemokines, longitudinally, between index cases and their household contacts with a view to identifying possible biomarkers with differential expression, which may guide the early subclinical infection in household contacts. A longitudinal study was carried out between 2014 and 2015. The serum levels of the cytokines and chemokines were measured in all patient samples by CBA (Cytometric Bead Array). We observed a reduction of IL-4 and IL-17 expression of HHC group in the second evaluation (T1), as also a reduction of IL-17 in MB. We observed increased expression of IL-2 in PB patients as well. HHC, PB and MB showed a similar reduction profile of the chemokines CXCL8, CXCL9 and CXCL10 from T0 to T1. Interestingly, only serological levels of CCL2 are increased after a follow-up of HHC group, and this group, but not PB and MB patients, showed a significant association and a negative correlation between CCL2 and IFN-γ. The present study showed for the first time a similarity in the immunological scenario between HHC, PB and MB patients. In addition, this work highlights CCL2 chemokine in association with IFN-γ as possible biomarkers of subclinical infection of HHC, as also a parameter of early infection monitoring.


Assuntos
Infecções Assintomáticas , Interferon gama , Hanseníase , Antígenos de Bactérias , Biomarcadores/sangue , Quimiocina CCL2 , Humanos , Interferon gama/sangue , Estudos Longitudinais , Mycobacterium leprae
3.
Trans R Soc Trop Med Hyg ; 114(12): 983-994, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33190154

RESUMO

BACKGROUND: Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. METHODS: This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. RESULTS: Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (ß=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (ß=-3.05 [95% CI -5.25 to -0.85), disability (ß=-0.08 [95% CI -0.15 to -0.01]) and social support (moderate support: ß=-2.27 [95% CI -3.66 to -0.89] and strong support: ß=-2.87 [95% CI -5.35 to -0.38]) were significantly associated with better QOL. CONCLUSION: High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia.


Assuntos
Filariose Linfática , Elefantíase , Hanseníase , Linfedema , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Elefantíase/epidemiologia , Filariose Linfática/complicações , Filariose Linfática/epidemiologia , Etiópia/epidemiologia , Humanos , Hanseníase/complicações , Estudos Longitudinais , Linfedema/epidemiologia , Linfedema/etiologia , Qualidade de Vida
4.
Rev. inf. cient ; 99(5): 435-441, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139205

RESUMO

RESUMEN * Introducción: La lepra es un problema de salud con elevado impacto biopsicosocial, sin embargo, no se encuentra un estudio que la caracterice en el municipio de Guantánamo. Objetivo: Caracterizar aspectos clínicos de la lepra en el municipio Guantánamo en el periodo de 2015-2019. Método: Se realizó un estudio observacional, retrospectivo, descriptivo y longitudinal de todos los pacientes (N=117) con este diagnóstico. Se precisó la frecuencia del diagnóstico por años, formas clínicas, modo de detección, momento del diagnóstico y grado de discapacidad secundaria a esta enfermedad. Resultados: Fue 2017 el año durante el cual se diagnosticaron más pacientes con lepra (25,7 %), la forma clínica más frecuente fue la lepromatosa (56,4 %). De manera más común, la lepra se detectó de modo espontáneo (83,8 %), el diagnóstico de lepra fue precoz (92,3 %) y en el 93,1 % de los pacientes no generó ningún grado de discapacidad. Conclusiones: La lepra no constituye actualmente un problema de salud en el municipio Guantánamo, pero el diagnóstico no suele ser con la precocidad que se demanda pues aún se realiza tardíamente, con un pobre reconocimiento de las manifestaciones clínicas por la atención primaria de salud y la población, lo que revela la importancia de las acciones dirigidas al pesquisaje de esta enfermedad.


* ABSTRACT * Introduction: Leprosy is a health problem with a high biopsychosocial impact, however, there is no study that characterizes it in the municipality of Guantánamo. Objective: To characterize clinical aspects of leprosy in the Guantánamo municipality in the period 2015-2019. Method: An observational, retrospective, descriptive and longitudinal study of all patients (N = 117) with this diagnosis was carried out. The frequency of diagnosis by years, clinical forms, detection method, time of diagnosis and degree of disability secondary to this disease were specified. Results: 2017 was the year during which more patients with leprosy were diagnosed (25.7%), the most frequent clinical form was lepromatous (56.4%). More commonly, leprosy was detected spontaneously (83.8%), the diagnosis of leprosy was early (92.3%) and in 93.1% of the patients it did not generate any degree of disability. Conclusions: Leprosy is not currently a health problem in the Guantánamo municipality, but the diagnosis is not usually with the precociousness that is demanded since it is still carried out late, with poor recognition of the clinical manifestations by primary health care and population, which reveals the importance of actions aimed at screening for this disease.


Assuntos
Humanos , Hanseníase Virchowiana/epidemiologia , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos Longitudinais , Estudo Observacional
5.
Diagn Microbiol Infect Dis ; 96(4): 114984, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954594

RESUMO

Simple measures that can facilitate early recognition of leprosy complications are still lacking. We therefore evaluated a lateral flow-based rapid diagnostic test and fast enzyme-linked immunosorbent assay measuring anti-LID-NDO antibody responses among leprosy cases in Cebu, Philippines. Responses were measured at diagnosis, then during and after the provision of standard multidrug therapy. Our data indicate that both platforms are highly sensitive tools for the primary diagnosis of, in particular, multibacillary leprosy. A gradual, quantifiable decline in both magnitude of response and percent positive responders was observed during and after treatment. As a group, patients that developed erythema nodosum leprosum (ENL) had a significantly higher response at diagnosis than patients that either developed reversal reactions or did not develop reactions. Although higher initial anti-NDO-LID responses were a risk factor for ENL, neither platform, however, could reliably predict the time of emergence of reactional episodes.


Assuntos
Anticorpos Antibacterianos/sangue , Hansenostáticos/uso terapêutico , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Mycobacterium leprae/efeitos dos fármacos , Adulto , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática/normas , Eritema Nodoso/diagnóstico , Eritema Nodoso/tratamento farmacológico , Feminino , Humanos , Imunoensaio , Imunoglobulina M/sangue , Hanseníase/complicações , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Multibacilar/diagnóstico , Hanseníase Multibacilar/tratamento farmacológico , Estudos Longitudinais , Masculino , Filipinas , Testes Sorológicos
6.
PLoS Negl Trop Dis ; 13(6): e0007400, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31181059

RESUMO

BACKGROUND: Early detection of Mycobacterium leprae is a key strategy for disrupting the transmission chain of leprosy and preventing the potential onset of physical disabilities. Clinical diagnosis is essential, but some of the presented symptoms may go unnoticed, even by specialists. In areas of greater endemicity, serological and molecular tests have been performed and analyzed separately for the follow-up of household contacts, who are at high risk of developing the disease. The accuracy of these tests is still debated, and it is necessary to make them more reliable, especially for the identification of cases of leprosy between contacts. We proposed an integrated analysis of molecular and serological methods using artificial intelligence by the random forest (RF) algorithm to better diagnose and predict new cases of leprosy. METHODS: The study was developed in Governador Valadares, Brazil, a hyperendemic region for leprosy. A longitudinal study was performed, including new cases diagnosed in 2011 and their respective household contacts, who were followed in 2011, 2012, and 2016. All contacts were diligently evaluated by clinicians from Reference Center for Endemic Diseases (CREDEN-PES) before being classified as asymptomatic. Samples of slit skin smears (SSS) from the earlobe of the patients and household contacts were collected for quantitative polymerase chain reaction (qPCR) of 16S rRNA, and peripheral blood samples were collected for ELISA assays to detect LID-1 and ND-O-LID. RESULTS: The statistical analysis of the tests revealed sensitivity for anti-LID-1 (63.2%), anti-ND-O-LID (57.9%), qPCR SSS (36.8%), and smear microscopy (30.2%). However, the use of RF allowed for an expressive increase in sensitivity in the diagnosis of multibacillary leprosy (90.5%) and especially paucibacillary leprosy (70.6%). It is important to report that the specificity was 92.5%. CONCLUSION: The proposed model using RF allows for the diagnosis of leprosy with high sensitivity and specificity and the early identification of new cases among household contacts.


Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Características da Família , Saúde da Família , Hanseníase/diagnóstico , Mycobacterium leprae/genética , Mycobacterium leprae/imunologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Inteligência Artificial , Brasil , Criança , Pré-Escolar , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/métodos , RNA Ribossômico 16S/genética , Sensibilidade e Especificidade , Testes Sorológicos/métodos , Adulto Jovem
7.
Rev Inst Med Trop Sao Paulo ; 61: e13, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30785567

RESUMO

The present study sought to investigate the risk factors for physical disability upon release from multidrug therapy (MDT) in new cases of leprosy, registered at a referral center in Brazil. This is a longitudinal and retrospective study that evaluated 260 patients. Multivariate analyses, using both the ordinal logistic regression, as well as the classification and regression tree (CART) algorithm were performed to determine the factors associated with physical disability upon release from treatment. The prevalence of disability did not differ significantly between diagnosis and release from treatment. Number of affected nerves and sensory impairment upon diagnosis were risk factors for disability at the end of MDT. The analysis using the CART algorithm resulted in the development of a clinical score to predict the risk of disability upon release from MDT. The decision tree may have a direct applicability in clinical practice for professionals dealing with leprosy, as it allows them to identify patients with a higher risk of physical disability through the use of simple and widely available clinical tests. This study also shows that the disability grade upon admission is the main risk factor for disability upon release from MDT. This result draws attention to the importance of early diagnosis in disability prevention.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Hansenostáticos/administração & dosagem , Hanseníase/tratamento farmacológico , Adulto , Idoso , Brasil , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos
8.
PLoS Negl Trop Dis ; 11(12): e0006083, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29228004

RESUMO

BACKGROUND: Despite elimination efforts, the number of Mycobacterium leprae (M. leprae) infected individuals who develop leprosy, is still substantial. Solid evidence exists that individuals living in close proximity to patients are at increased risk to develop leprosy. Early diagnosis of leprosy in endemic areas requires field-friendly tests that identify individuals at risk of developing the disease before clinical manifestation. Such assays will simultaneously contribute to reduction of current diagnostic delay as well as transmission. Antibody (Ab) levels directed against the M.leprae-specific phenolic glycolipid I (PGL-I) represents a surrogate marker for bacterial load. However, it is insufficiently defined whether anti-PGL-I antibodies can be utilized as prognostic biomarkers for disease in contacts. Particularly, in Bangladesh, where paucibacillary (PB) patients form the majority of leprosy cases, anti-PGL-I serology is an inadequate method for leprosy screening in contacts as a directive for prophylactic treatment. METHODS: Between 2002 and 2009, fingerstick blood from leprosy patients' contacts without clinical signs of disease from a field-trial in Bangladesh was collected on filter paper at three time points covering six years of follow-up per person. Analysis of anti-PGL-I Ab levels for 25 contacts who developed leprosy during follow-up and 199 contacts who were not diagnosed with leprosy, was performed by ELISA after elution of bloodspots from filter paper. RESULTS: Anti-PGL-I Ab levels at intake did not significantly differ between contacts who developed leprosy during the study and those who remained free of disease. Moreover, anti-PGL-I serology was not prognostic in this population as no significant correlation was identified between anti-PGL-I Ab levels at intake and the onset of leprosy. CONCLUSION: In this highly endemic population in Bangladesh, no association was observed between anti-PGL-I Ab levels and onset of disease, urging the need for an extended, more specific biomarker signature for early detection of leprosy in this area. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN61223447.


Assuntos
Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Glicolipídeos/imunologia , Hanseníase/diagnóstico , Mycobacterium leprae/imunologia , Adolescente , Adulto , Bangladesh/epidemiologia , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos de Coortes , Diagnóstico Tardio/prevenção & controle , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Hanseníase/imunologia , Hanseníase/transmissão , Estudos Longitudinais , Masculino , Mycobacterium leprae/isolamento & purificação , Estudos Prospectivos , Adulto Jovem
9.
Clin Vaccine Immunol ; 24(8)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28592626

RESUMO

Although rheumatoid arthritis (RA) is a chronic, persistent autoimmune disease, 10 to 15% of RA patients achieve sustained disease-modifying antirheumatic drug (DMARD)-free remission over time. The biological mechanisms underlying the resolution of persistent inflammation in RA are still unidentified, and there is a lack of prognostic markers. It is well established that increased serum levels of gamma interferon-induced protein 10 (IP-10) are associated with (acute) increased inflammatory responses (e.g., in leprosy). In order to assess the potential of IP-10 as a diagnostic tool for inflammatory episodes of RA, we performed a retrospective study and assessed IP-10 levels in longitudinally banked serum samples obtained from patients upon first diagnosis of RA. The selection consisted of 15 persistent RA patients and 19 patients who achieved DMARD-free sustained remission. IP-10 levels, measured by use of a user-friendly quantitative lateral flow assay (LFA), showed up to 170-fold variation interindividually, and baseline IP-10 levels could not be differentiated between the two patient groups. However, a difference in the change in IP-10 levels between the first and last visits (ΔIP-10) was observed (P = 0.003) between DMARD-free (median ΔIP-10, -662 pg/ml [decrease]) and persistent (median ΔIP-10, 468 pg/ml [increase]) RA patients. Moreover, intraindividual changes in IP-10 levels during the course of disease corresponded to the disease activity score (DAS) (P = 0.05). These data indicate that IP-10 is associated with disease activity and perseverance of RA. The association of IP-10 with DAS indicates that this tool may be a practical diagnostic aid to help in monitoring disease progression in RA patients and may also find applications in other chronic diseases with exacerbated inflammatory episodes.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/fisiopatologia , Quimiocina CXCL10/sangue , Artrite Reumatoide/tratamento farmacológico , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
Fontilles, Rev. leprol ; 30(6): 571-590, sept.-dic. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-159088

RESUMO

Se realizó un estudio descriptivo, longitudinal y retrospectivo con el objetivo de caracterizar el comportamiento de los pacientes con diagnóstico tardío de lepra notificados durante el período comprendido del 1 de enero del 2009 al 30 de septiembre del 2014 residentes en la provincia Camagüey. El universo de estudio estuvo constituido por 26 pacientes con diagnóstico tardío de lepra. Se determinó que el grupo de edad más afectado fue el de 60 años y más, con predominio del sexo masculino, escolaridad primaria y per cápita familiar regular. El mayor tiempo transcurrido entre los primeros síntomas y el diagnóstico fue de 1 a 3 años y la mancha anestésica constituyó el signo más frecuente de inicio de la enfermedad. Aproximadamente la mitad de los pacientes estuvieron evaluados por especialistas de Medicina General Integral antes del diagnóstico. Predominó la lepra lepromatosa, la discapacidad grado I, de localización en los pies y de tipo anestesia. Alrededor de las tres cuartas partes de los pacientes fueron detectados de forma espontánea y casi la mitad de los mismos presentó un tiempo de permanencia en el área de salud de entre 1 y 2 años


A descriptive, longitudinal and retrospective study was made with the aim of characterizing the behavior of the patients with a diagnosis of late leprosy notified during the period of January 1st, 2009 up to September 30th, 2014 in the county of Camagüey. The study consisted of 26 patients with a late diagnosis of leprosy. It was determined that the most affected age group was that of 60 years and above, with prevalence of the men, primary education and middle family per capita. The longest delay between first symptoms and diagnosis went from 1 to 3 years and the anesthetic patch constituted the most frequent sign as initial start of the illness. Approximately half of the patients were evaluated by specialists of Integral General Medicine before the diagnosis. The most frequent type was lepromatous leprosy, disability grade I prevailed mainly on feet. Approximately three fourths of the patients were detected in a spontaneous way and almost half of them were present in the area between 1 and 2 years


Assuntos
Humanos , Masculino , Adulto , Diagnóstico Tardio/classificação , Epidemiologia Descritiva , Hanseníase Virchowiana/metabolismo , Hanseníase Virchowiana/patologia , Doença Granulomatosa Crônica/patologia , Nervos Periféricos/citologia , Doenças Respiratórias/patologia , Diagnóstico Tardio/prevenção & controle , Cuba/etnologia , Estudos Longitudinais , Estudos Retrospectivos , Hanseníase Virchowiana/diagnóstico , Hanseníase , Doença Granulomatosa Crônica/metabolismo , Nervos Periféricos/metabolismo , Doenças Respiratórias/complicações
11.
PLoS Negl Trop Dis ; 10(11): e0005111, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27851766

RESUMO

BACKGROUND: Previous studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT. METHODOLOGY/PRINCIPAL FINDINGS: We performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56-38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler. CONCLUSIONS/SIGNIFICANCE: US nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.


Assuntos
Hansenostáticos/efeitos adversos , Hanseníase/complicações , Neurite (Inflamação)/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Hanseníase/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema Nervoso/diagnóstico por imagem , Sistema Nervoso/efeitos dos fármacos , Neurite (Inflamação)/etiologia , Estudos Prospectivos , Ultrassonografia , Adulto Jovem
12.
Indian J Lepr ; 88(1): 29-38, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29741823

RESUMO

This study has been carried out to assess the comparative efficacy of Prednisolone alone or thalidomide alone for the first attack of T2R, and combination of prednisolone plus thalidomide or prednisolone plus clofazimine for chronic and recurrent T2R. Efficacy of all four regimens was assessed on the basis of clinical recovery of T2R measured by reaction severity scores (RSS) ,visual analogue scale (VAS) and other relevant parameters, requirement of extra dose of steroid for clinical recovery, recurrence of T2R and side effects observed in each regimen. The designof study was an open prospective longitudinal single centre investigation. In the first episode T2R group I (prednisolone alone) the efficacy was 58.8% (10/17) compared to 93.75% (15/16) in Group 2 treated with thalidomide alone. This difference was statistically significant p <0.05 when compared using unpaired ttest. When clinical outcome was compared in recurrent/relapse of T2R Groups 3 and 4, it was observed to be statistically significant p<0.05 when compared using unpaired t test. It was 82.35% (14/17) in Group 3 (prednisolone plus clofazimine) and 10/16 (62.5%) in Group 4 (prednislone plus clofazimine). To conclude, for the management of recurrent/chronic ENL, both the combinations-prednisolone with thalidomide or clofazimine appear to be efficacious. While prednisolone with thalidomide appears to be better than prednisolone and clofazimine, however, by 20 weeks difference narrows down. As of now these findings may be considered indicative and larger experience on more number of cases using robust statistical design is required for marchingtowards making recommendations for clinical application.


Assuntos
Clofazimina/uso terapêutico , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Prednisolona/uso terapêutico , Talidomida/uso terapêutico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
13.
Rev Soc Bras Med Trop ; 48(6): 739-45, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26676499

RESUMO

INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS: Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.


Assuntos
Antígenos de Bactérias/imunologia , Vacina BCG/imunologia , Busca de Comunicante/estatística & dados numéricos , Glicolipídeos/imunologia , Hanseníase/imunologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Recém-Nascido , Antígeno de Mitsuda/imunologia , Hanseníase/prevenção & controle , Hanseníase/transmissão , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
14.
Rev. Soc. Bras. Med. Trop ; 48(6): 739-745, Nov.-Dec. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-767834

RESUMO

Abstract: INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS : Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antígenos de Bactérias/imunologia , Vacina BCG/imunologia , Busca de Comunicante/estatística & dados numéricos , Glicolipídeos/imunologia , Hanseníase/imunologia , Ensaio de Imunoadsorção Enzimática , Estudos Longitudinais , Antígeno de Mitsuda/imunologia , Hanseníase/prevenção & controle , Hanseníase/transmissão , Medição de Risco
15.
Diagn Microbiol Infect Dis ; 83(2): 154-61, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26233487

RESUMO

This study evaluated the impact of leprosy multidrug therapy (MDT) on cell-mediated immunity (CMI) and antibody responses at diagnosis in untreated paucibacillary (PB) (n=15) and multibacillary (MB) patients (n=15) using a panel of Mycobacterium leprae recombinant antigens (rMLs) (CMI: 46f, ML0276, ML2055, leprosy IDRI diagnostic 1 [LID-1], and ML2629, as negative control; serology: LID-1, 46f, 92f, and 33f, as negative control, and phenolic glycolipid I [PGL-I]) and at 2 time points after MDT (PB: 8-20months; MB: 4-22months). At diagnosis, PB patients produced interferon gamma (IFNγ), and MB patients exhibited low/absent response. Shortly after MDT, IFNγ production in PB patients declined except for LID-1; MB patients produced IFNγ to LID-1. Almost 2years after MDT, IFNγ levels declined in PB and MB patients. Most untreated PB patients were seronegative to PGL-I and rML, remaining so after MDT. Most untreated MB patients were seropositive to all antigens, and IgG to rMLs declined after MDT. Reduction in antigen-specific CMI in PB and in antibody response in MB patients may help monitor MDT effectiveness.


Assuntos
Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Hanseníase/tratamento farmacológico , Hanseníase/imunologia , Mycobacterium leprae/imunologia , Linfócitos T/imunologia , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
16.
PLoS Negl Trop Dis ; 9(6): e0003818, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26029928

RESUMO

BACKGROUND: Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. METHODOLOGY/PRINCIPAL FINDINGS: Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients' reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. CONCLUSIONS/SIGNIFICANCE: This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/complicações , Hanseníase Multibacilar/epidemiologia , Hanseníase Multibacilar/patologia , Hanseníase Paucibacilar/epidemiologia , Hanseníase Paucibacilar/patologia , Brasil/epidemiologia , Estudos de Coortes , Humanos , Estimativa de Kaplan-Meier , Hanseníase Multibacilar/complicações , Hanseníase Paucibacilar/complicações , Estudos Longitudinais , Prevalência
17.
Europace ; 17(8): 1241-50, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25687748

RESUMO

AIMS: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. CONCLUSION: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.


Assuntos
Fibrilação Atrial/patologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Imagem Cinética por Ressonância Magnética/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Meios de Contraste , Feminino , Gadolínio , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como Assunto , Resultado do Tratamento
18.
Rev Soc Bras Med Trop ; 46(4): 453-60, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23904077

RESUMO

INTRODUCTION: A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of socio demographic, epidemiological and operational indices. METHODS: This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. RESULTS: During the study period,149 associations were detected, with 14 hyperendemic counties: seven in 2007, fi ve in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index(5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However,most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. CONCLUSIONS: The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification.


Assuntos
Hanseníase/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Doenças Endêmicas , Feminino , Humanos , Estudos Longitudinais , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-23974583

RESUMO

BACKGROUND: Diagnostic accuracy (DA) is an outcome measure to assess the feasibility of teledermatology tools. Despite ample data with variable DA values, no study has examined the aggregate DA value obtained from the available studies and observed its consistency over a period of time. This kind of a longitudinal study about teledermatology will be necessary to check its usefulness and plan for further implementation. AIMS: To observe the DA trend over a period of 15 years (1997-2011). METHODS: Only those studies (n = 59) using a single tool for general, tertiary, and subspecialty teledermatology practice were included to obtain the DA values. Studies were graded based on the number of subjects and gold standard comparison between teledermatologist and clinical dermatologist (face-to-face examination). RESULTS: This analysis sought to identify the DA trend was carried out by evaluating 17 store and forward teledermatology (SAFT) based and 8 Video conference (VC) tool-based studies with 2385 and 1305 patients respectively, in comparison with the gold-standard assessment. The average DA was 73.35% ± 14.87% for SAFT and 70.37% ± 7.01% for VC. One sample t-test analysis with 100% accuracy as standard value revealed 28% deficiency for SAFT (t = 7.925; P = 0.000) and 30% deficiency for VC (t = 11.955; P = 0.000). Kruskall-Wallis test confirmed the consistency of DA values in the SAFT (χ2 = 1.852, P = 0.763) tool. CONCLUSION: SAFT and VC were adequately validated on a large number of patients by various feasibility studies with the gold standard (face-to-face) comparison between teledermatologists and clinical dermatologists. The DA of SAFT was good, stable over the 15 years and comparable to VC. Health-care providers need to plan for appropriate utility of SAFT either alone or in combination with VC to implement and deliver teledermatology care in India.


Assuntos
Dermatologia/normas , Dermatologia/tendências , Dermatopatias/diagnóstico , Telemedicina/normas , Telemedicina/tendências , Adulto , Criança , Estudos de Viabilidade , Humanos , Índia , Estudos Longitudinais , Pacientes Ambulatoriais , Padrões de Referência , Reprodutibilidade dos Testes
20.
Rev. Soc. Bras. Med. Trop ; 46(4): 453-460, Jul-Aug/2013. tab, graf
Artigo em Inglês | LILACS | ID: lil-683319

RESUMO

Introduction A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of sociodemographic, epidemiological and operational indices. Methods This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. Results During the study period, 149 associations were detected, with 14 hyperendemic counties: seven in 2007, five in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index (5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However, most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. Conclusions The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification. .


Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Gravidez , Adulto Jovem , Hanseníase/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Brasil/epidemiologia , Doenças Endêmicas , Estudos Longitudinais , Estudos Retrospectivos , Fatores Socioeconômicos
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