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1.
Artigo em Inglês | MEDLINE | ID: mdl-36197417

RESUMO

People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.


Assuntos
Vacina BCG , Hanseníase , Anticorpos Antibacterianos , Antígenos de Bactérias , Brasil , Glicolipídeos , Humanos , Mycobacterium leprae , Fatores de Risco
2.
J Glob Antimicrob Resist ; 30: 459-467, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35643395

RESUMO

OBJECTIVES: Dapsone is one of the important drugs in the treatment of leprosy. The present study aims to evaluate the resistance of Mycobacterium leprae isolates to dapsone, in turn assisting in implementing better control strategies for leprosy elimination. METHODS: A systematic literature search was conducted in PubMed, Embase, Medline, and Web of Science. Two independent reviewers selected the literature according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), extracted data, and evaluated the risk of bias. Drug resistance data were pooled using the random-effects model. Subgroup analysis was performed based on across sampling time, region, study population (treatment status, relapses status), and sample size. RESULTS: A total of 30 studies were included. The results of meta-analysis showed that the dapsone resistance rate of leprosy patients after treatment was 8% (95% confidence interval [CI], 6%-10%). Compared to the rates of primary resistance of new cases without treatment therapy (pooled incidence, 4% [95% CI, 2%-5%]), treatment cases (13% [95% CI 9%-16%]) had secondary resistance, and relapse cases (26% [95% CI, 18%-33%]) had drug resistance. In addition, the drug resistance rate of monotherapy was significantly increased than that of relapsed patients treated with diamino-diphenylsulfone monotherapy. Subgroup analysis showed that the patients in the Western Pacific have the highest dapsone resistance, and the resistance to dapsone was slightly lower after 2005. For sample size, the rate in the group under 100 samples was significantly higher than in the other. CONCLUSION: Dapsone resistance is closely related to leprosy relapse and long-term drug use. Dapsone monotherapy is one of important reasons for drug resistance in relapsed cases. Drug resistance varies among different populations and regions of the world.


Assuntos
Dapsona , Hanseníase , Dapsona/farmacologia , Dapsona/uso terapêutico , Humanos , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Mycobacterium leprae , Recidiva , Fatores de Risco
5.
Indian J Dermatol Venereol Leprol ; 88(5): 636-640, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34245522

RESUMO

Background Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.


Assuntos
Doenças da Unha , Unhas Encravadas , Braquetes , Humanos , Doenças da Unha/complicações , Unhas , Unhas Encravadas/diagnóstico , Unhas Encravadas/terapia , Estudos Retrospectivos , Fatores de Risco
6.
Indian J Dermatol Venereol Leprol ; 88(3): 337-341, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34491681

RESUMO

OBJECTIVES: The objectives of the study were to characterize the clinical profile of childhood leprosy presenting at tertiary leprosy care hospitals in the states of Bihar, West Bengal and Uttar Pradesh in India, and to determine the possible risk factors associated with disabilities at presentation. METHODS: Subjects were children with newly diagnosed leprosy registered for treatment at tertiary Leprosy Mission Hospitals in Muzaffarpur (Bihar), Purulia (West Bengal) and Faizabad (Uttar Pradesh), India, between June and December 2019. Demographic and leprosy characteristics were collected at the time of diagnosis. Parents/guardians were interviewed on reasons for delay in presenting at the hospital. Associations between various factors and delay in diagnosis were assessed. RESULTS: Among the 84 children, the mean (SD) age was 10 (3) years with a range of 4-14 years. There were more boys (58%) and most children were currently in school (93%), resident in rural areas (90%) and belonged to a lower socioeconomic status (68%). More children were diagnosed with multibacillary leprosy (69%), one-third of them being skin smear positive for Mycobacterium leprae. On presentation, 17% had deformity (5% grade 1 deformity and 12% grade 2), 29% had nerve involvement and skin lesions were spread across the body in half of the children. Mean (SD) duration of delay was 10.5 (9.8) months. Delayed presentation was more in boys (43% vs. 17%; P = 0.01), those without a history of migration for work compared to those who had a history of migration (40% vs. 9%; P = 0.008) and in those children who were from a poor economic status compared with those that came from a better economic status (44% vs. 7%; P = 0.001) Limitations: Because our study was conducted at tertiary care hospitals, the findings are not representative of the situation in the field. Furthermore, a comparison group of newly diagnosed adult leprosy patients with disability could have been included in the study. CONCLUSION: Childhood leprosy continues to occur in endemic pockets in India and a substantial number present with skin smear positivity and deformity. Guardians of these children cite many reasons for the delay in presentation.


Assuntos
Diagnóstico Tardio , Hanseníase , Adolescente , Criança , Pré-Escolar , Diagnóstico Tardio/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Índia , Hanseníase/diagnóstico , Hanseníase Multibacilar/diagnóstico , Masculino , Mycobacterium leprae/isolamento & purificação , Fatores de Risco , Pele/microbiologia , Fatores Socioeconômicos , Centros de Atenção Terciária
7.
Indian J Dermatol Venereol Leprol ; 88(2): 150-155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34877855

RESUMO

BACKGROUND: The polymorphism of interleukin-17F rs763780 has been found to have a probable association with increased risk of developing psoriasis. AIMS: This study aims to get a more convincing estimation of the association between the interleukin-17F rs763780 T /C polymorphism and psoriasis risk. METHODS: Two authors independently searched the databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Databases for case-control studies which reported the odds ratios with 95% confidence intervals comparing genotype and allele frequencies of the interleukin-17F rs763780 polymorphism in patients with psoriasis versus participants without psoriasis. RESULTS: A total of seven case-control studies incorporating 1824 cases and 1585 controls were identified. The pooled odds ratios indicated that interleukin-17F rs763780 C allele was a risk factor for psoriasis in allele frequency, recessive model and homozygote model (P < 0.05). Subgroup analysis by ethnicity further indicated that the C allele was closely related to increased risk of psoriasis in Asian populations (P < 0.05), but not in Caucasians. LIMITATIONS: Only a few studies on the interleukin-17F rs763780 polymorphism in psoriasis have been reported till date, thus the data is insufficient. Only one gene polymorphic site was selected for this study, and it is not clear whether other genetic mutation functional sites affect the gene. Further studies on confounding effects of other genetic polymorphisms are needed. CONCLUSION: The present meta-analysis results suggested that the interleukin-17F rs763780 T /C is significantly associated with psoriasis risk in Asians.


Assuntos
Predisposição Genética para Doença , Interleucina-17/genética , Polimorfismo de Nucleotídeo Único , Psoríase/genética , /genética , Humanos , Fatores de Risco
8.
PLoS Negl Trop Dis ; 15(12): e0010035, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34898634

RESUMO

BACKGROUND: Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7-2.9) and low schooling level (HR: 1.5; 95% CI: 1.2-1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40-55 years. CONCLUSIONS/SIGNIFICANCE: Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals.


Assuntos
Coinfecção/epidemiologia , Leishmaniose Cutânea/epidemiologia , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Coinfecção/diagnóstico , Doenças Endêmicas , Feminino , Humanos , Leishmaniose Cutânea/diagnóstico , Hanseníase/diagnóstico , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
PLoS Negl Trop Dis ; 15(11): e0009923, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34758025

RESUMO

BACKGROUND: Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. METHODOLOGY/PRINCIPAL FINDINGS: We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516-7.073, 3.714-5.212, and 2.063-2.509; for ≥ 10, 5-10 y, and 2-5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843-4.244, and 1.959-3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341-2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052-2.079, 1.075-1.923, 1.261-1.838, and 1.072-1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106-1.960 and 1.498-2.814; for 15-59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522-2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195-1.952), rural occupation (OR: 1.364; 95% CI: 1.128-1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159-1.386), and male sex (OR: 1.128; 95% CI: 1.024-1.243). CONCLUSIONS: Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , China/etnologia , Testes Diagnósticos de Rotina , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/etnologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
PLoS Negl Trop Dis ; 15(8): e0009651, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34383768

RESUMO

BACKGROUND: The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection. METHODS: This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. RESULTS: We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor. CONCLUSIONS: Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/complicações , Hanseníase/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores de Risco , Estigma Social , Fatores Socioeconômicos
11.
PLoS Negl Trop Dis ; 15(7): e0009635, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34319982

RESUMO

BACKGROUND: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Corticosteroides/uso terapêutico , Vacina BCG/administração & dosagem , Brasil/epidemiologia , COVID-19/diagnóstico , Teste para COVID-19 , Clofazimina/uso terapêutico , Estudos de Coortes , Dapsona/uso terapêutico , Humanos , Pentoxifilina/uso terapêutico , Estudos Prospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Análise de Sobrevida , Talidomida/uso terapêutico
12.
Trop Med Int Health ; 26(11): 1438-1445, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34288290

RESUMO

OBJECTIVES: To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019. METHODS: Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis. RESULTS: We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities. CONCLUSIONS: Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.


Assuntos
Hanseníase/epidemiologia , Adolescente , Adulto , Teorema de Bayes , Brasil/epidemiologia , Transmissão de Doença Infecciosa , Doenças Endêmicas , Feminino , Humanos , Hanseníase/transmissão , Masculino , Estudos Retrospectivos , Fatores de Risco , Análise Espaço-Temporal , Adulto Jovem
14.
Biosci Rep ; 41(7)2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34143211

RESUMO

The transmission and evolution of leprosy depends on several aspects, including immunological and genetic factors of the host, as well as genetic factors of Mycobacterium leprae. The present study evaluated the association of single nucleotide polymorphisms (SNPs) on the FokI (rs2228570), TaqI (rs731236), ApaI (rs7975232) regions of the vitamin D receptor (VDR) gene with leprosy. A total of 405 individuals were evaluated, composed by groups of 100 multibacillary (MB) and 57 paucibacillary (PB) patients, and 248 healthy contacts. Blood samples were collected from patients and contacts. The genotyping was performed by sequencing of the interest regions. The alleles of the studied SNPs, and SNP FokI genotypes, were not associated with leprosy. For the SNP on TaqI region, the relationship between the tt genotype, and for the SNP ApaI, the AA genotype, revealed an association with susceptibility to MB form, while Aa genotype with protection. The extended genotypes AaTT and AaTt of ApaI and TaqI were associated with protection against MB form. Further studies analyzing the expression of the VDR gene and the correlation with its SNPs might help to clarify the role of polymorphisms on the immune response in leprosy.


Assuntos
Hanseníase/genética , Polimorfismo de Nucleotídeo Único , Receptores de Calcitriol/genética , Brasil , Estudos de Casos e Controles , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Hanseníase/diagnóstico , Hanseníase/imunologia , Fatores de Proteção , Medição de Risco , Fatores de Risco
15.
PLoS Negl Trop Dis ; 15(6): e0009456, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34166403

RESUMO

BACKGROUND: Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection. METHODOLOGY/PRINCIPAL FINDINGS: Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06). CONCLUSIONS/SIGNIFICANCE: The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy.


Assuntos
Insegurança Alimentar/economia , Hanseníase/epidemiologia , Hanseníase/etiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Pobreza , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
16.
Indian J Dermatol Venereol Leprol ; 87(5): 603-610, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33969653

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is implicated in the ongoing pandemic across the globe since December 2019. It was first notified by China from Wuhan on 31 December 2020 and transmission to healthcare workers was first reported on 20 January 2020. Human-to-human transmission is mainly by droplet infection. At present no effective vaccine is available. Our speciality needs to collectively address the urgent issue of risk of transmission in dermatology practice. A case series of Coronavirus Disease 2019 (COVID-19) from Wuhan described that 41.3% of their patients may have acquired the infection from the hospital. Of all the infected health care workers, 77.5% worked in general wards and departments. These data highlight the significant risk of nosocomial transmission of COVID-19 and also the higher risk in general wards and departments compared to the emergency room or intensive care unit. Dermatology patients are generally seen in clinics and in outpatient departments in hospitals. Patients wait together in the waiting area, intermingle and then are seen by the physician in their chamber. This can cause transmission of the pathogen among patients and from patient to physician. Social distancing, hand hygiene and the use of personal protective equipment are important for preventing the spread of infection and dermatology practices also have to incorporate these aspects. Telemedicine is becoming an important tool for the management of dermatology patients in these times. At-risk patients in dermatology also need to be given priority care. Protocols for the use of immunosuppressants and biologics in dermatology during the pandemic are being developed.


Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Dermatologia/organização & administração , Dermatopatias/terapia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Produtos Biológicos/uso terapêutico , COVID-19/transmissão , Infecção Hospitalar/transmissão , Humanos , Imunossupressores/uso terapêutico , Índia , Fatores de Risco , SARS-CoV-2 , Dermatopatias/complicações , Dermatopatias/diagnóstico , Telemedicina/legislação & jurisprudência , Vacinação , Salas de Espera
17.
Rev Bras Enferm ; 74(1): e20200532, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33787801

RESUMO

OBJECTIVES: to understand how the therapeutic itineraries of people affected by leprosy are processed. METHODS: this is a descriptive, qualitative study, conducted in April 2018 in Barão de Grajaú in Maranhão, with interviews in the form of narratives of seven patients who had a late leprosy diagnosis. RESULTS: the search for diagnosis is a major difficulty in accessing health services, resulting in a late diagnosis and, consequently, with the presence of visible deformities. It was noticed that the health units do not have a flow, nor protocols for comprehensive treatment, and these people are referred to a referral unit in another state to perform sputum smear microscopy. FINAL CONSIDERATIONS: leprosy control actions need reformulations that seek the relationship between operational activities, epidemiological indicators and risk factors, in accordance with the real needs of each region, thus highlighting the gaps evidenced in the therapeutic itineraries.


Assuntos
Hanseníase , Brasil , Diagnóstico Tardio , Humanos , Hanseníase/terapia , Pesquisa Qualitativa , Fatores de Risco
18.
BMC Infect Dis ; 21(1): 290, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752632

RESUMO

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Bases de Dados Factuais , Escolaridade , Feminino , Humanos , Incidência , Hanseníase/epidemiologia , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , População Rural , Adulto Jovem
19.
Indian J Dermatol Venereol Leprol ; 87(2): 154-175, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33769736

RESUMO

Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei.


Assuntos
Tinha/epidemiologia , Distribuição por Idade , Uso Indevido de Medicamentos , Escolaridade , Glucocorticoides/efeitos adversos , Humanos , Doença Iatrogênica , Incidência , Índia/epidemiologia , Ocupações , Prevalência , Qualidade de Vida , Recidiva , Fatores de Risco , População Rural , Distribuição por Sexo , Classe Social , Tinha/diagnóstico , População Urbana
20.
Int J Infect Dis ; 105: 261-266, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33592342

RESUMO

BACKGROUND: Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. The aim of this study was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy using a case-control design. METHODS: From 2016 to 2018, individuals aged ≥3 years were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in three groups: cases of leprosy, household contacts and community-matched (non-contact) controls. Helminths were diagnosed through stool Kato Katz examination and serum reactivity to anti-soluble adult worm antigen preparation IgG4. Serum ferritin, 25-OH vitamin D and retinol concentrations were measured. Multi-variate logistic regression was conducted to identify associations with active leprosy. RESULTS: Seventy-nine cases of leprosy, 96 household contacts and 81 non-contact controls were recruited; 48.1% of participants were male with a median age of 40 years. Helminths were found in 7.1% of participants on Kato Katz test, all but one of which were Schistosoma mansoni, and 32.3% of participants were positive for S. mansoni serology. On multi-variate analysis, cases were more likely to be infected with helminths (diagnosed by stool) than household contacts [adjusted odds ratio (aOR) 8.69, 95% confidence interval (CI) 1.50-50.51]. Vitamin D deficiency was common, and was more likely in cases compared with non-contact controls (aOR 4.66, 95% CI 1.42,-15.33). Iron deficiency was not associated with leprosy, and vitamin A deficiency was not detected. CONCLUSION: These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy. Comorbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programmes to improve leprosy control.


Assuntos
Coinfecção/complicações , Helmintos/fisiologia , Hanseníase/complicações , Mycobacterium leprae/fisiologia , Deficiência de Vitamina D/complicações , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
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