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1.
Multimedia | MULTIMEDIA | ID: multimedia-9124

RESUMO

Nesse iH Ensina, o Prof. Cleverson Teixeira Soares abordará a histopatologia da Hanseníase. O médico patologista é também autor do livro "Histopathological Diagnosis of Leprosy" ("Diagnóstico Histopatológico da Hanseníase"), um guia de fácil compreensão sobre a patologia da Hanseníase que fornece informações essenciais ao diagnóstico diferencial dessa doença.


Assuntos
Hanseníase/patologia , Patologistas , Recidiva , Progressão da Doença , Aula
2.
PLoS Negl Trop Dis ; 15(5): e0009436, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34038422

RESUMO

BACKGROUND: Leprosy is an infectious disease caused by Mycobacterium leprae. As incidence begins to decline, the characteristics of new cases shifts away from those observed in highly endemic areas, revealing potentially important insights into possible ongoing sources of transmission. We aimed to investigate whether transmission is driven mainly by undiagnosed and untreated new leprosy cases in the community, or by incompletely treated or relapsing cases. METHODOLOGY/PRINCIPAL FINDINGS: A literature search of major electronic databases was conducted in January, 2020 with 134 articles retained out of a total 4318 records identified (PROSPERO ID: CRD42020178923). We presented quantitative data from leprosy case records with supporting evidence describing the decline in incidence across several contexts. BCG vaccination, active case finding, adherence to multidrug therapy and continued surveillance following treatment were the main strategies shared by countries who achieved a substantial reduction in incidence. From 3950 leprosy case records collected across 22 low endemic countries, 48.3% were suspected to be imported, originating from transmission outside of the country. Most cases were multibacillary (64.4%) and regularly confirmed through skin biopsy, with 122 cases of suspected relapse from previous leprosy treatment. Family history was reported in 18.7% of cases, while other suspected sources included travel to high endemic areas and direct contact with armadillos. None of the countries included in the analysis reported a distinct increase in leprosy incidence in recent years. CONCLUSIONS/SIGNIFICANCE: Together with socioeconomic improvement over time, several successful leprosy control programmes have been implemented in recent decades that led to a substantial decline in incidence. Most cases described in these contexts were multibacillary and numerous cases of suspected relapse were reported. Despite these observations, there was no indication that these cases led to a rise in new secondary cases, suggesting that they do not represent a large ongoing source of human-to-human transmission.


Assuntos
Hanseníase/epidemiologia , Hanseníase/transmissão , Mycobacterium leprae/fisiologia , Animais , Tatus/microbiologia , Vacina BCG/administração & dosagem , Quimioterapia Combinada , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Recidiva , Viagem
3.
PLoS Negl Trop Dis ; 15(5): e0009382, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939710

RESUMO

The World Health Organization has raised concerns about the increasing number of Hansen disease (HD) relapses worldwide, especially in Brazil, India, and Indonesia that report the highest number of recurrent cases. Relapses are an indicator of MDT effectiveness and can reflect Mycobacterium leprae persistence or re-infection. Relapse is also a potential marker for the development or progression of disability. In this research, we studied a large cohort of persons affected by HD treated with full fixed-dose multibacillary (MB) multidrug therapy (MDT) followed for up to 20 years and observed that relapses are a rare event. We estimated the incidence density of relapse in a cohort of patients classified to receive MB regime (bacillary index (BI) > 0), diagnosed between September 1997 and June 2017, and treated with twelve-dose MB-MDT at a HD reference center in Rio de Janeiro, Brazil. We obtained the data from the data management system of the clinic routine service. We linked the selected cases to the dataset of relapses of the national HD data to confirm possible relapse cases diagnosed elsewhere. We diagnosed ten cases of relapse in a cohort of 713 patients followed-up for a mean of 12.1 years. This resulted in an incidence rate of 1.16 relapse cases per 1000 person-year (95% CI = 0.5915-2.076). The accumulated risk was 0.025 in 20 years. The very low risk observed in this cohort of twelve-dose-treated MB patients reinforces the success of the current MDT scheme.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Clofazimina/uso terapêutico , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/efeitos dos fármacos , Recidiva , Estudos Retrospectivos , Rifampina/uso terapêutico , Pele/microbiologia , Pele/patologia , Adulto Jovem
4.
Rev Soc Bras Med Trop ; 54: e03892020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656147

RESUMO

INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.


Assuntos
Hanseníase Multibacilar , Hanseníase , Brasil/epidemiologia , Estudos Transversais , Humanos , Hanseníase/epidemiologia , Masculino , Recidiva
5.
Artigo em Inglês | MEDLINE | ID: mdl-33681915

RESUMO

INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Assuntos
Hanseníase , Brasil , Resistência a Medicamentos , Humanos , Hanseníase/tratamento farmacológico , Recidiva , Centros de Atenção Terciária
6.
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
10.
Rev. Soc. Bras. Med. Trop ; 54: e0375-2020, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1155553

RESUMO

Abstract INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Assuntos
Humanos , Hanseníase/tratamento farmacológico , Recidiva , Brasil , Resistência a Medicamentos , Centros de Atenção Terciária
11.
Rev. Soc. Bras. Med. Trop ; 54: e0389-2020, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1155534

RESUMO

Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.


Assuntos
Humanos , Masculino , Hanseníase Multibacilar , Hanseníase/epidemiologia , Recidiva , Brasil/epidemiologia , Estudos Transversais
12.
Bauru; s.n; 2021. 21 p. ilus, tab.
Tese em Português | SES-SP, CONASS, HANSEN, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP, SESSP-ESPECIALIZACAOSESPROD, SES-SP | ID: biblio-1150994

RESUMO

A Hanseníase é uma doença infectocontagiosa de caráter crônico, evolução lenta, causada pelo Mycobacterium leprae (M. leprae). A transmissão ocorre por meio do trato respiratório, e para o desenvolvimento da doença existe a necessidade da susceptibilidade, além do contato íntimo e prolongado. Para fins terapêuticos a Organização Mundial da Saúde (OMS) traz uma classificação mais simples que é baseada no número de lesões cutâneas. Os casos com até cinco lesões são considerados paucibacilares e aqueles com mais de cinco lesões são multibacilares. Apesar da implantação da poliquimioterapia (PQT) pela OMS ter sido um importante avanço técnico na história do controle da doença, em 2019 ainda foram notificados 202.185 novos casos no mundo, sendo o Brasil o segundo em concentração de casos. Um indicador importante para o controle da hanseníase são as taxas de retratamento, definido como nova notificação de hanseníase em paciente que já tenha recebido tratamento anterior, suas causas incluem abandono, insuficiência terapêutica, falência terapêutica, alteração de esquema por erro diagnóstico e recidiva. Embora um grande número de casos de recidivas seja detectado no Brasil, apenas 8,4%, 13,3% e 1,9% dos casos podem ser explicados por mutações que sabidamente conferem resistência bacilar aos medicamentos utilizados na PQT: rifampicina (RFP), dapsona (DDS) e ofloxacina (OFLO), respectivamente. Além dos aspectos relacionados ao patógeno, a contribuição do hospedeiro para esse cenário, apesar de pouco estudada, deve ser de grande importância. No geral a resposta ao medicamento é variável entre indivíduos, ocasionando falta de eficácia farmacológica ou reação adversas, em partes esses eventos podem ser explicados pela farmacogenética. Conhecer fatores genéticos que interferem no metabolismo dos medicamentos pode contribuir para melhores resultados terapêuticos. Dentre os desafios para atingir a eliminação da hanseníase estão a ausência de novas ferramentas de diagnóstico e de entendimento das causas associadas a recidiva e à não adesão a PQT, uma vez que a resistência medicamentosa explica pouco da reativação da doença, deste modo, o presente estudo teve como finalidade constituir banco de dados em hanseníase para estudos de associação do tipo caso-controle sobre os fatores associados com a falha terapêutica da PQT convencional. Dos 240 prontuários avaliados, 119 foram classificados como casos de falência terapêutica ou recidiva e 121 como sucesso terapêutico, aqui denominados como controles, a maioria dos pacientes era do sexo masculino, branco e procedente do estado de São Paulo; Em relação à faixa etária de diagnóstico, 18% foram diagnosticados com idade entre 40 e 49 anos, enquanto nos controles 14% tiveram diagnóstico com idade inferior a 19 anos; quanto à forma clínica da doença, 59% dos casos e 47% dos controles foram classificados como virchoviano. Dentre os casos de falência terapêutica ou recidiva, a resistência molecular explicou apenas 5,8 % dos casos de retratamento. Esse dado reforça a urgência de estudos que esclareçam as causas da falha terapêutica em hanseníase, contribuindo assim para o estabelecimento de medidas que visem o alcance de melhores índices relacionados aos desfechos terapêuticos.(AU)


Leprosy is a chronic infectious disease with insidious evolution, caused by Mycobacterium leprae (M. leprae). Transmission occurs through the respiratory tract, and the onset of the disease depends on susceptibility, in addition to intimate and prolonged contact with untreated patients. For therapeutic purposes, the World Health Organization's (WHO) classification is based on the number of skin lesions. Cases with up to five lesions are considered paucibacillary and those with more than five lesion are multibacillary. Although the implementation of multidrugtherapy (MDT) by WHO was an important technical advance in the history of disease control. In 2019, 202,185 new cases were reported in the world, with Brazil the second in the highest number of cases. An important indicator for the control of leprosy is retreatment rate, defined as a new notification of leprosy in a patient who has already received previous treatment. Its causes include abandonment, therapeutic failure, , alteration of the regimen due to diagnostic error and relapse. Although a large number of cases of relapses are detected in Brazil, only 8.4%, 13.3% and 1.9% of cases can be explained by mutations that are known to confer bacillary resistance to drugs used in the MDT: rifampicin (RFP), dapsone (DDS) and ofloxacin (OFLO), respectively. In addition to aspects related to the pathogen, the host's contribution to this scenario, although little studied, is highly important. In general, the response to the drug treatment is variable between individuals, causing a lack of pharmacological efficacy or adverse reactions. , These events may be explained by pharmacogenetics. Knowing genetic factors that interfere with drug metabolism can contribute to better therapeutic results. Among the challenges to achieve leprosy elimination are the absence of new diagnostic tools and understanding of the causes associated with relapse and non-adherence to MDT, since drug resistance explains little about the reactivation of the disease. Thus, the present study aimed at constituting a leprosy database for case-control association studies on factors associated with conventional MDT therapeutic failure. Of the 240 medical records evaluated, 119 were classified as cases of therapeutic failure or relapse and 121 as therapeutic success, here referred to as controls. The majority of patients were male, white and from the state of São Paulo. Regarding the age of diagnosis, 18% were diagnosed between 40 and 49 years, while in controls, 14% were diagnosed under 19 years; as to the clinical form of the disease, 59% of the cases and 47% of the controls were classified as lepromatous. Among the cases of therapeutic failure or relapse, molecular resistance explained only 5.8% of retreatment cases. This data reinforces the urgency of studies that clarify the causes of therapeutic failure in leprosy, thus contributing to the establishment of measures aimed at achieving better therapeutic outcomes(AU).


Assuntos
Humanos , Masculino , Feminino , Base de Dados , Quimioterapia Combinada , Hanseníase/terapia , Farmacogenética , Recidiva , Resistência a Medicamentos , Registros Médicos/estatística & dados numéricos , Coleta de Dados , Recusa do Paciente ao Tratamento , Retratamento , Hanseníase/epidemiologia
13.
In. Soares, Cleverson Teixeira. Histopathological diagnosis of leprosy. Sharjah, Bentham Science Publishers;Bentham Books, 2021. p.180-222, ilus.
Monografia em Inglês | SES-SP, HANSEN, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1292194

RESUMO

Immediately after leprosy treatment initiation, changes in leprosy lesions also commence. The histopathological and bacilloscopic characeristics of the regressing lesions undergo continuous changes over years of decades. It is important to recognize these changes as they allow for the assessment od whether a particular lesion is in regression or if there are signs of disease reactivation. Interpretation of the findings will depend on a close correlation among histopathological patterns, bacilloscopic characteristics, and clinical data. This chapter discusses the main factors that allow the recognition of the histopathological characteristics of regressive phenomena from initial phases to late or residual phases, the changes typical in effectiveness, the reaction phenomena triggered after treatment initiation on regressing lesions, and the evaluation of leprosy recurrence. Further, this chapter includes a discussion on the main differential diagnoses of leprosy regression and relapse.


Assuntos
Recidiva , Hanseníase , Prevenção Secundária , Exacerbação dos Sintomas
15.
Am J Trop Med Hyg ; 103(6): 2253-2256, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32901606

RESUMO

We report a case of visceral leishmaniasis (VL)/HIV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4+ T-lymphocyte count.


Assuntos
Anfotericina B/uso terapêutico , Antirretrovirais/uso terapêutico , Eritema Nodoso/tratamento farmacológico , Infecções por HIV/complicações , Leishmaniose Visceral/diagnóstico , Adulto , Coinfecção , Eritema Nodoso/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Leishmaniose Visceral/complicações , Leishmaniose Visceral/tratamento farmacológico , Masculino , Recidiva , Resultado do Tratamento
19.
J Am Acad Dermatol ; 83(1): 17-30, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32244016

RESUMO

In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.


Assuntos
Hanseníase/complicações , Hanseníase/tratamento farmacológico , Antibacterianos/uso terapêutico , Efeitos Psicossociais da Doença , Farmacorresistência Bacteriana , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/imunologia , Hanseníase/patologia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Qualidade de Vida , Recidiva
20.
Artigo em Inglês | MEDLINE | ID: mdl-32340990

RESUMO

A case of Mycobacterium leprae rifampin resistance after irregular antileprosy treatments since 1971 is reported. Whole-genome sequencing from four longitudinal samples indicated relapse due to acquired rifampin resistance and not to reinfection with another strain. A putative compensatory mutation in rpoC was also detected. Clinical improvement was achieved using an alternative therapy.


Assuntos
Hanseníase , Mycobacterium leprae , Humanos , Hanseníase/tratamento farmacológico , Mutação , Mycobacterium leprae/genética , Recidiva , Rifampina/farmacologia
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