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1.
PLoS Negl Trop Dis ; 11(2): e0005364, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28192426

RESUMEN

BACKGROUND: Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control. METHODS: A national databank of cases reported in Brazil (2001-2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center was used to determine factors associated with higher bacillary loads. RESULTS: A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65-69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33-2.38; OR = 1.99, CI95% = 1.96-2.02, respectively). Bacillary load was higher in male and in patients aged 20-39 and 40-59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country. CONCLUSION: Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.


Asunto(s)
Lepra Multibacilar/epidemiología , Grupos de Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Adulto Joven
2.
Lepr Rev ; 86(4): 335-44, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26964429

RESUMEN

INTRODUCTION: Leprosy is a public health problem in Brazil where 31,044 new cases were detected in 2013. Rio Grande do Norte is a small Brazilian state with a rate of leprosy lower than other areas in the same region, for unknown reasons. OBJECTIVES: We present here a review based on the analysis of a database of registered leprosy cases in Rio Grande do Norte state, comparing leprosy's geographic distribution among municipalities with local socio-economic and public health indicators and with historical documents about human migration in this Brazilian region. RESULTS: The current distribution of leprosy in Rio Grande do Norte did not show correlation with socio-economic or public health indicators at the municipal level, but it appears related to economically emerging municipalities 100 years ago, with spread facilitated by railroads and train stations. Drought-related migratory movements which occurred from this state to leprosy endemic areas within the same period may be involved in the introduction of leprosy and with its present distribution within Rio Grande do Norte. CONCLUSIONS: Leprosy may disseminate slowly, over many decades in certain circumstances, such as in small cities with few cases. This is a very unusual situation currently and a unique opportunity for epidemiologic studies of leprosy as an emerging disease.


Asunto(s)
Migración Humana , Lepra/epidemiología , Brasil/epidemiología , Humanos , Lepra/transmisión , Salud Pública , Viaje
3.
Mem. Inst. Oswaldo Cruz ; 109(2): 182-188, abr. 2014. tab
Artículo en Inglés | LILACS | ID: lil-705825

RESUMEN

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.


Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Eritema Nudoso/genética , /genética , Predisposición Genética a la Enfermedad/epidemiología , Lepra Lepromatosa/genética , Lepra Tuberculoide/genética , Brasil/epidemiología , Estudios de Casos y Controles , /metabolismo , Eritema Nudoso/epidemiología , Estudios de Asociación Genética , Técnicas de Genotipaje , Haplotipos , Lepra Lepromatosa/epidemiología , Lepra Tuberculoide/epidemiología , Polimorfismo de Nucleótido Simple/genética , Factores Socioeconómicos
4.
Mem Inst Oswaldo Cruz ; 109(2): 182-8, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24676663

RESUMEN

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.


Asunto(s)
Eritema Nudoso/genética , Genes erbB-2/genética , Predisposición Genética a la Enfermedad/epidemiología , Lepra Lepromatosa/genética , Lepra Tuberculoide/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Cromosomas Humanos Par 17/metabolismo , Eritema Nudoso/epidemiología , Femenino , Estudios de Asociación Genética , Técnicas de Genotipaje , Haplotipos , Humanos , Lepra Lepromatosa/epidemiología , Lepra Tuberculoide/epidemiología , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Factores Socioeconómicos , Adulto Joven
5.
Lepr Rev ; 84(3): 209-18, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24428115

RESUMEN

OBJECTIVES: The objective was to characterise and identify potential risk factors for intolerance to multi-drug leprosy therapy (MDT) which prompted a medication change in a leprosy referral centre in northeastern Brazil. DESIGN: A retrospective chart review of leprosy patients treated at a state referral centre for leprosy in Natal, Rio Grande do Norte, Brazil was completed. Chart review focus was on adverse effects necessitating modification of MDT regimen. RESULTS: Six hundred and twelve records were reviewed with detection of 91 (14.8%) adverse effects with associated change in MDT regimen. The most common recorded causes of medication intolerance were anemia (8.7%), headache (4.2%), cyanosis (1.8%), and gastrointestinal symptoms (1-6%). Both female gender (OR = 2.63) and age less than 42 years old (OR = 2.7) remained risk factors for MDT intolerance in a multivariate model including gender, age, and WHO regimen type. With intolerance due to anemia as the outcome, female gender (OR = 2.36) and age less than 42 years (OR = 1.86) were associated. CONCLUSIONS: In this study, female gender and younger age were associated with greater risk of medication intolerance and medication intolerance related to anemia. These findings have important operational implications for drug intolerance monitoring during therapy for leprosy.


Asunto(s)
Leprostáticos/administración & dosificación , Leprostáticos/efectos adversos , Lepra/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Resultado del Tratamiento
6.
Lepr Rev ; 83(4): 389-93, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23614258

RESUMEN

There are diverse skin manifestations of both leprosy and syphilis. These diseases can appear similar to many other dermatologic conditions as well as to systemic diseases with dermatologic signs. Nodular syphilis is an uncommon type of secondary syphilis. We present here a person from a leprosy-endemic area with diffuse nodular skin lesions of secondary syphilis who was initially suspected of having lepromatous leprosy.


Asunto(s)
Piel/patología , Sífilis/diagnóstico , Sífilis/patología , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Humanos , Lepra Lepromatosa/patología , Masculino , Persona de Mediana Edad , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico
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