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1.
Artículo en Inglés | MEDLINE | ID: mdl-32340990

RESUMEN

A case of M. leprae rifampicin resistance after irregular anti-leprosy treatments since 1971 is reported. Whole-genome sequencing from four longitudinal samples indicated relapse due to acquired rifampicin 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.

2.
Trials ; 19(1): 244, 2018 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-29685164

RESUMEN

BACKGROUND: The annual new-case detection rate for leprosy, while generally stable over the last decade, shows that transmission rates have remained stagnant despite the successful worldwide administration of multidrug therapy since the 1980s. As such, novel control strategies are urgently needed. Focusing on managing leprosy patient contacts, the most susceptible to contracting the disease, has been seen as a potential strategy in limiting the spread of leprosy as shown by a number of recent epidemiological studies. Immunoprophylaxis with Bacillus Calmette-Guérin (BCG) has been seen as an effective preventive measure due to its ability to stimulate the development of cellular immunity which is essential in controlling the disease, especially in its multibacillary (MB) forms. The association of immunoprophylaxis with chemoprophylaxis in a single dose of rifampicin has been shown to be a promising preventive strategy, although a variety of studies have found instances of early case detection just a few months after BCG vaccination. METHODS/DESIGN: The present study is a phase IV chemoprophylactic clinical trial consisting of administration of a single dose of rifampicin in MB leprosy patient contacts under care at the Souza Araújo Outpatient Clinic/FIOCRUZ as part of a randomized (2:1), double-blind, placebo-controlled study. It is comprised of two groups: 1) rifampicin + BCG; and 2) placebo + BCG. DISCUSSION: The aim is to evaluate whether the use of chemoprophylaxis with a single dose of rifampicin in MB leprosy patient contacts prior to the BCG vaccine would be able to prevent the onset of leprosy in those cases that may occur just a few months after vaccination. Contact subclinical infections (polymerase chain reaction) and the immunological parameters (anti-PGL-1, anti-LID-1, and IFN-γ) will be evaluated and the results will be compared after 12 months of follow-up. TRIAL REGISTRATION: The Brazilian Registry of Clinical Trials (ReBEC), RBR-69QK5P . Retrospectively registered on 1 June 2017.


Asunto(s)
Vacuna BCG/administración & dosificación , Trazado de Contacto , Leprostáticos/administración & dosificación , Lepra Multibacilar/prevención & control , Rifampin/administración & dosificación , Adolescente , Adulto , Anciano , Vacuna BCG/efectos adversos , Brasil , Niño , Preescolar , Ensayos Clínicos Fase IV como Asunto , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Lactante , Leprostáticos/efectos adversos , Lepra Multibacilar/inmunología , Lepra Multibacilar/microbiología , Lepra Multibacilar/transmisión , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Rifampin/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Vacunación , Adulto Joven
3.
PLoS Negl Trop Dis ; 11(5): e0005560, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28467415

RESUMEN

Household contacts of multibacillary leprosy patients (HCMB) constitute the group of individuals at the highest risk of developing leprosy. Early diagnosis and treatment of their index cases combined with Bacille Calmette-Guerin (BCG) immunization remain important strategies adopted in Brazil to prevent HCMB from evolving into active disease. In the present study, we assessed the impact of these measures on the immune response to Mycobacterium leprae in HCMB. Peripheral blood mononuclear cells (PBMC) from HCMB (n = 16) were obtained at the beginning of leprosy index case treatment (T0). At this time point, contacts were vaccinated (n = 13) or not (n = 3) in accordance with their infancy history of BCG vaccination and PBMCs were recollected at least 6 months later (T1). As expected, a significant increase in memory CD4 and CD8 T cell frequencies responsive to M. leprae whole-cell sonicate was observed in most contacts. Of note, higher frequencies of CD4+ T cells that recognize M. leprae specific epitopes were also detected. Moreover, increased production of the inflammatory mediators IL1-ß, IL-6, IL-17, TNF, IFN-γ, MIP1-ß, and MCP-1 was found at T1. Interestingly, the increment in these parameters was observed even in those contacts that were not BCG vaccinated at T0. This result reinforces the hypothesis that the continuous exposure of HCMB to live M. leprae down regulates the specific cellular immune response against the pathogen. Moreover, our data suggest that BCG vaccination of HCMB induces activation of T cell clones, likely through "trained immunity", that recognize M. leprae specific antigens not shared with BCG as an additional protective mechanism besides the expected boost in cell-mediated immunity by BCG homologues of M. leprae antigens.


Asunto(s)
Antígenos Bacterianos/inmunología , Vacuna BCG/uso terapéutico , Linfocitos T CD4-Positivos/inmunología , Inmunidad Celular , Lepra Multibacilar/inmunología , Adulto , Anticuerpos Antibacterianos/sangre , Brasil , Linfocitos T CD8-positivos/inmunología , Citocinas/metabolismo , Epítopos de Linfocito T/inmunología , Composición Familiar , Femenino , Humanos , Inmunoglobulina M/sangre , Lepra Multibacilar/prevención & control , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Mycobacterium leprae , Estudios Prospectivos , Adulto Joven
4.
PLoS Negl Trop Dis ; 10(10): e0005059, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27732610

RESUMEN

OBJECTIVE: We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. METHODS: This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. RESULT: Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. CONCLUSION: The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.


Asunto(s)
Lepra/terapia , Instituciones de Atención Ambulatoria/organización & administración , Brasil/epidemiología , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Salud Pública , Derivación y Consulta , Estudios Retrospectivos
5.
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
6.
Trop Med Int Health ; 18(9): 1145-1153, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23937704

RESUMEN

OBJECTIVE: To evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO). METHODS: Cohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics. RESULTS: The total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02-2.56), when disability was 2, the risk was 2.37 (95% CI 1.35-4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07-3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08-2.52]). CONCLUSION: Impairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.


Asunto(s)
Evaluación de la Discapacidad , Progresión de la Enfermedad , Leprostáticos/uso terapéutico , Lepra Multibacilar/complicaciones , Enfermedades del Sistema Nervioso/etiología , Adolescente , Adulto , Anciano , Instituciones de Atención Ambulatoria , Brasil , Niño , Preescolar , Estudios de Cohortes , Personas con Discapacidad , Quimioterapia Combinada , Femenino , Humanos , Leprostáticos/administración & dosificación , Leprostáticos/efectos adversos , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/complicaciones , Alta del Paciente , Modelos de Riesgos Proporcionales , Factores de Riesgo , Adulto Joven
7.
J Trop Med ; 2013: 596316, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23690793

RESUMEN

A broad variety of factors have been associated with leprosy among contacts, including socioeconomic, epidemiological, and genetic characteristics. Data from 7,174 contacts of leprosy patients from a leprosy outpatient clinic in Rio de Janeiro, Brazil, 1987-2010, were analyzed to investigate the effects of kinship, individual, and contextual factors on leprosy. Multivariate analyses were performed using a robust estimation method. In the prevalence analysis, close kinship (sibling OR = 2.75, offspring OR = 2.00, and other relatives OR = 1.70), socioeconomic factors, and the duration of exposure to the bacillus were associated to leprosy. In the incidence analysis, significant risks were found for all categories of kinship (parents RR = 10.93, spouse, boyfriend/girlfriend, and bride/groom RR = 7.53, sibling RR = 7.03, offspring RR = 5.34, and other relatives RR = 3.71). Once the treatment of the index case was initiated, other factors lost their significance, and the index case bacteriological index and BCG (Bacillus Calmette-Guérin vaccine) protection had a greater impact. Our findings suggested that both genetic susceptibility and physical exposure play an important role in the epidemiology of leprosy, but it was not possible establishing the role of genetic factor. Analyses of other factors related to the genotype of individuals, such as genetic polymorphisms, are needed.

8.
Mem. Inst. Oswaldo Cruz ; 107(8): 1054-1059, Dec. 2012. graf, tab
Artículo en Inglés | LILACS | ID: lil-660655

RESUMEN

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.


Asunto(s)
Humanos , Trazado de Contacto/estadística & datos numéricos , Lepra/transmisión , Estudios de Cohortes , Composición Familiar , Incidencia , Lepra/epidemiología , Lepra/prevención & control , Modelos Biológicos , Vigilancia de la Población , Factores de Tiempo
9.
Mem. Inst. Oswaldo Cruz ; 107(supl.1): 49-54, Dec. 2012. tab
Artículo en Inglés | LILACS | ID: lil-659740

RESUMEN

Contact surveillance is an important strategy to ensure effective early diagnosis and control of leprosy; passive detection may not be as efficient because it is directly tied to the ready availability of heath care services and health education campaigns. The aim of this study was to reinforce that contact surveillance is the most effective strategy for the control of leprosy. The analysed data were obtained from a cohort of contacts and cases diagnosed through a national referral service for leprosy. We analysed data from patients diagnosed between 1987-2010 at the Souza Araújo Ambulatory in Rio de Janeiro. Epidemiological characteristics of leprosy cases diagnosed through contact surveillance and characteristics of passively detected index cases were compared using a conditional logistic regression model. Cases diagnosed by contact surveillance were found earlier in the progression of the disease, resulting in less severe clinical presentations, lower levels of initial and final disability grades, lower initial and final bacterial indices and a lower prevalence of disease reaction. In this respect, contact surveillance proved to be an effective tertiary prevention strategy, indicating that active surveillance is especially important in areas of high endemicity, such as Brazil.


Asunto(s)
Femenino , Humanos , Masculino , Trazado de Contacto/estadística & datos numéricos , Lepra/epidemiología , Vigilancia de la Población , Brasil/epidemiología , Estudios de Cohortes , Lepra/transmisión , Prevalencia
10.
Cien Saude Colet ; 17(9): 2533-41, 2012 Sep.
Artículo en Portugués | MEDLINE | ID: mdl-22996903

RESUMEN

UNLABELLED: The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). RESULTS: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.


Asunto(s)
Lepra/epidemiología , Adolescente , Brasil/epidemiología , Femenino , Humanos , Masculino , Derivación y Consulta , Salud Urbana
11.
Ciênc. saúde coletiva ; 17(9): 2533-2541, set. 2012. tab
Artículo en Portugués | LILACS | ID: lil-649915

RESUMEN

O objetivo deste trabalho foi comparar dados epidemiológicos de pacientes de hanseníase residentes em dois municípios com perfil socioeconômico e nível de endemicidade diferentes e que foram acompanhados em um mesmo centro de referência. Foi realizado um estudo descritivo dos dados de pacientes tratados no ambulatório Souza Araújo, 1986 a 2008, residentes nos municípios do Rio de Janeiro (n = 1353) e Duque de Caxias (n = 336). Entre os pacientes desta cidade, em comparação com os da outra, observou-se maior proporção de casos: com idade inferior a 15 anos, multibalicares, com maior índice baciloscópico (IB) inicial, e detectados através da vigilância de contatos. Os pacientes de Duque de Caxias apresentaram menor renda média e nível de escolaridade. Não foram observadas diferenças estatisticamente significativas quanto ao sexo, grau de incapacidade inicial, reação no diagnóstico, IB final, abandono e regularidade do tratamento. As diferenças encontradas entre os pacientes acompanhados em um mesmo centro de referência poderiam estar, em parte, relacionadas a diferenças contextuais existentes entre os municípios. Por outro lado, observou-se que a oferta de tratamento e acompanhamento podem minimizar o efeito que os fatores contextuais apresentam sobre os desfechos de saúde.


The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). Results: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.


Asunto(s)
Adolescente , Femenino , Humanos , Lepra/epidemiología , Brasil/epidemiología , Derivación y Consulta , Salud Urbana
12.
Mem Inst Oswaldo Cruz ; 107(8): 1054-9, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23295758

RESUMEN

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.


Asunto(s)
Trazado de Contacto/estadística & datos numéricos , Lepra/transmisión , Estudios de Cohortes , Composición Familiar , Humanos , Incidencia , Lepra/epidemiología , Lepra/prevención & control , Modelos Biológicos , Vigilancia de la Población , Factores de Tiempo
13.
Mem Inst Oswaldo Cruz ; 107 Suppl 1: 49-54, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23283453

RESUMEN

Contact surveillance is an important strategy to ensure effective early diagnosis and control of leprosy; passive detection may not be as efficient because it is directly tied to the ready availability of heath care services and health education campaigns. The aim of this study was to reinforce that contact surveillance is the most effective strategy for the control of leprosy. The analysed data were obtained from a cohort of contacts and cases diagnosed through a national referral service for leprosy. We analysed data from patients diagnosed between 1987-2010 at the Souza Araújo Ambulatory in Rio de Janeiro. Epidemiological characteristics of leprosy cases diagnosed through contact surveillance and characteristics of passively detected index cases were compared using a conditional logistic regression model. Cases diagnosed by contact surveillance were found earlier in the progression of the disease, resulting in less severe clinical presentations, lower levels of initial and final disability grades, lower initial and final bacterial indices and a lower prevalence of disease reaction. In this respect, contact surveillance proved to be an effective tertiary prevention strategy, indicating that active surveillance is especially important in areas of high endemicity, such as Brazil.


Asunto(s)
Trazado de Contacto/estadística & datos numéricos , Lepra/epidemiología , Vigilancia de la Población , Brasil/epidemiología , Estudios de Cohortes , Femenino , Humanos , Lepra/transmisión , Masculino , Prevalencia
14.
Cad Saude Publica ; 23(4): 815-22, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17435879

RESUMEN

A comparative study was performed on the initial and final bacillary indexes of 213 multibacillary leprosy patients who received 12 doses (Group 1: 128 patients) or 24 doses (Group 2: 85 patients) of multidrug therapy (MDT/WHO) to measure the effectiveness of the two regimens. All patients were evaluated at treatment baseline, 12 months, and 24 months. The reduction in bacillary levels and mean bacillary indexes at 24 months was similar in the two groups. No statistical difference in reaction rates was observed between the two treatment regimens.


Asunto(s)
Leprostáticos/administración & dosificación , Lepra Lepromatosa/tratamiento farmacológico , Adulto , Protocolos Clínicos , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Lepra Lepromatosa/microbiología , Modelos Lineales , Masculino , Factores de Tiempo , Resultado del Tratamiento
15.
Cad. saúde pública ; 23(4): 815-822, abr. 2007. graf
Artículo en Inglés | LILACS | ID: lil-448508

RESUMEN

A comparative study was performed on the initial and final bacillary indexes of 213 multibacillary leprosy patients who received 12 doses (Group 1: 128 patients) or 24 doses (Group 2: 85 patients) of multidrug therapy (MDT/WHO) to measure the effectiveness of the two regimens. All patients were evaluated at treatment baseline, 12 months, and 24 months. The reduction in bacillary levels and mean bacillary indexes at 24 months was similar in the two groups. No statistical difference in reaction rates was observed between the two treatment regimens.


Foi realizado um estudo comparativo de dois grupos de pacientes definidos de acordo com o esquema terapêutico, a fim de se avaliarem os índices baciloscópicos: PQT/12 doses (Grupo 1: 128 pacientes) e PQT/24 doses (Grupo 2: 85 pacientes). Todos os pacientes foram avaliados no início do tratamento, aos 12 meses, e novamente aos 24 meses. Ao final dos 24 meses, observou-se uma redução das médias dos índices baciloscópicos, semelhantes nos dois grupos. Não houve diferença estatística na avaliação da freqüência de quadros reacionais nos dois esquemas terapêuticos.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Persona de Mediana Edad , Adolescente , Adulto , Lepra/tratamiento farmacológico , Leprostáticos/administración & dosificación , Estudio Comparativo , Esquema de Medicación , Quimioterapia Combinada , Resultado del Tratamiento
16.
An. bras. dermatol ; 81(4): 367-375, jul.-ago. 2006.
Artículo en Portugués | LILACS-Express | ID: lil-622408

RESUMEN

O reconhecimento clínico precoce dos episódios reacionais traz grandes benefícios para os pacientes com hanseníase, devido à possibilidade de intervenção terapêutica imediata e adequada, evitando o desenvolvimento de incapacidades que tanto estigmatizam e complicam a doença. Existem três formas de episódios reacionais: os tipos 1 e 2, e a neurite. Esta última pode aparecer isoladamente ou acompanhar as formas anteriores. Em alguns casos só são observadas as manifestações cutâneas e/ou neurológicas das reações, enquanto em outros, alterações sistêmicas podem acrescentar-se ao quadro. O tratamento utilizando a associação de medicamentos antiinflamatórios e imunossupressores parece ser o mais adequado para evitar as recorrências e os efeitos colaterais.


The early clinical recognition of reactional states brings great benefits to leprosy patients due to the possibility of appropriate and immediate therapeutic intervention, thus avoiding the development of disabilities that so much stigmatize and complicate the disease. There are three types of reactional episodes: types 1, 2 and neuritis. The latter may occur alone or together with the former forms. In some cases only neurological and/or skin manifestations are observed in the reactions; in others, patients present systemic alterations. The treatment with an association of immunosuppressors and anti-inflammatory drugs seems to be the most effective to avoid recurrences and side effects.

18.
Rev. panam. salud pública ; 16(5): 362-365, nov. 2004.
Artículo en Inglés | LILACS | ID: lil-396694

RESUMEN

La estrategia actual para el control de la lepra en Brasil se basa en dos actividades principales: la detección precoz de casos y el tratamiento de casos con farmacoterapia combinada. Además de dichas medidas, se realizan esfuerzos complementarios para identificar los contactos domésticos para el diagnóstico precoz y la vacunación con el bacilo de Calmette-Guérin (BCG). Sin embargo, la eficacia de estas acciones a la hora de reducir la incidencia de la lepra es aún discutible. Esto genera dudas acerca de la factibilidad de eliminar la lepra en Brasil e indica que deberían adoptarse otras medidas de prevención. A pesar del hecho de que la vacunación de los contactos se practica desde hace varios años, falta información sobre el impacto de esta medida sobre la incidencia de la lepra en la comunidad. Además, con frecuencia no se tiene en cuenta el impacto de la vacunación neonatal con la vacuna BCG. Sostenemos que hay lugar para la investigación de métodos alternativos en el control y recomendamos que el programa brasileño de control haga un seguimiento esmerado de las tasas de cobertura para la vacunación neonatal en aquellas zonas donde la lepra es endémica, con el fin de lograr que la cobertura siga siendo elevada. Además, recomendamos la realización de estudios, orientados hacia el desarrollo de políticas, sobre la eficacia, factibilidad e impacto de estrategias alternativas más previsoras. Algunos posibles temas para estos estudios serían: 1) el impacto de la vacunación de contactos sobre la incidencia de la enfermedad en la población en general, 2) la factibilidad y el impacto de la quimioprofilaxis, y 3) el impacto de la identificación de grupos de alto riesgo (o mediante la adopción de una definición amplia de los contactos expuestos a la lepra, o mediante la creación de nuevas herramientas diagnósticas), y del diseño de programas para la detección precoz y la administración de farmacoterapia combinada específicamente para estos grupos.


Asunto(s)
Lepra , Brasil
19.
Int J Lepr Other Mycobact Dis ; 72(3): 320-3, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15485290

RESUMEN

A comparative study was made of the initial and final bacterial indices (BIs) of 213 MB leprosy patients who had been administered 12-dose (Group 1/128 patients) and 24-dose (Group 2/85 patients) World Health Organization multi-drug therapy to measure the effectiveness of both treatment regimens. All patients were evaluated at the beginning of treatment, at 12 months, and again after 24 months had elapsed. Decline in BI values and average BIs at 24 months were found to be similar for both groups. Moreover, no statistical difference between the two treatment regimens was found in the frequency rate of reaction.


Asunto(s)
Leprostáticos/administración & dosificación , Lepra/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Lepra/clasificación , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
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