Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 44
Filtrar
1.
PLoS One ; 15(9): e0239186, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32941501

RESUMEN

BACKGROUND: The Stigma Scale of the Explanatory Model Interview Catalogue (EMIC-SS) is a useful option to investigate leprosy-related stigma, but its psychometric qualities are unknown in Brazil. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy. METHODOLOGY: The Brazilian Portuguese version of the EMIC-SS was validated in 180 persons affected by leprosy at a Reference Center in Rio de Janeiro. Confirmatory factorial analysis (CFA) and Cronbach alpha were used to assess the EMIC-SS internal consistency. The Construct validity was tested using Spearman Correlation, Kruskal-Wallis, and Mann-Whitney tests comparing with the Participation Scale, Rosenberg Self-esteem Scale, Beck Depression Inventory, and a Sociodemographic Questionnaire. Test-retest reliability was evaluated with intra-class correlation (ICC). MAIN FINDINGS: CFA confirmed the one- and two-dimensional models of the scale after retaining 12 of the 15 EMIC-SS items. The 12-item EMIC-SS was consistent (α = 0.78) and reproducible (ICC = 0.751, 95% Confidence Interval = 0.657-0.822, p < 0.0001). A significant correlation was observed between the EMIC-SS and the other scales confirming convergent validity. The EMIC-SS and its factors were able to differentiate several hypothesized groups (age, change of occupation, monthly family income, communicating others about the disease, and perception of difficulty to follow treatment) confirming the scale known-groups validity, both in its one and two-dimensional models. CONCLUSIONS/SIGNIFICANCE: Our study found support for the construct validity and reliability of the EMIC-SS as a measure of stigma experienced by people affected by leprosy in Brazil. However, future studies are necessary in other samples and populations with stigmatizing conditions to determine the optimal factor structure and to strengthen the indications of the validated scale.


Asunto(s)
Lepra/psicología , Estigma Social , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Brasil , Características Culturales , Femenino , Humanos , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Psicometría/métodos , Psicometría/normas , Factores Socioeconómicos
2.
Artículo en Inglés | MEDLINE | ID: mdl-32340990

RESUMEN

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.

3.
Mem Inst Oswaldo Cruz ; 114: e190056, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31389520

RESUMEN

BACKGROUND: Fibrosis in the peripheral nerve is the end stage of leprous neuropathy and the cause of the resulting permanent neural function impairments. Preventive measures to avoid this irreversible pathological state are a relief strategy for leprosy sufferers. OBJECTIVES: The present study describes the frequency of fibrosis along with its characterisation and pathogenic development. METHODS: Six-hundred-and-thirteen nerve samples were sorted from 278 neural leprosy (NL) and 335 non-leprosy neuropathy patients (ON). The total number of samples was histologically examined by routine staining methods (haematoxylin-eosin, Wade staining and Gomori's trichrome) and fibrosis was evaluated via semi-quantitative estimation. FINDINGS: Fibrosis was most frequent in the NL group (33% against 0.4% in ON) while fibrosis in association with endoneurial microfasciculation was found in 38 (41.3%) of the NL samples in the examination of semithin sections. Pericytic activation in the perivascular environment was confirmed to be the source of the fibroblasts and perineurial cells delimiting microfascicles. End-stage fibrosis in leprosy displays an arrangement of microfascicles devoid of neural components (i.e., Schwann cells and axons) lined by an intermediate phenotype of fibroblastic-perineurial cells filled with bundles of collagen fibres. MAIN CONCLUSIONS: The present study underscores that fibrosis is frequently the severe end stage of neural leprosy NL pathogeny after analysing the notably distinct development of fibrosis within the neural environment.


Asunto(s)
Fibrosis/patología , Lepra Tuberculoide/patología , Nervios Periféricos/patología , Biopsia , Humanos , Inmunohistoquímica , Enfermedades del Sistema Nervioso Periférico/patología , Células de Schwann/patología
4.
Mem. Inst. Oswaldo Cruz ; 114: e190056, 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1012667

RESUMEN

BACKGROUND Fibrosis in the peripheral nerve is the end stage of leprous neuropathy and the cause of the resulting permanent neural function impairments. Preventive measures to avoid this irreversible pathological state are a relief strategy for leprosy sufferers. OBJECTIVES The present study describes the frequency of fibrosis along with its characterisation and pathogenic development. METHODS Six-hundred-and-thirteen nerve samples were sorted from 278 neural leprosy (NL) and 335 non-leprosy neuropathy patients (ON). The total number of samples was histologically examined by routine staining methods (haematoxylin-eosin, Wade staining and Gomori's trichrome) and fibrosis was evaluated via semi-quantitative estimation. FINDINGS Fibrosis was most frequent in the NL group (33% against 0.4% in ON) while fibrosis in association with endoneurial microfasciculation was found in 38 (41.3%) of the NL samples in the examination of semithin sections. Pericytic activation in the perivascular environment was confirmed to be the source of the fibroblasts and perineurial cells delimiting microfascicles. End-stage fibrosis in leprosy displays an arrangement of microfascicles devoid of neural components (i.e., Schwann cells and axons) lined by an intermediate phenotype of fibroblastic-perineurial cells filled with bundles of collagen fibres. MAIN CONCLUSIONS The present study underscores that fibrosis is frequently the severe end stage of neural leprosy NL pathogeny after analysing the notably distinct development of fibrosis within the neural environment.


Asunto(s)
Humanos , Fibrosis/diagnóstico , Fibrosis/terapia , Lepra Tuberculoide/diagnóstico , Lepra Tuberculoide/prevención & control
5.
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
6.
Rev Saude Publica ; 51: 80, 2017 Sep 04.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-28876410

RESUMEN

OBJECTIVE: Describe the process of cross-cultural adaptation of the "Explanatory Model Interview Catalog - Stigma Scale" for people affected by leprosy in Brazil. METHODS: After being authorized by the author of the scale to use it in the national context, we initiated the five steps process of cross-cultural adaptation: (1) translation, (2) synthesis meeting, (3) back-translation, (4) committee of experts and (5) pre-test. The internal consistency of the scale was evaluated using Cronbach's alpha coefficient. RESULTS: The 15 items of the scale's original version were translated into Brazilian Portuguese. The adapted scale showed evidence of a good understanding of its content, attested both by experts and members of the target population. Its internal consistency was 0.64. CONCLUSIONS: The adapted instrument shows satisfactory internal consistency. It may be useful in future studies that intend to provide broad situational analysis that supports solid public health programs with a focus on effective stigma reduction. In a later study, the construct's validity, criterion, and reproducibility will be evaluated. OBJETIVO: Descrever o processo de adaptação transcultural da "Explanatory Model Interview Catalogue - Stigma Scale" para pessoas afetadas por hanseníase no Brasil. MÉTODOS: Após a autorização do autor da escala para seu uso no contexto nacional, deu-se início aos cinco passos do processo de adaptação transcultural: (1) tradução, (2) reunião de síntese, (3) retrotradução, (4) comitê de peritos e (5) pré-teste. A consistência interna da escala foi avaliada utilizando o coeficiente alfa de Cronbach. RESULTADOS: Os 15 itens da versão original da escala foram traduzidos para a língua portuguesa do Brasil. A escala adaptada apresentou evidência de boa compreensão de seu conteúdo, atestada tanto por peritos como por membros da população alvo. Sua consistência interna foi de 0,64. CONCLUSÕES: O instrumento adaptado apresenta consistência interna satisfatória. Pode ser útil em estudos futuros que intencionem viabilizar ampla análise situacional que sustente programas sólidos de saúde pública com enfoque na efetiva redução de estigma. Em estudo ulterior será avaliada a validade de constructo, critério e reprodutibilidade.


Asunto(s)
Comparación Transcultural , Lepra/psicología , Estigma Social , Encuestas y Cuestionarios , Adulto , Anciano , Brasil , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Traducciones
7.
PLoS Negl Trop Dis ; 11(7): e0005754, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28715406

RESUMEN

The pathways that trigger exacerbated immune reactions in leprosy could be determined by genetic variations. Here, in a prospective approach, both genetic and non-genetic variables influencing the amount of time before the development of reactional episodes were studied using Kaplan-Meier survival curves, and the genetic effect was estimated by the Cox proportional-hazards regression model. In a sample including 447 leprosy patients, we confirmed that gender (male), and high bacillary clinical forms are risk factors for leprosy reactions. From the 15 single nucleotide polymorphisms (SNPs) at the 8 candidate genes genotyped (TNF/LTA, IFNG, IL10, TLR1, NOD2, SOD2, and IL6) we observed statistically different survival curves for rs751271 at the NOD2 and rs2069845 at the IL6 genes (log-rank p-values = 0.002 and 0.023, respectively), suggesting an influence on the amount of time before developing leprosy reactions. Cox models showed associations between the SNPs rs751271 at NOD2 and rs2069845 at IL6 with leprosy reactions (HRGT = 0.45, p = 0.002; HRAG = 1.88, p = 0.0008, respectively). Finally, IL-6 and IFN-γ levels were confirmed as high, while IL-10 titers were low in the sera of reactional patients. Rs751271-GT genotype-bearing individuals correlated (p = 0.05) with lower levels of IL-6 in sera samples, corroborating the genetic results. Although the experimental size may be considered a limitation of the study, the findings confirm the association of classical variables such as sex and clinical forms with leprosy, demonstrating the consistency of the results. From the results, we conclude that SNPs at the NOD2 and IL6 genes are associated with leprosy reactions as an outcome. NOD2 also has a clear functional pro-inflammatory link that is coherent with the exacerbated responses observed in these patients.


Asunto(s)
Predisposición Genética a la Enfermedad , Inflamación/patología , Interleucina-6/genética , Lepra/patología , Proteína Adaptadora de Señalización NOD2/genética , Polimorfismo de Nucleótido Simple , Adulto , Estudios de Cohortes , Femenino , Humanos , Inflamación/genética , Lepra/genética , Masculino , Persona de Mediana Edad , Factores de Riesgo
8.
Fontilles, Rev. leprol ; 31(1): 21-32, ene.-abr. 2017. graf, tab
Artículo en Español | IBECS | ID: ibc-163766

RESUMEN

Antecedentes: El Mycobacterium leprae y el VIH causan enfermedades de tipo infecciosas muy preocupantes para la sanidad mundial. Son especial motivo de preocupación cuando los pacientes se coinfectan con ambos agentes patógenos. El objetivo de este estudio es evaluar los episodios de reacción de reversión (RR) y el efecto del uso de corticosteroides sobre el tratamiento de pacientes de lepra borderline tuberculoide co-infectados con el virus de inmunodeficiencia humana (VIH). Métodos: Este trabajo es un estudio retrospectivo de cohortes en el que se observan las respuestas a la terapia con corticoides y sus manifestaciones clínicas. Se analizan variables durante y después de la multiterapia farmacológica de la Organización Mundial de la Salud (OMS) entre el primer y último día de la toma de prednisona, con un máximo de hasta 6 meses posteriores a haber iniciado la terapia corticosteroidea. Resultados: Se incluye un total de 22 casos VIH-positivos y 28 VIH-negativos. La pérdida de sensibilidad y el engrosamiento neural eran estadísticamente significativos mientras que las lesiones ulceradas sólo se detectaron en el grupo coinfectado. La mayoría de pacientes fueron diagnosticados de lepra en fase de leprorreacción RR y seis pacientes manifestaron RR como un síndrome inflamatorio de restitución inmunológica. De promedio, ambos grupos recibieron dosis similares de corticosteroides (diferencia de 0·1 mg/kg/día). Conclusiones: Las manifestaciones clínicas de ambos grupos fueron similares y la mejoría general fue debida a la administración de corticoides. Registro del ensayo: Este trabajo fue presentado y aprobado por el Ethics Committee on Research of the Oswaldo Cruz Institute el 8 de agosto de 2011 (registro 616/11)


Background: Mycobacterium leprae and HIV cause infectious diseases of great concern for the public health care sector worldwide. Both are especially worrisome diseases when patients become co-infected and exhibit the expected clinical exuberance. The objective of this study was to evaluate episodes of reversal reaction (RR) and the effect of the use of corticosteroids on the treatment of borderline tuberculoid leprosy patients co-infected with the human immunodeficiency virus (HIV). Methods: This is a retrospective cohort study in which the clinical manifestations of the patients and their responses to corticosteroid therapy were observed. Variables were analysed during and after multidrug therapy between the first and last days of prednisone, which occurred up to a maximum of 6 months after initiating corticosteroid therapy. Results: A total of 22 HIV-positive and 28 HIV-negative cases were included. Loss of sensitivity and neural thickening were statistically significant while clinically ulcerated lesions were only observed in the co-infected group. Most patients were diagnosed with leprosy in the presence of RR and six patients manifested RR as an immune reconstitution inflammatory syndrome. On average, both groups received similar doses of corticosteroids (difference of 0·1 mg/kg/day).Conclusions: It is of special interest that the clinical manifestations in both groups were found to be similar and that overall improvement occurred as a result of corticosteroid therapy.Trial registration This work was submitted to and approved by the Ethics Committee on Research of the Oswaldo Cruz Institute on August 8, 2011 (registration 616/11)


Asunto(s)
Humanos , Femenino , Masculino , Adolescente , Corticoesteroides/uso terapéutico , Lepra Tuberculoide/tratamiento farmacológico , Infecciones por VIH/complicaciones , Coinfección/tratamiento farmacológico , Lepra Tuberculoide/complicaciones , Estudios Retrospectivos , Mycobacterium leprae/patogenicidad , Terapia Antirretroviral Altamente Activa
9.
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-903230

RESUMEN

ABSTRACT OBJECTIVE Describe the process of cross-cultural adaptation of the "Explanatory Model Interview Catalog - Stigma Scale" for people affected by leprosy in Brazil. METHODS After being authorized by the author of the scale to use it in the national context, we initiated the five steps process of cross-cultural adaptation: (1) translation, (2) synthesis meeting, (3) back-translation, (4) committee of experts and (5) pre-test. The internal consistency of the scale was evaluated using Cronbach's alpha coefficient. RESULTS The 15 items of the scale's original version were translated into Brazilian Portuguese. The adapted scale showed evidence of a good understanding of its content, attested both by experts and members of the target population. Its internal consistency was 0.64. CONCLUSIONS The adapted instrument shows satisfactory internal consistency. It may be useful in future studies that intend to provide broad situational analysis that supports solid public health programs with a focus on effective stigma reduction. In a later study, the construct's validity, criterion, and reproducibility will be evaluated.


RESUMO OBJETIVO Descrever o processo de adaptação transcultural da "Explanatory Model Interview Catalogue - Stigma Scale" para pessoas afetadas por hanseníase no Brasil. MÉTODOS Após a autorização do autor da escala para seu uso no contexto nacional, deu-se início aos cinco passos do processo de adaptação transcultural: (1) tradução, (2) reunião de síntese, (3) retrotradução, (4) comitê de peritos e (5) pré-teste. A consistência interna da escala foi avaliada utilizando o coeficiente alfa de Cronbach. RESULTADOS Os 15 itens da versão original da escala foram traduzidos para a língua portuguesa do Brasil. A escala adaptada apresentou evidência de boa compreensão de seu conteúdo, atestada tanto por peritos como por membros da população alvo. Sua consistência interna foi de 0,64. CONCLUSÕES O instrumento adaptado apresenta consistência interna satisfatória. Pode ser útil em estudos futuros que intencionem viabilizar ampla análise situacional que sustente programas sólidos de saúde pública com enfoque na efetiva redução de estigma. Em estudo ulterior será avaliada a validade de constructo, critério e reprodutibilidade.

10.
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
11.
PLoS Negl Trop Dis ; 10(8): e0004955, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27556927

RESUMEN

Erythema Nodosum Leprosum (ENL) is an immune reaction in leprosy that aggravates the patient´s clinical condition. ENL presents systemic symptoms of an acute infectious syndrome with high leukocytosis and intense malaise clinically similar to sepsis. The treatment of ENL patients requires immunosuppression and thus needs to be early and efficient to prevent both disabilities and permanent nerve damage. Some patients experience multiple episodes of ENL and prolonged use of immunosuppressive drugs may lead to serious adverse effects. Thalidomide treatment is extremely effective at ameliorating ENL symptoms. Several mechanisms have been proposed to explain the efficacy of thalidomide in ENL, including the inhibition of TNF production. Given its teratogenicity, thalidomide is prohibitive for women of childbearing age. A rational search for molecular targets during ENL episodes is essential to better understand the disease mechanisms involved, which may also lead to the discovery of new drugs and diagnostic tests. Previous studies have demonstrated that IFN-γ and GM-CSF, involved in the induction of CD64 expression, increase during ENL. The aim of the present study was to investigate CD64 expression during ENL and whether thalidomide treatment modulated its expression. Leprosy patients were allocated to one of five groups: (1) Lepromatous leprosy, (2) Borderline leprosy, (3) Reversal reaction, (4) ENL, and (5) ENL 7 days after thalidomide treatment. The present study demonstrated that CD64 mRNA and protein were expressed in ENL lesions and that thalidomide treatment reduced CD64 expression and neutrophil infiltrates-a hallmark of ENL. We also showed that ENL blood neutrophils exclusively expressed CD64 on the cell surface and that thalidomide diminished overall expression. Patient classification based on clinical symptoms found that severe ENL presented high levels of neutrophil CD64. Collectively, these data revealed that ENL neutrophils express CD64, presumably contributing to the immunopathogenesis of the disease.


Asunto(s)
Eritema Nudoso/inmunología , Leprostáticos/uso terapéutico , Neutrófilos/efectos de los fármacos , Neutrófilos/inmunología , Receptores de IgG/genética , Talidomida/uso terapéutico , Adolescente , Adulto , Anciano , Biopsia , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/inmunología , Lepra Dimorfa/microbiología , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Receptores de IgG/inmunología , Piel/microbiología , Piel/patología , Adulto Joven
12.
Lepr Rev ; 87(4): 516-25, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30226355

RESUMEN

Background: Mycobacterium leprae and HIV cause infectious diseases of great concern for the public health care sector worldwide. Both are especially worrisome diseases when patients become co-infected and exhibit the expected clinical exuberance. The objective of this study was to evaluate episodes of reversal reaction (RR) and the effect of the use of corticosteroids on the treatment of borderline tuberculoid leprosy patients co-infected with the human immunodeficiency virus (HIV). Methods: This is a retrospective cohort study in which the clinical manifestations of the patients and their responses to corticosteroid therapy were observed. Variables were analysed during and after multidrug therapy between the first and last days of prednisone, which occurred up to a maximum of 6 months after initiating corticosteroid therapy. Results: A total of 22 HIV-positive and 28 HIV-negative cases were included. Loss of sensitivity and neural thickening were statistically significant while clinically ulcerated lesions were only observed in the co-infected group. Most patients were diagnosed with leprosy in the presence of RR and six patients manifested RR as an immune reconstitution inflammatory syndrome. On average, both groups received similar doses of corticosteroids (difference of 0·1 mg/kg/day).


Asunto(s)
Corticoesteroides/administración & dosificación , Coinfección/tratamiento farmacológico , Infecciones por VIH/complicaciones , Lepra Dimorfa/tratamiento farmacológico , Lepra Tuberculoide/tratamiento farmacológico , Corticoesteroides/efectos adversos , Adulto , Coinfección/microbiología , Coinfección/virología , Femenino , Infecciones por VIH/virología , Humanos , Lepra Dimorfa/microbiología , Lepra Tuberculoide/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/efectos de los fármacos , Mycobacterium leprae/fisiología , Estudios Retrospectivos , Adulto Joven
13.
An Bras Dermatol ; 90(5): 756-7, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26560226

RESUMEN

Leprosy is a neglected disease. We point up the need of recognizing the unusual clinical presentations of the disease in order to make early diagnosis and proper treatment possible, and break the transmission chain. The authors report a rare type of multibacillary leprosy: histoid leprosy and present images of numerous well-circumscribed indurated papules and nodules distributed throughout the entire body.


Asunto(s)
Lepra Lepromatosa/patología , Biopsia , Eritema Nudoso/patología , Humanos , Masculino , Enfermedades Raras/patología , Adulto Joven
14.
Expert Rev Clin Immunol ; 11(3): 391-407, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25666357

RESUMEN

Type 1 reaction (T1R) or reversal reaction is the leading cause of physical disabilities and deformities in leprosy. Leprosy patients, even after being considered cured and released from treatment, may suffer from reactional episodes for long periods of time. Early diagnosis is a great challenge for effectively treating and managing T1R. There is an urgent need to identify the most significant biomarkers to prevent recurrent T1R and to differentiate late T1R from relapse. T1R continues to be treated with corticosteroids and complications due to iatrogenic treatment remain frequent. This review aims to provide a framework from which to approach the great challenges that still persist in T1R management and debate key issues in order to reduce the distance between basic research and the clinic.


Asunto(s)
Corticoesteroides/uso terapéutico , Inmunosupresores/uso terapéutico , Leprostáticos/uso terapéutico , Lepra/terapia , Mycobacterium leprae/inmunología , Animales , Ensayos Clínicos como Asunto , Humanos , Interferón gamma/antagonistas & inhibidores , Leprostáticos/farmacología , Lepra/inmunología , Factor de Crecimiento Transformador beta/antagonistas & inhibidores
15.
Mem Inst Oswaldo Cruz ; 109(7): 944-7, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25411000

RESUMEN

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.


Asunto(s)
ADN Bacteriano/análisis , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/genética , Piel/patología , Biopsia/clasificación , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Lepra Paucibacilar/clasificación , Masculino , Reacción en Cadena de la Polimerasa/métodos , Piel/lesiones , Centros de Atención Terciaria
16.
Mem. Inst. Oswaldo Cruz ; 109(7): 944-947, 11/2014. tab, graf
Artículo en Inglés | LILACS | ID: lil-728804

RESUMEN

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.


Asunto(s)
Femenino , Humanos , Masculino , ADN Bacteriano/análisis , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/genética , Piel/patología , Biopsia/clasificación , Técnicas de Apoyo para la Decisión , Lepra Paucibacilar/clasificación , Reacción en Cadena de la Polimerasa/métodos , Piel/lesiones , Centros de Atención Terciaria
17.
Appl Immunohistochem Mol Morphol ; 22(3): 222-30, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23702646

RESUMEN

The diagnosis of pure neural leprosy (PNL) is based on clinical and laboratory data, including the histopathology of nerve biopsy specimens and detection of Mycobacterium leprae DNA by polymerase chain reaction (PCR). Given that histopathologic examination and PCR methods may not be sufficient to confirm the diagnosis, immunolabeling of lipoarabinomanan (LAM) and/or phenolic glycolipid 1 (PGL-1) M. leprae wall components was utilized in the present investigation in an attempt to detect any vestigial presence of M. leprae in acid-fast bacilli (AFB) nerve samples. Twenty-three PNL nerve samples (6 AFB and 17 AFBPCR) were cryosectioned and subjected to LAM and PGL-1 immunohistochemical staining by immunoperoxidase. Five nonleprosy nerve samples were used as controls. The 6 AFB samples showed LAM/PGL-1 immunoreactivity. Among the 17 AFB samples, 8 revealed LAM and/or PGL-1 immunoreactivity. In 17 AFBPCR patients, just 7 yielded LAM and/or PGL-1 nerve results. In the PNL cases, the detection of immunolabeled LAM and PGL-1 in the nerve samples would have contributed to an enhanced diagnostic efficiency in the absence of molecular diagnostic facilities.


Asunto(s)
Antígenos Bacterianos/metabolismo , ADN Bacteriano/análisis , Glucolípidos/metabolismo , Lepra Tuberculoide/diagnóstico , Lipopolisacáridos/metabolismo , Mycobacterium leprae/genética , Nervios Periféricos/metabolismo , Adolescente , Adulto , Anciano , Biopsia , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Nervios Periféricos/inmunología , Mejoramiento de la Calidad , Adulto Joven
18.
An Bras Dermatol ; 88(5): 787-92, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24173185

RESUMEN

A type 1 reaction or reversal reaction is expressed clinically by inflammatory exacerbation of the skin lesions and nerve trunks, consequently leading to sensory and motor alterations. It occurs in non-polar forms of leprosy, although it can occur in a small percentage of sub-polar LL treated patients. Disabilities, deformities and morbidity, still present in leprosy, are mainly caused by these acute episodes. The recognition of reactional states is imperative for an early approach and efficient management, to avoid the emergence of disabilities that stigmatize the disease. This review aims to describe the clinical aspects, immunopathogenesis, epidemiology, histopathological features and therapeutics of type 1 reactions.


Asunto(s)
Lepra Multibacilar , Lepra Paucibacilar , Corticoesteroides/uso terapéutico , Diagnóstico Precoz , Humanos , Leprostáticos/uso terapéutico , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Lepra Paucibacilar/tratamiento farmacológico , Lepra Paucibacilar/patología , Factores de Riesgo , Piel/patología
19.
An. bras. dermatol ; 88(5): 787-792, out. 2013. tab, graf
Artículo en Inglés | LILACS | ID: lil-689738

RESUMEN

A type 1 reaction or reversal reaction is expressed clinically by inflammatory exacerbation of the skin lesions and nerve trunks, consequently leading to sensory and motor alterations. It occurs in non-polar forms of leprosy, although it can occur in a small percentage of sub-polar LL treated patients. Disabilities, deformities and morbidity, still present in leprosy, are mainly caused by these acute episodes. The recognition of reactional states is imperative for an early approach and efficient management, to avoid the emergence of disabilities that stigmatize the disease. This review aims to describe the clinical aspects, immunopathogenesis, epidemiology, histopathological features and therapeutics of type 1 reactions.


A reação do tipo 1 ou reação reversa expressa-se clinicamente por uma exacerbação inflamatória das lesões de pele e de troncos nervosos, levando a alterações sensitivas e motoras. Ocorre nas formas não-polares da hanseníase, embora possa ocorrer numa pequena percentagem de pacientes LL tratados. As incapacidades físicas, deformidades e morbidade, ainda presentes na hanseníase, são causadas principalmente por esses episódios agudos. O reconhecimento dos estados reacionais é imperativo para uma abordagem precoce e manejo adequado, evitando a instalação de incapacidades que tanto estigmatizam a doença. Esta revisão tem como objetivo descrever aspectos clínicos, imunopatogênese, epidemiologia, características histopatológicas e terapêutica do estado reacional do tipo 1.


Asunto(s)
Humanos , Lepra Multibacilar , Lepra Paucibacilar , Corticoesteroides/uso terapéutico , Diagnóstico Precoz , Leprostáticos/uso terapéutico , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Lepra Paucibacilar/tratamiento farmacológico , Lepra Paucibacilar/patología , Factores de Riesgo , Piel/patología
20.
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
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA