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1.
Int J Infect Dis ; 103: 549-551, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33326870

RESUMEN

Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.


Asunto(s)
Corticoesteroides/administración & dosificación , Eritema Nudoso/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Metotrexato/administración & dosificación , Adulto , Eritema Nudoso/inmunología , Humanos , Lepra Lepromatosa/inmunología , Masculino
2.
PLoS Negl Trop Dis ; 14(8): e0008329, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760161

RESUMEN

The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.


Asunto(s)
Lepra/tratamiento farmacológico , Talidomida/efectos adversos , Talidomida/uso terapéutico , Anomalías Inducidas por Medicamentos/epidemiología , Brasil/epidemiología , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Leprostáticos/efectos adversos , Leprostáticos/uso terapéutico , Lepra/epidemiología , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Embarazo
4.
Am J Trop Med Hyg ; 103(4): 1439-1440, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32700675

RESUMEN

Leprosy is a rare, chronic granulomatous disease, and India accounts for two-thirds of the new cases reported worldwide. Hypercalcemia is a rare complication of granulomatous disease. Here, we report a case of an older adult patient with leprosy and type I lepra reaction presenting with severe hypercalcemia.


Asunto(s)
Hipercalcemia , Lepra/complicaciones , Anciano , Eritema Nudoso/tratamiento farmacológico , Humanos , Hipercalcemia/complicaciones , Hipercalcemia/tratamiento farmacológico , India , Leprostáticos/uso terapéutico , Masculino
8.
Immunohorizons ; 4(2): 47-56, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32034084

RESUMEN

Erythema nodosum leprosum (ENL) is an inflammatory complication in leprosy. Yet, the involvement of ENL neutrophils in the inflammatory response against Mycobacterium leprae remains poorly explored. Our primary aim was to investigate the utility of the surface expression of neutrophil IL-10R1 as an ENL biomarker and, secondarily, to evaluate whether leprosy or healthy M. leprae-stimulated neutrophils produce cytokines and are able to respond to IL-10. We, in this study, describe a subpopulation of circulating neutrophils of ENL patients that exclusively expressed IL-10R1, providing evidence that IL-10R1+ neutrophils are present in ENL lesions. It was also found that ENL neutrophils, but not those of nonreactional leprosy controls, were able to secret detectable levels of TNF ex vivo and the addition of IL-10 blocked TNF release. It was likewise observed that M. leprae-stimulated, healthy neutrophils expressed IL-10R1 in vitro, and ENL-linked cytokines were released by M. leprae-cultured neutrophils in vitro. Moreover, consistent with the presence of a fully functional IL-10R, the addition of IL-10 prevented the release of M. leprae-induced cytokines. Most importantly, dead M. leprae revealed its superior capacity to induce CCL4 and IL-8 in primary neutrophils over live Mycobacterium, suggesting that M. leprae may hamper the inflammatory machinery as an immune escape mechanism.


Asunto(s)
Eritema Nudoso/inmunología , Subunidad alfa del Receptor de Interleucina-10/metabolismo , Interleucina-10/farmacología , Lepra Lepromatosa/inmunología , Neutrófilos/metabolismo , Piel/inmunología , Adulto , Células Cultivadas , Citocinas/metabolismo , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Mediadores de Inflamación/metabolismo , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Infiltración Neutrófila/efectos de los fármacos , Neutrófilos/efectos de los fármacos , Neutrófilos/microbiología , Talidomida/uso terapéutico , Adulto Joven
9.
Diagn Microbiol Infect Dis ; 96(4): 114984, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31954594

RESUMEN

Simple measures that can facilitate early recognition of leprosy complications are still lacking. We therefore evaluated a lateral flow-based rapid diagnostic test and fast enzyme-linked immunosorbent assay measuring anti-LID-NDO antibody responses among leprosy cases in Cebu, Philippines. Responses were measured at diagnosis, then during and after the provision of standard multidrug therapy. Our data indicate that both platforms are highly sensitive tools for the primary diagnosis of, in particular, multibacillary leprosy. A gradual, quantifiable decline in both magnitude of response and percent positive responders was observed during and after treatment. As a group, patients that developed erythema nodosum leprosum (ENL) had a significantly higher response at diagnosis than patients that either developed reversal reactions or did not develop reactions. Although higher initial anti-NDO-LID responses were a risk factor for ENL, neither platform, however, could reliably predict the time of emergence of reactional episodes.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Leprostáticos/uso terapéutico , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Mycobacterium leprae/efectos de los fármacos , Adulto , Quimioterapia Combinada , Ensayo de Inmunoadsorción Enzimática/normas , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Inmunoensayo , Inmunoglobulina M/sangre , Lepra/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/tratamiento farmacológico , Estudios Longitudinales , Masculino , Filipinas , Pruebas Serológicas
12.
Pharmacogenomics ; 20(7): 503-516, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31124417

RESUMEN

Aim: To evaluate the effects of gene polymorphisms in the treatment of erythema nodosum leprosum with prednisone/thalidomide. Patients & methods: A total of 152 patients from different regions of Brazil were included. Generalized estimating equation was used to evaluate the influence of polymorphisms and haplotypes on the drug dose variation throughout the treatment. Results: An association between the genotype tuberculoid of polymorphism ABCB1 3435C>T (rs1045642; p = 0.02) and prednisone dose was found in the recessive model. An association between the haplotypes 1031T/-863C/-857C/-308A/-238G (p = 0.006) and 1031T/-863C/-857T/-308A/-238G (p = 0.040) of the TNF gene and the CYP2C19*2 polymorphism were also identified, in relation to thalidomide dosage variation over the course of treatment. Conclusion: This work presents the first pharmacogenetic report of association between gene polymorphisms and erythema nodosum leprosum treatment with prednisone/thalidomide.


Asunto(s)
Citocromo P-450 CYP2C19/genética , Eritema Nudoso/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/genética , Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Adulto , Brasil/epidemiología , Relación Dosis-Respuesta a Droga , Eritema Nudoso/genética , Eritema Nudoso/patología , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Haplotipos/genética , Humanos , Masculino , Polimorfismo Genético , Prednisona/administración & dosificación , Prednisona/efectos adversos , Receptores de Glucocorticoides/genética , Talidomida/administración & dosificación , Talidomida/efectos adversos
14.
Indian J Pharmacol ; 51(1): 72-74, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31031470

RESUMEN

The distressing consequences of immunology in leprosy is the lepra reaction. Erythema nodosum leprosum(ENL) in special cases need to be managed with capsule thalidomide in varying doses. We report such a case of bradycardia in thalidomide dose dependent manner in a young ENL male.


Asunto(s)
Bradicardia/inducido químicamente , Eritema Nudoso/tratamiento farmacológico , Leprostáticos/efectos adversos , Lepra Lepromatosa/tratamiento farmacológico , Talidomida/efectos adversos , Adulto , Relación Dosis-Respuesta a Droga , Humanos , Leprostáticos/administración & dosificación , Masculino , Talidomida/administración & dosificación , Adulto Joven
17.
PLoS One ; 14(1): e0210436, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30682031

RESUMEN

BACKGROUND/AIMS: Extraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients. METHODS: We included 3266 SIBDCs patients, 1840 with Crohn's disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM). RESULTS: 354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients. CONCLUSION: Our results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.


Asunto(s)
Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/complicaciones , Eritema Nudoso/diagnóstico , Piodermia Gangrenosa/diagnóstico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/etiología , Factores de Riesgo , Factores Sexuales , Suiza , Adulto Joven
19.
Dermatology ; 235(2): 137-143, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30463069

RESUMEN

OBJECTIVES: Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. METHODS: The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. RESULTS: KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. CONCLUSIONS: Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.


Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Yoduro de Potasio/uso terapéutico , Sarcoidosis/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Adolescente , Adulto , Anciano , Dermatitis Perioral/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Femenino , Granuloma Anular/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Necrobiosis Lipoidea/tratamiento farmacológico , Estudios Retrospectivos , Rosácea/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Vasculitis/tratamiento farmacológico , Adulto Joven
20.
Int J Mycobacteriol ; 7(4): 390-393, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30531041

RESUMEN

Leprosy or Hansen's disease is a chronic infectious granulomatous disease with varied presentation, especially in the setting of lepra reactions. We report two such atypical presentations each of Type I and Type II Lepra reactions; the first being an elderly male presenting with fever, while the second case being of a young boy being evaluated for cervical lymphadenitis.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Piel/patología , Adolescente , Artritis Reumatoide/diagnóstico , Biopsia , Diagnóstico Diferencial , Eritema Nudoso/tratamiento farmacológico , Fiebre/etiología , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Piel/microbiología , Tuberculosis Ganglionar/diagnóstico
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