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2.
Int J Dermatol ; 58(6): 729-732, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30345504

RESUMEN

INTRODUCTION: Leprosy is a chronic granulomatous disease caused by M. leprae. It is a great imitator as it can manifest in different unusual and atypical ways. Mid borderline leprosy (BB) is an unstable form representing the immunologic midpoint in the clinical spectrum. CASE REPORT: Here, we report a case of BB leprosy having classical inverted saucer-shaped lesions elsewhere on the body with a linear psoriasiform lesion over the left forearm following the lines of Blaschko. Biopsy from this lesion revealed granulomas consisting of equal admixture of epithelioid cells and macrophages without multinucleate giant cells suggesting mid borderline leprosy. CONCLUSION: Occurrence of lesions in a Blaschko linear pattern supports the role of genetic susceptibility to leprosy. The genetically vulnerable cells along the lines of Blaschko were infected while the surrounding cells remained unaffected. This explains the concept of locus minoris resistentiae due to cutaneous mosaicism.


Asunto(s)
Antibacterianos/uso terapéutico , Lepra Dimorfa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Biopsia , Quimioterapia Combinada/métodos , Humanos , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/patología , Masculino , Persona de Mediana Edad , Piel/microbiología , Piel/patología , Resultado del Tratamiento
4.
Acta Dermatovenerol Alp Pannonica Adriat ; 27(3): 149-151, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30244266

RESUMEN

Sparfloxacin is an antibiotic in the quinolone group of antibacterial agents, which often induce photosensitive skin reactions, more often phototoxic reactions than photoallergic ones, and sometimes associated photo-onycholysis. We present a case of phototoxic dermatitis with photo-onycholysis in a 38-year-old man probably induced by sparfloxacin, which was prescribed to him along with rifampicin and clofazimine because he was suffering from borderline lepromatous leprosy. He developed exaggerated sunburn-like eruptions mainly on sun-exposed sites along with painful onycholysis of the fingernails. Interestingly, the hypopigmented patches of leprosy were spared, which is a very rare phenomenon. Withdrawal of sparfloxacin along with administration of systemic steroids and other supportive measures helped heal the skin eruptions with hyperpigmentation, but the photo-onycholysis was slow to resolve.


Asunto(s)
Antiinfecciosos/efectos adversos , Dermatitis Fototóxica/etiología , Fluoroquinolonas/efectos adversos , Onicólisis/inducido químicamente , Adulto , Antiinfecciosos/administración & dosificación , Dermatitis Fototóxica/complicaciones , Dermatitis Fototóxica/tratamiento farmacológico , Fluoroquinolonas/administración & dosificación , Humanos , Lepra Dimorfa/tratamiento farmacológico , Masculino , Onicólisis/complicaciones , Onicólisis/tratamiento farmacológico
5.
Int J Mycobacteriol ; 7(1): 97-100, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29516895

RESUMEN

Type 2 leprosy reactions commonly known as erythema nodosum leprosum, but various clinical manifestations of type 2 leprosy reaction were exist. The highlight of this case series was to report various atypical clinical manifestations of type 2 leprosy reaction such as reactive perforating leprosy, erythema multiforme-like reaction, and sweet's syndrome (SS)-like reaction.


Asunto(s)
Eritema Nudoso/patología , Lepra Dimorfa/patología , Lepra Lepromatosa/patología , Síndrome de Sweet/patología , Adulto , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Masculino
6.
Am J Dermatopathol ; 40(3): 205-208, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28937434

RESUMEN

BACKGROUND: Dapsone hypersensitivity syndrome (DHS) is a rare, but potentially life-threatening reaction to dapsone. OBJECTIVE: Evaluation of immunological factors involved in the sparing of borderline-lepromatous (BL) leprosy patches by the severe exanthema related to DHS. METHODS: The authors describe a 19-year-old man with borderline-lepromatous leprosy with a recent diffuse rash, sparing only the hypochromic patches of leprosy, generalized lymphadenopathy, hepatomegaly, and jaundice 25 days after the start of multibacillary multidrug therapy. RESULTS: Laboratory testing was remarkable for leukocytosis with eosinophilia, atypical lymphocytosis, and elevated liver and canalicular enzymes. Immunohistopathology of the rash showed stronger expression of Th1 cytokines (IL1ß, TNFα, IFNγ, and iNOS), and limited expression of IL17, TGFb, IL4, and IL10. Whereas the hypochromic leprosy patches showed high expression of inflammatory cytokines IL1ß, TNFα, IFNγ, iNOS, and TGFß (Th1), and presented strong expression of IL17 and TGFß with no IL4 and IL10 expression, by the inflammatory infiltrate, characterizing a participation of Th17 response. CONCLUSION: Th17 response, coupled with the presence of subepidermal collagen band, seems to be directly related to the absence of DHS rash in these hypochromic leprosy patches.


Asunto(s)
Dapsona/efectos adversos , Síndrome de Hipersensibilidad a Medicamentos/inmunología , Leprostáticos/efectos adversos , Lepra Dimorfa/tratamiento farmacológico , Células Th17/inmunología , Síndrome de Hipersensibilidad a Medicamentos/etiología , Humanos , Lepra Dimorfa/inmunología , Masculino , Adulto Joven
7.
BMC Dermatol ; 17(1): 16, 2017 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-29262820

RESUMEN

BACKGROUND: Erythroderma is characterized by erythema and scaling affecting more than 90% of the body surface area. Inflammatory, neoplastic and, more rarely, infectious diseases may culminate with erythroderma. Diagnosis of the underlying disorder is therefore crucial to institute the appropriate therapy. Leprosy is a chronic infectious disease that is endemic in Brazil. Here we present an unusual case of leprosy and reversal reaction causing erythroderma, and we discuss the underlying immunological mechanisms which could contribute to the generalized skin inflammation. CASE PRESENTATION: We report a case of a patient with reversal reaction (RR) in borderline borderline leprosy presenting with erythroderma and neural disabilities. Histopathology of the skin showed regular acanthosis and spongiosis in the epidermis and, in the dermis, compact epithelioid granulomas as well as grouped and isolated bacilli. This duality probably reflects the transition from an anergic/multibacillary state to a state of more effective immunity and bacillary control, typical of RR. Leprosy was successfully treated with WHO's multidrug therapy, plus prednisone for controlling the RR; the erythroderma resolved in parallel with this treatment. Immunologic studies showed in situ predominance of IFNγ + over IL-4+ lymphocytes and of IL-17+ over Foxp3+ lymphocytes, suggesting an exacerbated Th-1/Th-17 immunoreactivity and poor Th-2 and regulatory T-cell responses. Circulating Tregs were also diminished. We hypothesize that the flare-up of anti-mycobacteria immunoreactivity that underlies RR may have triggered the intense inflammatory skin lesions that culminated with erythroderma. CONCLUSIONS: This case report highlights the importance of thorough clinical examination of erythrodermic patients in search for its etiology and suggests that an intense and probably uncontrolled leprosy RR can culminate in the development of erythroderma.


Asunto(s)
Dermatitis Exfoliativa/etiología , Lepra Dimorfa/complicaciones , Piel/patología , Antiinflamatorios/uso terapéutico , Biopsia , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/patología , Quimioterapia Combinada , Humanos , Interferón gamma/metabolismo , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/inmunología , Linfocitos/metabolismo , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Linfocitos T Reguladores/inmunología
8.
J Dtsch Dermatol Ges ; 15(8): 801-827, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28763601

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely. The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO-supported preventive measures and strategies play a key role in endemic areas.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Tuberculoide/diagnóstico , Lepra Tuberculoide/tratamiento farmacológico , Enfermedades Desatendidas , Adulto , Anciano , Niño , Clofazimina/efectos adversos , Clofazimina/uso terapéutico , Estudios Transversales , Dapsona/efectos adversos , Dapsona/uso terapéutico , Progresión de la Enfermedad , Esquema de Medicación , Femenino , Adhesión a Directriz , Humanos , Inmunidad Celular/efectos de los fármacos , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/epidemiología , Lepra Dimorfa/inmunología , Lepra Lepromatosa/epidemiología , Lepra Lepromatosa/inmunología , Lepra Tuberculoide/epidemiología , Lepra Tuberculoide/inmunología , Cuidados a Largo Plazo , Masculino , Rifampin/efectos adversos , Rifampin/uso terapéutico
10.
J Eur Acad Dermatol Venereol ; 31(4): 705-711, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27859670

RESUMEN

BACKGROUND: Leprosy reactions are immunologically mediated conditions and a major cause of disability before, during and after multidrug therapy (MDT). Little data have been published on the epidemiology of leprosy reactions in Bangladesh. OBJECTIVES: To describe the pattern and prevalence of leprosy reactions in the postelimination stage. METHODS: A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients in the period between 2004 and 2013. RESULTS: Of the 670 patients with leprosy, 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was in 300 (44.78%) patients with a male:female ratio of 3.55 : 1. The age-specific cumulative reaction cases at >40 years were 115 (38.33%) among all age groups. The prevalence of reaction was found to be in 166 (55.33%) patients for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum (ENL) and 85 (28.33%) for the neuritis. Borderline tuberculoid was most common (106, 35.33%)in the reversal reaction group, while lepromatous leprosy was most common (37, 12.33%) in ENL group. More than half of the patients (169, 56.33%) had reactions at the time of presentations, while 85 (28.33%) and 46 (15.33%) patients developed reaction during and after MDT, respectively. The reversal reaction group presented with ≥six skin lesions in 96 (57.83%) patients and ≥two nerve function impairments (NFIs) in 107 (64.46%) patients. The ENL was present chiefly as papulo-nodular lesions in 45 (91.84%) patients followed by pustule-necrotic lesions in four (8.16%), neuritis in 33 (67.35%), fever in 24 (48.98%), lymphadenitis in six (12.24%), arthritis in five (10.20%) and iritis in two (4.08%). Bacterial index ≥3 had been demonstrated in 34 (60.71%) patients in ENL group. CONCLUSION: The incidence of leprosy reaction seemed to be more than three times common in borderline tuberculoid (52.33%) group than in lepromatous leprosy (14%) group. Reactions with NFI and disability still occur among multibacillary patients during and after MDT. Early detection and management of leprosy reaction are very important in preventing disability and deformity, and patients should be educated to undergo regular follow-up examinations. Developing reinforced new therapies to curb leprosy reactions is crucial for improving leprosy healthcare services.


Asunto(s)
Eritema Nudoso/inmunología , Hipersensibilidad Retardada/complicaciones , Hipersensibilidad Retardada/epidemiología , Lepra/tratamiento farmacológico , Linfadenitis/inmunología , Neuritis/inmunología , Adolescente , Adulto , Antígenos Bacterianos/inmunología , Artritis/epidemiología , Artritis/inmunología , Bangladesh/epidemiología , Niño , Preescolar , Eritema Nudoso/epidemiología , Femenino , Humanos , Lactante , Iritis/epidemiología , Iritis/inmunología , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Tuberculoide/tratamiento farmacológico , Linfadenitis/epidemiología , Masculino , Neuritis/epidemiología , Prevalencia , Estudios Retrospectivos , Adulto Joven
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
14.
J Immigr Minor Health ; 18(2): 490-3, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26018958

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, characterized by a very long incubation period, confounding signs and symptoms and difficulty to establish the onset time. Considering the stigma associated with the diagnosis and the difficulties in detecting asymptomatic leprosy, the incidence and prevalence of this disease are underestimated. In Italy, leprosy is currently included among the rare diseases and can occur as an imported pathology in native individuals or extra-EU immigrants. Currently, given its exceptional appearance in Italy, leprosy is extremely difficult to recognize. In fact, the incomplete knowledge by the medical class of geographical epidemiology and aetiology of tropical diseases including leprosy, often delays the definitive diagnosis. Due to the increasing rate of the migration flows, in Italy and in Europe, leprosy should be considered among the differential diagnosis in patients with cutaneous and neurological signs, especially when originating from endemic countries.


Asunto(s)
Leprostáticos/administración & dosificación , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Adulto , Grupo de Ascendencia Continental Africana , Biopsia con Aguja , Progresión de la Enfermedad , Estudios de Seguimiento , Ghana/etnología , Humanos , Italia , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades Raras , Refugiados , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Organización Mundial de la Salud
15.
An Bras Dermatol ; 90(3 Suppl 1): 73-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26312679

RESUMEN

Leprosy is an easily recognizable disease due to its dermato-neurological manifestations. It must be present in the physician's diagnostic repertoire, especially for those working in endemic areas. However, leprosy reaction is not always easily recognized by non-dermatologists, becoming one of the major problems in the management of patients with leprosy, as it presents clinical complications characterized by inflammatory process, accompanied by pain, malaise and sometimes the establishment or worsening of the patient's disabilities. We report the case of a patient with type-1 periorbital reaction admitted to the hospital, diagnosed and treated as facial cellulitis, whose late diagnosis may have contributed to the appearance or worsening of facial neuritis.


Asunto(s)
Celulitis (Flemón)/diagnóstico , Dermatosis Facial/diagnóstico , Lepra Dimorfa/diagnóstico , Anciano , Biopsia , Diagnóstico Diferencial , Diagnóstico Precoz , Cara , Dermatosis Facial/tratamiento farmacológico , Humanos , Lepra Dimorfa/tratamiento farmacológico , Masculino , Factores de Tiempo , Resultado del Tratamiento
17.
Lepr Rev ; 86(1): 96-101, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26065152

RESUMEN

A 30 year old woman who presented with multiple numb patches on the body was initially diagnosed as borderline lepromatous leprosy and started on multidrug therapy for leprosy. She had an episode of Type 1 reaction during the fifth month of pregnancy. After delivery, she stopped therapy fearing harm to her child and developed an episode of Type 2 reaction. The reaction was unusual in that bullous lesions developed over previous leprosy patches which had initially become indurated, with associated neuritis. Histopathology revealed bullae with intense neutrophilic reaction and strong positivity for acid fast bacilli. There was no response to steroid therapy which was started for the reaction. Thalidomide had to be prescribed after stopping lactation by medical means. She responded dramatically to Thalidomide with regression of cutaneous lesions and neuritis. This patient is being reported as a very unusual manifestation of bullous erythema nodosum leprosum in the postpartum period responding dramatically to thalidomide.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Adulto , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Periodo Posparto , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/tratamiento farmacológico , Talidomida/uso terapéutico
18.
An. bras. dermatol ; 90(3,supl.1): 73-76, May-June 2015. ilus
Artículo en Inglés | LILACS | ID: lil-755749

RESUMEN

Abstract

Leprosy is aneasily recognizable disease due to its dermato-neurological manifestations. It must be present in the physician’s diagnostic repertoire, especially for those working in endemic areas. However, leprosy reaction is not always easily recognized by non-dermatologists, becoming one of the major problems in the management of patients with leprosy, as it presents clinical complications characterized by inflammatory process, accompanied by pain, malaise and sometimes the establishment or worsening of the patient’s disabilities. We report the case of a patient with type-1 periorbital reaction admitted to the hospital, diagnosed and treated as facial cellulitis, whose late diagnosis may have contributed to the appearance or worsening of facial neuritis.

.


Asunto(s)
Anciano , Humanos , Masculino , Celulitis (Flemón)/diagnóstico , Dermatosis Facial/diagnóstico , Lepra Dimorfa/diagnóstico , Biopsia , Diagnóstico Diferencial , Diagnóstico Precoz , Cara , Dermatosis Facial/tratamiento farmacológico , Lepra Dimorfa/tratamiento farmacológico , Factores de Tiempo , Resultado del Tratamiento
20.
Clin Dermatol ; 33(1): 26-37, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25432808

RESUMEN

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. It mainly affects the peripheral nervous system, skin, and certain other tissues such as the reticulo-endothelial system, bones and joints, mucous membranes, eyes, testes, muscles, and adrenals. Leprosy clinical presentation varies from few to widespread lesions. In most patients, early leprosy presents as macular and hypopigmented lesions. This initial clinical presentation is known as indeterminate leprosy and occurs in individuals who have not developed cell-mediated immunity against M. leprae yet. The number of lesions depends on the genetically determined cellular immunity of the patient. Individuals presenting a vigorous cellular immune response and limited humoral immune responses to M. leprae, usually present few skin lesions. Without treatment, those patients tend to evolve into the polar tuberculoid or borderline tuberculoid form of leprosy. Due to the inability to mount an effective cellular-mediated response to M. leprae and the consequent hematogenous spread of the bacilli, some patients may present with numerous and symmetrically distributed hypochromic lesions. Without treatment these patients evolve to a nonresistant form of leprosy, polar lepromatous.


Asunto(s)
Progresión de la Enfermedad , Leprostáticos/uso terapéutico , Lepra/mortalidad , Lepra/fisiopatología , Mycobacterium leprae/aislamiento & purificación , Brasil , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/fisiopatología , Femenino , Humanos , Lepra/tratamiento farmacológico , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/epidemiología , Lepra Dimorfa/fisiopatología , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/fisiopatología , Lepra Tuberculoide/inmunología , Lepra Tuberculoide/fisiopatología , Masculino , Monitoreo Fisiológico , Mycobacterium leprae/inmunología , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
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