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1.
Am J Case Rep ; 22: e931655, 2021 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-34038399

RESUMEN

BACKGROUND Leprosy is an infection caused by Mycobacterium leprae. An extensive literature search did not reveal many reports of melioidosis in association with leprosy. CASE REPORT A 22-year-old woman, who was diagnosed with multibacillary leprosy, developed dapsone-induced methemoglobinemia and hemolytic anemia, complicated by melioidosis. Methemoglobinemia was treated with methylene blue and vitamin C. Two weeks of ceftazidime was initiated to treat melioidosis, and the patient was discharged on amoxicillin/clavulanic acid and doxycycline as melioidosis eradication therapy. However, she developed drug-induced hypersensitivity. Trimethoprim/sulfamethoxazole, as an alternative treatment for melioidosis eradication, was commenced and was successfully completed for 12 weeks. During the fifth month of multidrug therapy, the patient developed type II lepra reaction with erythema nodosum leprosum reaction, which was treated with prednisolone. Leprosy treatment continued with clofazimine and ofloxacin, and complete resolution of skin lesions occurred after 12 months of therapy. CONCLUSIONS Our case highlighted the challenges posed in managing a patient with multibacillary leprosy with multiple complications. Clinicians should be aware that dapsone-induced methemoglobinemia and hemolysis might complicate the treatment of leprosy. Our case also highlighted the safety and efficacy of combining ofloxacin and clofazimine as a leprosy treatment regimen in addition to gradual steroid dose titration in the presence of type II lepra reaction.


Asunto(s)
Anemia Hemolítica , Lepra Lepromatosa , Melioidosis , Metahemoglobinemia , Adulto , Anemia Hemolítica/inducido químicamente , Anemia Hemolítica/tratamiento farmacológico , Dapsona/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Leprostáticos/efectos adversos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Metahemoglobinemia/inducido químicamente , Metahemoglobinemia/tratamiento farmacológico , Adulto Joven
3.
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
4.
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
5.
An Bras Dermatol ; 95(5): 652-654, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32651045

RESUMEN

Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.


Asunto(s)
Lepra Dimorfa , Lepra Lepromatosa , Lepra , Quimioterapia Combinada , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Persona de Mediana Edad , Mycobacterium leprae
8.
Fontilles, Rev. leprol ; 32(4): 239-246, ene.-abr. 2020. ilus
Artículo en Español | IBECS | ID: ibc-193429

RESUMEN

El Fenómeno de Lucio (FL), leprorreacción mediada por inmunocomplejos, se caracteriza por una reacción cutánea necrosante grave que ocurre en pacientes portadores de Lepra no nodular. 1 Muchos autores identifican como Fenómeno de Lucio a las reacciones vasculonecróticas que ocurren en formas distintas a la Lepra difusa. 2 Se presenta el caso clínico de un varón de 61 años de edad con una variante clínica de lepra lepromatosa difusa que desarrollo Fenómeno de Lucio ampollar, leprorreaccion considerada muy poco frecuente. Se realizo tratamiento con terapia multibacilar según esquema de la OMS con remisión de las lesiones


Lucio phenomenon (LF), a leprosy reaction mediated by immunocomplexes, is characterized by a severe necrotizing cutaneous reaction occurring in patients presenting non-nodular leprosy. 1 Many authors identify the vasculonecrotic reactions presenting in other forms of leprosy other than diffuse leprosy as Lucio phenomenon. 2 We present the clinical case of a 61-year-old male with a clinical variant of diffuse lepromatous leprosy who developed a bullous Lucio phenomenon, a very rare leprosy reaction. WHO advised multibacillary therapy (MDT) was prescribed and the lesions remitted


Asunto(s)
Humanos , Animales , Masculino , Persona de Mediana Edad , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Leprostáticos/uso terapéutico , Necrosis
9.
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
10.
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
11.
Dis Mon ; 66(7): 100919, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31796205

RESUMEN

BACKGROUND: Dapsone has been the mainstay for the treatment of leprosy since its discovery in the 1940s. However, hematological disturbances are not uncommon in leprosy patients on daily dapsone therapy. Hence, the present study was conducted to document the hematologic alterations observed in lepromatous leprosy patients treated with Dapsone 100 mg daily. METHODOLOGY: A cross-sectional observational study was conducted amongst 32 lepromatous leprosy patients treated with Dapsone 100 mg daily. A complete hemogram was conducted for all the study recruits. The test results were compared against the standard average values for adults for the given variables. The one sample t-test was employed to compare the difference between the study values and the standard normal values for adults. The statistical significance was considered at p < 0.05. RESULTS: The study reveals a marked decrease in hemoglobin concentration in patients on dapsone, 100 mg daily. Other hematological alterations found were reduced platelet count, reduced mean platelet volume, reduced Hematocrit, reduced Mean Corpuscular hemoglobin, reduced Mean Corpuscular hemoglobin concentration. (p < 0.05). CONCLUSION: Treatment of lepromatous leprosy with 100 mg daily Dapsone therapy may lead to hematological alterations. These findings are suggestive of dapsone-induced hemolysis.


Asunto(s)
Dapsona/efectos adversos , Hemoglobinas/efectos de los fármacos , Leprostáticos/efectos adversos , Lepra Lepromatosa/tratamiento farmacológico , Adulto , Estudios de Casos y Controles , Estudios Transversales , Dapsona/administración & dosificación , Dapsona/uso terapéutico , Índices de Eritrocitos/efectos de los fármacos , Femenino , Hematócrito/estadística & datos numéricos , Enfermedades Hematológicas/inducido químicamente , Enfermedades Hematológicas/patología , Hemólisis , Humanos , Incidencia , India/epidemiología , Leprostáticos/administración & dosificación , Leprostáticos/uso terapéutico , Lepra Lepromatosa/sangre , Lepra Lepromatosa/epidemiología , Masculino , Volúmen Plaquetario Medio/estadística & datos numéricos , Persona de Mediana Edad , Recuento de Plaquetas/estadística & datos numéricos , Índice de Severidad de la Enfermedad
12.
Clin Oral Investig ; 24(6): 1981-1986, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31435822

RESUMEN

OBJECTIVES: To clinically evaluate the oro-facial manifestations in lepromatous leprosy patients undergoing multidrug therapy in Central India. MATERIALS AND METHODS: Two hundred patients from 2 leprosy treatment centers in Central India who satisfied the diagnostic criteria set by the WHO (2006-2010) committee on leprosy were included in the study. To avoid bias, only patients who started the multi-drug treatment regimen less than 1 year ago were included. All the patients were examined for the presence of oral and facial manifestations. To confirm that the oro-facial manifestations were not due to HIV co-infection, serological diagnostic tests including ELISA, Immunocomb, and Tri-dot were performed. RESULTS: Majority of the patients (n = 189) exhibited oral (n = 145) and/or facial (n = 147) manifestations. The most common oral lesions were found to be fissuring and depapillation of the tongue followed by fibrosis and loss of uvula. Among the facial manifestations, facial skin lesions and loss of eyebrows were most prevalent followed by sagging of facial skin and facies leonine. CONCLUSION: The facial manifestations of leprosy are quite common, readily recognizable, and relatively specific to the disease. Thus, the presence of facial manifestations, especially with co-existing oral lesions must prompt the clinician to mandate further investigations to confirm the diagnosis. CLINICAL RELEVANCE: As evidenced by the present study, facial manifestations and oral lesions are an integral part of leprosy. In addition to being a diagnostic parameter, facial manifestations and oral lesions could potentially be used to monitor the disease progression and treatment outcome.


Asunto(s)
Cara , Lepra Lepromatosa , Boca , Estudios Transversales , Quimioterapia Combinada , Cara/patología , Humanos , India/epidemiología , Leprostáticos/uso terapéutico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/epidemiología , Boca/patología
15.
Biomedica ; 39(Supl. 2): 26-31, 2019 08 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31529831

RESUMEN

Patients with lepromatous leprosy that have received treatment for many years usually get follow up biopsies for persistent skin lesions or positive bacilloscopy even if the values are lower than in the initial bacilloscopy. We report the case of a 48-year old woman with long-standing lepromatous leprosy of 15 years of evolution, with a bacterial index of 4 in the direct smear and the initial skin biopsy. The patient was treated with multidrug therapy for 32 months although the treatment recommended by the World Health Organization (WHO) is only for 12 months. A skin biopsy was taken to determine if there was an active disease. We observed a diffuse dermal inflammation with numerous foreign body giant cells and vacuolated macrophages (Virchow´s cells). These cells contained granular acid-fast material that was also positive with immunohistochemistry for BCG. There were fragmented bacilli and the BI was 2. These cells were also strongly positive for CD68. The biopsy was interpreted as a residual form of lepromatous leprosy that did not require further multidrug therapy. We have observed similar histological profiles in several cases. The lack of clinical data makes it a histological challenge. The accumulation of lipids in these giant cells is due to bacillary destruction and fusion of vacuolated macrophages. We discuss here the role of bacillary and host lipids in the pathogenesis of lepromatous leprosy. We concluded that there was no need to extend the 12-month multidrug therapy recommended by WHO.


Asunto(s)
Células Espumosas/patología , Células Gigantes de Cuerpo Extraño/patología , Lepra Lepromatosa/patología , Piel/patología , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Biopsia , Pared Celular/química , Quimioterapia Combinada , Femenino , Células Espumosas/química , Células Espumosas/microbiología , Células Gigantes de Cuerpo Extraño/química , Células Gigantes de Cuerpo Extraño/microbiología , Interacciones Huésped-Patógeno , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Lípidos/análisis , Persona de Mediana Edad , Mycobacterium leprae/química , Mycobacterium leprae/aislamiento & purificación , Piel/microbiología , Vacuolas
16.
PLoS Negl Trop Dis ; 13(8): e0007684, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31425515

RESUMEN

Neuritis is a frequent complication of Myocobacteria leprae infection and treatment due to the variety of mechanisms through which it can occur. Not only can mycobacterial invasion into peripheral nerves directly cause damage and inflammation, but immune-mediated inflammatory episodes (termed leprosy reactions) can also manifest as neuritis at any point during infection. Treatment of leprosy reactions with thalidomide can also lead to neuritis due to an adverse drug effect. Neuritis can emerge years after initial diagnosis and treatment, although it is most frequently found at time of diagnosis or early into the treatment course. Treatment of neuritis is dependent on high-dose corticosteroid therapy as well as therapy for suspected underlying etiology. Here, we present a case of ulnar neuritis presenting in a patient with lepromatous leprosy four years after treatment of initial infection, with subsequent improvement after corticosteroid burst while maintained on thalidomide therapy.


Asunto(s)
Corticoesteroides/administración & dosificación , Antiinflamatorios/administración & dosificación , Leprostáticos/administración & dosificación , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Talidomida/administración & dosificación , Neuropatías Cubitales/diagnóstico , Adulto , Humanos , Masculino , Resultado del Tratamiento , Neuropatías Cubitales/tratamiento farmacológico , Neuropatías Cubitales/patología
17.
BMJ Case Rep ; 12(6)2019 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-31256049

RESUMEN

Leprosy is a chronic infectious, granulomatous disease caused by the intracellular bacillus Mycobacterium leprae that infects macrophages and Schwann cells. While relatively rare in the USA, there is about 200 new cases of leprosy every year with the majority occurring in the southern parts of the country. It is believed to be linked to the region of the nine-banned armadillo in patients with no significant travel history outside of the country. In this case report, we encountered a 58-year-old Central Florida man that had extensive exposure to armadillos and presented with the typical symptoms of large erythaematous patches, numbness and peripheral nerve hypertrophy. Once diagnosed properly, patients are then reported to the National Hansen's Centre who provides the multidrug therapy for 12-24 months. Due to its rarity and its ability to mimic other more common ailments, leprosy should be included in the differential diagnosis in patients that have significant exposure to armadillos, live in the southern part of the country or have recently travelled to countries that have a high prevalence of leprosy.


Asunto(s)
Armadillos/microbiología , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Animales , Diagnóstico Diferencial , Florida , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Rifampin/uso terapéutico
18.
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
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