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3.
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
4.
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
5.
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
6.
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
9.
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
12.
J Assoc Physicians India ; 66(4): 63-6, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-30347957

RESUMEN

A 30-year old male presented with fever for last 1 year. There were associated multiple painful skin eruptions with hyperpigmentation and scaling over whole body which had been progressively increasing. He also had anasarca along with generalized weakness. He presented to us in shock after an acute episode of gastroenteritis. After stabilization, he was evaluated for cause of fever. Routine fever workup (for typhoid, syphilis, malaria, filariasis, HIV, scrub typhus, leishmaniasis) was negative. CECT chest and abdomen revealed hepatosplenomegaly. There was no response to intravenous (IV) antibiotics and anti-fungal medications. Slit skin smears revealed 3+ acid fast bacilli (AFB). Skin biopsy revealed fragmented acid-fast bacilli with dense collection of neutrophils and foamy histiocytes in upper and middle dermis suggestive of Erythema Nodosum Leprosum (ENL). A diagnosis of ENL with lepromatous leprosy was made and patient started on steroids and thalidomide and subsequently on multidrug therapy (MDT). On therapy, patient's symptoms improved, and skin lesions resolved. Though Leprosy itself is a well-known common cause of PUO in India, its first presentation as ENL is rare and needs good index of suspicion and timely management.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Adulto , Quimioterapia Combinada , Eritema Nudoso/complicaciones , Eritema Nudoso/tratamiento farmacológico , Fiebre/diagnóstico , Humanos , India , Leprostáticos/uso terapéutico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Masculino
14.
An Bras Dermatol ; 93(2): 181-184, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29723371

RESUMEN

BACKGROUND: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. OBJECTIVE: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. METHOD: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. RESULTS: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. STUDY LIMITATIONS: Small number of patients.. CONCLUSION: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/microbiología , Masculino , Neuritis/microbiología , Recurrencia , Retratamiento , Factores de Tiempo , Resultado del Tratamiento
16.
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
17.
An. bras. dermatol ; 93(2): 181-184, Mar.-Apr. 2018. graf
Artículo en Inglés | LILACS | ID: biblio-887190

RESUMEN

Abstract: Background: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. Objective: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. Method: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. Results: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. Study limitations: Small number of patients.. Conclusion: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Humanos , Masculino , Femenino , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Recurrencia , Factores de Tiempo , Lepra Lepromatosa/microbiología , Resultado del Tratamiento , Retratamiento , Eritema Nudoso/microbiología , Lepra Multibacilar/microbiología , Leprostáticos/uso terapéutico , Neuritis/microbiología
18.
Acta Trop ; 183: 134-141, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29474830

RESUMEN

Erythema Nodosum Leprosum (ENL) occurs due to the immunological complication of multibacillary leprosy and is characterized by painful nodules and systemic compromising. It is usually recurrent and/or chronic and has both physical and economic impact on the patient, being a very important cause of disability. In addition, ENL is a major health problem in countries where leprosy is endemic. Therefore, adequate control of this condition is important. The management of ENL aims to control acute inflammation and neuritis and prevent the onset of new episodes. However, all currently available treatment modalities have one or two drawbacks and are not effective for all patients. Corticosteroid is the anti-inflammatory of choice in ENL but may cause dependence, especially for chronic patients. Thalidomide has a rapid action but its use is limited due the teratogenicity and neurotoxicity. Clofazimine and pentoxifylline have slow action and have important adverse effects. Finally, there is no pattern or guidelines for treating these patients, becoming more difficult to evaluate and to control this condition. This review aims to show the main drugs used in the treatment of ENL and the challenges in the management of the reaction.


Asunto(s)
Antiinflamatorios/uso terapéutico , Eritema Nudoso/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Pentoxifilina/uso terapéutico , Talidomida/uso terapéutico , Eritema Nudoso/inmunología , Humanos , Inflamación , Lepra Lepromatosa/inmunología , Enfermedades Desatendidas/tratamiento farmacológico , Recurrencia , Inducción de Remisión , Resultado del Tratamiento
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