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2.
BMC Infect Dis ; 19(1): 1013, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783808

RESUMEN

BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. CASES PRESENTATION: We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. CONCLUSIONS: This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.


Asunto(s)
Lepra Multibacilar/diagnóstico , Úlcera Cutánea/diagnóstico , Adolescente , Adulto , Anciano , Errores Diagnósticos , Humanos , Leprostáticos , Lepra Multibacilar/complicaciones , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Piel/patología , Úlcera Cutánea/complicaciones
3.
BMC Infect Dis ; 19(1): 753, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462296

RESUMEN

BACKGROUND: Leprosy continues to be a health problem in endemic areas. More than 200,000 new cases of leprosy per year suggest that transmission of the disease is still ongoing, presumably as airborne infection through nasal droplets. Late diagnosis supports continued transmission and increases the individual risk for functional disabilities. Laboratory tools are considered beneficial to facilitate early detection and clinical assessment of cases. The aim of this study was to validate molecular tools allowing detection, quantification and assessment of viability of M. leprae from nasal swab samples which are easy to obtain without the need of any invasive procedures. METHODS: Validation of two real-time PCRs detecting M. leprae DNA (RLEP qPCR) and RNA (16S rRNA RT qPCR) was conducted on "must not detect"/"must detect" samples and 160 pre-treatment nasal swab samples from 20 clinically diagnosed multibacillary (MB) leprosy patients from Togo. RESULTS: Both assays were 100% M. leprae specific and showed analytical sensitivities of three templates each. Out of 20 clinically diagnosed MB leprosy patients, 15 (75.0%) had a positive RLEP qPCR result from nasal swab samples. The 16S rRNA RT qPCR detected viable bacilli in nasal swab samples of ten out of these 15 RLEP positive patients (66.7%). CONCLUSION: The combined RLEP/16S rRNA (RT) qPCR assay provides a sensitive and specific tool to determine the bacterial load and viability of M. leprae from nasal swab samples and is applicable for early diagnosis, monitoring treatment response and investigating the role of nasal carriage of M. leprae in human-to-human transmission through aerosol infection.


Asunto(s)
Lepra/microbiología , Mycobacterium leprae/genética , Cavidad Nasal/microbiología , ARN Ribosómico 16S , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , ADN Bacteriano/genética , Humanos , Lepra/diagnóstico , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/microbiología , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Mycobacterium leprae/patogenicidad , ARN Ribosómico 16S/genética , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Togo , Adulto Joven
4.
Fontilles, Rev. leprol ; 32(2): 67-73, mayo-ago. 2019. ilus
Artículo en Español | IBECS | ID: ibc-187210

RESUMEN

Dentro de los diagnósticos diferenciales de la lepra tuberculoide se citan la Sífilis secundaria, Tiña corporis, Granuloma anular, tuberculosis cutánea, entre otros. La sífilis es una enfermedad infectocontagiosa, sistémica, de transmisión predominantemente sexual, que en su larga evolución no interrumpida por tratamientos transcurre por dos periodos contrapuestos entre sí. Se trata de una paciente blanca, femenina, de 19 años, con antecedentes de salud, antecedente de ser contacto intradomiciliarios de primer orden de un paciente multibacilar, que acude a consulta de Dermatología por presentar lesiones desde hace varias semanas, las cuales describe como "empeines", que no pican ni causan molestias, que empezaban como "picazos de mosquito" y crecían paulatinamente. Unido a esto a presentó fiebre vespertina, cansancio, malestar general y cefalea, que las relacionó con la incubación de un proceso catarral. Durante el interrogatorio se recoge el antecedente que hace aproximadamente 5 meses presentó una lesión genital en forma de un "peladito" que desapareció sola y que su esposo también presentó una lesión genital similar antes que ella, que según refiere en su área de salud fue interpretado como tiña corporis por lo que habían iniciado tratamiento tópico con ketoconazol desde hacía una semana. Al examen dermatológico se constata cuadro diseminado constituido por lesiones anulares, con zona central de color más oscuro, con bordes bien definidos, papulosos, que en algunos se constatan costras hemáticas pequeñas, con diámetros que oscilan entre uno y cuatro centímetros, en número de menos de una decena, distribuidas en cara, V del escote, región proximal de los miembros. En la sífilis temprana, después que transcurre el período de segunda incubación y como tempestad en cielo despejado aparecen las manifestaciones del secundarismo sifilítico con lesiones en piel, mucosas, anejos y toma sistémica


Among the differential diagnoses of tuberculoid leprosy are among others, secondary syphilis, tinea corporis, granuloma annulare and cutaneous tuberculosis. Syphilis is an infectious, contagious, systemic disease of predominantly sexual transmission, which in its long evolution if not treated evolves through two periods opposed to each other. Here we describe the case of a 19-year-old white female patient with a history of health problems and a close contact of a multibacillary patient, who came to the Dermatology Department presenting lesions of several weeks of evolution, which she describes as "eczema", which do not sting or cause discomfort, and started as "mosquito bites" which gradually grew. In addition to this, she presented afternoon fever, fatigue, malaise and headache, which she related to the incubation of a catarrhal process. During the medical interview, she related that approximately 5 months ago she noticed a genital lesion she described as a "little problem" that disappeared alone and that before her husband already had presented a similar genital lesion that at her health center was diagnosed as tinea corporis and was prescribed topical treatment with ketoconazole for a week. The dermatological examination revealed a disseminated picture constituted by annular lesions, with a darker central area, with well-defined, papular edges, which in some cases showed small blood scabs. The diameters of the lesions, less than a dozen, ranging from one to four centimeters disseminated around the face, V of the neckline and proximal region of the limbs. In early syphilis, after the second incubation period and in form of a "clear-sky storm", the secondary syphilitic symptoms appear with lesions on the skin, mucous membranes, appendices and systemic dissemination


Asunto(s)
Humanos , Femenino , Adulto Joven , Lepra Tuberculoide/diagnóstico , Lepra Multibacilar/diagnóstico , Sífilis/diagnóstico , Diagnóstico Diferencial , Trazado de Contacto
5.
Int J Dermatol ; 58(12): 1415-1422, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31148144

RESUMEN

BACKGROUND: Dermatological diseases have a negative impact on quality of life (QoL), affecting mental and physical health. Leprosy patients usually present with a worse QoL compared with those affected by other conditions. Reactions, neural damage, and pain are some of the consequences that contribute to the lower QoL. However, due to the wide spectrum of the disease, symptoms vary according to leprosy's subtype. This study aimed to compare the QoL between paucibacillary and multibacillary leprosy patients. Individuals were also compared considering the presence of reactions and a correlation between questionnaires was performed. METHODS: A total of 104 patients with leprosy aged 18 years old and over were selected. QoL was assessed by the Brazilian-Portuguese validated versions of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the Dermatology Life Quality Life Index (DLQI). RESULTS: Multibacillary patients showed a more impaired physical function, worse bodily pain, lower score of SF-36, and higher interference of skin on the performance of daily activities when compared to the paucibacillary group. Individuals without reactions presented lower bodily pain and less effect of the skin on clothing choices compared to those with reactions. The SF-36 domains exhibited weak correlations with most DLQI questions, and the linear regression model showed that 32% of changes in QoL were related to the skin aspect. CONCLUSIONS: Multibacillary leprosy patients have a worse QoL when compared to paucibacillary patients. Reactions played a small role in the QoL of our cohort of patients.


Asunto(s)
Lepra Multibacilar/psicología , Lepra Paucibacilar/psicología , Dolor/psicología , Calidad de Vida , Adulto , Brasil , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Lepra Multibacilar/complicaciones , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/microbiología , Lepra Paucibacilar/complicaciones , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Dolor/diagnóstico , Dolor/etiología , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Piel/microbiología , Piel/patología
6.
Int J Mycobacteriol ; 8(2): 208-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31210170

RESUMEN

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/microbiología , Lepra Lepromatosa/microbiología , Lepra Multibacilar/diagnóstico , Adulto , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Masculino , Piel/microbiología , Piel/patología
8.
Am J Trop Med Hyg ; 100(5): 1145-1148, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30915953

RESUMEN

Type 1 reactions, characterized by increasing lesion erythema, pain, and nerve damage, commonly complicate leprosy. Dapsone hypersensitivity syndrome (DHS) is a potentially fatal reaction occurring 6-8 weeks into dapsone therapy. We present a case of intercurrent Type 1 reaction and DHS in a multibacillary leprosy patient recently started on multidrug treatment.


Asunto(s)
Dapsona/efectos adversos , Hipersensibilidad a las Drogas/complicaciones , Leprostáticos/efectos adversos , Lepra Multibacilar/complicaciones , Lepra Multibacilar/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Humanos , Lepra Multibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium leprae , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/microbiología , Centros de Atención Terciaria , Resultado del Tratamiento
9.
J. bras. nefrol ; 41(1): 152-156, Jan.-Mar. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1002430

RESUMEN

ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.


RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.


Asunto(s)
Humanos , Persona de Mediana Edad , Complemento C3/metabolismo , Lepra Multibacilar/diagnóstico , Lesión Renal Aguda/diagnóstico , Glomerulonefritis por IGA/diagnóstico , Rifampin/uso terapéutico , Biopsia , Nitrógeno de la Urea Sanguínea , Técnica del Anticuerpo Fluorescente , Clofazimina/uso terapéutico , Creatinina/sangre , Dapsona/uso terapéutico , Diagnóstico Diferencial , Lesión Renal Aguda/tratamiento farmacológico , Glomerulonefritis por IGA/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico
10.
BMC Infect Dis ; 19(1): 22, 2019 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-30616580

RESUMEN

BACKGROUND: Early detection of leprosy and multidrug therapy are crucial to achieve zero transmission and zero grade II incapacities goals of World Health Organization. Leprosy is difficult to diagnose because clinical forms vary and there are no gold standard methods to guide clinicians. The serological rapid tests aid the clinical diagnosis and are available for field use. They are easy to perform, do not require special equipment or refrigeration and are cheaper than the molecular tests. METHODS: We evaluated the performance of two rapid serological tests (PGL1 and NDO-LID) in the discrimination of leprosy cases from healthy individuals at the Alfredo da Matta Foundation, a reference center for the disease in Manaus, Amazonas, Brazil. PGL1 and NDO-LID rapid tests are capable of detecting specific antibodies of M. leprae, IgM and IgM/IgG, respectively. A total of 530 healthy subjects and 171 patients (50 with paucibacillary and 121 multibacillary leprosy) were included in the study. RESULTS: Among the paucibacillary leprosy patients, the sensitivity was 34.0 and 32.0% for the NDO-LID and PGL1, respectively. In multibacillary leprosy patients, the NDO-LID sensitivity was 73.6% and the PGL1 was 81.0%. Serological tests demonstrated specificities of 75.9% for PGL-1 and 81.7% for NDO-LID. The positive predictive value (PPV), negative predictive value (NPV) and accuracy in multibacillary patients were 47.9, 93.1, and 80.2% respectively for the NDO-LID, and 43.4, 94.6 76.8% for PGL1. CONCLUSIONS: The tests showed limited capacity in the diagnosis of the disease, however, the high negative predictive value of the tests indicates a greater chance of true negatives in this group favoring exclusion of leprosy. This characteristic of the ML flow test is important in aiding clinical Diagnosis, especially in a region endemic to the disease and with other confounding skin conditions.


Asunto(s)
Antígenos Bacterianos/inmunología , Glucolípidos/inmunología , Lepra/diagnóstico , Pruebas Serológicas/métodos , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Brasil , Estudios de Casos y Controles , Niño , Diagnóstico Precoz , Femenino , Humanos , Lepra/sangre , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Sensibilidad y Especificidad
12.
J Bras Nefrol ; 41(1): 152-156, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30160772

RESUMEN

Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Complemento C3/metabolismo , Glomerulonefritis por IGA/diagnóstico , Inmunoglobulina A/metabolismo , Lepra Multibacilar/diagnóstico , Lesión Renal Aguda/tratamiento farmacológico , Biopsia , Nitrógeno de la Urea Sanguínea , Clofazimina/uso terapéutico , Creatinina/sangre , Dapsona/uso terapéutico , Diagnóstico Diferencial , Femenino , Técnica del Anticuerpo Fluorescente , Glomerulonefritis por IGA/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Riñón/patología , Leprostáticos/uso terapéutico , Persona de Mediana Edad , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Diálisis Renal , Rifampin/uso terapéutico , Resultado del Tratamiento
16.
Rev Inst Med Trop Sao Paulo ; 60: e67, 2018 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-30427402

RESUMEN

Leprosy remains a public health problem in Brazil, and the Mato Grosso do Sul State (MS) had the seventh highest rate of detection of new cases in the country in 2015 (26.59 per 100,000 inhabitants) which was classified as very high. This work aimed to determine the epidemiological characteristics of leprosy in MS. Descriptive statistics were performed with data from the Information System on Diseases of Compulsory Declaration (SINAN) between 2001 and 2015, with all patients included in the system serving as the sample. Clinical forms of multibacillary (MB) leprosy predominated in MS during the study period, with a clear positive trend from 2009 to 2015 and a peak in the detection rate of new cases (NCDR) in 2014 corresponding to 40.39 per 100,000 population (p<0.001). The most affected groups were men (56.7%) aged 20-59 years (70.52%), an economically active population. We observed that Northern MS had the highest overall NCDR in the State. In cities bordering other countries, NCDRs were significantly lower than in those of other analyzed cities. There was no dependency ratio correlating NCDRs in cities with higher or lower indexes with basic care coverage (p=0.799) and human development index (p=0.887). In conclusion, the large number of patients with MB leprosy indicates that the diagnosis of leprosy is delayed in MS, perhaps due to difficulties related to diagnostic methods. This situation contributes to the continuing prevalence of leprosy in MS.


Asunto(s)
Lepra Multibacilar/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Diagnóstico Tardío , Métodos Epidemiológicos , Femenino , Humanos , Lactante , Recién Nacido , Lepra Multibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Adulto Joven
19.
An Bras Dermatol ; 93(3): 460-461, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29924248

RESUMEN

Leprosy patients can present reactions during the course of the disease. There are no official data on these reactions in Brazil. We aimed to describe the epidemiological characteristics of patients with such reactions, analyzing information from patient records at a referral center in Campinas (SP), from 2010 to 2015.


Asunto(s)
Lepra/epidemiología , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Lepra/diagnóstico , Lepra Multibacilar/diagnóstico , Masculino , Persona de Mediana Edad
20.
An. bras. dermatol ; 93(3): 460-461, May-June 2018. graf
Artículo en Inglés | LILACS | ID: biblio-1038272

RESUMEN

Abstract: Leprosy patients can present reactions during the course of the disease. There are no official data on these reactions in Brazil. We aimed to describe the epidemiological characteristics of patients with such reactions, analyzing information from patient records at a referral center in Campinas (SP), from 2010 to 2015.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Lepra/epidemiología , Brasil/epidemiología , Estudios Transversales , Lepra Multibacilar/diagnóstico , Lepra/diagnóstico
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