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1.
PLoS Negl Trop Dis ; 13(10): e0007713, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31603913

RESUMEN

Few investigations to date have analyzed the epidemiology of Hansen's disease (leprosy) in the United States, and in particular, if birth location is related to multibacillary versus paucibacillary leprosy. We collected data on 123 patients diagnosed with leprosy in Georgia from the National Hansen's Disease Program from 1923-January 2018. A logistic regression model was built to examine the relationship between country of origin (U.S.-born or immigrant) and the type of leprosy. While the model showed no significant relationship between country of origin and type of leprosy, being Asian or Pacific Islander was associated with a higher odds of multibacillary disease (aOR = 5.71; 95% CI: 1.25-26.29). Furthermore, since the early 1900s, we found an increasing trend of leprosy reports in Georgia among both domestic born and immigrant residents, despite the overall decrease in cases in the United States during the same time period. More research is therefore necessary to further evaluate risk for multibacillary leprosy in certain populations and to create targeted interventions and prevention strategies.


Asunto(s)
Lepra/epidemiología , Lepra/historia , Emigrantes e Inmigrantes , Grupos Étnicos , Femenino , Georgia/epidemiología , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lepra/prevención & control , Lepra Multibacilar/epidemiología , Lepra Multibacilar/historia , Lepra Multibacilar/prevención & control , Lepra Paucibacilar/epidemiología , Lepra Paucibacilar/historia , Lepra Paucibacilar/prevención & control , Masculino , Estados Unidos
2.
Enferm. glob ; 18(56): 119-132, oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-188268

RESUMEN

Objetivo: Evaluar el grado de deterioro de la calidad de vida de las personas con enfermedad de Hansen, de acuerdo con las variables sociodemográficas y clínicas Método: Estudio descriptivo, transversal, cuantitativo, que involucró a 45 pacientes de un hospital de referencia en João Pessoa, Paraíba, Brasil. Para la obtención de datos, las entrevistas se realizaron a partir de un cuestionario semiestructurado que incluyó las variables sociodemográficas y clínicas de los participantes; para evaluar su calidad de vida se utilizó el instrumento Dermatology Life Quality Index, luego de su aprobación en el Comité de Ética en Investigación de la Universidad Federal de Paraíba. En el análisis de los datos, se utilizó la Prueba no paramétrica del Qui-cuadrado de Pearson con un nivel de significación del 5% (p <0,05), usándose la continuidad de corrección de Yates, cuando fue necesario. Resultados: Se destaca la prevalencia de individuos varones, pardos, solteros, de entre 18 y 40 años, con ingresos familiares inferiores a tres salarios mínimos y baja escolaridad. De este total, el 88,9% presentó la forma clínica multibacilar de la enfermedad de Hansen y el 60% de ellos, con un nivel de deterioro de la calidad de vida que varía entre moderado y muy grave, según los puntajes del instrumento utilizado. Conclusión: Se confirma el importante impacto de la enfermedad de Hansen en la calidad de vida de sus portadores, como lo indican los altos puntajes obtenidos en la aplicación del DLQI


Objective: Evaluate the degree of impairment of the quality of life of people with Hansen's disease, according to social demographic and clinical variables Method: Descriptive, transversal, quantitative study, involving 45 patients from a reference hospital located in João Pessoa, Paraíba, Brazil. For obtaining data, interviews were performed based on a semi-structured questionnaire, including social demographic and clinic variables of the participants; to evaluate their life quality the instrument Dermatology Life Quality Index was used, after approval in the Committee of Ethics in Research of the Federal University of Paraíba. In the data analysis, the non-parametric Test of the Chi-square of Pearson was used with level of significance of 5% (p<0,05), being used the Yates correction continuity, when necessary. Results: It is highlighted a prevalence of male, brown, single, aged 18 to 40 individuals, with family income lower than three minimum salaries and low schooling. From this total, 88,9% presented the clinical multibacillary form of the Hansen's disease and 60% of them, with level of impairment of quality of life varying between moderate and very serious, according to scores of the instrument used. Conclusion: It is reassured the important impact of the Hansen's disease in the quality of life of their carriers, as indicated by the high scores obtained in the application of the DLQI


Objetivo: Avaliar o grau de comprometimento da qualidade de vida de pessoas com hanseníase, segundo variáveis sociodemográficas e clínicas. Método: Estudo descritivo, transversal, quantitativo, envolvendo 45 pacientes de um hospital de referência, localizado em João Pessoa, Paraíba, Brasil. Para obtenção dos dados, realizou-se entrevistas a partir de questionário semiestruturado, contemplando variáveis sociodemográficas e clínicas dos participantes; para avaliar sua qualidade de vida foi utilizado o instrumento Dermatology Life Quality Index, após aprovação do Comitê de Ética em Pesquisa da Universidade Federal da Paraíba. Na análise dos dados, utilizou-se o Teste não-paramétrico do Qui-quadrado de Pearson com nível de significância de 5% (p<0,05), sendo utilizado a Correção de Continuidade de Yates, quando necessário. Resultados: Evidencia-se uma prevalência dos indivíduos do sexo masculino, pardos, solteiros, com idade entre 18 e 40 anos, com renda familiar inferior a três salários mínimos e baixa escolaridade. Desse total, 88,9% apresentavam a forma clínica multibacilar da hanseníase e 60% deles, com grau de comprometimento da qualidade de vida vaiando de moderado a muito grave, segundo escores do instrumento utilizado. Conclusão: Reafirma-se o importante impacto da hanseníase na qualidade de vida de seus portadores, tal como indicado pelos altos escores obtidos na aplicação do DLQI


Asunto(s)
Humanos , Masculino , Femenino , Lepra/epidemiología , Calidad de Vida/psicología , Cuestionario de Salud del Paciente/estadística & datos numéricos , Psicometría/instrumentación , Atención de Enfermería/métodos , Brasil/epidemiología , Perfil de Impacto de Enfermedad , Lepra Multibacilar/epidemiología , Estudios Transversales , Lepra Paucibacilar/epidemiología
3.
PLoS Negl Trop Dis ; 13(9): e0007696, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31525196

RESUMEN

BACKGROUND: Killer-cell immunoglobulin-like receptors (KIRs) are a group of regulatory molecules able to activate or inhibit natural killer cells upon interaction with human leukocyte antigen (HLA) class I molecules. Combinations of KIR and HLA may contribute to the occurrence of different immunological and clinical responses to infectious diseases. Leprosy is a chronic neglected disease, both disabling and disfiguring, caused mainly by Mycobacterium leprae. In this case-control study, we examined the influence of KIRs and HLA ligands on the development of multibacillary leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Genotyping of KIR and HLA genes was performed in 264 multibacillary leprosy patients and 518 healthy unrelated controls (238 healthy household contacts and 280 healthy subjects). These are unprecedented results in which KIR2DL2/KIR2DL2/C1/C2 and KIR2DL3/2DL3/C1/C1 indicated a risk for developing lepromatous and borderline leprosy, respectively. Concerning to 3DL2/A3/A11+, our study demonstrated that independent of control group (contacts or healthy subjects), this KIR receptor and its ligand act as a risk factor for the borderline clinical form. CONCLUSIONS/SIGNIFICANCE: Our finding suggests that synergetic associations of activating and inhibitory KIR genes may alter the balance between these receptors and thus interfere in the progression of multibacillary leprosy.


Asunto(s)
Predisposición Genética a la Enfermedad , Antígenos HLA/genética , Lepra Multibacilar/genética , Receptores KIR/genética , Adulto , Anciano , Brasil/epidemiología , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Lepra Multibacilar/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades Desatendidas
4.
Rev Soc Bras Med Trop ; 51(6): 789-794, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30517532

RESUMEN

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.


Asunto(s)
Lepra Multibacilar/epidemiología , Lepra Paucibacilar/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Femenino , Educación en Salud , Humanos , Incidencia , Lepra Multibacilar/prevención & control , Lepra Paucibacilar/prevención & control , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Adulto Joven
6.
An. bras. dermatol ; 93(6): 824-828, Nov.-Dec. 2018. graf
Artículo en Inglés | LILACS | ID: biblio-973623

RESUMEN

Abstract: Background: Leprosy is a chronic infectious disease that is endemic in Brazil and little studied in patients over 60 years old. Objective: The aim of this study was the epidemiological and clinical description of cases of leprosy in individuals older than 60 years, notified in the State of Espírito Santo - Brazil. Methods: It was an observational, descriptive and retrospective study of leprosy patients notified between 2001 and 2011. Results: Out of 16,025 notifications, 2,510 (15.6%) were of patients over 60 years of age; the distribution among the period was egalitarian except in the last 2 years, when there was a mild reduction of cases; the average was 70 years of age (±7 years); 46% were women, being 62% of those paucibacillary cases; 1,145 (50.5%) were dark-skined people in particular among paucibacillary cases; 1,638 (72.9%) were illiterates or poorly instructed n particular among multibacillary cases (P=0.022); 59.9% patients were clinically multibacillary cases and 37.4% had positive bacilloscopy; 37.9% patients had clinical alterations on peripheral nerves, 36.7% of all the multibacillary cases were classified as grade I and 15.3% as grade in assessment of disability. Study limitations: This was a retrospective study, which used secondary data generated by physicians and notified by other professionals, whar could have enabled possible errors on original data. Conclusions: Leprosy in this age group suggests a long incubation period with reactivation of latent focus or late infection. Men were more affected, as well as the afro descendent race was statistically significant in the paucibacillary cases (P=0.000) and illiterate/poor education in multibacillary cases (P=0.022). Nearly 40% of patients had positive bacilloscopy and grade I/II disability, demonstrating a late diagnosis.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Lepra Multibacilar/epidemiología , Lepra Paucibacilar/epidemiología , Índice de Severidad de la Enfermedad , Brasil/epidemiología , Estudios Retrospectivos , Distribución por Edad , Notificación de Enfermedades
7.
An Bras Dermatol ; 93(6): 824-828, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30484526

RESUMEN

BACKGROUND: Leprosy is a chronic infectious disease that is endemic in Brazil and little studied in patients over 60 years old. OBJECTIVE: The aim of this study was the epidemiological and clinical description of cases of leprosy in individuals older than 60 years, notified in the State of Espírito Santo - Brazil. METHODS: It was an observational, descriptive and retrospective study of leprosy patients notified between 2001 and 2011. RESULTS: Out of 16,025 notifications, 2,510 (15.6%) were of patients over 60 years of age; the distribution among the period was egalitarian except in the last 2 years, when there was a mild reduction of cases; the average was 70 years of age (±7 years); 46% were women, being 62% of those paucibacillary cases; 1,145 (50.5%) were dark-skined people in particular among paucibacillary cases; 1,638 (72.9%) were illiterates or poorly instructed n particular among multibacillary cases (P=0.022); 59.9% patients were clinically multibacillary cases and 37.4% had positive bacilloscopy; 37.9% patients had clinical alterations on peripheral nerves, 36.7% of all the multibacillary cases were classified as grade I and 15.3% as grade in assessment of disability. STUDY LIMITATIONS: This was a retrospective study, which used secondary data generated by physicians and notified by other professionals, whar could have enabled possible errors on original data. CONCLUSIONS: Leprosy in this age group suggests a long incubation period with reactivation of latent focus or late infection. Men were more affected, as well as the afro descendent race was statistically significant in the paucibacillary cases (P=0.000) and illiterate/poor education in multibacillary cases (P=0.022). Nearly 40% of patients had positive bacilloscopy and grade I/II disability, demonstrating a late diagnosis.


Asunto(s)
Lepra Multibacilar/epidemiología , Lepra Paucibacilar/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Notificación de Enfermedades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
9.
Cad Saude Publica ; 34(11): e00007818, 2018 11 23.
Artículo en Portugués | MEDLINE | ID: mdl-30484557

RESUMEN

The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.


Asunto(s)
Lepra Multibacilar/epidemiología , Lepra Multibacilar/prevención & control , Lepra Paucibacilar/epidemiología , Lepra Paucibacilar/prevención & control , Atención Primaria de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Brasil/epidemiología , Enfermedades Endémicas , Femenino , Sistemas de Información en Salud , Personal de Salud/educación , Humanos , Incidencia , Masculino , Prevalencia , Valores de Referencia , Análisis de Regresión , Índice de Severidad de la Enfermedad , Factores de Tiempo
10.
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
11.
Am J Trop Med Hyg ; 98(6): 1609-1613, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29611495

RESUMEN

Neural pain is a frequent symptom in leprosy disease. There is a paucity of data regarding neural pain diagnostics resulting in common prescriptive errors when neuritis is confused with neuropathic or mixed nociceptive-neuropathic pain. The present study identified important demographic, clinical, and neurophysiological features of 42 leprosy neuropathy patients presenting neuropathic pain (NP). During routine evaluations, patients were selected asking if they had ever experienced neural pain. Data analyses of their pain characteristics, clinical examination results, and both the Douleur Neuropathique 4 Questionnaire and Hamilton Depression Scale scores were used to classify these patients. The most common word they used to describe the sensation of pain for 25 (60%) of these patients was "burning." In the early stages of the disease and before leprosy diagnosis, 19 (45%) had already complained about NP and leprosy treatment was unable to prevent its occurrence in 15 (36%). Leprosy reactions, considered NP risk factors, occurred in 32 (76%) cases. Knowledge of typical NP characteristics could be used to develop more effective therapeutic approaches for a notoriously difficult-to-treat pain condition.


Asunto(s)
Lepra/complicaciones , Neuralgia/fisiopatología , Adulto , Anciano , Femenino , Humanos , Lepra/epidemiología , Lepra/fisiopatología , Lepra Multibacilar/complicaciones , Lepra Multibacilar/epidemiología , Lepra Multibacilar/fisiopatología , Masculino , Persona de Mediana Edad , Trastornos Motores/epidemiología , Trastornos Motores/etiología , Conducción Nerviosa/fisiología , Neuralgia/epidemiología , Neuralgia/etiología , Dolor , Dimensión del Dolor , Trastornos de la Sensación/epidemiología , Trastornos de la Sensación/etiología , Adulto Joven
12.
Clin. biomed. res ; 38(4): 348-355, 2018.
Artículo en Portugués | LILACS | ID: biblio-1023937

RESUMEN

Introdução: A hanseníase é de grande importância para a saúde pública, devido à sua epidemiologia e a seu poder incapacitante. A eficiência no diagnóstico desta doença é limitada. O objetivo deste estudo foi o de analisar o desempenho de um teste rápido imunocromatográfico para hanseníase multibacilar (MB) e paucibacilar (PB), em amostras positivas e negativas pela baciloscopia de raspado dérmico em pacientes diagnosticados com hanseníase, comparando analiticamente com os critérios da Organização Mundial da Saúde (OMS). Métodos: O estudo foi realizado no município de Ji-Paraná/RO, entre 2015 e 2016, sendo avaliados 140 indivíduos. A análise comparativa entre os métodos foi realizada pelo cálculo de sensibilidade e especificidade utilizando o software SPSS®. Foi estimado o índice de Kappa (k) para avaliação da concordância entre os métodos. Valores de p <0,05 foram considerados significativos. Resultados: O índice de concordância entre o teste rápido e a classificação da OMS foi de k= 0,94 (p <0,01). Quando comparado a baciloscopia de indivíduos com hanseníase PB e o teste rápido, foi verificada concordância não significante (k= 0,01; p= 0,59). Comparando a concordância entre a baciloscopia de indivíduos com hanseníase MB e o teste rápido, foi detectado um índice de k= 0,64 (p <0,01). Além disso, sensibilidade de 94% e especificidade de 98% foram detectadas para hanseníase PB. Para hanseníase MB a sensibilidade foi de 95% e a especificidade de 98%. Conclusão: O teste rápido avaliado é uma ferramenta útil, rápida e eficaz no auxílio do diagnóstico da hanseníase. (AU)


Introduction: Leprosy is of great importance for public health because of its epidemiology and disabling power. Efficiency in the diagnosis of this disease is limited. The objective of this study was to evaluate the performance of a rapid immunochromatographic test for multibacillary (MB) and paucibacillary (BP) leprosy, in positive and negative samples by skin smear examination in patients with leprosy, and to compare the rapid test analytically with World Health Organization (WHO) criteria. Methods: The study was conducted in the municipality of Ji-Paraná/RO, Brazil, between 2015 and 2016. In total, 140 individuals were evaluated. For a comparative analysis of the methods, sensitivity and specificity were calculated using SPSS® software. The Kappa (k) index was used to evaluate agreement between the methods. A p-value < 0.05 was considered significant. Results: Regarding agreement between the rapid test and WHO classification, k index was 0.94 (p < 0.01). When skin smear of individuals with BP leprosy was compared to the rapid test, agreement was non-significant (k = 0.01; p = 0.59). For agreement between skin smear of individuals with MB leprosy and the rapid test, a k index of 0.64 (p < 0.01) was detected. In addition, for PB leprosy sensitivity was 94% and specificity was 98%, while for MB leprosy sensitivity was 95% and specificity was 98%. Conclusion: The rapid test is a useful tool, fast and effective in aiding the diagnosis of leprosy. (AU)


Asunto(s)
Humanos , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/epidemiología , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/epidemiología , Brasil/epidemiología
13.
Cad. Saúde Pública (Online) ; 34(11): e00007818, 2018. tab, graf
Artículo en Portugués | LILACS, Sec. Est. Saúde SP, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-974592

RESUMEN

Resumo: O projeto Palmas Livre da Hanseníase foi implementado para o incremento dos indicadores e o enfrentamento da doença, visto que a capital do Tocantins é a mais hiperendêmica do país. Este estudo mede o impacto da intervenção do projeto por meio da análise da tendência de indicadores prioritários em Palmas, 2002-2016. Baseia-se em análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN) e de relatórios de capacitações aplicadas com metodologia de problematização. Os indicadores dos casos novos de hanseníase residentes em Palmas foram investigados, e suas tendências foram identificadas por análise de regressão joinpoint para avaliação dos resultados. No ano de implementação do projeto de intervenção (2016), o coeficiente de detecção de casos novos na população geral foi de 236,3/100 mil habitantes, e esse indicador apresentava decréscimo significativo de -7,5% no período de 2002 a 2014. Nos anos entre 2014 e 2016, houve aumento significativo de 104,6% para a detecção geral. O coeficiente de detecção em menores de 15 anos também apresentava queda de -4,6%, mas nos anos de 2014, 2015 e 2016, houve aumento de 111,1%, juntamente com os coeficientes de detecção de casos com grau 0, 1 e 2, com 59,3%, 225,2% e 121,7%, respectivamente. A proporção de casos detectados por avaliação de contatos teve acréscimo significativo de 201,1% no período de 2014 a 2016. Os dados comprovaram a efetividade e potencialidade da estratégia de intervenção do projeto para as ações de diagnóstico e controle da hanseníase em Palmas. Trouxe evidências de que a agilidade diagnóstica dos serviços de atenção primária resulta em indicadores que refletem a incidência real de casos.


Abstract: The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.


Resumen: El proyecto Palmas Libre de Hanseniasis se implementó para el incremento de indicadores y combate a la enfermedad, dado que la capital de Tocantins es la más hiperendémica de Brasil. Este estudio mide el impacto de la intervención del proyecto, mediante el análisis de la tendencia de indicadores prioritarios en Palmas, 2002-2016. Se basa en un análisis de datos procedentes del Sistema de Información sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués) y de informes de capacitaciones, aplicadas con metodología de problematización. Se investigaron los indicadores de casos nuevos de hanseniasis, en residentes de Palmas, y se identificaron sus tendencias mediante análisis de regresión joinpoint para la evaluación de los resultados. En el año de implementación del proyecto de intervención (2016), el coeficiente de detección de casos nuevos en la población general fue de 236,3/100 mil habitantes, y ese indicador presentaba una disminución significativa de un -7,5%, durante el período de 2002 a 2014. Entre los años de 2014 a 2016, hubo un aumento significativo de un 104,6% en la detección general. El coeficiente de detección en menores de 15 años también presentaba una bajada de -4,6%, pero durante los años de 2014, 2015 y 2016, hubo un aumento de 111,1%, junto a los coeficientes de detección de casos con grado 0, 1 y 2, con un 59,3%, 225,2% y 121,7%, respectivamente. La proporción de casos detectados por la evaluación de contactos tuvo un aumento significativo de un 201,1%, durante el período de 2014 a 2016. Los datos comprobaron la efectividad y potencialidad de la estrategia de intervención del proyecto para las acciones de diagnóstico y control de la hanseniasis en Palmas. Hubo evidencias de que la agilidad diagnóstica de los servicios de atención primaria se traduce en indicadores que reflejan la incidencia real de casos.


Asunto(s)
Humanos , Masculino , Femenino , Evaluación de Programas y Proyectos de Salud , Lepra Multibacilar/prevención & control , Lepra Multibacilar/epidemiología , Lepra Paucibacilar/prevención & control , Lepra Paucibacilar/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Valores de Referencia , Factores de Tiempo , Índice de Severidad de la Enfermedad , Brasil/epidemiología , Incidencia , Prevalencia , Análisis de Regresión , Personal de Salud/educación , Enfermedades Endémicas , Sistemas de Información en Salud
14.
Fontilles, Rev. leprol ; 31(3): 167-175, sept.-dic. 2017. graf, tab
Artículo en Español | IBECS | ID: ibc-170808

RESUMEN

La lepra es una enfermedad incluida en el grupo de enfermedades desatendidas según la Organización Mundial de la Salud, en Cuba la enfermedad dejó de ser un problema de salud desde 1993. En La Habana se notifican cada año casos de lepra de forma tardía con diferentes grados de discapacidad. El objetivo de este estudio fue caracterizar a los enfermos notificados de lepra tardíamente en La Habana. Se realizó un estudio longitudinal, descriptivo y retrospectivo de los casos de lepra diagnosticados tardíamente en la provincia entre 2008 y 2016, se incluyeron 96 casos a los cuales se revisó la Encuesta Epidemiológica para enfermos de lepra para evaluar variables como edad, sexo, tiempo transcurrido entre los primeros síntomas y el diagnóstico, grado de discapacidad al diagnóstico, formas clínicas y especialidades involucrados en el diagnóstico tardío. El grupo de edad más afectado fue el de 25 a 59 años, los municipios más afectados fueron Lisa y Arroyo Naranjo, predominó la forma clínica multibacilar, y la discapacidad grado ll se presentó en el 18% de los casos. Se evidenció la importancia de un diagnóstico precoz para evitar la aparición de discapacidades y que los municipios periféricos tienen la mayor posibilidad de diagnosticar casos tardíos


Leprosy is a disease included in the group of neglected diseases by The World Health Organization. In Cuba, the disease has ceased to be a health problem since 1993. In Havana, each year cases of late leprosy are reported with various grades of disability. The aim of this study was to characterize the behavior of patient whom reported with late leprosy in Havana. We conducted a longitudinal, descriptive and retrospective study of the leprosy cases diagnosed late in the province between 2008 and 2016. We included 96 cases in which the epidemiological survey for leprosy patients was carried out, variables such as age, sex, time elapsed between the first symptoms and the diagnosis, degree of disability at diagnosis, clinical forms, and specialties involved in the late diagnosis were evaluated. The most affected age group was between 25-59 years old, the most affected municipalities were Lisa and Arroyo Naranjo, the multibacillary clinical form predominated, and the grade II disability was present in 18% of the cases. The importance of an early diagnosis to avoid the appearance of disability in the patients was put in evidence by the series studied and the most peripheral municipalities are the one with the greatest possibility of diagnosing late cases


Asunto(s)
Humanos , Masculino , Femenino , Lepra/epidemiología , Mycobacterium leprae/patogenicidad , Enfermedades Desatendidas/epidemiología , Diagnóstico Tardío , Cuba/epidemiología , Lepra Multibacilar/epidemiología , Tiempo de Tratamiento/tendencias , Personas con Discapacidad
15.
Pan Afr Med J ; 27: 174, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28904702

RESUMEN

Leprosy is an infectious and transmissible disease. According to the WHO, the number of new cases of leprosy in children in Senegal has risen moderately since 2013. This study aimed to analyze the epidemiological, clinical, therapeutic and evolutionary features of leprosy in children in the geographical areas of two social rehabilitation villages in the region of Thiès. We conducted a retrospective study over a period of 3 years (2013-2015). All new cases of Hansen's disease aged 0 -15 years were included. Over the three year period, 39 children were included in the study, with a boy predominance (n=23, 59%). Among these children, 27 (66.7%) came from a social rehabilitation village for leprosy patients. One family member was affected by leprosy in 27 cases (69.2%). More than half of the children (23 cases, 58.9%) had multibacillary leprosy (lepromatous-lepromatous). All children underwent a 12-month treatment, at the end of which thirty-six (92.3%) children were healed. Leprosy is still present in Senegal despite the efforts made by the national programme to combat leprosy. In the light of these results, it is important to emphasize the role of active screening strategy targeted to children, which seems to have shown its effectiveness in the region. Early detection, contact tracing and early treatment are important factors in the reduction of the contagiousity of leprosy.


Asunto(s)
Leprostáticos/administración & dosificación , Lepra Multibacilar/epidemiología , Lepra/epidemiología , Programas Nacionales de Salud , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Lepra/tratamiento farmacológico , Lepra/prevención & control , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/prevención & control , Masculino , Recurrencia , Estudios Retrospectivos , Senegal/epidemiología , Resultado del Tratamiento
16.
Fontilles, Rev. leprol ; 31(2): 119-132, mayo-ago. 2017. ilus, tab, graf, mapas
Artículo en Español | IBECS | ID: ibc-167626

RESUMEN

Objetivos: El objetivo del estudio es describir los patrones y tendencias de la lepra autóctona en la Comunidad Valenciana (España). Métodos: Se incluyeron todos los casos nuevos d lepra de la Comunidad Valenciana entre los años 1940 y 2015. Se excluyeron pacientes de otros países u otras regiones españolas. Los nuevos casos se analizaron por edad, sexo, forma clínica, ocupación y distribución geográfica. Resultados: Se incluyeron 442 pacientes presumiblemente autóctonos. La incidencia disminuye de forma constante a lo largo del período de estudio. La edad media al comienzo de la enfermedad aumenta desde 34·2 años durante el período 1940-1949 hasta 59·5 años durante 2000-2015. No se detectaron nuevos casos desde 2006 y ningún caso nacidos después de 1973. Los pacientes eran mayoritariamente hombres (57·7%) y el 85·4% con tipo multibacilar. La proporción de casos multibacilares aumentó gradualmente después de 1970. La mayoría de los pacientes varones (67·9%) desarrollaban labores en el campo. La mayoría de los casos, sobre todo en los últimos períodos, se concentran en las regiones costeras. Conclusiones: Nuestros resultados concuerdan con otros estudios de otras regiones con características semejantes y sugieren que la transmisión de M. leprae en esta área ha sido interrumpida. La lepra autóctona ha sido mayoritariamente masculina con muchos casos multibacilares. Hay que investigar más porque su distribución geográfica y la elevada incidencia en trabajadores del campo sugieren posibles causas medioambientales


Objectives: The aim of this study was to describe the patterns and trends of autochthonous leprosy in the Valencia Region (Spain). Methods: : We included all new leprosy cases originating from the Valencia Region between the years 1940 and 2015. Patients originating from other countries or other Spanish regions were excluded. New cases were analysed by age, sex, clinical type, occupation, and geographic distribution.Results: A total of 442 patients with presumably autochthonous leprosy were included. Incidence rates consistently declined over the study period. Mean age at onset gradually increased from 34·2 years during the period 1940-1949 to 59·5 years during 2000-2015. There were no cases with clinical onset after 2006 and no cases born after 1973. Patients were predominantly males (57·7%) and 85·4% had multibacillary leprosy. The proportion of multibacillary cases increased gradually after 1970. The majority of male patients (67·9%) worked in agriculture. Most of the cases, especially during the later periods, were concentrated in the coastal regions. Conclusions: Our findings are consistent with trends described in other regions with declining leprosy incidence rates and suggest that the transmission of M. leprae infection in this area may well have now stopped. Autochthonous leprosy in this region has had a male predominance and a high proportion of multibacillary cases. The geographic distribution and the high incidence in agricultural workers suggest that environmental factors should be further explored (AU)


Asunto(s)
Humanos , Lepra/epidemiología , Mycobacterium leprae/aislamiento & purificación , Distribución por Edad y Sexo , Lepra Multibacilar/epidemiología , Población Rural/estadística & datos numéricos
17.
Fontilles, Rev. leprol ; 31(1): 7-14, ene.-abr. 2017. tab, ilus
Artículo en Español | IBECS | ID: ibc-163764

RESUMEN

Introducción: El objetivo del estudio fue analizar las características clínico epidemiológicas y evolutivas de los de los pacientes ingresados en una sala de hospitalización específica de la lepra. Métodos: Recogida retrospectiva de datos de pacientes ingresados por lepra usando los libros de registro de admisión desde septiembre 2002 hasta septiembre 2016 en el Hospital General Rural de Gambo. Resultados: Durante el período de estudio hubo 2.134 ingresos en la sala de lepra; de ellos 1.386 (64,9%) fueron hombres, el ratio de admisiones hombres /mujeres fue 1,9. Ciento ochenta pacientes (8,4%) pacientes tenían 18 años o menos. El número de casos nuevos fue 287 (13,4%) frente a los antiguos casos 1.847 (86,6%). Mil setecientos ochenta y cuatro pacientes presentaban lepra multibacilar (83,6%). El principal diagnóstico durante el ingreso fueron úlceras de piel neuropáticas (n=1280; 60%). Otros diagnósticos por orden de frecuencia fueron leprorreacción (n=305; 14,3%) y neuropatía (n=132; 6,2%). La mediana de estancia en el hospital fue 58 días (recorrido intercuartílico: 31-96,5). La mayoría de los pacientes se recuperaron satisfactoriamente al alta 1.822 (84,9%). La mortalidad fue baja 1,7%. Conclusiones: La mayoría de los pacientes eran varones, que ingresaron en el curso de la enfermedad (en tratamiento o antiguos leprosos), la mayoría adultos y principalmente por ulceraciones


Introduction: The objective of the study was to analyze the clinical and evolutionary characteristics of the patients admitted to a specific hospitalization room for leprosy at the Hospital Rural of Gambo .Methods: Retrospective data collection of patients admitted for leprosy using the admission logbooks from September 2002 to September 2016 at the General Rural Hospital of Gambo. Results: During the study period, there were 2,134 admissions in the leprosy ward; there were 1,386 (64.9%) men, the ratio of admissions for men / women was 1.9. One hundred and eighty patients (8.4%) were 18 years or younger. The number of new cases was 287 (13.4%) compared to the old cases, 1,847 (86.6%). One thousand seven hundred and eighty four patients presented multibacillary leprosy (83.6%). The main diagnosis during admission was neuropathic skin ulcers (n = 1280; 60%). Other diagnoses in order of frequency were leprosy reactions (n = 305, 14.3%) and neuropathy (n = 132, 6.2%). The median hospital stay was 58 days (interquartile range: 31-96.5). The majority of the patients recovered satisfactorily at the 1822 discharge (84.9%). Mortality was low 1.7%. Conclusions: The majority of the patients were men, who entered the course of the disease (in treatment or old lepers), most of them adults and mainly ulcerations


Asunto(s)
Humanos , Femenino , Masculino , Adolescente , Adulto , Lepra/epidemiología , Lepra Multibacilar/epidemiología , Lepra Lepromatosa/epidemiología , Mycobacterium leprae/patogenicidad , Etiopía/epidemiología , Hospitalización/estadística & datos numéricos , Estudios Retrospectivos , Tiempo de Internación/estadística & datos numéricos , Diagnóstico Precoz , Resultado del Tratamiento
18.
PLoS Negl Trop Dis ; 11(2): e0005364, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28192426

RESUMEN

BACKGROUND: Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control. METHODS: A national databank of cases reported in Brazil (2001-2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center was used to determine factors associated with higher bacillary loads. RESULTS: A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65-69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33-2.38; OR = 1.99, CI95% = 1.96-2.02, respectively). Bacillary load was higher in male and in patients aged 20-39 and 40-59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country. CONCLUSION: Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.


Asunto(s)
Lepra Multibacilar/epidemiología , Grupos de Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Adulto Joven
19.
BMC Infect Dis ; 16: 258, 2016 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-27278453

RESUMEN

BACKGROUND: The clinical spectrum of leprosy is dependent on the host immune response against Mycobacterium leprae or the newly discovered Mycobacterium lepromatosis antigen. Helminth infections have been shown to affect the development of several diseases through immune regulation and thus may play a role in the clinical manifestations of leprosy and leprosy reactions. The purpose of this study is to determine the proportion of helminth infections in leprosy and its association with the type of leprosy and type 2 leprosy reaction (T2R). METHODS: History or episode of T2R was obtained and direct smear, formalin-ether sedimentation technique, and Kato-Katz smear were performed on 20 paucibacillary (PB) and 61 multibacillary (MB) leprosy participants. RESULTS: There are more helminth-positive participants in MB leprosy compared to PB (11/61 versus 0/20, p = 0.034) and in T2R participants compared to non-T2R (8/31 versus 3/50, p = 0.018). CONCLUSIONS: Our results suggest that soil-transmitted helminth infections may have a role in the progression to a more severe type of leprosy, as well as the occurrence of T2R. These findings could serve as a fundamental base for clinicians to perform parasitological feces examination in patients who have MB leprosy and severe recurrent reactions to rule out the possibility of helminth infection. Further secondary confirmation of findings are needed to support these conclusions.


Asunto(s)
Helmintiasis/epidemiología , Helmintos/aislamiento & purificación , Lepra Multibacilar/epidemiología , Mycobacterium leprae/inmunología , Microbiología del Suelo , Adolescente , Adulto , Animales , Estudios Transversales , Heces/parasitología , Femenino , Helmintiasis/complicaciones , Helmintiasis/parasitología , Humanos , Indonesia/epidemiología , Lepra Multibacilar/complicaciones , Lepra Multibacilar/microbiología , Masculino , Persona de Mediana Edad , Recuento de Huevos de Parásitos , Adulto Joven
20.
An Bras Dermatol ; 91(2): 196-203, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27192519

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.


Asunto(s)
Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Lepra Paucibacilar/tratamiento farmacológico , Lepra Paucibacilar/patología , Adolescente , Factores de Edad , Vacuna BCG/uso terapéutico , Brasil/epidemiología , Niño , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Multibacilar/epidemiología , Lepra Paucibacilar/epidemiología , Masculino , Factores de Riesgo
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