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1.
Hautarzt ; 71(6): 419-427, 2020 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-32333041

RESUMEN

Due to the often late detection and the neurological disability as a consequence of the disease, leprosy plays an important role in the public health system of emerging countries with the highest prevalence such as India and Brazil. The National Leprosy Control Program of the Ministry of Health and the Health Institutions of the Federal States in Brazil has implemented a strategy to ensure successful treatment of people in rural areas both at the preventive and curative level. A successful screening program, timely treatment of patients according to the stage of disease, and the introduction of preventive measures have significantly reduced the prevalence of leprosy in Brazil over the last 20 years. Due to limited medical care and socioeconomic weakness in the Amazon region in Brazil, the early eradication of leprosy does not seem to be currently realistic.


Asunto(s)
Enfermedades Endémicas/prevención & control , Promoción de la Salud/organización & administración , Lepra/diagnóstico , Tamizaje Masivo , Salud Pública , Brasil , Humanos , Evaluación de Programas y Proyectos de Salud
2.
Orthop Clin North Am ; 51(2): 279-291, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138865

RESUMEN

Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.


Asunto(s)
Enfermedades del Pie/cirugía , Lepra/cirugía , Enfermedades del Sistema Nervioso Periférico/cirugía , Enfermedades del Pie/diagnóstico , Enfermedades del Pie/tratamiento farmacológico , Enfermedades del Pie/microbiología , Humanos , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Lepra/microbiología , Transferencia de Nervios , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/etiología
3.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-46978

RESUMEN

Você sabe o que é hanseníase? Muitas pessoas não sabem. Por isso, o mês de janeiro ganhou o título de ‘Janeiro Roxo’


Asunto(s)
Lepra , Lepra/diagnóstico
4.
PLoS Negl Trop Dis ; 14(2): e0007891, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32078623

RESUMEN

BACKGROUND: A few new leprosy cases still can be seen in Shandong province after elimination. In post-elimination era, government commitments dwindled and active case-finding activities were seldom done. Most of the cases were detected by passive modes and advanced cases with longer delay and visible disability were common. MATERIALS AND METHODS: Comprehensive measures including health promotion, personnel training, reward-offering, symptom surveillance and a powerful referral center were implemented in the past decade. The diagnosis of leprosy was mainly based on three cardinal clinical signs. Two-group classification system developed by the WHO was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. Cases detected during period 2007-2017 were analyzed and associated factors of grade 2 disability (G2D) were explored. RESULTS: 231 new leprosy cases detected during 2007-2017 were analyzed. The mean age at diagnosis is 51.7±16.0 years and the number of males, peasants, illiterates, MB cases, G2D cases and immigrants were 130(56.3%), 221(95.7%), 73(31.6%), 184(79.7%), 92(39.8%) and 40(17.3%) respectively. 181(78.4%) cases were reported by skin clinics and 152 (65.8%) cases came from formerly high endemic counties/districts. The annual number of new cases showed a decreasing trend, from 42 cases in 2008 to 13 cases in 2017. 92 (39.8%) cases presented with G2D at diagnosis. The annual proportion of new cases with G2D declined from 50% in 2008 to 23% in 2017. PB type (OR = 2.76, 95% CI, 1.43-5.32), >12 months of patient delay (OR = 2.40, 95% CI, 1.38-4.19), >24 months of total delay (OR = 4.35, 95% CI, 2.33-8.11), detected by non skin-clinic (OR = 3.21, 95% CI, 1.68-6.14), known infectious source (OR = 1.77, 95% CI, 1.01-3.12) were associated with G2D. CONCLUSION: A few scattered cases still can be seen in post-elimination era and some kind of leprosy control program is still necessary. Government commitments including adequate financial security and strong policy support are vital. Comprehensive case-finding measures including health promotion, personnel training, reward-offering, with an emphasis on former high or middle endemic areas, are necessary to improve early presentation of suspected cases and to increase suspicion and encourage participation of all relevant medical staff. Symptom surveillance based on a powerful transfer center may play an important role in the early detection of new cases in post-elimination era.


Asunto(s)
Lepra/diagnóstico , Lepra/epidemiología , Adulto , Anciano , China/epidemiología , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad
5.
PLoS One ; 14(12): e0223042, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31794554

RESUMEN

BACKGROUND: Many neglected tropical diseases (NTDs) are not fatal, but they are disabling, disfiguring and stigmatizing. More accurate data on these aspects would benefit planning, monitoring and evaluation of interventions, as well as provision of appropriate services for the often life-long consequences. In 2015, a cross-NTD toolkit was developed, consisting of a variety of existing questionnaires to measure morbidity, disability and health-related quality of life. The toolkit covers the domains of the International Classification of Functioning, Disability and Health (ICF) framework. These tools have been developed in a source country, however, it was intended for the cross-NTD toolkit to be applicable across NTDs in many countries with different cultures and languages in order to generate universally comparative data. Therefore; the present study aimed to validate several tools of the toolkit among people affected by leprosy or leishmaniasis in the cultural settings of Cartagena and Cúcuta, Colombia. METHODOLOGY: This study aimed to validate the following tools among 55 participants between 18-85 years old, affected by leprosy and leishmaniasis: (I) Clinical Profile, (II) Self-Reporting Questionnaire (SRQ), (III) WHO Quality of Life assessment-abbreviated version (WHOQOL-BREF), and (IV) WHO Quality of Life assessment-Disability (WHOQOL-DIS). The tools were administered during face-to-face interviews and were followed by open questions about the respondents' thoughts on format of the tool and the understanding, relevance and acceptability of the items. The tools were validated using a qualitative method approach based on the framework for cultural equivalence, measured by the cultural, item, semantic and operational equivalences. RESULTS: The Clinical Profile was seen as acceptable and relevant, only the semantic equivalence was not as satisfying and needs a few adaptations. The SRQ was very well understood and shows to reach the equivalences for the population of Colombia without any additional changes. Several items of the WHOQOL-BREF and the WHOQOL-DIS were not well understood and changes are recommended due to semantic difficulties. Operational equivalence of both questionnaires was not as desired in relation to the used response scales. The participants shared that the tools are relevant and important for their particular situation. CONCLUSIONS/SIGNIFICANCE: The SRQ is found to be a valid tool for Colombia and can be included in the cross-NTD toolkit. The Clinical Profile, WHOQOL-BREF & WHOQOL-DIS need changes and retesting among Colombian people affected by an NTD. The toolkit as a whole is seen as useful to show the effects leprosy and leishmaniasis have on the participants. This cultural validation will contribute to a universally applicable cross-NTD toolkit.


Asunto(s)
Enfermedades Desatendidas/diagnóstico , Psicometría/métodos , Adulto , Anciano , Anciano de 80 o más Años , Colombia , Comparación Transcultural , Femenino , Humanos , Leishmaniasis/diagnóstico , Lepra/diagnóstico , Masculino , Persona de Mediana Edad , Morbilidad , Enfermedades Desatendidas/mortalidad , Satisfacción Personal , Calidad de Vida , Reproducibilidad de los Resultados , Proyectos de Investigación , Autoinforme , Encuestas y Cuestionarios , Medicina Tropical
6.
BMC Infect Dis ; 19(1): 1016, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783799

RESUMEN

BACKGROUND: Leprosy is a neglected disease that poses a significant challenge to public health in Uganda. The disease is endemic in Uganda, with 40% of the districts in the country affected in 2016, when 42 out of 112 districts notified the National Tuberculosis and Leprosy Program (NTLP) of at least one case of leprosy. We determined the spatial and temporal trends of leprosy in Uganda during 2012-2016 to inform control measures. METHODS: We analyzed quarterly leprosy case-finding data, reported from districts to the Uganda National Leprosy Surveillance system (managed by NTLP) during 2012-2016. We calculated new case detection by reporting district and administrative regions of treatment during this period. New case detection was defined as new leprosy cases diagnosed by the Uganda health services divided by regional population; population estimates were based on 2014 census data. We used logistic regression analysis in Epi-Info version 7.2.0 to determine temporal trends. Population estimates were based on 2014 census data. We used QGIS software to draw choropleth maps showing leprosy case detection rates, assumed to approximate the new case detection rates, per 100,000 population. RESULTS: During 2012-2016, there was 7% annual decrease in reported leprosy cases in Uganda each year (p = 0.0001), largely driven by declines in the eastern (14%/year, p = 0.0008) and central (11%/year, p = 0.03) regions. Declines in reported cases in the western (9%/year, p = 0.12) and northern (4%/year, p = 0.16) regions were not significant. The combined new case detection rates from 2012 to 2016 for the ten most-affected districts showed that 70% were from the northern region, 20% from the eastern, 10% from the western and 10% from the central regions. CONCLUSION: There was a decreasing trend in leprosy new case detection in Uganda during 2012-2016; however, the declining trends were not consistent in all regions. The Northern region consistently identified more leprosy cases compared to the other regions. We recommend evaluation of the leprosy surveillance system to ascertain the leprosy situation.


Asunto(s)
Lepra/diagnóstico , Bases de Datos Factuales , Humanos , Lepra/epidemiología , Modelos Logísticos , Vigilancia en Salud Pública , Estudios Retrospectivos , Análisis Espacio-Temporal , Uganda/epidemiología
7.
RECIIS (Online) ; 13(4): 831-842, out.-dez. 2019. tab, ilus
Artículo en Inglés | LILACS | ID: biblio-1047577

RESUMEN

The objective of this study was to compare intra-domiciliary contacts (IDCs) in the Health Information System (SIS) with records of people diagnosed with leprosy. This was a cross-sectional, retrospective, and quantitative study based on the physical information collected in medical records and the SIS records in 2015 and 2016, in a municipality in the countryside of the State of São Paulo. We used an instrument with variables related to IDCs such as gender, age, relationship, disease, BCG-ID vaccine, SIS records, and descriptive analysis. Out of the 81 IDCs from 40 diagnosed patients, 72 were evaluated, and 71 were included in the SIS. One IDC became ill after the end of treatment of the index case. The prevalent gender among IDCs was female, young adults, and children. A difference of 12.4% as observed between the physical and SIS records; a difference of 11.1% was observed when correlating 81 records with the frequency of the 72 evaluated IDCs. It is concluded that the IDC and SIS records are in disagreement.


O objetivo deste estudo foi comparar os contatos intradomiciliares (CIs) do Sistema de Informação em Saúde (SIS) com os registros de pessoas diagnosticadas com hanseníase. Estudo transversal, retrospectivo e quantitativo, baseado nas informações coletadas em registros físicos e do SIS em 2015 e 2016, em um município do interior do Estado de São Paulo. Foi utilizado um instrumento com variáveis relacionadas aos CIs: sexo, idade, relacionamento, doença, vacina BCG-ID, registros SIS e análise descritiva. Dos 81 CIs de 40 pacientes diagnosticados, 72 foram avaliados e 71 foram incluídos no SIS. 01 CIs adoeceu após o término do tratamento do caso índice. O sexo prevalente dos CIs é feminino, adulto jovem e filho. Entre os registros físicos e do SIS, houve uma diferença de 12,4%; e correlacionando os mesmos registros (81) com a frequência dos CIs avaliados (72), há uma diferença de 11,1%. Conclui-se que existe discordância entre os registos de CIs nos registos com o SIS.


El estudio tiene el objetivo de comparar las anotaciones de comunicantes intradomiciliares (CI) del Sistema de Información en Salud (SIS), con las de los prontuarios de las personas diagnosticadas con leprae. En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el análisis de los resultados obtenidos, evaluados en los registros del SIS. De los 81 CI de 40 pacientes diagnosticados, 72 fueron evaluados y 71 fueron incluidos en el SIS. Y en el caso de las mujeres, El grado de parentesco frecuente fue infantil, mujeres y adultos jóvenes. Entre las anotaciones del SIS y los prontuarios, hay diferencia del 12,4%; y correlacionando los mismos registros (81) con la frecuencia de los CI evaluados (72), hay una diferencia del 11,1%. Se concluye que hay discordancia entre los registros de CI en los prontuarios con el SIS.


Asunto(s)
Humanos , Epidemiología , Comunicación en Salud , Vigilancia en Salud Pública , Sistemas de Información en Salud , Lepra , Sistema Único de Salud , Registros Médicos , Epidemiología Descriptiva , Estudios Transversales , Lepra/diagnóstico
8.
Fontilles, Rev. leprol ; 32(3): 163-168, sept.-dic. 2019. ilus
Artículo en Español | IBECS | ID: ibc-189963

RESUMEN

El síndrome de inmunodeficiencia humana conocido por las siglas SIDA, y la lepra son enfermedades estigmatizadas por la sociedad lo que se debe, fundamentalmente al impacto social producido por dichas entidades. La lepra ha afligido a la humanidad desde tiempos inmemorables. Se trata de un paciente blanco, masculino, de 24 años de edad, con antecedentes de ser VIH positivo, que marcó SIDA, desde hace aproximadamente cinco años, que acude a consulta por presentar lesiones nodulares de diferentes tamaños, localizadas en miembros superiores y en cara principalmente en la frente, pabellones auriculares y cejas, las cuales no pican ni duelen, algunas se encuentran exulceradas y tienen una evolución de aproximadamente un año. Al examen dermatológico se constata cuadro cutáneo diseminado, caracterizado por la presencia de nódulos eritematosos, con trastornos de la sensibilidad, en número y tamaños variables a nivel en miembros superiores y en cara principalmente en la frente, pabellones auriculares y cejas, algunos de los cuales presentan exulceraciones centrales y en otras costras hemáticas. Se constata además infiltración del rostro a nivel de los salientes, atrofia de la región tenar e hipotenar, nervios cubitales engrosados, no dolorosos, de forma simétrica y bilateral. Esta forma clínica suele presentarse en forma de placas, máculas, pápulas, nódulos, variables en número, de distribución simétrica y bilateral que pueden o no acompañarse de áreas con anestesia. Pueden afectarse numerosos nervios y la baciloscopía suele ser positiva. La infección por VIH/SIDA afecta la inmunidad celular mediada por linfocitos T CD4+. Los pacientes portadores de VIH/SIDA, al cual se le diagnostica lepra, pueden presentar síndrome inflamatorio de reconstitución inmunitaria tras iniciar el tratamiento


The human immunodeficiency syndrome known by the acronym AIDS, and leprosy are diseases stigmatized by society, which is mainly due to the social impact produced by these entities. Leprosy has afflicted humanity since time immemorial. We report a case of a white male patient, 24 years old, with a history of being HIV positive, and diagnosed of AIDS approximately five years ago who attended the clinic for presenting nodular lesions of different sizes. They were located in upper limbs and in face mainly on the forehead, ear pavilions and eyebrows. They do not itch or hurt; some are ulcerated and have an evolution of approximately one year. The dermatological examination shows disseminated cutaneous symptoms, characterized by the presence of erythematous nodules, with variable sensitivity disorders of the upper limbs and in the face mainly on the forehead, ear pavilions and eyebrows, some of which have central ulcerations and blood scabs. He also presented infiltration on the face, atrophy of the tenar and hypothenar region, thickened symmetrically and bilaterally but not painful ulnar nerves. This clinical type usually occurs in the form of plaques, macules, papules, nodules, variable in number with symmetrical and bilateral distribution that may or may not be accompanied by areas with anesthesia. Several nerves can be affected and the skin smear is usually positive. HIV/AIDS infection affects cell immunity mediated by CD4 + T cells. Patients with HIV/AIDS, who are diagnosed with leprosy, may present immune reconstitution inflammatory syndrome after starting treatment


Asunto(s)
Humanos , Masculino , Adulto Joven , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Lepra/diagnóstico
10.
Kathmandu Univ Med J (KUMJ) ; 17(65): 40-45, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31734677

RESUMEN

Background Visceral leishmaniasis (VL) and leprosy are important public health problem in Nepal. Female Community Health Volunteers (FCHVs) play pivotal role to promote community based health services. Therefore, we designed an implementation research to assess the effectiveness of active case detection (ACD) and information education and communication (IEC) campaign of Visceral leishmaniasis cases along with leprosy cases through Female Community Health Volunteers in Visceral leishmaniasis endemic 10 Village Development Committees of both Visceral leishmaniasis and leprosy prevalent Sarlahi district of Nepal. Objective To determine the effectiveness of active case search strategy of visceral leishmaniasis along with leprosy through Female Community Health Volunteers in Sarlahi district. Method One hundred fifty one Female Community Health Volunteers of twelve Village Development Committees were oriented on detection, identification and referral of Visceral leishmaniasis and leprosy patients. They were oriented on referring the patients to district hospital for confirmatory diagnosis and treatment. The intervention was continued up to ten months after training of Female Community Health Volunteers. Data on number of Visceral leishmaniasis and leprosy patients detected and referred by Female Community Health Volunteers and detected through passively at district hospital were collected and indicators was calculated. Result Altogether 151 Female Community Health Volunteers were trained from 12 (Village Development Committees) VDCs of Sarlahi district. Their knowledge on leprosy and Visceral leishmaniasis related information subsequently increased after training. None of the Visceral leishmaniasis or leprosy cases were detected actively through Female Community Health Volunteers. However, two leprosy cases were detected through household screening. Conclusion Female Community Health Volunteers should be provided sufficient knowledge to use them in community based active case detection of Visceral leishmaniasis and leprosy.


Asunto(s)
Agentes Comunitarios de Salud/normas , Leishmaniasis Visceral/diagnóstico , Lepra/diagnóstico , Voluntarios/educación , Agentes Comunitarios de Salud/educación , Femenino , Humanos , Nepal/epidemiología , Prevalencia , Salud Pública/métodos
11.
J Immunol Res ; 2019: 3405103, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31781675

RESUMEN

Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01 ± 0.23, TLR2: 1.22 ± 0.18; p = 0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24 ± 0.17, TLR2: 2.88 ± 0.37; p = 0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93 ± 0.17, TLR2: 2.81 ± 0.15; p = 0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect = 0.503 > residual effect = 0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect = 0.778 > residual effect = 0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.


Asunto(s)
Eritema Nudoso/etiología , Regulación de la Expresión Génica , Interferón gamma/genética , Interleucina-10/genética , Lepra/etiología , Receptor Toll-Like 1/genética , Receptor Toll-Like 2/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Susceptibilidad a Enfermedades , Eritema Nudoso/diagnóstico , Eritema Nudoso/epidemiología , Eritema Nudoso/metabolismo , Femenino , Humanos , Interferón gamma/metabolismo , Interleucina-10/metabolismo , Lepra/diagnóstico , Lepra/epidemiología , Lepra/metabolismo , Masculino , Persona de Mediana Edad , Modelos Biológicos , Unión Proteica , Transducción de Señal , Receptor Toll-Like 1/metabolismo , Receptor Toll-Like 2/metabolismo , Adulto Joven
12.
PLoS Negl Trop Dis ; 13(10): e0007798, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31652262

RESUMEN

INTRODUCTION: Post-kala-azar dermal leishmaniasis (PKDL) is a skin manifestation that is a late clinical outcome of visceral leishmaniasis (VL). Its presentation is similar to leprosy, and the differential diagnosis is not always easy. In VL endemic rural areas of Bihar, India, both infectious diseases co-exist. This observational study aimed to determine the prevalence and distribution of both conditions in an area that had until recently been highly endemic for VL. METHODS: We conducted a door-to-door survey in an area that belongs to the Health and Demographic Surveillance Site (HDSS) of Muzaffarpur, Bihar, India. Within the HDSS we selected the villages that had reported the highest numbers of VL cases in preceding years. All consenting household members were screened for skin conditions, and minor conditions were treated on the spot. Upon completion of screening activities at the level of a few villages, a dermatology clinic ("skin camp") was conducted to which suspect leprosy and PKDL patients and other patients with skin conditions requiring expert advice were referred. We studied the association between distance from an index case of leprosy and the probability of disease in the neighborhood by fitting a Poisson model. RESULTS: We recorded a population of 33,319, out of which 25,686 (77.1%) were clinically screened. Participation in skin camps was excellent. Most common conditions were fungal infections, eczema, and scabies. There were three PKDL patients and 44 active leprosy patients, equivalent to a prevalence rate of leprosy of 17.1 per 10,000. Two out of three PKDL patients had a history of VL. Leprosy patients were widely spread across villages, but within villages, we found strong spatial clustering, with incidence rate ratios of 6.3 (95% C.I. 1.9-21.0) for household members and 3.6 (95% C.I. 1.3-10.2) for neighbors within 25 meters, with those living at more than 100 meters as the reference category. DISCUSSION: Even in this previously highly VL endemic area, PKDL is a rare condition. Nevertheless, even a single case can trigger a new VL outbreak. Leprosy is also a rare disease, but current prevalence is over 17 times the elimination threshold proclaimed by WHO. Both diseases require continued surveillance. Active case finding for leprosy can be recommended among household members and close neighbors of leprosy patients but would not be feasible for entire populations. Periodic skin camps may be a feasible and affordable alternative.


Asunto(s)
Leishmaniasis Cutánea/epidemiología , Leishmaniasis Visceral/epidemiología , Lepra/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Brotes de Enfermedades , Monitoreo Epidemiológico , Femenino , Humanos , India/epidemiología , Lactante , Leishmaniasis Cutánea/diagnóstico , Leishmaniasis Visceral/diagnóstico , Lepra/diagnóstico , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Piel/parasitología , Adulto Joven
13.
PLoS Negl Trop Dis ; 13(10): e0007731, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31577795

RESUMEN

BACKGROUND: Detection and pathology analysis of Mycobacterium leprae using skin biopsy tissues are essential for leprosy diagnosis and monitoring response to treatment. Although formalin fixation of patient tissues may not be ideal for molecular studies, biopsy samples are the most accessible material from suspected cases. Therefore, clinical molecular laboratories must be able to utilize formalin-fixed, paraffin-embedded (FFPE) material. OBJECTIVE: To determine the best molecular method for diagnosing and monitoring leprosy in FFPE specimens, we developed a single-tube nested PCR (STNPCR) (131 bp) and SYBRGreen PCR (101 bp) assay using primers for the M. leprae-specific repetitive element (RLEP) gene and evaluated the results compared to those using previously established RLEP primers (372 bp). METHODS: FFPE biopsy samples obtained from 145 leprosy patients (during or after multidrug therapy (MDT)) and patients with 29 other confounding dermatoses were examined by the bacteria index (BI) and by simple PCR, STNPCR, and SYBRGreen PCR using primers amplifying a 372-bp, 131-bp or 101-bp fragment of RLEP, respectively. RESULTS: In leprosy patients receiving MDT, STNPCR showed a highest specificity of 100% and a positive predictive value (PPV) of 100%. For multibacillary (MB), paucibacillary (PB) and all leprosy patients, the highest sensitivities were 91.42%, 39.13%, and 67.92%, negative predictive values (NPVs) were 8.57%, 60.36%, and 32.07%, and the highest accuracies were 93.93%, 62.67%, and 74.81%, respectively, higher than the results of SYBRGreen PCR and simple PCR. For post-MDT leprosy patients, SYBRGreen PCR showed the highest sensitivity of 50.0%, highest specificity of 100%, a PPV of 100%, an NPV of 100% and the highest accuracy of 83.72% for MB patients, which were higher than those of STNPCR and simple PCR. STNPCR showed the highest sensitivity of 26.66% and 34.48%, highest specificity of 100% and 100%, a PPV of 100% and 100%, NPV of 72.50% and 60.21%, and highest accuracy of 75.00% and 67.24% for PB and leprosy patients, respectively, higher than those of SYBRGreen PCR and simple PCR. CONCLUSIONS: These findings suggest that STNPCR or SYBRGreen PCR (131-bp and 101-bp fragment amplification, respectively) for RLEP using FFPE specimens performs better as a diagnostic test and for monitoring response to MDT than does simple PCR based on 372-bp fragment amplification. Additionally, STNPCR showed increased sensitivity for PB diagnosis using FFPE specimens, which can be transferred remotely or retrieved from previous leprosy patients.


Asunto(s)
Formaldehído , Lepra/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Adhesión en Parafina/métodos , Reacción en Cadena de la Polimerasa/métodos , Biopsia/métodos , China , Cartilla de ADN , ADN Bacteriano/genética , Quimioterapia Combinada , Humanos , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Mycobacterium leprae/genética , Secuencias Repetitivas de Ácidos Nucleicos/genética , Sensibilidad y Especificidad , Piel/microbiología
16.
Int J Infect Dis ; 88: 65-72, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31499206

RESUMEN

OBJECTIVE: To assess the effectiveness of single-dose rifampicin (SDR) after bacillus Calmette-Guérin (BCG) vaccination in preventing leprosy in contacts. METHODS: This was a single-centre, cluster-randomized controlled trial at a leprosy control programme in northwest Bangladesh. Participants were the 14988 contacts of 1552 new leprosy patients who were randomized into the SDR-arm (n=7379) and the SDR+arm (n=7609). In the intervention group, BCG vaccination was followed by SDR 8-12 weeks later. In the control group, BCG vaccination only was given. Follow-up was performed at 1year and 2 years after intake. The main outcome measure was the occurrence of leprosy. RESULTS: The incidence rate per 10000 person-years at risk was 44 in the SDR-arm and 31 in the SDR+arm at 1year; the incidence rate was 34 in the SDR-arm and 41 in the SDR+arm at 2 years. There was a statistically non-significant (p=0.148; 42%) reduction for paucibacillary (PB) leprosy in the SDR+ arm at 1 year. Of all new cases, 33.6% appeared within 8-12 weeks after BCG vaccination. CONCLUSIONS: In the first year, SDR after BCG vaccination reduced the incidence of PB leprosy among contacts by 42%. This was a statistically non-significant reduction due to the limited number of cases after SDR was administered. To what extent SDR suppresses excess leprosy cases after BCG vaccination is difficult to establish because many cases appeared before the SDR intervention. TRIAL REGISTRATION: Netherlands Trial Register: NTR3087.


Asunto(s)
Vacuna BCG/administración & dosificación , Leprostáticos/administración & dosificación , Lepra/prevención & control , Rifampin/administración & dosificación , Adolescente , Adulto , Bangladesh , Niño , Preescolar , Femenino , Humanos , Incidencia , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Lepra/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/efectos de los fármacos , Mycobacterium leprae/fisiología , Vacunación , Adulto Joven
17.
Rev Bras Enferm ; 72(5): 1333-1340, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531659

RESUMEN

OBJECTIVE: Elaborate and validate an educational technology for adolescents on leprosy, focusing on preventing the disease and reducing stigma. METHOD: First, a prototype of the educational technology was elaborated and later analyzed by 17 adolescents and 7 researchers' experts in the leprosy area and educational technologies who answered a questionnaire with questions related to the subject. Subsequently, the technology has been applied to 43 adolescents, and a questionnaire was handed before and after the use of the game, so that questionnaire scores were compared by a Wilcoxon paired test. RESULTS: After the data collection with researchers and adolescents, the answers received descriptive treatment, and the Content Validity Index was calculated, which reached a good level of agreement, with an overall value (0.86), although there were improvements to the technology, based on the perceptions of researchers and adolescents. CONCLUSIONS: There was an increase in knowledge about leprosy.


Asunto(s)
Conducta del Adolescente/psicología , Tecnología Educacional/normas , Difusión de la Información/métodos , Lepra/terapia , Adolescente , Brasil , Tecnología Educacional/métodos , Femenino , Humanos , Lepra/diagnóstico , Lepra/fisiopatología , Masculino , Encuestas y Cuestionarios , Estudios de Validación como Asunto
18.
Rev Bras Enferm ; 72(5): 1356-1362, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531662

RESUMEN

OBJECTIVE: to analyze the temporal trend and epidemiological patterns of leprosy indicators in Sobral, a municipality countryside of the state of Ceará, from 2001 to 2016. METHOD: a time series study based on data from the Department of Informatics of the Unified Health System. The time trend analysis was performed using the join point regression model. RESULTS: There were 2,220 new cases of leprosy in Sobral from 2001 to 2016. Of these, 158 (7.2%) in children younger than 15 years of age, the proportion of new male cases was 52.8% (1,162), cases with grade 2 were 7.0% (156), and proportion of cases diagnosed by contact examination 5.7% (126). FINAL CONSIDERATIONS: leprosy remains hyperendemic in adults and children, demonstrating the character of neglected disease. Analysis of the temporal trend allowed to verify that the instability in the detection coefficients, reflect operational problems in the organization of the services.


Asunto(s)
Lepra/diagnóstico , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lepra/epidemiología , Masculino , Persona de Mediana Edad
19.
Rev Bras Enferm ; 72(5): 1397-1404, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531667

RESUMEN

OBJECTIVES: to identify scientific evidence in the literature regarding educational actions on leprosy developed with adolescents. METHOD: an integrative review of the literature, with the following research question: what are the leprosy educational practices currently being developed with adolescents? The search was performed in the following databases: MEDLINE, Scopus, LILACS, CINAHL, BVS Hanseníase and other sources, using "adolescent"; "leprosy"; "health education"; "public health", and "public health practice" as keywords. Results: the sample was comprised of nine studies. Leprosy educational practices with adolescents verifiably promote change in knowledge when they are based on constructivist methodologies. The nurse is recognized as a professional with potential for developing these educational practices. Final considerations: actions for leprosy education with adolescents do lead to changes in knowledge, but new research is needed to evaluate their effectiveness in further improving this knowledge as well as changing behaviors and practices.


Asunto(s)
Conducta del Adolescente/psicología , Educación en Salud/métodos , Lepra/diagnóstico , Adolescente , Femenino , Educación en Salud/normas , Humanos , Lepra/fisiopatología , Lepra/terapia , Masculino
20.
Rev Bras Enferm ; 72(5): 1421-1425, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531670

RESUMEN

OBJECTIVE: To report the experience of professors and students in the development and implementation of an educational workshop on leprosy with adolescents. Method: This is a case report from actions contained in a university extension project. RESULTS: The workshop program was elaborated with duration of two hours, including five dynamic techniques adapted to the topic: adjective, face, traffic light, true or false and mosaic. It was verified that the construction of knowledge in light of the verbalization of the adolescents and the interest in working in the society they live through sharing this knowledge, especially those who were more involved in the process. CONCLUSION: It was concluded that the applied workshops enabled building knowledge and demystifying myths and stigmas socially constructed to adolescents, as well as allowed Nursing students to experience educational interventions on leprosy with adolescents.


Asunto(s)
Conducta del Adolescente/psicología , Educación/métodos , Lepra/terapia , Educación del Paciente como Asunto/métodos , Adolescente , Femenino , Humanos , Lepra/diagnóstico , Lepra/fisiopatología , Masculino
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