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1.
J Pak Med Assoc ; 71(3): 838-842, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34057932

RESUMEN

OBJECTIVE: To determine the occurrence and characteristics of the two types of lepra reactions in new leprosy cases at initial diagnosis. Methods: The retrospective descriptive study was conducted at the Marie Adelaide Leprosy Centre, Karachi, and comprised all new leprosy cases registered from January 1, 2016, to June 30, 2018. Data was collected from the medical record database using a predesigned proforma. RESULTS: Of the 50 cases, 2(4%) were children and 48 (96%) were adults, with overall age ranging from 12 to 85 years. There were 41(82%) males and 9(18%) females.. Of the total, 30(60%) cases presented with type 1 reaction and 20(40%) with type 2. Further, 30(60%) cases were classified as borderline lepromatous. Among them, 17(57%) had type 2 reaction. Inflamed plaques were the main feature in 27(90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19(95%) cases of type 2. Conclusion: Lepra reactions were found to be a presenting feature in a significant number of new leprosy cases at initial diagnosis.


Asunto(s)
Lepra , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Grupos Étnicos , Femenino , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Adulto Joven
2.
JMIR Mhealth Uhealth ; 9(4): e23718, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33825685

RESUMEN

BACKGROUND: According to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease. OBJECTIVE: The main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN). METHODS: Leprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System. RESULTS: We mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was "operational classification does not match the clinical form." After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively. CONCLUSIONS: The proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians.


Asunto(s)
Lepra , Aplicaciones Móviles , Inteligencia Artificial , Brasil/epidemiología , Humanos , India/epidemiología , Lepra/diagnóstico , Lepra/epidemiología
3.
An Bras Dermatol ; 96(3): 301-308, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33838953

RESUMEN

BACKGROUND: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. OBJECTIVE: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. METHODS: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. RESULTS: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2 = 7.23; 4 degrees of freedom; p = 0.12). STUDY LIMITATIONS: Use of recorded data, with incomplete medical records and lack of patient follow-up. CONCLUSIONS: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.


Asunto(s)
Lepra , Brasil/epidemiología , Hospitales , Humanos , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Lepra/epidemiología , Atención Primaria de Salud , Estudios Retrospectivos
5.
BMC Infect Dis ; 21(1): 290, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752632

RESUMEN

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Lepra/diagnóstico , Adolescente , Adulto , Brasil/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Escolaridad , Femenino , Humanos , Incidencia , Lepra/epidemiología , Lepra/patología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Población Rural , Adulto Joven
6.
Rev Soc Bras Med Trop ; 54: e03892020, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656147

RESUMEN

INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.


Asunto(s)
Lepra Multibacilar , Lepra , Brasil/epidemiología , Estudios Transversales , Humanos , Lepra/epidemiología , Masculino , Recurrencia
7.
Acta Trop ; 218: 105884, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33676938

RESUMEN

OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.


Asunto(s)
Enfermedades Endémicas/estadística & datos numéricos , Lepra/epidemiología , Factores Socioeconómicos , Adulto , Brasil/epidemiología , Brasil/etnología , Ciudades/epidemiología , Ciudades/etnología , Escolaridad , Ambiente , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Lepra/etnología , Masculino , Persona de Mediana Edad , Adulto Joven
9.
Int J Infect Dis ; 105: 261-266, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33592342

RESUMEN

BACKGROUND: Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. The aim of this study was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy using a case-control design. METHODS: From 2016 to 2018, individuals aged ≥3 years were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in three groups: cases of leprosy, household contacts and community-matched (non-contact) controls. Helminths were diagnosed through stool Kato Katz examination and serum reactivity to anti-soluble adult worm antigen preparation IgG4. Serum ferritin, 25-OH vitamin D and retinol concentrations were measured. Multi-variate logistic regression was conducted to identify associations with active leprosy. RESULTS: Seventy-nine cases of leprosy, 96 household contacts and 81 non-contact controls were recruited; 48.1% of participants were male with a median age of 40 years. Helminths were found in 7.1% of participants on Kato Katz test, all but one of which were Schistosoma mansoni, and 32.3% of participants were positive for S. mansoni serology. On multi-variate analysis, cases were more likely to be infected with helminths (diagnosed by stool) than household contacts [adjusted odds ratio (aOR) 8.69, 95% confidence interval (CI) 1.50-50.51]. Vitamin D deficiency was common, and was more likely in cases compared with non-contact controls (aOR 4.66, 95% CI 1.42,-15.33). Iron deficiency was not associated with leprosy, and vitamin A deficiency was not detected. CONCLUSION: These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy. Comorbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programmes to improve leprosy control.


Asunto(s)
Coinfección/complicaciones , Helmintos/fisiología , Lepra/complicaciones , Mycobacterium leprae/fisiología , Deficiencia de Vitamina D/complicaciones , Adolescente , Adulto , Anciano , Animales , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Heces/parasitología , Femenino , Humanos , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo
10.
Medisan ; 25(1)ene.-feb. 2021. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1154843

RESUMEN

Introducción: La lepra es una enfermedad infectocontagiosa crónica, producida por el Mycobacterium leprae, y constituye uno de los males más antiguos de la humanidad. Objetivo: Describir algunas características clínicas y epidemiológicas de los pacientes con lepra pertenecientes al Policlínico Docente Ramón López Peña de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 11 pacientes diagnosticados con la enfermedad de Hansen en la mencionada área de salud en el período 2005-2019. Para el procesamiento de la información se creó una base de datos mediante el sistema SPSS, versión 11.5 para Windows, donde se tabularon los datos de las encuestas. El análisis de los resultados se expresó en números absolutos y porcentajes para su mejor interpretación. Resultados: Predominaron el grupo etario de 35-44 años (54,5 %), el sexo masculino (54,6 %) y la lepra dimorfa, en su forma clínica multibacilar. La mayoría de los pacientes fueron diagnosticados precozmente y solo se observó algún grado de discapacidad en los diagnósticos tardíos; asimismo, las condiciones higiénicas desfavorables y el hacinamiento fueron los factores de riesgo de mayor relevancia. Conclusiones: A pesar de la existencia de pacientes con lepra en dicha área de salud, se observó un período de silencio epidemiológico, que unido a los factores de riesgo presentes, aumenta la posibilidad de contagio y pone en peligro los objetivos establecidos para su erradicación.


Introduction: Leprosy is an infectious chronic disease, produced by the Mycobacterium leprae, and constitutes one of the oldest ills of humanity. Objective: To describe some clinical and epidemiological characteristics of the patients with leprosy belonging to Ramón López Peña Teaching Polyclinic in Santiago de Cuba. Methods: A descriptive and retrospective study of the 11 patients diagnosed with Hansen disease in the mentioned health area during 2005-2019 was carried out. A database was created by means of the SPSS system, version 11.5 for Windows, for processing the information, where the data of the surveys were tabulated. The analysis of the results was expressed in absolute numbers and percentages for its best interpretation. Results: There was a prevalence of the 35-44 age group (54.5 %), the male sex (54.6 %) and the borderline lepromatous leprosy, in its multibacilar clinical form. Most of the patients were early diagnosed and certain degree of disability was just observed in the late diagnoses; also, the unfavorable hygienic conditions and overcrowding were the risk factors of more relevance. Conclusions: In spite of the existence of patients with leprosy in this health area, a period of epidemiological silence was observed that along with the existing risk factors, increases the infection possibility and puts in danger the established objectives for its eradication.


Asunto(s)
Enfermedades Transmisibles , Lepra/epidemiología , Atención Primaria de Salud , Mycobacterium leprae
11.
PLoS Negl Trop Dis ; 15(1): e0008881, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33400698

RESUMEN

BACKGROUND: The province of Formosa, Argentina, is endemic for leprosy. In the present paper, we assessed the trend (T, 2002-2016 time series) and the forecast for 2022 of new case detection rate (NCDR) and determined the spatial distribution of new cases detected (NCD) of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: This is a descriptive observational study of 713 NCD of leprosy from provincial medical records between January 2002 and December 2016. The whole dataset from the provincial medical record was used to independently estimate the NCDR trends of the general population, age groups, sexes and Departments. This same database was used to estimate the NCDR forecast of the general population for 2022, applying a dynamic linear model with a local linear trend, using the MCMC algorithm. The NCDR was higher in men (p<0.05), increased with age (0.20, 8.17, 21.04, and 29.49 for the 0-14, 15-44, 45-64 and over 65-year-old age groups, respectively; p<0.05) and showed a downward trend (negative values) of estimated slopes for the whole province and each Department. Bermejo Department showed the highest (T:-1.02, 95%CI: [-1.42, -0.66]) and Patiño the lowest decreasing trend (T:-0.45, 95%CI: [-0.74, -0.11]). The NCDR trend for both sexes was similar (T:-0.55, 95%CI: [-0.64, -0.46]), and age groups showed a decreasing trend (S15-44:-103, S45-64:-81, S>65:-61, p<0.05), except for the 0-14 age group (S:-3, p>0.05), which showed no trend. Forecasts predicted that leprosy will not be eliminated by 2022 (3.64, 95%CI: [1.22, 10.25]). CONCLUSIONS/SIGNIFICANCE: Our results highlight the status of leprosy in Formosa and provide information to the provincial public health authorities on high-risk populations, stressing the importance of timely detection of new cases for further elimination of the disease in the province.


Asunto(s)
Lepra/epidemiología , Adolescente , Adulto , Anciano , Algoritmos , Argentina/epidemiología , Niño , Preescolar , Predicción , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Lineales , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
12.
PLoS Negl Trop Dis ; 15(1): e0008956, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33411800

RESUMEN

BACKGROUND: After the elimination of leprosy in 1995, there were 10-30 newly detected leprosy cases every year in Zhejiang Province, and the epidemiological characteristics of the newly detected leprosy cases have changed. While most of the newly detected cases came from other provinces in China, not Zhejiang, it brought a new challenge for leprosy prevention and control in post- elimination era in Zhejiang, China. This study was aimed to understand the temporal-spatial distribution characteristics of newly detected leprosy cases, and provide the scientific rationales for the development of leprosy control strategy. METHODS: Data on the demographic of Zhejiang Province from 2011 to 2019 were obtained from the China Information System for Disease Control and Prevention, and the epidemiological data on leprosy cases newly detected in Zhejiang Province from 2011 to 2019 were obtained from the LEPROSY MANAGEMANT INFORMATION SYSTEM IN CHINA (LEPMIS), and temporal-spatial distributions were described. The geographic information system software-ArcGIS 10.4 was used to draw the statistical maps, and Geoda 1.14.0 was used for local spatial autocorrelation analysis (local Getis coefficient method). Ridley-Jopling classification was used to classify the clinical types into I, TT, BT, BB, BL or LL. Two-group classification system developed by the World Health Organization (WHO) was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. RESULTS: A total of 167 leprosy cases were reported in Zhejiang Province during 2011-2019, including 107 cases in males and 60 in females. The mean age at diagnosis was 37.99±14.81 years, and 94.01% of the cases were detected through the examination at skin-clinics. The number of workers, MB cases, G2D cases were 81 (48.50%), 159 (94.01%), 24 (14.37%) respectively, and the rate of early detection increased from 45.16% in 2011 to 90.91% in 2019. Leprosy cases were reported in all the prefectures of Zhejiang except Zhoushan City. The cases in local population accounted for 23.35% (39 cases), and the cases in floating population (especially coming from high epidemic provinces in China) accounted for 76.65% (128 cases). The annual number of newly detected cases showed a decreasing trend, from 31 cases in 2011 to 11 in 2019. Time of the floating population living in Zhejiang Province ranged from several months to more than 10 years. The annual proportion of new cases with G2D declined from 22.58% in 2011 to 9.09% in 2019. The results of local indicators of autocorrelation (LISA) analysis showed that the high-high areas were mainly concentrated in the middle and northeast of Zhejiang Province, while the low-low areas were in the east and southwest. CONCLUSION: A few scattered cases still can be seen in post-elimination era, and there was a spatial clustering of the newly detected leprosy cases in Zhejiang Province. Most of the cases in Zhejiang Province were from other high epidemic provinces in China, which brought a new challenge for leprosy control and prevention in post- elimination era in Zhejiang, and it is also necessary to strengthen the early detection and standard management of the leprosy cases in floating population in Zhejiang.


Asunto(s)
Lepra/epidemiología , Lepra/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , China/epidemiología , Ciudades , Diagnóstico Precoz , Epidemias , Femenino , Sistemas de Información Geográfica , Humanos , Lepra/diagnóstico , Masculino , Persona de Mediana Edad , Análisis Espacial , Adulto Joven
13.
PLoS Negl Trop Dis ; 15(1): e0009031, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33476343

RESUMEN

BACKGROUND: Understanding how knowledge, attitudes and practices regarding leprosy differ in endemic countries can help us develop targeted educational and behavioural change interventions. This study aimed to examine the differences and commonalities in and determinants of knowledge, attitudes, practices and fears regarding leprosy in endemic districts in India and Indonesia. PRINCIPLE FINDINGS: A cross-sectional mixed-methods design was used. Persons affected by leprosy, their close contacts, community members and health workers were included. Through interview-administered questionnaires we assessed knowledge, attitudes, practices and fears with the KAP measure, EMIC-CSS and SDS. In addition, semi-structured interviews and focus group discussions were conducted. The quantitative data were analysed using stepwise multivariate regression. Determinants of knowledge and stigma that were examined included age, gender, participant type, education, occupation, knowing someone affected by leprosy and district. The qualitative data were analysed using open, inductive coding and content analysis. We administered questionnaires to 2344 participants (46% from India, 54% from Indonesia) as an interview. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low in both countries: 88% of the participants in India and 90% of the participants in Indonesia had inadequate knowledge of leprosy. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels (a mean score of up to 17.4 on the EMIC-CSS and 9.1 on the SDS). Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed, for instance that leprosy is in the family for seven generations (Indonesia) or that leprosy is a result of karma (India). The determinants of leprosy knowledge and stigma explained 10-29% of the variability in level of knowledge and 3-10% of the variability in level of stigma. CONCLUSION: Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Detailed knowledge of local knowledge gaps, beliefs and fears can help tailor health education to local circumstances.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Lepra/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , India/epidemiología , Indonesia/epidemiología , Masculino , Persona de Mediana Edad , Percepción , Estigma Social , Adulto Joven
14.
Rev. Soc. Bras. Med. Trop ; 54: e0389-2020, 2021. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1155534

RESUMEN

Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.


Asunto(s)
Humanos , Masculino , Lepra Multibacilar , Lepra/epidemiología , Recurrencia , Brasil/epidemiología , Estudios Transversales
15.
Acta Trop ; 215: 105791, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33310076

RESUMEN

BACKGROUND: Leprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil. METHOD: Exploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003-2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level. RESULT: A total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51-1.66)], children [OR: 1.49 (1.36-1.64)]; paucibacillary [OR: 1.08 (1.02-1.13)], indeterminate clinical forms [OR: 2.37 (2.15-2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09- 3.73)] and contact examination [OR: 2.30 (2.13-2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19-2.77)] when compared with those presenting both skin lesion and affected nerves. CONCLUSION: Misdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.


Asunto(s)
Errores Diagnósticos , Lepra/diagnóstico , Adolescente , Adulto , Anciano , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
16.
Bauru; s.n; 2021. 21 p. ilus, tab.
Tesis en Portugués | Sec. Est. Saúde SP, CONASS, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP, SESSP-ESPECIALIZACAOSESPROD, Sec. Est. Saúde SP | ID: biblio-1150994

RESUMEN

A Hanseníase é uma doença infectocontagiosa de caráter crônico, evolução lenta, causada pelo Mycobacterium leprae (M. leprae). A transmissão ocorre por meio do trato respiratório, e para o desenvolvimento da doença existe a necessidade da susceptibilidade, além do contato íntimo e prolongado. Para fins terapêuticos a Organização Mundial da Saúde (OMS) traz uma classificação mais simples que é baseada no número de lesões cutâneas. Os casos com até cinco lesões são considerados paucibacilares e aqueles com mais de cinco lesões são multibacilares. Apesar da implantação da poliquimioterapia (PQT) pela OMS ter sido um importante avanço técnico na história do controle da doença, em 2019 ainda foram notificados 202.185 novos casos no mundo, sendo o Brasil o segundo em concentração de casos. Um indicador importante para o controle da hanseníase são as taxas de retratamento, definido como nova notificação de hanseníase em paciente que já tenha recebido tratamento anterior, suas causas incluem abandono, insuficiência terapêutica, falência terapêutica, alteração de esquema por erro diagnóstico e recidiva. Embora um grande número de casos de recidivas seja detectado no Brasil, apenas 8,4%, 13,3% e 1,9% dos casos podem ser explicados por mutações que sabidamente conferem resistência bacilar aos medicamentos utilizados na PQT: rifampicina (RFP), dapsona (DDS) e ofloxacina (OFLO), respectivamente. Além dos aspectos relacionados ao patógeno, a contribuição do hospedeiro para esse cenário, apesar de pouco estudada, deve ser de grande importância. No geral a resposta ao medicamento é variável entre indivíduos, ocasionando falta de eficácia farmacológica ou reação adversas, em partes esses eventos podem ser explicados pela farmacogenética. Conhecer fatores genéticos que interferem no metabolismo dos medicamentos pode contribuir para melhores resultados terapêuticos. Dentre os desafios para atingir a eliminação da hanseníase estão a ausência de novas ferramentas de diagnóstico e de entendimento das causas associadas a recidiva e à não adesão a PQT, uma vez que a resistência medicamentosa explica pouco da reativação da doença, deste modo, o presente estudo teve como finalidade constituir banco de dados em hanseníase para estudos de associação do tipo caso-controle sobre os fatores associados com a falha terapêutica da PQT convencional. Dos 240 prontuários avaliados, 119 foram classificados como casos de falência terapêutica ou recidiva e 121 como sucesso terapêutico, aqui denominados como controles, a maioria dos pacientes era do sexo masculino, branco e procedente do estado de São Paulo; Em relação à faixa etária de diagnóstico, 18% foram diagnosticados com idade entre 40 e 49 anos, enquanto nos controles 14% tiveram diagnóstico com idade inferior a 19 anos; quanto à forma clínica da doença, 59% dos casos e 47% dos controles foram classificados como virchoviano. Dentre os casos de falência terapêutica ou recidiva, a resistência molecular explicou apenas 5,8 % dos casos de retratamento. Esse dado reforça a urgência de estudos que esclareçam as causas da falha terapêutica em hanseníase, contribuindo assim para o estabelecimento de medidas que visem o alcance de melhores índices relacionados aos desfechos terapêuticos.(AU)


Leprosy is a chronic infectious disease with insidious evolution, caused by Mycobacterium leprae (M. leprae). Transmission occurs through the respiratory tract, and the onset of the disease depends on susceptibility, in addition to intimate and prolonged contact with untreated patients. For therapeutic purposes, the World Health Organization's (WHO) classification is based on the number of skin lesions. Cases with up to five lesions are considered paucibacillary and those with more than five lesion are multibacillary. Although the implementation of multidrugtherapy (MDT) by WHO was an important technical advance in the history of disease control. In 2019, 202,185 new cases were reported in the world, with Brazil the second in the highest number of cases. An important indicator for the control of leprosy is retreatment rate, defined as a new notification of leprosy in a patient who has already received previous treatment. Its causes include abandonment, therapeutic failure, , alteration of the regimen due to diagnostic error and relapse. Although a large number of cases of relapses are detected in Brazil, only 8.4%, 13.3% and 1.9% of cases can be explained by mutations that are known to confer bacillary resistance to drugs used in the MDT: rifampicin (RFP), dapsone (DDS) and ofloxacin (OFLO), respectively. In addition to aspects related to the pathogen, the host's contribution to this scenario, although little studied, is highly important. In general, the response to the drug treatment is variable between individuals, causing a lack of pharmacological efficacy or adverse reactions. , These events may be explained by pharmacogenetics. Knowing genetic factors that interfere with drug metabolism can contribute to better therapeutic results. Among the challenges to achieve leprosy elimination are the absence of new diagnostic tools and understanding of the causes associated with relapse and non-adherence to MDT, since drug resistance explains little about the reactivation of the disease. Thus, the present study aimed at constituting a leprosy database for case-control association studies on factors associated with conventional MDT therapeutic failure. Of the 240 medical records evaluated, 119 were classified as cases of therapeutic failure or relapse and 121 as therapeutic success, here referred to as controls. The majority of patients were male, white and from the state of São Paulo. Regarding the age of diagnosis, 18% were diagnosed between 40 and 49 years, while in controls, 14% were diagnosed under 19 years; as to the clinical form of the disease, 59% of the cases and 47% of the controls were classified as lepromatous. Among the cases of therapeutic failure or relapse, molecular resistance explained only 5.8% of retreatment cases. This data reinforces the urgency of studies that clarify the causes of therapeutic failure in leprosy, thus contributing to the establishment of measures aimed at achieving better therapeutic outcomes(AU).


Asunto(s)
Humanos , Masculino , Femenino , Base de Datos , Quimioterapia Combinada , Lepra/terapia , Farmacogenética , Recurrencia , Resistencia a Medicamentos , Registros Médicos/estadística & datos numéricos , Recolección de Datos , Negativa del Paciente al Tratamiento , Retratamiento , Lepra/epidemiología
17.
Bauru; s.n; 2021. 34 p. tab, graf, mapas.
Tesis en Portugués | Sec. Est. Saúde SP, CONASS, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP, SESSP-ESPECIALIZACAOSESPROD, Sec. Est. Saúde SP | ID: biblio-1178629

RESUMEN

INTRODUÇÃO: A hanseníase causada pelo Mycobacterium leprae acomete a pele e os nervos periféricos e gerar graves sequelas. O Brasil apresenta alto índice de prevalência e incidência com o segundo maior número de casos da doença no mundo. Conhecer o perfil dos pacientes é fundamental para melhorar o atendimento e traçar políticas de controle da doença. OBJETIVOS: Identificar aspectos clínico-epidemiológicos e sociodemográficos de casos novos de hanseníase diagnosticados no Instituto Lauro de Souza Lima (ILSL) (Bauru-SP) no período de 2015 a 2019. MÉTODOS: Estudo epidemiológico transversal retrospectivo a partir de dados secundários obtidos de prontuários médicos. RESULTADOS: Foram diagnosticados 177 novos casos de hanseníase, sendo 38,4% dos pacientes naturais de outros estados. A maioria da população era do sexo masculino (59,9%), a faixa etária mais prevalente foi de 60 a 74 anos (29,9%), 79,1% pertenciam à raça branca e 65,6% possuíam pouca ou nenhuma escolaridade. A forma clínica dimorfa foi a mais frequente (42,4%), a baciloscopia foi positiva em 38,4% dos pacientes (49,0% entre os homens e 22,5% entre as mulheres) e 56,9% possuíam incapacidades no diagnóstico. A maioria dos pacientes do município de Bauru (n=31) era originária de regiões com elevado nível de vulnerabilidade social. CONCLUSÃO: O perfil dos pacientes atendidos aponta para predominância de homens maduros com baixa escolaridade, multibacilares já com incapacidades, sugerindo uma endemia oculta que pode sustentar a manutenção da hanseníase. Políticas públicas voltadas para essa faixa populacional devem ser consideradas a redução da carga da hanseníase no estado de São Paulo.(AU)


INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and peripheral nerves and can result in severe sequelae. Brazil has high prevalence and incidence rates of leprosy, being the second country with highest number of leprosy cases in the world. To know the profile of leprosy patients is essential to improve care and design policies in order to control the disease. OBJECTIVES: To identify clinical, epidemiological and sociodemographic aspects of new cases of leprosy diagnosed at the Lauro de Souza Lima Institute (ILSL)/SES-SP from 2015 to 2019. METHODS: A retrospective cross-sectional epidemiological study based on secondary data obtained from medical records. RESULTS: 177 new cases of leprosy were diagnosed at ILSL, with 38.4% patients born in other states. The majority of the population was male (59.9%), the most prevalent age group was 60 to 74 years old (29.9%), 79.1% belonged to the white race and 65.6% had little or none schooling. The dimorphic clinical form was the most frequent (42.4%), slit skin smear was positive in 38.4% of patients (49.0% among men and 22.5% among women) and 56.9% had disabilities at diagnosis. In the municipality of Bauru, most cases were from regions with a high level of social vulnerability. CONCLUSION: The profile of patients points to a predominance of mature men with low education, multibacillary and showing disabilities, suggesting a hidden endemic that can support the maintenance of leprosy. Public policies aimed at this group of the population must be considered for the reduction of leprosy burden in the state of São Paulo


Asunto(s)
Estudios Epidemiológicos , Lepra/epidemiología , Perfil de Salud , Brasil/epidemiología , Registros Médicos , Mapeo Geográfico , Colonias de Leprosos
20.
PLoS Negl Trop Dis ; 14(12): e0008883, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33362202

RESUMEN

Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae), with about 210,000 new cases per year worldwide. Although numerous risk loci have been uncovered by genome-wide association studies, the effects of common genetic variants are relatively modest. To identify possible new genetic locus involved in susceptibility to leprosy, whole exome sequencing was performed for 28 subjects including 14 patients and 12 unaffected members from 8 leprosy-affected families as well as another case and an unrelated control, and then the follow-up SNP genotyping of the candidate variants was studied in case-control sample sets. A rare missense variant in mitochondrial ribosomal protein S5 (MRPS5), rs200730619 (c. 95108402T>C [p. Tyr137Cys]) was identified and validated in 369 cases and 270 controls of Chinese descent (Padjusted = 0.006, odds ratio [OR] = 2.74) as a contributing factor to leprosy risk. Moreover, the mRNA level of MRPS5 was downregulated in M. leprae sonicate-stimulated peripheral blood mononuclear cells. Our results indicated that MRPS5 may be involved in leprosy pathogenesis. Further studies are needed to determine if defective MRPS5 could lead to impairment of energy metabolism of host immune cells, which could further cause defect in clearing M. leprae and increase susceptibility to infection.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Predisposición Genética a la Enfermedad , Lepra/genética , Proteínas Mitocondriales/genética , Polimorfismo de Nucleótido Simple , Proteínas Ribosómicas/genética , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , China/epidemiología , Femenino , Regulación de la Expresión Génica , Humanos , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Adulto Joven
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