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2.
An Bras Dermatol ; 95(1): 52-56, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31952993

RESUMEN

BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.


Asunto(s)
Evaluación de la Discapacidad , Lepra/patología , Lepra/fisiopatología , Estudios Transversales , Progresión de la Enfermedad , Cara/anomalías , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/patología , Deformidades Adquiridas del Pie/fisiopatología , Deformidades Adquiridas de la Mano/patología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , India , Masculino , Registros Médicos , Nervios Periféricos/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo
3.
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
4.
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
5.
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
7.
Arq Neuropsiquiatr ; 77(5): 346-351, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31188999

RESUMEN

OBJECTIVE: Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. METHODS: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. RESULTS: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. CONCLUSION: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.


Asunto(s)
Analgésicos/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Lepra/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Calidad de Vida , Adulto , Femenino , Humanos , Lepra/fisiopatología , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Dimensión del Dolor , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento
8.
PLoS One ; 14(3): e0213842, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30870498

RESUMEN

BACKGROUND: Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed. OBJECTIVES: The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals. METHODOLOGY: 19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve. RESULTS: The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases. CONCLUSION: The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.


Asunto(s)
Cara/fisiopatología , Lepra/clasificación , Lepra/fisiopatología , Trastornos de la Sensación/epidemiología , Adulto , Brasil/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Trastornos de la Sensación/patología , Adulto Joven
11.
J Plast Reconstr Aesthet Surg ; 71(12): 1704-1710, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30174287

RESUMEN

BACKGROUND: Loss of protective sensation of the sole may lead to repeated trauma, chronic nonhealing ulcers, and even amputation. Saphenous nerve (SN) to posterior tibial nerve (PTN) transfer can restore sensation of the sole. METHOD: This study was conducted in a tertiary referral center in Central India. Twenty-one patients (32 feet) diagnosed with loss of sensation of the sole were included in this study. Causes of loss of sensation were Hansen's disease (n = 18), complex sciatic nerve injury (n = 1), lumbosacral spinal tumor (n = 1), and lumbosacral meningomyelocele (n = 1). Seventeen feet (14 patients) had ulcers on the sole. Preoperative and postoperative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration, and two-point discrimination. Results were classified as per the British Medical Research Council (MRC) scoring system. RESULTS: Seventeen patients (26 feet) were available for follow-up at 6 months after surgery. All patients had improvement in sensory parameters. Ulcers completely healed in 13 feet and reduced in size in four feet. MRC score improved from S0 in 22 feet and S1 in 10 feet to S3 + in 20 feet, S3 in four feet, and S2 in two feet. CONCLUSIONS: Sensory neurotization with SN transfer to PTN can restore protective sensation to the sole and help in the healing of ulcers.


Asunto(s)
Pie/inervación , Transferencia de Nervios/métodos , Vena Safena/trasplante , Trastornos de la Sensación/cirugía , Adolescente , Adulto , Anciano , Femenino , Pie/fisiopatología , Humanos , Lepra/complicaciones , Lepra/fisiopatología , Masculino , Persona de Mediana Edad , Tempo Operativo , Umbral del Dolor/fisiología , Sensación/fisiología , Trastornos de la Sensación/fisiopatología , Umbral Sensorial/fisiología , Nervio Tibial/cirugía , Neuropatía Tibial/fisiopatología , Neuropatía Tibial/cirugía , Resultado del Tratamiento , Vibración , Adulto Joven
12.
Trans R Soc Trop Med Hyg ; 112(11): 492-499, 2018 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-30189090

RESUMEN

Background: In Nigeria, little is known about the development of new or additional physical disability during leprosy treatment. The objective of this study was to determine the prevalence and evaluate factors associated with worsening of physical disability during leprosy treatment in Nigeria. Methods: This was a retrospective cohort study conducted among leprosy patients treated in six referral facilities in six States in Nigeria between January 2011 and December 2015. Multivariable logistic regression analysis was used to identify predictors of worsening disability after treatment. Results: Of 984 leprosy patients who completed treatment, the mean age of the patients was 39.8±17.6 years and 57.4% (565/984) of them were male. Also, 51.6% (508/984) of the patients had either grade 1 or 2 disability at diagnosis, but this declined to 30.8% (303/984) following treatment (p<0.001). Overall, 4.7% (46/984) of the cases developed new or additional disability (or worsening disability) during treatment. The cases with the greatest odds for developing worsening physical disability were patients from the southwest (adjusted odds ratio [aOR] 15.9; 95% CI 3.8-67.4) and southeast zones (aOR 4.7; 95% CI 1.1-19.2), and patients who had a leprosy reaction requiring additional corticosteroid therapy (aOR 11.7; 95% CI 4.4-31.2). Conclusion: Sustained capacity building for health professionals on better monitoring and management of leprosy and its complications is strongly recommended in Nigeria.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Leprostáticos/uso terapéutico , Lepra/fisiopatología , Lepra/terapia , Adolescente , Adulto , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
13.
Microb Pathog ; 124: 1-4, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30118799

RESUMEN

Leprosy is a disease caused by Mycobacterium leprae, which is characterized by two distinct poles, the tuberculoid pole and the lepromatous pole, depending on the immune response to the bacillus. Langerin-positive cells are dendritic cells that appear to play an essential role in the development of the disease. These cells are specialized in the processing and presentation of antigens, exerting an important function in the activation of the immune system. To evaluate the expression of langerin-positive cells (CD207+) in skin lesion fragments of patients with a diagnosis of M. leprae infection and to associate the expression of these cells with the polar forms of the disease. Langerin-positive cells were detected in larger numbers in lesions of patients with the tuberculoid form compared to those with the lepromatous form. The presence of a larger number of these cells in patients with the tuberculoid form suggests an important participation of langerin-positive cells, capturing antigens and favoring an effective immune response to infection with M. leprae.


Asunto(s)
Antígenos CD/análisis , Células Dendríticas/química , Células Dendríticas/inmunología , Lectinas Tipo C/análisis , Lepra/patología , Lepra/fisiopatología , Lectinas de Unión a Manosa/análisis , Piel/patología , Adulto , Brasil , Femenino , Humanos , Inmunohistoquímica , Masculino , Microscopía
14.
Med. oral patol. oral cir. bucal (Internet) ; 23(4): e376-e383, jul. 2018. tab
Artículo en Inglés | IBECS | ID: ibc-176314

RESUMEN

Background: The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects. Material and Methods: A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA). Results: The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment). Conclusions: It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Lepra/diagnóstico por imagen , Salud Bucal , Estudio Observacional , Halitosis/etiología , Lepra/complicaciones , Lepra/fisiopatología , Salivación , Índice de Severidad de la Enfermedad
15.
Med Oral Patol Oral Cir Bucal ; 23(4): e376-e383, 2018 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-29924752

RESUMEN

BACKGROUND: The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects. MATERIAL AND METHODS: A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA). RESULTS: The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment). CONCLUSIONS: It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals.


Asunto(s)
Lepra/diagnóstico , Salud Bucal , Adolescente , Adulto , Anciano , Femenino , Halitosis/etiología , Humanos , Lepra/complicaciones , Lepra/fisiopatología , Masculino , Persona de Mediana Edad , Salivación , Índice de Severidad de la Enfermedad , Adulto Joven
16.
Clin Genet ; 94(2): 259-263, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29722023

RESUMEN

Seven new risk coding variants have been identified through an exome-wide association study (EWAS), which studied the contributions of protein-coding variants to leprosy susceptibility. But some potential susceptibility loci were not studied in the previous EWAS study because of the project consideration. Seventeen unstudied potential susceptibility loci of the previous EWAS were validated in 3169 cases and 9814 controls in this study. Four disease-associated exonic loci were identified: rs671 in ALDH2 (P = 2.0 × 10-20 , odds ratio [OR] = 1.35), rs13259978 in SLC7A2 (P = 1.74 × 10-8 , OR = 1.28), rs925368 in GIT2 (P = 9.18 × 10-17 , OR = 1.44), and rs75680863 in TCN2 (P = 8.37 × 10-21 , OR = 0.74). Potentially implicating ZFP36L1 as a new susceptibility gene, 1 intergenic single nucleotide polymorphism (SNP), rs1465788 (P = 7.81 × 10-6 , OR = 0.88), was also suggested to be associated with leprosy. A luciferase reporter assay showed that the rs1465788 risk allele notably decreased the transcription activity of the flanking sequence. These findings suggest the possible involvement of lipid metabolism, NF-κB homeostasis and macrophage antimicrobial pathways in leprosy pathogenesis.


Asunto(s)
Predisposición Genética a la Enfermedad , Estudio de Asociación del Genoma Completo , Lepra/genética , Aldehído Deshidrogenasa Mitocondrial/genética , Grupo de Ascendencia Continental Asiática/genética , Factor 1 de Respuesta al Butirato/genética , Transportador de Aminoácidos Catiônicos 2/genética , ADN Intergénico/genética , Exoma/genética , Exones/genética , Femenino , Proteínas Activadoras de GTPasa/genética , Humanos , Lepra/fisiopatología , Masculino , FN-kappa B/genética , Polimorfismo de Nucleótido Simple/genética , Transcobalaminas/genética
17.
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
18.
Trans R Soc Trop Med Hyg ; 112(1): 31-35, 2018 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-29566236

RESUMEN

Background: Leprosy, a disease caused by Mycobacterium leprae, is an important cause of preventable disability. Methods: The present cross-sectional study was undertaken among leprosy-affected persons in a rural block in Kanchipuram District, Tamil Nadu, India in the year 2013. The sample included treatment completed leprosy affected persons ≥18 y of age. Persons with difficulty in cognition and those who were not willing to participate in the study were excluded. Subjects were also graded for any deformities of the body using World Health Organization (WHO) disability grading. Results: The present study, carried out among 171 people affected with leprosy in a rural block, showed the lifetime prevalence of disability was 88.3% (95% confidence interval 83.4 to 93.1). The mean age of the study participants was 61.58±12.31 y with almost equal distribution of males (49.7%) and females (50.3%). WHO disability grading showed that 147 (86%) of the subjects were grade 2 (visible deformity) while only 4 (2.3%) were grade 1. It was found that education, occupation, income and duration since diagnosis had statistical significance with disability. Conclusions: Disability was observed more in males and the most common type of deformity was hand and foot deformity. Further studies are needed to assess those patients who completed treatment and recommends periodic neurological assessment of those in treatment.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Lepra/epidemiología , Lepra/fisiopatología , Salud Rural/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Escolaridad , Empleo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Renta , India/epidemiología , Lepra/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural/estadística & datos numéricos , Distribución por Sexo , Adulto Joven
20.
Med Hypotheses ; 109: 162-169, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29150278

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae mainly affecting skin and peripheral nerves. Leprosy has a broad range of clinical manifestations that range from mild (tuberculoid leprosy) to severe (lepromatous leprosy) forms, and are highly dependent on the host's immune response. Among the immune response elements involved in the pathogenesis of leprosy are the Toll-like receptors (TLRs), vitamin D receptor (VDR), natural killer cells (NK), and T cells. These innate and adaptive immune response elements may be related to the Notch signaling pathway, which is involved in immune cell growth, differentiation, and proliferation. We hypothesize that failure in Notch signaling in leprosy patients may be associated to: 1) compromising NK cell maturation, lysing of infected cells, and CD4+ Th1 differentiation. 2) VDR alterations and TLR polymorphisms may affect expression of Notch Delta-like ligands (DLL) in antigen presenting cells (APCs). 3) altered DLL expression by APCs could compromise CD4+ T cell differentiation towards the Th1 and Th17 effector phenotypes; and finally 4) expression of Notch Jagged ligands would induce CD4+ T cell differentiation towards Th2 effector phenotype and alternative activation of macrophages. Altogether, these signaling failures could favor proliferation of M. leprae in the host. Therefore, evidence of the proposed immunologic failures in leprosy patients would be essential for the better understanding of immunopathogenesis of this disease, and would ultimately enable detection of susceptible individuals, providing a valuable tool for prevention of this debilitating disease.


Asunto(s)
Lepra/inmunología , Lepra/metabolismo , Receptores Notch/metabolismo , Transducción de Señal , Inmunidad Adaptativa , Animales , Linfocitos T CD4-Positivos/citología , Diferenciación Celular , Citocinas/metabolismo , Humanos , Células Asesinas Naturales/metabolismo , Lepra/fisiopatología , Ligandos , Ratones , Modelos Teóricos , Mycobacterium leprae , Fenotipo , Polimorfismo Genético , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo
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