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1.
PLoS Negl Trop Dis ; 14(3): e0008138, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32226013

RESUMEN

The changes in host lipid metabolism during leprosy have been correlated to fatty acid alterations in serum and with high-density lipoprotein (HDL) dysfunctionality. This is most evident in multibacillary leprosy patients (Mb), who present an accumulation of host lipids in Schwann cells and macrophages. This accumulation in host peripheral tissues should be withdrawn by HDL, but it is unclear why this lipoprotein from Mb patients loses this function. To investigate HDL metabolism changes during the course of leprosy, HDL composition and functionality of Mb, Pb patients (paucibacillary) pre- or post-multidrug therapy (MDT) and HC (healthy controls) were analyzed. Mb pre-MDT patients presented lower levels of HDL-cholesterol compared to HC. Moreover, Ultra Performance Liquid Chromatography-Mass Spectrometry lipidomics of HDL showed an altered lipid profile of Mb pre-MDT compared to HC and Pb patients. In functional tests, HDL from Mb pre-MDT patients showed impaired anti-inflammatory and anti-oxidative stress activities and a lower cholesterol acceptor capacity compared to other groups. Mb pre-MDT showed lower concentrations of ApoA-I (apolipoprotein A-I), the major HDL protein, when compared to HC, with a post-MDT recovery. Changes in ApoA-I expression could also be observed in M. leprae-infected hepatic cells. The presence of bacilli in the liver of a Mb patient, along with cell damage, indicated hepatic involvement during leprosy, which may reflect on ApoA-I expression. Together, altered compositional and functional profiles observed on HDL of Mb patients can explain metabolic and physiological changes observed in Mb leprosy, contributing to a better understanding of its pathogenesis.


Asunto(s)
Lepra/patología , Lipoproteínas HDL/sangre , Adolescente , Adulto , Anciano , Cromatografía Líquida de Alta Presión , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Masculino , Espectrometría de Masas , Persona de Mediana Edad , Plasma/química , Adulto Joven
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
4.
PLoS Negl Trop Dis ; 14(1): e0008016, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31929530

RESUMEN

BACKGROUND: Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world's newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India's official declaration of 'elimination', which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. METHODS AND FINDINGS: This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital's sustainability. Open coding, axial coding and selective coding were conducted, and Glaser's Six C's model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients' strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a 'consumer-provider cooperative', where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients' occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. CONCLUSIONS: This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.


Asunto(s)
Lepra/tratamiento farmacológico , Lepra/epidemiología , Personas con Discapacidad , Salud Holística , Hospitales , Humanos , India/epidemiología , Pobreza , Investigación Cualitativa , Estigma Social
5.
Am J Trop Med Hyg ; 102(3): 547-552, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31933458

RESUMEN

Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for M leprae DNA and sequenced for drug resistance-determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ± 13.4 (range 14-71) years and 34.9 ± 12.6 years (range 10-63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens. Mutations seen were those associated with resistance to rifampicin, ofloxacin, and dapsone. All the six patients were drug-naive. The clinical and pathological manifestations in this group did not differ from the drug-sensitive group. This study highlights the occurrence of resistance to the standard multidrug therapy and ofloxacin in leprosy. Among the entire cohort, 1/77 (1.3%) showed resistance to rifampicin, 2/77 (2.6%) to dapsone, and 5/77 (6.4%) to ofloxacin. Six new patients showing infection by mutant strains indicated the emergence of primary resistance. Resistance to ofloxacin could be due to frequent use of quinolones for many bacterial infections. The results of the study indicate the need for development of a robust and strict surveillance system for detecting drug resistance in leprosy in India.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra/microbiología , Mycobacterium leprae/efectos de los fármacos , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Femenino , Humanos , India/epidemiología , Lactante , Leprostáticos/farmacología , Lepra/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mutación , Mycobacterium leprae/genética , Adulto Joven
6.
Rev Soc Bras Med Trop ; 53: e20190468, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31859957

RESUMEN

Histoid leprosy (HL) is a rare variant of lepromatous leprosy with unique clinical, histopathological, and microbiological features. A 32-year-old man from Malawi who immigrated to Johannesburg 1-year-ago, presented with a 4-month history of flesh-colored nodules on the face and trunk and hyperpigmented plaques on the chest and limbs. Skin slit smears confirmed multibacillary leprosy, and skin punch biopsies showed proliferation of spindled cells containing a large number of acid-fast bacilli. The prevalence of de novo HL is increasing in the era of leprosy elimination. HL cases may act as reservoirs and negatively affect the global control of leprosy.


Asunto(s)
Lepra/parasitología , Adulto , Biopsia , Humanos , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Masculino
7.
BMC Health Serv Res ; 19(1): 787, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31679517

RESUMEN

BACKGROUND: In 2013, Lepra Bangladesh (a non-government organization) and the National Leprosy Programme of the Directorate General of Health Services under the Ministry of Health and Family Welfare, Bangladesh implemented a 3 years project entitled "2015 and Beyond: Poverty Reduction through Strengthened Health Systems". The aims of this Health System Strengthening (HSS) project were to improve quality of leprosy services through service delivery, capacity development, curriculum development, improved collaboration, coordination, operational research and knowledge sharing to identify and treat leprosy in order to contribute to strengthen existing health systems. We evaluated the changes in knowledge of primary and community level healthcare providers about cardinal signs, course of leprosy treatment, and drug use for paucibacillary (PB) and multibacillary (MB) leprosy cases. METHODS: We conducted two surveys using purposive sampling technique in two pilot districts: Bogra and Moulvibazar. The first survey was conducted before implementing the HSS project from March to June 2014 among 98 providers. The end-line survey was conducted in November 2015 and included 49 providers. The interview was conducted using the same pre-tested structured questionnaire. Descriptive statistics followed by further analysis was done including proportions, 90% confidence intervals, and p values were calculated for the selected variables. RESULTS: The primary and community level healthcare providers demonstrated significant increases in knowledge on one cardinal sign (definite loss of sensation in a pale -hypopigmented- or reddish skin patch), doses and courses for the adult PB and MB cases and duration of Multi-Drug Therapy (MDT) course at the end line compared to the beginning of the project. All the providers except TB and Leprosy Control Assistants demonstrated statistically significant decreases in knowledge at the end-line compared to the baseline about supportive counseling. CONCLUSIONS: HSS activities including training and capacity building of the providers recorded significant increase of knowledge on types of leprosy, one cardinal sign, courses of MDT and drug use for the adult PB and MB cases and use MDT for leprosy treatment among the service providers at the end-line. Any health systems strengthening project should incorporate a capacity building approach within the programme all through.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Lepra , Atención Primaria de Salud , Adulto , Bangladesh , Femenino , Encuestas de Atención de la Salud , Personal de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Lepra/tratamiento farmacológico , Masculino
9.
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
11.
PLoS Negl Trop Dis ; 13(9): e0007368, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31504035

RESUMEN

Up to 50% of patients with the multibacillary form of leprosy are expected to develop acute systemic inflammatory episodes known as type 2 reactions (T2R), thus aggravating their clinical status. Thalidomide rapidly improves T2R symptoms. But, due to its restricted use worldwide, novel alternative therapies are urgently needed. The T2R triggering mechanisms and immune-inflammatory pathways involved in its pathology remain ill defined. In a recent report, we defined the recognition of nucleic acids by TLR9 as a major innate immunity pathway that is activated during T2R. DNA recognition has been described as a major inflammatory pathway in several autoimmune diseases, and neutrophil DNA extracellular traps (NETs) have been shown to be a prime source of endogenous DNA. Considering that neutrophil abundance is a marked characteristic of T2R lesions, the objective of this study was to investigate NETs production in T2R patients based on the hypothesis that the excessive NETs formation would play a major role in T2R pathogenesis. Abundant NETs were found in T2R skin lesions, and increased spontaneous NETs formation was observed in T2R peripheral neutrophils. Both the M. leprae whole-cell sonicate and the CpG-Hlp complex, mimicking a mycobacterial TLR9 ligand, were able to induce NETs production in vitro. Moreover, TLR9 expression was shown to be higher in T2R neutrophils, suggesting that DNA recognition via TLR9 may be one of the pathways triggering this process during T2R. Finally, treatment of T2R patients with thalidomide for 7 consecutive days resulted in a decrease in all of the evaluated in vivo and ex vivo NETosis parameters. Altogether, our findings shed light on the pathogenesis of T2R, which, it is hoped, will contribute to the emergence of novel alternative therapies and the identification of prognostic reactional markers in the near future.


Asunto(s)
Trampas Extracelulares/inmunología , Inmunidad Innata , Lepra/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/microbiología , Femenino , Humanos , Inflamación/inmunología , Inflamación/patología , Lepra/tratamiento farmacológico , Lepra/patología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Mycobacterium leprae/patogenicidad , Neutrófilos/patología , Talidomida/administración & dosificación , Talidomida/uso terapéutico
12.
PLoS Negl Trop Dis ; 13(9): e0007714, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31490925

RESUMEN

BACKGROUND: Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25-1.97) and Northeast (OR = 1.44; 95%CI 1.17-1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01-1.69), no income (OR = 1.41; 95%CI 1.07-1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13-1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28-1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10-1.66). CONCLUSIONS: The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Factores Socioeconómicos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Brasil/epidemiología , Estudios de Cohortes , Quimioterapia Combinada/estadística & datos numéricos , Grupos Étnicos , Femenino , Geografía , Humanos , Lepra/epidemiología , Masculino
13.
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
14.
Int J Mycobacteriol ; 8(3): 305-308, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31512611

RESUMEN

While Type 1 reaction in Hansen's disease is commonly encountered, the triggers and reasons for its persistence are not well understood even though the immunological milieu and cytokine interplay have been studied. Herein, we present a case of Type 1 downgrading reaction in which multidrug resistance was the probable cause of steroid-nonresponsiveness and which responded promptly on starting alternate antileprosy treatment.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/clasificación , Lepra/tratamiento farmacológico , Esteroides/uso terapéutico , Adulto , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Lepra/diagnóstico , Piel/microbiología , Piel/patología
15.
PLoS Negl Trop Dis ; 13(9): e0007709, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31479442

RESUMEN

BACKGROUND: Leprosy has a global presence; more than 180 thousand new cases were registered in 2013, 15% of which were found in the Americas. The elderly are a very susceptible demographic in terms of developing illnesses, mainly because of characteristics natural to the senescence of the human organism. This study's goals were to analyze leprosy in an elderly population from a hyperendemic region of the Brazilian Amazon in a historical series from 2004 to 2013 and to determine the clinical and epidemiological profile of a series of leprosy cases of elderly people in the period spanning from 2009 to 2013. METHODS: To achieve these goals, an observational, longitudinal, retrospective and descriptive study was put together to analyze leprosy in elderly people from data acquired from the Notification Aggravations Information System. Furthermore, a profile of the disease from a retrospective cohort based on data collected from medical records was developed. RESULTS: The number of new cases and the leprosy detection rate decreased across the observed period but remained stable among the elderly. The trend for the next ten years indicates decreases in the number of cases and in the detection rate in the general population and an increase in only the elderly. The overall profile was characterized by a predominance of males (64.32%), the multibacillary clinical form (87.57%), Type 1 reaction episodes (37.50%) and some physical incapacity at diagnosis (49.19%). The risk of reaction was greater in the first six months of multidrug therapy, and the positive result from the skin smear was associated with the greater chance of reactional condition development. CONCLUSIONS: The resulting data demonstrate that leprosy amongst the elderly deserves attention because of the increased susceptibility to disability in this age group, with their higher risk of reaction and their greater level of co-morbidity.


Asunto(s)
Quimioterapia Combinada/estadística & datos numéricos , Leprostáticos/uso terapéutico , Lepra/epidemiología , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Leprostáticos/efectos adversos , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
18.
Clin Dermatol ; 37(3): 200-212, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31178103

RESUMEN

In recent years, advances in medical diagnosis and treatment have greatly attracted our attention, whereas some rare diseases, such as leprosy, have not found a place in the medical education curriculum; their existence may even be forgotten. Although the prevalence and incidence rates for leprosy have been significantly reduced as a result of the control strategies of the World Health Organization, new cases still appear. A total of 214,783 new cases were reported from 143 countries during 2016, corresponding to the global new-case detection rate of 2.9 per 100,000 population. Leprosy proves to be a very interesting model due to its immunologic properties. It joins with syphilis, mycosis fungoides, cutaneous tuberculosis, and sarcoidosis as one of the great imitators. The diagnosis of leprosy can be simple and practical, but considering the diagnosis of leprosy in the differential diagnosis is the first requisite again.


Asunto(s)
Lepra , Animales , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Quimioterapia Combinada , Diagnóstico Precoz , Femenino , Infecciones por VIH , Humanos , Periodo de Incubación de Enfermedades Infecciosas , Pruebas Intradérmicas/métodos , Lepromina , Leprostáticos/uso terapéutico , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Lepra/inmunología , Lepra/patología , Masculino , Educación del Paciente como Asunto , Embarazo , Pruebas Serológicas , Piel/microbiología , Piel/patología
19.
Rev Gaucha Enferm ; 40: e20180258, 2019 Jun 06.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31188975

RESUMEN

OBJECTIVE: To analyze contextual relations of health care in the discharge of leprosy. METHOD: An analytical, reflexive study based on the theoretical framework of context analysis, elaborated through an integrative review of literature in the databases SCOPUS, PUBMED, LILACS, SCIELO and BDENF, with uncontrolled descriptors Leprosy and Patient Discharge, obtaining 14 publications. RESULTS: The immediate context addresses health care at discharge in leprosy; the specific context treats leprosy as a public health problem; the symbolic conceptions and marks involving leprosy are encompassed by the general context; and in the metacontext are described the health programs and policies that subsidize the care of leprosy patients. CONCLUSION: The contextual elements emphasize the need to guarantee universal coverage of cases of leprosy, from diagnosis to the post-discharge, reinforcing leprosy as a public health problem. Despite the limitations of the bibliographic studies, these have relevance for the health area.


Asunto(s)
Prestación de Atención de Salud , Lepra/tratamiento farmacológico , Alta del Paciente , Salud Pública , Brasil , Diagnóstico Tardío , Promoción de la Salud , Humanos , Leprostáticos/uso terapéutico , Lepra/diagnóstico , Lepra/prevención & control
20.
BMC Infect Dis ; 19(1): 501, 2019 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-31174481

RESUMEN

BACKGROUND: The island of Anjouan (Comoros) is highly endemic for leprosy with an annual incidence of 5-10/10,000. In May/June, 2015 single-dose Rifampicin post-exposure prophylaxis (SDR-PEP) was administered to 269 close contacts of 70 leprosy-patients in four villages as a pilot programmatic intervention. Two years later we revisited the villages for follow-up investigations. The main aim of our study was to quantify spatial associations between reported leprosy cases before and after PEP implementation. A secondary aim was to assess the effect of this single round of SDR-PEP at the individual level. METHODS: We conducted door-to-door leprosy screening in all four villages in August/September, 2017. We screened all consenting individuals for leprosy and recorded geographic coordinates of their household. We also recorded whether they had received SDR-PEP and whether they had been diagnosed with leprosy, before or after the 2015 intervention. We fitted a Poisson model with leprosy as outcome and distance to the nearest pre-intervention case and SDR-PEP as predictors. RESULTS: During the survey we found 114 new cases among 5760 contacts screened (2.0% prevalence), in addition to the 39 cases detected in the two preceding years. We found statistically significant associations of incident leprosy with physical distance to index cases ranging from 2.4 (95% confidence interval (95% CI) 1.5-3.6) for household contacts to 1.8 (95% CI 1.3-2.5) for those living at 1-25 m, compared to individuals living at ≥75 m. The effect of SDR-PEP appeared protective but did not reach statistical significance due to the low numbers, with an incidence rate ratio (IRR) of 0.6 (95% CI 0.3-1.2) overall, and 0.5 (95% CI 0.2-1.3) when considering only household contacts. CONCLUSIONS: This pilot demonstrated an increased risk of leprosy in contacts beyond the household, therefore a wider circle should be considered for chemoprophylaxis. Baseline surveys and extended contact definitions are essential for improving SDR-PEP effectiveness.


Asunto(s)
Lepra/diagnóstico , Lepra/epidemiología , Antibióticos Antituberculosos/uso terapéutico , Análisis por Conglomerados , Comoras/epidemiología , Humanos , Lepra/tratamiento farmacológico , Profilaxis Posexposición , Prevalencia , Rifampin/uso terapéutico
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