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1.
BMC Infect Dis ; 21(1): 540, 2021 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-34098890

RESUMEN

BACKGROUND: A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. CASE PRESENTATION: We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient's face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. CONCLUSION: In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.


Asunto(s)
Personas sin Hogar , Lepra/diagnóstico , Trastornos Psicóticos/complicaciones , Enfermedades de la Piel/diagnóstico , Diagnóstico Diferencial , Humanos , Leprostáticos/uso terapéutico , Lepra/complicaciones , Lepra/tratamiento farmacológico , Lepra/patología , Masculino , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patología , Resultado del Tratamiento
2.
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
4.
Artículo en Inglés | MEDLINE | ID: mdl-33681915

RESUMEN

INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Asunto(s)
Lepra , Brasil , Resistencia a Medicamentos , Humanos , Lepra/tratamiento farmacológico , Recurrencia , Centros de Atención Terciaria
5.
An Bras Dermatol ; 96(2): 224-227, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33637399

RESUMEN

Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia.


Asunto(s)
Leprostáticos , Lepra , Brasil , Clofazimina/uso terapéutico , Dapsona/efectos adversos , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Leprostáticos/efectos adversos , Lepra/tratamiento farmacológico , Estudios Retrospectivos , Rifampin/uso terapéutico
6.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-48012

RESUMEN

Pacientes com hanseníase resistentes a medicamentos já ofertados na rede pública passam a contar com um novo tratamento disponível no Sistema Único de Saúde (SUS). O antibiótico Claritromicina já é utilizado no SUS para o tratamento de outras patologias, como infecções de vias aéreas superiores e inferiores, infecções na pele e tecidos moles, entre outros, e agora passa a fazer parte do rol de medicamentos para tratamento da hanseníase.


Asunto(s)
Lepra/tratamiento farmacológico , Claritromicina/farmacología , Sistema Único de Salud
7.
s.l; s.n; 2021. 6 p. tab, ilus.
No convencional en Inglés | Sec. Est. Saúde SP, CONASS, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1146794

RESUMEN

Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective(AU).


Asunto(s)
Humanos , Masculino , Femenino , Quimioterapia Combinada , Lobomicosis/tratamiento farmacológico , Rifampin/uso terapéutico , Clofazimina/uso terapéutico , Itraconazol/uso terapéutico , Dapsona/uso terapéutico , Lepra/tratamiento farmacológico
8.
J Neurol Sci ; 420: 117288, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33360424

RESUMEN

Neuropathies form an integral part of the symptomatology of leprosy. Neuropathies of leprosy take various forms and shapes. At one end is the cutaneous nerve involvement adjacent to the anaesthetic skin patch and the other is of symmetrical pansensory neuropathy and the devastating sensory ataxia of leprous ganglionits. Lepra reactions add to the spectrum. Hosts immunological status largely decides the clinical manifestations seen in nerves and skin. A wide array of diagnostic techniques like ultrasonography, magnetic resonance neurography, serological markers, molecular tests, skin biopsy and in selected cases, the nerve biopsy with special stains and electron microscopy are obtainable to help the clinical diagnosis. The unsuspecting clinician, lack of community awareness and limited availability of diagnostic tests are important adverse factors in the total outcome. Multi drug therapy is efficacious and corticosteroids reduce the impact of nerve damage in leprosy. The efficacy, dose and duration of corticosteroid therapy are presently inexact and other immune suppressants like azathioprine are being evaluated. Chronic disabilities and residual deficits require attention of multiple specialties. In the coming time, focus on prevention could lead to favourable results. This review will discuss the classification systems, common and uncommon clinical features, diagnostic armamentarium and therapeutic and preventive aspects of neuropathies of leprosy.


Asunto(s)
Lepra , Enfermedades del Sistema Nervioso Periférico , Biopsia , Humanos , Lepra/complicaciones , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Procedimientos Neuroquirúrgicos , Piel
9.
Rev. Soc. Bras. Med. Trop ; 54: e0375-2020, 2021. tab
Artículo en Inglés | LILACS | ID: biblio-1155553

RESUMEN

Abstract INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Asunto(s)
Humanos , Lepra/tratamiento farmacológico , Recurrencia , Brasil , Resistencia a Medicamentos , Centros de Atención Terciaria
10.
PLoS One ; 15(12): e0244451, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33373997

RESUMEN

Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013-2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.


Asunto(s)
Coinfección/tratamiento farmacológico , Atención a la Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Implementación de Plan de Salud , Lepra/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Cuidados Posteriores/organización & administración , Cuidados Posteriores/estadística & datos numéricos , Antirretrovirales/uso terapéutico , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Quimioprevención/métodos , Estudios de Cohortes , Coinfección/microbiología , Atención a la Salud/métodos , Atención a la Salud/estadística & datos numéricos , Farmacorresistencia Bacteriana Múltiple , Femenino , Infecciones por VIH/virología , Humanos , Lepra/microbiología , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Mycobacterium leprae/aislamiento & purificación , Mycobacterium tuberculosis/aislamiento & purificación , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Uganda , Adulto Joven
11.
Lancet Infect Dis ; 20(11): 1236-1237, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33098775
13.
Curr Opin Ophthalmol ; 31(6): 514-520, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33002989

RESUMEN

PURPOSE OF REVIEW: Ocular manifestations of leprosy do occur despite advances in the areas of leprosy research. Understanding the nuances in the domain shall guide the clinician for effective patient-centered care. RECENT FINDINGS: Despite the existence of microbiologic cure for leprosy, ocular manifestations of this disease do occur. Advances in genetic and genomic studies have better characterized the interaction that the bacteria has with the host. The ocular features vary with the spectrum of the disease. Its careful correlation can help to predict the bacillary load of the patient. Investigations are particularly relevant in multibacillary cases. The WHO suggests a treatment duration longer than the 2 years in ocular involvement. SUMMARY: The isolation of lepra bacilli from the iris biopsy in negative skin smear patients and multidrug therapy completion highlights the potential role of bactericidal agents in the planned intraocular treatment. Lepra reactions need careful titration of oral steroids and appropriate antibacterial agents. Advances in phacoemulsification with in the bag implantation of intraocular lenses is a game changer in the management of the most common cause of blindness of leprosy. Advances in vaccine research in leprosy are promising.


Asunto(s)
Oftalmopatías , Lepra , Animales , Biopsia , Quimioterapia Combinada , Oftalmopatías/tratamiento farmacológico , Humanos , Lentes Intraoculares , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra/microbiología , Lepra/patología , Facoemulsificación
14.
PLoS Negl Trop Dis ; 14(9): e0008583, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32936818

RESUMEN

BACKGROUND: Subclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials. METHODOLOGY/PRINCIPAL FINDINGS: Athymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation. CONCLUSIONS/SIGNIFICANCE: The delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3-4 months) and late (8-9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.


Asunto(s)
Infecciones Asintomáticas/terapia , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Mycobacterium leprae/efectos de los fármacos , Profilaxis Posexposición/métodos , Animales , Carga Bacteriana/efectos de los fármacos , Claritromicina/uso terapéutico , Combinación de Medicamentos , Lepra/transmisión , Ratones , Ratones Desnudos , Minociclina/uso terapéutico , Moxifloxacino/uso terapéutico , Mycobacterium leprae/crecimiento & desarrollo , Rifampin/análogos & derivados , Rifampin/uso terapéutico
15.
Int J Mol Sci ; 21(17)2020 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-32824985

RESUMEN

The aim of this study is to examine the use of an inflammasome competitor as a preventative agent. Coronaviruses have zoonotic potential due to the adaptability of their S protein to bind receptors of other species, most notably demonstrated by SARS-CoV. The binding of SARS-CoV-2 to TLR (Toll-like receptor) causes the release of pro-IL-1ß, which is cleaved by caspase-1, followed by the formation and activation of the inflammasome, which is a mediator of lung inflammation, fever, and fibrosis. The NLRP3 (NACHT, LRR and PYD domains-containing protein 3) inflammasome is implicated in a variety of human diseases including Alzheimer's disease (AD), prion diseases, type 2 diabetes, and numerous infectious diseases. By examining the use of 4,4'-diaminodiphenyl sulfone (DDS) in the treatment of patients with Hansen's disease, also diagnosed as Alzheimer's disease, this study demonstrates the diverse mechanisms involved in the activation of inflammasomes. TLRs, due to genetic polymorphisms, can alter the immune response to a wide variety of microbial ligands, including viruses. In particular, TLR2Arg677Trp was reported to be exclusively present in Korean patients with lepromatous leprosy (LL). Previously, mutation of the intracellular domain of TLR2 has demonstrated its role in determining the susceptibility to LL, though LL was successfully treated using a combination of DDS with rifampicin and clofazimine. Of the three tested antibiotics, DDS was effective in the molecular regulation of NLRP3 inflammasome activators that are important in mild cognitive impairment (MCI), Parkinson's disease (PD), and AD. The specific targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by DDS may be responsible for its observed preventive effects, functioning as a competitor.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Dapsona/farmacología , Inflamasomas/metabolismo , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Neumonía Viral/tratamiento farmacológico , Enfermedad de Alzheimer/patología , Clofazimina/farmacología , Disfunción Cognitiva/patología , Humanos , Interleucina-1beta/metabolismo , Lepra/tratamiento farmacológico , Lepra/genética , Pandemias , Trastornos Parkinsonianos/patología , Rifampin/farmacología , Glicoproteína de la Espiga del Coronavirus/metabolismo , Receptor Toll-Like 2/genética
16.
PLoS Negl Trop Dis ; 14(8): e0008521, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32750059

RESUMEN

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.


Asunto(s)
Programas de Gobierno , Lepra/tratamiento farmacológico , Lepra/prevención & control , Profilaxis Posexposición/economía , Quimioprevención/economía , Análisis Costo-Beneficio , Humanos , India , Leprostáticos/economía , Leprostáticos/uso terapéutico , Lepra/diagnóstico , Lepra/economía , Profilaxis Posexposición/métodos , Años de Vida Ajustados por Calidad de Vida , Rifampin/economía , Rifampin/uso terapéutico
17.
PLoS Negl Trop Dis ; 14(8): e0008329, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760161

RESUMEN

The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.


Asunto(s)
Lepra/tratamiento farmacológico , Talidomida/efectos adversos , Talidomida/uso terapéutico , Anomalías Inducidas por Medicamentos/epidemiología , Brasil/epidemiología , Eritema Nudoso/tratamiento farmacológico , Femenino , Humanos , Leprostáticos/efectos adversos , Leprostáticos/uso terapéutico , Lepra/epidemiología , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Embarazo
18.
Fontilles, Rev. leprol ; 32(5): 361-370, mayo-ago. 2020. tab
Artículo en Español | IBECS | ID: ibc-198461

RESUMEN

OBJETIVO: El objetivo del estudio es cribar convivientes de personas diagnosticadas de lepra con un elevado índice bacteriológico en un centro de referencia. MÉTODOS: El estudio hospitalario incorporo a 334 personas recién diagnosticadas de lepra con un elevado índice bacteriológico. El hospital de referencia es el de Champa, Chhattisgarh, India. Se anotaron todos los convivientes de estos casos registrados de lepra y se les ofreció ser examinados. RESULTADOS: De 334 casos con un índice bacteriológico elevado (IB), 252 (75%) eran varones y 82 (25%) mujeres, con edades comprendidas entre los 12 y los 75 años. Sesenta y dos (18%) presentaron discapacidad Grado 2 y un 32% presentaron un índice bacteriológico mayor de 5 en el momento del diagnóstico. Se registraron un total de 1,397 convivientes para cribaje y 678 (49%) fueron examinados clínicamente para detectar lepra. Ciento dieciséis convivientes presentaron signos de lepra y, de entre ellos, 57 (44%) se identificaron como nuevos casos, 11 (10%) como casos conocidos en tratamiento y 48 (41%) habían sido tratados anteriormente por la enfermedad. CONCLUSIÓN: El estudio revela que el cribaje de convivientes de pacientes con elevados IB es un método efectivo para la detección de posibles nuevos casos y enfatiza la necesidad continua de cribaje y seguimiento. La educación sanitaria y la motivación de los convivientes incrementara su presentación voluntaria para ser cribados y así detectar nuevos casos


OBJECTIVE: The study aimed to screen household contacts of persons diagnosed with leprosy having a high bacterial index, at a tertiary referral centre. METHODS: This hospital based study involved 334 persons who were newly diagnosed as leprosy with a high bacterial index, attending a tertiary referral hospital, Champa, Chhattisgarh, India. We enumerated all the household contacts of registered cases and invited them to be screened for leprosy. RESULTS: Of 334 high BI cases, 252 (75%) were male and 82 (25%) were female, with ages ranging from 12 to 75 years. Sixty two (18%) had Grade 2 disability and 32% had a bacterial index of above 5+ at the time of diagnosis. A total of 1,397 household members were enrolled for screening and 678 (49%) were examined for leprosy. One hundred and sixteen household members were found to have signs of leprosy, and among these, 57 (49%) were identified as new cases, 11 (10%) were known cases on treatment and 48 (41%) had been previously treated for leprosy. CONCLUSION: This study showed that screening of household contacts of high BI cases is an effective method of leprosy case detection and emphasizes the continuing need to screen and follow up. Continued health education and motivation of household contacts will enhance voluntary reporting for periodical screening


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Trazado de Contacto/estadística & datos numéricos , Lepra/diagnóstico , Lepra/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Familia , Lepra/tratamiento farmacológico , Carga Bacteriana , Distribución por Edad y Sexo , India/epidemiología
19.
An Bras Dermatol ; 95(5): 652-654, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32651045

RESUMEN

Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.


Asunto(s)
Lepra Dimorfa , Lepra Lepromatosa , Lepra , Quimioterapia Combinada , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Persona de Mediana Edad , Mycobacterium leprae
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