Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review.

Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, "leprosy reactions" and "inflammatory mediators"; Stage II, "dental infections" and "inflammatory mediators"; and Stage III, "leprosy reactions," "dental infections," and "inflammatory mediators"). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1ß, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1ß were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1ß were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum.

Evaluation of light-touch sensation in the buccal mucosa of leprosy patients.

OBJECTIVE: The aim of this study is to evaluate the light-touch sensation of the oral mucosa in leprosy patients. MATERIALS AND METHODS: A cross-sectional study included 228 adults, 133 being leprosy patients and 95 normal controls. To assess light-touch sensation, the five-filament standard Semmes-Weinstein kit in eight regions of the oral mucosa was used. Chi-square test was used to verify the differences in responses between the studied groups. RESULTS: Normal sensation was predominant in both groups, and diminished sensation was found also in the nonleprosy group. Normal controls showed diminished light-touch sensation in at least one point, which may be attributed to the definition of sensation normality. The chi-square test revealed no significant difference between the two groups (p = 0.43171). Severe diminished sensation was detected only in the leprosy group. CONCLUSION: It is concluded that altered light-touch sensation in the oral cavity may not be a common feature in leprosy. CLINICAL RELEVANCE: Decreased or lost sensation in skin lesions is a paramount in leprosy diagnosis; however, clinicians must be aware that this seems not to be true in the oral mucosa in leprosy cases for diagnosis purpose.

Desenvolvimento do software para monitoração neural em hanseníase

No diagnóstico das lesões neurológicas periféricas é usualmente realizado o exame clínico que consta de mapeamento sensitivo, palpação de nervo e teste de força muscular associado a outros métodos como a avaliação analógica da dor. Todos esses exames podem ser graduados numericamente, constituindo assim um Escore Clínico (EC) para o monitoramento da função neural em estudos longitudinais e análises estatísticas. Atualmente os registros são manuais e anexados ao prontuário do paciente dificultando a organização e visualização em longo prazo da função neural.

Neurophysiological patterns of ulnar nerve neuropathy in leprosy reactions.

BACKGROUND: Leprosy neuropathy, despite being primarily demyelinating, frequently leads to axonal loss. Neurophysiological examination of the nerves during Type 1 (T1R) and Type 2 reactions (T2R) may give some insight into the pathophysiological mechanisms. METHODS: Neurophysiological examinations were performed in 28 ulnar nerves during a clinical trial of steroid treatment effectiveness, 19 patients with T1R and nine with T2R. The nerves were monitored during a period of 6 months; there were eight assessments per nerve, for a total of 224 assessments. Nine neurophysiological parameters were assessed at three sites of the ulnar nerve. The compound motor action potential amplitudes elicited at wrist, elbow and above, as well as the conduction velocity and temporal dispersion across the elbow, were chosen to focus on the changes occurring in the parameters at the elbow tunnel. RESULTS AND CONCLUSION: Neurophysiological changes indicating axonal and demyelinating processes during both T1R and T2R were detected across the elbow. Changes in demyelination, i.e. a Conduction Block, as a primary event present during T2R, occurring as an acute phenomenon, were observed regularly; in T1R Temporal Dispersion, a subacute phenomenon, was seen. During treatment remyelination occurred after both types of reactions.

Surgical correction of deformities and disabilities in leprosy patients.

Despite some positive experiences, surgical rehabilitation, presently, is minimally available in endemic countries and the contingent of patients in need of this modality of treatment is enlarging constantly. With the reduction of prevalence of leprosy and the progressive integration of care of leprosy-affected persons into the general health services, surgical rehabilitation should be made available in these centres. Training health personnel of general health services in leprosy surgery is mandatory and urgent. There is a need for the settlement of a multi-organizational task-force (WHO-ILEP-ILA) to deal with this problem. The aim of this task-force should be the definition of strategies to organize such training and to increase awareness among medical societies and schools regarding this issue. This group should also remember that the referral centres in Africa, Asia, North and South America should act as reservoir of this knowledge and, as such, should be fully supported and enhanced, since they have an important and unique role to play in the training of general health services personnel.

The nose in leprosy: immunohistology of the nasal mucosa.

A detailed study of the nose was undertaken in 40 leprosy patients with different classifications of leprosy and different durations of disease at two hospitals in Brazil. This manuscript describes the immunohistochemical data on cellular infiltrates in the nasal biopsies of those patients. It was surprising that the damage to the whole depth of the nasal mucosa, epithelium and lamina propria was considerable, as was the case in the nasal mucosa which looked relatively normal during clinical inspection. The epithelium showed large holes which looked like very extended goblet cells. Very obvious was the lack of vasoconstriction after cocaine application, and the vessels also showed a lack of staining with factor VIII, possibly indicating a disruption of the endothelium. The number of neurofilaments was extensively reduced in all leprosy groups compared to normal controls. As in the skin, an increased number of CD68+ cells was found in the lamina propria of the nasal mucosa of the lepromatous patients. Contrary to findings in the skin, in the nasal mucosa of the borderline/lepromatous patients the number of CD4+ cells was increased and the number of CD8+ cells was decreased compared to normal controls. The number of CD8+ cells tended to be more reduced when the history of leprosy was longer. It is not clear as yet whether the reduced numbers of CD8+ cells are acquired during infection or whether persons with a low number of CD8+ cells in the nose might have a higher risk of acquiring leprosy.

A técnica de estudo de conduçäo nervosa no tatu / Nerve conduction study technique in the armadillo

Os autores apresentam uma técnica para realizar estudo de conduçao nervosa em tatus (D. novemcinctus) e sugerem que 66.17 m/s poderia ser a média da velocidade de conduçao normal para o nervo ciático, um parâmetro que pode ser usado para a avaliaçao do sistema nervoso periférico nesse animal, considerando-se a sua escolha como modelo experimental na hanseníase, e mesmo em outras neuropatias periféricas.

Carvable silicone rubber prosthetic implant for atrophy of the first web in the hand.

Muscular atrophy of the first web space in the hand is a common finding following ulnar nerve palsy and this deformity is very stigmatizing among leprosy patients in some countries and cultures. We present our experience with the carvable soft-silicone rubber block implant to correct this deformity. We discuss the procedure, results and advantages over other techniques. Fifteen operations were performed at the 'Lauro de Souza Lima' Research Institute, Bauru, Brazil during a period of six years. One complication was encountered due to an implant that was too large. The results were considered good in twelve instances and fair in three.

Report and evaluation of Brazilian experience in the rehabilitation of patients with leprosy.

As part of an investigation of the rehabilitation of physically disabled leprosy patients, a report and evaluation of Brazilian experience in this area given. After describing leprosy as a genuine and relevant public health problem in Brazil because of the numbers involved, the suffering caused and the difficulties inherent in its control the authors emphasize the important role of physical disability in this context. The description of a project set up in 1975 shows a model based on a Reference Centre as an epicentre for irradiating triggering action in five Brazilian cities. The results obtained thus far consist of 32 courses given at the Reference Centre and approximately 449 surgical interventions performed by one of the authors, 93.10% of which were considered satisfactory. The need to evaluate the clinical and therapeutic procedures involved from an epidemiological viewpoint is emphasized.

[Current status of surgery in the comprehensive treatment of Hansen's disease]. / A situação atual da cirurgia no tratamento global da hanseníase.

In the last decades the neural component of Hansen's disease has achieved its place of prime importance among other manifestations of the disease. Provided that there is a close relationship between neural involvement and deformities and that hitherto antileprosy drugs are able only to kill and prevent bacillary growth and not able to interrupt the immunological features of the disease, we can expect a significant load of patients with some degree of disability, including those in regular treatment. Surgery plays an important role in control programmes since it has not just the single aim to restore lost function but also to prevent further damage and to improve patient's self-confidence.