The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study.

BACKGROUND: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.

Sinus computed tomography findings in patients with COVID-19.

OBJECTIVE: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. METHODS: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. RESULTS: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). CONCLUSION: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

Sinus computed tomography findings in patients with COVID-19 / Achados de imagem em tomografias computadorizadas de seios paranasais em pacientes com COVID-19

ABSTRACT Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

RESUMO Objetivo: Analisar imagens de tomografia computadorizada de seios paranasais de pacientes com a doença por coronavírus 2019, e correlacionar os achados com a doença. Métodos: Foram analisadas imagens de tomografia computadorizada de 95 pacientes submetidos a teste de reação em cadeia da polimerase para coronavírus 2 da síndrome respiratória aguda grave. Os dados clínicos foram obtidos por meio dos prontuários dos pacientes e de ligações telefônicas. A opacificação dos seios paranasais foi graduada e comparada entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave. Resultados: Vinte e oito (29,5%) dos pacientes tiveram resultado positivo para coronavírus 2 da síndrome respiratória aguda grave (idade mediana de 52 [26-95] anos) e 67, resultado negativo (idade mediana de 50 [18-95] anos). O espessamento mucoso estava presente em 97,4% dos seios maxilares, 80% das células etmoidais anteriores, 75,3% das células etmoidais posteriores, 74,7% dos seios frontais e em 66,3% dos seios esfenoidais. Mínimo ou discreto espessamento mucoso (pontuação 1) e seios com aeração normal (pontuação 0) corresponderam a 71,4% e 21,3% de todos os seios paranasais, respectivamente. A nota média de cada seio paranasal entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave foi de 0,85±0,27 e 0,87±0,38, respectivamente (p=0,74). A nota mediana de opacificação dos seios paranasais entre pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave foi de 9 (intervalo interquartil de 8 a 10), comparada a 9 (intervalo interquartil de 5 a 10) em pacientes negativos (p=0,89). Não houve diferença na nota média ajustada para idade e sexo. A congestão nasal foi mais frequente em pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave que naqueles com resultados negativos (p=0,05). Conclusão: A infecção pelo coronavírus 2 da síndrome respiratória aguda grave apresentou associação com congestão nasal, mas não mostrou correlação com espessamento mucoso dos seios paranasais.

Case Report: Nasal Myiasis in an Elderly Patient with Atrophic Rhinitis and Facial Sequelae of Leprosy.

We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscopy removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis (ozena), and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.

PGL-1 and LID-1 antibody levels in HIV-infected and HIV-uninfected individuals in a Hansen's disease (leprosy) endemic area of Brazil.

Serological tests for subclinical Mycobacterium leprae infection based on antibodies to phenolic glycolipid-1 (PGL-1) and leprosy IDRI diagnostic-1 (LID-1) have not been compared in HIV-infected and uninfected individuals. PGL-1 seropositivity by ELISA was 6.0 % (21/350) in HIV-infected compared with 29.1 % (102/350) in HIV-uninfected individuals (p < 0.001); LID-1 seropositivity was 45.4 % (159/350) in HIV-infected compared with 50.3 % (153/304) in HIV-uninfected individuals (p = 0.21). In HIV-infected individuals, LID-1 but not PGL-1 antibody levels were inversely associated with CD4+ cell count (p = 0.02). These differential associations of HIV infection and CD4 count with PGL-1 and LID-1 have implications for M leprae immunodiagnostic tools and require replication.

Armadillos and leprosy: from infection to biological model.

Mycobacterium leprae is the primary causative agent of Hansen's disease or leprosy. Besides human beings, natural infection has been described in animals such as mangabey monkeys and armadillos. Leprosy is considered a global health problem and its complete pathogenesis is still unknown. As M. leprae does not grow in artificial media, armadillos have become the primary experimental model for leprosy, mimicking human disease including involvement of the peripheral nervous system. Leprosy transmission occurs through continuous and close contact of susceptible people with untreated infected people. However, unknown leprosy contact has been reported in leprosy-affected people, and contact with armadillos is a risk factor for leprosy. In the USA, leprosy is considered a zoonosis and this classification has recently been accepted in Brazil. This review presents information regarding the role of wild armadillos as a source of M. leprae for human infections, as well as the pathogenesis of leprosy.

Case Study of Onychomycosis Patients Treated with 1,064-nm Nd:YAG Laser.

Onychomycosis is the most frequent nail disease, with an estimated prevalence of 2-8%. Current treatment strategies include the use of oral and topical antifungals, despite low cure rates following these treatments. The objectives of this study were to assess the therapeutic response of patients with onychomycosis to 1,064-nm Nd:YAG laser treatment, the clinical evaluation method available for this therapy, and the possible side effects of this treatment. Twenty patients with onychomycosis underwent laser therapy. A total of 34 nails with onychomycosis were assessed according to the Onychomycosis Severity Index (OSI). This index generates scores that classify onychomycosis as mild, moderate, or severe. The OSI was determined before treatment and after a mean follow-up period of 8 months. The comparison between the initial and the final OSI for all 34 nails treated with laser therapy showed a significant difference; however, a low association was shown between these variables. A general reduction in the area of involvement and in the OSI numerical scores was observed. These data show a trend toward improvement in onychomycosis treated with 1,064-nm Nd:YAG laser. The OSI allowed an adequate clinical assessment of the response to laser therapy. Laser treatment did not cause marked discomfort in most patients, indicating that laser is a well-tolerated procedure.

Detection of Mycobacterium leprae infection in wild nine-banded armadillos (Dasypus novemcinctus) using the rapid ML Flow test.

Mycobaterium leprae infection was investigated in armadillos from the State of Espírito Santo, Brazil. The ML Flow test was performed on 37 nine-banded armadillos and positive results were found in 11 (29.7%). The ML Flow test may be used to identify possible sources of Mycobaterium leprae among wild armadillos.

Detection of Mycobacterium leprae infection in wild nine-banded armadillos (Dasypus novemcinctus) using the rapid ML Flow test

Mycobaterium leprae infection was investigated in armadillos from the State of Espírito Santo, Brazil. The ML Flow test was performed on 37 nine-banded armadillos and positive results were found in 11 (29.7 percent). The ML Flow test may be used to identify possible sources of Mycobaterium leprae among wild armadillos.

Tem sido pesquisado infecção pelo Mycobaterium leprae em tatus provenientes do estado do Espírito Santo-Brasil. O teste rápido ML Flow, foi realizado em 37 tatus selvagens, tendo sido positivo em 11 (29,7 por cento). O teste de ML Flow pode ser utilizado para identificar possíveis fontes de Mycobaterium leprae em tatus selvagens.

Aspectos epidemiologicos da transmissao da hanseniase em relacao a exposicao ao tatu / Epidemiological features of the leprosy transmission in relation to armadillo exposure

A transmissao da hanseniase ainda hoje e um tema que necessita de estudos. Alguns autores demonstram a possibilidade dos tatus da especie Dasypus Novemcinctus serem uma fonte ambiental do Mycobacterium leprae. O inquerito epidemiologico realizado verifica a correlacao do contato seres humanos com tatus e a ocorrencia de hanseniase. Discute-se, ainda, uma serie de fatores que podem ser envolvidos no processo dinamico do desenvolvimento da hanseniase. O objetivo foi verificar a frequencia dos contatos dos hansenianos com tatus e o interhumano antes do seu diagnostico, visando estabelecer uma possivel forma de transmissao do M. leprae ao ser humano atraves do contato com tatus. Foram realizadas entrevistas com 107 pacientes ex-hansenianos (hansenianos ja tratados com PQT) que moravam no Hospital-Colonia Dr. Pedro Fontes em Cariacica/ES, 29 hansenianos e 173 nao hansenianos de um servico de dermatologia. O questionario coletou dados sobre o consumo de carne de tatu antes do diagnostico, a existencia de contatos conhecidos e/ou familiares portadores de hanseniase. Os dados foram analisados pela realizacao do teste do Qui-quadrado, correlacao e teste exato de Fisher. Encontrou-se que 90,4% dos pacientes portadores de hanseniase ou ex-hansenianos consumiram carne de tatu antes do diagnostico de hanseniase, enquanto 15% dos nao hansenianos consumiram carne de tatu. No grupo de hansenianos sem contatos com outros pacientes com hanseniase antes do diagnostico, 96,1% ja tinham consumido carne de tatu e apenas 3,9% nao o fizeram. O trabalho sugere um possivel fonte de M. leprae atraves do consumo de carne de tatu, principalmente, nos hansenianos sem historia de contatos com outros pacientes portadores de hanseniase antes do seu diagnostico.

Pesquisa de Mycobacterium leprae em tatus selvagens da espécie Dasypus Novencintus do Estado do Espírito Santo / Mycobacterium leprae research in wild armadillos of the Dasypus novemcinctus specie from Espirito Santo state

Introducao: Realizou-se um estudo de prevalencia em 52 tatus selvagens da especie Dsypus novemcinctus, capturados no estado do Espirito Santo, no periodo de junho de 2000 a julho de 2001. Objetivos: Estudar a prevalencia da infeccao pelo Mycobacterium leprae e compara-la aos trabalhos publicados na literatura, bem como avaliar e comparar os metodos utilizados para deteccao da infeccao. Metodos: Apos anestesiados, os tatus foram pesados, determinado o sexo, submetidos a exame clinico e coleta de fragmento de orelha para estudos histopatologicos (hematoxilina-eosina e Ziehl-Neelsen), imunohistoquimicos com anti-BCG, e fragmentos de orelha, pele, pata e lesao cutanea para a tecnica de PCR. Vinte tres tatus foram necropsiados e fragmentos de figado, baco, cerebro, pulmao, rim e intestino foram obtidos para a tecnica de PCR. Resultados e conclusoes: Nao foram evidenciadas lesoes de hansenomas e apenas um tatu apresentou linfadenomegalia palpavel na regiao inguinal dentre os 52 tatus examinados. Nao foi evidenciado quadro histopatologico compativel com nenhuma das formas de hanseniase pela coloracao de hematoxilina-eosina, e nao foi evidenciado presenca de BAAR pela tecnica de Ziehl-Neelsen, nem imunoexpressao do marcador BCG compativel com M. leprae. Foi detectada 10,6 porcento de soro-prevalencia de anticorpos IgM anti-PGL-I, e 11,9 porcento de positividade nas amostras de sangue, atraves da tecnica de PCR. Foi detectada 52,8 porcento de positividade na pesquisa de DNA de M. leprae nos fragmentos de tecidos (pele, orelha, lesao, pata, figado, baco, pulmao, cerebro, rim e intestino) atraves da tecnica de PCR. Dos tecidos testados, o cerebro foi o orgao onde mais se encontrou positividade pela tecnica de PCR (40,9 porcento), seguido da pele (22,2 porcento), orelha (20 porcento), pulmao (13,6 por cento), baco (13 porcento), pata (11,5 porcento), lesao cutanea (11,1 porcento), figado (8,7 porcento), rim (8,7 porcento) e intestino (4,5 porcento). O metodo diagnostico mais sensivel para deteccao de M. leprae foi o PCR dos tecidos, seguido do PCR do sangue e pesquisa de anticorpos anti-PGL-I atraves da tecnica de ELISA.

Como o mycobacterium leprae é transmitido? / How is the mycobacterium leprae transmitted?

A hanseníase ocorre em todo o mundo; contudo, a prevalência da doença é altamente variável e maior em países tropicais. Acredita-se que o modo mais comum de transmissäo, inter-humana, seja por secreçöes naso-respiratórias infectadas. O papel dos reservatórios naturais e a transmissäo zoonótica de outras epécies para o homem ainda permanece näo completamente entendido. Este artigo revisa os conhecimentos atuais concernentes aos potenciais reservatórios do Mycobacterium leprae tais quais solo, vegetaçöes, água e artópodes; anfíbios e mamíferos e o seu papel na doença humana

Melanoma maligno:estudo casuístico retrospectivo de 1982 a 1992, no Hospital Universitário da UFES / Malignant melanoma: retrospective study in the period 1982-1992, in the University Hospital of UFES

Entre 35. 695 biópsias realizadas no decênio 1982-92, no HUCAM, foram encontrados 55 casos de melanoma maligno (MM), correspondendo a 0,15 por cento dos diagnósticos histopatológicos. A distribuiçäo dos casos de MM quanto a cor e idade näo diferiram do existente na literatura. Observou-se alta freqüência de melanoma metastático e de casos em fase avançada com baixo índice de concordância (43,33 por cento) e o alto índice de inceerteza (33,33 por cento) em relaçäo ao diagnóstico clínico. Estes dados sugerem falha no diagnóstico precoce dos MM pelos médicos e/ou uma desinformaçäo da populaçäo quanto ao risco das lesöes pigmentadas. Através dos dados obtidos verifica-se que existe necessidade de divulgaçäo dos critérios clínicos de diagnósticos de melanoma maligno cutâneo (MMc) dentro da classe médica e de uma campanha de educaçäo para a populaçäo em geral, talvez associado a um programa de exame sistematizado dos indivíduos com alto risco para MM