Epidemiological characteristics of leprosy from 2000 to 2019 in a state with low endemicity in southern Brazil.

BACKGROUND: Leprosy is an infectious and contagious disease caused by Mycobacterium leprae and is mainly characterized by lesions in the skin and peripheral nerves. In Brazil, it is a public health problem due to its high endemicity. However, the state of Rio Grande do Sul presents low endemicity of this disease. OBJECTIVE: To characterize the epidemiological profile of leprosy in the state of Rio Grande do Sul from 2000 to 2019. METHODS: This was a retrospective observational study. Epidemiological data were collected from the Notifiable Diseases Information System (SINAN, Sistema de Informação de Agravos de Notificação). RESULTS: Among the 497 municipalities in the state, 357 (71.8%) registered cases of leprosy in the assessed period, with an average of 212 (81.5%) new cases per year. The average detection rate was 1.61 new cases per 100,000 inhabitants. The male sex was predominant (51.9%) and the mean age was 50.4 years. Regarding the epidemiological clinical profile; 79.0% of the patients were multibacillary; 37.5% presented the borderline clinical form; 16% had grade 2 physical disability at diagnosis and bacilloscopy was positive in 35.4% of cases. As for treatment, 73.8% of the cases were treated with the standard multibacillary therapeutic regimen. STUDY LIMITATIONS: There were missing/inconsistent data in the database available. CONCLUSIONS: The findings observed in this study indicate that the state presents a low endemicity profile of the disease and these results can support adequate health policies relevant to the reality of Rio Grande do Sul, inserted in a national scenario of highly endemic leprosy.

Epidemiological characteristics of leprosy from 2000 to 2019 in a state with low endemicity in southern Brazil

Abstract Background Leprosy is an infectious and contagious disease caused by Mycobacterium leprae and is mainly characterized by lesions in the skin and peripheral nerves. In Brazil, it is a public health problem due to its high endemicity. However, the state of Rio Grande do Sul presents low endemicity of this disease. Objective To characterize the epidemiological profile of leprosy in the state of Rio Grande do Sul from 2000 to 2019. Methods This was a retrospective observational study. Epidemiological data were collected from the Notifiable Diseases Information System (SINAN, Sistema de Informação de Agravos de Notificação). Results Among the 497 municipalities in the state, 357 (71.8%) registered cases of leprosy in the assessed period, with an average of 212 (81.5%) new cases per year. The average detection rate was 1.61 new cases per 100,000 inhabitants. The male sex was predominant (51.9%) and the mean age was 50.4 years. Regarding the epidemiological clinical profile; 79.0% of the patients were multibacillary; 37.5% presented the borderline clinical form; 16% had grade 2 physical disability at diagnosis and bacilloscopy was positive in 35.4% of cases. As for treatment, 73.8% of the cases were treated with the standard multibacillary therapeutic regimen. Study limitations There were missing/inconsistent data in the database available. Conclusions The findings observed in this study indicate that the state presents a low endemicity profile of the disease and these results can support adequate health policies relevant to the reality of Rio Grande do Sul, inserted in a national scenario of highly endemic leprosy.

Epidemiological characteristics and trends of leprosy in children and adolescents under 15 years old in a low-endemic State in Southern Brazil.

Leprosy is an infectious and contagious disease affecting skin and nerves. The number of cases in individuals under 15 years old is one of the parameters used in Brazil as an indicator of endemic permanence of the disease and its continuous transmission. Rio Grande do Sul State, in Southern Brazil, is low-endemic to leprosy. However, the disease remains a public health problem. This is a retrospective, observational and analytical study of a historical series of new cases of leprosy in children under 15 years old diagnosed in the period from 2000 to 2019, in all health units in Rio Grande do Sul State. Seventy-seven new cases were notified. The male gender was predominant in 53.2% of the cases (n=41). The average age was 10.4 years (standard deviation of 2.9), with predominance of the age group between 10 and 15 incomplete years old. The most frequent operational classification was multibacillary, in 62.3% of cases (n=48), and the most common clinical form was borderline, in 38.9% of cases (n=28). The predominant disability degree in the sample was grade zero, in 80.0% of the cases (n=60), but in 4.0% (n=3) the grade assessed was 2. In 54.0% of cases (n=27), bacilloscopy was performed, with positive results in 36.0% (n=9) of the exams. Multibacillary cases, with physical disability and/or positive bacilloscopy, draws attention that that the diagnosis is frequently not made in early stages.

Histoid leprosy - A rare clinical presentation

Abstract Histoid leprosy is considered a rare form of lepromatous leprosy. Its peculiar clinical picture makes its diagnosis a challenging one, which can delay starting treatment and perpetuate the disease as endemic. In addition to representing a reservoir of bacilli, and being an important means of contamination, these patients have greater resistance to standard treatment. This is a report of a typical case of this rare presentation, aiming to share the knowledge and favor earlier diagnosis of the disease.

Histoid leprosy - A rare clinical presentation.

Histoid leprosy is considered a rare form of lepromatous leprosy. Its peculiar clinical picture makes its diagnosis a challenging one, which can delay starting treatment and perpetuate the disease as endemic. In addition to representing a reservoir of bacilli, and being an important means of contamination, these patients have greater resistance to standard treatment. This is a report of a typical case of this rare presentation, aiming to share the knowledge and favor earlier diagnosis of the disease.

Evaluation of Polymorphisms in Toll-Like Receptor Genes as Biomarkers of the Response to Treatment of Erythema Nodosum Leprosum.

Erythema nodosum leprosum (ENL) is an inflammatory complication caused by a dysregulated immune response to Mycobacterium leprae. Some Toll-like receptors (TLRs) have been identified as capable of recognizing antigens from M. leprae, triggering a wide antimicrobial and inflammatory response. Genetic polymorphisms in these receptors could influence in the appearance of ENL as well as in its treatment. Thus, the objective of this work was to evaluate the association of genetic variants of TLRs genes with the response to treatment of ENL with thalidomide and prednisone. A total of 162 ENL patients were recruited from different regions of Brazil and clinical information was collected from their medical records. Genomic DNA was isolated from blood and saliva samples and genetic variants in TLR1 (rs4833095), TLR2 (rs3804099), TLR4 (rs1927914), and TLR6 (rs5743810) genes were genotyped by TaqMan real-time PCR system. In order to evaluate the variants' association with the dose of the medications used during the treatment, we applied the Generalized Estimating Equations (GEE) analysis. In the present sample, 123 (75.9%) patients were men and 86 (53.1%) were in treatment for leprosy during the ENL episode. We found an association between polymorphisms in TLR1/rs4833095, TLR2/rs3804099, TLR4/rs1927914, and TLR6/rs5783810 with the dose variation of thalidomide in a time-dependent manner, i.e., the association with the genetic variant and the dose of the drug was different depending on the moment of the treatment evaluated. In addition, we identified that the association of polymorphisms in TLR1/rs4833095, TLR2/rs3804099, and TLR6/rs5783810 with the dose variation of prednisone also were time-dependent. Despite these associations, in all the interactions found, the influence of genetic variants on dose variation was not clinically relevant for therapeutic changes. The results obtained in this study show that TLRs polymorphism might play a role in the response to ENL treatment, however, in this context, they could not be considered as useful biomarkers in the clinical setting due small differences in medication doses. A larger sample size with patients with a more genetic profile is fundamental in order to estimate the association of genetic variants with the treatment of ENL and their clinical significance.

Onychomycosis caused by Arthrinium arundinis in leprosy patient: Case report.

We report a case of a 56-year-old Brazilian woman, with relapsing lepromatous leprosy, and onychomycosis caused by a non-dermatophyte filamentous fungi. The pathogenic fungi was identified as Arthrinium arundinis and treated with chemical abrasion of the nail with 40% urea and application of terbinafine cream. Onychomycosis caused by Arthrinium species is rare, and this is the second reported case.

Aspectos epidemiológicos da hanseníase em menores de 15 anos, diagnosticados em um Centro de Referência do Sul do Brasil, entre 2007 e 2017: uma tendência à mudança na detecção de casos novos? / Epidemiological aspects of leprosy under 15 years old diagnosed at a Referral Center in the South of Brazil, between 2007-2017: a tendency to change in the detection of new cases?

Introdução: A Hanseníase (Doença de Hansen) é uma doença infectocontagiosa, que apresenta tropismo pela pele e nervos periféricos, cujo diagnóstico tardio pode causar sequelas físicas e emocionais. A Hanseníase em crianças é considerada um dos principais indicadores da tendência da doença e sugere intensa circulação do Mycobacterium leprae. Métodos: Um estudo retrospectivo, observacional e analítico foi conduzido com dezoito crianças diagnosticadas e tratadas no Ambulatório de Dermatologia Sanitária de Porto Alegre, Brasil. As informações clínicas e sociodemográficas foram obtidas através do Sistema de Informação de Agravos de Notificação (SINAN). Resultados: Durante o período de 2007-2017, 478 indivíduos foram diagnosticados como novos casos de Hanseníase em nosso Serviço; dentre esses, 18 (3,76%) eram crianças menores de 15 anos de idade, e sete foram diagnosticadas somente no ano de 2017. Dentre as 18 crianças, 15 (83,3%) eram multibacilares, e somente uma apresentou grau 2 de incapacidade. Aproximadamente 11% da amostra desenvolveram reações hansênicas durante o período de acompanhamento; 61,1% tinham entre 10 e 14 anos de idade. Contatos domiciliares foram identificados em 77,8% dos pacientes. Conclusão: Este estudo mostra que, apesar da situação endêmica ser menos preocupante no Sul do Brasil em relação às demais regiões brasileiras, o aumento da incidência de casos de Hanseníase em 2017 em indivíduos menores de 15 anos pode indicar uma mudança na tendência da doença e do indicador de detecção de casos novos da Hanseníase no Rio Grande do Sul, Brasil(AU).

Setting: Leprosy (Hansen's disease) is an infectious and contagious disease, which presents tropism on the skin and peripheral nerves, and its late diagnosis can lead to serious physical and emotional disabilities. Leprosy in children is considered one of the main indicators of the disease trend and suggests intense circulation of Mycobacterium leprae. Methods: A retrospective, observational and analytical study was conducted of 18 children, diagnosed as new cases of Leprosy and registered for treatment at the Ambulatory of Sanitary Dermatology, Porto Alegre, Brazil. The medical and socio-demographic details were obtained from the Information System for Notificable Diseases. Results: During 2007-2017, 478 people were diagnosed as new active cases of Leprosy at our referral center; among the registered patients, 18 (3,76%) were children aged under 15 years, of whom 15 (83,3%) were diagnosed with multibacillary disease and just one was reported with grade 2 of disability (G2D). Between new cases under 15 years of age, seven were detected in 2017. Nearly 11% of the sample developed reactions during the follow-up period; 61,1% were between 10 to 14 years old. Household contacts were identified in 77,7% of the patients. Conclusion: This study shows that despite the more favourable situation in the South of Brazil, the increase in Leprosy incidence in 2017 in individuals under 15 years may reveal a change in the trend of the disease and in the detection of the new cases of the Hansen's disease in Rio Grande do Sul, Brazil(AU).

Prevalence of dermatoses in dermatologic evaluation requests from patients admitted to a tertiary hospital for 10 years.

Skin diseases are common in hospitalized patients. However, there is a lack of data concerning their frequency. The objective of this study is to evaluate the prevalence of dermatological diagnoses in hospitalized patients after consultation requested by non-dermatologist physicians to the Department of Dermatology, Hospital de Clinicas de Porto Alegre period of 10 years. A total of 5685 patients were evaluated, representing an average of 48.2 patients per month. The five most frequent groups were infectious dermatoses(33.25%), eczematous dermatoses (11.49%), drug reactions (11.43%), vascular dermatoses (6.81%) and group of pruritus, prurigo nodularis and urticaria (hives) (4.71%).

Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil.

BACKGROUND: One of the most stigmatizing physical sequelae of leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE: To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS: After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Samples were collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS: Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS: In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.

Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil

BACKGROUND: One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE: To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS: After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS: Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS: In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV. .

Avaliação do estado nutricional e do consumo alimentar de pacientes com hanseníase do Ambulatório de Dermatologia Sanitária / Assessment of nutritional status and dietary intake in patients with Hansen's Disease under care at Dermatology Clinic Health

A Hanseníase é uma doença sistêmica, infectocontagiosa, de evolução crônica. Seu tratamento é realizado por meio de poliquimioterapia que pode desencadear algumas alterações nutricionais. Sendo assim, este trabalho teve como objetivo avaliar o estado nutricional e o consumo alimentar de pacientes com Hanseníase em acompanhamento no Ambulatório de Dermatologia Sanitária. Estudo de delineamento transversal, no qual realizou avaliação antropométrica, laboratorial e dietética. A amostra final foi de 39 pacientes, de ambos os sexos, com concentração de indivíduos na faixa etária a avaliação foi realizada apenas após o início do trata-entre os 40-50 anos, predomínio do ensino fundamen-tal incompleto e baixa renda familiar. A população se caracterizou pelo sedentarismo, sobrepeso, ocorrência de doenças crônicas não transmissíveis, insegurança alimentar e nutricional, consumo muito elevado de gorduras e inadequação de micronutrientes essenciais para a prevenção de doenças. Os resultados mostraram a necessidade da inserção do nutricionista na equipe multiprofissional, a fim de promover alimentação ade-quada e a prevenção de comorbidades, garantindo a promoção à saúde e a segurança alimentar. No entanto, não foi possível associar esses distúrbios nutricionais ao diagnóstico/tratamento da Hanseníase, uma vez que a avaliação foi realizada apenas após o início do tratamento da doença.

Leprosy is a systemic, infectious disease with a chronic course. It can be treated by drug therapy combination that may induce nutritional changes. Thus, this study aimed to assess the nutritional status and dietary in-take of leprosy patients under care at the Dermatology Clinic Health. Cross-sectional study, which was held on anthropometric, dietary and laboratory evaluation. The final sample of 39 patients of both sexes, presented a concentration of individuals aged between 40-50 years, prevalence of incomplete primary education and low family income. The population was characterized by sedentary, overweight, occurrence of chronic non-com-municable diseases, food and nutrition insecurity, high consumption of fats and inadequacy of micronutrients essentials for disease prevention. The results showed the necessity of inserting a nutritionist in the multidisci-plinary team in order to promote proper nutrition and the prevention of comorbid conditions, ensuring the promotion of health and food safety. However, it could not associate these nutritional disorders to the diagno-sis/treatment of leprosy, since the evaluation was per-formed only after the start of the treatment of disease.

Comunicantes que adoeceram de hanseníase: estudo em um centro de referência, Porto Alegre, RS / Contacts that sicked by hanseniasis: a research at a center of reference, Porto Alegre city, Brazil

Este trabalho é um estudo quantitativo descritivo que teve como objetivo estudar os comunicantes que adoeceram de hanseníase detectados em um Centro de Referência Estadual para atendimento desta doença em Porto Alegre, RS, no período de março de 1992 a fevereiro de 2004. Os dados foram coletados nas fichas de investigação epidemiológica e clínica de caso e fichas de notificação SINAN de todos os casos novos detectados no Serviço de Hanseníase do Ambulatório de Dermatologia Sanitária (ADS), encontrados a partir de um livro de registros no setor. Dos 418 prontuários pesquisados, encontamos 120 casos que informaram conviver ou ter convivido com doente de hanseníase no momento do preenchimento da ficha de notificação. Foi possível caracterizar que houve predomínio do sexo feminino, de adultos jovens e adultos, de formas clínicas multibacilares e com incapacidade física instalada no momento da notificação, evidenciando que o diagnóstico é tardio em nosso meio e reforçando a necessidade de se investir em capacitações de pessoal para que o diagnóstico seja realizado o mais precoce possível a fim de se conseguir a interrupção da cadeia epidemiológica da doença e a preservação de deformidades físicas. A partir destes resultados são feitas algumas sugestões para melhorias no acompanhamento dos comunicantes no ADS e para a realização de novas pesquisas.

Breve história da hanseníase: sua expansão do mundo para as Américas, o Brasil e o Rio Grande do Sul e sua trajetória na saúde pública brasileira / Trajectory in the brazilian public health

Este trabalho faz uma revisão sobre a história da hanseníase através dos tempos, desde sua provável origem na Antiguidade até sua vinda para as Américas, o Brasil e o Rio Grande do Sul. Relata, também, a evolução das políticas de saúde pública brasileiras adotadas para seu controle e descreve algumas atitudes da sociedade para com os doentes de hanseníase no passado. Este retrospecto histórico contribui para o conhecimento da doença, para a detecção de fatores predisponentes do binômio saúde-doença e auxilia na compreensão dos sentimentos dos pacientes com relação a sua doença na atualidade.

Ser hanseniano: sentimentos e vivencias / Being leprous: feelings and experiences

A hanseniase, doenca existente desde os mais remotos tempos, traz consigo marcas sociais e culturais indeleveis ate os dias atuais. Os trabalhos sobre o tema em sua grande maioria, predominantemente quantitativos e normativos, pouco evidenciam ou aprofundam a questao humana da hanseniase, os sentimentos destes pacientes ou as experiencias vivenciadas nesta trajetoria. Surgiu, entao, a proposta desde estudo que teve como objetivos evidenciar o significado da hanseniase na vida dos pacientes, as repercussoes da doenca sobre as relacoes intra e interpessoais e os sentimentos implicados neste processo. Esta pesquisa se realizou no periodo de dezembro de 1998 a dezembro de 1999, no Ambulatorio de Dermatologia Sanitaria, Porto Alegre - RS, e participaram do estudo onze doentes com idade entre 22 a 76 anos. As informaçoes foram coletadas por meio de entrevista dialogada e semi-estruturada e, posteriormente, analisadas pelo metodo fenomenologico. Os resultados evidenciaram o desconhecimento da hanseniase, as dificuldades enfrentadas pelos doentes desde o diagnostico ate o termino do tratamento, os diversos sentimentos vivenciados com a doenca, a importancia de cuidar e resgatar a auto-estima dos pacientes, o despreparo dos profissionais de saude em manejar a hanseniase e acolher os doentes e a importancia da educacao para a saude. A partir destes resultados sao feitas algumas consideracoes aos servicos e profissioanais que prestam atendimento aos doentes de hanseniase a as instituicoes de ensino responsaveis pela formacao de futuros profissionais da saude, objetivando o atendimento mais eficiente e humano ao hanseniano

Breve história da hanseníase: sua expansão domundo para as Américas, o Brasil e o Rio Grandedo Sul e sua trajetória na saúde pública brasileira / Brief history of leprosy: expansion of the wrld for the Americas, Brazil and Rio Grande do Sul and its trajectory in the Brazilian public health

Este trabalho faz uma revisão sobre a história da hanseníase através dos tempos, desde sua provável origem na Antigüidade até a sua vinda para as Américas, o Brasil e o Rio Grande do Sul. Relata, também, a evolução das políticas de saúde pública brasileiras adotadas para o seu controle e descreve algumas atitudes da sociedade para com os doentes de hanseníase no passado. Este retrospecto histórico contribui para o conhecimento da doença, para a detecção de fatores predisponentes do binômio saúde-doença e auxilia na compreensão dos sentimentos dos pacientes com relação a sua doença na atualidade. (AU)

O mundo da vida do ser hanseniano: sentimentos e vivencias / ?

A proposta deste estudo foi a de compreender, por meio de uma abordagem fenomenologica, os sentimentos e vivencias de hansenianos com relacao a sua doenca. A investigacao teve o objetivo de evidenciar o significado da hanseniase na vida dos pacientes, as repercussoes da doenca sobre as relacoes intra e interpessoais, a elaboracao de projetos de vida, as implicacoes em seu trabalho, as percepcoes das distintas fases do tratamento e os sentimentos implicados neste processo. Este estudo se realizou no periodo de dezembro de 1998 a dezembro de 1999, na cidade de Porto Alegre - RS. Os "locus" deste estudo foi a Ambulatorio de Dermatologia Sanitaria, da Secretaria de Saude e o Meio Ambiente do Estado do Rio Grande do Sul. Participaram desta pesquisa onze doentes