[Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil]. / Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil / Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil / Vulnerabilidad programática en el control de la lepra: padrones desde la perspectiva de género en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Carboxymethyl Cellulose, Trichloroacetic Acid, and Unna Boot for Healing Venous Ulcers: A Comparative Study of Their Efficacy and Socioeconomic Impact.

Chronic ulcers are defined as a breakdown of the long-term cutaneous barrier or frequent recurrence of breakdowns. Dressings are a form of treatment and, in view of the variety and high cost of the products on the market, three agents were selected for this investigation, regarding their efficacy and cost/benefit ratio. The objective of the investigation was to evaluate and compare the efficacy, costs, and benefits of carboxymethylcellulose in paste at 20% (CMC 20%), trichloroacetic acid at 90% (TCA 90%), and Unna boot for treatment of chronic venous ulcers. Three groups of 30 patients each were chosen randomly for ambulatory treatment with TCA 90% (G1), CMC 20% (G2), and Unna boot (G3). The evolution of the cicatricial process of each group separately and between groups was analyzed with measurement of the lesion areas in square centimeters (cm2) and observation of the amount of exudate from observation of the photographic record, until their healing, in the maximum period of 20 weeks. A significant reduction of lesion areas in all groups was observed (P=.0001), with a median reduction of 7.6 cm2 (38.1%) for G1, 3.9 cm2 (38.8%) for G2, and 16.2 cm2 (77.8%) for G3. There was a significant difference in the absolute delta of the lesion areas (P=.0001) of the groups. The three types of treatments promoted effective improvement, with acquisition and utilization of all three products in the public health services being recommended.

Could Mycobacterium leprae Infection Be an Occupational Disease? A Survey in Healthcare Workers From an Endemic Area in the Amazonian Region.

A serologic survey was conducted to evaluate the prevalence of Mycobacterium leprae infection among healthcare workers and associated factors. Of 280 workers, 26 (9.3%) were positive using immunoglobulin M serology for PGL-I M. leprae antigen. Exposure to leprosy patients in the workplace was significantly associated with seropositivity (P=.044).

[Epidemiological aspects of leprosy: a spatial approach]. / Aspectos epidemiológicos da hanseníase: uma abordagem espacial.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Aspectos epidemiológicos da hanseníase: uma abordagem espacial / Epidemiological aspects of leprosy: a spatial approach

O objetivo foi identificar o padrão espacial da ocorrência da hanseníase em Duque de Caxias, município de alta endemicidade da doença no Estado do Rio de Janeiro, Brasil. Foram selecionados todos os casos novos de hanseníase registrados no banco do Sistema de Informação de Agravos de Notificação (SINAN), entre 1998 e 2006. Realizou-se análise por período subdividido a cada três anos, seguido de análise espacial por meio da estimativa bayesiana empírica local e do cálculo da autocorrelação espacial global (Moran) e local (LISA). A análise mostrou melhora acentuada do quadro epidemiológico, com o diagnóstico mais precoce. Houve redução da proporção de casos com grau II de 13,6% para 8,6% (p = 0,04). Verificou-se aumento da detecção de casos com forma indeterminada, de 10,3% para 18% (p = 0,00). A análise espacial identificou cluster na faixa sul-noroeste, não relacionado diretamente às ações de campanhas ou descentralização, mostrando ser uma ferramenta importante para identificação de áreas críticas da endemia e para avaliação do impacto das ações estratégias de combate à doença.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Drug and multidrug resistance among Mycobacterium leprae isolates from Brazilian relapsed leprosy patients.

Skin biopsy samples from 145 relapse leprosy cases and from five different regions in Brazil were submitted for sequence analysis of part of the genes associated with Mycobacterium leprae drug resistance. Single nucleotide polymorphisms (SNPs) in these genes were observed in M. leprae from 4 out of 92 cases with positive amplification (4.3%) and included a case with a mutation in rpoB only, another sample with SNPs in both folP1 and rpoB, and two cases showing mutations in folP1, rpoB, and gyrA, suggesting the existence of multidrug resistance (MDR). The nature of the mutations was as reported in earlier studies, being CCC to CGC in codon 55 in folP (Pro to Arg), while in the case of rpoB, all mutations occurred at codon 531, with two being a transition of TCG to ATG (Ser to Met), one TCG to TTC (Ser to Phe), and one TCG to TTG (Ser to Leu). The two cases with mutations in gyrA changed from GCA to GTA (Ala to Val) in codon 91. The median time from cure to relapse diagnosis was 9.45 years but was significantly shorter in patients with mutations (3.26 years; P = 0.0038). More than 70% of the relapses were multibacillary, including three of the mutation-carrying cases; one MDR relapse patient was paucibacillary.

Hansen's disease: a vanishing disease?

The introduction, implementation, successes and failures of multidrug therapy (MDT) in all Hansen's disease endemic countries are discussed in this paper. The high efficacy of leprosy treatment with MDT and the global reduction of prevalence led the World Health Organization, in 1991, to establish the goal of elimination of Hansen's disease (less than 1 patient per 10,000 inhabitants) to be accomplished by the year 2000. Brazil, Nepal and East Timor are among the few countries that didn't reach the elimination goal by the year 2000 or even 2005. The implications of these aspects are highlighted in this paper. Current data from endemic and previously endemic countries that carry a regular leprosy control programme show that the important fall in prevalence was not followed by the reduction of the incidence. This means that transmission of Mycobacterium leprae is still an issue. It is reasonable to conclude that we are still far from the most important goal of Hansen's disease control: the interruption of transmission and reduction of incidence. It is necessary to emphasize to health managers the need of keeping Hansen's disease control activities to better develop control programmes in the future. The recent international proposal to interrupt the transmission of leprosy by the year 2020 seems to unrealistic and it is discussed in this paper. The possibility of epidemiological impact related to the human immunodeficiency virus/Hansen's disease coinfection is also considered.

TNF -308G>A single nucleotide polymorphism is associated with leprosy among Brazilians: a genetic epidemiology assessment, meta-analysis, and functional study.

Leprosy is an infectious disease caused by Mycobacterium leprae. Tumor necrosis factor (TNF) plays a key role in the host response. Some association studies have implicated the single nucleotide polymorphism TNF -308G>A in leprosy susceptibility, but these results are still controversial. We first conducted 4 association studies (2639 individuals) that showed a protective effect of the -308A allele (odds ratio [OR] = 0.77; P = .005). Next, results of a meta-analysis reinforced this association after inclusion of our new data (OR = 0.74; P = .04). Furthermore, a subgroup analysis including only Brazilian studies suggested that the association is specific to this population (OR = 0.63; P = .005). Finally, functional analyses using whole blood cultures showed that patients carrying the -308A allele produced higher TNF levels after lipopolysaccharide (LPS) (6 hours) and M. leprae (3 hours) stimulation. These results reinforce the association between TNF and leprosy and suggest the -308A allele as a marker of disease resistance, especially among Brazilians.

Genotyping of Mycobacterium leprae from Brazilian leprosy patients suggests the occurrence of reinfection or of bacterial population shift during disease relapse.

We performed genotyping of Mycobacterium leprae present in skin biopsy samples that were collected during the first and the second disease occurrences from eight leprosy patients, seven of whom were diagnosed as suffering from disease relapse. Sequence analysis of part of the M. leprae rpoB, folP1, gyrB and gyrA genes did not show genetic change that supported the presence of drug-resistant bacilli. However, we observed a synonymous nucleotide change at position 297 of gyrA among five of these patients, one presenting C to T (CgyrAT) and four presenting T to C (TgyrAC) at this position. Additional genotyping by analysis of the four short tandem repeats GAA, GTA9, AT17 and TA18 showed that the gyrA single nucleotide polymorphism change was accompanied by a change in short tandem repeat genotype. Our data suggest that leprosy relapse in these patients, living in an area endemic for leprosy, could be caused by M. leprae with a genotype different from the one that caused initial disease.

TNF - 308G>A single nucleotide polymorphism is associated with leprosy among Brazilians: a genetic epidemiology assessment, meta-analysis, and functional study

Leprosy is an infectious disease caused by Mycobacterium leprae. Tumor necrosis factor (TNF) plays a key role in the host response. Some association studies have implicated the single nucleotide polymorphism TNF -308G>A in leprosy susceptibility, but these results are still controversial. We first conducted 4 association studies (2639 individuals) that showed a protective effect of the -308A allele (odds ratio [OR] = 0.77; P = .005). Next, results of a meta-analysis reinforced this association after inclusion of our new data (OR = 0.74; P = .04). Furthermore, a subgroup analysis including only Brazilian studies suggested that the association is specific to this population (OR = 0.63; P = .005). Finally, functional analyses using whole blood cultures showed that patients carrying the -308A allele produced higher TNF levels after lipopolysaccharide (LPS) (6 hours) and M. leprae (3 hours) stimulation. These results reinforce the association between TNF and leprosy and suggest the -308A allele as a marker of disease resistance, especially among Brazilians.

Memória e história da hanseníase no Brasil através de seus depoentes (1960-2000): catálogo de história oral / Memory and history of the leprosy in Brasil through its deponents (1960-2000): oral history catalog

A partir de meados da década de 1980 a história das ciências conheceu uma profunda transformação - ou melhor, uma inflexão - resultante das abordagens desenvolvidas a partir do início dos anos 1970 e que visavam redefinir a natureza das práticas científicas. Historiadores, filósofos e cientistas sociais em várias partes do mundo passaram a estabelecer os contornos de uma área que procurou rever paradigmas e modelos, o que se traduziu em variados enfoques, novas abordagens e métodos, recortes temáticos e uso de fontes documentais. Nesse processo de institucionalização da história das ciências emergiram inúmeros estudos nas linhas da história social das doenças e da medicina. No Brasil, nos últimos 20 anos, a Casa de Oswaldo Cruz ao lado de outras instituições tem contribuído de forma efetiva para a atualização constante da agenda de pesquisa, muitas vezes de forma integrada às atividades de identificação, reunião e organização de acervos. O Catálogo Memória e história da hanseníase no Brasil através de seus depoentes (1960-2000) é um dos produtos de um amplo projeto interinstitucional e teve como objetivo a constituição de um acervo de depoimentos de personagens que fizeram parte da história da hanseníase no Brasil, como profissionais de saúde (médicos, enfermeiros, assistentes sociais, psicólogos e gestores públicos), pacientes e ex-pacientes. São histórias de vida, com lembranças, memórias e relatos de quem padeceu da doença ou atuou contra ela.

Memória e história da hanseníase no Brasil através de seus depoentes (1960-200): catálogo de história oral / Memory and history of the leprosy in Brasil through its deponents (1960-2000): oral history catalog

A partir de meados da década de 1980 a história das ciências conheceu uma profunda transformação - ou melhor, uma inflexão - resultante das abordagens desenvolvidas a partir do início dos anos 1970 e que visavam redefinir a natureza das práticas científicas. Historiadores, filósofos e cientistas sociais em várias partes do mundo passaram a estabelecer os contornos de uma área que procurou rever paradigmas e modelos, o que se traduziu em variados enfoques, novas abordagens e métodos, recortes temáticos e uso de fontes documentais. Nesse processo de institucionalização da história das ciências emergiram inúmeros estudos nas linhas da história social das doenças e da medicina. No Brasil, nos últimos 20 anos, a Casa de Oswaldo Cruz ao lado de outras instituições tem contribuído de forma efetiva para a atualização constante da agenda de pesquisa, muitas vezes de forma integrada às atividades de identificação, reunião e organização de acervos. O Catálogo Memória e história da hanseníase no Brasil através de seus depoentes (1960-2000) é um dos produtos de um amplo projeto interinstitucional e teve como objetivo a constituição de um acervo de depoimentos de personagens que fizeram parte da história da hanseníase no Brasil, como profissionais de saúde (médicos, enfermeiros, assistentes sociais, psicólogos e gestores públicos), pacientes e ex-pacientes. São histórias de vida, com lembranças, memórias e relatos de quem padeceu da doença ou atuou contra ela (AU).

Potential plasma markers of Type 1 and Type 2 leprosy reactions: a preliminary report.

BACKGROUND: The clinical management of leprosy Type 1 (T1R) and Type 2 (T2R) reactions pose challenges mainly because they can cause severe nerve injury and disability. No laboratory test or marker is available for the diagnosis or prognosis of leprosy reactions. This study simultaneously screened plasma factors to identify circulating biomarkers associated with leprosy T1R and T2R among patients recruited in Goiania, Central Brazil. METHODS: A nested case-control study evaluated T1R (n = 10) and TR2 (n = 10) compared to leprosy patients without reactions (n = 29), matched by sex and age-group (+/- 5 years) and histopathological classification. Multiplex bead based technique provided profiles of 27 plasma factors including 16 pro inflammatory cytokines: tumor necrosis factor-alpha (TNF-alpha), Interferon-gamma (IFN-gamma), interleukin (IL)- IL12p70, IL2, IL17, IL1 beta, IL6, IL15, IL5, IL8, macrophage inflammatory protein (MIP)-1 alpha (MIP1alpha), 1 beta (MIP1beta), regulated upon activation normal T-cell expressed and secreted (RANTES), monocyte chemoattractrant protein 1 (MCP1), CC-chemokine 11 (CCL11/Eotaxin), CXC-chemokine 10 (CXCL10/IP10); 4 anti inflammatory interleukins: IL4, IL10, IL13, IL1Ralpha and 7 growth factors: IL7, IL9, granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), platelet-derived growth factor BB (PDGF BB), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF). RESULTS: Elevations of plasma CXCL10 (P = 0.004) and IL6 (p = 0.013) were observed in T1R patients compared to controls without reaction. IL6 (p = 0.05), IL7 (p = 0.039), and PDGF-BB (p = 0.041) were elevated in T2R. RANTES and GMCSF were excluded due to values above and below detection limit respectively in all samples. CONCLUSION: Potential biomarkers of T1R identified were CXCL10 and IL6 whereas IL7, PDGF-BB and IL6, may be laboratory markers of TR2. Additional studies on these biomarkers may help understand the immunopathologic mechanisms of leprosy reactions and indicate their usefulness for the diagnosis and for the clinical management of these events.

Single lesion leprosy pacients multicentric cohort treated with single dose drug therapy: findings on three-year follow-up and public health perspective in Brazil

Single skin lesion, paucibacillary (SSL-PB) leprosy is considered and early disease manifesation. This study the clinical outcome of a cohort of 259 newly diagnosed SSL-PB treated with one dose of rifampicin, ofloxacin, minocycline (ROM) and followed-up for three-years. Patients were recruited from the North, Central West and Southeast regions in Brazil (1997-2001). The result expected with ROM therapy was disappearance or the reduction of lesion size. Manifestation that required additional intervention were considered as poor clinical outcome: type-1 reaction (T1R) with or without neuritis alone, increase in lesion size and shift from paucibacillary to multibacillary. The incidence of poor clinical outcome was calculated by person-month and with the Kaplan-Meier methods. 61.8% of the participants were females, mean age 32.2, and 67,2% had borderline tuberculoid (BT) or tuberculoid forms. T1R was the predominant event; shift from paucibacillary to multibacillaru was rare. 92.0% of the volunteers shown no events during the first year, the same occurring to 80.6% of them after 3 years of clinical monitoring. The probability of remaining event-free was highest among those 40 years old or younger. Poor outcome predominated among BT patients. Extended monitoring of SSL-PB leprosy cases under minimal therapy provided valuable case management information for reference centers.

Memória e história da hanseníase no Brasil através de seus depoentes (1960-2000) / Memories and history of Hansen´s disease in Brazil told by witnesses (1960-2000)

Este trabalho é resultado preliminar de pesquisa sobre memória e história da hanseníase, desenvolvido pela Fiocruz e Universidade Federal do Rio de Janeiro. O objetivo é o resgate desta história por meio de depoimentos de quem padeceu da doença ou atuou contra ela. Foi realizada durante aproximadamente cinco anos, período no qual gravamos, transcrevemos e conferimos as entrevistas realizadas, objetivando a constituição de um acervo em história oral, para compo o material já existente na Casa de Oswaldo Cruz. A pesquisa se encontra em fase avançada, partindo para a etapa de finalização com a divulgação das entrevistas por meio de publicação e site (www.memoriadahanseniase,fiocruz.br), o que deverá acontecer ao longo de 2008.

Single lesion leprosy pacients multicentric cohort treated with single dose drug therapy: findings on three year follow up and public health perspective in Brazil

Single skin lesion, paucibacillary (SSL PB) leprosy is considered an early disease manifestation. This study evaluated the clinical outcome of a cohort of 259 newly diagnosed SSL PB treated with one dose of rifampicin, ofloxacin, minocycline (ROM) and followed up three years. Patients were recruited from the North, Central West and Southeast regions in Brazil (1997-2001). The result expected with ROM therapy was disappearance or the reduction of lesion size. Manifestations that required additional intervention were considered as poor clinical outcome: type 1 reaction (T1R) with or without neuritis, neuritis alone, increase in lesion size and shift from paucibacillary to multibacillary. The incidence of poor clinical outcome was calculated by person month and with the Kaplan Meier methods. 61,8 percent of the participants were females, mean age 32.2 and 67,2 percent had borderline tuberculoid (BT) or tuberculoid forms. TIR was the predominant event; shift from paucibacillary to multibacillary was rare. 92 percent of the volunteers shown no events during the first year, the same occurring to 80,6 percent of them after 3 years of clinical monitoring. The probability of remaining event free was highest among those 40 years old or younger. Poor outcome predominated among BT patients. Extended monitoring of SSL PB leprosy cases under minimal therapy provided valuable case management information for reference centers.