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2.
Rev Inst Med Trop Sao Paulo ; 61: e44, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531622

RESUMO

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.


Assuntos
Tatus/microbiologia , Reservatórios de Doenças/microbiologia , Hanseníase/veterinária , Mycobacterium leprae , Animais , Modelos Animais de Doenças , Humanos , Hanseníase/microbiologia , Hanseníase/transmissão
3.
Rev Saude Publica ; 53: 61, 2019 Aug 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31390430

RESUMO

OBJECTIVE: To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015. METHODS: This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region. RESULTS: 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators. CONCLUSIONS: A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.


Assuntos
Doenças Endêmicas/estatística & dados numéricos , Indicadores Básicos de Saúde , Hanseníase/epidemiologia , Doenças Negligenciadas/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Geografia , Humanos , Hanseníase/diagnóstico , Hanseníase/prevenção & controle , Hanseníase/transmissão , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Tempo , Adulto Jovem
4.
Rev Bras Epidemiol ; 22: e190047, 2019 Aug 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31460663

RESUMO

INTRODUCTION: Tocantins is the most hyperendemic state for leprosy in Brazil. OBJECTIVE: To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012. METHODOLOGY: Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression. RESULTS: There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7). CONCLUSION: Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands.


Assuntos
Hanseníase/epidemiologia , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Análise de Regressão , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Fatores de Tempo
6.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 873-879, jul.-set. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005618

RESUMO

Objetivo: Avaliar a situação dos contatos intradomiciliares dos casos de hanseníase notificados no ano de 2012 em São Luís/Maranhão. Métodos: Estudo quantitativo-descritivo-transversal, com coleta de dados utilizando-se instrumento estruturado. Resultados: A maioria dos contatos intradomiciliares eram mulheres (51,87%), idade entre 0 e 20 anos (40,29%), parentesco consanguíneo de 1º grau (54,92%), forma dimorfa (59,78%) e multibacilares (75,53%). Do total, 1880 (67,96%) não realizaram o exame dermatoneurológico. Entre os examinados, houve maior frequência no distrito Bequimão (28,48%), no qual 59,82% eram mulheres, idade entre 0 a 20 anos (44,77%). Ao exame, 91,27% apresentou-se normal. Dentre os suspeitos, 36,73% tinham hanseníase, 58,21% possuíam cicatriz da 1ª dose da BCG e 59,98% foram encaminhados a vacinação. A prevalência da doença entre os contatos foi de 1,62%. As ações da vigilância de contatos classificaram-se como precárias em São Luís. Conclusão: A maioria dos contatos registrados não foi examinada, evidenciando necessidade de fortificação das ações da vigilância no município


Objective: To evaluate the situation of in-house contacts of the cases of leprosy reported in 2012 in São Luis, Maranhão. Methods: Quantitative cross-sectional descriptive study, with data collection using a structured instrument. Results: The majority of in-house contacts were women (51.87%), from 0 to 20 years of age (40.29%), first-degree kinship (54.92%), dimorphic shape (59.78) and multibacillary (75.53%). In total, 1880 (67.96%) did not take the dermato-neurological exam. Among those tested, there was a greater frequency in the Bequimão district (2.48%), 59.82% were women, from 0 to 20 years of age (44.77%). On the exam, 91.27% were normal. Among those suspected of carrying the disease, 36.73% had leprosy, 58.21% had scars from the first dose of BCG and 59.98% were sent to receive vaccination. The prevalence of the disease among the contacts was 1.62%. The actions of contact monitoring were classified as precarious in São Luis. Conclusion: The majority of registered contacts were not examined, highlighting the need for strengthening of monitoring efforts in the city


Objetivo: Evaluar la situación de los contactos intradomiciliares de los casos de hanseniasis notificados en el año 2012 en São Luis - MA. Métodos: Estudio cuantitativo-descriptivo-transversal, con recolección de datos utilizando instrumento estructurado. Resultados: La mayoría de los contactos intradomiciliares eran mujeres (51,87%), edad entre 0 y 20 años (40,29%), parentesco consanguíneo de primer grado (54,92%), forma dimorfa (59,78%), multibacilares (75,53%). Del total, 1880 (67,96%) no realizaron el examen dermatoneurológico. Entre los examinados, hubo mayor frecuencia en el distrito de Bequimão (28,48%), el 59,82% eran mujeres, entre 0 a 20 años (44,77%). En el examen, el 91,27% se presentó normal. Entre los sospechosos, el 36,73% tenían hanseniasis, el 58,21% tenía cicatriz de la 1ª dosis de BCG y el 59,98% fueron encaminados a la vacunación. La prevalencia de la enfermedad entre los contactos fue del 1,62%. Las acciones de la vigilancia de contactos se clasificaron como precarias en San Luis. Conclusión: La mayoría de los contactos registrados no fueron examinados, evidenciando necesidad de fortificación de las acciones de la vigilancia en el municipio


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Notificação de Doenças/estatística & dados numéricos , Hanseníase/transmissão , Hanseníase/epidemiologia , Contaminação/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Monitoramento Epidemiológico
7.
Rev Bras Enferm ; 72(3): 744-752, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269141

RESUMO

OBJECTIVES: To identify useful terms for nursing practice in the care of people with leprosy and to cross-mapp the identified terms with the ICNP® terms. METHOD: A descriptive, documentary study that included publications of the Ministry of Health in the area of leprosy launched between 2002 and 2017. The terms identified in these publications were extracted and underwent a normalization proces and then, were cross-mapped with terms of the ICNP® version 2015 for the identification of constant and non-constant terms in this terminology. RESULTS: In total, were extracted 1,177 terms, of which 26.76% were equal, 4.59% similar, 4.26% were broader, 19.62% were more restricted, and 44.77% were totally different from the ICNP® terms. CONCLUSIONS: The large number of terms identified and not included in the ICNP® show the need for its expansion in order to contemplate the phenomena of clinical practice more effectively and allow better representation of nursing care for people with leprosy.


Assuntos
Hanseníase/classificação , Diagnóstico de Enfermagem/classificação , Humanos , Hanseníase/enfermagem , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/tendências , Diagnóstico de Enfermagem/estatística & dados numéricos , Terminologia Padronizada em Enfermagem
8.
Clin Dermatol ; 37(4): 380-381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345327

Assuntos
Hanseníase , Humanos
9.
Rev Soc Bras Med Trop ; 52: e20180540, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340360

RESUMO

INTRODUCTION: Monitoring disability trends is required to evaluate leprosy elimination. We assessed the trends in disability indicators and its association with space in Alagoas, Brazil. METHODS: We conducted an ecological study in all leprosy cases from 2006 to 2016. Disability indicators were analyzed using the joinpoint regression model. RESULTS: The proportion of new cases with grade 2 disability at diagnosis ranged from 4.7% to 11.9% (annual percent change, 1.4; P= 0.7), while at discharge, it ranged from 0.0% to 12.3% (annual percent change, -21.8; P= 0.2). CONCLUSIONS: Disability indicators had a stable trend over the study period.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/epidemiologia , Brasil/epidemiologia , Doenças Endêmicas/estatística & dados numéricos , Humanos , Hanseníase/complicações , Análise Espacial
10.
BMC Infect Dis ; 19(1): 501, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174481

RESUMO

BACKGROUND: The island of Anjouan (Comoros) is highly endemic for leprosy with an annual incidence of 5-10/10,000. In May/June, 2015 single-dose Rifampicin post-exposure prophylaxis (SDR-PEP) was administered to 269 close contacts of 70 leprosy-patients in four villages as a pilot programmatic intervention. Two years later we revisited the villages for follow-up investigations. The main aim of our study was to quantify spatial associations between reported leprosy cases before and after PEP implementation. A secondary aim was to assess the effect of this single round of SDR-PEP at the individual level. METHODS: We conducted door-to-door leprosy screening in all four villages in August/September, 2017. We screened all consenting individuals for leprosy and recorded geographic coordinates of their household. We also recorded whether they had received SDR-PEP and whether they had been diagnosed with leprosy, before or after the 2015 intervention. We fitted a Poisson model with leprosy as outcome and distance to the nearest pre-intervention case and SDR-PEP as predictors. RESULTS: During the survey we found 114 new cases among 5760 contacts screened (2.0% prevalence), in addition to the 39 cases detected in the two preceding years. We found statistically significant associations of incident leprosy with physical distance to index cases ranging from 2.4 (95% confidence interval (95% CI) 1.5-3.6) for household contacts to 1.8 (95% CI 1.3-2.5) for those living at 1-25 m, compared to individuals living at ≥75 m. The effect of SDR-PEP appeared protective but did not reach statistical significance due to the low numbers, with an incidence rate ratio (IRR) of 0.6 (95% CI 0.3-1.2) overall, and 0.5 (95% CI 0.2-1.3) when considering only household contacts. CONCLUSIONS: This pilot demonstrated an increased risk of leprosy in contacts beyond the household, therefore a wider circle should be considered for chemoprophylaxis. Baseline surveys and extended contact definitions are essential for improving SDR-PEP effectiveness.


Assuntos
Hanseníase/diagnóstico , Hanseníase/epidemiologia , Antibióticos Antituberculose/uso terapêutico , Análise por Conglomerados , Comores/epidemiologia , Humanos , Hanseníase/tratamento farmacológico , Profilaxia Pós-Exposição , Prevalência , Rifampina/uso terapêutico
11.
BMC Infect Dis ; 19(1): 520, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196008

RESUMO

BACKGROUND: Leprosy is is still considered a public health issue and in Colombia 7-10% of new cases are found in children, indicating both active transmission and social inequality. We hypothesized that circulating antibodies against Natural Octyl Disaccharide-Leprosy IDRI Diagnostic (NDO-LID) (a combination of Mycobacterium leprae antigens) could reveal the social and environmental aspects associated with higher frequencies of M. leprae infection among children and adolescents in Colombia. METHODS: An observational cross-sectional study was conducted involving sampling from 82 children and adolescents (younger than 18 years of age) who had household contact with index leprosy patients diagnosed in the last 5 years. Data were analyzed through bivariate analysis made by applying a Pearson x2 test for qualitative variables, while quantitative variables, depending on their distribution, were analyzed using either a Student's t-test or Mann-Whitney U test. Multivariate analysis was performed using a multiple regression and binomial logistic approach. RESULTS: A bivariate analysis demonstrated that antibody titers against NDO-LID were significantly greater in children and adolescents with a low socioeconomic status that had: lived in vulnerable areas of the UAChR shared region; eaten armadillo meat; exposure of over 10 years to an index case and; not received BCG immunization. Moreover, a multivariate analysis showed that residing in the UAChR region has a strong association with a greater possibility of M. leprae infection. CONCLUSIONS: M. leprae transmission persists among young Colombians, and this is associated with social and environmental conditions. An intensification of efforts to identify new leprosy cases in vulnerable and forgotten populations where M. leprae transmission continues therefore appears necessary.


Assuntos
Hanseníase/diagnóstico , Mycobacterium leprae/isolamento & purificação , Adolescente , Animais , Anticorpos Antibacterianos/sangue , Tatus , Vacina BCG/imunologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Hanseníase/epidemiologia , Hanseníase/transmissão , Modelos Logísticos , Masculino , Carne/análise , Carne/microbiologia , Mycobacterium leprae/imunologia , Classe Social , Estatísticas não Paramétricas
12.
Int J Exp Pathol ; 100(3): 161-174, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124597

RESUMO

This study evaluated the immune response of nude and BALB/c mice inoculated in the footpads (FP) with Mycobacterium leprae after 3, 5 and 8 months. At each timepoint peritoneal cells, peripheral blood, FP and popliteal lymph nodes (PLN) were collected. Peritoneal cell cultures were performed to measure the H2 O2 , O2 - , NO, IL-2, IL-4, IL-10, IL-12, IFN-γ and TNF levels. Serum levels of anti-PGL-I antibodies were also quantified. The results showed that the infection was progressive in nude mice with bacterial multiplication, development of macroscopic lesions in the FP and presence of bacilli in the PLN at 8 months. In BALB/c mice, the infection reached a plateau of bacillary multiplication at 5 months and regressed at 8 months. Histopathological analysis of FP revealed a mononuclear inflammatory infiltrate with a large number of neutrophils at 5 months, with a higher number in nude mice. At 8 months, the number of neutrophils decreased and the infiltrate was predominantly mononuclear in both mouse strains. There was no H2 O2, O2 - , IL-2, IL-4, IL-10 and IFN-γ production in the course of infection in nude mice; however, in BALB/c, O2 - and IL-12 production was higher at 5 months and NO, IFN-γ and TNF production was higher at 8 months when there was a decrease in the number of bacilli. The level of anti-PGL-I antibodies was higher in BALB/c mice. Thus, nude and BALB/c mice can be used as experimental models for the study of various aspects of leprosy.


Assuntos
Pé/patologia , Hanseníase/patologia , Mycobacterium leprae/imunologia , Lavagem Peritoneal , Animais , Modelos Animais de Doenças , Interleucina-10/metabolismo , Hanseníase/imunologia , Camundongos Endogâmicos BALB C , Camundongos Nus , Pele/imunologia , Pele/patologia
13.
An Bras Dermatol ; 94(2): 182-191, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31090823

RESUMO

BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.


Assuntos
Demografia/métodos , Doenças Endêmicas/estatística & dados numéricos , Hanseníase/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Distribuição por Idade , Teorema de Bayes , Brasil/epidemiologia , Cidades/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Análise Espacial , Populações Vulneráveis/estatística & dados numéricos
15.
Int J Exp Pathol ; 100(2): 83-93, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31090128

RESUMO

Schwann cells (SCs) critically maintain the plasticity of the peripheral nervous system. Peripheral nerve injuries and infections stimulate SCs in order to retrieve homeostasis in neural tissues. Previous studies indicate that Mycobacterium leprae (ML) regulates the expression of key factors related to SC identity, suggesting that alterations in cell phenotype may be involved in the pathogenesis of neural damage in leprosy. To better understand whether ML restricts the plasticity of peripheral nerves, the present study sought to determine the expression of Krox-20, Sox-10, c-Jun and p75NTR in SC culture and mice sciatic nerves, both infected by ML Thai-53 strain. Primary SC cultures were stimulated with two different multiplicities of infection (MOI 100:1; MOI 50:1) and assessed after 7 and 14 days. Sciatic nerves of nude mice (NU-Foxn1nu ) infected with ML were evaluated after 6 and 9 months. In vitro results demonstrate downregulation of Krox-20 and Sox-10 along with the increase in p75NTR-immunolabelled cells. Concurrently, sciatic nerves of infected mice showed a significant decrease in Krox-20 and increase in p75NTR. Our results corroborate previous findings on the interference of ML in the expression of factors involved in cell maturation, favouring the maintenance of a non-myelinating phenotype in SCs, with possible implications for the repair of adult peripheral nerves.


Assuntos
Regulação para Baixo , Proteína 2 de Resposta de Crescimento Precoce/biossíntese , Hanseníase/metabolismo , Células de Schwann/metabolismo , Nervo Isquiático/metabolismo , Animais , Diferenciação Celular/fisiologia , Células Cultivadas , Modelos Animais de Doenças , Hanseníase/microbiologia , Hanseníase/patologia , Camundongos Nus , Mycobacterium leprae/isolamento & purificação , Plasticidade Neuronal/fisiologia , Receptores de Fator de Crescimento Neural/metabolismo , Células de Schwann/microbiologia , Células de Schwann/patologia , Nervo Isquiático/microbiologia , Nervo Isquiático/patologia , Técnicas de Cultura de Tecidos
16.
BMC Infect Dis ; 19(1): 455, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117984

RESUMO

BACKGROUND: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. CASE REPORT: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. CONCLUSION: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.


Assuntos
Edema/diagnóstico , Hanseníase/etiologia , Mycobacterium leprae/isolamento & purificação , Sinovite/diagnóstico , Idoso , Antibacterianos , Artrite/tratamento farmacológico , Artrite/etiologia , Edema/etiologia , Humanos , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Masculino , Mycobacterium leprae/patogenicidade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pele/microbiologia , Pele/patologia , Síndrome , Sinovite/etiologia
17.
BMC Infect Dis ; 19(1): 460, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118048

RESUMO

BACKGROUND: The multidrug therapy (MDT) for leprosy treatment adopted by Brazil in the 1990s was important for reducing leprosy in the country; however, recurrent cases remained problematic. Mechanisms involved in leprosy recurrence are heterogeneous and can be sorted into three groups: insufficient therapy, bacillary persistence and new infections. This study aimed to analyse the time interval of leprosy recurrence in relation to the therapeutic scheme in the state of Acre. The hypotheses were as follows: 1) treatments (a) rifampicin, ofloxacin and minocycline (ROM) and (b) dapsone (DDS) have a short leprosy recurrence time, 2) treatments based on MDT have a long leprosy recurrence time, 3) there is a dose-response relationship between MDT and the time interval between leprosy episodes. METHODS: This retrospective cohort study included 201 patients with a second episode of clinical leprosy at the reference centers for leprosy control in the state of Acre. Exposure was the type of therapeutic scheme as follows: 1) ROM, 2) DDS, 3) MDT0-9 doses, 4) MDT10-19 doses, 5) MDT20-29 doses, and 6) MDT30+ doses. Outcome was the time interval between release from treatment and a diagnosis of a recurrent leprosy case. Incidence rate ratios and relative risk Poisson regressions adjusted by age and sex were calculated with 95% confidence intervals. RESULTS: The 201 patients studied during this retrospective follow-up resulted in a total of 224 cases of recurrent leprosy. Incidence rate ratios within this therapeutic scheme were as follows: 3.3 (2.39, 4.2; ROM/MDT30+), 1.12 (0.33, 1.92; DDS/MDT30+), 2.17 (1.39, 2.94; MDT0-9/MDT30+), 1.94 (1.13, 2.75; MDT10-19/MDT30+) and 1.26 (0.47, 2.05; MDT20-29/MDT30+). Relative risk Poisson regressions showed a protective effect of MDT30+ in comparison with ROM (0.22; 0.07, 0.72), MDT0-9 (0.42; 0.21, 0.85), and MDT10-19 (0.44; 0.21, 0.92). No differences among MDT30+ and DDS (0.71; 0.36, 1.41) and MDT20-29 (0.76; 0.38, 1.49) were observed. CONCLUSIONS: New infection is an important-yet neglected-mechanism in leprosy recurrence in the state of Acre and can challenge the leprosy elimination plan in Brazil. MDT with few doses might be associated with leprosy recurrence due to insufficient therapy or bacillary persistence.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/etiologia , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Minociclina/uso terapêutico , Ofloxacino/uso terapêutico , Recidiva , Estudos Retrospectivos , Rifampina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
18.
PLoS Negl Trop Dis ; 13(4): e0007302, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30951526

RESUMO

BACKGROUND: With the introduction of new interventions to prevent leprosy, such as post-exposure prophylaxis (PEP) given to contacts of leprosy patients, it is necessary to update our understanding of knowledge and perception of leprosy among the populations where these interventions will be introduced, in order to tailor communication optimally to the current situation. This study is a baseline study of the PEP++ project and aimed to assess the knowledge, attitudes and practices regarding leprosy in Fatehpur, India. METHODOLOGY: The study used a community-based cross-sectional design with a mixed-methods approach. We assessed knowledge, attitudes, and practices with the KAP measure, and stigma with the Explanatory Model Interview Catalogue community stigma scale (EMIC-CSS) and the Social Distance Scale (SDS). In addition, semi-structured interviews and focus group discussions were conducted with all participant groups. The quantitative data were analysed using stepwise multivariate regression. The qualitative data were analysed using open, inductive coding and content analysis. FINDINGS: A total of 446 participants were included in the study: 100 persons affected by leprosy, 111 close contacts, 185 community members and 50 health care workers. In addition, 24 in-depth interviews were conducted and 35 people were included in focus group discussions. 12.5% of the participants had adequate knowledge of leprosy, while 22% had poor knowledge. Knowledge on cause (answered correctly by 10% of the participants), mode of transmission (5%) and symptoms of leprosy (16%) was especially poor. The mean EMIC-CSS score was 15.3 (95%CI 14.6-16.0) and mean SDS score 7.2 (95%CI 6.6-7.8). Better knowledge of leprosy was associated with lower levels of social distance towards persons affected by leprosy. CONCLUSION: This study revealed poor knowledge regarding leprosy and high levels of stigma and fear and desire to keep social distance towards persons affected by leprosy. Community education that takes cultural beliefs, knowledge gaps and fears into consideration could improve knowledge, reduce misconceptions and positively influence the perception of leprosy.


Assuntos
Erradicação de Doenças , Conhecimentos, Atitudes e Prática em Saúde , Hanseníase/prevenção & controle , Percepção Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Feminino , Educação em Saúde , Pessoal de Saúde/psicologia , Humanos , Índia/epidemiologia , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Estigma Social , Inquéritos e Questionários , Adulto Jovem
19.
Expert Opin Drug Metab Toxicol ; 15(5): 367-379, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30943794

RESUMO

INTRODUCTION: In their 70-year history, dapsone and other sulfones have been used as both antibacterial and anti-inflammatory agents. Dapsone has been the main active principle in the multidrug regimen recommended by the World Health Organization for the treatment of leprosy. In addition, dapsone has been successfully used to treat a wide range of dermatological and systemic disorders, mostly characterized by neutrophilic and eosinophilic accumulation and infiltration. Areas covered: The PubMed database was searched using combinations of the following keywords: dapsone, sulfones, pharmacodynamics, pharmacology, adverse events, pharmacokinetics, drug interaction, dermatologic uses, and antimicrobial uses. This article reviews and updates the chemistry, pharmacokinetics, mechanism of action, adverse effects, drug interactions, and clinical application of sulfones. Expert opinion: Dapsone exhibits clinical efficacy in several cutaneous and systemic conditions and is now generally accepted as the therapy of choice for leprosy and for rare dermatosis, as dermatitis herpetiformis. Careful patient selection and close monitoring during treatment are mandatory to provide safe and effective use of dapsone. Familiarity with sulfones and dapsone is crucial because of this agent retains its niche in the clinician's therapeutic armamentarium.


Assuntos
Anti-Infecciosos/administração & dosagem , Dapsona/administração & dosagem , Hansenostáticos/administração & dosagem , Animais , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/farmacocinética , Dapsona/efeitos adversos , Dapsona/farmacocinética , Interações de Medicamentos , Humanos , Hansenostáticos/efeitos adversos , Hansenostáticos/farmacocinética , Hanseníase/tratamento farmacológico , Dermatopatias/tratamento farmacológico
20.
Rev Soc Bras Med Trop ; 52: e20180172, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30994795

RESUMO

INTRODUCTION: American tegumentary leishmaniasis (ATL) and leprosy share common areas of prevalence, but reports of coinfection are scarce. METHODS: We report a series of 9 ATL-leprosy cases and discuss the association. An integrative diagram to analyze the clinico-immunological features of coinfection with both diseases. RESULTS: Nine patients with leishmaniasis (5 cutaneous, 3 mucocutaneous, 1 disseminated case) exhibited concurrent infection with distinct clinical forms of leprosy. Our diagram-based analysis evidenced a divergent clinico-immunological spectrum for each disease in 8 out of 9 cases. CONCLUSIONS: The spectrum of ATL-leprosy comorbidity suggests that the host has a specific immune response against each pathogen.


Assuntos
Coinfecção/imunologia , Leishmaniose Cutânea/imunologia , Hanseníase/imunologia , Células Th1/imunologia , Células Th2/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leishmaniose Cutânea/complicações , Hanseníase/complicações , Masculino , Pessoa de Meia-Idade
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