Clofazimine-induced cutaneous hyperpigmentation as a source of stigma in the treatment of leprosy: A cross-sectional study.

OBJECTIVES: Cutaneous hyperpigmentation is one of the main adverse effects encountered in patients undergoing leprosy treatment with multidrug therapy (WHO-MDT). This adverse effect has been described as intolerable and capable of contributing to social stigma. The objectives of this study were to quantify the variation in skin colour induced by clofazimine during and after treatment and to assess the related stigma. METHODS: This observational cross-sectional study objectively measured skin colour in 51 patients by reading the individual typology angle (ITA°) with a spectrophotometer, followed by the application of the Stigma Scale of the Explanatory Model Interview Catalogue (EMIC). RESULTS: Skin hyperpigmentation was observed in 100% of the individuals. They showed more negative ITA° values in lesion areas than non-lesion areas, particularly in sun-exposed regions. Clofazimine-induced cutaneous hyperpigmentation was not homogeneous and seemed to follow the lesion locations. The mean EMIC score was 18.8 points. CONCLUSION: All patients presented skin hyperpigmentation caused by clofazimine, detectable through spectrophotometry. Hyperpigmentation strongly impacted the social domain, indicating the intersectionality of disease and skin colour stigma, contributing to the social isolation of these patients. Health authorities should consider the negative impact of clofazimine on treatment adherence.

Evidence of hidden leprosy in a supposedly low endemic area of Brazil.

OBJECTIVES: Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations. METHODS: The study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA). RESULTS: From July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases. CONCLUSIONS: During the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.

Evidence of hidden leprosy in a supposedly low endemic area of Brazil

OBJECTIVES Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations. METHODS The study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA). RESULTS From July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases. CONCLUSIONS During the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.

TGF- plasma levels in chromoblastomycosis patients during itraconazole treatment

Background: Chromoblastomycosis (CBM) is a dermal mycosis. The disease evolves to a chronic state, presenting a suppurative granulomatous dermatitis, combined with variable dermal fibrosis. Pathogenesis of the inflammation and tissue repair in CBM are poorly understood. Aim: To quantify Transforming Growth Factor-β (TGF-β) plasma levels of CBM patients during itraconazole (ITZ) treatment. Methods: Blood plasma of 12 CBM patients was subjected to TGF-β titration with ELISA at 0, 3, 6 and 12 months of 200 mg per day of ITZ therapy, and correlated with the clinical aspects. Plasma of 12 healthy individuals were used for control. Results: CBM patients present high plasma levels of TGF-β (7.016 ± 1988 pg/ml), decreasing after 03 months (4.625 ± 645 pg/ml) of ITZ treatment, which correlates with a rapid clinical improvement. However, after 6 (6.566 ± 777 pg/ml) and 12 months (6.908 ± 776) of treatment, TGF-β levels increaseto almost the same levels observed before treatment, which is related to a slow clinical improvement, fungal persistence on the lesion, and fibrotic scars.Conclusion: TGFβ plasma levels are high in CBM patients. Fungal destruction by ITZ correlates with TGFβ downregulation, but tissue remodeling and fungal persistence probably raises its levels again, interfering with cellular immune responses.(AU)

Development of Natural Culture Media for Rapid Induction of Fonsecaea pedrosoi Sclerotic Cells In Vitro

Fonsecaea pedrosoi is the main agent of chromoblastomycosis, a skin disease presenting verrucous lesions, in which round, thick-walled sclerotic cells are found. In vitro induction of sclerotic cells is time-consuming (20 to 45 days) and temperature dependent. We present two new natural media that reduce the sclerotic-cell induction time to only 2 days.(AU)

Isolation of Fonsecaea pedrosoi from thorns of Mimosa pudica, a probable natural source of chromoblastomycosis

Este trabalho demonstra o isolamento de Fonsecaea pedrosoi de espinhos da planta Mimosa pudica L., a partir do local de suposta infecção identificado pela paciente infectada. O diagnóstico clínico de cromoblastomicose foi estabelecido pelo achado de corpos fumagóides no exame microscópico direto e pelas culturas de F. pedrosoi do material obtido da lesão da paciente. A mesma espécie foi isolada da paciente e da planta. A microscopia eletrônica de transmissão da superfície dos espinhos evidenciou a disposição conidial característica de F. pedrosoi. Estes dados indicam que a planta M. pudica deve ser uma fonte natural de infecção do fungo F. pedrosoi.

Isolation of Fonsecaea pedrosoi from thorns of Mimosa pudica, a probable natural source of chromoblastotomycosis

We report the isolation of fonsecaea pedrosoi from thorns of the plant mimosa pudica L. at the place of infection identified by one of our patients. Clinical diagnosis of chromoblastomycosis was stabilished by direct microscopic examination and cultures from the patient's lesion. The same species was isolated from the patient and from the plant. Scanning electron mycroscopy of the surface of the thorns showed the characteristic conidial arrangement of F.pedrosoi. these data indicate that M. pudica could be a natural source of infection for the fungus F. pedrosoi...(AU)