Human migration, railways and the geographic distribution of leprosy in Rio Grande do Norte State--Brazil.

INTRODUCTION: Leprosy is a public health problem in Brazil where 31,044 new cases were detected in 2013. Rio Grande do Norte is a small Brazilian state with a rate of leprosy lower than other areas in the same region, for unknown reasons. OBJECTIVES: We present here a review based on the analysis of a database of registered leprosy cases in Rio Grande do Norte state, comparing leprosy's geographic distribution among municipalities with local socio-economic and public health indicators and with historical documents about human migration in this Brazilian region. RESULTS: The current distribution of leprosy in Rio Grande do Norte did not show correlation with socio-economic or public health indicators at the municipal level, but it appears related to economically emerging municipalities 100 years ago, with spread facilitated by railroads and train stations. Drought-related migratory movements which occurred from this state to leprosy endemic areas within the same period may be involved in the introduction of leprosy and with its present distribution within Rio Grande do Norte. CONCLUSIONS: Leprosy may disseminate slowly, over many decades in certain circumstances, such as in small cities with few cases. This is a very unusual situation currently and a unique opportunity for epidemiologic studies of leprosy as an emerging disease.

Lepra en la infancia: caracterización de parámetros clínicos en los estados reaccionales / Leprosy in childhood: characterization of clinical parameters in reactional states

Objetivo: El objetivo del presente trabajo fue caracterizar los estados reaccionales en pacientes con lepra en la infancia y correlacionarlos con las variables sexo, edad, forma clínica, extensión de las lesiones, baciloscopía, momento de presentación de la reacción, respuesta al tratamiento y grado de incapacidad. Material y métodos: Estudio retrospectivo y descriptivo de los pacientes atendidos en el sector de Dermatología Sanitaria del Instituto de Dermatología Profesor Rubem David Azulay en Río de Janeiro entre marzo de 1992 y diciembre de 2003. Resultados: De 734 pacientes atendidos, 85 (12%) pacientes estaban en la faja etárea de 0 a 14 años; 15 (18%) pacientes presentaron reacción siendo que 8 (53%) eran multibacilares; 10 pacientes (67%) tuvieron reacción tipo 1, 3 (20%) reacción tipo 2 y 2 (13%) neuritis aislada. De los 15 pacientes con reacción, 9 eran hombres y 6 mujeres. Los episodios reaccionales se presentaron a partir de los 5 años de edad. Hubo predominio significativo de reacción en los pacientes con lesiones cutáneas diseminadas (p = 0,0055). Todos respondieron al tratamiento respectivo. Cinco pacientes presentaron incapacidad física como secuela. Conclusión: La ocurrencia de episodios reaccionales en esta faja etárea es común; debe evaluarse siempre esta posibilidad y educar a los padres sobre señales de alerta para que el niño sea rápidamente tratado y evitar el desarrollo de incapacidad física

Objetive: To characterize the reaction states in patients with leprosy in childhood and to correlate them with the next variables: sex, age, clinical form, lesion extension, smear, moment of reaction presentation, response to treatment and grade of disability. Subjects and methods: Retrospective and descriptive study of patients attended in the Leprosy Service of the Instituto de Dermatología Profesor Rubem David Azulay in Rio de Janeiro, between March 1992 and December 2003 was performed. Results: Seventy hundred and thirty four patients were attended, 85 (12%) patients were between 0 to 14 years old; 15 (18%) patients had reaction, 9 men and 6 women; 8 (53%) were multibacilary; 10 patients (67%) had type 1 reaction, 3 (20%) type 2 reaction and 2 (13%) isolated neuritis. The reaccional episodes appeared at mean age of 5 years old. Patients with disseminated cutaneous lesions had significative predominance of reaction (p = 0,0055). All of patients had a good response to respective treatment. Five patients presented disability as sequel. Conclusion: The occurrence of reaccional episodes at this age is common; the search of clinical signs of this disorder and the education of parents about alert signs must be implemented in order to treat children as soon as possible and avoid development of disabilities

A hanseníase no diagnóstico diferencial das adenomegalias: relato de caso / Leprosy in differential diagnosis of adenomegalies

A hanseníase é doença infecto-contagiosa, crónica, causada pelo Mycobacterium leprae, com tropismo, predominante, por pele e nervos periféricos. Os autores apresentan o caso de um paciente masculino, de 60 anos, que evoluia há 6 meses com perda de peso de 17 kg, febre diária e adenomegalia generalizada. Iniciou investigaçao para doença hematológica, más o estudo histopatológico de gânglio axilar, revelou tratar-se de hanseníase virchowiana. O exame físico nao evidenciou alteraçoes. A partir deste caso, revisaram a literatura sobre as causas de adenomegalia e seu diagnóstico diferencial com hanseníase

A hanseníase no diagnóstico diferencial das adenomegalias: relato de caso / Leprosy in differential diagnosis of adenomegalies

A hanseníase é doenþa infecto-contagiosa, crónica, causada pelo Mycobacterium leprae, com tropismo, predominante, por pele e nervos periféricos. Os autores apresentan o caso de um paciente masculino, de 60 anos, que evoluia há 6 meses com perda de peso de 17 kg, febre diária e adenomegalia generalizada. Iniciou investigaþao para doenþa hematológica, más o estudo histopatológico de gÔnglio axilar, revelou tratar-se de hanseníase virchowiana. O exame físico nao evidenciou alteraþoes. A partir deste caso, revisaram a literatura sobre as causas de adenomegalia e seu diagnóstico diferencial com hanseníase (AU)