7 research outputs found

    O risco de infecção por SARS-CoV-2 nos pacientes com hanseníase e seus contactantes : um estudo de coorte prospectivo

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    Tese (doutorado) — Universidade de Brasília, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, 2021.Efeitos protetores da vacinação com Bacillus Calmette-Guérin (BCG) e tratamento com clofazimina e dapsona contra infecção pelo novo coronavírus (SARS-CoV-2) foram relatados. Pacientes em risco de hanseníase representam um modelo interessante para avaliar os efeitos de tais terapias sobre a ocorrência e gravidade da doença causada pelo coronavírus SARS-CoV-2 (COVID-19). Objetivos: O objetivo do presente estudo foi avaliar, de forma prospectiva, a influência de variáveis relacionadas à hanseníase na ocorrência e na gravidade da COVID-19. Metodologia: Realizou-se um estudo de coorte prospectivo por 14 meses, no qual o principal fator de risco foram duas vacinações anteriores com BCG e o principal desfecho foi a ocorrência de COVID-19, detectada por reação em cadeia da polimerase de transcrição reversa (RT-PCR). O modelo de riscos proporcionais de Cox foi utilizado para análise principal. Resultados: Entre 406 pacientes incluídos, 113 foram diagnosticados com hanseníase. Durante o acompanhamento, 69 (16,99%) pacientes contraíram COVID-19. A análise de sobrevivência mostrou que a hanseníase estava associada com COVID-19 (p <0,001), mas, a análise multivariada mostrou que apenas contatos domiciliares de pacientes infectados pelo SARS-CoV-2 (razão de risco (HR) = 8,04; 95% CI = 4,93-13,11), bem como a ocorrência do diabetes mellitus (HR = 2,06; 95% CI= 1,04-4,06) foram fatores de risco significativos para COVID-19. Conclusões: Pacientes com hanseníase são vulneráveis ao COVID-19, porque têm contato mais frequente com pacientes infectados com SARS-CoV-2, possivelmente, devido às limitações sociais e econômicas. O modelo mostrou que nem o uso de corticosteroides, talidomida, pentoxifilina, clofazimina ou dapsona e nem a vacinação BCG afetaram a ocorrência de COVID-19 e a gravidade da doença.Protective effects of Bacillus Calmette–Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of such therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). Objectives: We aimed to assess the risk of COVID-19 development in patients with Mycobacterium leprae infection and those vaccinated with BCG. Methodology: We performed a 14-month prospective cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detected by reverse transcription polymerase chain reaction (RT-PCR). The Cox proportional hazards model was used for the measurement of the main outcome. Results: Among 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. Conclusions: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, probably due to social and economic limitations. Our model showed that neither the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone nor BCG vaccination affected the occurrence of COVID-19 or its severity

    Interferência da polimedicação no tratamento da hanseníase : um estudo caso-controle

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    Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2019.Introdução: A hanseníase é caracterizada por um quadro infectocontagioso, causado pelo Mycobacterium leprae, evoluindo de forma lenta e gradativa, com a manifestação de sinais e sintomas dermatoneurológicos. Nesse sentido, aplica-se o tratamento baseado na poliquimioterapia (PQT). Essa estratégia, cada vez mais comum nos tratamentos atuais, deve ser realizada com regularidade na administração da dose, requerendo supervisão constante. Objetivos: O principal objetivo do presente estudo consiste em verificar o efeito da polimedicação como fator de risco para a suspensão do esquema PQT no tratamento da hanseníase no Hospital Universitário de Brasília. Métodos: Trata-se de um estudo de caso-controle não pareado, em que o desfecho primário foi definido como a necessidade, ou não, de suspensão do tratamento poliquimioterápico por qualquer motivo e o fator de risco principal foi definido como a presença de polimedicação (uso de 5 ou mais medicamentos não constantes do tratamento da hanseníase). Foram recrutados, de forma consecutiva, pacientes com diagnóstico de hanseníase tratados no Hospital Universitário de Brasília-DF, de janeiro de 2018 a julho de 2019. Resultados: Foram incluídos 103 pacientes na pesquisa. Desse total, 43 pacientes necessitaram suspender o tratamento PQT formando o grupo de casos e 60 não necessitaram suspender o tratamento formando o grupo dos controles. A análise multivariada confirmou que o sexo masculino foi fator protetor para a suspensão do esquema de PQT. Interações medicamentosas não tiveram qualquer efeito na suspensão do tratamento. O número de drogas utilizadas pelos pacientes estudados influenciou, de forma importante, a suspensão da PQT (razão de chances = 3,86, intervalo de confiança de 95% = 2,01 – 8,09; p<0,001). A ocorrência de anemia hemolítica relacionou-se com a presença de polimedicação. Conclusão: No que se refere aos possíveis fatores de risco com a ocorrência de suspensão do esquema poliquimioterápico, destacam-se como principais a possibilidade do desenvolvimento de anemia hemolítica. Portanto, ressalta-se a necessidade de um estudo mais detalhado sobre a suspensão de fármacos como a dapsona, rifampicina e clofazimina, haja vista o elevado prazo para conclusão do tratamento.Introduction: Leprosy is a contagious infectious disease caused by Mycobacterium leprae, slowly and gradually evolving, with the manifestation of dermatoneurological signs and symptoms. In this sense, treatment based on multidrug therapy (MDT) is applied. This strategy, increasingly common in current treatments, should be performed regularly, requiring constant supervision. Objectives: The main objective of the present study was verify the effect of polypharmacy as a risk factor for the suspension of the MDT regimen in the treatment of leprosy. Methods: We performed an unpaired case-control study in which the primary outcome was defined as the need or not to discontinue multidrug therapy for any reason and the main risk factor was defined as the presence of polypharmacy (the use of 5 or more non-leprosy drugs). Consecutive leprosy patients treated at the University Hospital of Brasilia-DF, from January 2018 to July 2019, were consecutively recruited. Results: A total of 103 patients were included in the study. Of this total, 43 patients needed to discontinue multidrug therapy forming the case group and 60 did not need to discontinue treatment forming the control group. Multivariate analysis confirmed that male gender was a protective factor for the suspension of the MDT regimen. Drug interactions had no effect on discontinuation of treatment. The number of drugs used by the studied patients significantly influenced the suspension of MDT (odds ratio = 3,86, 95% confidence interval = 2.01 - 8.09; p <0.001). Hemolysis was significantly related to polypharmacy. Conclusion: Regarding the possible risk factors for the occurrence of discontinuation of MDT, the main one is probably the possibility of developing hemolytic anemia. Therefore, the need for a more detailed study on the suspension of drugs such as dapsone, rifampicin and clofazimine is emphasized, given the long term for completion of treatment

    Can leprosy reaction states mimic symptoms of fibromyalgia? : a cross-sectional analytical study

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    Leprosy causes significant pain in affected patients, especially those experiencing reactional states. Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue. Confusion between the clinical manifestations of fibromyalgia and those of leprosy reactions is possible at the primary care level, the first contact with the health system in most cases. We aimed to determine whether the presence of leprosy reactional states is related to the development of signs and symptoms included in the case definition of fibromyalgia and establish recommendations for obtaining the correct diagnosis. We performed a cross-sectional study in which the main independent variable was the presence of any leprosy reactional state and the primary dependent variable was the diagnosis of fibromyalgia according to the 2016 Revisions of the 2010/2011Fibromyalgia Provisional Criteria of the American College of Rheumatology. Forty-three patients were included in the study. Twenty-eight (65.12%) patients had a type I reactional state, only 1 (2.33%) had an isolated type II reactional state, and 5 (11.63%) had both type I and type II reactional states. Only 2 patients who suffered from cooccurring type I and II reactional states obtained sufficient scores for the diagnosis of fibromyalgia. Although diffuse pain was common in leprosy patients, none of the types of reactional states were associated with a higher frequency of criteria for fibromyalgia. We can conclude that a leprosy reactional state is probably not a risk factor for fibromyalgia but can act as a confounder, as tender points may be similar in both diagnoses. In patients diagnosed with fibromyalgia, leprosy must be considered in the differential diagnosis in endemic regions

    The challenge of concomitant infections in the coronavirus disease 2019 pandemic era : severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy

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    Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines

    The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19 : a prospective realworld cohort study

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    Background Protective effects of Bacillus Calmette–Gue´rin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. Methodology/Principal findings We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93– 13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04–4.06) were significant risk factors for COVID-19. Conclusions/Significance Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19

    Enhanced il-6 and il-12b gene expression after SARS-CoV-2 infection in leprosy patients may increase the risk of neural damage

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    Experts have called attention to the possible negative impact of the coronavirus disease 2019 (COVID19)–related cytokine storm syndrome on the progression of leprosy-related disabilities. We assessed the frequency of reactional states in patients co-infected with Mycobacterium leprae and severe acute respiratory syndrome (SARS) coronavirus (CoV) 2 (SARS-CoV-2). We consecutively included patients during the first peak of the COVID-19 epidemic in Brazil and analyzed the expressions of genes encoding interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12A, IL-12B, and tumor necrosis factor-α in peripheral blood mononuclear cells. We included 64 leprosy patients and 50 controls. Twelve of the leprosy patients and 14 of the controls had been diagnosed with COVID-19. Co-infection was associated with increased IL-6 (P = 0.043) and IL-12B (P = 0.017) expression. The median disability grades were higher for leprosy/COVID-19 patients; however, the difference was not significant (P = 0.194). Patients co-infected with M. leprae and SARS-CoV-2 may experience a higher-grade proinflammatory state

    SARS-CoV-2/DENV co-infection : a series of cases from the Federal District, Midwestern Brazil

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    Background: Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods: Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results: Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions: The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic area
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