Hanseniase neural primaria: revisao sistematica

The authors proposed a systematic review on the current concepts of primary neural leprosy by consulting the following online databases: MEDLINE, Lilacs/SciELO, and Embase. Selected studies were classified based on the degree of recommendation and levels of scientific evidence according to the “Oxford Centre for Evidence-based Medicine”. The following aspects were reviewed: cutaneous clinical and laboratorial investigations, i.e. skin clinical exam, smears, and biopsy, and Mitsuda's reaction; neurological investigation (anamnesis, electromyography and nerve biopsy); serological investigation and molecular testing, i.e. serological testing for the detection of the phenolic glycolipid 1 (PGL-I) and the polymerase chain reaction (PCR); and treatment (classification criteria for the definition of specific treatment, steroid treatment, and cure criteria).Os autores propuseram-se a realizar uma revisão sistemática em conceitos atuais sobre a hanseníase neural primária, consultando as seguintes bases bibliográficas on-line: MEDLINE, Lilacs/SciELO e Embase. Os estudos selecionados foram classificados conforme o grau de recomendação e o nível de evidência científica de acordo com o “Oxford Centre for Evidence-based Medicine”. Os seguintes temas foram revisados: investigações clínica e laboratorial cutâneas, ou seja, exame, esfregaço e biópsia de pele e reação de Mitsuda; investigação neurológica (anamnese, eletroneuromiografia e biópsia de nervo); investigação sorológica e testes moleculares, ou seja, testes sorológicos para detecção de um glicolipídio fenólico e reação de cadeia de polimerase (PCR) e tratamento (critérios de classificação para definição de tratamento específico, tratamento com esteroides e critérios de cura).Secretaria de Estado de Saude Instituto Lauro de Souza LimaUniversidade de São Paulo (USP) School of Medicine of Ribeirao Preto Department of NeurosciencesUSP Department of Neurology and NeurosurgeryFundacao Oswaldo CruzUniversidade Federal de São Paulo (UNIFESP) Department of DermatologySecretaria de Estado de Saude Instituto de SaudeConselho Federal de Medicina Associacao Medica Brasileira Projeto DiretrizesUNIFESP, Department of DermatologySciEL

Retrospective study of the morbidity associated with Erythema Nodosum Leprosum in Brazilian leprosy patients

Introduction: Leprosy patients may develop immune-mediated inflammatory reactions, which are the main cause of nerve function impairment and disability. Among them, Erythema Nodosum Leprosum (ENL) is a potentially life-threatening systemic condition. There are few data on ENL-associated morbidity and mortality, and the need of hospitalisation due to its complications. Material and methods: We conducted a retrospective cohort study including patients diagnosed at the Souza Araújo Outpatient Clinic, Rio de Janeiro. All patients had a first ENL episode at the clinic or were admitted to the Evandro Chagas Hospital, between 2005–2010. In 2014, we obtained the required data from the patients’ files to describe ENL morbidity and mortality, including treatment-related adverse events. Results: A total of 112 patients (72% male, median age at diagnosis 35 years, 83% had lepromatous leprosy) developed ENL, among the 676 patients diagnosed with leprosy during the study period. Most of the episodes were chronic and severe. Patients were treated with thalidomide and corticosteroids. Half of the patients receiving corticosteroids had adverse events. 14 patients were hospitalised, ten due to ENL complications. Six patients died, four during the ENL episode. None of these deaths could be considered directly caused by ENL or its treatment.Conclusion: In the group of patients studied, although a high morbidity due to the reaction itself and to the adverse effects of its prolonged treatment was observed, mortality due to ENL was not registered. Prospective studies are required in order to recognise leprosy complications, such as ENL, as consequential causes of death

Development and validation of a severity scale for leprosy Type 1 Reactions

Objectives: To develop a valid and reliable quantitative measure of leprosy Type 1 reactions.Methods: A scale was developed from previous scales which had not been validated. The face and content validity were assessed following consultation with recognised experts in the field. The construct validity was determined by applying the scale to patients in Bangladesh and Brazil who had been diagnosed with leprosy Type 1 reaction. An expert categorized each patient's reaction as mild or moderate or severe. Another worker applied the scale. This was done independently. In a subsequent stage of the study the agreement between two observers was assessed.Results: The scale had good internal consistency demonstrated by a Cronbach's alpha &gt;0.8. Removal of three items from the original scale resulted in better discrimination between disease severity categories. Cut off points for Type 1 reaction severities were determined using Receiver Operating Characteristic curves. A mild Type 1 reaction is characterized using the final scale by a score of 4 or less. A moderate reaction is a score of between 4.5 and 8.5. A severe reaction is a score of 9 or more.Conclusions: We have developed a valid and reliable tool for quantifying leprosy Type 1 reaction severity and believe this will be a useful tool in research of this condition, in observational and intervention studies, and in the comparison of clinical and laboratory parameters.<br/

Secondary Syphilis Mimicking Leprosy Type1 Reaction

Submitted by sandra infurna ([email protected]) on 2015-11-03T15:01:43Z No. of bitstreams: 1 cassio_ferreira2_etal_IOC_2015.pdf: 382622 bytes, checksum: 5f12ad6f298548375e0961fc0dfabffa (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2015-11-03T15:02:02Z (GMT) No. of bitstreams: 1 cassio_ferreira2_etal_IOC_2015.pdf: 382622 bytes, checksum: 5f12ad6f298548375e0961fc0dfabffa (MD5)Made available in DSpace on 2015-11-03T15:17:26Z (GMT). No. of bitstreams: 1 cassio_ferreira2_etal_IOC_2015.pdf: 382622 bytes, checksum: 5f12ad6f298548375e0961fc0dfabffa (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.s. af.s. af.Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Syphilis and leprosy have cutaneous manifestations with great lesional polymorphism with subsequent difficult differential diagnosis. Both have additional tests that, in certain situations, are inconclusive, making it difficult to confirm the clinical diagnosis. In medical literature there are several clinical cases reported in which patients with syphilis were erroneously diagnosed and treated as having leprosy. Physicians need to maintain a high index of suspicion for the diagnosis of syphilis

The impact of Erythema Nodosum Leprosum on health related quality of life in Rio de Janeiro

Objectives: Erythema nodosum leprosum (ENL - leprosy Type 2 reaction) is a severe immune-inflammatory complication of leprosy that frequently affects patients at any stage of the disease, even after release from multidrug therapy (MDT). Its effect on the patient's health related quality of life (HRQoL) was evaluated with the SF-36 in a group of 59 multibacillary patients at the Fiocruz leprosy outpatient clinic in Rio de Janeiro. Results: A total of 40 patients with ENL or a history of ENL, 19 patients with neuritis, Type 1 reaction or no reaction, of which six patients had never experienced reactions were recruited. Patients with acute ENL episode had significantly lower scores than patients with recurrent episodes in the mental health (P = 0·036) and the role physical (P = 0·03) domains. Patients with active ENL (new or on treatment) had the lowest scores on all domains of both physical and mental health components. They were significantly more affected in the bodily pain (P < 0·01), physical functioning (P = 0·037) and general health (P = 0·04) domains than patients with no reaction at the time of interview. In general, ENL patients have reduced quality of life, especially in the physical health component. Conclusion: Larger studies of HRQoL of people affected by leprosy are needed to give a more detailed picture of the impact of ENL. It is clear that leprosy, its complications and sequela affect HRQoL which should be routinely evaluated in the assessment of patients to improve care

Pure neural leprosy: steroids prevent neuropathy progression Corticosteróides previnem a neuropatia na hanseníase

Multidrug therapy (MDT), with rifampicin, dapsone, and clofazimine, treats leprosy infection but is insufficient in arresting or preventing the nerve damage that causes impairments and disabilities. This case-series study evaluates the benefits of the combined use of steroids and MDT in preventing nerve damage in patients with pure neural leprosy (PNL). In addition to MDT, 24 patients (88% male aged 20-79 years, median=41) received a daily morning dose of 60 mg prednisone (PDN) that was gradually reduced by 10 mg during each of the following 5 months. PNL was clinically diagnosed and confirmed by nerve histopathology or PCR. A low prevalence (8.3%) of reaction was observed after release from treatment. However, most of the clinical parameters showed significant improvement; and a reduction of nerve conduction block was observed in 42% of the patients. The administration of full-dose PDN improved the clinical and electrophysiological condition of the PNL patients, contributing to the prevention of further neurological damage.<br>A poliquimioterapia (PQT), com rifampicina, dapsona, e clofazimina, trata a infecção na hanseníase, mas é insuficiente para interromper ou prevenir o comprometimento neurológico que causa as incapacidades e desabilidades, nesta enfermidade. Este estudo de série de casos avalia o benefício do uso combinado de prednisona e PQT na prevenção do dano neurológico em pacientes com a forma neural pura da hanseníase (FNP). Além do PQT, 24 pacientes (88% homens, com idade variando entre 20-79, mediana=41) receberam uma dose diária de 60 mg prednisona que foi reduzida gradualmente na dose de 10 mg durante cada um dos 5 meses subseqüentes. FNP foi diagnosticada clinicamente e confirmada através do estudo histopatológico ou PCR. Baixa prevalência de reação (8,3%) foi observada apenas após o final do tratamento. A maioria dos parâmetros clínicos mostrou melhora significativa e redução do bloqueio de condução foi observada em 42% dos pacientes. A administração de doses altas de prednisona melhora a evolução clínica e eletrofisiológica de pacientes com a FNP de hanseníase, contribuindo na prevenção de novos comprometimentos neurológicos

Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy

A type 1 reaction or reversal reaction is expressed clinically by inflammatory exacerbation of the skin lesions and nerve trunks, consequently leading to sensory and motor alterations. It occurs in non-polar forms of leprosy, although it can occur in a small percentage of sub-polar LL treated patients. Disabilities, deformities and morbidity, still present in leprosy, are mainly caused by these acute episodes. The recognition of reactional states is imperative for an early approach and efficient management, to avoid the emergence of disabilities that stigmatize the disease. This review aims to describe the clinical aspects, immunopathogenesis, epidemiology, histopathological features and therapeutics of type 1 reactions

Distinct patterns of microvasculature in the cutaneous lesions of leprosy

Submitted by Gentil Jeorgina ([email protected]) on 2012-11-26T15:20:30Z No. of bitstreams: 1 Distinct Patterns of Microvasculature in theCutaneous Lesions of Leprosy'.pdf: 9601548 bytes, checksum: 900cc8e99fca8d6adf61d54fcb63005e (MD5)Made available in DSpace on 2012-11-26T15:20:30Z (GMT). No. of bitstreams: 1 Distinct Patterns of Microvasculature in theCutaneous Lesions of Leprosy'.pdf: 9601548 bytes, checksum: 900cc8e99fca8d6adf61d54fcb63005e (MD5) Previous issue date: 2000Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Medicina Tropical. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil/ Universidade de Nova Iguaçu. Nova Iguaçu, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Patologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Patologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Medicina Tropical. Laboratório de Hanseníase. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Medicina Tropical. Laboratório de Hanseníase. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Medicina Tropical. Laboratório de Hanseníase. Rio de Janeiro, RJ, BrasilThis work is an investigation on the microvasculature of the cutaneous infiltrates of leprosy with the immunohistochemical staining of endothelial cells in cutaneous biopsies. Anti-Factor VIII-related antigen antibody (anti-FVIII-ra) and Ulex Europaeus-1 lectin (UEA-1) binding were utilized as endothelial cell markers. Thirty-nine patients grouped according to the Ridley-Jopling classification (14 borderline tuberculoid, 18 borderline lepromatous, 6 lepromatous, and 1 indeterminate leprosy) were selected for this study. Two microvascular architectural patterns could be clearly distinguished: lepromatous lesions presented a dense and tortuous mesh of microvessels among the Mycobacterium leprae-glutted macrophages; whereas the microvessels in the tuberculoid lesions were restricted to the periphery of the granulomas and were not seen among the central epithelioid cells. We were able to distinguish three basic morphological kinds of infiltrate distribution related to the microvessels: micronodules, cords and macronodules. Intensifications of the FVIII-ra immunoreactivity and UEA-1 binding capacity were observed in the endothelial cells of microvessels involved by the inflammatory infiltrate. A distinct cytokine expression profile at the leprosy poles and the role of mast cells in angiogenesis were speculated as factors contributing to these distinct patterns. Growth of the lesion and systemic dissemination of M. leprae in the bipolar spectrum of leprosy may hypothetically be influenced by the vascular-infiltrate relationship. The detection of angiogenesis in the cutaneous lesions of leprosy may bring about alternate and/or additional strategies for leprosy treatment