Episódios reacionais na hanseníase

Episódios reacionais são quadros agudos, que ocorrem de modo súbito, interrompendo a evolução crônica da hanseníase. Constituem, geralmente, em exacerbada reação inflamatória, localizada ou sistêmica, que pode ser acompanhada de comprometimento de nervos periféricos, resultando em manifestação de dor acentuada, que requer, para sua condução, cuidados especiais. Existem dois tipos de reações hansênicas: Reação tipo1 ou Reação Reversa (RR) e Reação tipo 2 ou Eritema Nodoso Hansênico (ENH). Essas reações foram descritas, segundo suas características clínicas e laboratoriais, sendo destacados os critérios de diagnóstico e as principais diferenças entre RR e ENL, e, ainda, seguidas da apresentação das condutas preconizadas para a condução das alterações clínicas e da opção terapêutica para os dois tipos de reações.Reactional episodes are acute inflammatory reactions that suddenly appear on the chronic evolution of the leprosy disease. Currently these reactions represent a located or systemic exacerbation of the inflammatory reaction that can reach peripheral nerves, inducing a very painful situation which must be conducted with special care. The leprosy reactions are classified as Type1 Reaction or Reversal Reaction (RR) and Type2 Reaction or Erythema Nodosum Leprosum (ENL). The clinical and laboratories characteristics of these reactions, the diagnostic criteria and the main differences between the RR and ENL were presented, followed by the presentation of the approval conducts for the management of clinical alterations and the therapeutics ons for the two types of leprosy reactions

Immunological aspects of leprosy

The clinical spectrum of leprosy has been associated with immunological alterations induced by the parasite M.leprae on the host. It was observed that lepromatous leprosy present a depressed cellular immune response associated with elevated production of suppressor cytokines (IL-4 and TGF b) and reduced levels of cytokines related with the induction of the immune response (IL-1,TNFa and IFNg). Furthemore, all these alterations are associated with depressed production of intracellular oxidative elements responsible for the parasite destruction, the reactives of oxigen and nitrogen, the latter evaluated by the enzyme induced NO synthase (iNOS). On the other hand, in tuberculoid leprosy, high levels of inflammatory cytokines and absence of suppressor cytokines have been described.A distribuição espectral das formas clínicas da hanseníase tem sido associada a alterações imunológicas do hospedeiro, frente ao M. leprae . Foi verificado que, no pólo de maior suscetibilidade, hanseníase virchoviana, apresenta depressão da resposta imune celular, associada ao aumento da produção de citocinas supressoras (IL-4 e TGF b) e redução dos níveis de citocinas ativadoras da resposta imune (TNFa, IL-1 e IFNg). Há, ainda, menor produção de elementos responsáveis pela oxidação intracelular, como intermediários do nitrogênio (RNI), avaliada pela expressão da enzima NO sintase induzida (iNOS). Por outro lado, no pólo de resistência, hanseníase tuberculóide, não foram detectadas as citocinas supressoras, em contraste com elevadas concentrações de TNFa e IL-1, citocinas indutoras da reação inflamatória

Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries

Leprosy is an ancient disease that remains endemic and continues to be a major public health problem in some tropical countries, where it has been internationally recognized as being linked to the underdevelopment conditions. The natural course of the disease covers a wide variety of clinical conditions with systemic involvement. In this paper, we review the findings obtained in studies of the pathological mechanisms of leprosy, including a survey of the literature and of our own work. The understanding and control of the wide variety of clinical conditions should help improve patient care and thus prevent the onset of physical impairment and the stigma of the disease.CNPqCNPqFAEPA/FMRP-USPFAEPA/FMRPUSPFPCHFPC

Critérios brasileiros de elegibilidade à doação de sangue para pacientes dermatológicos

A focused and commented review on the impact of dermatologic diseases and interventions in the solidary act of donating blood is presented to dermatologists to better advise their patients. This is a review of current Brazilian technical regulations on hemotherapeutic procedures as determined by Ministerial Directive #1353/2011 by the Ministry of Health and current internal regulations of the Hemotherapy Center of Ribeirão Preto, a regional reference center in hemotherapeutic procedures. Criteria for permanent inaptitude: autoimmune diseases (>1 organ involved), personal history of cancer other than basal cell carcinoma, severe atopic dermatitis or psoriasis, pemphigus foliaceus, porphyrias, filariasis, leprosy, extra pulmonary tuberculosis or paracoccidioidomycosis, and previous use of etretinate. Drugs that impose temporary ineligibility: other systemic retinoids, systemic corticosteroids, 5-alpha-reductase inhibitors, vaccines, methotrexate, beta-blockers, minoxidil, anti-epileptic, and anti-psychotic drugs. Other conditions that impose temporary ineligibility: occupational accident with biologic material, piercing, tattoo, sexually transmitted diseases, herpes, and bacterial infections, among others. Discussion: Thalidomide is currently missing in the teratogenic drugs list. Although finasteride was previously considered a drug that imposed permanent inaptitude, according to its short halflife current restriction of 1 month is still too long. Dermatologists should be able to advise their patients about proper timing to donate blood, and discuss the impact of drug withdrawal on treatment outcomes and to respect the designated washout periods

Episódios reacionais da hanseníase podem ser exacerbados por infecções orais?

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.(CNPq) National Council for Scientific and Technological DevelopmentSão Paulo State Foundation against Leprosy(FAEPA) USP - Teaching, Research and Assistance Support Foundation of HCFMR

Leprosy-specific oral lesions : a report of three cases

Leprosy is a chronic infection caused by Mycobacterium leprae, a bacillus that presents a peculiar tropism for the skin and peripheral nerves. The clinical spectrum of leprosy ranges from the tuberculoid form (TT) to the disseminative and progressive lepromatous form (LL). Oral lesions are rare but, when present, occur in the lepromatous form. This article describes the clinical and microscopic findings of three cases of LL with oral manifestations. All patients had the lepromatous form and their leprosy-specific oral lesions occurred in the palate. The diagnosis was based on clinical, serological and histopathological findings, and multidrug therapy for multibacillary leprosy was started and continued for 24 months. All patients completed treatment, but developed reaction episodes which were treated with prednisone and/or thalidomide. The authors emphasize the importance of oral mucosa evaluation by a dental health professional during patient care since oral lesions may act as a source of infection

Oral treatment with Hev b 13 prevents experimental arthritis in mice

Hev b 13 is an allergenic esterase obtained from the rubber tree Hevea brasiliensis, which has been shown recently to induce human monocytes to release interleukin (IL)-10 in vitro, and to exert a potent anti-inflammatory effect in vivo. Moreover, Hev b 13 has been shown to reduce clinical signs of inflammation and also histological damage to the distal colon of mice with 2,4,6-trinitrobenze sulphonic acid (TNBS)-induced colitis after its oral administration. The aim of this study was to investigate the effect of Hev b 13 on human mononuclear cells, as well as its therapeutic use in the methylated bovine serum albumin (mBSA) model of antigen-induced arthritis. Five days before the intra-articular challenge, and daily thereafter for 8 days, Hev b 13 was administered by oral gavage. In mice treated with a dose of 0.5 mg/kg of Hev b 13, the severity of oedema, leucocyte infiltration, pannus formation and cartilage erosion were reduced significantly. These findings underscore the anti-inflammatory activity suggested previously for Hev b 13, an activity speculated to be related to its interaction with monocytes/macrophages and the consequent stimulation of IL-10 release and reduction of tumour necrosis factor (TNF) release. The study also opens a wide range of possible applications in the field of immune-mediated inflammatory diseases.FAEPA (Foundation for the Support of Instruction, Research and Treatment)FINEP through Pele Nova Biotecnologia S/ACAPES (Coordination for the Improvement of Higher Education Personnel