Erythema nodosum leprosum case series report: clinical profile, immunological basis and treatment implemented in health services

O eritema nodoso hansênico é evento inflamatório agudo no curso crônico da hanseníase. É considerado evento de base imunológica e importante causa de morbidade e incapacidade física. Avaliou-se o perfil clínico, sorológico e histopatológico de 58 pacientes com eritema nodoso hansênico recrutados sequencialmente entre julho-dezembro de 2000, em área urbana hiperendêmica do Brasil Central (Estado de Goiás). A metade dos pacientes apresentava quadro reacional grave, e em 66% dos casos o primeiro episódio reacional ocorreu durante tratamento específico. A maioria dos casos com eritema nodoso hansênico e dos controles apresentaram reatividade para IgM anti-PGL I. Os achados histopatológicos mais freqüentes no eritema nodoso hansênico foram infiltrado neutrofílico, paniculite, vasculite e agressão neural. Dos pacientes com eritema nodoso hansênico, 96% usaram corticosteróide sistêmico no primeiro episódio. Os casos de eritema nodoso hansênico estavam associados à neurite e raramente usaram talidomida como medicação isolada nos serviços de saúde.Erythema nodosum leprosum is an acute inflammatory event in the chronic course of leprosy. It is considered an immunological disorder and an important cause of morbidity and disability. We evaluate the clinical profile, serology and histhopathology 58 erythema nodosum leprosum patients sequentially recruited, from July- December 2000, in an endemic area in Central Brazil (Goiás State). Half of the reactins were considered severe and 66% of the cases had the first episode of reaction during specific treatment. The majority of patients and controls were positive to anti-PGL-I IgM. The more frequent histopathological findings in erythema nodosum leprosum were presence of intracellular acid-fast bacilli, perivascular/peradnexial mononuclear inflammatory infiltrate, and neural aggression. Ninity six percent of the patients were treated with systemic steroid in the first episode. The results point out to the association between ENL and neuritis and the rare adoption of thalidomide as a solely medication in the health services

Characterization of HIV-1 CRF90_BF1 and putative novel CRFs_BF1 in Central West, North and Northeast Brazilian regions

<div><p>The Brazilian AIDS epidemic has been characterized by an increasing rate of BF1 recombinants and so far eight circulating recombinant forms/CRFs_BF1 have been described countrywide. In this study, <i>pol</i> sequences (protease/PR, reverse transcriptase/RT) of 87 BF1 mosaic isolates identified among 828 patients living in six Brazilian States from three geographic regions (Central West, North, Northeast) were analyzed. Phylogenetic and bootscan analyses were performed to investigate the evolutionary relationship and mosaic structure of BF1 isolates. Those analyses showed that 20.7% of mosaics (18 out of 87) were CRFs-like isolates, mostly represented by CRF28/CRF29_BF-like viruses (14 out of 18). We also identified five highly supported clusters that together comprise 42 out of 87 (48.3%) BF1 sequences, each cluster containing at least five sequences sharing a similar mosaic structure, suggesting possible new unidentified CRFs_BF1. The divergence time of these five potential new CRFs_BF1 clusters was estimated using a Bayesian approach and indicate that they probably originated between the middle 1980s and the middle 1990s. DNA was extracted from whole blood and four overlapping fragments were amplified by PCR providing full/near full length genomes (FLG/NFLG) and partial genomes. Eleven HIV-1 isolates from Cluster # 5 identified in epidemiologically unlinked individuals living in Central West and North regions provided FLG/NFLG/partial genome sequences with identical mosaic structure. These viruses differ from any known CRF_BF1 reported to date and were named CRF90_BF1 by the Los Alamos National Laboratory. This is the 9^th CRF_BF1 described in Brazil and the first one identified in Central West and North regions. Our results highlight the importance of continued molecular screening and surveillance studies, especially of full genome sequences to understand the evolutionary dynamics of the HIV-1 epidemic in a country of continental dimensions as Brazil.</p></div

Phylogenetic tree of study BF1 isolates from Central West, North, Northeast and South Brazil and BF1 sequences from GenBank sharing over 95% similarity with study isolates.

<p>Trees were constructed using MEGA software, 6.0 version under neighbor-joining and Kimura 2 parameters methods (Bootstrap value over 70%). The sequences described in our study are distinguished from the sequences retrieved from the GenBank by a diamond signal. The five clusters identified in our study are indicated by different colors: Cluster # 1: purple, Cluster # 2: blue, Cluster # 3: pink, Cluster # 4: green and Cluster # 5: red.</p