Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Leprosy is a serious infectious disease whose treatment still poses some challenges. Patients are usually treated with a combination of antimicrobial drugs called multidrug therapy. Although this treatment is effective against Mycobacterium leprae, the bacillus that causes leprosy, patients may develop severe inflammatory reactions during treatment. These reactions may be either attributed to an improvement in the immunological reactivity of the patient along with the treatment, or to relapse of the disease due to the proliferation of remaining bacilli. In certain patients these two conditions may be difficult to differentiate. The present study addresses the histopathology picture of and the M. leprae bacilli in sequential biopsies taken from lesions of patients who presented such reactions aiming to improve the differentiation of the two conditions. This is important because these reactions are one of the major causes of the disabilities of the patients with leprosy, and should be treated early and appropriately. Our results show that the histopathology picture alone is not sufficient, and that bacilli's counting is necessary

Clinical oxidative stress during leprosy multidrug therapy:impact of dapsone oxidation

This study aims to assess the oxidative stress in leprosy patients under multidrug therapy (MDT; dapsone, clofazimine and rifampicin), evaluating the nitric oxide (NO) concentration, catalase (CAT) and superoxide dismutase (SOD) activities, glutathione (GSH) levels, total antioxidant capacity, lipid peroxidation, and methemoglobin formation. For this, we analyzed 23 leprosy patients and 20 healthy individuals from the Amazon region, Brazil, aged between 20 and 45 years. Blood sampling enabled the evaluation of leprosy patients prior to starting multidrug therapy (called MDT 0) and until the third month of multidrug therapy (MDT 3). With regard to dapsone (DDS) plasma levels, we showed that there was no statistical difference in drug plasma levels between multibacillary (0.518±0.029 μg/mL) and paucibacillary (0.662±0.123 μg/mL) patients. The methemoglobin levels and numbers of Heinz bodies were significantly enhanced after the third MDTsupervised dose, but this treatment did not significantly change the lipid peroxidation and NO levels in these leprosy patients. In addition, CAT activity was significantly reduced in MDT-treated leprosy patients, while GSH content was increased in these patients. However, SOD and Trolox equivalent antioxidant capacity levels were similar in patients with and without treatment. These data suggest that MDT can reduce the activity of some antioxidant enzyme and influence ROS accumulation, which may induce hematological changes, such as methemoglobinemia in patients with leprosy. We also explored some redox mechanisms associated with DDS and its main oxidative metabolite DDS-NHOH and we explored the possible binding of DDS to the active site of CYP2C19 with the aid of molecular modeling software

Growth of BiVO4 particles in cellulosic fibres by in situ reaction

Cellulosic fibres were used to obtain well-defined BiVO4 particles using a simple controlled precipitation method; microscopy analysis suggests that the BiVO4 particles grow from nucleation sites located in the cell wall structure and inside the lumen of fibres

Reação reversa atípica em paciente com hanseníase dimorfa co-infectado pelo HIV Atypical reversal reaction in a borderline leprosy patient co-infected with HIV

A infecção pelo HIV não altera a história natural da hanseníase. Observa-se maior incidência de estados reacionais nos pacientes co-infectados, além de casos mais graves de neurite. Paciente soropositiva com hanseníase dimorfa tuberculóide manifestou reação reversa exuberante. Lesões cutâneas atípicas e raras surgiram após a introdução da terapia anti-retroviral que promoveu o início da recuperação imunológica com aumento de linfócitos T CD4+ e queda da carga viral. A restauração da imunidade celular nos pacientes soropositivos pode precipitar reações reversas, descritas recentemente como uma das manifestações da síndrome inflamatória de reconstituição imunológica associada à hanseníase.<br>HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy

Vivência da puérpera-adolescente no cuidado do recém-nascido, no domicílio La vivencia de la adolescente durante el puerperio con relación al cuidado del recién nacido en casa The adolescent puerpera's experience of taking care of the newborn at home

Este estudo qualitativo teve o objetivo de compreender como as puérperas-adolescentes vivenciam o cuidado do filho no âmbito domiciliar. Como referencial de análise, empregou-se o conceito de Maternidade e, no tratamento dos dados, utilizou-se o método do Discurso do Sujeito Coletivo. Participaram do estudo 15 puérperas-adolescentes que ficaram internadas com o recém-nascido na unidade de Alojamento-Conjunto do Hospital Universitário da USP, e que foram entrevistadas após a alta hospitalar. Os resultados evidenciaram a construção diária do ser-mãe-adolescente que direciona o sentimento de segurança diante da superação das dificuldades ao cuidar do recém-nascido. A rede de apoio familiar mostrou-se importante para ajudar a jovem mãe nesta nova fase de sua vida. Ao final do puerpério foi possível constatar que a puérpera-adolescente atende, com competência, as necessidades de higiene, alimentação e afeto do recém-nascido.<br>Estudio cualitativo que tuvo por objetivo comprender como las adolescentes en el puerperio pasan por la vivencia de cuidar de su hijo en casa. Como fundamento de análisis se empleó el concepto de Maternidad, para el análisis de los datos fue utilizado el método del Discurso del Sujeto Colectivo. Participaron del estudio 15 adolescentes y sus recién nacidos hospitalizados durante el puerperio en el servicio de Alojamiento Conjunto del Hospital Universitario de la Universidad São Paulo, entrevistas realizadas posterior al alta. Los resultados mostraron que la construcción diaria de ser madre-adolescente orienta el sentimiento de seguridad frente a la superación de dificultades cuando se cuida del recién nacido. La red de apoyo familiar fue importante para ayudar a la joven madre en esta nueva etapa de su vida. Al final del puerperio se observó que esta adolescente cuida del recién nacido en cuanto a sus necesidades de higiene, alimentación y afecto competentemente.<br>This qualitative study aimed to understand how the adolescent puerperae experience caring for their child at home. The Maternity concept was used as the reference for the analysis and the method based on the Collective Subject Speech was used to analyse the data. Fifteen adolescent puerperae participated in the study. They were all in the rooming-in of the USP University Hospital with their child. The interviews were performed after the adolescent mothers were discharged from the hospital. The results showed an everyday building process concerning the role of being an adolescent mother, which leads to a feeling of security in view of the difficulties related to caring for the newborn. Family support was considered important to help the young mother during this new phase of her life. In the end of the puerperium, it was possible to realize that the adolescent puerperae was able to meet the newborn's needs concerning hygiene, feeding, and affection