RESUMO
We evaluated the incidence, severity, and duration of reactional states in 139 multibacillary (MB) leprosy patients in the first 2 years after the completion of the 1 year regimen of multidrug therapy (MDT) currently recommended by the World Health Organization (WHO) and compared those findings with 295 MB leprosy patients treated with the same regimen previously recommended for 2 years. During the first year after the completion of 1 year MDT, patients experienced 1 or more reactional states 27% of the time, the vast majority being lepra type 1 reactions (reversal reactions, RR), whereas patients who received 2 year MDT experienced a reactional state during that time period only 8% of the time (P < 0.001). Furthermore, during the first year after the completion of therapy, and during the first 2 years, both the number of reactional states and reversal reactions were significantly (P < or = 0.004) more frequent, severe, of longer duration, and more commonly associated with neuritis.
Assuntos
Masculino , Adulto Jovem , Adolescente , Adulto , Estudos de Coortes , Hansenostáticos , Hanseníase , Quimioterapia CombinadaRESUMO
Some mycobacterial infections, such as tuberculosis, are characterized by apoptosis in infected or by-stander mononuclear immune cells. For localized (paucibacillary, PB) and diseminated (multibacillary, MB) leprosy, characterized by polarized Thl-like vs, Th2-like immune responses, respectivelly little is known about lesional apoptosis. We analyzed sections of paraffin-embedded, untreated leprosy lesions from 21 patients by an indirect immunofluorescent terminal deoxynucleotide-transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. Some TUNEL (+) PB sections were then reacted with phycoerythein-conjugated (red)antibodies against T cells, monocytes, or antigen-presenting (Langerhans) cells. TUNEL (+) bodies were detected in 9 of 16 PB lesions (56%) and in 1 of 5 MB lesions (20%). Some TUNELL (+) bodies in PB disease were CD3+ (T cell), as well as CD4+ (T-helper) or cd8+ (T-cytotoxic) Apoptosis characterizes PB and MB leprosy lesions and may be more freqeunt in PB disease. In PB disease, some TUNEL (+) bodies may derive from T cells
Assuntos
Humanos , Hanseníase Dimorfa/imunologia , Hanseníase Dimorfa/patologia , Hanseníase Tuberculoide/imunologia , Hanseníase Tuberculoide/patologia , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/patologia , Hanseníase/imunologia , Hanseníase/patologia , Imuno-Histoquímica , Mycobacterium leprae/patogenicidade , Apoptose/fisiologia , Apoptose/imunologia , Biópsia , Imuno-Histoquímica/normasAssuntos
Amoxicilina/uso terapêutico , Anti-Infecciosos/uso terapêutico , Clofazimina/uso terapêutico , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Hanseníase Virchowiana/tratamento farmacológico , Mycobacterium leprae , Mycobacterium leprae/isolamento & purificação , Ofloxacino/uso terapêutico , Pele , Pele/patologia , Quimioterapia Combinada , Resultado do Tratamento , Ácidos Clavulânicos/uso terapêuticoRESUMO
At a time when primary dapsone resistance was prevalent in many leprosy endemic areas, Cebu in The Philippines reported only 3.6% in the period 1975-1978 and later 8.1% in the period 1979-1982. In our current study of patients in the period 1988-1992, the number increased dramatically to 52.7%. In addition, 7.9% of the isolates are highly resistant to dapsone, a level of resistance not seen in earlier studies. This finding could have severe ramifications to the World Health Organization's multidrug therapy (WHO-MDT) mode of treatment, where dapsone is one of the principal drugs. Moreover, the increase in primary dapsone resistance may be a contributing factor in the recent finding that there has been no decline in the number of new cases found in Cebu, even after the implementation of WHO-MDT in 1985. There is a need for new drugs that could be included in the multidrug treatment for multibacillary and paucibacillary leprosy.
Assuntos
Humanos , Dapsona/farmacologia , Hanseníase/epidemiologia , Hanseníase/tratamento farmacológicoRESUMO
Twelve patients were treated with three dose levels of minocycline for 30 days, primarily to detect the dose-related effects on Mycobacterium leprae viability, followed by another 5 months of daily minocycline for overall efficacy and persistence of clinical and antibacterial effects. Subsequently, the patients were given standard WHO/MDT chemotherapy for multibacillary leprosy. Clinical improvement was recognizable during the first month, occurring much earlier among those on minocycline 200 mg daily than those who received minocycline 100 mg daily. A similar change also was observed in one patient 11 days after three daily doses of 100 mg of minocycline. At the end of 6 months, all patients were clinically improved with a slight reduction in the average bacterial index (BI) and logarithmic index of bacilli in biopsy (LIB). The effects of minocycline on viability by mouse foot pad inoculation and palmitic acid oxidation assays were noted beginning at 10 to 14 days of daily dosing and becoming more definite after 30 days of treatment. Both tests correlated fairly well. Doses of 200 mg daily did not appear to be more efficient than minocycline 100 daily. Phenolic glycolipid-I (PGL-I) antigen determinations done on some patients during the first month remained positive and did not correlate with changes in viability results. At the end of 6 months, after 5 months of 100 mg of minocycline monotherapy, no viable organisms could be demonstrated by mouse foot pad inoculation and palmitic acid oxidation assays; assays for PGL-I antigen were all negative