RESUMO
The parasite Leishmania siamensis is a zoonotic agent of leishmaniasis; infection in animals has been documented in Europe and the United States. Reported authochthonous human infections have been limited to Thailand. We report a case of human visceral Leishmania siamensis infection acquired in Guyana, suggesting colonization in South America.
Assuntos
Leishmania/classificação , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/parasitologia , Idoso , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , DNA Intergênico/genética , DNA de Protozoário/genética , Feminino , Guiana/epidemiologia , Humanos , Leishmania/genética , Leishmaniose Visceral/tratamento farmacológico , Londres/epidemiologia , Polimorfismo de Fragmento de Restrição , ViagemAssuntos
Erradicação de Doenças/normas , Hanseníase/prevenção & controle , Brasil/epidemiologia , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Saúde Global , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/normas , Humanos , Índia/epidemiologia , Hanseníase/epidemiologia , Prevalência , Fatores de Tempo , Organização Mundial da Saúde/organização & administraçãoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/classificação , Síndrome Inflamatória da Reconstituição Imune/complicações , Hanseníase/complicações , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/imunologia , Hanseníase/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
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 >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.
Assuntos
Hanseníase/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh , Brasil , Criança , Feminino , Humanos , Hanseníase/fisiopatologia , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Sistema Nervoso/fisiopatologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Nervo Ulnar/fisiopatologiaRESUMO
Immune reconstitution inflammatory syndrome (IRIS) may occur in HIV-infected patients after starting highly active antiretroviral therapy (HAART). Since 2003, 19 cases were published as IRIS. Leprosy has been reported as an example of an IRIS, and it is important that this syndrome should be recognized in leprosy-endemic areas. The case definition of leprosy as IRIS is based on clinical presentation of leprosy, evidence of immune restoration and timing of onset. Case definition should include the following: (1) leprosy and/or leprosy type 1 reaction presenting within six months of starting HAART; (2) advanced HIV infection; (3) low CD4+ count before start HAART; (4) CD4+ count increasing after HAART has been started. Although pathogenic mechanisms are still unclear, it is likely that leprosy-associated IRIS will be increasingly reported in those countries endemic for both diseases and as access to HAART becomes more widely available.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Hanseníase/induzido quimicamente , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Contagem de Linfócito CD4 , Humanos , Hanseníase/imunologiaRESUMO
Leprosy reactions are a major cause of nerve damage and morbidity in a significant proportion of leprosy patients. Reactions are immunologically mediated and can occur even after successful completion of multi-drug therapy. This review focuses on the epidemiology, pathology and treatment of leprosy type 1 reactions, erythema nodosum leprosum and silent neuropathy.
As reações hansênicas são a principal causa de dano e morbidade neural em grande parte dos pacientes hansênicos. São imunomediadas e podem ocorrer mesmo após o término bem sucedido da poliquimioterapia. Esta revisão enfoca a epidemiologia, a patologia e o tratamento das reações hansênicas do tipo 1, do eritema nodoso hansênico e da neuropatia silenciosa.
RESUMO
Can leprosy be eliminated? This paper considers the question against the background of the WHO programme to eliminate leprosy. In 1991 the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. Elimination was defined as reaching a prevalence of < 1 case per 10 000 people. The elimination programme has been successful in delivering highly effective antibiotic therapy worldwide. However, despite this advance, new-case detection rates remain stable in countries with the highest rates of endemic leprosy, such as Brazil and India. This suggests that infection has not been adequately controlled by antibiotics alone. Leprosy is perhaps more appropriately classed as a chronic stable disease than as an acute infectious disease responsive to elimination strategies. In many countries activities to control and treat leprosy are being integrated into the general health-care system. This reduces the stigma associated with leprosy. However, leprosy causes long-term immunological complications, disability and deformity. The health-care activities of treating and preventing disabilities need to be provided in an integrated setting. Detecting new cases and monitoring disability caused by leprosy will be a challenge. One solution is to implement long-term surveillance in selected countries with the highest rates of endemic disease so that an accurate estimate of the burden of leprosy can be determined. It is also critical that broad-based research into this challenging disease continues until the problems are truly solved.
Assuntos
Humanos , Controle de Doenças Transmissíveis , Desenvolvimento de Programas , Hansenostáticos , Hanseníase , Mycobacterium leprae , Organização Mundial da Saúde , Prestação Integrada de Cuidados de Saúde , Prevalência , Saúde Global , Vigilância da PopulaçãoRESUMO
To investigate genetic diversity in a bacterial population, we measured the copy numbers of simple sequence repeats, or microsatellites, in Mycobacterium leprae from patients living in and around Hyderabad, India. Three microsatellite loci containing trinucleotide or dinucleotide repeats were amplified from infected tissues, and the copy numbers were established by sequence analysis. Extensive diversity was observed in a cross-sectional survey of 33 patients, but closely related profiles were found for members of a multicase family likely to share a common transmission source. Sampling of multiple tissues from single individuals demonstrated identical microsatellite profiles in the skin, nasal cavity, and bloodstream but revealed differences at one or more loci for M. leprae present in nerves. Microsatellite mapping of M. leprae represents a useful tool for tracking short transmission chains. Comparison of skin and nerve lesions suggests that the evolution of disease within an individual involves the expansion of multiple distinct subpopulations of M. leprae.