RESUMO
BACKGROUND: Leprosy, or Hansen's disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. In 2000, the World Health Organization (WHO) defined the elimination of the disease as a global prevalence of less than one case per 10,000 population. However, disease transmission is an ongoing worldwide public health concern, as evidenced by the more than 220,000 new cases diagnosed each year. METHODS: This study is an update of the incidence and prevalence of leprosy in Puerto Rico for the period of 2000-2014. A retrospective analysis of data was obtained from the Tropical Disease Clinic (TDC) of the University of Puerto Rico School of Medicine. RESULTS: Sixty-three new cases of leprosy are detailed in this study. Disease incidence and prevalence were 1.65 and 5.26 per 100,000 inhabitants (of the island of Puerto Rico), respectively, and an average of 4.2 new cases per year. Most of the male patients in the study suffered from lepromatous leprosy (P = 0.026). In all, 47 (74.6%) patients had been born in Puerto Rico, and 29 (46%) had an affected family member or were in close contact with someone with leprosy. CONCLUSIONS: Compared to those of previous studies, these results demonstrate a decrease in both the incidence and prevalence of leprosy in Puerto Rico over the past 15 years. The relatively high prevalence of leprosy in Puerto Rico means that it remains endemic on the island. Concerted efforts must be undertaken to achieve the goal of the elimination of this old and stigmatized disease.
Assuntos
Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Hanseníase/diagnóstico , Hanseníase/transmissão , Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Eritema Nodoso/genética , /genética , Predisposição Genética para Doença/epidemiologia , Hanseníase Virchowiana/genética , Hanseníase Tuberculoide/genética , Brasil/epidemiologia , Estudos de Casos e Controles , /metabolismo , Eritema Nodoso/epidemiologia , Estudos de Associação Genética , Técnicas de Genotipagem , Haplótipos , Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/epidemiologia , Polimorfismo de Nucleotídeo Único/genética , Fatores SocioeconômicosRESUMO
Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.
Assuntos
Eritema Nodoso/genética , Genes erbB-2/genética , Predisposição Genética para Doença/epidemiologia , Hanseníase Virchowiana/genética , Hanseníase Tuberculoide/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Cromossomos Humanos Par 17/metabolismo , Eritema Nodoso/epidemiologia , Feminino , Estudos de Associação Genética , Técnicas de Genotipagem , Haplótipos , Humanos , Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/epidemiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Fatores Socioeconômicos , Adulto JovemRESUMO
Leprosy is an infectious disease with an average incubation period of two to five years. It is caused by Mycobacterium leprae, mainly affecting skin, mucous membranes and peripheral nerves. When it occurs in children under fifteen, it reflects an intense and long contact period, with a high bacillary load. Therefore, it is considered an important alert sign that points to the challenge of controlling the disease. The authors report three cases of leprosy in children under fifteen that occurred in the Itaguaí district, Rio de Janeiro. The epidemiologic implications of new cases detected at this age and the fundamental role of examining the patients' close contacts and the possible identification of source cases as an effort for leprosy control are discussed.
Assuntos
Hanseníase Tuberculoide/patologia , Brasil/epidemiologia , Criança , Família , Feminino , Humanos , Hanseníase Tuberculoide/epidemiologiaRESUMO
A hanseníase é uma doença infectocontagiosa, com período de incubação médio de dois a cinco anos, causada pelo Mycobacterium leprae, o qual possui tropismo para a pele, as mucosas e os nervos periféricos. Quando manifestada em crianças abaixo de quinze anos, reflete a intensidade e longo período de exposição à grande carga bacilar. Representa, então, um importante evento de alerta que aponta para uma dificuldade no controle da doença. Os autores relatam três casos de hanseníase, em menores de quinze anos, provenientes do Município de Itaguaí, Rio de Janeiro. Discutem-se as implicações epidemiológicas da detecção de novos casos nessa faixa etária e o papel fundamental do exame de contatos e da busca do caso fonte no controle da Hanseníase.
Leprosy is an infectious disease with an average incubation period of two to five years. It is caused by Mycobacterium leprae, mainly affecting skin, mucous membranes and peripheral nerves. When it occurs in children under fifteen, it reflects an intense and long contact period, with a high bacillary load. Therefore, it is considered an important alert sign that points to the challenge of controlling the disease. The authors report three cases of leprosy in children under fifteen that occurred in the Itaguaí district, Rio de Janeiro. The epidemiologic implications of new cases detected at this age and the fundamental role of examining the patients' close contacts and the possible identification of source cases as an effort for leprosy control are discussed.
Assuntos
Criança , Feminino , Humanos , Hanseníase Tuberculoide/patologia , Brasil/epidemiologia , Família , Hanseníase Tuberculoide/epidemiologiaRESUMO
OBJECTIVE: We investigated the in vitro and skin lesions production of cytokines in non-treated borderline tuberculoid (BT) and borderline lepromatous (BL) patients. PATIENTS AND METHODS: Seven untreated, non-reactional BT patients and 12 untreated, non-reactional BL patients were studied. Levels of the cytokines IFN-gamma, IL-10, TGF-beta1 and TNF-alpha were measured in supernantant of peripheral blood mononuclear cells (PBMC) cultures, stimulated with specific M. leprae antigen (sonicated and whole). The cytokines iNOS, IL-10 and TGF-beta1 were detected by immunohistochemistry in skin biopsies. RESULTS: BT patients produced higher levels of IFN-gamma than BL patients; iNOS expression in skin lesions was also higher in BT patients. TGF-beta1 was detected in more cells in BL patients; IL-10 expression was similar in both groups. There was a negative correlation between iNOS and TGF-beta1 expression in skin biopsies, positive correlation between TGF-beta1 in skin lesions and bacillary index, as well as positive correlation between iNOS detected in skin biopsies and PBMC IFN-gamma production. CONCLUSIONS: The BT patients had a mainly a Th1-profile of cytokines in their skin lesions and BL patients had a Th2 profile.
Assuntos
Citocinas/metabolismo , Hanseníase Dimorfa/metabolismo , Hanseníase Virchowiana/metabolismo , Hanseníase Tuberculoide/metabolismo , Biomarcadores/metabolismo , Biópsia , Brasil/epidemiologia , Feminino , Humanos , Imuno-Histoquímica , Interferon gama/metabolismo , Interleucina-10/metabolismo , Hanseníase Dimorfa/epidemiologia , Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/epidemiologia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico Sintase Tipo II/metabolismo , Estatísticas não Paramétricas , Fator de Crescimento Transformador beta/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Estudio descriptivo, retrospectivo, de corte transversal, para determinar el comportamiento de la lepra en ciudad de la Habana entre los años 2004 y 2008. De un universo de 97 casos notificados en este quinquenio, se estudiaron 94 pacientes que tenían encuesta epidemiológica. Se analizaron variables sociodemográficas y clínicas para caracterizar los casos notificados. Se determinó que más de la mitad de los casos estudiados estuvo en el grupo de edad de 45 y más años (64.9%) y fue más frecuente en el sexo masculino (65.9%). El mayor número de los casos diagnosticados (79.7%) clasificaron con lepra multibacilar, correspondiendo un 54.2% de ellos a lepromatosa. El síntoma más frecuente corresponde a la presencia de máculas con un 49.2%. Considerando el resultado de la investigación realizada, se presentará una propuesta al Departamento Provincial de este programa, para capacitar al personal que trabaja en las diferentes áreas de salud.
Descriptive, retrospective, cross-sectional study, to determine the behavior of leprosy in Havana City between 2004 and 2008. In a universe of 97 cases reported in the five years, 94 patients who had an epidemiological survey were studied. Sociodemographic and clinical variables were analyzed to characterize the reported cases. It was determined that more than half of the cases studied were in the age group 45 and over (64.9%), and was more frequent in males (65.9%). The highest number of diagnosed cases (79.7%) classified as multibacillary leprosy, corresponding a 54.2% of them to Lepromatous. The most common symptom is the presence of macules in 49.2%, Considering the outcomne of the investigation, a proposal will be presented to the Provincial Department of this program to train staff working in different health areas. .
Assuntos
Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/epidemiologia , Hanseníase Multibacilar/epidemiologia , Hanseníase/epidemiologia , Cuba , Hanseníase PaucibacilarRESUMO
Resistance to intracellular pathogens such as Mycobacterium leprae is dependent upon an effective T helper type 1 (Th1)-type immune response. On the other hand, intestinal helminths are known to subvert the host's immune response towards to either a Th2-type immune response or a regulatory T cell up-regulation, which may affect the host's ability to mount an effective response to mycobacteria. Here, we report a significant association between intestinal helminth infections and lepromatous leprosy [odds ratio (OR), 10.88; confidence interval (CI) 95%: 4.02-29.4; P<0.001]. We also observed that the frequency of intestinal helminths correlated strongly with the mycobacterial index (r=0.982, P<0.01). Corroborating with our hypothesis, intracellular levels of interferon-gamma were decreased significantly in leprosy patients co-infected with intestinal helminths when compared to leprosy patients without worms. Conversely, lepromatous leprosy patients with intestinal worms produced higher levels of both interleukin (IL)-4 and IL-10. Our results suggest that a pre-existing infection by intestinal helminths may facilitate the establishment of M. leprae infection or its progression to more severe forms of leprosy.
Assuntos
Enteropatias Parasitárias/imunologia , Hanseníase Virchowiana/imunologia , Hanseníase Tuberculoide/imunologia , Células Th1/imunologia , Adolescente , Adulto , Idoso , Antígenos de Bactérias/imunologia , Antígenos de Bactérias/farmacologia , Antígenos de Helmintos/imunologia , Antígenos de Helmintos/farmacologia , Brasil/epidemiologia , Estudos de Casos e Controles , Células Cultivadas/efeitos dos fármacos , Células Cultivadas/imunologia , Comorbidade , Progressão da Doença , Feminino , Humanos , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-4/sangue , Enteropatias Parasitárias/sangue , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/epidemiologia , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/epidemiologia , Hanseníase Tuberculoide/sangue , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/epidemiologia , Leucócitos Mononucleares/química , Ativação Linfocitária/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/imunologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
The seroprevalence rates of IgM anti-phenolic glycolipid-I (PGL-I) antibodies in four study groups with differing exposure to Mycobacterium leprae in Ceará, Brazil were investigated between March 2005 and August 2006. The first three groups in a high prevalence area included 144 cases of leprosy, their 380 contacts and 317 participants with no known leprosy contact. The fourth group in a low prevalence area consisted of 87 participants with no known leprosy contact living in an area in which no cases of leprosy had been reported in the previous 6 months. Seropositivity and levels of IgM antibodies to PGL-I were investigated using ELISA. The seropositivity levels of anti-PGL-I among the different clinical forms of leprosy cases were 61% for lepromatous, 25% for tuberculoid and 27% indeterminate. The levels of anti-PGL-I antibodies in the endemic area differentiated leprosy cases from non-cases. However, the seropositivity was similar among contact cases (15.8%) and no known leprosy contact cases from high (15.1%) and low (13.8%) prevalence areas. The seropositivity of both contacts and no known contacts was much higher than previously reported among no known contacts in other endemic areas. The study indicates that anti-PGL-I antibodies are not useful as immunological markers of household leprosy contacts and no known leprosy contacts in endemic areas.
Assuntos
Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Glicolipídeos/imunologia , Imunoglobulina M/sangue , Hanseníase/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/imunologia , Biomarcadores/sangue , Brasil/epidemiologia , Busca de Comunicante , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina M/imunologia , Hanseníase/sangue , Hanseníase/epidemiologia , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/epidemiologia , Hanseníase Virchowiana/imunologia , Hanseníase Tuberculoide/sangue , Hanseníase Tuberculoide/epidemiologia , Hanseníase Tuberculoide/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Adulto JovemRESUMO
A Hansenise, doença cronica infecto-contagiosa e de nofificaçao compulsoria, e causada pelo bacilo de Hansen (Mycobacterium leprae), e pode apresentar multiplas lesoes em qualquer local do corpo...