Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Lepra/complicaciones , Lepra/inmunología , Mycobacterium leprae/inmunología , Adulto , Recuento de Linfocito CD4 , Femenino , VIH-1/inmunología , Humanos , Inmunidad Celular , Lepra/microbiología , Lepra/patología , Masculino , Persona de Mediana EdadRESUMEN
In Brazil, there is little information about the clinical and epidemiological characteristics of paucibacillary, single skin lesion leprosy patients (SSL-PB). Only recently has the official notification system distinguished leprosy patients with a single lesion as a clinical entity, for whom the single-dose ROM (rifampin, ofloxacin and minocycline) regimen has been recommended. In this paper, we describe the baseline clinical features and the immunological background of a multicenter cohort of SSL-PB leprosy cases enrolled between December 1997-1998. Patients were recruited at health centers located in the following regions: Southeast = Rio de Janeiro; North = Amazon and Rondônia states and Center-West = Goiás state. Eligible cases were newly detected, untreated single-lesion leprosy patients without thickened nerve involvement, and were assessed by clinical, bacilloscopic and histopathological exams. The Mitsuda skin test and anti-PGL-I serology (ELISA) were also performed. Of the 299 SSL-PB leprosy patients, 259 (86.6%) fulfilled the criteria for single-dose ROM intervention. Our results showed that patients recruited from different sites had similar features, considering the clinical and immunological profiles. There was a predominance of adults (mean age 32.4; S.D. = 16.0), and a BCG scar was detected in 76.7% of the children (< or = 15 years old). Only 7 cases were diagnosed as the multibacillary type, representing less than 3% of the patients being misclassified. Our data indicate that in Brazil SSL-PB case ascertainment based on clinical and bacilloscopic criteria can be accurately defined under a routine control program; 75.0% of SSL-PB cases were Mitsuda positive (> or = 5 mm) and seropositivity for anti-PGL-I was detected in 17.3% of the patients. These data are compatible with effective cell-mediated immunity and low bacillary load, suggesting favorable clinical outcomes for most SSL-PB participants of this cohort.
Asunto(s)
Lepra Lepromatosa/patología , Mycobacterium leprae/aislamiento & purificación , Selección de Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Biopsia , Brasil/epidemiología , Niño , Estudios de Cohortes , Quimioterapia Combinada , Escolaridad , Femenino , Humanos , Leprostáticos/administración & dosificación , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/epidemiología , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Minociclina/administración & dosificación , Minociclina/uso terapéutico , Mycobacterium leprae/crecimiento & desarrollo , Ofloxacino/administración & dosificación , Ofloxacino/uso terapéutico , Rifampin/administración & dosificación , Rifampin/uso terapéuticoRESUMEN
Edema, which is commonly described as a symptom of reactional states, may occur during the course of leprosy. Both diagnosis and adequate treatment measures are often difficult to achieve and failure to do so may result in permanent damage to the lower limbs. In a one-year follow-up study of leprosy patients--ten multibacillary and one paucibacillary--who had been submitted to a clinical protocol for diagnosis and pathological classification, a clinical pattern of localized and/or systemic edema was observed. Among these patients, five simultaneously presented other symptoms related to reactional states, 4 were diagnosed as Type I, and one as Type II. On the other hand, while three of the patients did not present reaction at the time when edema was diagnosed, they did develop some aspects of reactional disease later on (two had neuritis e one had Type I reaction). The edemas that preceded or were associated with reactional episodes showed clinical regression as a result of specific treatment against reactions (corticosteroids and/or pentoxifylline and/or thalidomide) in the absence of another treatment normally used for edemas. Although these data need to be confirmed by controlled studies, they strongly suggest that immunological mechanisms are involved in the physiopathology of edema in leprosy.