Assuntos
Biópsia/efeitos adversos , Doenças do Sistema Nervoso Periférico/patologia , Hanseníase/patologia , Neoplasias do Sistema Nervoso/etiologia , Nervo Musculocutâneo/fisiopatologia , Nervo Musculocutâneo/patologia , Nervo Radial/fisiopatologia , Nervo Radial/patologia , Neuritos/patologia , Neuroma/etiologia , Neurônios Aferentes/fisiologia , Neurônios Aferentes/patologia , Sensação/fisiologiaRESUMO
Untreated patients suffering from tuberculoid, lepromatous and indeterminate leprosy, their domiciliary contacts, and healthy controls, all living in Guadeloupe, West Indies, were tested by an ELISA for detecting IgM antibodies to the terminal disaccharide of the phenolic glycolipid-I antigen of Mycobacterium leprae. On most subjects, a Mitsuda test was also performed. A large majority of the tuberculoid patients and healthy subjects were Mitsuda positive. The seropositivity rate reached 44% among tuberculoid patients, and 6% among healthy subjects, with low antibody levels. Lepromatous patients were all Mitsuda negative and seropositive, with antibody production varying from low levels, as seen in tuberculoid patients, to much higher levels. Indeterminate leprosy patients included 62% Mitsuda-positive subjects and 54% seropositive subjects with a large dispersion of antibody levels. Comparing the results of the Mitsuda test to those of the ELISA by factorial analysis allowed us to define several subgroups among this population: some (25%) showed a "lepromatous-like" immune status (Mitsuda negative, seropositive); others (54%) exhibited "tuberculoid-like" profiles (Mitsuda positive without antibodies or with low antibody levels). "Lepromatous-like" cases were significantly older than "tuberculoid-like" patients. A group of subjects (17%) was Mitsuda negative and seronegative, thus displaying a true "indeterminate" immune profile, which had not been seen in other forms of the disease and had been observed in only 2 out of 51 healthy controls. A large majority of contacts was Mitsuda positive, with 33% of them being seropositive, indicating that the prevalence of M. leprae infection greatly exceeds that of overt leprosy in this population.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anticorpos Antibacterianos/análise , Dissacarídeos , Glicolipídeos/imunologia , Hanseníase/diagnóstico , Mycobacterium leprae/imunologia , Anticorpos/análise , Antígenos de Bactérias/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina G/análise , Prognóstico , Soroalbumina Bovina/imunologiaAssuntos
Hanseníase/epidemiologia , Adulto , Criança , Dapsona/uso terapêutico , Feminino , Humanos , Hanseníase/tratamento farmacológico , Masculino , Recidiva , Índias OcidentaisRESUMO
Primary and secondary dapsone resistance were studied among lepromatous patients living in Martinique, Guadeloupe, New Caledonia, Tahiti, Senegal, and Paris. Four hundred fifteen biopsies were taken from clinically active and bacteriologically positive (bacterial index greater than 2) patients in the 6-year period of 1980-1985. Among these, 280 biopsies that contained 5 x 10(4) acid-fast bacilli per ml with a morphological index of at least 0.10 were inoculated into the mouse foot pad, and 229 harbored infective Mycobacterium leprae. Among the 129 infective M. leprae isolated from new cases, 54% had some degree of dapsone resistance, a low degree being prominent in all cases. Among the 100 infective M. leprae isolated from relapsed cases, 79% had a high or an intermediate degree of dapsone resistance. The annual incidence of secondary dapsone resistance was estimated to be about 0.55% in Guadeloupe.
Assuntos
Dapsona/farmacologia , Hanseníase/microbiologia , Mycobacterium leprae/efeitos dos fármacos , Dapsona/uso terapêutico , Resistência Microbiana a Medicamentos , Humanos , Hanseníase/tratamento farmacológico , Martinica , Nova Caledônia , Paris , Polinésia , Senegal , Índias OcidentaisRESUMO
Analysis of computerized data compiled according to the OMSLEP system in the leprosy control service in Guadeloupe has shown that from 1970 to 1984, 80% of the patients were detected by passive case-finding (symptomatic patients), 10% by active case-finding among the school population and 10% by active case-finding among the house-hold contacts of known patients. During the same period of time, global incidence of new cases of leprosy declined from 24 to 11 per 100,000 inhabitants. The decline was greater for paucibacillary cases (y = -0,94) than for multibacillary cases (y = -0,45), and much greater among persons under 15 years of age (y = -3,22) than among those older ones (y = -0,67). Simultaneously 118 relapses, an annual incidence of 1,3%, were observed among the multibacillary patients previously treated by dapsone monotherapy for five years or more. All cases the biopsies of whom were inoculated for drug sensitivity testing in the mouse foot pad yielded dapsone-resistant M. leprae. The proportions of relapses among the annual sources of infection increased from 16% in 1970 to 47% in 1984. Chemoprophylaxis of relapses among multibacillary patients already treated for more than five years with dapsone monotherapy is one of the priorities for leprosy control in Guadeloupe.
Assuntos
Hanseníase/epidemiologia , Fatores Etários , Resistência Microbiana a Medicamentos , Humanos , Hanseníase/diagnóstico , Recidiva , Índias OcidentaisRESUMO
From January 1980 to December 1984, 418 leprosy patients were treated in Guadeloupe with a daily multiple drug regimen using rifampin as an essential drug. The analysis of the data collected during this period of times gives the possibility of estimating the patient's approval, tolerance and attendance to this treatment. The approval is satisfactory in new cases of leprosy and in ancient cases relapsed under dapsone monotherapy but less in inactive ancient patients already treated with dapsone monotherapy. Attendance of the 418 patients to the multiple drug regimen is satisfactory too and similar to the attendance of patients treated with dapsone monotherapy in Guadeloupe and to the attendance of patients with monthly multiple drug regimen in another Caribbean country. Reactions did not occur with higher gravity or frequency than in patients under dapsone monotherapy. The high incidence of hepatitis (14%) due to the toxicity of protionamide in the combination rifampin-protionamide-dapsone make obligatory the monthly assessment of the liver functions in multibacillary patients treated with such a drug combination.