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dos Santos DF, Borges IS, Garcia LP, Antunes DE, Luppi ADM, Goulart IMB. Description of electroneuromiographic and laboratorial findings in leprosy neuropathy, according to its clinical forms: the confirmation of a spectral disease. Front Med (Lausanne) 2024; 10:1304131. [PMID: 38259847 PMCID: PMC10801246 DOI: 10.3389/fmed.2023.1304131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Leprosy is one of the most common infectious cause of peripheral neuropathy in the world and can lead to sequelae and physical disabilities. Electroneuromyography (ENMG) is the gold-standard test for evaluating neural impairment, detecting from subclinical abnormalities to advanced lesions. This study aims to describe the electroneuromyographic findings in patients with leprosy, according to their clinical forms. Methods The study is a retrospective observational analysis of the medical records of patients with leprosy, of a National Reference Center of Sanitary Dermatology and Leprosy in Brazil between 2014 and 2022. 513 patients underwent ENMG at leprosy diagnosis and also underwent a clinical, serological and molecular evaluation of the disease. Results The electroneuromyographic findings showed 2,671 altered nerves, with an average of 6.9 (±5.1) altered nerves per patient. The most affected sensory nerves were the superficial peroneal (25.0%; 413/1649), sural (15.1%; 397/2627) and ulnar (13.8%; 363/2627), with average of 4.3 (±3.2) affected sensory nerves per patient. The most affected motor nerves were the ulnar (33.1%; 338/1022) and common peroneal (12.1%; 319/2627), with average of 2.6 (±2.5) motor nerves affected per patient. 126 patients presented normal ENMG and, among the 387 with abnormalities in the exam, 13.2% (51/387) had mononeuropathy and 86.8% (336/387) had multiple mononeuropathy. Axonal involvement was more frequent in primary neural leprosy, borderline-tuberculoid, borderline-lepromatous and lepromatous forms. Discussion Our findings support that leprosy is a spectral disease, characterized by a balance between host immunity and bacillary load. Therefore, the impairment and electroneuromyographic characteristics are distinct and may vary according to the clinical form.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabella Sabião Borges
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Leonardo Peixoto Garcia
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Radiology Division, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
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Alcântara SBC, de Araújo JG, Santos DF, da Silva TR, Goulart IMB, Bernardes da Silva AM, Antunes DE. Identification of types of wound bed tissue as a percentage and total wound area by planimetry in neuropathic and venous ulcers. J Vasc Nurs 2023; 41:164-170. [PMID: 38072568 DOI: 10.1016/j.jvn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/13/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Neuropathic and venous leg ulcers are chronic wounds associated with devitalized tissue and recurrent infection. Management should be guided by accurate tissue assessment, including the use of planimetry, which provides tissue types as a percentage of the total wound bed surface area. OBJECTIVE This innovative study aimed to assess and identify the wound bed tissues, as a percentage, of neuropathic and venous ulcers using digital planimetry, providing support to nurses optimize the management of necrotic tissues and, consequently, to avoid wound infection. METHODS This cross-sectional study enrolled 24 patients with chronic wounds who were assessed from January to March 2021 at the Wound Outpatients Clinic. The wound photographs were analyzed using Image J 1.53e and a smartphone with WoundDoc Plus® 2.8.2 via digital planimetry. Statistical analyses were performed using the binomial test, t-test, and Mann-Whitney. RESULTS Median wound areas (p=0.3263) did not differ between the group with 2 or 3 risk factors for delayed healing (Md: 31.7) and the group with up to 1 risk factor (Md: 5.3). A low exudate level was associated with the up-to-1-risk-factor-for-delayed-healing group (p=0.0405), while a medium level was associated with the two-or-three-risk-factor group (p=0.0247). A heat map displayed the tissue percentages in the wound bed. In the group with 2 or 3 risk factors for delayed healing, 91.7% (11/12) had less than 70% granulation tissue, which was the primary factor for this group (p<0.0001). Additionally, 66.7% (8/12) of patients with 2 or 3 risk factors for delayed healing exhibited discolored and/or dark red granulation tissue as the primary factor (p=0.0130). CONCLUSION This novel identification of wound area and tissue types as a percentage, using digital planimetry, can play a crucial role in assisting nurses in decision-making related to the appropriate management of devitalized tissues. Furthermore, this measurements may facilitate the conducting of virtual wound consultations and offer valuable support in the development of protocols aimed at preventing infection and biofilm formation in the wound bed.
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Affiliation(s)
- Silvia Bottaro Carvalho Alcântara
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Juliano Gonçalves de Araújo
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Diogo Fernandes Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil.
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Luppi ADM, Ferreira GE, Prudêncio DL, Antunes DE, Araújo L, Dos Santos DF, Nogueira-Barbosa MH, Goulart IMB. High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts. PLoS One 2023; 18:e0285450. [PMID: 37220153 DOI: 10.1371/journal.pone.0285450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.
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Affiliation(s)
- Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Radiology Division, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Guilherme Emilio Ferreira
- Radiology Division, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
| | - Denis Luiz Prudêncio
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Lúcio Araújo
- Department of Mathematics, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Radiology Division, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, São Paulo, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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dos Santos DF, Garcia LP, Borges IS, Oliveira TJ, Antunes DE, Luppi ADM, Goulart IMB. Early diagnosis of neural impairment in seropositive leprosy household contacts: The experience of a reference center in Brazil. Front Med (Lausanne) 2023; 10:1143402. [PMID: 36993802 PMCID: PMC10040679 DOI: 10.3389/fmed.2023.1143402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionLeprosy is an infectious disease that remains with a high number of new cases in developing countries. Household contacts have a higher risk for the development of the disease, but the neural impairment in this group is not well elucidated yet. Here, we measured the chance of occurrence of peripheral neural impairment in asymptomatic leprosy household.MethodsContacts who present anti-PGL-I IgM seropositivity, through electroneuromyography (ENMG) evaluation. We recruited 361 seropositive contacts (SPC) from 2017 to 2021, who were subjected to an extensive protocol that included clinical, molecular, and electroneuromyographic evaluations.ResultsOur data revealed a positivity of slit skin smear and skin biopsy qPCR of 35.5% (128/361) and 25.8% (93/361) respectively. The electroneuromyographic evaluation of the SPC showed neural impairment in 23.5% (85/361), with the predominance of a mononeuropathy pattern in 62.3% (53/85). Clinical neural thickening was observed in 17.5% (63/361) of seropositive contacts, but among the individuals with abnormal ENMG, only 25.9% (22/85) presented neural thickening in the clinical exam.DiscussionOurs results corroborates the need to make the approach to asymptomatic contacts in endemic countries more timely. Since leprosy in its early stages can present an indolent and subclinical evolution, serological, molecular, and neurophysiological tools are essential to break the disease transmission chain.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- *Correspondence: Diogo Fernandes dos Santos,
| | - Leonardo Peixoto Garcia
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabella Sabião Borges
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Thales Junqueira Oliveira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
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Antunes DE, Santos DF, Lima MIS, Caixeta LP, Correa MBC, Moraes ECDS, Conceição NCA, Goulart LR, Goulart IMB. Clinical, epidemiological, and laboratory prognostic factors in patients with leprosy reactions: A 10-year retrospective cohort study. Front Med (Lausanne) 2022; 9:841030. [PMID: 35957854 PMCID: PMC9358030 DOI: 10.3389/fmed.2022.841030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Leprosy reactions, the main cause of neural damage, can occur up to 7 years after starting multidrug therapy. We aimed to approach the prognostic factors that may influence the leprosy reactions over the follow-up time. Methods Retrospective cohort study, encompassing 10 years of data collection, composed of 390 patients, divided into 201 affected by reactions and 189 reaction-free individuals. Epidemiological, clinical, and laboratory variables were approached as prognostic factors associated with leprosy reactions. The association among variables was analyzed by a binomial test and survival curves were compared by the Kaplan-Meier and Cox proportional-hazards regression. Results 51.5% (201/390) of patients were affected by leprosy reactions. These immunological events were associated with lepromatous leprosy (16.2%; 63/390; p < 0.0001) and multibacillary group (43%; 169/390; p < 0.0001). This study showed that survival curves for the prognostic factor anti-PGL-I, comparing positive and negative cases at diagnosis, differed in relation to the follow-up time (Log Rank: p = 0.0760; Breslow: p = 0.0090; Tarone-Ware: p = 0.0110). The median survival times (time at which 50% of patients were affected by leprosy reactions) were 5 and 9 months for those reactional cases with negative (26/51) and positive serology (75/150), respectively. The time-dependent covariates in the cox proportional-hazards regression showed anti-PGL-I as the main prognostic factor to predict leprosy reactions (hazard ratio=1.91; p = 0.0110) throughout the follow-up time. Conclusions Finally, these findings demonstrated that anti-PGL-I serology at diagnosis is the most important prognostic factor for leprosy reactions after starting multidrug therapy, thus enabling prediction of this immunological event.
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Affiliation(s)
- Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
- *Correspondence: Douglas Eulálio Antunes
| | - Diogo Fernandes Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | | - Larissa Pereira Caixeta
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | | | | | | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Institute of Biochemistry and Genetics, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
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de Oliveira MF, dos Santos DF, Peres LB, Antunes DE, Braga VHG, de Oliveira Andrade A, Pereira AA, Goulart IMB. Evaluation of the integrity of the facial muscles in leprosy patients using surface electromyography: a cross-sectional study. LEPROSY REV 2022. [DOI: 10.47276/lr.93.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marlice Fernandes de Oliveira
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- University Center of Cerrado, Patrocínio, Minas Gerais, Brazil
| | - Diogo Fernandes dos Santos
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Luciano Brinck Peres
- Postgraduate Program in Biomedical Engineering, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Douglas Eulálio Antunes
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | | | - Adriano de Oliveira Andrade
- Postgraduate Program in Biomedical Engineering, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Adriano Alves Pereira
- Postgraduate Program in Biomedical Engineering, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
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Mendes do Nascimento AC, Dos Santos DF, Antunes DE, Gonçalves MA, Santana MADO, Dornelas BDC, Goulart Filho LR, Goulart IMB. Leprosy Relapse: a Retrospective Study on Epidemiological, Clinical and Therapeutics Aspects at a Brazilian Referral Center. Int J Infect Dis 2022; 118:44-51. [PMID: 35017109 DOI: 10.1016/j.ijid.2022.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES We aim to characterize the profile of patients diagnosed with leprosy relapse and understand the influence of different multidrug therapy (MDT) treatments and initial disease presentation. METHODS This retrospective study included patients diagnosed with leprosy relapse at a referral center in Brazil from 2013-2018. We analyzed their clinical-epidemiological characteristics, laboratory, and bacilloscopic tests. Survival analysis was used to determine the time elapsed until relapse, according to the previous treatment and the disease clinical forms. RESULTS 126 cases of relapse were analyzed, which comprised 11.89% (126/1059) of the cases. The median time elapsed until relapse was 10 years, and most patients had previously undergone 12 doses of MDT (40.48%; 51/126). Undergoing 24 doses of MDT was associated with a better prognosis regarding relapse over time compared to six or 12 doses of MDT therapy. Most of the cases of relapse were classified as multibacillary (96.03%; 121/126). CONCLUSION The incidence of relapse was greater than observed in other studies. The high percentage of multibacillary patients who had negative bacillary indices demonstrated that the bacillary index cannot be considered to be an essential criterion for relapse, especially with regard to making an early diagnosis.
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Affiliation(s)
| | - Diogo Fernandes Dos Santos
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Maria Aparecida Gonçalves
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Marcela Araujo de Oliveira Santana
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Bruno de Carvalho Dornelas
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart Filho
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Isabela Maria Bernardes Goulart
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
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Eulálio Antunes D, Ribeiro Silva T. Incidentes e eventos adversos em segurança do paciente: uma série temporal de 2019 a 2020. R Saúde Públ Paraná 2021. [DOI: 10.32811/25954482-2021v4n3p2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trata-se de uma análise de série temporal que objetivou caracterizar o perfil de incidentes e eventos adversos associados à segurança do paciente, na região sudeste entre julho de 2019 e junho de 2020. Para fins de associação e análise de tendência, foram utilizados os testes G de independência e Mann-Kendall, respectivamente. Do total de 59.822 incidentes, 76,9% (46.336) acarretaram eventos adversos ao paciente. Houve associação entre falhas envolvendo cateteres venosos e dano leve nos estados do Espírito Santo (87,4%;p<0,0001) e Rio de Janeiro leve (66,2%;p<0,0001). Em São Paulo (24,1%;p<0,0001) e Minas Gerais (30%;p<0,0001), as lesões por pressão associaram-se ao dano moderado. Quanto ao número de notificação de incidentes, registraram-se tendências decrescentes no Espirito Santo e Rio de Janeiro. Portanto, evidenciou-se elevado número de eventos adversos de dano moderado, além de tendências decrescentes nas notificações em alguns estados requerendo monitoramento e avaliação contínua de falhas na assistência para evitar subnotificações.
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Dos Santos DF, Antunes DE, Dornelas BC, da Cunha BA, Oliveira TJ, Pereira RC, Goulart LR, Goulart IMB. Peripheral nerve biopsy: a tool still needed in the early diagnosis of neural leprosy? Trans R Soc Trop Med Hyg 2020; 114:792-797. [PMID: 32710545 DOI: 10.1093/trstmh/traa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 07/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The early recognition of neural impairment in leprosy, especially in primary neural forms, represents a challenge in clinical practice and a peripheral nerve biopsy may be required for diagnostic confirmation. This study aims to characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural cases in leprosy. METHODS A total of 104 patients with peripheral neuropathy who were referred to a national reference centre for leprosy were biopsied from 2014 to 2018. All cases underwent clinical, laboratory, histopathological and electroneuromyographic evaluations. RESULTS Of 104 biopsied patients, leprosy was confirmed in 89.4% (93/104). The biopsied nerves were the ulnar (67.8% [63/93]), superficial fibular (21.5% [20/93]), sural (8.6% [8/93]), radial (1.1% [1/93]) and deep fibular (1.1% [1/93]). Twenty-nine percent (27/93) presented histopathological abnormalities and 4.4% (4/93) presented acid-fast bacilli. Nerve and superjacent skin quantitative polymerase chain reaction were positive in 49.5% (46/93) and 24.8% (23/93) of cases, respectively. Patients with multiple mononeuropathy had a higher frequency of histopathological abnormalities (p=0.0077). CONCLUSIONS This study reinforces peripheral nerve biopsy's role as an important tool in the investigation of primary neural cases, contributing to the early diagnosis and also reducing diagnostic errors and the need for empirical treatment.
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Affiliation(s)
- Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Carvalho Dornelas
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Araujo da Cunha
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Thales Junqueira Oliveira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
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Affiliation(s)
- Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
- * E-mail:
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
- Institute of Biochemistry and Genetics, Federal University of Uberlandia, Uberlandia, Brazil
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
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dos Santos OAL, dos Santos DF, Antunes DE, da Cunha BA, Goulart IMB. Ocular conditions in newly diagnosed and post-treatment leprosy patients at a National Reference Center in Brazil. LEPROSY REV 2020. [DOI: 10.47276/lr.91.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dos Santos DF, Mendonça MR, Antunes DE, Goulart LR, Goulart IMB. Epidemiologic, clinical, and laboratory aspects of leprosy neural relapses. Neurol Clin Pract 2020; 9:468-471. [PMID: 32042480 DOI: 10.1212/cpj.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/27/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy (DFS, MRM, DEA, LRG, IMBG), Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU); Postgraduate Program in Health Sciences (DFS, LRG, IMBG), School of Medicine, Federal University of Uberlândia (UFU); Institute of Genetics and Biochemistry (LRG), Federal University of Uberlândia (UFU), MG, Brazil; and Department of Medical Microbiology and Immunology (LRG), University of California Davis
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy (DFS, MRM, DEA, LRG, IMBG), Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU); Postgraduate Program in Health Sciences (DFS, LRG, IMBG), School of Medicine, Federal University of Uberlândia (UFU); Institute of Genetics and Biochemistry (LRG), Federal University of Uberlândia (UFU), MG, Brazil; and Department of Medical Microbiology and Immunology (LRG), University of California Davis
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy (DFS, MRM, DEA, LRG, IMBG), Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU); Postgraduate Program in Health Sciences (DFS, LRG, IMBG), School of Medicine, Federal University of Uberlândia (UFU); Institute of Genetics and Biochemistry (LRG), Federal University of Uberlândia (UFU), MG, Brazil; and Department of Medical Microbiology and Immunology (LRG), University of California Davis
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy (DFS, MRM, DEA, LRG, IMBG), Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU); Postgraduate Program in Health Sciences (DFS, LRG, IMBG), School of Medicine, Federal University of Uberlândia (UFU); Institute of Genetics and Biochemistry (LRG), Federal University of Uberlândia (UFU), MG, Brazil; and Department of Medical Microbiology and Immunology (LRG), University of California Davis
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy (DFS, MRM, DEA, LRG, IMBG), Clinics' Hospital, School of Medicine, Federal University of Uberlândia (UFU); Postgraduate Program in Health Sciences (DFS, LRG, IMBG), School of Medicine, Federal University of Uberlândia (UFU); Institute of Genetics and Biochemistry (LRG), Federal University of Uberlândia (UFU), MG, Brazil; and Department of Medical Microbiology and Immunology (LRG), University of California Davis
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de Oliveira MF, Antunes DE, dos Santos DF, Goulart IMB. Evaluation of the cutaneous sensation of the face in patients with different clinical forms of leprosy. PLoS One 2019; 14:e0213842. [PMID: 30870498 PMCID: PMC6417732 DOI: 10.1371/journal.pone.0213842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 03/02/2019] [Indexed: 11/28/2022] Open
Abstract
Background Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed. Objectives The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals. Methodology 19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve. Results The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases. Conclusion The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.
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Affiliation(s)
- Marlice Fernandes de Oliveira
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- University Center of Cerrado, Patrocínio, Minas Gerais, Brazil
| | - Douglas Eulálio Antunes
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- * E-mail:
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Rodrigues DDM, Aquino RLD, Antunes DE, Costa MMD, Oliveira PCD, Aragão ADS. WORK ABILITY ASSESSMENT FOR NURSING TEAM WORKING AT A LARGE HOSPITAL IN THE REGION
OF TRIÂNGULO MINEIRO – MG. Reme Revista Mineira de Enfermagem 2019. [DOI: 10.5935/1415-2762.20190108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts. PLoS Negl Trop Dis 2018; 12:e0006494. [PMID: 29782495 PMCID: PMC5983863 DOI: 10.1371/journal.pntd.0006494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/01/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022] Open
Abstract
Background Household contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs. Methods We have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations. Results/Principal findings The positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044). Conclusions/Significance ELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment. Despite the apparent progress observed in recent years in leprosy control, early identification of cases remains one of the primary objectives of control programs. In addition, the failure of the current therapeutic scheme on the incidence of leprosy demonstrates that the disease elimination as a public health program promoted by the World Health Organization (WHO) depends on an incisive action to interrupt its transmission chain. The long incubation period of leprosy, its insidious symptoms and signs may difficult its diagnosis. Several studies have recently demonstrated that IgM anti-PGL-I seropositive contacts present higher chances to become ill than seronegative ones. Therefore, our question was: do seropositive contacts at greater risk of becoming sick already present subclinical neural damage? Therefore, our approach was to analyse anti-PGL-I seropositive contacts through electroneuromyography. The development and implementation of more specific and sensitive methods for the detection of M. leprae and its neural impairment, using immunological, molecular and neurophysiological tools are mandatory to increase the knowledge of leprosy epidemiology, to break its chain of transmission, thereby enabling effective control of this disease. This report demonstrated that seropositive contacts is the population group with higher chances of neural impairment.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Biotechnology, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- * E-mail:
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dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects. PLoS Negl Trop Dis 2017; 11:e0006086. [PMID: 29176796 PMCID: PMC5720806 DOI: 10.1371/journal.pntd.0006086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2017] [Accepted: 10/31/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Leprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study. METHODOLOGY/PRINCIPAL FINDINGS Seventy patients diagnosed with primary neural leprosy from 2014 to 2016 underwent clinical, laboratorial and neurophysiological evaluation. All patients presented an asymmetric neural impairment, with nerve thickening in 58.6%. Electroneuromyography showed a pattern of mononeuropathy in 51.4%. Positivity for ELISA anti-PGL1 was 52.9%, while the qPCR of slit skin smear was 78.6%. The qPCR of nerve biopsies was positive in 60.8%. Patients with multiple mononeuropathy patterns showed lower levels of anti-PGL-1 (p = 0.0006), and higher frequency of neural thickening (p = 0.0008) and sensory symptoms (p = 0.01) than those with mononeuropathy. CONCLUSIONS/SIGNIFICANCE PNL is not a synonym of pure neural leprosy, as this condition may include a generalized immune response and also a skin involvement, documented by molecular findings. Immunological, molecular, and neurophysiological tools must be implemented for diagnosing primary neural leprosy to achieve effective treatment and reduction of its resultant disabilities that still represent a public health problem in several developing nations. Finally, we propose a algorithm and recommendations for the diagnosis of primary neural leprosy based on the combination of the three clinical-laboratorial tools.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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Antunes DE, Ferreira GP, Nicchio MVC, Araujo S, Cunha ACRD, Gomes RR, Costa AVD, Goulart IMB. Number of leprosy reactions during treatment: clinical correlations and laboratory diagnosis. Rev Soc Bras Med Trop 2017; 49:741-745. [PMID: 28001221 DOI: 10.1590/0037-8682-0440-2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 11/23/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: The occurrence of leprosy reactions, a common event during treatment, may be mostly related to the action of multidrug therapy on Mycobacterium leprae. The clinical and laboratory monitoring of patients with reactions is important, since collecting data that assists in predicting the risk of reactions may help to prevent disability. METHODS: This was a sectional study, in order to correlate clinical and laboratory diagnosis with the number of reactions during treatment. Spearman's correlation was used to verify the degree of association between the assessed variables. RESULTS: This study was conducted with 211 patients with leprosy reactions during treatment of M. leprae. The borderline tuberculoid group was the most prevalent clinical form (74/211; 35.1%) and the type one reaction showed the highest frequency (136/211; 64.5%). It was observed that 73.5% (155/211) of reactions occurred within 3 months of the initiation of multidrug therapy. The diagnostic values, including the bacterial indices (BIs) of dermal smears (r = 0.21, p < 0.05) and skin biopsies (r = 0.20; p < 0.05), showed a positive correlation with the number of reactions during treatment. CONCLUSIONS: This research showed a positive correlation between bacillary load markers and the number of leprosy reactions. This study provided scientific support to future research aiming to elucidate the influence of antigenic load on the number of leprosy reactions during treatment.
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Affiliation(s)
- Douglas Eulálio Antunes
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Gabriela Porto Ferreira
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Mariana Vitorino Candeiro Nicchio
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Sergio Araujo
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Ana Carolina Rodrigues da Cunha
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Rafaela Resende Gomes
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Adeilson Viera da Costa
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
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Cunha MADS, Antunes DE, Da Silveira RWM, Goulart IMB. Application of the SRQ20 and the protocol of psychological assessment in patients with leprosy in a Reference Centre in Brazil. LEPROSY REV 2015; 86:229-239. [PMID: 26665358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aims to apply the protocol of psychological assessment (PAP) and the SRQ-20 to analyse the psychological profile of 130 leprosy patients, in order to evaluate the incidence of Common Mental Disorders (CMD), and screen patients with higher risk of psychological distress. The following results were found in the PAP: 31.53%, 23.8% and 16.9% reported an unsatisfactory childhood, adolescence and adulthood, respectively; 31.53% are afraid of being discriminated against and 16.9% experienced discrimination. Also, 13.07% reported drastic life changes due to leprosy; 29.23% have low self-esteem, 31.53% have real fear and 22.3% have phantasmal fear. In the SRQ-20, the prevalence of CMDs was 32.3%, with the majority being female, married, with low education (primary education), low self-esteem, and with a drastic change in life. Conclusion: This is one of the few studies on the psychological profile of leprosy patients demonstrating the importance of the application of investigative technologies in psychopathological screening, aiming on adherence to treatment and psychotherapy planning. Furthermore, it provides support for reflection on the integrality of healthcare for leprosy patients and the importance of psychologists in health teams.
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Antunes DE, Araujo S, Ferreira GP, da Cunha ACSR, da Costa AV, Gonçalves MA, Goulart IMB. Identification of clinical, epidemiological and laboratory risk factors for leprosy reactions during and after multidrug therapy. Mem Inst Oswaldo Cruz 2013; 108:901-8. [PMID: 24271045 PMCID: PMC3970646 DOI: 10.1590/0074-0276130222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/16/2013] [Indexed: 11/03/2022] Open
Abstract
This cross-sectional retrospective study evaluated 440 leprosy patients; 57% (251/440) had leprosy reactions during and/or after multidrug therapy, 80.5% (202/251) of whom presented with multibacillary leprosy. At diagnosis, positive bacterial index (BI) [odds ratio (OR) = 6.39; 95% confidence interval (CI): 4.1-10.1)] or polymerase chain reaction (PCR) (OR = 9.15; 95% CI: 5.4-15.5) in skin smears, anti-phenolic glycolipid-1 (anti-PGL-1) ELISA (OR = 4.77; 95% CI: 2.9-7.9), leucocytosis (OR = 9.97; 95% CI: 3.9-25.7), thrombocytopenia (OR = 5.72; 95% CI: 2.3-14.0) and elevated lactate dehydrogenase (OR = 2.38; 95% CI: 1.4-4.0) were potential markers for the development of reactions during treatment. After treatment, positive BI (OR = 8.47; 95% CI: 4.7-15.3) and PCR (OR = 6.46; 95% CI: 3.4-12.3) in skin smears, anti-PGL-1 ELISA (OR = 2.25; 95% CI: 1.3-3.9), anaemia (OR = 2.36; 95% CI: 1.2-4.5), leucocytosis (OR = 4.14; 95% CI: 1.5-11.6) and thrombocytopenia (OR = 3.70; 95% CI: 1.3-2.2) were risk factors for the occurrence of reactions during the study period. The identification of groups with an increased risk for developing reactions will allow for the timely development of a treatment plan to prevent nerve damage and, therefore, the appearance of the disabling sequelae associated with the stigma of leprosy.
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Affiliation(s)
- Douglas Eulálio Antunes
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Sergio Araujo
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Gabriela Porto Ferreira
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Ana Carolina Sousa Rodrigues da Cunha
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Adeilson Vieira da Costa
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Maria Aparecida Gonçalves
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Isabela Maria Bernardes Goulart
- Centro de Referência Nacional em Hanseníase/Dermatologia Sanitária, Hospital de Clínicas,Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
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