Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.

h Skin biopsy samples from 145 relapse leprosy cases and from five different regions in Brazil were submitted for sequence analysis of part of the genes associated with Mycobacterium leprae drug resistance. Single nucleotide polymorphisms (SNPs) in these genes were observed in M. leprae from 4 out of 92 cases with positive amplification (4.3%) and included a case with a mutation in rpoB only, another sample with SNPs in both folP1 and rpoB, and two cases showing mutations in folP1, rpoB, and gyrA, suggesting the existence of multidrug resistance (MDR). The nature of the mutations was as reported in earlier studies, being CCC to CGC in codon 55 in folP (Pro to Arg), while in the case of rpoB, all mutations occurred at codon 531, with two being a transition of TCG to ATG (Ser to Met), one TCG to TTC (Ser to Phe), and one TCG to TTG (Ser to Leu). The two cases with mutations in gyrA changed from GCA to GTA (Ala to Val) in codon 91. The median time from cure to relapse diagnosis was 9.45 years but was significantly shorter in patients with mutations (3.26 years; P ‫؍‬ 0.0038). More than 70% of the relapses were multibacillary, including three of the mutation-carrying cases; one MDR relapse patient was paucibacillary. There is no doubt about the efficiency of the currently used multidrug therapy (MDT) scheme for treatment of leprosy, as demonstrated by the strong decrease in disease prevalence since its implementation and the low number of reported relapse cases (18). However, there has been a scarcity of in-depth studies of relapse occurrences in recent decades (27). As is known, differentiating diagnosis of relapse and reactional states poses some difficulties in the field, being responsible for under-or overdiagnosis of both disease stages. This is important because undiagnosed relapse cases could contribute to continuing disease transmission. In addition, hardly any data on the contribution of emergence of drug-resistant strains of Mycobacterium leprae to leprosy relapses exist.Diaminodiphenylsulfone (DDS), also called dapsone, was the first drug to be effective against leprosy worldwide, and the first cases of resistance to dapsone were detected in 1964 and involved two single nucleotide polymorphisms (SNPs) in the gene folP1, located in codons 53 and 55 (8, 9, 14, 29). Rifampin is the key component of the standard multidrug regimen used for treatment of leprosy, and it has been shown that PCR-based DNA sequence analysis of the rpoB gene of M. leprae was in full concordance with rifampin susceptibility testing in the mouse footpad system (17, 30). In addition to dapsone and rifampin, ofloxacin is also used for leprosy treatment and is a quinolone with an action mechanism based on interaction with DNA gyrase (2); SNPs in gyrA and gyrB confer resistance or hypersensitivity to quinolones (15). Although there is not yet an official definition of multidrug resistance (MDR) in leprosy, in parallel with tuberculosis, we adopt this terminology when we encounter resistance to rifampin and one other drug of the standard M...

SummaryResistance 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-g 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.

Abstract.Intestinal helminths are known to subvert the host's immune response towards a Th2 response, which in turn may lead to both eosinophilia and high immunoglobulin E titers often associated with these parasites. Mycobacterium leprae infection may lead to different clinical and pathological forms. Multibacillary forms are associated with Th2 cytokines, whereas paucibacillary forms are associated with Th1 cytokines. We report a significantly higher frequency of intestinal helminthic infections in patients with the lepromatous form, a multibacillary form of leprosy (odds ratio, 2.99; 95% confidence interval, 1.82-4.95; P ϭ 0.006) when compared with patients with paucibacillary leprosy or to a control group without leprosy. A direct correlation was also found between mycobacterial index and the frequency of intestinal helminths. Our results suggest that the presence of intestinal helminths may facilitate the establishment of M. leprae infection or the progression to more severe forms of leprosy.

SUMMARY Background: Tuberculosis is a serious health problem in Brazil so that the knowledge on the aspects of cutaneous tuberculosis is medically important. Objective: To assess the characteristics of patients with cutaneous tuberculosis treated at the Cassiano Antonio Moraes University Hospital, located in the city of Vitória, State of Espírito Santo, Brazil. Methods: This is a retrospective, descriptive, observational and cross-sectional study using the medical records of 29 patients with cutaneous tuberculosis treated at the Dermatology and Pulmonology services of the hospital from 1986 to 2011. The inclusion criterion was the confirmation of cutaneous tuberculosis taking into account clinical, epidemiological, immunological, and bacteriological findings, as well as the response to specific treatment. Results: Of the 29 studied patients; 18 (62%) were women with average age of 37 years; the predominant clinical condition was erythema induratum of Bazin in 12 (41.4%) cases; and the cutaneous lesions were in the lower limbs in 19 (65.8%) patients. Extra-cutaneous involvement occurred in eight (27.6%) cases. The tuberculin tests were positive in 15 (79%) individuals and the assessment of the infectious agent was negative in most of the investigated cases. Conclusion: The study found a low frequency (0.44%) of cutaneous tuberculosis in an endemic area of tuberculosis. There was a predominance of infection in women aged thirty to forty years. Erythema induratum was the most common clinical condition, affecting mainly the lower limbs, in contrast to other Brazilian studies that found scrofuloderma as the most common manifestation, predominating in the cervical region of male children and adolescents.

A piedra branca é infecção fúngica do pêlo, rara, causada pelo Trichosporon beigelii, caracterizada por nódulos amarelados nos pêlos genitais, bigode, barba, axilas e raramente, no couro cabeludo. O estudo registra 15 casos, diagnosticados em serviço de dermatologia de Vitória, durante cinco anos, todos de pacientes do sexo feminino, com nódulos nos pêlos do couro cabeludo. Os autores supõem que o clima quente e úmido da região e o hábito de as pacientes utilizarem cremes recondicionadores nos fios dos cabelos tenham favorecido a infecção. O umedecimento dos fios com água facilita a visualização dos nódulos.

Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.

Revista da Sociedade Brasileira de Medicina Tropical 42(4):420-424, jul-ago, 2009ARTIGO/ARTICLE Caso de recidiva na hanseníase é o paciente que tratado regularmente pelos esquemas oficiais vigentes no país, recebe alta por cura, e após um período de incubação variável aparece com sinais e sintomas de atividade da doença 14 .Na recidiva, ocorre o aparecimento de novas lesões características das formas clínicas da hanseníase, nos mesmos locais do primeiro diagnóstico ou em outras áreas da pele e/ ou acometimento de nervos periféricos (neurite). Nos casos paucibacilares (PB), é imprescindível o diagnóstico diferencial com a reação reversa, sendo que esta responde favoravelmente ABSTRACTLeprosy relapse is the reappearance of the disease after regular treatment with current regimens and discharge due to cure. In this retrospective and descriptive cohort study, the aim was to evaluate the characteristics of cases of leprosy relapse in the State of Espírito Santo between 2000 and 2005.The investigation strategies consisted of monitoring the SINAN entries, with file analysis and case discussions at the State Reference Center. One hundred and four cases of relapse were studied, representing 1.12% of the new cases detected over this period. The greatest frequency was between 21 and 60 years of age; 59.6% were men; 44.2% presented relapse more than five years after discharge; 66.4% were multibacillary; and 42.2% presented positive bacilloscopy (complete bacilli) and therefore were relapse cases. Negatives bacilloscopy was observed in 57.8%. Prospective studies should be conducted to establish the real relapse rate. Key-words:Leprosy. Recurrence. Relapse. Epidemiology. Multidrug therapy.com a terapia de corticosteróide sistêmico em doses preconizadas, diferente da recidiva 14 . Também, suspeita-se de recidiva, quando os casos multibacilares (MB) iniciam reações após três anos da alta por cura ou que as apresentem durante o tratamento e permanecem desta maneira por cinco anos 14 .Os fatores relacionados ao desenvolvimento da recidiva na hanseníase podem dever-se à persistência ou resistência do bacilo, à imunossupressão, gravidez, formas virchowianas avançadas do hospedeiro, à endemicidade do meio (reinfecção) e ao diagnóstico tardio, terapêutica inadequada ou irregular da doença e erro de classificação 4 11 17 .O diagnóstico clínico deve ser acompanhado pela realização de baciloscopias, estudo histopatológico da lesão e se possível, a inoculação de bacilos no coxim plantar de camundongo ou a realização de técnicas moleculares, como a reação em cadeia da polimerase e o sequeciamento de regiões do DNA do Mycobacterium leprae, que são alvos de drogas, para a verificação de resistência medicamentosa, no material da lesão obtido por biópsia 5 14 20 .