O exame neurológico inicial na hanseníase multibacilar: correlação entre a presença de nervos afetados com incapacidades presentes no diagnóstico e com a ocorrência de neurites francas

ABSTRACT ABSTRACT ABSTRACT The study examines the performance of the sector of leprosy as a municipality of Minas Gerais, from January 1996 to December 2004, through a descriptive and retrospective study of medical records of patients who started multi-drug therapy in this period. It was the frequent presence of the state technical supervision, with attention to the most severe cases, courses of training for professionals and constant support in the face of difficulties. The result was increasing the number of cases detected and improvement in quality of care to the diseased of leprosy. Currently, 100% of cases are assessed on the degree of disability, in addition to monitoring the reactions and neuritis, thus preventing deformities. Descriptors Descriptors Descriptors Descriptors Descriptors: Leprosy; Health policy; Prevention & control. RESUMEN RESUMEN RESUMEN RESUMEN RESUMENEl estudio examina el desempeño del sector de la lepra de un municipio de estado de Minas Gerais, a partir de enero de 1996 a diciembre de 2004, a través de un estudio descriptivo y retrospectivo de historias clínicas de los pacientes que iniciaron poli quimioterapia en este período. Fue verificada a frecuente presencia de la supervisión técnica del Estado, con atención a los casos más graves, cursos de formación para los profesionales y apoyo constante ante las dificultades. El resultado fue el aumento del número de casos detectados y la mejora en la calidad de la atención al portador de la lepra. Actualmente, el 100% de los casos son evaluados por el grado de discapacidad, además de supervisar las reacciones y neuritis, evitando así deformaciones. Descriptores Descriptores Descriptores Descriptores Descriptores: Lepra; Política de salud; Prevención & control. INTRODUÇÃO INTRODUÇÃO INTRODUÇÃO INTRODUÇÃO INTRODUÇÃOO Brasil ocupa hoje o segundo lugar mundial em número de casos de hanseníase. Nos últimos anos foram elaborados planos, com metas e estratégias para se alcançar a eliminação da hanseníase, isto é, chegar a uma taxa de prevalência menor que 1 caso por 10.000 habitantes. Conseguiu-se a redução da taxa de prevalência e o aumento do número de casos tratados com a poliquimioterapia (PQT).Porém, apesar dos esforços, a meta de eliminação para o país ainda não foi atingida. Dentre os fatores que impediram alcançar a meta está a permanência de casos não diagnosticados, prevalência oculta, responsáveis pela manutenção de fontes de contágio na população. É preciso quebrar a cadeia de transmissão da doença por meio do diagnóstico precoce de todos os casos e tratamento imediato com a poliquimioterapia (1) .Estudo realizado pela Área Técnica de Hanseníase do estado de Minas Gerais em 2000, mostrou que o estado vinha deixando de diagnosticar, em média, 1.000 casos a cada ano (1) .Dados do Ministério da Saúde (1998Saúde ( -2000 mostram um aumento no número de casos principalmente na região Norte e Nordeste (56% dos casos), enquanto apenas 5% são da região sul do país. Coeficientes de prevalência para as regiões sul e sudeste c...

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“…É importante identificar os fatores de risco envolvidos, de modo a acompanhar os pacientes mais propensos com maior atenção (8) .…”

Section: Resul Resul Resul Resul Results T T T Tados E Discussão Ados unclassified

Políticas públicas na Hanseníase: contribuição na redução da exclusão social

Dias

Pedrazzani

2008

Rev. Bras. Enferm.

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“…Pimentel, 39 assessed 103 patients with MB leprosy to study the role of neuritis in inducing and worsening physical disability, and observed that clear episodes of neuritis were usually associated with EN states (55.3%), compared with the incidence of neuritis in RR patients (33.3%), although this difference was not statistically significant.…”

Section: Neuritismentioning

confidence: 99%

Contribuição ao diagnóstico e manejo dos estados reacionais: Uma abordagem prática

Nery¹,

Sales²,

Illarramendi³

et al. 2006

An. Bras. Dermatol.

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Abstract:The early clinical recognition of reactional states brings great benefits to leprosy patients due to the possibility of appropriate and immediate therapeutic intervention, thus avoiding the development of disabilities that so much stigmatize and complicate the disease. There are three types of reactional episodes: types 1, 2 and neuritis. The latter may occur alone or together with the former forms. In some cases only neurological and/or skin manifestations are observed in the reactions; in others, patients present systemic alterations. The treatment with an association of immunosuppressors and anti-inflammatory drugs seems to be the most effective to avoid recurrences and side effects. INTRODUCTIONLeprosy would not have major repercussions during its progression if there were not reactional episodes. The aim of this review is to provide theoretical support for improved understanding and management of these episodes to decrease morbidity and clinical consequences. CONCEPTReactional states are immunoinflammatory events presenting almost always as local or systemic dermatological and neurological manifestations that occur at distinct moments (before, during or after the specific treatment of leprosy) and that require immediate intervention. CLASSIFICATIONThere are three clinical presentations of reactional states. Type I is the reverse reaction (RR) that occurs mostly in patients with borderline tuberculoid (BT), borderline-borderline (BB) and borderline lepromatous (BL) forms.1 This reaction occurs very seldom in the lepromatous-lepromatous type (LL). Type II, erythema nodosum leprosum (ENL), occurs in patients with LL and BL. A third type of reaction, named isolated neuritis, is a reactional state which presents as pain (spontaneous or promoted by compression of a nerve trunk), accompanied or not by nerve thickening, with no dermatological features of types I or II.2 Nery et al. found seven cases of isolated neuritis in 100 multibacillary (MB) patients with reactional states. The frequency of isolated neuritis was 57.1% in the BB form, 28.6% in the BL form and 4.3% in LL patients. 3 TYPE I REACTION: REVERSAL REACTION PathophysiologyReversal reaction (RR) or type I reaction is an event that follows a sudden development of cell mediated immunity; it is considered a transitory state directed towards the tuberculoid type, sometimes with positive lepromin skin tests and formation of epithelioid granulomas. The presentation may vary with the clinical form (Chart 1). Usually reactivation of preexisting lesions or the appearance of new lesions in previously healthy areas with erythema and infiltration are observed, forming a smooth and bright plaque with an edematous surface, which may regress with scaling and residual hyperchromia. The reactional state may last weeks or months.The mucosa and semimucosa may also be affected, as well as the skin. A burning sensation in cutaneous lesions, facial or extremity pain, paresthesis, decreased sensitivity and reduced muscular strength may be present. 4,5Clinical varia...

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“…It can be better understood when regarded as an association of two diseases: first, a chronic infection that induces a cell-mediated immune response; second, a peripheral neuropathy which is triggered by infection and followed by a series of immunological events, whose evolution, sequels and disabilities often last many years, even after infection has ceased [4][5][6][7] . Leprosy still remains the commonest cause of peripheral neuropathy in developing countries 8 .…”

mentioning

confidence: 99%

Study of the profile of the neurotrophin BDNF in new leprosy cases before, during and after multidrug therapy

Costa

Mendonça

Penido³

et al. 2011

Arq. Neuro-Psiquiatr.

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Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in the survival of neurons and growth and differentiation of dendrites and axons. The purpose of the present study was to evaluate plasma levels of BDNF of leprosy patients at different stages of multidrug therapy (MDT) in comparison with non-infected individuals. Plasma levels of BDNF were measured by ELISA in 30 healthy controls and 37 leprosy patients at diagnosis, during and after MDT. Plasma levels of BDNF tended to be higher in control subjects in comparison with leprosy patients, but this difference does not reach statistical significance. Interestingly, BDNF levels changed following MDT, achieving statistical difference only at the 2 nd dose of MDT. These results indicate that BDNF may not be a surrogate marker of leprosy infection and/or related neuropathy. Further research is needed to investigate the meaning of BDNF level changes following leprosy treatment. Key words: leprosy, BDNF, peripheral neuropathy, biomarker, follow-up.Estudo do perfil da neurotrofina BDNF em casos novos de hanseníase antes, durante e após poliquimioterapia RESUMO O fator neurotrófico derivado do cérebro (BDNF) é uma neurotrofina envolvida na sobrevivência neuronal e no crescimento e diferenciação dos dendritos e axônios. O objetivo do presente estudo foi avaliar os níveis plasmáticos do BDNF de pacientes com hanseníase em diferentes fases da poliquimioterapia (PQT), em comparação com indivíduos não-infectados. Os níveis plasmáticos do BDNF foram mensurados pelo teste ELISA em 30 controles sadios e 37 pacientes com hanseníase no momento do diagnóstico, durante e após PQT. Os níveis plasmáticos do BDNF mostraram-se maiores nos indivíduos controles em comparação com os pacientes com hanseníase, mas não houve diferença estatisticamente significante. Curiosamente, os níveis de BDNF modificaram-se com o tratamento, mostrando diferença estatística apenas na segunda dose de PQT. Esses resultados indicam que o BDNF pode não ser um marcador de infecção na hanseníase e/ ou neuropatias relacionadas. Novas pesquisas são necessárias para investigar o significado das alterações nos níveis de BDNF ao longo do tratamento da hanseníase. Palavras-chave: hanseníase, BDNF, neuropatia periférica, biomarcador, seguimento.

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O exame neurológico inicial na hanseníase multibacilar: correlação entre a presença de nervos afetados com incapacidades presentes no diagnóstico e com a ocorrência de neurites francas

Cited by 28 publications

References 10 publications

Políticas públicas na Hanseníase: contribuição na redução da exclusão social

Políticas públicas na Hanseníase: contribuição na redução da exclusão social

Contribuição ao diagnóstico e manejo dos estados reacionais: Uma abordagem prática

Study of the profile of the neurotrophin BDNF in new leprosy cases before, during and after multidrug therapy

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