ANTI M. leprae IgM ANTIBODY DETERMINATION BY ULTRAMICROIMMUNOENZYMATIC (UMELISA HANSEN) FOR THE DIAGNOSIS AND MONITORING LEPROSY

The relationship between the IgM antibody response, antigenic load as well as the clinical improvement after chemotherapy was studied in order to obtain useful data for the early diagnosis and monitoring leprosy. A level of 82% (94/115) agreement was obtained between IgM UMELISA HANSEN and slitskin smear examination. Discrepant results were observed in 16 patients who showed positive IgM response despite negative by the skin smear examination. In these patients, the IgM response was seen to be associated to the early signal for bacilli recurrence in the skin. In one of these patients the presence of bacilli was demonstrated in the skin, two months after IgM antibodies being detected by UMELISA HANSEN. Also in one of the treated patients positive by both diagnostic techniques, a remarkable decrease in the IgM antibody levels was seen, correlating with a significant clinical improvement. Moreover it was found a direct relationship between the IgM antibody response and bacterial antigenic load, regardless the time elapsed in the disease's evolution.

REACTIONAL STATES IN MULTIBACILLARY HANSEN DISEASE PATIENTS DURING MULTIDRUG THERAPY

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI < 3, while ENL predominated among those patients with BI > 3.

Degree of disability, pain levels, muscle strength, and electromyographic function in patients with Hansen's disease with common peroneal nerve damage

INTRODUCTION: This study evaluated the degree of disability, pain levels, muscle strength, and electromyographic function (RMS) in individuals with leprosy. METHODS: We assessed 29 individuals with leprosy showing common peroneal nerve damage and grade 1 or 2 disability who were referred for physiotherapeutic treatment, as well as a control group of 19 healthy participants without leprosy. All subjects underwent analyses of degree of disability, electromyographic tests, voluntary muscle force, and the Visual Analog Pain Scale. RESULTS: McNemar's test found higher levels of grade 2 of disability (Δ = 75.9%; p = 0.0001) among individuals with leprosy. The Mann-Whitney test showed greater pain levels (Δ = 5.0; p = 0.0001) in patients with leprosy who had less extension strength in the right and left extensor hallucis longus muscles (Δ = 1.28, p = 0.0001; Δ = 1.55, p = 0.0001, respectively) and dorsiflexion of the right and left feet (Δ = 1.24, p = 0.0001; Δ = 1.45, p = 0.0001, respectively) than control subjects. The Kruskal-Wallis test showed that the RMS score for dorsiflexion of the right (Δ = 181.66 m·s-2, p = 0.001) and left (Δ = 102.57m·s-2, p = 0.002) feet was lower in patients with leprosy than in control subjects, but intragroup comparisons showed no difference. CONCLUSIONS: Leprosy had a negative influence on all of the study variables, indicating the need for immediate physiotherapeutic intervention in individuals with leprosy. This investigation opens perspectives for future studies that analyze leprosy treatment with physical therapeutic intervention.

Contribuição ao estudo da influência dos fatores físicos do solo, sôbre a incidência da murcha do algodoeiro, causada por Fusarium oxysporum f. vasinfectum (Atk.) Snyder & Hansen

A finalidade do trabalho, foi obter dados para o melhor conhecimento dos fatôres físicos do solo, que influenciam a incidência de murcha do algodoeiro, causada por Fusarium oxysporum f. vasinfectum (Atk.) Snyder & Hansen. Foi estudada a influência do tamanho das partículas de areia e porcentagem da mesma no solo. O primeiro ensaio mostrou que, a porcentagem de areia tinha um efeito sôbre a incidência de murcha na variedade IAC - 12. A maior incidência de murcha, foi notada nos tratamentos que possuiam maior porcentagem de areia. No segundo ensaio, foi notado o efeito do tamanho das partículas de areia sôbre a incidência de murcha na variedade IAC - 12. A incidência foi mais intensa nos substratos com Areias Fina e Média. O terceiro ensaio mostrou que a resistência da variedade RM4, ao Fusarium, aparentemente não foi afetada pela porcentagem de areia ou pelo tamanho das partículas.

Influência da porcentagem de areia no solo e Meloidogyne incognita (Kofoid e White) Chitwood sobre a incidência de murcha de algodoeiro causada por Fusarium oxysporum f. vasinfectum (Atk) Snyder e Hansen

O presente trabalho teve por finalidade estudar o efeito das diferentes porcentagens de areia, em substratos artificiais sobre a severidade de murcha do algodoeiro. Para êste fim foram utilizados substratos artificiais com quantidades variáveis de areia. Como inóculo foram utilizados suspensões de Meloidogyne, Fusarium e Fusarium mais Meloidogyne. Os três inóculos foram testados em duas; variedades de algodão. Os resultados obtidos com a variedade RM2 no 1.° ensaio mostraram uma maior incidência de murcha nos substratos, com maior porcentagem de areia, isto é, 90% e 60%. Quanto ao inóculo utilizado, a maior incidência da doença ocorreu nos tratamentos que receberam inoculação conjunta de Fusarium mais Meloidogyne. No segundo ensaio, utilizando-se a variedade RM4 não foram obtidos dados que mostrassem diferenças significativas entre substratos. Isto provavelmente se deve a um aumento no potencial de inóculo e uma melhor distribuição do mesmo. No entanto, houve uma diferença significativa para os tipos de inóculo utilizados, sendo que a maior severidade de doença ocorreu quando o inóculo era constituído de fungo e de nematóide, seguindo-se o tratamento cujo inóculo era constituido só de fungo No ensaio feito com variedade RM4 foi obtida significância para a interação tipos de inóculo versus substratos. A interação mostrou que o inóculo constituído só de Fusarium comportou-se diferentemente nos diferentes, tipos de substratos, utilizados. Tendo a maior severidade da doença ocorrido no substrato contendo a maior porcentagem de areia. No entanto, não houve diferenças significativas para a severidade da doença causada pelo inóculo constituido do fungo mais nematóides nos diferentes substratos, o que mostra efeito do inóculo de Meloidogyne sôbre o inóculo em potencial de Fusarium. Os diferentes tipos de inóculo comportaram-se de modo diferentes nos substratos de terra roxa, e nos substratos contendo 60% e 90% de areia, sendo que a maior coloração dos vasos foi obtida nos tratamentos que receberam os inóculos de Fusarium e Fusarium mais Meloidogyne.

Culturas de bacilos ácido-álcool resistentes isolados de hematófagos infectados em leprosos: evidências de se tratar do bacilo de Hansen

The A. summarises the history of his first culture of acidfast bacillus isolated directly from leprosy lesions (Sample José) and refers about two samples recovered from guinea pig and white rat inoculated with said culture. Then the A. completes his previous descriptions of four cultures of acidfast bacilli isolated by him from ticks (Amblyomma cajaennense and Boophilus microplus, two cultures from each species) infected experimentally in lepers. The A. having found specimens of two species of Triatomidae (Triatoma infestans and Panstrongylus megistus) naturally infected with HANSEN bacillus in huts habited by lepers in the State of Minas Gerais (Dec. 1942), started a series of experiments, using larvae and nymphs of T. infestans bred in laboratory at the Instituto Oswaldo Cruz, to infect in active cases of leprosy, in the city of Rio de Janeiro, could obtain two new samples of cultures of acid-fast bacilli (Ns. 6 and 7 of his set). In this papaer the A. studies the biological properties of said cultures, proving that Penicilin has not effect upon them, like other substances. The sulphuric and acetic acids were used to purify some of the cultures, with good results, the cultures becoming more rich and growing faster. Potassium hydroxide Sodium (10% solution) was also used with success to isolate and to purify the cultures, but it seems that it affects the bacilli in some way. In flud glycerinated media the majority of such cultures produce velum suitable for the preparation of antigens for skin tests and for therapeutical use. At last the A. says that he is becoming convinced that the HANSEN bacillus is in cause, especially after thee evidences of culturing the bacillus from one patient, in different opportunities.

Verificação da infecção de moscas da família Tachinidae pela Empusa Cohn, 1855: essas moscas, sugando ulceras lepróticas, se infestaram com o bacilo de Hansen

The A. refers that, in his last study, in his last studying trip to Colonia Santa Fé, Minas Gerais State, last month of March (autumn), had captured many wild flies (all from Tachinidae family, according to various entomologists of the Instituto Oswaldo Cruz), on a leprotic ulceration of the left leg of a lepromatous case of leprosy. The microscopical examination of the abdominal material from sch flies proved the presence, in rather great number, of HANSEN bacilli and a fungus of the genus Empusa COHN 1855. The A. intends to continue, next summer, such interesting research.

Hansen's disease: a vanishing disease?

The introduction, implementation, successes and failures of multidrug therapy (MDT) in all Hansen's disease endemic countries are discussed in this paper. The high efficacy of leprosy treatment with MDT and the global reduction of prevalence led the World Health Organization, in 1991, to establish the goal of elimination of Hansen's disease (less than 1 patient per 10,000 inhabitants) to be accomplished by the year 2000. Brazil, Nepal and East Timor are among the few countries that didn't reach the elimination goal by the year 2000 or even 2005. The implications of these aspects are highlighted in this paper. Current data from endemic and previously endemic countries that carry a regular leprosy control programme show that the important fall in prevalence was not followed by the reduction of the incidence. This means that transmission of Mycobacterium leprae is still an issue. It is reasonable to conclude that we are still far from the most important goal of Hansen's disease control: the interruption of transmission and reduction of incidence. It is necessary to emphasize to health managers the need of keeping Hansen's disease control activities to better develop control programmes in the future. The recent international proposal to interrupt the transmission of leprosy by the year 2020 seems to unrealistic and it is discussed in this paper. The possibility of epidemiological impact related to the human immunodeficiency virus/Hansen's disease coinfection is also considered.

Examining ERBB2 as a candidate gene for susceptibility to leprosy (Hansen’s disease) in Brazil

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.

Family Health Strategy professionals' view on the effects of Hansen's disease training

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

Avaliação dos parâmetros de solubilidade de Hildebrand/Hansen na seleção de solventes para a extração de pesticidas organoclorados do solo

This work evaluated the use of the Hildebrand/Hansen solubility parameters for selection of solvents for extraction of the organochlorine pesticides pp' DDT, pp' DDE, Aldrin and a-Endossulfan from soil using columns packed with Al2O3. The mixtures hexane:dichloromethane (7:3; v/v), hexane:acetonitrile (1:1; v/v), hexane:acetone (1:1; v/v) and pure hexane were chosen as extracting solutions. In the addition and recovery tests, different extraction solutions provided high recoveries percentages (>75%) with coefficients of variation below 15%. The recoveries are in agreement with the Hildebrand/Hansen parameters, demonstrating its applicability in the selection of extracting solution and in the replacement of toxic solvents, as dichloromethane

Estudo retrospectivo de dez anos em endoscopia das cavidades nasais de pacientes com hanseníase

A hanseníase é uma doença infecciosa de evolução crônica, causada pelo Mycobacterium leprae. Acomete com freqüência a mucosa das cavidades nasais, independentemente da forma clínica, antes mesmo do aparecimento de lesões na pele ou em outras partes do corpo, na presença ou não de queixas clínicas. OBJETIVO: Mostrar a eficácia da endoscopia nasal na identificação de lesões mucosas endonasais e a importância do especialista Otorrinolaringologista no diagnóstico e no acompanhamento dos pacientes com hanseníase. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Realizou-se estudo retrospectivo de 173 prontuários de pacientes, sem tratamento prévio, durante o período de 1990 a 2000, no Serviço de Otorrinolaringologia do Instituto de Pesquisa Clínica do Hospital Evandro Chagas Fiocruz. RESULTADOS: Todos os pacientes apresentaram lesões nasais, sendo 121 com e 52 sem queixas clínicas. DISCUSSÃO: O exame endoscópico das cavidades nasais não só permitiu identificar precocemente alterações da mucosa em pacientes com hanseníase como também permitiu identificar a evolução das lesões. Este tipo de exame também auxilia na instituição do tratamento local. CONCLUSÃO: Justificam-se a avaliação e o acompanhamento de todos os pacientes com hanseníase pelo Otorrinolaringologista junto à equipe multidisciplinar, oferecendo ao paciente a precocidade no diagnóstico e o tratamento específico.