Anti-neutrophil cytoplasmic antibodies (ANCA) in the clinical forms of leprosy

Anti-neutrophil cytoplasmic antibodies (ANCA) are autoantibodies against enzymes present in primary granules of neutrophils and lysosomes of monocytes detected in systemic vasculitis and in other diseases, including infections, ANCA are markers of active Wegener granulomatosis, which presents some anatomo-pathologic and immune response features similar to those of leprosy. Thus, we raised the hypothesis that ANCA may be present in leprosy as markers specifically linked to the presence of vasculitis. The aim of this study was to determine the presence of ANCA in leprosy and its correlation with the clinical forms of the disease. Sera from 60 normal individuals and from 59 patients with different clinical forms of leprosy were studied. The patients were also allocated into reactional and nonreactional groups. By indirect immunofluorescence, ANCA were positive, an atypical pattern A-ANCA, in 28.8% of the patient sera. A-ANCA predominated, although not significantly (p >0,05), in the reactional groups (37.9% vs 20.0%), and in those at the lepromatous pole (41.6% vs 20.0%). There was no correlation between ANCA positivity and either disease duration, disease activity, or therapeutic regimen (p >0.05), An interesting finding was the correlation between ANCA and gender: 94.1% of ANCA-positive patients were males (p <0.01), a feature that so far has not been reported in ANCA-related diseases and for which there is no explanation at the moment. By ELISA, the sera of the lepromatous leprosy patients did not show activity against either PR3, MPO, HLE, the most common ANCA antigens. Because A-ANCA are nonspecific, this finding requires further investigation for the determination of the responsible antigen(s), in conclusion, A-ANCA are present in 28.8% of leprosy patients but are not related to vasculitis in the erythema nodosum leprosum reaction and are not a marker of a specific clinical form.

Renal lesions in leprosy: A retrospective study of 199 autopsies

In the present work, 199 patients with leprosy who underwent autopsy between 1970 and 1986 were retrospectively studied to determine the prevalence, types, clinical characteristics, and etiologic factors of renal lesions (RLs) in leprosy. Patients were divided into two groups: 144 patients with RLs (RL+) and 55 patients without RLs (RL-), RLs observed in 72% of the autopsied patients were amyloidosis (AMY) in 61 patients (31%), glomerulonephritis (GN) in 29 patients (14%), nephrosclerosis (NPS) in 22 patients (11%), tubulointerstitial nephritis (TIN) in 18 patients (9%), granuloma in 2 patients (1%), and other lesions in 12 patients (6%), AMY occurred most frequently in patients with lepromatous leprosy (36%; nonlepromatous leprosy, 5%; P < 0.01), recurrent erythema nodosum leprosum (33%; P < 0.02), and trophic ulcers (27%; 0.05 < P < 0.10), Ninety-seven percent of AMY was found in patients with lepromatous leprosy, 88% showed recurrent trophic ulcers, and 76% presented with erythema nodosum leprosum, NPS was found in older patients with arterial hypertension, neoplastic diseases, infectious diseases, and vasculitis associated with GN, Most patients with AMY presented with proteinuria (95%) and renal failure (88%), the most frequent causes of death were renal failure in patients with AMY (57%), infectious diseases in patients with GN (41%) and TIN (45%), and cardiovascular diseases in patients with NPS (41%), No difference in survival rates was observed among RL- patients and those with AMY, GN, NPS, or TIN. (C) 2001 by the National Kidney Foundation, Inc.

Ticks associated with armadillo (Euphractus sexcinctus) and anteater (Myrmecophaga tridactyla) of Emas National Park, State of Goias, Brazil

This study was conducted in October 1998 and November 1999 in the Emas National Park (131,868 ha), a savanna-type cerrado region situated in the far south of Goias State, Brazil, near the geographic center of South America (15degrees-23degrees S; 45degrees-55degrees W). Animals were captured with the aid of nets and anesthetized (15 mg/kg ketamine + 1 mg/kg xylasine) in order to collect ticks for identification and to establish laboratory colonies. They included giant anteaters (Myrmecophaga tridactyla) (n = 4) and yellow armadillos (Euphractus sexcinctus) (n = 6). Free-living ticks (larvae, nymphs, and adults) were collected from the field by using a 1 X 2-m flannel cloth. Free-living ticks were identified as Amblyomma sp., A. cajennense, and A. triste. Adult ticks collected from anteaters were identified as Amblyomma cajennense and A. nodosum and from armadillos as A. pseudoconcolor and A. nodosum. The relevance of these host-tick relationships to possible mechanisms underlying emergence of tick-borne pathogens of importance to public health is discussed.

A REAPPRAISAL OF GENERIC AND SUBGENERIC CLASSIFICATION IN THE BATRACHOSPERMACEAE (RHODOPHYTA)

The generic and subgeneric classification of the family Batrachospermaceae (Rhodophyta) has long been recognized as ambiguous and often inconsistent. One of the prime features used to delineate sections of Batrachospermum, trichogyne shape, is variable even within given species. However, characters associated with the carposporophyte and the carpogonial branch, as well as carpogonial symmetry, are practical and consistent taxonomic criteria. These features have been used to redefine sectional delineation in Batrachospermum. Based on phylogenetic reasoning and practicality, it is proposed that the three genera Nothocladus, Sirodotia and Tuomeya be reduced to sectional level within Batrachospermum. The genus Batrachospermum would thus become the sole member of the Batrachospermaceae and would include two subgenera, Batrachospermum and Acarposporophytum, the former with nine clearly defined sections (Aristata, Batrachospermum, Contorta, Hybrida, Nothocladus (Skuja) stat. nov., Sirodotia (Kylin) stat. nov., Tuomeya (Harvey) stat. nov., Turficola and Viridia). As a result, the following nomenclatural changes are proposed: Batrachospermum lindaueri (Skuja) comb. nov., B. nodosum (Skuja) comb. nov., B. delicatulum (Skuja) comb. nov., B. fennicum (Skuja) comb. nov., B. suecicum (Kylin) comb. nov. and B. americanum (Kutzing) comb. nov.

Species diversity and seasonality of free-living ticks (Acari : Ixodidae) in the natural habitat of wild Marsh deer (Blastocerus dichotomus) in Southeastern Brazil

This study evaluated the presence and seasonal activity of free-living ticks in remaining marsh areas by the Parana river, in Brazil. Eight field trips (once per season) for collection of ticks were performed during 2 years. Using CO2 traps, dragging, and visual inspection of vegetation, five free-living tick species were collected, in the following order of abundance: Amblyomma cajennense, Amblyom\ma dubitatum, Amblyomma triste, Amblyomma coelebs, and Amblyomma nodosum. The seasonal pattern of A. cajennense was characterized by the highest peaks for adult ticks in the summer/spring months, for nymphs in the winter and for larvae in the autumn and winter. A. dubitatum and A. triste presented similar seasonal patterns characterized by peaks of adult ticks in the autumn. Nymphs of A. dubitatum peaked in the winter of the first year and in the winter/spring of the second year. A. triste was the only species to be collected in significantly higher numbers in the marsh than in surrounding drier areas such as forest patches. Among domestic animals living close the marsh areas, horses were infested by Anocentor nitens, A. cajennense, and Boophilus microplus, bovines were infested solely by B. microplus, and dogs were infested by Rhipicephalus sanguineus. Adults of A. triste showed to be well adapted to the marsh environment. This result, at least partially, explains local previous observations on the association of A. triste with marsh deer, as this vertebrate host inhabits mainly the marsh area. (c) 2006 Published by Elsevier B.V.

Ticks (Acari: Ixodidae) associated with wild animals in the Pantanal region of Brazil

This paper describes the identification of ticks from wild animals of the Pantanal region in Brazil as part of a comprehensive study about established and emerging tick-host relationships and related pathological aspects. Eighty-one animals were captured (representing 13 species six orders), and ticks were found on 63 (78%). Tick species identified included Boophilus microplus (Canestrini), Amblyomma cajennense (F.), Amblyomma parvum Aragão, Amblyomma pseudoconcolor Aragão, Amblyomma scalpturatum Neumann, Amblyomma nodosum Neumann, Amblyomma ovale Koch, and Amblyomma tigrinum Koch. Dragging from grasslands yielded negative results compared with the high concentration of ticks that were collected from leaves in the forests.

Ticks associated with wild animals in the Nhecolândia Pantanal, Brazil

A study of ticks associated with wild animals was carried out from September 1996 to April 1998 at the Fazenda Alegria (21,000 ha), in the Nhecolândia Pantanal, State of Mato Grosso do Sul, Brazil, a sunken plain bordering the upper Paraguay river, located 19 × 08′S; 56 × 46′W. A total of 81 wild animals (13 species, 6 orders) were captured with the aid of nets, and ticks were found on 63 (78%). Tick species identified included Boophilus microplus (Canestrini), Amblyomma cajennense (F.), A. parvum (Aragão), A. pseudo-concolor (Aragão), A. scalpturatum (Neumann), A. nodosum (Neumann), A. ovale (Koch), and A. tigrinum (Koch). Dragging from grasslands (campos) yielded negative results compared to the high concentration of ticks, mainly nymphs, that were collected from leaves in the forests (capão). Predominance of immature instars (Amblyomma genera) was observed in the end of winter (August-September). Ticks were associated mainly with coatis, deer (Mazama gouazoubira) and anteater, and these animals may play a role in the epidemiology of tick-transmitted pathogens in the Pantanal if one considers their coexistence with local domestic animals.

Importância de Yersinia enterocolitica em microbiologia médica

Y. enterocolitica is a human invasive enteropathogen which causes a number of intestinal and extraintestinal clinical symptoms of various degrees of severity, ranging from mild gastroenteritis to mesenteric lymphadenitis, which mimics appendicitis and in rare cases can evolve to septicemia. Infection by Y. enterocolitica can also lead to post-infection immunological sequelae including arthritis, erythema nodosum and glomerulonephritis. Pathogenic Y. enterocolitica strains have traditionally been linked to specific biotypes and serogroups and associated to a variety of phenotypic characteristics related to virulence. Molecular genetics studies have pointed to the importance of the pYV virulence plasmid, which encodes various virulence genes, as well that of specific chromosomal virulence genes, in determining the pathogenesis of this bacterium. Intestinal infections by Y. enterocolitica are mostly self-limiting and usually do not need an antibiotic treatment. The occurrence of this microorganism is not as frequently described in Brazil as it is in other countries, such as Japan, USA and many European countries. This review focuses on the general characteristics, pathogenesis, clinical symptoms, virulence characteristics, treatment and antibiotic susceptibility of Yersinia enterocolitica strains isolated in Brazil and around the world.

Estudo terapêntico comparando a associação de rifampicina, ofloxacina e minociclina com a associação rifampicina, clofazimina e dapsona em pacientes multibacilar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Talidomida usada por pacientes com eritema nodoso hansênico

A talidomida é um fármaco utilizado atualmente no tratamento do eritema nodoso hansênico no Brasil. Métodos: Estudo prospectivo para acompanhar a evolução clínica, registrar os eventos adversos e determinar as concentrações plasmáticas de talidomida em dose diária de 100mg/dia, em 20 pacientes com manifestações clínicas de eritema nodoso hansênico, divididos em dois grupos: após ou em curso da poliquimioterapia para hanseníase. Resultados: Não foram observadas diferenças significativas nos grupos no decorrer do estudo, tanto na evolução clínica favorável dos pacientes, de 70% e 90%, quanto nos eventos adversos registrados que foram tontura e sonolência. Os teores plasmáticos de talidomida em D7 e D14 foram de 0,82±0,4µg/mL e 0,79±0,3µg/mL no grupo 1 e de 0,82±0,4 e 1,55±1,0 no grupo 2, respectivamente. Conclusões: Na amostra estudada, a poliquimioterapia não interferiu na evolução clínica, na incidência dos efeitos adversos e nos níveis plasmáticos de talidomida.

Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients

BACKGROUND: Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE: The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS: Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS: Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION: Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results.

Reações hansênicas em pacientes coinfectados com HIV/Hanseníase: Clínica e ibmunopatologia

O Brasil é um dos poucos países que permanece endêmico para a infecção pelo vírus da imunodeficiência humana (HIV) e hanseníase, e estas doenças têm grande impacto em custos sociais e em qualidade de vida. Embora seja reconhecida a relevância desta coinfecção, vários aspectos ainda não são totalmente compreendidos. Este estudo tem como objetivo descrever aspectos clínicos, histopatológicos e imunopatológicos dos estados reacionais de pacientes coinfectados HIV/hanseníase, comparando-os aos pacientes com hanseníase, sem HIV. Foram acompanhados, dois grupos: (1) com 40 pacientes coinfectados HIV/hanseníase; (2) com 107 pacientes com hanseníase. Prevaleceram indivíduos do sexo masculino em ambos os grupos. No Grupo 1, a maioria eram paucibacilar (70%), na forma borderline tuberculóide (45%) e com menor risco de ter reação hansênica em relação aos não coinfectados. Todos os coinfectados que apresentaram reação hansênica (n= 15) estavam em uso de Terapia Anti-retroviral (TARV), e a maioria no estado de aids (n=14), sendo a Síndrome da Reconstituição Imune (SRI) uma condição clínica marcadamente importante em muitos destes pacientes (n=7). No grupo dos não coinfectados, o padrão de infecção da maioria foi multibacilar (80.4%), forma borderline-borderline (40.2%), e com Risco Relativo maior de apresentar reações hansênicas (p = 0,0026). A reação reversa foi a mais frequente em ambos os grupos. No grupo de coinfectados observaram-se lesões dermatológicas com aspecto de acordo com o esperado para cada forma clínica, em geral, eritemato infiltradas, com evolução semelhante aos sem coinfecção. O edema na derme foi o achado histopatológico mais comum em ambos os grupos. No Grupo 1, foram encontradas células gigantes, em todos os histopatológicos e em maior quantidade (2+) e de tamanho grande. A morfologia do eritema nodoso hansênico não apresentou diferenças significantes entre os grupos, assim como a expressão de IL-1β e IL-6. Este estudo corrobora com as hipóteses de que o quadro clínico e imunopatológico das reações nestes pacientes é um quadro inflamatório ativo, e não de anergia, semelhante ao encontrado nos não coinfectados.

Prevention of repeated episodes of type 2 reaction of leprosy with the use of thalidomide 100 mg/day

BACKGROUND: Leprosy can have its course interrupted by type 1 and 2 reactional episodes, the last named of erythema nodosum leprosum (ENL). Thalidomide has been the medication of choice for the control of ENL episodes since 1965. OBJECTIVES: These episodes can repeat and cause damages to the patient. In order to prevent these episodes, an extra dose of 100 mg/day thalidomide was used during six months, followed by a follow-up period of six more months after thalidomide discontinuation. METHODS: We included 42 patients with multibacillary (MB) leprosy who had episodes of ENL. They were male and female patients aged between 18 and 84 years. RESULTS: Of the 42 patients, 39 (92.85%) had the lepromatous form and three (7.15%) had the borderline form. We found that 100% of patients had no reactional episode during the use of the drug. During the follow-up period after thalidomide discontinuation, 33 (78.57%) patients had no reactional episode and nine (21.43%), all of them with the lepromatous form, had mild episodes, which were controlled using non-steroidal anti-inflammatory. There were no thalidomide-related side effects. CONCLUSION: A maintenance dose of 100 mg/day of thalidomide showed to be effective to prevent repeated type 2 reactional episodes of ENL.

Synthesis and evaluation of novel dapsone-thalidomide hybrids for the treatment of type 2 leprosy reactions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)