Hansenologia internationalis最新文献

Socieconomic and sanitary characteristics of São Paulo State, where the Unified and Decentralized Health System (SUDS) is being developed, are described. SUDS basic strategy is the municipalization of primary health care. The Hanseniasis Control Program (GEPRO-hanseniasis), included in this context, is analysed under the point of view of administrative connections, objectives and performance. Special programs aiming at the absorption of new technology, such as multidrugtherapy and the early serological diagnosis of the disease, are also studied.

Lymphomatoid granulomatosis (LYG) was first described by LIEBOW, A.A. et al. Histologically is characterized by an lymphohistiocytic infiltrate with granulomatous features, polymorphous and pleiomorphic, angiocentric and angiodestructive and mainly involves lungs, skin, kidneys and CNS. LYG does not involves spleen, bone marrow and lymph nodes. Presently there is a concept that LYG is an angiocentric variant of T-cell peripheral lymphoma and histologically indistinguishable from polymorphic reticulosis of the upper airways (midline lethal granuloma). The prognosis for patients with LYG is guarded. Treatment with cyclophosphamide and prednisone may lead to remission in early cases. The skin is the most commonly involved extrapulmonary organ and in 13 to 34% of patients the skin lesions precede the pulmonary involvement. The clinical features of the skin lesions may vary, but frequently they are erythematous and violaceous plaque lesions or annular infiltrated lesions with central clearing. The differential diagnosis of these lesions includes granuloma annular, sarcoidosis and Hansen's disease. Since Hansen's disease is common among us and that LYG includes involvement of cutaneous branches and nerve trunks, with hypo or hyperesthesia in skin lesions and paresthesia of limbs, it is of utmost importance to make differential diagnosis. This report deals with a 42 years old male with cutaneous lesions of LYG and concomitant pulmonary and systemic manifestations. A first skin biopsy roughly suggested tuberculoid leprosy due to a granulomatous and perineural localization of cellular infiltrate. The patient died on respiratory insufficiency and the necropsy findings of the skin revealed important histological modifications. The infiltrate was more polymorphous, pleiomorphic and angiocentric. The same histological features were found in CNS, heart, digestive tract, liver, prostate, testes, lungs and kidneys. In these two last organs there were large nodules made of the characteristic cellular infiltrate and also large necrotic areas.

The present paper intends to show what coloration method for mycobacteria is the better. Samples was assessed and processed by hot Ziehl-Neelsen, cold Ziehl-Neelsen, Ziehl Gabbet and Ziehl-Neelsen with alkaline metilene blue. After microscopy by five different persons the method selected were the cold Ziehl-Neelsen.

All post graduated young doctors should be conscious of our major public health problems and should be able to diagnose and treat these endemic diseases. Hanseniasis is an infectious disease that has a special affinity by peripheric nerves and for that a high potential to produce disability and deformity leading to stigma and social out cast. There are 5,546,000 known patients on the world and the WHO estimates that the real figure is around 12 million in Brasil the registered number of patient is 259,000 but realistic estimations would increase it up to half a million. The disease spreads out all over Brasil but, in absolute figures the southeast region has the highest load. To cope with this problem one the basic actions is training and the teaching of hanseniasis in medical school is essential. As a systemic disease it should be present in all specialities involved leading to an increase of time devoted to the teaching of hanseniasis. This approach, which could be extended to other endemic diseases, will contribute to the eradication of many diseases that afflict our population. There is no reason for public health budget if there is no trained personal to use it.

A 75 years old white male, for 3 years on treatment for virchowian hanseniasis, was admitted with active HD lesions, infiltration on the base of right lung, leg ulcer and malaise. After two days he developed purpura and hemorrhagic blisters in the limbs. The biopsy of these lesions revealed Lucio phenomenon. The patient worsened with mental confusion, psychomotor agitation and anisocoric pupils. In the 18th day of internation the patient died. Necropsy revealed virchowian infiltration plenty of bacilli in the skin and viscera as well as tuberculoid granuloma with acid-fast bacilli in the liver, spleen and bone marrow. These findings lead us to review the patient's classification from virchowian to borderline. In the lungs, leptomeninge, renal papile, prostate and thyroid it was found loose tuberculoid granuloma with a great amount of fungi surrounded by a gelly halo resembling Criptococcus neoformans. These findings and the onset of Lucio phenomenon are discussed in a patient that has been treated for 3 years and still having several virchowian lesions and a great amount of acid-fast bacilli.

In the last decades the neural component of Hansen's disease has achieved its place of prime importance among other manifestations of the disease. Provided that there is a close relationship between neural involvement and deformities and that hitherto antileprosy drugs are able only to kill and prevent bacillary growth and not able to interrupt the immunological features of the disease, we can expect a significant load of patients with some degree of disability, including those in regular treatment. Surgery plays an important role in control programmes since it has not just the single aim to restore lost function but also to prevent further damage and to improve patient's self-confidence.

The authors report the isolation of two mycobacteria from armadillos livers and spleens, inoculated with Mycobacterium leprae in the Kato medium. They discuss this results.

This study was dedicated to the analysis the behaviour of the Hansen's, disease in Maringá, State of Paraná. Three hundred and forty eight clinical-epidemic cards were studied in patients who had Hansen's disease in the periods from 1977 to 1986. It was verified that the clinical forms Virchowian + Borderline had the highest percentual and prevailed in the age limit where people are economically active, concluding the same of a previous study which was performed by Belda & Lombardi and by Asseis et al. Tables and Figuras of the disease distribution are presented according to sex, origins, year of the detection, clinical form, age when it was diagnosed (the disease), time when symptoms appeared until the diagnosis with short comments, and its importance to the epidemic valuation of Hansen's disease in this city.