Hansenologia internationalis最新文献

Twelve hanseniasis patients, undifferentiated group, with negative bacilloscopy and having undergone no prior treatment, were submitted to a biopsy of the cubial epineurium for histopathological study. All subjects were clinically observed after one month, and six of them were examined 4 to 5 years afterwards. Histopathology of the epineurium presented acid-fast bacilli in one patient and tuberculoid granuloma formation tendency in another. Epineural thickening was observed in nine patients and perivascular lymphomonocuclear inflammatory infiltration in six. The clinical examination after 1 month in the 12 patients as well as after 4 to 5 years in 6 of them, demonstrated innocuousness of the performed biopsy. Four to five years after the initial observation, the clinical examination showed that two patients who remained Mitsuda negative did not present histopathologically thickened epineurium at the beginning, while in four patients who then presented positive Mitsuda, the initial histopathological examination showed epineural thickening. Among the nine patients having a histopathologically thickened epineurium, six did not present initial lesions in the upper limbs. Therefore, the study of the cubital epineurium early thickening deserves special mention, and should be performed in a larger number of patients, as well as in control groups, since the follow-up of four among six patients showed epineural thickening and reversal of the Mitsuda reactions to positivity.

The number of patients treated for hanseniasis and cancer in Israel is not sufficient for a statistical analysis. A general conclusion about the incidence of cancer in hanseniasis patients has not been reached. The data presented may be perhaps useful for a comparison with those of other researchers interested in the subject.

Immersion of a hand in water at 38-40 degrees C for half an hour was performed in two phases with a one year interval in 38 patients with Hansen's disease and 20 controls. In all 20 controls wrinkles were produced. However, 32 of the 38 patients failed to show wrinkles in the fingertips. In 12, who participated in both phases, results of the second test confirmed those of the first. This may be an indication of irreversible damage. Due to the small number of individuals tested, no conclusions may be drawn in reference to groups and types of the disease. Provided that these results can be confirmed in larger groups of patients, this method could prove to be a tool in the diagnosis of Hansen's disease. Since the test is very easy to perform, it would be of great value in areas far from specialized medical centers.

The levels of total C3 (native C3 plus its degradation products) and the degree of conversion of native C3 into its breakdown products were studied in sera of Virchowian (V), tuberculoid (T), indeterminate (I), and Virchowian with erythema nodosum Hansenicum (ENH) patients. Sera from normal individuals (N) were also analysed. While the levels of total C3 were not significantly different among the groups, the percentage of conversion of C3 into its degradation products was significantly higher in V and ENH sera. The activation of the complement system and the involvement of immune complexes (IC) are discussed.

The beta-thalassemia trait was investigated among 165 Brazilians who were unmixed Italian descendants (80 Virchowian patients and 85 normal controls, composed of universitary students). The frequency of the beta-thalassemia trait was 6.25% among the Virchowian patients and 5.88% in the control group. In spite of the similar geographical distribution of both hanseniasis and the gene for beta-thalassemia in Asia, the present data does not support the hypothesis that hanseniasis might have contributed to maintain high prevalence of this allele by selection favouring beta-thalassemia trait.

The cell mediated immunity (CMI) to protein purified derivates of Mycobacterium leprae, Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium marinum was studied. Leukocyte Migration Inhibition (LMI) and Delayed Hypersensitivity skin reactions to these antigens were examined in 44 hanseniasis patients (20 quiescent Virchowians, 13 reactional Virchowians and 11 tuberculoid patients) and 15 healthy subjects. An impairment in LMI and Delayed Hypersensitivity tests to M. leprae and M. marinum was observed in Virchowians patients both quiescent and reactional. The CMI response to all mycobacterial antigens was increased in tuberculoid patients and was observed a poor response to M. leprae and M. marinum in healthy controls. Our results show a high correlation between the CMI response to M. leprae and to M. marinum (r = + 0,8). This close relationship between both antigens may express cross-reactivity.

The author introduces a new diagnostic technique to test skin sensitivity in hanseniasis. Sulphuric ether boils at 35 degrees C, i.e., practically at skin temperature. One gram of vaporized ether applied to the skin substracts 90 calories and causes a clear ice-cold sensation. By touching the cooled area with his fingertip the observer provokes a warm sensation. In hyposthetic skin that sensation of cold is diminished and in anesthetic areas there is no feeling of cold at all with this ether technique. The test is made with a small cotton ball wetted in sulphuric ether, which is lightly passed over the patient's skin. The subjective cooling sensation depends on the patient's information but sometimes it is accompanied by an objective "goose skin" aspect, which is especially useful when testing children and other non-cooperative persons. The technique is quite simple and much more practical and precise than the classic warm/cold tubes. It permits the mapping of the whole skin surface for disesthesic areas in a few minutes. Precautions regarding the use of ether are given.

Examination of intrafamilial contacts among the first degree relatives of 400 hanseniasis patients, revealed an additional 101 cases. Distribution pattern of disease types detected in the contacts, in relation to that found in the index cases, are analysed. An attempt has been made to evaluate the role of genetic factor in determining the type of hanseniasis in a patient.

The author describes the situation of endemic Hansen's disease in Parnaíba City (in the State of Piauí) in 1980. The epidemiologic rates showed an incidence of 31,67% and a prevalence of 2,67%. The author requires the attention of the Public Health Services for the important problem.