Treatment Of Leprosy Research Articles

Clofazimine: Can it be Useful in COVID 19?

Clofazimine is a riminophenazine dye originally used as an antitubercular agent after its first synthesis in 1954, just few years after it was administered as a treatment for leprosy by YT Chang. In the following years, also an anti-inflammatory effectiveness on erythema nodosum leprosum was recognized [1]. In the ‘70s, its therapeutic activity on discoid lupus erythematosus and pyoderma gangrenosum was documented [2]. The safety of Clofazimine is good with a median frequency of the most reported adverse event (skin discoloration and gastrointestinal events) of 5.1% and a requiring discontinuation of the treatment in 0.1% of cases [3].

Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication?

Leprosy disease remains an important public health issue as it is still endemic in several countries. Mycobacterium leprae, the causative agent of leprosy, presents tropism for cells of the reticuloendothelial and peripheral nervous system. Current multidrug therapy consists of clofazimine, dapsone and rifampicin. Despite significant improvements in leprosy treatment, in most programs, successful completion of the therapy is still sub-optimal. Drug resistance has emerged in some countries. This review discusses the status of leprosy disease worldwide, providing information regarding infectious agents, clinical manifestations, diagnosis, actual treatment and future perspectives and strategies on targets for an efficient targeted delivery therapy.

From relief to life, the last memory of leprosy sanatorium: investigation and patient interview in Wukang sanatorium

Zhejiang Wukang sanatorium evolved from Hangchow C. M.S. Hospital, which was founded in 1887. It is the leprosy prevention and treatment center of Zhejiang Province after the founding of the People's Republic of China. Most of the leprosy patients (convalescents)in sanatoriums entered the hospital successively in 1960s. Due to the limitation of dapsone monotherapy and the poor living conditions, the convalescents need to receive long-term isolation treatment and engage in collective production. After the implementation of Reform and Opening-up policy, the leprosy patients' health care has been greatly improved. The leprosy prevention and treatment course has been gradually reduced; the widespread knowledge of leprosy gradually freed leprosy patients from the dilemma of being stigmatized. In the post-leprosy era, Wukang sanatorium changed from the original focus on disease treatment to strengthening the psychological construction of patients. Its function changed from isolation and prevention to rest and pension, and the status of leprosy patients changed from "patients" to "convalescents" . These changes reflect the humanistic care and guidance of destigmatization in the process of leprosy isolation and epidemic prevention from prevention to treatment to the aged.

Human macrophage polarization in the response to Mycobacterium leprae genomic DNA.

Infection with Mycobacterium leprae, the causative organism of leprosy, is still endemic in numerous parts of the world including the southwestern United States. The broad variation of symptoms in the leprosy disease spectrum range from the milder tuberculoid leprosy (paucibacillary) to the more severe and disfiguring lepromatous leprosy (multibacillary). The established thinking in the health community is that host response, rather than M. leprae strain variation, is the reason for the range of disease severity. More recent discoveries suggest that macrophage polarization also plays a significant role in the spectrum of leprosy disease but to what degree it contributes is not fully established. In this study, we aimed to analyze if different strains of M. leprae elicit different transcription responses in human macrophages, and to examine the role of macrophage polarization in these responses. Genomic DNA from three different strains of M. leprae DNA (Strains NHDP, Br4923, and Thai-53) were used to stimulate human macrophages under three polarization conditions (M1, M1-activated, and M2). Transcriptome analysis revealed a large number of differentially expressed (DE) genes upon stimulation with DNA from M. leprae strain Thai-53 compared to strains NHDP and Br4923, independent of the macrophage polarization condition. We also found that macrophage polarization affects the responses to M. leprae DNA, with up-regulation of numerous interferon stimulated genes. These findings provide a deeper understanding of the role of macrophage polarization in the recognition of M. leprae DNA, with the potential to improve leprosy treatment strategies.

Type 2 lepra reaction presenting as nasal septal perforation: A case report

Lepra reactions, the acute exacerbations occurring during the otherwise chronic course of leprosy, are an important cause for deformities. Reactions can occur before, during, or after completion of treatment of leprosy.

Cardiovascular disease risk factors and markers of oxidative stress and DNA damage in leprosy patients in Southern Nigeria.

Leprosy reduces quality of life of affected persons. Oxidative stress caused by reactive oxygen species may play a vital role in the pathogenesis of leprosy. This study evaluated anthropometric indices, fasting plasma glucose (FPG), lipid profile, total antioxidant capacity (TAC), total plasma peroxide (TPP), oxidative stress index (OSI), malondialdehyde (MDA), glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdg) in leprosy patients. Sixty test participants of both genders, aged 18-65years and diagnosed of multibacillary leprosy and 30 apparently healthy controls were consecutively recruited for this study. The test participants comprised of 30 patients on multidrug therapy (MDT) and 30 patients relieved from therapy (RFT). Body mass index (BMI), Waist-hip ratio (WHR), FPG, lipid profile, TAC, TPP, OSI, MDA, GSH and 8-OHdg were determined using appropriate methods. Data were analyzed using Analysis of variance; p<0.05 was considered statistically significant. The MDT group had significantly lower BMI (p = 0.0001), Total cholesterol (p = 0.001), HDL-C (p = 0.019), LDL-C (p = 0.005), TAC (p = 0.0001) and higher TPP (p = 0.001), MDA (p = 0.0001), OSI (p = 0.005) and 8-OHdg (p = 0.035) compared to the controls. The RFT group had significantly lower BMI (p = 0.001) Total cholesterol (0.0001), HDL-C (p = 0.006) LDL-C (p = 0.0001), TAC (p = 0.001) and higher WHR (p = 0.010), VLDL-C (p = 0.035), TG (p = 0.023) Atherogenic index of plasma (p = 0.0001) and TPP (p = 0.001), MDA (p = 0.0001) compared to the control group. GSH levels correlated negatively with duration of treatment (r = -0.401, p = 0.028). This study has shown that there is oxidative stress in multibacillary leprosy patients irrespective of drug treatment status. This study also shows that leprosy patients relieved from treatment may be susceptible to cardiovascular events. Antioxidants supplementation may be beneficial in the treatment of leprosy and clinical follow up on patients relieved from treatment may also be necessary to monitor health status and prevent development of cardiovascular events.

Leprosy treatment: Can we replace opinions with research?

Leprosy treatment: Can we replace opinions with research?

The State of Affairs in Post-Exposure Leprosy Prevention: A Descriptive Meta-Analysis on Immuno- and Chemo-Prophylaxis.

ObjectiveAnnually, over 200,000 people are diagnosed with leprosy, also called Hansen’s disease. This number has been relatively stable over the past years. Progress has been made in the fields of chemoprophylaxis and immunoprophylaxis to prevent leprosy, with a primary focus on close contacts of patients. In this descriptive meta-analysis, we summarize the evidence and identify knowledge gaps regarding post-exposure prophylaxis against leprosy.MethodsA systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted by searching the medical scientific databases Cochrane, Embase, Pubmed/MEDLINE, Research Gate, Scopus and Web of Science on Jan. 22, 2020, using a combination of synonyms for index terms in four languages: “leprosy” and “population” or “contacts” and “prevention” or “prophylaxis.” Subsequently, Infolep.org and Google Scholar were searched and the "snowball method" was used to retrieve other potentially relevant literature. The found articles were screened for eligibility using predetermined inclusion and exclusion criteria.ResultsAfter deduplication, 1,515 articles were screened, and 125 articles were included in this descriptive meta-analysis. Immunoprophylaxis by bacillus Calmette-Guérin (BCG) vaccination is known to provide protection against leprosy. The protection it offers is higher in household contacts of leprosy patients compared with the general population and is seen to decline over time. Contact follow-up screening is important in the first period after BCG administration, as a substantial number of new leprosy patients presents three months post-vaccination. Evidence for the benefit of re-vaccination is conflicting. The World Health Organization (WHO) included BCG in its Guidelines for the Diagnosis, Treatment and Prevention of Leprosy by stating that BCG at birth should be maintained in at least all leprosy high-burden regions. Literature shows that several vaccination interventions with other immunoprophylactic agents demonstrate similar or slightly less efficacy in leprosy risk reduction compared with BCG. However, most of these studies do not exclusively focus on post-exposure prophylaxis. Two vaccines are considered future candidates for leprosy prophylaxis: Mycobacterium indicus pranii (MiP) and LepVax. For chemoprophylaxis, trials were performed with dapsone/acedapsone, rifampicin, and ROM, a combination of rifampicin, ofloxacin, and minocycline. Single-dose rifampicin is favored as post-exposure prophylaxis, abbreviated as SDR-PEP. It demonstrated a protective effect of 57% in the first two years after administration to contacts of leprosy patients. It is inexpensive, and adverse events are rare. The risk of SDR-PEP inducing rifampicin resistance is considered negligible, but continuous monitoring in accordance with WHO policies should be encouraged. The integration of contact screening and SDR-PEP administration into different leprosy control programs was found to be feasible and well accepted. Since 2018, SDR-PEP is included in the WHO Guidelines for the Diagnosis, Treatment and Prevention of Leprosy.ConclusionProgress has been made in the areas of chemoprophylaxis and immunoprophylaxis to prevent leprosy in contacts of patients. Investing in vaccine studies, like LepVax and MiP, and increasing harmonization between tuberculosis (TB) and leprosy research groups is important. SDR-PEP is promising as a chemoprophylactic agent, and further implementation should be promoted. More chemoprophylaxis research is needed on: enhanced medication regimens; interventions in varying (epidemiological) settings, including focal mass drug administration (fMDA); specific approaches per contact type; combinations with screening variations and field-friendly rapid tests, if available in the future; community and health staff education; ongoing antibiotic resistance surveillance; and administering chemoprophylaxis with SDR-PEP prior to BCG administration. Additionally, both leprosy prophylactic drug registration nationally and prophylactic drug availability globally at low or no cost are important for the implementation and further upscaling of preventive measures against leprosy, such as SDR-PEP and new vaccines.

Legal Authorities and their Legislative Priorities: The Treatment of Leprosy in the Sources of Canon Law

Abstract This essay considers medieval leprosy in ecclesiastical legislation through the lens of legal pluralism, that is the range of normative orders that are independent from the “state” as a monolithic entity. It focuses on the period between the mid-eleventh and the turn of the fourteenth century marked by efforts at church reform, by the proliferation of leprosaria, and by canonical interest in matrimonial law. It argues that the environment in which various legal authorities worked influenced how they engaged with leprosy. The policies they enacted resulted from a negotiation of their circumstances and needs, which were not necessarily the same. The result was a rich and overlapping legal tradition that, over time, coalesced into a comprehensive legislative policy that both protected the rights of the afflicted as well as the safety of the healthy. The first section of this essay sets forth research on leprosy and the arguments to be pursued. The second section argues that the “old law” in canonical collections used leprosy as an allegory for sin and as a metaphor for simony in pursuit of personal reform and renewal. The third section focuses on the proliferation of leprosaria and argues that the challenge of arranging for pastoral care fell on the shoulders of councils and prelates making policy at the regional or local level. The fourth section argues that the papacy and jurists worked parallel to other legislative bodies. Yet it would be the requests to which the papacy responded and the importance of juridical commentary as a source clarifying the legal ambiguities in these responses that would provide the inroad for the papacy, acting similar to the proverbial “state”, to normalize ecclesiastical life and Christian society.

Leprosy reactions: a prospective study at tertiary care hospital of South Gujarat

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Clinical diagnosis of early leprosy lesions is important as it is one of the leading causes of physical disabilities which cause social stigma leading to discrimination &amp;amp; isolation. Its diagnosis is based upon detailed cutaneous examination along with peripheral nerves. The objectives were to study associations between reaction types with type of leprosy and various deformities and disabilities relating to treatment for leprosy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a hospital-based prospective, cross-sectional observational study. 110 clinically diagnosed Leprosy patients with reactions visiting Dermatology OPD were analysed after obtaining informed consent. Participants’ data were collected for demographic criteria, clinical history, past medical history and family history. Clinical examination of a study participant was performed. Collected data was entered in Microsoft excel worksheet and analysed for frequency distribution. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; All subjects were in a mean age of 38.03±14.37 years.13.64% patients had positive family history of leprosy. 59 (53.64%) and 51 (46.36%) cases were of type 1 and type 2 reactions, respectively. Out of 59 patients with type 1 reaction, the most common presenting symptom was inflammation of pre-existing lesion observed in 35 (59.32%) cases while the most common presenting symptom of type 2 reactions was erythema nodosum leprosum seen in 34 (66.67%) cases. Type 1 reaction presented histopathologically as upgrading (67.80%) and downgrading reactions (5.08%). Histopathological finding in type 2 reaction were neutrophillic infiltration with macrophage granuloma seen in 54.90% cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; It is important to identify reactions associated with leprosy and its treatment as they can significantly alter the morbidity of an affected individual.&lt;/p&gt;

Trends of the leprosy control indicators in Benin from 2006 to 2018

BackgroundLeprosy, or Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. The purpose of this study was to describe the epidemiological characteristics of leprosy in Benin from 2006 to 2018.MethodsThis descriptive retrospective study included data from January 2006 to December 2018. The data of all patients treated in the leprosy treatment centres (LTCs) of the Republic of Benin were obtained from the LTC registers and analysed using Stata/SE 11.0 software. Quantum GIS (Geographic Information System) version 2.18.23 software was used for mapping. The main indicators of leprosy were calculated according to the World Health Organization (WHO) recommendations.ResultsDuring the study period, a total of 2785 (annual average of 214) new cases of leprosy were diagnosed. The median age of the patients was 38 years, with extremes ranging from 6 to 88 years. The sex ratio (males/females) was 1.18 (1509/1276). The departments of Plateau, Atacora, and Zou were the most endemic; their leprosy detection rate per 100,000 population during these thirteen years were 6.46 (479/7414297), 5.38 (534/9932880) and 5.19 (526/10134877), respectively. The leprosy detection rate declined from 3.8 to 1.32 per 100,000 inhabitants. The proportion of paediatric cases varied from 8.56 to 2.67% as the proportion of multibacillary forms increased from 72.95 to 90%. From 2006 to 2018, 622 leprosy patients detected had grade 2 disability (G2D) at screening, indicating an average rate of 5.06 (622/122877474) cases with G2D per million population. The proportion of grade 2 disabilities increased from 21.23 to 32% during the study period. The majority of new leprosy cases among foreign-born persons were Nigerian (85.71%). The completion of multidrug therapy (MDT) for paucibacillary (PB) and multibacillary (MB) leprosy cases ranged from 96.36 to 95.65% and from 90.53 to 94.12%, respectively.ConclusionIn Benin, leprosy remains a major health challenge; it is important to revitalize the epidemiological surveillance system to achieve its elimination by 2030.

Diagnosis and Management of Leprosy

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which tends to attack peripheral nerves and skin. The diagnosis of leprosy is based on the presence of one of three cardinal signs. Early diagnosis of leprosy is critical and is made through clinical examination and investigation. Purpose: To discuss the diagnosis, laboratory examination, and treatment of leprosy, considering that early diagnosis and appropriate treatment are the key elements in breaking the chain of transmission and preventing leprosy patients' disabilities. Review: Leprosy is a chronic granulomatous infectious disease caused by the Mycobacterium leprae. Based on clinical appearance, histopathology findings, and immunological, leprosy is grouped into six forms using the Ridley-Jopling classification, namely Tuberculoid (TT), Borderline Tuberculoid (BT), Borderline-borderline Mid-borderline (BB), Borderline-lepromatous (BL), Subpolar Lepromatous (LLs), and Polar Lepromatous (LLp). Based on the treatment category, leprosy is grouped into paucibacillary (PB) and multibacillary (MB). Leprosy is often diagnosed clinically, and skin scraping smear remains the preferred laboratory method. The negative results of smear skin scraping may not necessarily exclude leprosy. Therefore, a higher sensitivity test might be needed to detect M. leprae. Treatment with Multi-Drug Therapy (MDT) is adjusted based on the type of leprosy, whether it belongs to the PB or MB group. Treatment of PB type, regimens are rifampicin and dapsone, while in MB type, the patients received rifampicin, dapsone, and clofazimine regimens. Conclusion: A proper diagnosis for leprosy, both through physical examination and laboratory examination, is required to determine an effective MDT treatment and break the chain of disease transmission.

Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.

Unfavorable Attitude and Perceived Stigma towards Leprosy: A Concern for Status Perpetuation in a Community in Cross River State, Nigeria

Background: Negative attitude and stigma against leprosy patients constrain them to resort to concealing their status thus resulting in delayed detection, treatment, complications and perpetuation of the condition in the locality. This study was aimed at finding out the prevailing attitude and stigma toward leprosy in the community with a view to addressing the fueling factors.&#x0D; Materials and Methods: It was descriptive cross sectional study. Semi-structured interviewer administered questionnaires were used for data collection. Explanatory Model Interview Catalogue (EMIC), was used to grade stigma against leprosy amongst participants. Answers to questions in the questionnaire were assigned scores which were summed up into percentage breakpoints. A respondent was interpreted as having favorable or unfavorable attitude to leprosy depending on his or her percentage sum of score.&#x0D; Stigma was categorized based on the sum of an individual’s EMIC score as high, moderate or low level of stigma. Data were analyzed using SPSS version 20.&#x0D; Results: The study revealed that only 44(15%) of respondents had favorable attitude towards leprosy whereas 250(85%) had unfavorable attitude towards this group. Attitude to leprosy was observed to be significantly related to age and sex of respondent, religion and ethnicity, p-value&lt; 0.05. EMIC profile of the study respondents revealed that 47(16%) demonstrated low stigma, 81(28%) demonstrated moderate stigma and 166(56%) demonstrated high stigma towards leprosy. There was no statistically significant relationship between stigma and socio-demographic variables.&#x0D; Conclusion: Misunderstanding and misconceptions about leprosy and leprosy patients is still well rooted in the norms and culture of the people of Ikun, breeding negative attitude and stigma toward leprosy. Vigorous leprosy awareness programs structured along the lines of attitude-stigma influencing socio-demographic variables, with emphasis on the cause, transmission, diagnosis and treatment of leprosy will help to stem the tide of myths and misconceptions.

Coexistence of mycobacterial infections \u2013 Mycobacterium tuberculosis and Mycobacterium leprae \u2013 in Sri Lanka: a case series

BackgroundLeprosy is one of the oldest mycobacterial infections and tuberculosis is the most common mycobacterial infection with a higher degree of infectivity than leprosy. Although both diseases are prevalent in clusters in developing countries, simultaneous occurrence of them in an individual is a rare entity, even in an endemic setting.Case presentationWe describe six cases of tuberculosis and leprosy coinfection: a 57-year-old Sinhalese woman, a 47-year-old Tamil woman, a 72-year-old Tamil man, a 59-year-old Sinhalese man, a 54-year-old Sinhalese man, and a 50-year-old Sinhalese man. In this case series, five patients had lepromatous leprosy and the majority of patients were men. Three patients were detected to have tuberculosis at the outset of treatment of leprosy, while two developed tuberculosis later and one had extrapulmonary tuberculosis 5 years before the diagnosis of leprosy. The latter developed pulmonary tuberculosis as a reactivation while on treatment for leprosy. A majority of our patients with pulmonary tuberculosis had positive Mantoux test, high erythrocyte sedimentation rate, radiological evidence, and acid-fast bacilli in sputum. Human immunodeficiency virus and diabetes were detected in one patient. One patient had rifampicin-resistant tuberculosis, while she was on monthly rifampicin therapy for leprosy.ConclusionAn immunocompromised status, such as human immunodeficiency virus infection, diabetes, and immunosuppressive drugs, are risk factors for tuberculosis infection. The use of steroids in the treatment of leprosy may increase the susceptibility to develop tuberculosis. Development of rifampicin resistance secondary to monthly rifampicin in leprosy is a major concern in treating patients coinfected with tuberculosis. Despite the paucity of reports of coinfection, it is advisable to screen for tuberculosis in patients with leprosy, especially if there are respiratory or constitutional symptoms, high erythrocyte sedimentation rate, and abnormal chest X-ray. The fact is that positive Mantoux and QuantiFERON Gold tests and presence of acid-fast bacilli in sputum are misleading, chest X-ray evidence of active tuberculosis and positive tuberculosis cultures are important diagnostic clues for active tuberculosis infection in a patient with leprosy. This is important to avoid monthly rifampicin in patients with suspected coinfections, which may lead to development of drug resistance to tuberculosis treatment. Whether prolonged steroid therapy in leprosy is a risk factor for development of tuberculosis is still controversial.

Assessment of direct shoot organogenesis and genetic fidelity in Solanum viarum Dunal—a commercially important medicinal plant

Solanum viarum Dunal is an important medicinal plant with a high quantity of steroidal alkaloids used for the synthesis of contraceptives, corticosteroids, and sex hormones. It is also used by Indian tribal people for the treatment of leprosy, toothache, and diabetes. Therefore, to meet the existing needs for this plant, it is necessary to develop an efficient regeneration system useful for rapid and large-scale clonal propagation with ensured genetic fidelity. An efficient and improved regeneration protocol for prickly and prickleless genotypes of S. viarum has been developed using three explants, leaf, petiole, and internodes, under the influence of two plant growth regulators, thidiazuron (TDZ) and 6-benzyladenine (BA). Effects of genotype, explant type, and concentrations of TDZ and BA were studied. A higher percentage of shoot organogenesis (78.25% ± 2.53) and shoot number per explant (6.79 ± 1.04) were achieved in the leaf segments of prickly genotype cultured on modified Murashige and Skoog (MS) medium supplemented with TDZ (1.50 mg L−1). Furthermore, basal leaf segments showed 100% regeneration from the prickly genotype. A significantly higher content of total phenolics was quantified in prickleless (3.66 μg mg−1) than prickly genotypes (2.73 μg mg−1). The monomorphic banding pattern of random amplified polymorphic DNA (RAPD) and simple sequence repeats (SSR) analysis confirmed the genetic fidelity of the regenerated plants. Additionally, flow cytometric analysis of regenerants showed no variation in the ploidy levels when compared to the mother (control) plants. These results clearly depicted the efficiency of developed protocol that can be utilized for generating genetically stable population of S. viarum.

Estudo da dispensação da talidomida no tratamento da hanseníase pela Assistência Farmacêutica do Município de Araguaína-TO

A talidomida foi amplamente prescrita no passado por seus efeitos contra enjôos matinais de gravidas, no entanto, muitas crianças foram afetadas por seus efeitos teratogênicos até então desconhecidos, alguns anos depois o fármaco vem sendo utilizado no tratamento do Eritema Nodoso Hansêmico (ENH). O presente estudo visa analisar a dispensação da talidomida no tratamento da hanseníase por meio da Assistência farmacêutica (AF), que utiliza o método de consultório no município de Araguaína-TO. Objetivando averiguar a dispensação e analisar o método empregado, além de revisar o tratamento da hanseníase com a talidomida. Trata-se de um estudo retrospectivo de prontuários referentes às dispensações de talidomida no tratamento da hanseníase, obtidos pela Assistência Farmacêutica nos anos de 2013 a 2018. Através disto, foi desenvolvida uma planilha como instrumento de trabalho, onde foram obtidos os dados de cada usuário referente ao gênero, número de pacientes, idade e reações frequentes, e assim traçar o perfil do usuário em tratamento de hanseníase atendido pela AF e ressaltar o atendimento realizado no consultório farmacêutico, uma iniciativa pioneira no Brasil.

Treatment of histoid leprosy: a lack of consensus.

Histoid leprosy is a rare variant of leprosy with a unique clinical presentation and bacilli rich histology. These patients are large reservoirs for disease and vectors for spread, making prompt diagnosis and treatment crucial. To date, no consensus on treatment and duration exists. This paper aims to investigate the efficacy, safety, and duration of varying treatment regimens in patients with histoid leprosy. A systematic PubMed review of all articles published before January 2020 containing the key words histoid leprosy. All patients included must have completed their prescribed treatments with comment on outcomes and treatment duration. The review generated 165 articles containing 62 cases that met inclusion criteria. A majority of cases reported excellent clinical outcomes with limited adverse events. Regimens included variations of rifampicin, dapsone, clofazimine, minocycline, ofloxacin, and sulforthormadine with most treatment duration lasting 12 or 24months. Existing literature is limited to case reports or case series and may be subject to publication bias of successful cases. Many reports lack quantifiable data regarding outcomes and rely on clinical judgment. Continued observation for complete clearance or relapse was limited. The findings demonstrate that multibacillary-multidrug therapy is an efficacious and safe treatment for histoid leprosy. No significant differences were observed between 12 and 24months of treatment. There remains no consensus on treatment duration for histoid leprosy.

Characterization of the Rifamycin-Degrading Monooxygenase From Rifamycin Producers Implicating Its Involvement in Saliniketal Biosynthesis.

Rifamycin derivatives, such as rifampicin, have potent antibiotic activity and have long been used in the clinic as mainstay components for the treatment of tuberculosis, leprosy, and AIDS-associated mycobacterial infections. However, the extensive usage of these antibiotics has resulted in the rapid development of bacterial resistance. The resistance mechanisms mainly include mutations of the rifamycin target RNA polymerase of bacteria and enzymatic modifications of rifamycin antibiotics. One modification is the recently characterized rifamycin degradation catalyzed by Rox enzymes, which belong to the widely occurring flavin monooxygenases. Intriguingly, our recent sequence analysis revealed the rifamycin producers also encode Rox homologs that are not yet characterized. In this work, we expanded the study of the Rox-catalyzed rifamycin degradation. We first showed that the Rox proteins from rifamycin producers have the enzymatic rifamycin SV-degrading activity. Then we used the structurally diverse rifamycin compounds rifampicin and 16-demethylrifamycin W to probe the substrate scope and found that they each have a slightly different substrate scope. Finally, we demonstrated that Rox proteins can also catalyze the transformation of 16-demethylsalinisporamycin to 16-demethylsaliniketal A. Since 16-demethylsalinisporamycin and 16-demethylsaliniketal A are the counterpart analogs of salinisporamycin and saliniketal A, our biochemical findings not only uncover a previously uncharacterized self-resistance mechanism in the rifamycin producers, but also bridge the gap between the biosynthesis of the potential antitumor compound saliniketal A.

The implementation of an integrated e-leprosy framework in a leprosy control program at primary health care centers in Indonesia

Background and ObjectiveThe implementation of health information systems (HIS) could overcome obstacles in human resources and infrastructure at primary health care centers (PHCs). This study involved an e-Leprosy framework being integrated into the real setting of a leprosy control program in Indonesia. The objectives of this implementation study were to integrate e-Leprosy into a leprosy control program at 27 PHCs in Pekalongan District. Central Java Province, Indonesia to explore factors related the success or failure of such an implementation regarding the usability, involvement, and acceptance of e-Leprosy by PHC staff and to evaluate the effect of the implementation on leprosy patient attendance at PHCs. This paper is based on the Standards for Reporting Implementation Studies (StaRI) statement. MethodThis study used mixed methods implementation research with longitudinal analysis and involved two groups of participants: Leprosy Surveillance Officers (LSOs), patients, and the relatives of patients. This study involved four phases consisting of preparation, baseline assessment, intervention, and evaluation. The qualitative study conducted focus group discussions and in-depth interviews. The e-Leprosy program automatically sent SMS reminders regarding leprosy treatment to the LSOs, patients, and patients’ relatives every month. FindingsThis study determined that LSO had difficulties related to their workloads in PHCs while managing information and monitoring treatment and contact after release from treatment. The baseline assessment phase found that LSOs in Pekalongan District were unfamiliar with email but familiar using the internet. Overall, LSOs had a positive perception of the e-Leprosy program. The usability of this e-Leprosy program tended to increase over time, while acceptance of the e-Leprosy exhibited a significant relationship with computer and internet fluency (r = 0.48, p < 0.05) and age (r = 0.621, p < 0.01). The responsible patients correlated (r = 0.67, p < 0.01) with involvement in the e-Leprosy program. This study revealed that patient reminders increased on-time attendance by 13.9 % (p < 0.01 with OR = 2.41). ConclusionFactors that should be considered during implementation HIS included the digital gap, PHC’s staff workload, as well as the level of commitment and leadership in the health office.