More than 200,000 new cases of leprosy were reported by 105 countries in 2011. The disease is a public health problem in Brazil, particularly within high-burden pockets in the Amazon region where ...leprosy is hyperendemic among children.
We applied geographic information systems and spatial analysis to determine the spatio-temporal pattern of leprosy cases in a hyperendemic municipality of the Brazilian Amazon region (Castanhal). Moreover, we performed active surveillance to collect clinical, epidemiological and serological data of the household contacts of people affected by leprosy and school children in the general population. The occurrence of subclinical infection and overt disease among the evaluated individuals was correlated with the spatio-temporal pattern of leprosy.
The pattern of leprosy cases showed significant spatio-temporal heterogeneity (p<0.01). Considering 499 mapped cases, we found spatial clusters of high and low detection rates and spatial autocorrelation of individual cases at fine spatio-temporal scales. The relative risk of contracting leprosy in one specific cluster with a high detection rate is almost four times the risk in the areas of low detection rate (RR = 3.86; 95% CI = 2.26-6.59; p<0.0001). Eight new cases were detected among 302 evaluated household contacts: two living in areas of clusters of high detection rate and six in hyperendemic census tracts. Of 188 examined students, 134 (71.3%) lived in hyperendemic areas, 120 (63.8%) were dwelling less than 100 meters of at least one reported leprosy case, 125 (66.5%) showed immunological evidence (positive anti-PGL-I IgM titer) of subclinical infection, and 9 (4.8%) were diagnosed with leprosy (8 within 200 meters of a case living in the same area).
Spatial analysis provided a better understanding of the high rate of early childhood leprosy transmission in this region. These findings can be applied to guide leprosy control programs to target intervention to high risk areas.
Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children.
We selected two ...elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups.
Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in "positive houses" compared to "negative houses" (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years.
Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.
Photobiomodulation therapy (PBMT) has been used in several musculoskeletal disorders to reduce pain, inflammation, and promoting tissue regeneration. The current evidence about the effects of PBMT on ...low back pain (LBP) is still conflicting. We aimed to evaluate the effects of PBMT against placebo on pain intensity and disability in patients with chronic nonspecific LBP. This was a prospectively registered, randomised placebo-controlled trial, with blinded patients, therapists, and assessors. The study was conducted on an outpatient physical therapy clinic in Brazil, between April 2017 and May 2019. A total of 148 patients with chronic nonspecific LBP were randomised to either active PBMT (n = 74) or placebo (n = 74). Patients from both groups received 12 treatment sessions, 3 times a week, for 4 weeks. Patients from both groups also received an educational booklet based on "The Back Book." Clinical outcomes were measured at baseline and at follow-up appointments at 4 weeks, 3, 6, and 12 months after randomisation. The primary outcomes were pain intensity and disability measured at 4 weeks. We estimated the treatment effects using linear mixed models following the principles of intention-to-treat. There was no clinical important between-group differences in terms of pain intensity (mean difference = 0.01 point; 95% confidence interval = -0.94 to 0.96) and disability (mean difference = -0.63 points; 95% confidence interval = -2.23 to 0.97) at 4 weeks. Patients did not report any adverse events. Photobiomodulation therapy was not better than placebo to reduce pain and disability in patients with chronic nonspecific LBP.
Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological ...examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.
IntroductionLow back pain (LBP) is one of the largest and most frequent public health problems worldwide. Photobiomodulation therapy (PBMT) is a frequently used non-pharmacological therapy for the ...treatment of musculoskeletal disorders. However, there is little high-quality scientific evidence that demonstrates the effectiveness of PBMT in the treatment of patients with chronic LBP in the short, medium and long term. Therefore, the objective of this clinical trial is to evaluate the effects of PBMT in patients with chronic non-specific LBP in the short, medium and long term.Methods and analysesThis is a prospectively registered, two-arm randomised placebo-controlled trial with blinded patients, assessors and treatment providers. One hundred and forty-eight patients with chronic non-specific LBP will be recruited. Treatment sessions will be provided three times a week for 4 weeks (totaling 12 sessions) with patients receiving either placebo or active PBMT. For ethical reasons, all patients, regardless of treatment allocation, will also receive an information booklet based on ‘The Back Book’. Clinical outcomes will be measured at baseline, at the end of treatment, as well as 3, 6 and 12 months after randomisation. The primary outcomes will be pain intensity and disability measured after 12 sessions of treatment. The secondary outcomes will be pain intensity and disability measured at 3, 6 and 12 months after randomisation, in addition to specific disability and global perceived effect in all time points.Ethics and disseminationThe study was approved by the Research Ethics Committee of Universidade Cidade de São Paulo. The results will be disseminated through scientific publications and presentations at national and international scientific meetings.Trial registration number NCT03089424.
We investigated the prevalence of antibodies against PGL-I in people affected by leprosy (PAL) who were diagnosed and treated between 2004 and 2010, their household contacts (HC) and school children ...(SC) from a hyperendemic municipality in the Brazilian Amazon, and determined the prevalence of previously undiagnosed leprosy (PPUL) among both the HC and SC.
We conducted a cross-sectional study involving 87 PAL, 302 HC and 188 SC. The subjects were clinically assessed, and their levels of anti-PGL-I antibodies were determined by ELISA. The subjects were also interviewed to determine their demographic and socio-economic characteristics.
For PAL, a mean of 44 (SD = 21.8) months had passed since their initial diagnosis, and 34 (39%) of them remained seropositive. The level of anti-PGL-I antibodies was significantly higher in multibacillary (MB) than in paucibacillary (PB) cases (P < 0.05). Thirty-nine percent of HC were positive for anti-PGL-I, and we detected eight (2.6%) new cases among these individuals. One hundred and twenty-five SC (66.5%) were seropositive, and we detected nine (4.8%) new cases of leprosy (eight PB and one MB) in this group. When we visited the homes of SC affected by leprosy, 31 contacts were clinically examined, and three (10%) new cases were detected (one PB and two MB). The mean age of students with leprosy was 14.1 years (SD = 2.5; min = 10, max = 18).
The seroepidemiology of anti-PGL-I and the PPUL among both HC and SC suggests that there are many active foci of infection and that Mycobacterium leprae is circulating among this population.
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Previous issue date: 2013
A incapacidade física é o principal problema da hanseníase. Apesar do sucesso da poliquimioterapia (PQT) no tratamento da doença, sabe-se que cerca de 25% a 50% dos pacientes podem ter algum dano do nervo e desenvolver incapacidades físicas, classificada pela Organização Mundial de Saúde (OMS) como grau de incapacidade física (GIF) 0 para sensibilidade normal, sem deformidades visíveis, 1 para a sensibilidade diminuída, sem alterações visíveis, ou 2 para deficiências visíveis / deformidade. De 2004 a 2010 o Brasil registrou 21,7% dos casos como sendo GIF 1 e 7% como GIF 2, enquanto que no Estado do Pará, 15,3% dos pacientes foram diagnosticados com GIF 1, e 5,1% com GIF 2 no momento do diagnóstico de hanseníase. A fim de investigar as incapacidades físicas em pacientes curados, examinamos as funções sensitivo-motoras de 517 pessoas afetadas pela hanseníase, notificados 2004 a 2010 em oito municípios hiperendêmicos da Amazônia brasileira, correlacionando os achados com aspectos epidemiológicos e sócio-econômico, e comparando com os dados encontrados no Sistema Nacional de Informação de Agravos de Notificação (SINAN). Adicionalmente, 2164 contatos intradomiciliares dos pacientes visitados foram avaliados clinicamente em busca de sinais e sintomas da doença. As visitas domiciliares dos pacientes constaram de avaliação clínica, avaliação neurológica simplificada e determinação do GIF, realização de entrevista sobre suas características demográficas e sócio-econômicas. O GIF 1 foi encontrado em 16,2% e DG 2 em 12,4% dos pacientes avaliados. Foi encontrada uma correlação estatisticamente significativa entre as formas multibacilares (MB) e o GIF 1 ou 2 (p <0,001), incapacidade física e o sexo masculino (p <0,001); incapacidade ocorreu em casos acima de 40 anos de idade (p <0,001). Mais da metade (50,5%) dos casos não tinha cicatriz de BCG, correlacionada com idades mais elevadas (p <0,001), casos MB (p <0,001), e com incapacidade (p <0,005). Por fim, embora SINAN informe apenas 5,6% de casos com GIF 2, encontramos 12,4% durante nossas visitas. Entre os contatos, foram diagnosticados 181 casos novos, 127 (70,2%) foram diagnosticados como multibacilares e 17,1% apresentaram incapacidade física, sendo 5,5% GIF 2. A ocorrência de deficiência física foi predominante em pacientes MB, homens,> 40 anos de idade e sem cicatriz de BCG, todos os fatores de risco importantes para o desenvolvimento de deficiência. As diferenças de GIF encontradas no SINAN e no nosso estudo sugerem piora das funções sensório-motor após a alta da PQT, indicando a importância do acompanhamento destes pacientes por anos depois de terminar o tratamento MDT. A alta taxa de detecção de casos novos diagnosticados neste estudo reflete o baixo índice de avaliação de contatos no estado do Pará (58,8%), perpetuando o diagnóstico tardio. Os achados clínicos sugerem a existência de prevalência oculta e alto índice de infecção subclínica na amostra estudada, indicando necessidade de avaliação clínica periódica.
Physical disability is the main problem of leprosy. Despite multidrugtherapy (MDT) success in treating leprosy, it is known that about 25%>50% of patients may have some nerve damage and develop physical disabilities, classified by WHO disability grading (DG) as 0 for normal sensation, no visible impairments, 1 for impaired sensation, no visible impairments, or 2 for visible impairments/deformity. From 2004 to 2010 Brazil registered 21,7% of the cases as DG 1, and 7% as DG 2, while in Pará State 15,3% of the patients were diagnosed with DG 1, and 5,1% with DG 2 on the diagnosis of leprosy. In order to investigate physical disabilities in MDT cured patients, we examined the sensory-motor functions of 517 people affected by leprosy reported from 2004 to 2010 in eight hyperendemic municipalities of the Brazilian Amazon Region, correlating our findings with epidemiological and socio-economic features, and comparing with data found at the National Information System for Notifiable Diseases (SINAN). Additionally, 2164 household contacts of leprosy patients were clinically evaluated for signs and symptoms of leprosy. Patients’ home visits were planned with clinical assessment, simplified neurological evaluation and determination of DG, together with an interview about their demographic and socio-economic characteristics. DG 1 was found on 16,2% and DG 2 on 12,4% of the patients evaluated. It was found a statistically significant correlation between multibacillary (MB) forms and DG 1 or 2 (p<0.001); physical disability and males (p<0.001); impairment and age over 40 years-old (p<0.001). More than half (50,5%) of the cases did not have a BCG scar, and this was correlated to higher ages (p<0.001), MB cases (p<0.001), and disability (p<0.005). Finally, although SINAN showed only 5,6% of DG 2, we found 12,4% during our visits. Among the household contacts were diagnosed 181 new case, 127 (70,2%) were MB forms and 17,1% had physical disability, 5,5% DG 2. The occurrence of physical disability was predominant in MB patients, males, >40 years-old and no BCG scar, all important risk factors for developing disability. The differences of DG found in SINAN in contrast to our study suggest worsening of the sensory-motor functions after discharge from MDT, indicating the importance of monitoring these patients for years after finishing MDT treatment. The high rate of detection in this study reflects the low level of evaluation of household contacts in Pará (58,8%), perpetuating the late diagnosis. Clinical findings suggest that there is a high rate of undiagnosed leprosy and subclinical infection in our sample, indicating a need for periodic clinical evaluation.
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