Sandra Lyon

Incidence and anatomic localization of oral candidiasis in patients with AIDS hospitalized in a public hospital in Belo Horizonte, MG, Brazil

The objective of this study was to evaluate the incidence, anatomic localization and yeast species isolated from each clinical type of oral candidiasis. The clinical samples were obtained from 67 patients with AIDS with CD4 cell counts below 200 cells/mm3 and hospitalized in a public hospital (Eduardo de Menezes Hospital) in the city of Belo Horizonte, MG, Brazil. Yeasts were isolated using Chromagar® Candida. The results show that 50.7% of these patients had oral candidiasis. The pseudomembranous form was the most frequent clinical manifestation of oral candidiasis, followed by the erythematous and angular cheilite forms. The most common site of these clinical forms of oral candidiasis was the tongue. Candida albicans was the most common yeast species isolated from the lesions. However, other species were also found to be associated with these forms of oral candidiasis.

Assessment of quality of life of patients with leprosy reactional states treated in a dermatology reference center

BACKGROUND Disabilities and deformities resulting from reactive outbreaks of leprosy can cause many problems for the patients, interfering with their quality of life. OBJECTIVES To assess the quality of life of patients with leprosy reactional states identified at the Reference Center in Belo Horizonte - MG. METHODS This was an epidemiological cross-sectional descriptive and analytical study, involving 120 patients in treatment for leprosy reactional states, from December 2007 to March 2008, held at the Dermatology outpatients clinic of the Hospital Eduardo de Menezes from FHEMIG, BH. We used two instruments for the socio-demographic, economic and clinical variables and a generic instrument WHOQOL WHO. The data were tabulated in SPSS and analyzed using the mean score with the application of statistical tests (p <0.05). RESULTS We found that the median age of the patients was 48 years, most were males, married, from cities around BH, with incomplete elementary school, retired or pensioner, and with a family income of two minimum wages. Most of them reported that the disease interfered a great deal with their professional activities and leisure. In the assessment of QoL, the lowest rating was observed in the physical domain and the highest was observed in the psychological and social relations. The internal consistency of WHO-QOL-bref was acceptable to the facets and domains. CONCLUSIONS Leprosy causes suffering that goes beyond the pain and discomfort strictly related to the physical damage, with great social and psychological impact.

Associação do teste sorológico ML Flow com a baciloscopia

A descriptive, exploratory study was conducted analyzing the association of covariables in the results of the ML Flow serological test and slit skin smear. A total of 60 leprosy cases diagnosed at the state Sanitary Dermatology Referral Center were investigated. Slit skin smear samples were collected from four sites and the results were expressed by the bacillary index. ML Flow was registered in both qualitative and semi-quantitative terms. Cohens kappa coefficient was used to study the agreement with Landis and Kochs observer criteria for interpretation. For statistical analysis, the logistic regression model and Kruskal-Wallis test were used. ML Flow showed a strong association with slit skin smear results, since a gradual increase in BI was accompanied by a semi-quantitative rise in antibody levels measured by ML Flow, with 100% positivity in cases presenting a positive slit skin smear. Given its strong correlation to slit skin smear, the results of this study provide evidence that the ML Flow test could be a valuable auxiliary tool in the classification and treatment of leprosy patients.

Comportamento dos testes sorológicos ML Flow e ELISA (PGL-I) em áreas endêmica e não endêmica de hanseníase

ML Flow and anti-PGL-I ELISA are serological tests that detect IgM antibodies against the phenolic glycolipid I (PGL-I), specific to Mycobacterium leprae. To evaluate the outcomes of ML Flow and ELISA (PGL-I) serological tests in leprosy-endemic areas in comparison to non-endemic ones, a total of 351 volunteers from Brazil and Chile were examined, including leprosy patients, healthy controls and others affected by other infectious or non-infectious diseases that are common differential diagnoses for leprosy. The ELISA cut-off point was established using the ROC Curve method (>or= 0.157). In endemic areas, 70% of leprosy patients present positive ML Flow results and 53.3% were ELISA-positive. In non-endemic areas, ML Flow was negative in all the subjects tested and ELISA was positive in 4 volunteers. ML Flow is faster and more easily performed and, therefore, a more adequate test for use in basic, primary-level health care centers. ELISA requires trained personnel, in addition to a more complex laboratory infrastructure.

Correlation between ELISA and ML Flow assays applied to 60 Brazilian patients affected by leprosy

Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The investigation involved 60 patients with newly diagnosed leprosy. Together with the application of the serological assays, selected demographic, clinical and epidemiological data relating to the study population were recorded. ML Flow detected anti-PGL1 antibodies in 70% of the leprosy patients, while ELISA was positive in 53.3%. The degree of concordance between the tests was substantial (83.3%). A positive correlation was demonstrated between the results obtained in the semi-quantitative ML Flow test and ELISA absorbance values. We concluded that both serological assays were found to be efficient in detecting anti-PGL1 antibodies. The ML Flow test may be a cheaper and easier to perform alternative to ELISA in leprosy patients.

A case of eumycetoma due to Madurella grisea in northern Brazil

A case of mycetoma caused by the black fungus Madurella grisea in northern Brazil is reported. The lesion was located on the patient’s right foot without bone involvement. Clinical samples were collected by opening the fistules with a scalp and the grains removed for microbiological and histopathological analyses. Although mycetoma caused by M. grisea has been previously reported in Brazil, this is the first time that of this fungus has been identify in this particular region of the country.

Plasma levels of chemokines during leprosy specific treatment.

Leprosy, whose etiologic agent is Mycobacterium leprae, is an illness of ample clinical and immunopathological spectrum. Although chemokines seem to be involved in the immunopathogenesis of leprosis, few studies have been carried out to unveil the potential of chemokines as biological markers of the disease. The purpose of this study was to investigate the value of measuring CCL2, CCL3, CCL11 and CCL24 in plasma of patients with leprosy (LE) at different stages of multi-drug therapy (MDT). Chemokines were measured by ELISA in plasma of 30 non-infected individuals (NI) and 33 LE patients before and at different stages of treatment. The plasma concentration of CCL11 (p<0.01) and CCL24 (p<0.05) was increased in LE patients before treatment when compared to NI individuals. The plasma concentration of CCL24 decreased after MDT (p<0.05). No differences were observed in the concentration of CCL2 and CCL3 in plasma of NI and LE individuals. The elevated levels of CCL11 and CCL24 in plasma of patients with LE suggest that these chemokines may play a role in disease pathogenesis. Moreover, the decrease of CCL24 after treatment suggests that this chemokine might be useful as a biomarker of response to MDT in patients with leprosy.

A influência do teste sorológico ML Flow na classificação da hanseníase

This is a descriptive, exploratory study correlating ML Flow, bacilloscopy and classification of paucibacillary (PB) and multibacillary (MB), involving 1,041 new leprosy cases in 13 municipalities of Minas Gerais State, from October 2002 to March 2004. Agreement between ML Flow and the classification of the number of skin lesions and bacilloscopy was moderate (K:0.51 and K:0.48, respectively); and substantial for final classification (K:0.77). From January 2000 to March 2004, the proportion of new MB cases in Minas Gerais decreased from 78.1 to 65.8%. The reduction in the percentage of MB cases was higher in health centers that participated in the ML Flow study (73.1% to 53.3%). The difference between PB and MB in the participating and non-participating health centers from January to March 2004 was statistically significant. Implementation of the ML Flow test influenced the classification of patients, suggesting a direct and beneficial impact on patient treatment and the control of the leprosy endemic in Minas Gerais, Brazil.

Cytokines as biomarkers to monitoring the impact of multidrug therapy in immune response of leprosy patients

&NA; Leprosy or Hansens disease is a chronic infectious disease of the skin and nerves, caused by the intracellular bacilli Mycobacterium leprae. It is characterized by a spectrum of clinical forms depending on the hosts immune response to M. leprae. Patients with tuberculoid (TT) leprosy have strong cell‐mediated immunity (CMI) with elimination of the bacilli, whereas patients with lepromatous (LL) leprosy exhibit defective CMI to M. leprae. Despite advances in the understanding of the pathogenesis of leprosy and the development of new therapeutic strategies, there is a need for the identification of biomarkers which be used for early diagnosis and to discrimination between different forms of the disease, as prognostic markers. Here, we analyzed the serum levels of IL‐1&bgr;, IL‐6, IL‐8, IL‐10, IL‐12p70, IL‐13, IL‐17A, IFN‐&ggr; and TNF in order to address the contribution of these cytokines in late phase of M. leprae infection, and the impact of multidrug therapy (MDT). Our results demonstrated that patients of LL group presented higher expression of serum levels of inflammatory cytokines before MDT, while TT patients presented a balance between inflammatory and regulatory cytokines. MDT changes the profile of serum cytokines in M. leprae infected patients, as evidenced by the cytokine network, especially in TT patients. LL patients displayed a multifaceted cytokine system characterized by strong connecting axes involving inflammatory/regulatory molecules, while TT patients showed low involvement of regulatory cytokines in network overall. Cytokines can be identified as good biomarkers of the impact of MDT on the immune system and the effectiveness of treatment. HighlightsCytokines are biomarkers of immune response and efficacy of multidrug therapy.Leprosy shows an unbalance between inflammatory and regulatory cytokines.Multidrug therapy leads to distinct impact in cytokine profile of leprosy patients.

Study of the profile of the neurotrophin BDNF in new leprosy cases before, during and after multidrug therapy.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in the survival of neurons and growth and differentiation of dendrites and axons. The purpose of the present study was to evaluate plasma levels of BDNF of leprosy patients at different stages of multidrug therapy (MDT) in comparison with non-infected individuals. Plasma levels of BDNF were measured by ELISA in 30 healthy controls and 37 leprosy patients at diagnosis, during and after MDT. Plasma levels of BDNF tended to be higher in control subjects in comparison with leprosy patients, but this difference does not reach statistical significance. Interestingly, BDNF levels changed following MDT, achieving statistical difference only at the 2(nd) dose of MDT. These results indicate that BDNF may not be a surrogate marker of leprosy infection and/or related neuropathy. Further research is needed to investigate the meaning of BDNF level changes following leprosy treatment.