Martelli C M, Stefani M M, Gomes M K, Rebello P F, Peninni S, Narahashi K, Maroclo A L, Costa M B, Silva S A, Sacchetim S C, Nery J A, Salles A M, Gillis T P, Krahenbuhl J L, Andrade A L
Universidade Federal de Goias, Instituto de Patologia Tropical e Saude Publica, Rua Delenda Rezende de Mello, S/N, Setor Universitario, Goiania/GO, Brazil.
Int J Lepr Other Mycobact Dis. 2000 Sep;68(3):247-57.
In Brazil, there is little information about the clinical and epidemiological characteristics of paucibacillary, single skin lesion leprosy patients (SSL-PB). Only recently has the official notification system distinguished leprosy patients with a single lesion as a clinical entity, for whom the single-dose ROM (rifampin, ofloxacin and minocycline) regimen has been recommended. In this paper, we describe the baseline clinical features and the immunological background of a multicenter cohort of SSL-PB leprosy cases enrolled between December 1997-1998. Patients were recruited at health centers located in the following regions: Southeast = Rio de Janeiro; North = Amazon and Rondônia states and Center-West = Goiás state. Eligible cases were newly detected, untreated single-lesion leprosy patients without thickened nerve involvement, and were assessed by clinical, bacilloscopic and histopathological exams. The Mitsuda skin test and anti-PGL-I serology (ELISA) were also performed. Of the 299 SSL-PB leprosy patients, 259 (86.6%) fulfilled the criteria for single-dose ROM intervention. Our results showed that patients recruited from different sites had similar features, considering the clinical and immunological profiles. There was a predominance of adults (mean age 32.4; S.D. = 16.0), and a BCG scar was detected in 76.7% of the children (< or = 15 years old). Only 7 cases were diagnosed as the multibacillary type, representing less than 3% of the patients being misclassified. Our data indicate that in Brazil SSL-PB case ascertainment based on clinical and bacilloscopic criteria can be accurately defined under a routine control program; 75.0% of SSL-PB cases were Mitsuda positive (> or = 5 mm) and seropositivity for anti-PGL-I was detected in 17.3% of the patients. These data are compatible with effective cell-mediated immunity and low bacillary load, suggesting favorable clinical outcomes for most SSL-PB participants of this cohort.
在巴西，关于少菌型单皮损麻风患者（SSL-PB）的临床和流行病学特征的信息很少。直到最近，官方通报系统才将单皮损麻风患者作为一种临床实体区分出来，并推荐了单剂量ROM（利福平、氧氟沙星和米诺环素）治疗方案。在本文中，我们描述了1997年12月至1998年期间登记的多中心SSL-PB麻风病例队列的基线临床特征和免疫背景。患者在以下地区的卫生中心招募：东南部=里约热内卢；北部=亚马逊州和朗多尼亚州；中西部=戈亚斯州。符合条件的病例为新发现的、未经治疗的单皮损麻风患者，无神经粗大，通过临床、细菌学和组织病理学检查进行评估。还进行了麻风菌素皮肤试验和抗PGL-I血清学（ELISA）检测。在299例SSL-PB麻风患者中，259例（86.6%）符合单剂量ROM干预标准。我们的结果表明，从不同地点招募的患者在临床和免疫特征方面具有相似的特点。以成年人为主（平均年龄32.4岁；标准差=16.0），76.7%的儿童（≤15岁）有卡介苗接种疤痕。仅7例被诊断为多菌型，占误诊患者的比例不到3%。我们的数据表明，在巴西，基于临床和细菌学标准的SSL-PB病例确诊可以在常规控制项目下准确界定；75.0%的SSL-PB病例麻风菌素试验阳性（≥5mm），17.3%的患者抗PGL-I血清学阳性。这些数据与有效的细胞介导免疫和低菌负荷相一致，表明该队列中大多数SSL-PB参与者的临床结局良好。
