San-Martín Álvaro, Carrasco Cristián, Fica Alberto, Navarrete Maritza, Velásquez Juan Carlos, Herrera Tania
Hospital Base de Valdivia, Valdivia, Chile.
Programa Control y Eliminación Tuberculosis, MINSAL, Santiago, Chile.
Rev Chilena Infectol. 2018;35(6):722-728. doi: 10.4067/S0716-10182018000600722.
Hansen's disease (HD) is caused by Mycobacterium leprae. It has a chronic course and preferentially affects the skin and the peripheral nerves. It's an emergent infection in Chile due to migration waves. This case report affecting a migrant worker from Haiti that presented several compatible skin lesions, with hypoesthesia and unilateral madarosis that appeared before arrival. The diagnosis of a multibacillary form was established by clinical findings, presence of fast acid bacilli on a direct skin smear, and inflammatory cell surrounding nerve endings and granulomas on skin biopsy. Besides, specific rpoB and hsp65 gene segments from M. leprae were amplified from skin samples. Patient was treated with the WHO standard combined regimen for multibacillary forms during one year showing partial regression of skin lesions. Nasopharyngeal samples showed the presence of M. leprae rpoB copies detected by PCR decreasing until six months of therapy. Notifiable diseases databases showed a recent increment of cases, all related to migrant population. Hansen's disease is a new condition in Chile and clinicians should be aware of this possibility. Molecular tools may facilitate diagnosis and follow up.
麻风病（HD）由麻风分枝杆菌引起。其病程呈慢性，主要累及皮肤和周围神经。由于移民潮，它在智利成为一种新发感染病。本病例报告涉及一名来自海地的移民工人，其出现了多种符合症状的皮肤损害，伴有感觉减退和单侧睫毛脱落，这些症状在抵达之前就已出现。通过临床症状、直接皮肤涂片发现抗酸杆菌以及皮肤活检显示神经末梢周围有炎性细胞和肉芽肿，确诊为多菌型麻风。此外，从皮肤样本中扩增出了麻风分枝杆菌的特定rpoB和hsp65基因片段。患者接受了世界卫生组织针对多菌型麻风的标准联合治疗方案，为期一年，皮肤损害部分消退。鼻咽样本显示，通过聚合酶链反应（PCR）检测到的麻风分枝杆菌rpoB拷贝数在治疗六个月后逐渐减少。法定传染病数据库显示，近期病例有所增加，均与移民人口有关。麻风病在智利是一种新出现的疾病，临床医生应意识到这种可能性。分子工具可能有助于诊断和随访。
