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D V Opromolla

Publications and source records attributed to D V Opromolla.

At least 19 recordsLinked to original sources
PubMed2001

Factors influencing the development of leprosy: an overview.

The clinical manifestations of leprosy vary, seemingly depending on the host's immune response. Mode and route of infection, such as skin versus nasal mucosa, insect bites, sexual and gastroenteral transmission, together with genetic factors that may contribute to the outcome of the infection, including HLA, Lewis factor, Nramp1 and more subtle inherited alterations, are discussed. It is theorized that a balance between host responses elicited by different routes of infection and size and spacing of inocula is responsible for the clinical and immunological manifestations of the disease. Genetic factors and contact with environmental microorganisms may modulate these responses. The final result, resistance, delayed-type hypersensitivity, tolerance, disease or no disease, spectrum and reactions, is most likely reached via the orchestration of the induced cyto- and chemokines.

Humans↗
PubMed2001

No evidence of linkage between Mitsuda reaction and the NRAMP1 locus.

Thirty sib-pairs were ascertained through unrelated lepromatous probands. They consisted of 22 healthy individuals and 8 leprosy patients. The Mitsuda reactions of all sibs were evaluated both macroscopically and histologically, and high molecular weight genomic DNA was extracted from the white blood cells of all sib-pairs. Three DNA polymorphisms identified by polymerase chain reaction (274C/T, D543N, 1729 + 55del4) were used as chromosome markers at the NRAMP1 locus. Sib-pair comparisons did not disclose any sign of close linkage between the Mitsuda reaction and the genetic markers.

Adult↗
PubMed1998

Serial Mitsuda tests for identification of reactional tuberculoid and reactional borderline leprosy forms.

The authors studied the Mitsuda reaction in 37 leprosy patients (18 reactional tuberculoid, 19 reactional borderline cases) and compared the results with clinical findings, histopathology and bacilloscopy. Evaluation of the Mitsuda reaction was carried out on days 30, 60, 90 and 120. Most of the reactional tuberculoid patients showed a Mitsuda reaction of +3 in opposition to the reactional borderline patients who showed only +. Bacilloscopic analysis revealed that in 75% of the reactional tuberculoid cases there were rare or no bacilli; bacilli were present in 95% of the reactional borderline cases. The authors conclude that reactional tuberculoid cases have a greater ability to clear bacilli than reactional borderline cases, and that the Mitsuda reaction is a useful tool for the differentiation between these two types of leprosy.

Adolescent↗
PubMed1996

Results of a surveillance system for adverse effects in leprosy's WHO/MDT.

The implementation of the World Health Organization's multidrug therapy (WHO/MDT) in Brazil began slowly and gradually in 1986, and in 1991 it was adopted officially by the Brazilian Ministry for Health. After 1991, during the intensive phase of WHO/MDT implementation, there was some concern about the number of cases of renal failure observed in several Brazilian states, including some fatalities. This was the motive behind the state of São Paulo's Health Department's decision to carry out a study that would evaluate not only the incidence rate of adverse effects of rifampin in relation to kidney function but also in relation to the use of WHO/MDT in general. Due to the existence in the state of São Paulo of health services with a program for the control of Hansen's disease and an organized and stratified system of epidemiological surveillance, it was possible to elaborate a subsystem for data collecting. During the period from July 1991 to December 1993, 20,667 patients were treated with WHO/MDT. Among this group there were 127 notifications considered as adverse effects, mainly: "flu"-like syndrome (54), acute renal failure (20), cutaneous reactions (15), toxic hepatitis (15), gastrointestinal complaints (8), hemolytic anemia (6), methemoglobinemia (4), thrombocytopenic purpura (2), hypotension (2) and disseminated intravascular coagulation (1). There was a predominance of adverse effects among multibacillary (MB) patients and the majority of the reactions occurred before the 6th dose; 82.7% of MB patients had had previous treatment with dapsone and rifampin and, due the fact that most severe reactions were related to rifampin, a booster mechanism could be an explanation for this occurrence. So far, there are seven published reports on renal failure in the world, and in Brazil only in the state of Søao Paulo there were 20 cases reported among 20,667 patients under WHO/MDT treatment, This striking difference deserves a better explanation, but in no way do these reports undermine the positive aspects of WHO/MDT. However, the authors believe that a world alert about its possible serious side effects is not only necessary but ethically required.

Drug Therapy, Combination↗
PubMed1990

[An estimation of the prevalence of hanseniasis by research in non-specific demand for health services].

In view of the importance of knowing the prevalence and incidence rates of a disease to learn about its behavior and control at the collective level, a study was undertaken to determine the occurrence of hanseniasis among the clients of health agencies and to explore the use of this methodology for estimating the epidemiologic "iceberg" of the disease, i.e., the total number of cases including those that are not officially reported. The city of Taubaté in the Paraíba Valley, State of S. Paulo, Brazil, was chosen for the study. All clients aged 15 years or older were screened regardless of variables such as sex, age, social condition or marital status. The study was based on what is known about the populational distribution of the disease and the characteristics of health services. In view of the local peculiarities of operationalization (e.g., identity of the different clientele, availability of offices, hours of greatest flux), the sampling process used was simple randomization. The patients with active disease detected, 40 of the 10,013 persons examined, correspond to a prevalence of 3.99/1000, with a confidence interval (at the 5% level of reliability) of 3,365 to 4,625/1000, indicating that the minimum estimated increase of prevalence is of the order of 52% and the maximum estimated increase is of the order of 109%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Myocardial disease, heart failure and reactional tuberculoid leprosy].

A 60-year-old woman was admitted with congestive heart failure, essential hypertension and abdominal distension. Her son reported that she appeared with red spots in the body and that she was under dapsone therapy. Seven months ago there was sudden increase of the skin lesions. In the 11th day after admission she underwent a stroke that progressed to decerebration and she expired on the fourth day. Autopsy confirmed CHF due to chronic myocarditis related to Chagas' disease. Aneurysm of the apical region of the left ventricular chamber was also observed leading to thrombosis and systemic embolism with brain and spleen hemorrhagic infarct. In the encephalous there was edema, uncus herniation and hemorrhagic infarct of the brain stem. The skin lesions were due to reactional tuberculoid hanseniasis (RHT) with focal lesions in axillary lymphnodes, nasopharyngeal mucosa and in the posterior tibial nerve. The pathogenesis of RHT is discussed as well as its differentiation with the BT group of Ridley and Jopling and its probably relationship with the secondary tuberculoid hanseniasis reported by Ridley. The focal lesions are also discussed with END to the involvement of a peripheral nerve trunk what is said to be uncommon in this form of Hansen's disease.

Arteriosclerosis↗
PubMed1988

[Comparative study of various staining methods for mycobacteria].

The present paper intends to show what coloration method for mycobacteria is the better. Samples was assessed and processed by hot Ziehl-Neelsen, cold Ziehl-Neelsen, Ziehl Gabbet and Ziehl-Neelsen with alkaline metilene blue. After microscopy by five different persons the method selected were the cold Ziehl-Neelsen.

Bacteriological Techniques↗
PubMed1988

[The teaching of leprosy in medical schools].

All post graduated young doctors should be conscious of our major public health problems and should be able to diagnose and treat these endemic diseases. Hanseniasis is an infectious disease that has a special affinity by peripheric nerves and for that a high potential to produce disability and deformity leading to stigma and social out cast. There are 5,546,000 known patients on the world and the WHO estimates that the real figure is around 12 million in Brasil the registered number of patient is 259,000 but realistic estimations would increase it up to half a million. The disease spreads out all over Brasil but, in absolute figures the southeast region has the highest load. To cope with this problem one the basic actions is training and the teaching of hanseniasis in medical school is essential. As a systemic disease it should be present in all specialities involved leading to an increase of time devoted to the teaching of hanseniasis. This approach, which could be extended to other endemic diseases, will contribute to the eradication of many diseases that afflict our population. There is no reason for public health budget if there is no trained personal to use it.

Brazil↗
PubMed1985

[Fernandez and Mitsuda reactions in patients with leprosy and their contacts].

Hanseniasis patients and contacts of Virchowian patients, totaling 467 persons have been submitted to Mitsuda's reaction. These individuals have been divided into five groups: group 1 compounded of 59 persons, relatives of Virchowian patients; group 2 - 171 persons, employees of the Hospital Lauro de Souza Lima working there for more than one year; group 3 - 127 hanseniasis patients in activity, Mitsuda negative; group 4 - 63 hanseniasis patients in activity, Mitsuda positive; group 5 - 47 Virchowian patients, inactive, Mitsuda negative. The analysis of the data showed that: a) hanseniasis patients, both Mitsuda positive and negative, do not present positivity to Fernandez's reaction; b) early reaction can be observed more frequently in individuals of group 1 than in those of group 2. Mitsuda's antigen causes the reversal of Fernandez's reaction in about 30% of indirect contacts; c) the percentage of negative Mitsuda's reactions (without induration) does not differ between groups 1 and 2, though indurations smaller than 5 mm have been as many as 10 times more frequent in individuals of group 1. A second application of the antigen in Mitsuda negative persons showed the reversal of the test in 100% of the tested subjects.

Humans↗
PubMed1983

Oral lesions in borderline and reactional tuberculoid leprosy.

Thirty patients, fifteen with borderline and fifteen with reactional tuberculoid leprosy, were submitted to clinical and histopathologic studies of the buccal mucosa for detection of specific lesions. Five reactional tuberculoid and eight borderline patients presented specific conditions characterized by chronic granulomatous lesions with bacilli, chronic granulomatous lesions without bacilli, and nonspecific chronic inflammatory lesions with bacilli. The infiltrate had small extension, low bacterial levels and the mucosa, with the exception of one case, did not show ulceration. These results suggest that in the reactional tuberculoid and borderline patients the buccal mucosa is not an important source of bacilli elimination.

Adolescent↗
PubMed1983

[The Rubino reaction. Criterion for inactivation in lepromatous patients].

Approximately 55% of active lepromatous patients respond positively to the Rubino reaction. With arrested cases this rate of positivity lowers considerably to about 15%. In an effort to associate this reaction with the presence of bacilli, a study of 796 cases was undertaken. The patients were divided into: a control group, active tuberculoid cases, arrested tuberculoid cases, active borderline cases, arrested borderline cases, active lepromatous cases, and arrested lepromatous cases. The patients were submitted to the following tests: Rubino reaction, presence of cryoglobulins, and VDRL and PCR positivity. By the results obtained we may conclude that: a) A positive Rubino reaction may be present in all the forms of leprosy studied, this reaction having an inverse relationship with the organism's resistance to "M. leprae". b) The Rubino reaction has specificity to leprosy. c) This reaction does not depend on the number of bacilli present in the host. d) A positive Rubino reaction is not related to the presence of cryoglobulins in the serum, nor to VDRL or PCR positivity, nor to the length of time the patient's disease has been arrested. The authors present these findings and suggest that this reaction be used as one of the criteria for determining cure.

Agglutination Tests↗
PubMed1982

Once-monthly rifampicin plus daily dapsone in initial treatment of lepromatous leprosy.

In an international multicentre controlled single-blind trial of 93 previously untreated lepromatous leprosy patients the therapeutic effects of adding rifampicin, 450 mg/day orally or 1,200 mg once monthly in a single oral dose, to dapsone (50 mg/day orally) for the first 6 months of treatment were compared. Clinical and histopathological improvements and bacteriological regression, indicated by the decreases in the bacterial and morphological indices of the skin and nose-blow smears, were satisfactory and practically identical after 6 months' treatment. The once-monthly rifampicin schedule was better tolerated than the daily one. In view of the good therapeutic efficacy and tolerability, the much lower cost of treatment (about one-tenth of that of the daily rifampicin regimen) and the possibility of administration under supervision, once-monthly rifampicin given in a single oral 1,200 mg dose should be recommended, along with a standard dapsone regimen, for large-scale, initial, and intensive combination treatment of patients with lepromatous and borderline-lepromatous leprosy, to help prevent an increase in dapsone resistance. A third antileprosy drug (e.g., clofazimine) may be added to this initial dual-treatment regimen.

Adolescent↗
PubMed1982

[Developmental aspects of the Rubino reaction].

The Rubino reaction was studied in 178 leprosy patients to correlate its positivity, clinical form, E.N.L., and time and activity of the disease. The patients studied were classified according to the criteria established by the 1953 Madrid Congress. The results show that the tuberculoid patients presented negative Rubino reactions regardless of any of the parameters studied. The borderline patients showed 9% positive Rubino reaction not related to any of the observed parameters studied. The lepromatous patients showed a significant difference of positivity to the Rubino reaction when grouped as to the disease's active or non-active presence. Active lepromatous patients showed 55% of positivity to the Rubino reaction whereas patients considered clinically inactive showed only 6% of positivity. The fact that the Rubino reaction is negative in the majority of patients who are clinically cured would indicate that this test could be included as part of the criteria used in determining which clinically cured lepromatous patients can discontinue medication without risking a relapse.

Adolescent↗
PubMed1982

[Cellular immunity in leprosy patients].

Forty eight clinically arrested lepromatous patients were submitted to several tests to evaluate cellular immunological competence (PPD, Trichophytin, DNCB, determination of the percentage of T lymphocytes in the peripheral blood, and early and late reactions to the lepromin). The results of the Trychophytin test and of the lymphocyte percentage test did not differ from those of the control group, whereas the results to the PPD test were more often positive for the arrested Virchovian cases. All the patients presented positivity to the DNCB test, and none of them showed positivity to the Fernandez reaction. As for the late reaction to the lepromin, all the patients were negative, although in histopathological testing four degrees of reactivity was observed ranging from focal, non specific inflammatory reaction to granulomatous histiocytic with an epithelioid outline. By means of these results the authors were able to confirm that: 1. There is no cross reactivity between the PPD and lepromin tests. 2. Sulfone therapy does not interfere in immunocellular results for the tests employed. 3. Lepromatous patients respond like the general population to the unspecific sensitivity tests utilized. 4. The finding of histiocytic reaction with epithelioid outline in some biopsies of Mitsuda reaction in lepromatous patients, suggests the presence of a sub-population within this group, probably Borderline patients that suffered during the infection's evolution downgrading of theirs clinic and histological characteristics.

Dinitrochlorobenzene↗
PubMed1981

A controlled trial to compare the therapeutic effects of dapsone in combination with daily or once-monthly rifampin in patients with lepromatous leprosy.

In this controlled trial in 35 patients with lepromatous leprosy the therapeutic effects of adding rifampin 450 mg daily (Regimen A) or 1200 mg once a month (Regimen B) to a standard dapsone regimen of 50 mg daily were practically identical. Moderate to marked clinical improvement was observed in 88% and 83% of the patients treated with Regimens A and B respectively. The average rates of decrease in the MI of the skin smears and nose-blow smears were similar. The average decreases in the BI of the skin smears were 0.7 and 0.6 in patients on the Regimen A and B respectively. Following 6 months' treatment with Regimens A and B the average decreases in the Logarithmic Bacterial Indexes of Biopsies were 4.7% and 7% respectively. The once-monthly rifampin schedule was well tolerated and did not lead to "flu" syndrome, anuria, oliguria, hemolytic anemia, thrombocytopenia, or anaphylactic shock. This trial revealed the satisfactory efficacy, good tolerability, and practicability of a supervised once-monthly 1200 mg single oral dose rifampin schedule as a component of combination regimes for the initial treatment of patients with lepromatous (LLs and LLp) leprosy.

Adolescent↗
PubMed1980

[Maintenance of armadillos in captivity and results of the inoculation of Mycobacterium leprae].

The authors report their experiences in raising armadillos and the results obtained in inoculating them with M. leprae. They begin by reporting on the origin of the animals, how they were captured, and their efforts until they found the right kind of housing for the armadillos. They also tell of their attempts to develop the correct feeding procedures. The result is the feed used now in their laboratory: chicken feed mixed with bread, eggs, meat and milk. Along with this, they report on the way each animal is registered and the examination it undergoes upon admittance, namely, recording of its weight, rectal temperature, feces examination, hemogram and hemossedimentation. They also tell how animals are immobilized so as to take blood samples for the inoculations. Lastly, they present the results of the inoculations with M. leprae in three armadillos of the Euphractus sexticinctus species and 26 of the Dasypus novemcinctus species, with special reference to an armadillo of the D. novemcinctus species, which had systemic infection 15 months after being inoculated subcutaneously and intravenously. Bacilli were found in large quantities in various organs like the skin, lymph nodes, liver, kidneys and spleen. No bacilli were found in the myocardium, pancreas, thyroid and testicles. The authors are of the opinion that this is the first armadillo of the D. novemcinctus species to present experimental systemic infection with M. leprae in South America. Another armadillo, which has been inoculated with a suspension of 1.2 X 10(8) bacilli by the intracardiac route already showed nodules with bacilli on the abdominal wall 10 months after being inoculated. They believe that the results already obtained indicate that soon they will be able to provide material for institutions in Brazil as well as other countries that are interested in the study of M. leprae and in the preparation of the Mitsuda antigen which is so vital to the control of Hansen's disease.

Animal Feed↗