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      Epidemiological characteristics and trends of leprosy in children and adolescents under 15 years old in a low-endemic State in Southern Brazil

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          ABSTRACT

          Leprosy is an infectious and contagious disease affecting skin and nerves. The number of cases in individuals under 15 years old is one of the parameters used in Brazil as an indicator of endemic permanence of the disease and its continuous transmission. Rio Grande do Sul State, in Southern Brazil, is low-endemic to leprosy. However, the disease remains a public health problem. This is a retrospective, observational and analytical study of a historical series of new cases of leprosy in children under 15 years old diagnosed in the period from 2000 to 2019, in all health units in Rio Grande do Sul State. Seventy-seven new cases were notified. The male gender was predominant in 53.2% of the cases (n=41). The average age was 10.4 years (standard deviation of 2.9), with predominance of the age group between 10 and 15 incomplete years old. The most frequent operational classification was multibacillary, in 62.3% of cases (n=48), and the most common clinical form was borderline, in 38.9% of cases (n=28). The predominant disability degree in the sample was grade zero, in 80.0% of the cases (n=60), but in 4.0% (n=3) the grade assessed was 2. In 54.0% of cases (n=27), bacilloscopy was performed, with positive results in 36.0% (n=9) of the exams. Multibacillary cases, with physical disability and/or positive bacilloscopy, draws attention that that the diagnosis is frequently not made in early stages.

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          Leprosy now: epidemiology, progress, challenges, and research gaps.

          Leprosy continues to be a challenge to health worldwide, with about 250,000 new cases being detected every year. Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. A third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services. We review data and make recommendations for research on diagnosis, treatment, and prevention, such as further use of molecular analysis of the Mycobacterium leprae genome, implementation of BCG vaccination, and administration of chemoprophylaxis to household contacts. We also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - Part 1*

            Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.
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              Physical distance, genetic relationship, age, and leprosy classification are independent risk factors for leprosy in contacts of patients with leprosy.

              Close contacts of patients with leprosy have a higher risk of developing leprosy. Several risk factors have been identified, including genetic relationship and physical distance. Their independent contributions to the risk of developing leprosy, however, have never been sufficiently quantified. Logistic-regression analysis was performed on intake data from a prospective cohort study of 1037 patients newly diagnosed as having leprosy and their 21,870 contacts. Higher age showed an increased risk, with a bimodal distribution. Contacts of patients with paucibacillary (PB) leprosy with 2-5 lesions (PB2-5) and those with multibacillary (MB) leprosy had a higher risk than did contacts of patients with single-lesion PB leprosy. The core household group had a higher risk than other contacts living under the same roof and next-door neighbors, who again had a higher risk than neighbors of neighbors. A close genetic relationship indicated an increased risk when blood-related children, parents, and siblings were pooled together. Age of the contact, the disease classification of the index patient, and physical and genetic distance were independently associated with the risk of a contact acquiring leprosy. Contact surveys in leprosy should be not only focused on household contacts but also extended to neighbors and consanguineous relatives, especially when the patient has PB2-5 or MB leprosy.
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                Author and article information

                Journal
                Rev Inst Med Trop Sao Paulo
                Rev Inst Med Trop Sao Paulo
                rimtsp
                Revista do Instituto de Medicina Tropical de São Paulo
                Instituto de Medicina Tropical de São Paulo
                0036-4665
                1678-9946
                06 December 2021
                2021
                : 63
                : e80
                Affiliations
                [1 ]Secretaria Estadual de Saúde do Rio Grande do Sul, Ambulatório de Dermatologia Sanitária de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
                [2 ]Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre, Rio Grande do Sul, Brazil
                [3 ]Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Microbiologia Agrícola e do Ambiente, Porto Alegre, Rio Grande do Sul, Brazil
                [4 ]Universidade Federal do Rio Grande do Sul, Departamento de Microbiologia, Imunologia e Parasitologia, Porto Alegre, Rio Grande do Sul, Brazil
                Author notes
                Correspondence to: Maria Lúcia Scroferneker Universidade Federal do Rio Grande do Sul, Departamento de Microbiologia, Imunologia e Parasitologia, Rua Sarmento Leite, 500, CEP 90050-170, Porto Alegre, RS, Brazil Tel: +55 51 33083934, Fax: +55 51 33083121 E-mail: scrofern@ 123456ufrgs.br

                AUTHORS’ CONTRIBUTIONS

                PCM: data curation, formal analysis, investigation, methodology, writing of the original draft; LME: supervision, writing of the review, editing; AK: validation, visualization, writing of the review, editing; DMP: writing of the review, editing; MLS: conceptualization, project administration, supervision.

                Author information
                http://orcid.org/0000-0002-4596-1724
                http://orcid.org/0000-0003-0584-1258
                Article
                00247
                10.1590/S1678-9946202163080
                8660027
                34878038
                de30765e-adcd-4030-823d-bc7beb36838a

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 June 2021
                : 20 September 2021
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 34
                Categories
                Original Article

                leprosy,public health,children,adolescents,epidemiology
                leprosy, public health, children, adolescents, epidemiology

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