多药治疗后麻风性麻风患者的进行性神经病变。

IF 2.5 4区 医学 Q2 PARASITOLOGY
Patricia Sola Penna, Izabela Jardim Rodrigues Pitta, Robson Teixeira Vital, Mariana Andrea Vilas Boas Hacker, Ana Maria Salles, Roberta Olmo Pinheiro, Sergio Luiz Gomes Antunes, Euzenir Nunes Sarno, Márcia Rodrigues Jardim
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引用次数: 1

摘要

背景:麻风极点是麻风患者的污名化原型。一般来说,这些患者在诊断时很少或没有周围神经受累的症状。然而,晚期周围神经病变的迹象在最初的神经学评估中是可见的,并且在多药治疗(MDT)期间和之后可能会恶化。周围神经损伤导致的残疾严重影响患者的生活,神经损伤的病理生理机制尚不清楚。目的:评估麻风性麻风(LL)患者周围神经病变的预后,并在完成MDT后持续出现神经病变症状。方法:我们评估了14例因MDT后神经病变恶化至少4年而接受神经活检的LL患者的病历。结果:64.3%的患者出现神经性疼痛,神经学检查显示,大多数患者在治疗开始时中、大口径纤维发生改变。神经症状和体征恶化,尽管完全MDT和泼尼松或沙利度胺使用多年。神经传导研究表明,感觉神经受影响最大。主要结论:LL患者可发生进行性周围神经病变,即使长期接受抗炎和免疫抑制治疗,也会继续发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy.

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy.

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy.

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy.

Background: The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients' lives, and the pathophysiological mechanisms underlying nerve damage remain unclear.

Objectives: To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT.

Methods: We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT.

Findings: Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected.

Main conclusions: Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.

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来源期刊
CiteScore
5.00
自引率
3.60%
发文量
91
审稿时长
3-8 weeks
期刊介绍: Memórias do Instituto Oswaldo Cruz is a journal specialized in microbes & their vectors causing human infections. This means that we accept manuscripts covering multidisciplinary approaches and findings in the basic aspects of infectious diseases, e.g. basic in research in prokariotes, eukaryotes, and/or virus. Articles must clearly show what is the main question to be answered, the hypothesis raised, and the contribution given by the study. Priority is given to manuscripts reporting novel mechanisms and general findings concerning the biology of human infectious prokariotes, eukariotes or virus. Papers reporting innovative methods for diagnostics or that advance the basic research with these infectious agents are also welcome. It is important to mention what we do not publish: veterinary infectious agents research, taxonomic analysis and re-description of species, epidemiological studies or surveys or case reports and data re-analysis. Manuscripts that fall in these cases or that are considered of low priority by the journal editorial board, will be returned to the author(s) for submission to another journal.
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