Abstract Histoid leprosy is a rare form of multibacillary leprosy, characterized by the presence of papules, plaques, or nodules whose appearance is keloid-like, skin colored, or erythematous. Fusiform cells are the main histopathological feature. Due to the fact that it can simulate other dermatological lesions, for example, dermatofibroma and neurofibroma, it constitutes a diagnostic challenge for clinicians and pathologists. It is a bacilliferous form of leprosy, and it plays an important role in disease transmission. A case of a patient with histoid leprosy living in the Northeast Region of Brazil is reported.

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

SUMMARY OBJECTIVE: To describe the epidemiological and neurofunctional profile, as well as the prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil. METHODS: A cross-sectional study including 50 leprosy patients diagnosed in Juazeiro-Bahia. Variables analyzed: sex, age, history of leprosy in the family, time to diagnosis, clinical form, operational classification, degree of disability, eyes-hand-foot score, peripheral nerve function, muscle strength and sensitivity. Descriptive statistics and inferential statistics (χ² test or Fisher’s exact, Poisson regression with robust estimation and prevalence reason were used. Significance of 5%). RESULTS: An equal distribution was found between men and women of economically active age and low education; multibacillary forms in men (64%) and paucibacillary forms in women (60%). 78% of individuals had some degree of disability and 64% had a compromised ulnar nerve. Plantar sensitivity was decreased in 66% of patients. The predictors of disability were: age ≥45 years (PR 1.44; p=0.005), no education (PR 1.21; p=0.013) and OMP score ≥6 (PR 1.29; p<0.001). CONCLUSION: The findings show the importance of monitoring neural functions and developing measures that allow early diagnosis, the opportune method and the prevention of disabilities, especially in the male population.

SUMMARY OBJECTIVE: To review the literature and to report a clinical case with initial suspicion of pure neural leprosy and final diagnosis of amyloid neuropathy. METHODS: The study was conducted in two stages. In stage one, a systematic literature review was carried out, with searches performed in the PubMed, Medline, and Lilacs databases, as well as in the leprosy sectoral library of the Virtual Health Library, using the following descriptors: neuritic leprosy, pure neural leprosy, primary neural leprosy, pure neuritic leprosy, amyloid polyneuropathy, amyloid neuropathies, and amyloid polyneuropathy. The search was carried out on May 28, 2020. Clinical trials, cohort studies, cross-sectional studies, clinical cases, and case studies published in Portuguese, English or Spanish between 2010 and 2020 were included. Stage two reports a case with initial suspicion of pure neural leprosy. Laboratory tests, electroneuromyography, ultrasound, and biopsy of the sural nerve were requested. RESULTS: Twenty-three scientific texts were included. No publications were found that contained both topics together. The challenging diagnosis of pure neural leprosy and the possibility of using auxiliary resources in diagnosis were the most emphasized themes in the studies. In the clinical case, the patient's electroneuromyography showed sensitive and motor polyneuropathy of the lower limbs, which was predominantly sensory and axonal, symmetrical, of moderate intensity, and the mixed type (axonal-demyelinating). Ultrasonography of the sural nerve revealed changes in the contour of the deep fibular nerves; biopsy of the sural nerve showed an accumulation of amorphous eosinophilic material in the nerve path, and Congo red stain showed apple-green birefringence of the deposit under polarized light. The final diagnosis was amyloid neuropathy. CONCLUSIONS: The final clinical diagnosis was amyloid neuropathy. The diagnosis of pure neural leprosy in endemic areas in Brasil is still a challenge for the health system.

RESUMO OBJETIVO: Comparar a prevalência oculta de hanseníase entre duas cidades brasileiras com diferenças distintas quanto à região geográfica e perfil de desenvolvimento socioeconômico, como Juazeiro, Bahia e Joinville, Santa Catarina. MÉTODOS: Estudo epidemiológico retrospectivo baseado em dados secundários obtidos nas notificações de casos de hanseníase nos municípios de Juazeiro-BA e Joinville-SC, 2007-2017. Para o cálculo da prevalência oculta foi utilizado o método proposto por Gil Suárez e Lombardi. Resultados: Joinville teve 105 casos de hanseníase que não foram diagnosticados no período (adição de 42,0% à prevalência registrada). Para Juazeiro, estimou-se que 295 casos não foram diagnosticados (adição de 18,9%). CONCLUSÃO: Joinville apresentou maior prevalência oculta que Juazeiro.

SUMMARY OBJECTIVE: We compared the hidden prevalence of leprosy in two Brazilian cities with distinct differences regarding geographic region and socio-economic development profile, namely, Juazeiro, Bahia and Joinville, Santa Catarina. METHODS: A retrospective epidemiological study based on secondary data obtained from leprosy case notifications in the cities of Juazeiro-BA and Joinville-SC, 2007-2017. To calculate hidden prevalence, we used the method proposed by Gil Suárez and Lombardi. RESULTS: Joinville had 105 cases of leprosy that went undiagnosed (addition of 42.0% to the registered prevalence). For Juazeiro, it was estimated that 295 cases went undiagnosed (addition of 18.9%). CONCLUSION: Joinville presents a higher hidden prevalence than Juazeiro.

RESUMO Metástases cutâneas de neoplasias viscerais são raras, e os carcinomas uroteliais ou de células transicionais são responsáveis por menos de 1% dos casos. Relatamos o caso de um paciente de 50 anos que desenvolveu progressivamente múltiplos nódulos cutâneos (cabeça, abdômen, axila e virilha), alguns com ulceração, antes de qualquer outra sintomatologia. A biópsia cutânea e o estudo imuno-histoquímico foram consistentes com metástases cutâneas de um carcinoma urotelial. O exame tomográfico revelou metástase generalizada nos órgãos internos. Além da raridade destes tipos de metástases cutâneas, neste caso foi o sinal inaugural e, como habitualmente descrito, associado a mau prognóstico.

ABSTRACT Cutaneous metastases of visceral neoplasms are rare conditions, and urothelial or transitional cell carcinomas are responsible for less than 1% of cases. We report the case of a 50-year-old male patient who progressively developed multiple cutaneous nodules on his head, abdomen, axilla, and groin, some with ulceration. Skin biopsy and immunohistochemistry were consistent with cutaneous metastasis of urothelial carcinoma. Computed tomography scan revealed generalized metastasis in internal organs. In this rare case, cutaneous metastases were the presenting sign of the disease and, as reported, a sign of bad prognosis.

RESUMO OBJETIVO: Descrever a tendência temporal, o perfil clínico e a prevalência de fatores de risco e comorbidades associadas em casos novos de tuberculose no Nordeste (2001-2016). MÉTODOS: Estudo de prevalência envolvendo todos os casos de tuberculose registrados no Nordeste do Brasil, no período 2001-2016. Os dados foram obtidos do Sistema de Nacional de Agravos de Notificação. Para a análise estatística, empregaram-se o modelo de regressão por pontos de inflexão e a estatística descritiva. RESULTADOS: Foram notificados 331.245 casos de tuberculose. A taxa de incidência geral reduziu de 44,84/100.000 habitantes (2001) para 30,92/100.000 habitantes (2016), com tendência decrescente (AAPC: −2,3; p<0,001). O perfil foi caracterizado por homens (73,53%), idade 20-59 anos (73,56%), tuberculose pulmonar (86,37%), baciloscopia positiva (54,78%). Os principais fatores de risco e comorbidade foram: Aids (4,64%), HIV (12,10%), Diabetes mellitus (5,46%), álcool (11,63%), institucionalizados (4,31%) e população privada de liberdade (2,30%). A taxa de cura foi 70,66% e a de abandono, 9,11%. CONCLUSÕES: Mesmo com redução da incidência, a tuberculose representa um real problema de saúde pública na região Nordeste. O perfil caracterizado pela população masculina, idade economicamente ativa, forma pulmonar com baciloscopia positiva e os fatores e comorbidade Aids, coinfecção TB/HIV, diabetes mellitus, consumo de álcool, institucionalizados e privados de liberdade refletem a complexidade dos desafios para o enfrentamento à doença.

SUMMARY OBJECTIVE: To describe the temporal trend, clinical profile, and the prevalence of risk factors and associated comorbidities in new cases of tuberculosis in the Northeast (2001-2016). METHODS: A prevalence study involving all tuberculosis cases registered in Northeast Brasil, 2001-2016. Data were obtained from the National System of Notification of Disorders. For statistical analysis, the inflection point regression model and descriptive statistics were used. RESULTS: 331,245 cases of tuberculosis were reported. The overall incidence rate decreased from 44.84/100,000 inhabitants (2001) to 30.92/100,000 inhabitants (2016), with a decreasing trend (AAPC: −2.3; p<0.001). The profile was characterized by men (73.53%), age 20-59 years (73.56%), pulmonary tuberculosis (86.37%), positive smear microscopy (54.78%). The main risk factors and comorbidities were: AIDS (4.64%), HIV (12.10%), Diabetes mellitus (5.46%), alcohol (11.63%), institutionalized, (4.31%) and deprived of liberty (2.30%). The cure rate was 70.66% and the abandonment rate was 9.11%. CONCLUSIONS: Even with a reduced incidence, tuberculosis represents a real public health problem in the Northeast region. The profile was characterized by a male population, in economically-active age, lung smear-positive pulmonary presentation, and the risk factors and comorbidities of Aids, TB/HIV co-infection, diabetes mellitus, alcohol consumption, institutionalized and deprived of freedom reflect the complexity of the challenges in facing the disease.

Abstract This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC] = −3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.