MARIA ANGELA BIANCONCINI TRINDADE

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LIM/56 - Laboratório de Investigação em Dermatologia e Imunodeficiências, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 27
  • article 17 Citação(ões) na Scopus
    Immunology of leprosy
    (2022) FROES JR., Luis Alberto Ribeiro; TRINDADE, Maria Angela Bianconcini; SOTTO, Mirian Nacagami
    Leprosy is a disease caused by Mycobacterium leprae (ML) with diverse clinical manifestations, which are strongly correlated with the host's immune response. Skin lesions may be accompanied by peripheral neural damage, leading to sensory and motor losses, as well as deformities of the hands and feet. Both innate and acquired immune responses are involved, but the disease has been classically described along a Th1/Th2 spectrum, where the Th1 pole corresponds to the most limited presentations and the Th2 to the most disseminated ones. We discuss this dichotomy in the light of current knowledge of cytokines, Th subpopulations and regulatory T cells taking part in each leprosy presentation. Leprosy reactions are associated with an increase in inflammatory activity both in limited and disseminated presentations, leading to a worsening of previous symptoms or the development of new symptoms. Despite the efforts of many research groups around the world, there is still no adequate serological test for diagnosis in endemic areas, hindering the eradication of leprosy in these regions.
  • article 1 Citação(ões) na Scopus
    Bacterial, fungal and parasitic co-infections in leprosy: A scoping review
    (2023) FROES, Luis Alberto Ribeiro; TOMA, Tereza Setsuko; JACHIET, Marie; ROUSSET, Laurie; PODEROSO, Rosana Evangelista; TRINDADE, Maria Angela Bianconcini
    Author summaryOur review summarizes the clinical and epidemiological characteristics of non-viral co-infections in leprosy patients, including tuberculosis, leishmaniasis, chromoblastomycosis, and helminths. By conducting a systematic literature search, my colleagues and I identified 89 studies and found a male-dominated pattern of co-infections among working-age individuals with multibacillary leprosy. Our findings suggest that co-infections with tuberculosis and leishmaniasis may reduce the occurrence of leprosy reactions, which is in contrast to prior studies reporting increased reactions in chronic viral co-infections. Additionally, we observed that the occurrence of leprosy reactions varied from 37% to 81% across studies, depending on the type of helminth co-infection, which is higher than the general population. Overall, our study highlights the importance of understanding the potential impact of co-infections on leprosy patients, as it may affect their disease outcomes and treatment. This information is relevant not only to researchers and healthcare providers but also to the general public, as leprosy is still a significant public health problem in many parts of the world. Our review adds to the growing body of knowledge in the field of infectious diseases and underscores the need for further research on this topic. BackgroundIn leprosy patients, the most commonly reported non-viral co-infections are Tuberculosis, Leishmaniasis, Chromoblastomycosis and Helminths. The presence of a secondary infection is believed to increase the likelihood of leprosy reactions. The purpose of this review was to describe the clinical and epidemiological characteristics of the most reported bacterial, fungal, and parasitic co-infections in leprosy. Methodology/Principal findingsFollowing the PRISMA Extension for Scoping Reviews guidelines, a systematic literature search was conducted by two independent reviewers, resulting in the inclusion of 89 studies. For tuberculosis, a total of 211 cases were identified, with a median age of 36 years and male predominance (82%). Leprosy was the initial infection in 89% of cases, 82% of individuals had multibacillary disease, and 17% developed leprosy reactions. For leishmaniasis, 464 cases were identified, with a median age of 44 years and male predominance (83%). Leprosy was the initial infection in 44% of cases, 76% of individuals presented with multibacillary disease, and 18% developed leprosy reactions. Regarding chromoblastomycosis, we identified 19 cases with a median age of 54 years and male predominance (88%). Leprosy was the primary infection in 66% of cases, 70% of individuals had multibacillary disease, and 35% developed leprosy reactions. Additionally, we found 151 cases of co-infection with leprosy and helminths, with a median age of 43 years and male predominance (68%). Leprosy was the primary infection in 66% of cases, and 76% of individuals presented with multibacillary disease, while the occurrence of leprosy reactions varied from 37% to 81% across studies. ConclusionWe observed a male-dominated pattern of co-infections among working-age individuals with multibacillary leprosy. Unlike prior studies reporting increased leprosy reactions in chronic viral co-infections, our findings did not indicate any increase among bacterial, fungal, or parasitic co-infections. Rather, co-infections with tuberculosis and leishmaniasis appeared to reduce leprosy reactions.
  • bookPart
    Hanseníase
    (2016) AVANCINI, João; TRINDADE, Maria Angela Bianconcini
  • article 5 Citação(ões) na Scopus
    Trichoscopic findings of eyebrow alopecia in patients with multibacillary leprosy
    (2019) DOCHE, Isabella; TOSTI, Antonella; NETO, Cyro F.; TRINDADE, Maria Angela B.; RIVITTI-MACHADO, Maria Cecilia M.; AVANCINI, Joao
  • conferenceObject
    Necrotisans erythema nodosum leprosum with systemic manifestations
    (2018) ISHIY, Patricia; TRINDADE, Maria Angela; AVANCINI, Joao; PAZZINI, Renato; JORGE, Lecticia; SOTTO, Mirian
  • article 1 Citação(ões) na Scopus
    Severe adverse reactions to multidrug therapy for leprosy, registered in tertiary services between 2012 and 2017 in Brazil
    (2018) PANTE, Cristina Castro; COELHO, Silvio Caetano; CARELLI, Luzia; AVANCINI, Joao; TRINDADE, Maria Angela Bianconcini
    Objectives: This work aims to determinate the main severe adverse reactions to multidrug therapy (MDT), as well as the characteristics of the patients who had them and the period when they were more prevalent. Results: Of the 158 patients undergoing treatment for leprosy in the period 2012-2017, 22 (13.9%) were using substitutive treatment for leprosy and presented criteria to enter this study. Adverse reactions were more frequent in women (59.1%), above 45 years age and during second month of treatment. Dapsone was the most frequently implied drug (86.4%), and hemolytic anemia was the main reaction (72.7%). Conclusion: Severe adverse reaction to dapsone is common in MDT, mainly due to hemolytic anemia.
  • bookPart
    Hanseníase
    (2022) ALVES, João de Magalhães Avancini Ferreira; TRINDADE, Maria Ângela Bianconcini
  • article 9 Citação(ões) na Scopus
    Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases
    (2019) MIYASHIRO, Denis; CARDONA, Carolina; VALENTE, Neusa Yuriko Sakai; AVANCINI, Joao; BENARD, Gil; TRINDADE, Maria Angela Bianconcini
    Background Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. Cases presentation We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. Conclusions This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.
  • article 16 Citação(ões) na Scopus
    Post-kala-azar dermal leishmaniasis and leprosy: case report and literature review
    (2015) TRINDADE, Maria Angela Bianconcini; SILVA, Lana Luiza da Cruz; BRAZ, Lucia Maria Almeida; AMATO, Valdir Sabbaga; NAAFS, Bernard; SOTTO, Mirian Nacagami
    Background: Post-kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis (VL), which may occur after or during treatment. It has been frequently reported from India and the Sudan, but its occurrence in South America has been rarely reported. It may mimic leprosy and its differentiation may be difficult, since both diseases may show hypo-pigmented macular lesions as clinical presentation and neural involvement in histopathological investigations. The co-infection of leprosy and VL has been reported in countries where both diseases are endemic. The authors report a co-infection case of leprosy and VL, which evolved into PKDL and discuss the clinical and the pathological aspects in the patient and review the literature on this disease. Case presentation: We report an unusual case of a 53-year-old female patient from Alagoas, Brazil. She presented with leprosy and a necrotizing erythema nodosum, a type II leprosy reaction, about 3 month after finishing the treatment (MDT-MB) for leprosy. She was hospitalized and VL was diagnosed at that time and she was successfully treated with liposomal amphotericin B. After 6 months, she developed a few hypo-pigmented papules on her forehead. A granulomatous inflammatory infiltrate throughout the dermis was observed at histopathological examination of the skin biopsy. It consisted of epithelioid histiocytes, lymphocytes and plasma cells with the presence of amastigotes of Leishmania in macrophages (Leishman's bodies). The diagnosis of post-kala-azar dermal leishmaniasis was established because at this time there was no hepatosplenomegaly and the bone marrow did not show Leishmania parasites thus excluding VL. About 2 years after the treatment of PKDL with liposomal amphotericin B the patient is still without PKDL lesions. Conclusion: Post-kala-azar dermal leishmaniasis is a rare dermal complication of VL that mimics leprosy and should be considered particularly in countries where both diseases are endemic. A co-infection must be seriously considered, especially in patients who are non-responsive to treatment or develop persistent leprosy reactions as those encountered in the patient reported here.
  • article 10 Citação(ões) na Scopus
    Histoid leprosy: clinical and histopathological analysis of patients in follow-up in University Clinical Hospital of endemic country
    (2018) CANUTO, Maria J. M.; YACOUB, Carolina R. D.; TRINDADE, Maria A. B.; AVANCINI, Joao; PAGLIARI, Carla; SOTTO, Mirian N.
    BackgroundHistoid leprosy (HL) is a rare form of lepromatous leprosy, characterized by hyperchromic indurated nodules above normal skin. Its main histopathological aspect is spindle cells. Because it may simulate other aspects, such as dermatofibroma and neurofibroma, histoid leprosy poses itself as a diagnostic challenge. MethodsThis is a retrospective study with all patients having been selected from the leprosy clinic of the Hospital das Clinicas da Universidade de SAo Paulo from 2006 to 2016. ResultsThere were 12 patients in this study, eight in the histoid group and four in the lepromatous leprosy group. The prevalence of HL was 1.12% in all leprosy subjects. All individuals from HL group were de novo cases, and the histopathological analysis of skin lesions presented spindle cells generating a storiform pattern. Immunohistochemistry for CD68, vimentin, and anti-BCG were positive in all 12 cases. Factor XIIIa was visualized only in the papillary dermis, and S100 protein was negative in all biopsies. Smooth-muscle actin was present in 62.5% of the HL samples. ConclusionThe prevalence of HL was similar to previous reports. However, all histoid patients were de novo cases, differing from published studies. Fusocellular macrophage transformation could be explained by the differences in cytoskeleton proteins expressed in histoid lesions in comparison to other leprosy variants, with emphasis on vimentin and smooth muscle actin.