02724nas a2200421   4500000000100000008004100001260001600042653001000058653000900068653002200077653001100099653001100110653001400121653002300135653001100158653004800169653001200217653000900229653001500238653001600253653002500269653001500294100002800309700001300337700001000350700001600360700001800376700001400394700001500408700001200423700002100435245009400456856007700550300000900627490000600636520164600642022001402288       2010                            d  c2010 Dec 2110aAdult10aAged10aAged, 80 and over10aBiopsy10aFemale10aGranuloma10aHistocytochemistry10aHumans10aImmune Reconstitution Inflammatory Syndrome10aleprosy10aMale10aMicroscopy10aMiddle Aged10aMycobacterium leprae10aRecurrence1 aBianconcini Trindade MA1 aBenard G1 aUra S1 aGhidella CC1 aAvelleira JCR1 aVianna FR1 aMarques AB1 aNaafs B1 aNegrão Fleury R00aGranulomatous reactivation during the course of a leprosy infection: reaction or relapse.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3006134/pdf/pntd.0000921.pdf  ae9210 v43 a<p><b>BACKGROUND: </b>Leprosy is a chronic granulomatous infectious disease and is still endemic in many parts of the world. It causes disabilities which are the consequence of nerve damage. This damage is in most cases the result of immunological reactions.</p><p><b>OBJECTIVES: </b>To investigate the differences between a type 1 leprosy (reversal) reaction and relapse on using histopathology.</p><p><b>METHODS: </b>The histopathological changes in 167 biopsies from 66 leprosy patients were studied. The patients were selected when their sequential biopsies demonstrated either different patterns or maintained the same pattern of granulomatous reaction over more than two years during or after the treatment of leprosy.</p><p><b>RESULTS: </b>In 57 of the patients studied, a reactivation was seen which coincided with a decrease in the bacteriological index (BI), suggesting that this reactivation (reversal reaction or type 1 leprosy reaction) coincides with an effective capacity for bacteriological clearance. In nine patients, an increase of the bacteriologic index (IB) or persistence of solid bacilli occurred during the reactivation, indicating proliferative activity, suggestive of a relapse. The histopathological aspects of the granulomas were similar in both groups.</p><p><b>CONCLUSION: </b>Bacterioscopy provided the only means to differentiate a reversal reaction from a relapse in patients with granulomatous reactivation. The type 1 leprosy reaction may be considered as a part effective immune reconstitution (reversal, upgrading reaction) or as a mere hypersensitivity reaction (downgrading reaction) in a relapse.</p>  a1935-2735