Identification of clinical, epidemiological and laboratory risk factors for leprosy reactions during and after multidrug therapy

This cross-sectional retrospective study evaluated 440 leprosy patients; 57% (251/440) had leprosy reactions during and/or after multidrug therapy, 80.5% (202/251) of whom presented with multibacillary leprosy. At diagnosis, positive bacterial index (BI) [odds ratio (OR) = 6.39; 95% confidence interval (CI): 4.1-10.1)] or polymerase chain reaction (PCR) (OR = 9.15; 95% CI: 5.4-15.5) in skin smears, anti-phenolic glycolipid-1 (anti-PGL-1) ELISA (OR = 4.77; 95% CI: 2.9-7.9), leucocytosis (OR = 9.97; 95% CI: 3.9-25.7), thrombocytopenia (OR = 5.72; 95% CI: 2.3-14.0) and elevated lactate dehydrogenase (OR = 2.38; 95% CI: 1.4-4.0) were potential markers for the development of reactions during treatment. After treatment, positive BI (OR = 8.47; 95% CI: 4.7-15.3) and PCR (OR = 6.46; 95% CI: 3.4-12.3) in skin smears, anti-PGL-1 ELISA (OR = 2.25; 95% CI: 1.3-3.9), anaemia (OR = 2.36; 95% CI: 1.2-4.5), leucocytosis (OR = 4.14; 95% CI: 1.5-11.6) and thrombocytopenia (OR = 3.70; 95% CI: 1.3-2.2) were risk factors for the occurrence of reactions during the study period. The identification of groups with an increased risk for developing reactions will allow for the timely development of a treatment plan to prevent nerve damage and, therefore, the appearance of the disabling sequelae associated with the stigma of leprosy.

Deficiências e incapacidades por hanseníase: avaliação clínica e epidemiológica dos pacientes atendidos em um Centro de Referência Nacional do Brasil / Disabilities and impairments in leprosy: clinical and epidemiological survey of patients seen in a National Reference Center in Brazil

A classificação de incapacidades nos graus 0, 1 e 2 nos pacientes com hanseníase é usada como indicador da qualidade dos métodos preventivos e curativos da doença,entretanto, algumas deficiências e incapacidades não estão contempladas nesse sistema. Esta pesquisa realizou um levantamento de incapacidades decorrentes da hanseníase em um Centro de Referência Nacional do Brasil, por meio de estudo retrospectivo, com análise de prontuários de 318 pacientes atendidos no período de 2003 a 2008 e software específico. Houve predomínio de casos multibacilares (63%), de formas clínicas dimorfas-tuberculóides (41,5%) e do sexo masculino(58,5%). Os nervos mais acometidos foram ulnar (22,3%), tibial (21,7%) e fibular (20,7%). Dos casos analisados, 41,5% apresentavam algum tipo de deficiência, sendo 81,1% multibacilar. Os sítios mais acometidos foram os pés (51,8%), seguidos pelas mãos (29%), olhos (10,9%) e nariz (8,3%). As deficiências mais comuns foram artelhos em martelo (2,8%) e lesões tróficas (2,5%) no pé; garra móvel (3,1%) e lesões tróficas (2,8%) na mão; madarose superciliar (2,8%) e perfuração do septo nasal (1,2%). Na alta houve diminuição do número pacientes com deficiências por sítio, exceto oculares, com aumento de 2,5%.Os resultados enfatizam a necessidade de promover assistência detalhada no atendimento realizado no SUS e de adequar os parâmetros utilizados no estadiamento dos pacientes, que atualmente omite alterações funcionais e estéticas dos sítios orgânicos representativas de obstáculos à integração social. A reprodução desse tipo de estudo fornecerá subsídios para que a gestão do SUS desenvolva estratégias que tratem a hanseníase como doença crônica e incapacitante.

The classification of disabilities in grades 0, 1 and 2 in patients with leprosy is used as an indicator of the quality of preventive and curative methods of the disease, however, some deficiencies and disabilities are not included in this system. This research conducted a survey of disability due to leprosy in a National Reference Center of Brazil, through a retrospective study with analysis of records of 318 patients treated between 2003 to 2008 and specific software. There was a predominance of multibacillary cases (63%), clinical forms of borderline tuberculoid (41.5%) and male (58.5%). The most affected nerves were ulnar (22.3%), tibial (21.7%) and fibular (20.7%). Of these cases, 41.5% had sometype of disability, with 81.1% multibacillary. The most affected sites were the feet (51.8%), followed by hands (29%), eyes (10.9%) and nose (8.3%). The most common deficiencies were clawed toes (2.8%) and trophic lesions (2.5%) in thefoot, mobile claw (3.1%) and trophic lesions (2.8%) in thehand; eyebrow madarosis (2 8%) and nasal septum perforation(1.2%). The number of disabilities decreased atdischarge, except at the eye, which increased 2.5%. The results emphasize the need to promote comprehensive care in the NHS and to adjust the parameters used in the staging of patients, that currently omit functional and aesthetic lesions, which represent organic obstacles to social integration. Reproduction of this type of study will provide data for the NHS management to develop strategies in order to deal with leprosy as a chronicand disabling disease.