Prevention of repeated episodes of type 2 reaction of leprosy with the use of thalidomide 100 mg/day

BACKGROUND: Leprosy can have its course interrupted by type 1 and 2 reactional episodes, the last named of erythema nodosum leprosum (ENL). Thalidomide has been the medication of choice for the control of ENL episodes since 1965. OBJECTIVES: These episodes can repeat and cause damages to the patient. In order to prevent these episodes, an extra dose of 100 mg/day thalidomide was used during six months, followed by a follow-up period of six more months after thalidomide discontinuation. METHODS: We included 42 patients with multibacillary (MB) leprosy who had episodes of ENL. They were male and female patients aged between 18 and 84 years. RESULTS: Of the 42 patients, 39 (92.85%) had the lepromatous form and three (7.15%) had the borderline form. We found that 100% of patients had no reactional episode during the use of the drug. During the follow-up period after thalidomide discontinuation, 33 (78.57%) patients had no reactional episode and nine (21.43%), all of them with the lepromatous form, had mild episodes, which were controlled using non-steroidal anti-inflammatory. There were no thalidomide-related side effects. CONCLUSION: A maintenance dose of 100 mg/day of thalidomide showed to be effective to prevent repeated type 2 reactional episodes of ENL. .

Percepción de la lepra y las discapacidades antes del diagnóstico en Recife, Brasil / Perceptions regarding leprosy and resulting handicaps prior to diagnosis in Recife, Brazil

Este artículo presenta un estudio de casos y controles realizado en Recife, Brasil, entre noviembre de 1993 y julio de 1994. En él se investigó cómo influyen la percepción y las apreciaciones de los propios pacientes de lepra en el proceso de manejar la enfermedad y en la utilización de los servicios de salud. La muestra estuvo constituida por 183 pacientes de 20 a 70 años de edad, residentes en Recife, que acudieron en busca de un diagnóstico a los servicios de dermatología sanitaria de dos centros de referencia de las regiones politicoadministrativas tercera, cuarta y sexta. Se clasificaron como casos los 64 pacientes que tenían discapacidades o lesiones precursoras de discapacidad; los 119 restantes se consideraron controles. Todos fueron diagnosticados durante el período de la investigación. En el análisis se ajustó según sexo, edad, escolaridad y antecedentes de la enfermedad de Hansen de los pacientes. El estudio reveló la coexistencia de dos tipos de "invisibilidad" de la enfermedad en una zona endémica en expansión: 1) para los pacientes de ambos grupos, la baja frecuencia de modelos explicativos, espontáneos, relacionados con la dolencia, aun en presencia de antecedentes de la enfermedad, y 2) para los profesionales sanitarios, las limitaciones de la detección. Puesto que afectan a las decisiones relacionadas con el manejo individual y colectivo de la enfermedad, esas deficiencias constituyen por sí mismas un factor de riesgo y representan un obstáculo para la eliminación de la lepra como problema de salud pública.

This article reports on a case-control study conducted in Recife, Brazil, between November 1993 and July 1994, to determine how leprosy patients' perceptions and notions influence disease management and use of health services. The sample was composed of 183 residents of Recife between the ages of 20 and 70 years who sought diagnostic services in the dermatology clinics of two referral centers situated in the third, fourth, and sixth political and administrative regions. Sixty-four patients having handicaps or their precursor lesions were classified as cases; the remaining 119 were used as controls. All were diagnosed during the study period. For the analysis, adjustments were made for sex, age, schooling, and a previous history of Hansen's disease among patients. The study revealed the simultaneous presence of two types of "invisibility" of the disease in an area where endemicity is increasing: 1) for patients in both groups, the low frequency of spontaneous explanatory models related to the illness, even in the presence of disease, and 2) for health professionals, the limitations of detection methods. Since such deficiencies affect decisions bearing on individual and collective disease management, they are a risk factor in and of themselves and stand in the way of eliminating leprosy as a public health problem.

effect of BCG vaccination against leprosy in Assiut governorate

The purpose of this study is to find out, in our area, the role of BCG in prevention of leprosy. A case control study was carried out in Assiut and Abnub districts, the study included 100 leprosy cases under 35 years old [68 males, 32 females] who represented the number of patients drained from several villages. Two healthy matched contacts for every leprosy case were selected as a control. We were looking for BCG scars among leprosy cases and controls at the left deltoid region. Only one leprotic case was vaccinated; 61 contacts of leprosy cases were vaccinated. 99 Leprotic cases were not vaccinated, while 139 contacts of leprosy cases were not vaccinated. The difference between cases and controls regarding BCG vaccination status was highly significant by using x2- test to [p 0.001]