Evolução do grau de incapacidade física e do escore olhos, mãos e pés em casos novos de hanseníase: do diagnóstico à alta medicamentosa / Evolution of the degree of physical disability and the eye, hand and foot score in new cases of leprosy: from diagnosis to medication discharge

Este estudo tem por objetivo avaliar a evolução do grau de incapacidade física e do escore olhos, mãos e pés, do diagnóstico à alta medicamentosa, segundo as variáveis sociodemográficas e clínicas, em pacientes diagnosticados com hanseníase. Trata-se de estudo transversal, baseado na análise de 71 pacientes com diagnóstico de hanseníase, acompanhados no Hospital Eduardo de Menezes, centro de referência em Belo Horizonte, Minas Gerais, Brasil, entre janeiro de 2017 a dezembro de 2020. Foi observado predomínio do sexo feminino (53,5%), média de idade de 46 anos, sendo a maioria procedente de outros municípios do interior de Minas Gerais (54,9%). A forma clínica mais frequente foi a dimorfa (64,8%), classificação operacional multibacilar (84,5%). O grau de incapacidade física 0 foi o mais prevalente no diagnóstico (56,5%) e na alta (53,1%), e em relação ao escore olhos, mãos e pés, houve variação entre 0 e 10 no diagnóstico e entre 0 e 8 na alta. Pelo teste de McNemar foi observado que dentre os pacientes que apresentavam algum grau de incapacidade física no momento do diagnóstico, 30,8% apresentaram ausência de incapacidade na alta. Ao comparar a evolução do grau de incapacidade física de paucibacilares e multibacilares no momento do diagnóstico e da alta, houve manutenção em 59,3% e melhora em 17,2% dos pacientes. Os dados apresentados indicam que muitos pacientes foram tratados tardiamente já apresentando as formas graves e com sequelas, já que o estudo foi desenvolvido em um centro de referência, que atende casos mais complexos e com complicações já instaladas. Os dados sugerem que pacientes assistidos que realizam o tratamento com poliquimioterapia podem ter melhora das incapacidades já instaladas. O mesmo ocorreu com o escore olhos, mãos e pés, que ao final do tratamento instituído houve melhora se comparado com a admissão.(AU)

This study aims to evaluate the evolution of the degree of physical disability and the eye, hand and foot score, from diagnosis to medication discharge, according to sociodemographic and clinical variables, in patients diagnosed with leprosy. This is a cross-sectional study, based on the analysis of 71 patients diagnosed with leprosy, followed by Hospital Eduardo de Menezes, a reference center in Belo Horizonte, Minas Gerais, Brazil, between January 2017 and December 2020. There was a predominance of females (53.5%), average age of 46 years old, the majority coming from other municipalities in the interior of Minas Gerais (54.9%). The most frequent clinical form was borderline (64.8%), multibacillary operational classification (84.5%). Degree of physical disability 0 was the most prevalent at diagnosis (56.5%) and at discharge (53.1%); in relation to the eye, hand and foot score, there was variation between 0 and 10 at diagnosis and between 0 and 8 at discharge. By the McNemar test, it was observed that of the patients who had degree of physical disability at the time of diagnosis, 30.8% had no disability at discharge. When comparing the evolution of the GIF in paucibacillary and multibacillary patients at the time of diagnosis and discharge, there was maintenance in 59.3% and improvement in 17.2% of the patients. The presented data indicates that many patients were treated late, already presenting severe forms and with sequelae, since the study was carried out in a reference center, which treats cases with complications already installed and more complex cases. The data suggest that assisted patients undergoing treatment with multidrug therapy may experience improvement in disabilities already established. The same occurred with eye, hand and foot score, at the end of the established treatment there was an improvement compared to admission.(AU)

Efficacy of fixed duration multidrug therapy for the treatment of multibacillary leprosy: A prospective observational study from Northern India

Background: In endemic regions of several countries, the prevalence of leprosy has not come down to the level of elimination. On the contrary, new cases are being detected in large numbers. Clinically, it is frequently noted that despite completion of multibacillary multidrug therapy for 12 months, the lesions remain active, especially in cases with high bacteriological indices. Aim: The present study focused on finding out the viable number of Mycobacterium leprae during the 12-month regimen of multibacillary multidrug therapy, at six and 12 months intervals and, attempting to determine their role in disease transmission. Methods: Seventy eight cases of multibacillary leprosy cases were recruited from leprosy patients registered at The Leprosy Mission hospitals at Shahdara (Delhi), Naini (Uttar Pradesh) and Champa (Chhattisgarh), respectively. Slit skin smears were collected from these patients which were transported to the laboratory for further processing. Ribonucleic acid was extracted by TRIzol method. Total Ribonucleic acid was used for real-time reverse transcription-polymerase chain reaction (two-step reactions). A standard sample with a known copy number was run along with unknown samples for a reverse transcription-polymerase chain reaction. Patients were further assessed for their clinical and molecular parameters during 6th month and 12th month of therapy. Results: All 78 new cases showed the presence of a viable load of bacilli at the time of recruitment, but we were able to follow up only on 36 of these patients for one year. Among these, using three different genes, 20/36 for esxA, 22/36 for hsp18 and 24/36 for 16S rRNA cases showed viability of M. leprae at the time of completion of 12 months of multidrug therapy treatment. All these positive patients were histopathologically active and had bacillary indexes ranging between 3+ and 4+. Patients with a high copy number of the Mycobacterium leprae gene, even after completion of treatment as per WHO recommended fixed-dose multidrug therapy, indicated the presence of live bacilli. Limitations: Follow up for one year was difficult, especially in Delhi because of the migratory nature of the population. Patients who defaulted for scheduled sampling were not included in the study. Conclusion: The presence of a viable load of bacilli even after completion of therapy may be one of the reasons for relapse and continued transmission of leprosy in the community

The Burden of Histoid Leprosy in Post Elimination Era

Histoid leprosy is a rare variant of lepromatous leprosy, may occur de novo or may occur in cases earlier treated with dapsone monotherapy. Demographic, clinico-histopathological and treatment details of biopsy proven cases of histoid leprosy, collected retrospectively from the leprosy clinic of tertiary care hospital of SMS Medical College, Jaipur. During the study period of 5 years (2011-2016), 28 (2.98 %), patients had histoid leprosy among total 937 patients of leprosy. Most were in 21 – 40 years of age group with M: F ratio 2.5: 1. Histoid lesions developed with primary diagnosis of lepromatous leprosy in (71.4%) and de novo in (28.6%). Predominant site of involvement was upper extremity (85.7%) and most common presentation was subcutaneous nodules, Nerve thickening seen in (85.7%), and ulnar nerve being most common. Neuritis and disabilities were present in 6 and 16 patients respectively. Type 2 reaction seen in17.9% (5/28) patients. Biopsy and slit skin smear of all cases were done. Most (25/28) cases responded well to standard one-year multibacillary drug therapy (MDT), it had to be extended in three cases up to 2 years. Histoid leprosy may occur de novo or may be due to inadequate therapy, resistant strains, earlier dapsone monotherapy. Although India as whole has achieved leprosy elimination in January 2006, however new cases continue to be reported. Occurrence of histoid leprosy specially with changed morphology of the lesions and poor histopathological correlation needs to be investigated as these cases may be important source of infection even in low endemic situations.

The Experiences of Leprosy Clients Attending Self-Care Groups During Community-Based Rehabilitation for Fulfilling Their Health Needs

The experience of leprosy clients undergoing treatment in community-based rehabilitation (CBR) needs to be identified more deeply to reduce, prevent transmission and the disability it causes because it will impact the social life of leprosy clients in the community. The non-fulfillment of the needs of leprosy clients in the community will impact the conditions of transmission and disability of leprosy clients. We explored the experiences of leprosy clients attending self-care groups during CBR for identifying their health needs. A descriptive phenomenology study was performed among leprosy clients, families, and healthcare providers. Our study included 16 leprosy clients and their families and six healthcare providers. A triangulation method was performed to compare the third source data. Thematic analysis was used to identify the phenomenon of leprosy during CBR for fulfilling their health needs. We have identified five themes, including leprosy prevention efforts, self-care process and client treatment for leprosy, the needs of clients with leprosy during self-care at CBR, medication, and therapy during the CBR family support during rehabilitation and treatment. Therefore, fulfilling the needs for self-care, medication, and therapy during the rehabilitation period for leprosy clients in the community needs to be facilitated and fulfilled to support recovery. Furthermore, CBR designs that prioritize self-care aspects and are integrated with family care need to be developed in the future. All these approaches should be developed, adapted and validated in different settings with specific needs

Procedural dermatology in the COVID-19 era: an online survey of the Philippine Dermatological Society members and practical recommendations for safe practice

@#BACKGROUND: The novel COVID-19 (Coronavirus Disease 19) predisposes the general population to a high risk of infection. The 106 million population of the Philippines would be considered an at-risk group due to the high density of the populace in cities. As the situation in each country differs during this era of the COVID-19 pandemic, this paper aims to give practical recommendations for safe procedural dermatology practice in the Philippine setting after the lifting of the government-mandated quarantine. METHODS: An online survey was conducted among Philippine Dermatological Society members. The survey was sent electronically on March 22, 2020. RESULTS: A total of 466 or 42% of the PDS’s 1100 current members replied to the survey. The top 10 procedures performed among the respondents are: 1. Electrocautery (N=437, 94.38%), 2. Chemical peeling (N=422, 91.13%), 3. Laser & energy based device treatment (N= 341, 73.65%), 4. Botulinum toxin injection (N=323, 69.76%), 5. Excision (N=263, 56.80%), 6. Acne surgery (N=176, 38.01%), 7. Injectable Filler (N=171, 36.93%), 8. Cryotherapy (N=145, 31.32%), 9. Platelet rich plasma injection (N=111, 23.97%) and 10. Scar revision (N=85, 18.36%). The majority of the respondents have access to personal protective equipment (PPE) such as surgical masks (N=457, 98.7%), face shields (57.67%), goggles (46.00%), protective gown (42.76%) and bonnets (32.83%). Before the government quarantine, the majority (N=375, 81.17%) of respondents see patients on a firstcome, first-serve system. Only 18.83% (N=87) see patients only by appointment. Regarding teledermatology, most respondents answered that they would advise patients to do digital consultation with only a minority responding they would not consider doing teledermatology. CONCLUSIONS: In the Philippine setting, the best ways to prevent COVID infection inthe procedural dermatology setting include: 1. Education of staff and patients on proper exposure prevention and sanitation measures. 2. Ensuring the correct usage of PPE. 3. Ensuring physical distancing and reducing patient wait times by scheduling visits on an appointment basis. 4. Sufficient protocols must be made for sanitation before and after each patient visit. 5. Teledermatology in pre-procedure consults and post-procedure follow-ups would reduce the risk of COVID-19 transmission for both patient and physician.

Relapse rate among smear-positive leprosy cases after 12 blister packs and 24 blister packs of multibacillary drug therapy in a tertiary hospital

@#BACKGROUND: Several trials on relapse rates on duration of multibacillary regimens have varying results. OBJECTIVE: To compare the relapse rate among smear-positive Leprosy patients receiving 12 blister packs of multibacillary drug therapy and 24 blister packs of multibacillary drug therapy. METHOD: A review of records of smear positive Leprosy patients seen from 2002 to 2006 was done. Demographic, clinical and therapeutic data were collected. Bacteriologic index was determined from Leprosy Laboratory records. RESULT: A total of 391 patients were found to have complete records for review and analysis. Relapse rate was 11.9%(28) for patients who received 12 blister packs and 1.91%(3) for patients who received 24 blister packs and the difference was found to be statistically significant (p<0.01). Distribution of relapse was statistically significant according to age (p<0.01), bacteriologic index (p<0.01) and clinical spectrum (p<0.01). CONCLUSION: Relapse rates shown among smear positive leprosy patients receiving 12 blister packs vs. those receiving 24 blister packs was statistically higher which differs from previously published studies. Significant predictors were clinical spectrum, bacteriologic index of >3.5, and >4 and number of blister packs.

Prevalence and influencing factors of leprosy reactions from2010 to 2019 in Zhejiang Province / 预防医学

Objective @#To analyze the prevalence and influencing factors of leprosy reactions in Zhejiang Province from 2010 to 2019, so as to provide reference for the control of leprosy.@*Methods@#Through the national leprosy management system, the new leprosy cases in Zhejiang Province from 2010 to 2019 were recruited to analyze the incidence of leprosy reactions in different demographic characteristics and leprosy clinical features. The multivariate logistic regression analysis was conducted to explore the influencing factors for leprosy reactions.@*Results @#Totally 191 leprosy cases were investigated. The incidence rate of leprosy reactions was 29.32%; the the incidence rate of typeⅠand type Ⅱreaction was 16.75% and 9.42%, respectively. There were 33 leprosy reaction cases (58.93%) before multidrug therapy (MDT) , 13 cases (23.21%) during 0-6 months of MDT, 5 cases (8.93%) during 7-12 months of MDT, 3 cases (5.36%) during over 12 months of MDT, and 2 cases (3.57%) after MDT. The results of the multivariate logistic analysis showed that the cases who were 35 years old or below (OR=2.245, 95%CI: 1.006-5.008) , were not floating population (OR=3.442, 95%CI: 1.394-8.494) , were infected outside family (OR=3.878, 95%CI: 1.075-13.993) and were smear positive (>0+,OR=4.514, 95%CI: 1.365-14.926; >3+,OR=4.727, 95%CI: 1.443-15.485) were risk factors for leprosy reactions.@*Conclusions@#The prevalence of leprosy reactions is high in Zhejiang Province from 2010 to 2019, and is associated with age, floating population, source of infection and BI.

Assessment of Factors Responsible for Dropout to Multi Drug Therapy for Leprosy

This study was conducted over 2 years period at two leprosy centers of a Tertiary Care Service Hospitals one located in Eastern Uttar Pradesh and second in northern India to assess the factors resulting in pre-mature termination of anti-leprosy treatment in patients. A total of 124 patients, undergoing treatment for leprosy who consumed MDT for at least a month, then stopped it and thereafter reported to us for various reasons, were included. It was observed that 41.1% (51/124) patients dropped out on MDT. 33% (41/124) of the patients who stopped the medication were not formally educated. Most common disease forms observed in these patients was Borderline Lepromatous (BL) and Lepromatous Leprosy in 41.1% (51/124). 49.1% (61/124) patients completed 2-5 months of therapy with MDT prior to stopping it and 38.7% (48/124) patients reported back to us within 2-5 months after suspension of MDT. Reason for reporting in 31.4% (39/124) of these patients was development of deformities while 25% (31/124) reported due to weakness of hands and feet. 23.3% (29/124) developed lepra reaction becoming the reason for their reporting to us for review. Social stigma was the most common factor leading to termination of drug therapy against advice in 25.8% (32/124) patients, 21.7% (27/124) cited loss of occupational hours while 11.2% (14/124) patients felt there was no need to take MDT. To conclude non-compliance to multi drug therapy for leprosy is one of the major obstacles in achieving a leprosy free world and we need to look into all the personal, health care related and social factors responsible for it. Although these factors may vary depending upon the region, society, efficiency of the health care system and the individual commitment level of the patients, the need for better communication at professional and user level is apparent. Focus should be on psychological counselling, motivation of patients, their families and a receptive society to reduce the source of infection, complications and deformities which are otherwise largely preventable and adherence to treat will also prevent of emergence of resistance to MDT. Modified strategy(ies) addressing the factors as identified in this study well in time can make a difference.

Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro

Abstract INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

A curious case of Lepromatous Leprosy Developing Complete loss of Pigmentation, followed by Reappearance of Pigmentation with Multi Drug Therapy (MDT) alone - A Support for Neural Theory of Vitiligo Pathogenesis?

Lepromatous leprosy is a multisystem disease characterized by a decline in delayed hypersensitivity to Mycobacterium leprae antigens, causing multiplication of bacilli in huge numbers. We herein report a case of an adult male with lepromatous leprosy who was started on adult multibacillary multi-drug therapy. With treatment, the surface of lesions developed depigmented macules and patches. However, on continuation of antileprotic drugs, there was progressive perifollicular as well as inter-follicular re-pigmentation. This case clinically depicts re-pigmentation of depigmented skin following multidrug therapy for leprosy supporting the role of neural system in the homeostasis of melanocytes.

Elimination of leprosy in India: An analysis

India attained the elimination figure of less than 1 case of leprosy per 10,000 people during December 2005. Despite this, India still accounts for the largest number of new leprosy cases in the world, maintaining more than 50 per cent of the leprosy burden of the world, notwithstanding over three decades of use of multidrug therapy. The present review analyzes the process of execution of the elimination program, identifies any lacunae therein and presents corrective measures that could be taken up for elimination of the disease from the country.

Uma cura controversa: a promessa biomédica para a hanseníase em Portugal e no Brasil / A controversial cure: the biomedical promise for hanseniasis in Portugal and Brazil

Este artigo procura responder à pergunta, nascida na empiria do trabalho de campo: por que algumas pessoas portadoras de hanseníase e tratadas com a poliquimioterapia (PQT) se sentem curadas e outras não? Com base numa etnografia multissituada nas escalas transnacional (programa global para a hanseníase da Organização Mundial da Saúde), nacional (paisagens morais e paradigmas biopolíticos para a hanseníase em Portugal e Brasil) e local (prática clínica em contexto hospitalar e experiência incorporada das pessoas portadoras nos dois países), analisa como a incerteza documentada na clínica da hanseníase e a clivagem experienciada por algumas pessoas, entre a cura bacteriológica e o sentimento de se sentir sanado, abre uma controvérsia em torno dos principais postulados que sustentam o emprego da PQT como uma entidade autônoma do contexto e difratam a fronteira entre o normal e o patológico em que se baseia o enquadramento contemporâneo da hanseníase e as respostas institucionais à mesma. Finalmente, conclui pela necessidade de incluir uma escolha incorporada na atual política ontológica para a hanseníase que amplie a própria nosologia e refunde um novo paradigma de cuidado, de tipo participativo.

This paper aims to answer the following question that arouse during fieldwork: why some people with hanseniasis and treated with multidrug therapy (MDT) feel healed and others don't? From a multi-sited ethnography in the transnational (global program for hanseniasis from the World Health Organization), national (Portuguese and Brazilian moral landscapes and biopolitical paradigms), local (clinical practice and incorporated experience of people with hanseniasis in both countries) scales, it examines how the uncertainty documented in the clinic and the gap experienced by some people between the bacteriological cure and the feeling of being healed, opens for a controversy on the main postulates that sustain the use of MDT as an autonomous entity and diffract the contemporaneous framing of hanseniasis and the institutional responses to it. Finally, it concludes on the need for including an incorporated choice that might widen hanseniasis' ontological politics and rebuild a new participatory paradigm of care.

A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India.

To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT) with monthly rifampicin, ofl oxacin, and minocycline for six months (ROM-6) among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001–2004, who had paucibacillary (PB) leprosy having 1–5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the fi rst day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for fi rst 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Chi square test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not signifi cant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group) giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053; statistically not signifi cant). Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6), 4 during 5–8 years (3 in PB-MDT and 1 in ROM-6), and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional diffi culties in the fi eld. Conclusion: The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate.

Caracterización de adultos mayores con polifarmacia evaluados en la consulta de geriatría / Characterization of older adults with multidrug consumption assessed by the geriatric service

OBJETIVO: caracterizar a los adultos mayores con polifarmacia. MÉTODOS: investigación descriptiva, retrospectiva. Se conformó la muestra con 261 adultos mayores con polifarmacia, pertenecientes al área de salud del Policlínico Universitario "Carlos Manuel Portuondo" del municipio Marianao. Se evaluaron los pacientes en la consulta de Geriatría entre marzo de 2010 y abril de 2011. Para considerar la presencia de polifarmacia, se tomó como referencia la administración simultánea de más de tres fármacos; no se incluyeron vitaminas ni suplementos alimenticios. RESULTADOS: hubo una elevada polifarmacia en el grupo de estudio; se presentó con mayor frecuencia en el grupo de edad de 60-64 años; predominó el sexo femenino y un nivel educacional primario. El grupo de edad comprendido entre 60-69 años consumió entre tres y cinco medicamentos. Las enfermedades más relacionadas con la polifarmacia fueron las cardiovasculares. La mayoría de los pacientes con polifarmacia mostró alguna limitación en su estado funcional global. CONCLUSIONES: dado el predominio de la polifarmacia en adultos mayores con medicamentos para trastornos cardiovasculares, se hace necesario desarrollar nuevas concepciones sobre la farmacología clínica del anciano para crear una conciencia que permita una política racional de uso de medicamentos.

OBJECTIVE: to characterize the older adults with multidrug therapy. METHODS: retrospective and descriptive research study. The sample was 261 older adults with multidrug therapies, who were attended to by the health area of "Carlos Manuel Portuondo" university polyclinics in Marianao municipality. The patients were evaluated at the geriatric service from March 2010 through April 2011. For consideration of multidrug therapy, the patient should take more than three drugs at the same time excluding vitamins and food supplements. RESULTS: the study group presented with high index of multidrug consumption; the predominant age group was 60-64 years; females and elementary education level prevailed. The 60-69 years age group consumed 3 to 5 drugs. The most related diseases to multidrug therapy were cardiovascular illnesses. Most of the patients showed some limitations in their general functional status. CONCLUSIONS: given the predominance of multidrug therapy in older adults to treat cardiovascular disorders, it is necessary to develop new concepts on the clinical pharmacology of the old people in order to raise awareness and to allow the implementation of a rational drug use policy.

Twelve months fixed duration WHO multidrug therapy for multibacillary leprosy: incidence of relapses in Agra field based cohort study.

Background & objectives: The reported low relapse rates after 24 months multidrug therapy (MDT) for multibacillary leprosy (MB) led to the recommendation of reducing duration of therapy to 12 months. However, only a few reports exist on long term follow up data after 12 months fixed duration therapy (FDT). The present study was done to assess the incidence of relapse in MB leprosy patients after 12 months treatment. Methods: The leprosy patients detected in field surveys during 2001-2006 in Agra district, Uttar Pradesh, India, were put on WHO-MDT and followed up for treatment completion, relapse, reactions and development of disability. The assessment was done clinically by following up the patients until January 2011. Data collected were analyzed for risk and survival analysis. Results: The incidence of relapse was found to be 1.97/100 person years of follow up. The incidence of relapse by age (34 yr vs >34 yr), sex (male vs female), delay in detection (<36 months vs >36 months) and smear status (smear +ve vs -ve) was not found to be significantly different but patients with no nerve involvement were observed to have significantly higher relapses than those with three or more nerve involvement (P<0.05). Similarly, borderline-borderline and BB with reaction (BB/BBR) patients were observed to have significantly high relapses than among those with borderline tuberculoid or BT with reaction (BT/BTR) or borderline lipromatous/lepromatous/neuritic (BL/LL/N) type of leprosy (P<0.01). Interpretation & conclusion: From the observations in the study, it can be suggested that relapses occur in 12 months FDT and almost as much as reported in 24 months FDT for MB leprosy. Although, early relapses may be due to insufficient treatment, late relapses may be due to persistent dormant mycobacteria. However, a study relating to immunological response of treatment and change in immunological profile relating to the occurrence of relapses and its clinical correlates may suggest better information on causes of relapses.

Avaliação dos pacientes com hanseníase multibacilar submetidos ao esquema terapêutico substitutivo / Evaluation of multibacillary patients undergoing replacement regimen

O tratamento da hanseníase tem como objetivo a cura bacteriológica que interrompe a transmissão, a cura clínica que devolve bem estar ao paciente e a redução das incapacidades permanentes, sendo considerado um ponto estratégico para o controle da endemia e para sua eliminação como problema de saúde pública. Entretanto, as medicações da poliquimioterapia podem causar eventos adversos, levando a desfechos clínicos desfavoráveis, prejudicando a evolução clínica desses pacientes, podendo contribuir para o abandono da poliquimioterapia padrão. O esquema terapêutico substitutivo é indicado para pacientes que apresentam intolerância a poliquimioterapia padrão. Este estudo teve como objetivo avaliar a evolução clínica dos pacientes multibacilares tratados com esquema terapêutico substitutivo preconizado pelo Ministério da Saúde, comparando-os com aqueles submetidos ao esquema padrão (PQT/OMS – 12 doses) para o tratamento da hanseníase. Adicionalmente, pretendese descrever os principais eventos adversos que levaram a troca do esquema padrão. Foi realizado um estudo retrospectivo, utilizando uma coorte de 435 pacientes de hanseníase multibacilares registrados no Ambulatório Souza Araújo no período de janeiro de 1998 a dezembro de 2009. Os pacientes foram divididos em dois grupos: grupo 1 composto por 390 pacientes que realizaram tratamento com a poliquimioterapia padrão e o grupo 2 por 45 pacientes que realizaram tratamento com poliquimioterapia substitutiva. Os desfechos clínicos utilizados para comparação dos dois esquemas terapêuticos foram: evolução da carga bacilar, evolução do grau de incapacidade física e evolução da ocorrência de episódios reacionais após a alta da PQT/OMS, comparando com o esquema padrão. Para isso, foi realizado um estudo retrospectivo, utilizando uma coorte de pacientes de hanseníase multibacilares registrados no Ambulatório Souza Araújo (Laboratório de Hanseníase/IOC/Fiocruz) no período de janeiro de 1998 a dezembro de 2009...(AU)

The treatment of leprosy aims to bacteriological cure that stops transmission, clinical cure that returns the patient welfare and reduce permanent disability and is considered a strategic point for disease control and elimination as a public health problem. However, medications can cause multidrugtherapy adverse events leading to unfavorable clinical outcomes, impairing the clinical outcomes of patients and may contribute to the abandonment ofstandard polychemotherapy. The replacement regimen is indicated for patients who are intolerant to standard polychemotherapy. This study aimed to evaluate the clinical outcomeof patients treated with multibacillary regimen substitute recommended by the Ministry of Health, comparing them with those undergoing standard regimen (WHO / MDT - 12 doses)for the treatment of leprosy. Additionally, we intend to describe the main adverse events that led to the exchange of the default schema. We conducted a retrospective study using a cohort of 435 patients with multibacillary leprosy recorded in Ambulatory Souza Araújo fromJanuary 1998 to December 2009. Patients were divided into two groups: group 1 comprised of 390 patients who underwent standard treatment with multidrug therapy and group 2 of 45patients who underwent treatment with multidrug therapy replacement. Clinical outcomes used to compare the two regimens were: evolution of bacterial load, evolution of physical disability and evolution of the occurrence of reactional episodes after discharge from MDT /WHO, compared with the standard regimen. For this, we conducted a retrospective study using a cohort of multibacillary leprosy patients registered at the Clinic Souza Araújo(Leprosy Laboratory / IOC / Fiocruz) from January 1998 to December 2009...

A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.

Leprosy: a modern assessment of an ancient neglected disease

Leprosy or Hansen's disease is a chronic mycobacterial infectious disease caused by Mycobacterium leprae and affects mainly peripheral nerves and skin as well as upper respiratory mucosae. This infection is a conjoined bacteriological and immunological disease. Target cells of infection are macrophages, histiocytes in the skin, and the nonmyelinating and myelinating Schwann cells in the peripheral nerves leading to axonal dysfunction and demyelination leading to functional impairment and deformity. Leprosy reactions represent the most important determinant of nerve impairment if untreated and unrecognized. Control of leprosy transmission remains a challenge despite substantial improvements through the use of multidrug therapy in many settings. Most importantly, although many patients have been microbiologically cured through the efforts of the World Health Organization, many are left with significant disability that has recently been estimated to be ~20% of those treated (~15 million individuals) in the last decades. Further efforts are needed to elucidate the epidemiology and risk factors for disability among those with multibacillary forms.

Reações hansênicas em pacientes em alta por cura pela poliquimioterapia / Leprosy reactions in discharged patients following cure by multidrug therapy

INTRODUÇÃO: Reações hansênicas são a principal causa de lesões dos nervos e incapacidades provocadas pela hanseníase. MÉTODOS: Estudo retrospectivo com objetivo de verificar a frequência de reações hansênicas em pacientes com alta por cura pela poliquimioterapia (PQT). RESULTADOS: Pacientes que apresentaram reações durante o tratamento, 35,5 por cento continuaram pós-PQT; aqueles que não apresentaram no tratamento, somente 12,7 por cento tiveram pós-PQT; 63,4 por cento multibacilares apresentaram durante e 31,7 por cento após; paucibacilares 27,7 por cento durante e 8,3 por cento após. CONCLUSÕES: Existe relação diretamente proporcional entre presença de reações durante e após o tratamento. Formas clínicas multibacilares apresentam maior frequência de reações durante e após a cura.

INTRODUCTION: Reactional states are the main cause of nerve lesions and incapacities provoked by leprosy. METHODS: Retrospective study aimed at verifying the frequency of leprosy reactions in discharged patients following cure by multidrug therapy (MDT). RESULTS: Among patients who presented reactions during treatment, 35.5 percent continued after MDT; of those that did not present during treatment, only 12.7 percent presented after discharge; 63.4 percent multibacillary patients presented during and 31.7 percent after; 27.7 percent paucibacillary patients presented during and 8.3 percent after. CONCLUSIONS: A direct proportional relation exists between the presence of reactions during and after treatment. Multibacillary clinical forms present a greater frequency of reactions during and after cure.