ABSTRACT
BACKGROUND: The question was raised as to why 'obvious' signs of leprosy, Hansen's disease (HD), are often missed by medical doctors working in a HD endemic area. METHODS: This study describes a small sample of patients who were diagnosed with HD during their hospital admission and not before. The discussion is whether the typical early signs and symptoms of HD are just not recognized, or whether unusual presentations confuse the attending physician. RESULTS: A total of 23 HD patients were hospitalized during the study period, of which 6 (26%) were only diagnosed with HD during their admission. All were classified as lepromatous leprosy (LL) with a history of signs and symptoms of HD. In nearly all patients, a suspicion of HD might have been raised earlier if a careful history and dermato-neurological examination had been done. CONCLUSIONS: Multibacillary (MB) HD, especially close to the lepromatous end of the spectrum, may mimic other diseases, and the patient can not be diagnosed without a biopsy or a slit skin smear examination. Clinicians working in a HD endemic area (Rio de Janeiro) do not always include HD in their differential diagnosis, especially when the clinical presentation is unusual. HD should be considered in all patients with skin lesions not responding to treatment, especially when they have neurological deficits, and live or have lived in an HD endemic area. Due to the increase in global travel and immigration, doctors in low endemic areas need to consider HD as a possible diagnosis.
Subject(s)
Hospitals, General , Leprosy/diagnosis , Leprosy/pathology , Adult , Aged , Brazil/epidemiology , Female , Humans , Leprosy/epidemiology , Male , Middle Aged , Prospective StudiesABSTRACT
The purpose of this article is to demonstrate the complexities of adapting technology and developing the sensory testing technique of the Semmes-Weinstein (S-W) monofilaments in Brazil to enable early detection and monitoring of peripheral nerve function in Hansen's disease (Hd). This history of the adoption and implementation of the use of the S-W monofilaments in Brazil follows the sequence described in adoption and diffusion theory of innovations. As a result, the availability of the S-W monofilaments produced in Brazil facilitated the utilization of this sensory testing technique in Brazil. In addition, the Brazilian model proved to be more accessible, durable, portable, and practical in meeting local needs. It improved health care worker awareness of and desire to use better sensory testing technology, making it possible to prevent disability.
Subject(s)
Leprosy/diagnosis , Touch/physiology , Brazil , Differential Threshold , Health Knowledge, Attitudes, Practice , Humans , Leprosy/physiopathology , Nylons , Physical Therapy Modalities/education , Physical Therapy Modalities/methodsABSTRACT
The purpose of this article is to demonstrate the complexities of adapting technology and developing the sensory testing technique of the Semmes-Weinstein (S-W) monofilaments in Brazil to enable early detection and monitoring of peripheral nerve function in Hansen's disease(Hd). This history of the adoption and implementation of the use of theS-Wmonofilaments in Brazil follows the sequence described in adoption and diffusion theory of innovations.As a result, the availability of the S-W monofilaments produced in Brazil facilitated the utilization of this sensory testing technique in Brazil. In addition, the Brazilian model proved to be more accessible, durable, portable, and practical in meeting local needs. It improved health care worker awareness of and desire to use better sensory testing technology, making it possible to prevent disability