RESUMO
This paper presents a retrospective study on the detection of the treatment of leprosy reactions in a field situation, and the effect of prednisone on the various affected nerves. Two patient cohorts were analysed. The leprosy control programme in the testing area is not backed up by a specialized referral leprosy hospital, but patients are treated on an ambulatory basis at peripheral health centres by trained multipurpose health workers supervised by the health centre doctors. For operational purposes the guidelines and procedures for reaction management in the field were adjusted and partially simplified. In both studies it appeared that the time of the occurrence of severe reactions was the same: 80% or more of the severe reactions occurred in the first year of treatment, the majority in the first few months after the start of the multidrug (MDT) treatment. One third of all reaction patients suffered from a silent neuritis. Well-instructed fieldworkers proved to be competent in detecting and treating leprosy reactions. Treatment of severe reactions with prednisone in the field situation can preserve or considerably improve the functions of the affected nerves. It is interesting that often the motor function of a nerve was found to be impaired without any loss in sensibility, which was tested using the ballpoint pen method.
PIP: A retrospective study of two patient cohorts in Central Sulawesi, Indonesia, analyzed the detection of the treatment of leprosy reactions in a field situation and the effect of prednisone on the affected nerves. In Indonesia, leprosy patients are treated on an outpatient basis at peripheral health centers by trained multipurpose health workers supervised by the health center doctor. The first cohort included 69 patients with severe reactions (125 affected nerves) and the second was comprised of 85 patients with severe reactions (180 affected nerves). Both groups were treated with the minimum standard dose of prednisone for 10 weeks. 81% of severe reactions occurred in the first year of treatment. 27% appeared to suffer from a severe reaction at the time of first contact. The ulnar nerve was most frequently affected. 33% of all reactors suffered from a silent neuritis. 75-80% of affected nerves improved either partially or totally. Treatment of severe reactions with prednisone appears to preserve or considerably improve the functions of the affected nerves. In many cases, the nerve's motor function was impaired with no loss in sensitivity. These findings confirm that well-instructed leprosy field workers are capable of detecting severe reactions on a timely basis and are competent to treat these complications adequately.