Underlying mechanisms of leprosy recurrence in the Western Amazon: a retrospective cohort study
s.l; s.n; 2019. 10 p. tab, mapas, graf.
Non-conventional
in English
| Sec. Est. Saúde SP, HANSEN, Hanseníase Leprosy, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP
| ID: biblio-1099450
Responsible library:
BR191.1
Localization: BR191.1; 9737/S
ABSTRACT
BACKGROUND:
The multidrug therapy (MDT) for leprosy treatment adopted by Brazil in the 1990s was important for reducing leprosy in the country; however, recurrent cases remained problematic. Mechanisms involved in leprosy recurrence are heterogeneous and can be sorted into three groups insufficient therapy, bacillary persistence and new infections. This study aimed to analyse the time interval of leprosy recurrence in relation to the therapeutic scheme in the state of Acre. The hypotheses were as follows 1) treatments (a) rifampicin, ofloxacin and minocycline (ROM) and (b) dapsone (DDS) have a short leprosy recurrence time, 2) treatments based on MDT have a long leprosy recurrence time, 3) there is a dose-response relationship between MDT and the time interval between leprosy episodes.METHODS:
This retrospective cohort study included 201 patients with a second episode of clinical leprosy at the reference centers for leprosy control in the state of Acre. Exposure was the type of therapeutic scheme as follows 1) ROM, 2) DDS, 3) MDT0-9 doses, 4) MDT10-19 doses, 5) MDT20-29 doses, and 6) MDT30+ doses. Outcome was the time interval between release from treatment and a diagnosis of a recurrent leprosy case. Incidence rate ratios and relative risk Poisson regressions adjusted by age and sex were calculated with 95% confidence intervals.RESULTS:
The 201 patients studied during this retrospective follow-up resulted in a total of 224 cases of recurrent leprosy. Incidence rate ratios within this therapeutic scheme were as follows 3.3 (2.39, 4.2; ROM/MDT30+), 1.12 (0.33, 1.92; DDS/MDT30+), 2.17 (1.39, 2.94; MDT0-9/MDT30+), 1.94 (1.13, 2.75; MDT10-19/MDT30+) and 1.26 (0.47, 2.05; MDT20-29/MDT30+). Relative risk Poisson regressions showed a protective effect of MDT30+ in comparison with ROM (0.22; 0.07, 0.72), MDT0-9 (0.42; 0.21, 0.85), and MDT10-19 (0.44; 0.21, 0.92). No differences among MDT30+ and DDS (0.71; 0.36, 1.41) and MDT20-29 (0.76; 0.38, 1.49) were observed.CONCLUSIONS:
New infection is an important-yet neglected-mechanism in leprosy recurrence in the state of Acre and can challenge the leprosy elimination plan in Brazil. MDT with few doses might be associated with leprosy recurrence due to insufficient therapy or bacillary persistence.
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
SDG3 - Health and Well-Being
/
Neglected Diseases
Health problem:
Target 3.3: End transmission of communicable diseases
/
Leprosy
/
Neglected Diseases
Database:
HANSEN
/
Hanseníase Leprosy
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Sec. Est. Saúde SP
/
SESSP-ILSLACERVO
/
SESSP-ILSLPROD
Main subject:
Rifampin
/
Time Factors
/
Ofloxacin
/
Cohort Studies
/
Treatment Outcome
/
Dapsone
/
Drug Therapy, Combination
/
Leprostatic Agents
/
Leprosy
/
Minocycline
Type of study:
Etiology study
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Incidence study
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Observational study
/
Risk factors
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
English
Year:
2019
Document type:
Non-conventional