Características de la lepra infantil en el Hospital Mennonita km. 81 / Characteristcs of leprosy in children at the Mennonite Hospital at kilometer 81

Introducción: La Lepra infantil sigue siendo una patología poco descripta y sub valorada en la consulta diaria. El diagnóstico exige buena habilidad clínica porque las lesiones cutáneas son asintomáticas y pueden pasar desapercibidas. Objetivo: Presentar una casuística pediátrica y dar ponderancia a los criterios clínicos y epidemiológicos para el diagnóstico. Material y Método: Estudio descriptivo, retrospectivo. En 73 casos se observó contacto familiar intradomiciliario. La clínica y la epidemiología fueron los pilares básicos del diagnóstico, pues la baciloscopía resultó negativa en el 78% de los casos. Conclusión: La lepra figura dentro de las enfermedades reemergentes en nuestro país y a nivel mundial, razón por la cual el pediatra debe pensar en ella para el diagnóstico diferencial ante un paciente con lesiones cutáneas y/o alteraciones sensitivas, y orientar el interrogatorio en la búsqueda de antecedentes familiares de la afección.

Introduction: Leprosy in children remains a pathology that is little described, and is underestimated in routine examination. Diagnosis of leprosy requires superior clinical skills because the lesions of the skin are asymptomatic and can pass unnoticed. Objective: To present pediatric case material and offer considerations concerning clinical and epidemiological criteria for diagnosis. Materials and Methods: A retrospective descriptive study. We evaluated 88 patient records stored in the archives of the Mennonite Hospital loca-ted at Kilometer 81, Route 2, Paraguay, from the time period of January 2000 until June of 2003, analyzing age, gender, clinical signs leading to diagnosis, time of progression, bacilloscopy the form of leprosy (lepromatous or tuberculoid), and history of contacts. Results: The most affected age group (42%) was that of ages 10- to 14-years of age, among males (58%), the most common form is tuberculoid, or paucibacillary leprosy (27 cases) and lepromatous, or multibacillary leprosy (25 cases). In 73 cases, intra-household contact was observed. Clinical examination and epidemiology were the primary tools for diagnosis, given that bacilloscopy was negative in 78% of patients. Conclusion: Leprosy is a disease that is re-emerging in Paraguay and around the world, for that reason pediatricians should consider it in differential diagnosis when faced with a patient with lesions of the skin or changes in sensitivity, and should ask questions to elicit any family history of the disease.

Delay in presentation in the context of local knowledge and attitude towards leprosy--the results of qualitative fieldwork in Paraguay.

OBJECTIVE: The primary objective of our research was to explore help-seeking behavior in the context of knowledge, attitude, and practice as factors contributing to delay in presentation in leprosy. The secondary objective was to demonstrate the value of basic qualitative research methods in this context. METHODOLOGY: Fieldwork was based at the Hospital Mennonita Km 81, the referral center for leprosy services in Paraguay. We adopted exclusively qualitative methods for fieldwork, effectively carrying out a rapid assessment of factors contributing to delay. We relied on multiple sources of information and the use of multiple methods to ensure the validity of our findings. RESULTS: Our findings linked delay in presentation to traditional beliefs, lack of awareness of the early symptoms of leprosy, stigma, seeking help from natural healers, and to interactions with the health services. Traditional beliefs diminish the importance of the early symptoms of leprosy. Stigma has an impact on decisions to seek help. Natural healers have maintained their traditional status in society; their preferred treatments for leprosy are ineffective. Only rarely do natural healers refer to the health services. Once presented to the health services, some individuals affected by leprosy experienced lengthy delays in diagnosis and start of treatment. DISCUSSION: To address the traditional values of a society and provide effective public health initiatives is a clearly a major challenge for program organizers and for health education. Increased awareness of leprosy and sensitivity to its social consequences among health service practitioners is a further priority.