[Leprosy in Amazonas-impressions of the National Leprosy Program]. / Lepra in Amazonien ­ Eindrücke aus einem Kontrollprogramm.

Due to the often late detection and the neurological disability as a consequence of the disease, leprosy plays an important role in the public health system of emerging countries with the highest prevalence such as India and Brazil. The National Leprosy Control Program of the Ministry of Health and the Health Institutions of the Federal States in Brazil has implemented a strategy to ensure successful treatment of people in rural areas both at the preventive and curative level. A successful screening program, timely treatment of patients according to the stage of disease, and the introduction of preventive measures have significantly reduced the prevalence of leprosy in Brazil over the last 20 years. Due to limited medical care and socioeconomic weakness in the Amazon region in Brazil, the early eradication of leprosy does not seem to be currently realistic.

Falhas operacionais no controle da hanseníase em redes de convívio domiciliar com sobreposição de casos em áreas endêmicas no Brasil / Fallas operacionales en el control de la lepra en redes de convivencia domiciliar con sobreposición de casos en zonas endémicas de Brasil / Operational failures of leprosy control in household social networks with overlapping cases in endemic areas in Brazil

Objetivo: Analisar a vulnerabilidade institucional/programática de serviços de saúde no desenvolvimento das ações de atenção a pessoas acometidas pela hanseníase e de vigilância de contatos. Métodos: Estudo transversal, conduzido em 2017, sobre dados primários de amostra de casos de hanseníase notificados no período 2001-2014, com sobreposição de casos em redes de convívio domiciliar (RCD), em municípios dos estados da Bahia, Piauí e Rondônia, Brasil. Resultados: Dos 233 casos de hanseníase analisados, 154 (66,1%) pertenciam a RCD com 3 ou mais casos de hanseníase. Em 53,2% dos casos, houve acometimento de duas ou mais gerações, um desfecho significativamente associado a não realização do exame dermato-neurológico (razão de prevalências [RP] 1,32; intervalo de confiança [IC95%1,10;1,59]; p-valor=0,004). Conclusão: Falhas operacionais na vigilância de contatos de hanseníase em áreas de alta endemicidade reforçam o caráter de vulnerabilidade institucional/programática em contextos de RCD com mais de um caso de hanseníase, nos três estados analisados.

Objetivo: Analizar la vulnerabilidad institucional/programática de los servicios de salud para el desarrollo de acciones de atención a personas afectadas por lepra y de vigilancia de sus contactos. Métodos: Estudio transversal realizado en 2017 basado en datos primarios de una muestra de casos de lepra notificados entre 2001-2014 con casos superpuestos en redes de convivencia domiciliar (RCD) en Municipios de los Estados de Bahía, Piauí y Rondônia, Brasil. Resultados: Del total de 233 casos de lepra analizados, 154 (66,1%) pertenecían a RCD con 3 o más casos de lepra. En el 53.2% de los casos hubo 2 o más generaciones afectadas, resultado significativamente asociado con la no realización del dermato-neurológico (razón de prevalencias [RP] 1,32; intervalo de confianza [IC95%1,10;1,59]; valor-p=0.004). Conclusión: Las fallas operativas en la vigilancia de los contactos de lepra en áreas de alta endemicidad refuerzan el carácter de vulnerabilidad institucional/programática en los contextos de redes de convivencia domiciliar (RCD) con más de un caso de lepra en los tres estados analizados.

Objective: To analyze institutional/programmatic vulnerability of health services in the development of health care actions for people affected by leprosy and contact surveillance. Methods: This was a cross-sectional study conducted in 2017 based on primary data from a sample of leprosy cases notified between 2001-2014 with overlapping cases in household social networks (HSN) in municipalities in the states of Bahia, Piauí and Rondônia, Brazil. Results: A total of 233 leprosy cases were analyzed, 154 (66.1%) belonged to HSN with 3 or more leprosy cases. In 53.2% of cases, 2 or more generations were affected, this being an outcome associated with absence of dermato-neurological examination (prevalence ratio 1.32; confidence interval [95%CI 1.10;1.59]; p-value=0.004). Conclusion: Operational failures in the surveillance of leprosy contacts in areas of high endemicity reinforce the character of institutional/programmatic vulnerability in HSN contexts with more than one case of leprosy in the three states analyzed.

[Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil]. / Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil / Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil / Vulnerabilidad programática en el control de la lepra: padrones desde la perspectiva de género en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Lesiones pruriginosas en el embarazo como presentación inusual de una variante poco frecuente de lepra multibacilar / Pruritic Lesions During Pregnancy: An Unusual Presentation of a Rare Variant of Multibacillary Leprosy

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A importância da busca ativa como estratégia de controle da hanseníase em territórios endêmicos / The importance of active surveillance as a strategy to control leprosy in endemic areas

De acordo com a literatura, contatos de casos de hanseníase apresentam maior risco de adoecimento e, nesse sentido, é primordial fortalecer e ampliar as ações de busca ativa de casos no âmbito da atenção primária de saúde, potencializando a ampliação do diagnóstico precoce, tratamento oportuno e demais medidas de vigilância, controle e reabilitação necessárias. Neste cenário, objetivou-se realizar a busca ativa de novos casos de hanseníase em um distrito rural do município de Mantena, MG, e caracterizar a situação socioeconômica e epidemiológica da doença na região. Foram realizadas visitas aos residentes do distrito e palestras informativas sobre a doença, sendo os moradores convidados a participar da pesquisa. Um total de 292 indivíduos foi examinado no período de julho de 2016 a fevereiro de 2017. Foram diagnosticados 27 casos novos, 22 dos quais eram multibacilares. Os graus de incapacidade 1 e 2 foram identificados em 74% da amostra. Sobre as variáveis socioeconômicas, a maioria dos casos possui baixa escolaridade e baixa renda familiar, além de todos os casos terem tido contato com a doença em algum momento. A busca ativa foi eficiente para a detecção de casos novos de hanseníase na população estudada e contribuiu para o controle da doença que é endêmica na região. Ademais, a busca ativa foi relevante, especialmente considerando a baixa instrução dos indivíduos e, portanto, menor acesso à informação.

Contacts of leprosy cases present a higher risk of illness and, therefore it is essential to strengthen and expand actions to actively search for cases in primary health care, thus intensifying early diagnosis, timely treatment and other surveillance measures, and improve control and rehabilitation. In this setting, we aimed to perform the active search of new cases of leprosy in the rural area of Mantena, MG, and to characterize the socioeconomic and epidemiological situation related to the disease in the region. For this purpose, visits were made to the residents of the region with informative talks about the disease, and subsequently inhabitants were invited to participate in the research. A total of 292 individuals were examined from July 2016 to February 2017. Twenty-seven new cases were diagnosed, 22 of which were multibacillary. Grade 1 and 2 physical disabilities were identified in 74% of the new cases. Regarding socioeconomic variables, the majority of the cases had little schooling and low family income. In addition, all cases had had contact with the illness, at some point. We conclude that the active search was efficient to detect new leprosy cases in the population, and it contributed to the control of the disease, which is endemic in the region. In addition, active search is an important methodology, especially when the population involved has little schooling and thus less access to information.

Leprosy in New Zealand: an epidemiological update.

AIM: To examine the current epidemiological trends of leprosy in New Zealand and raise awareness of this disease in the health professional community. METHOD: Epidemiological data of leprosy, a notifiable disease in New Zealand, was accessed for the 10 year time period 2004 to 2013. Using an illustrative case as an introduction, all 38 case reports from the study period are summarised. RESULTS: Most cases of leprosy in New Zealand notified during the study period are immigrants from countries with endemic leprosy, reflecting the origin of disease. Delay to diagnosis is common. CONCLUSION: Leprosy remains a clinical problem in New Zealand. Cases are more likely to arise in geographical areas with higher numbers of immigrants from endemic countries.

Feasibility of a combined camp approach for vector control together with active case detection of visceral leishmaniasis, post kala-azar dermal leishmaniasis, tuberculosis, leprosy and malaria in Bangladesh, India and Nepal: an exploratory study.

BACKGROUND: We assessed the feasibility and results of active case detection (ACD) of visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and other febrile diseases as well as of bednet impregnation for vector control. METHODS: Fever camps were organized and analyzed in twelve VL endemic villages in Bangladesh, India, and Nepal. VL, PKDL, tuberculosis, malaria and leprosy were screened among the febrile patients attending the camps, and existing bednets were impregnated with a slow release insecticide. RESULTS: Among the camp attendees one new VL case and two PKDL cases were detected in Bangladesh and one VL case in Nepal. Among suspected tuberculosis cases two were positive in India but none in the other countries. In India, two leprosy cases were found. No malaria cases were detected. Bednet impregnation coverage during fever camps was more than 80% in the three countries. Bednet impregnation led to a reduction of sandfly densities after 2 weeks by 86% and 32%, and after 4 weeks by 95% and 12% in India and Nepal respectively. The additional costs for the control programmes seem to be reasonable. CONCLUSION: It is feasible to combine ACD camps for VL and PKDL along with other febrile diseases, and vector control with bednet impregnation.

Geographical heterogeneity in the analysis of factors associated with leprosy in an endemic area of Brazil: are we eliminating the disease?

BACKGROUND: The leprosy transmission chain is very complex and, in order to intervene in this transmission, more must be known about the factors linked to falling ill. There are doubts as to the influence of population size, population density and the disease's magnitude in detection rate trends. This paper aimed to identify factors associated with detection of leprosy in an endemic municipality of Rio de Janeiro State, Brazil. METHODS: This ecological study in Duque de Caxias municipality, Rio de Janeiro State, Brazil, used neighbourhoods (bairros) as the unit of analysis. Selecting new cases of leprosy detected from 1998 to 2006, the analysis examined clinical, socioeconomic and service variables using a Poisson log-Normal model. RESULTS: In the municipality overall, 2572 new cases were detected, a rate of 3.70 cases/10,000 inhabitants. The results describe a heterogeneous distribution of cases and rates in the municipality. The final model displayed a significant association with indeterminate clinical form (ß = 2.599), proportion of homes with running water (ß = -2.334) and presence of a decentralised health care unit (ß = 0.524). CONCLUSION: Although the results indicate progress towards elimination of the disease in the municipality, high rates continue to be detected in municipal sub-regions. The following question can thus be posed: over how wide a geographical area could the disease be thoroughly eliminated, given this heterogeneity within a small municipality?

Health information system model for monitoring treatment and surveillance for leprosy patients in indonesia (case study in Pekalongan District, Central Java, Indonesia).

After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.

Persisting leprosy transmission despite increased control measures in an endemic cluster in Brazil: the unfinished agenda.

OBJECTIVE: To provide an evidence base for improvement of leprosy control in Brazil's high transmission areas. DESIGN: We obtained data from municipalities in a major disease cluster from databases for notifiable diseases of four states (Maranhão, Parâ, Tocantins, Piauí), including notifications from 2001 to 2009. Indicators for monitoring and evaluation of leprosy according to the World Health Organization were evaluated with emphasis on the rates of new cases presenting grade-2 disabilities and among children < 15 years of age, indicating late diagnosis and active transmission, respectively. RESULTS: A total of 82,463 leprosy cases were detected in the area (mean annual case detection rate: 95.9/100,000; RR = 4.56 as compared to the rest of Brazil; 95% CI: 4.45-4.66, P < 0.0001). There was a steady decrease of detection rates in the study period, from 100.8 to 75.6/100,000 inhabitants. In children <15 years of age, 9,009 cases of leprosy were detected (28.40/100,000), significantly more than in the rest of Brazil (RR = 5.80; 95% CI: 5.39-6.25, P < 0.0001). New cases with grade-2 disabilities/100,000 population maintained a stable trend at a high level (4.43 cluster vs. 1.28 rest of country; RR = 3.46; 95% CI: 3.11-3.84, P < 0.0001), whereas the proportion of new cases with grade-2 was slightly lower than the country's average (5.51% vs. 6.75%; RR = 0.84; 95% CI: 0.81-0.86, P < 0.0001). CONCLUSIONS: Despite recently improved leprosy control measures, there is still major active transmission and late diagnosis in the cluster. Further specific actions are needed to improve early case detection and prompt treatment with the aim to reduce disease burden in the population, considering social inequities.

Leprosy elimination campaign in Qazvin province, Islamic Republic of Iran (2006-07).

Multi-drug therapy (MDT) and Leprosy Elimination Campaigns (LEC) are the major strategies for eliminating leprosy. We report the results of a LEC conducted in 2006 in Qazvin. A total of 1987 individuals (1379 household contacts of 319 registered leprosy patients and 608 people from 3 endemic villages with a high prevalence of leprosy) were examined for detection of new cases of leprosy. All new cases were given MDT and were reviewed after a year. There were 256 suspected cases of leprosy, 13 of whom were confirmed as new cases (7 were classified as multibacillary leprosy). None had visible deformity nor was < 20 years old. All patients completed the recommended MDT course. The few cases detected suggest that in low prevalence areas, a long-term approach of integrated leprosy services and disability management may be more appropriate than LEC as a leprosy elimination strategy.

Lepra hoy: consideraciones epidemiológicas del Hospital Nacional / Leprosy today: epidemiologycal considerations of the National Hospital

La lepra o enfermedad de Hansen, enfermedad infectocontagiosa producida por el Mycobacterium leprae, sigue siendo un problema de salud pública en países como el nuestro. Se estudian aspectos epidemiológicos de la lepra en los casos registrados en el Servicio de Dermatología . Estudio retrospectivo observacional y descriptivo de los casos de Consultorio Externo e interconsultas hospitalarias registrados en el periodo de 1999 al 2009. La lucha contra la lepra, a pesar de algunas fortalezas como la distribución gratuita de los fármacos, sigue presentando grandes desafíos como el elevado número de abandono del tratamiento y el escaso y el escaso control de las personas contactantes, máxime considerando que el 80% son bacilíferos...