Transmission of Hansen's disease and unscreened household contacts.

INTRODUCTION: Leprosy household contact investigation has been recommended as an epidemiological surveillance strategy for more than 50 years. OBJECTIVE: The purpose of this study was to estimate the yield that could be achieved in case detection if four contacts could be examined for every case found. METHODS: For the estimation of the number of cases not detected (lost) and yield per contact investigation in Mato Grosso, the incidence rates and yield calculations from a cohort study conducted in Rio de Janeiro by Matos et al (1999) were applied to data from the state of Mato Grosso. Also, to identify high-risk groups for leprosy, a cross-sectional study was conducted in which leprosy cases found as a result of a contact investigation were compared with index cases detected by other means. RESULTS: The lost cases among household contacts were at least 4 per every 10 new cases detected. This is the result of insufficient contact investigations--it being 0.8 instead of 4 contact investigations per each case as recommended by the Brazilian Ministry of Health. Up to 60% of the incidence of leprosy could be explained by the high number of lost cases among household contacts not examined. Women and children are more likely to be contacts. CONCLUSION: The lost cases due to insufficient contact investigation represent lost opportunities in early detection and treatment, thus losing the opportunity to reduce leprosy transmission.

The nose in leprosy: immunohistology of the nasal mucosa.

A detailed study of the nose was undertaken in 40 leprosy patients with different classifications of leprosy and different durations of disease at two hospitals in Brazil. This manuscript describes the immunohistochemical data on cellular infiltrates in the nasal biopsies of those patients. It was surprising that the damage to the whole depth of the nasal mucosa, epithelium and lamina propria was considerable, as was the case in the nasal mucosa which looked relatively normal during clinical inspection. The epithelium showed large holes which looked like very extended goblet cells. Very obvious was the lack of vasoconstriction after cocaine application, and the vessels also showed a lack of staining with factor VIII, possibly indicating a disruption of the endothelium. The number of neurofilaments was extensively reduced in all leprosy groups compared to normal controls. As in the skin, an increased number of CD68+ cells was found in the lamina propria of the nasal mucosa of the lepromatous patients. Contrary to findings in the skin, in the nasal mucosa of the borderline/lepromatous patients the number of CD4+ cells was increased and the number of CD8+ cells was decreased compared to normal controls. The number of CD8+ cells tended to be more reduced when the history of leprosy was longer. It is not clear as yet whether the reduced numbers of CD8+ cells are acquired during infection or whether persons with a low number of CD8+ cells in the nose might have a higher risk of acquiring leprosy.

Prevalence of HIV1 in leprosy patients in Rio de Janeiro, Brazil.

The purpose of this study was to learn if HIV1 infection was associated with leprosy in Rio de Janeiro, Brazil by comparing the prevalence rates of 1.016 leprosy patients tested on a voluntary basis and 78.482 blood donors. A cross-sectional survey of anti-HIV1 antibodies was conducted in Rio de Janeiro, from 1990 to 1992 for this purpose. HIV1 prevalence found among leprosy patients was (3 cases) 2.9 per 1000, and among blood donors was (282 cases) 3.8 per 1000. Such difference was not significant (OR = 0.79; p = 0.69). Since HIV1 cases were only found among male leprosy patients, further analysis excluded females. Male leprosy patients showed a slightly higher prevalence of HIV1 than blood donors before and after age adjustment. However, this result was not statistically significant (adjusted odds ratio = 1.38, 95% CI 0.35-4.5; p = 0.83). These data do not provide evidence that leprosy and HIV1 infection are associated in the State of Rio de Janeiro. This is consistent with similar investigations conducted elsewhere.

PIP: A cross-sectional study conducted in Rio de Janeiro, Brazil, in 1990-92 failed to document any association between HIV-1 infection and leprosy. Tested for antibodies to HIV were 1016 leprosy patients and 78,482 volunteer blood donors. The HIV prevalence was 2.9/1000 (3 cases) among leprosy patients and 3.8/1000 (282 cases) among blood donors (odds ratio, 0.79)--a nonsignificant difference. When standardized for age, these rates were 2.8/1000 and 2.9/1000, respectively. Since all 3 HIV cases in the leprosy group were men, the analysis was repeated to exclude females. Although male leprosy patients were 28% more likely to be HIV-infected than male blood donors (odds ratio, 0.79), the difference was, again, not significant. A similar lack of association has been reported in studies from other areas where both HIV and leprosy are prevalent. However, a large-scale nested case-control study in a cohort at high risk of HIV is necessary to more definitively reject this association.

[Factors associated with household and family in leprosy transmission in Rio de Janeiro, Brazil]. / Fatores associados ao domicílio e à família na determinação da hanseníase, Rio de Janeiro, Brasil.

A cross-sectional study was carried out to characterize the contribution of several household characteristics to the transmission of leprosy. Households with diagnosed cases of illness were compared to two healthy groups. All randomly selected households were located in the municipality of Sao Goncalo, in the State of Rio de Janeiro. Using an aerial map with the description of the census tract, 2,412 cases were marked. Three groups were established, while the household was the analytical unit: group I - households with cases; group II - neighboring households; and group III - households located in tracts with no reported case of illness, that is, outside disease foci. Group I was compared with that of neighboring households using a multiple logistic regression model by conditional methods. Unconditional methods were used to compare groups I and III. Group I as compared to Group II showed an association with age and educational level for households and heads of families. Comparison of characteristics of the heads of families and households with cases of leprosy with those located outside the focus showed that the differential factors were age, type of dwelling, and availability of running water. This is probably due to more recent settlement in a peripheral region where water resources are not available yet. Households are the basic ecological unit, and age and educational level are determinant factors for leprosy morbidity in this area.

[Efficacy of multidrug therapy in treatment of paucibacillary leprosy patients--preliminary results]. / Eficácia da MDT no tratamento de pacientes hansenianos paucibacilares--resultados preliminares.

The efficaciousness evaluation of the polychemotherapics regimens recommended by WHO to the hansenian paucibacillary patients, is carried out mainly by the suitable follow up of patients after therapeutic discharge. The criterion for inclusion of patients as paucibacillary ones is another point of importance. The authors based on the follow up of 66 patients that completed treatment and in the absence of relapses until the moment, advise that together with the clinical classification it should be considered factors like: the Mitsuda test, the number of lesions and the bacilloscopy result.

Feasibility of multidrug therapy (MDT) in Hansen's disease in an urban population--Curupaiti State Hospital, Rio de Janeiro, Brazil.

The acceptance of the WHO regimen in a group of 220 patients was approximately 84.5%. Only 11% abandoned the treatment, and the substitution of ethionamide or prothionamide for clofazimine due to excessive hyperpigmentation was necessary in only eight cases. The WHO regimens adopted provided a more frequent (monthly) relationship between the patients and their health service. It was necessary to: a) reorganize the technical-administrative infrastructure, with the intention of providing an improved service to the patients for treatment and control; and b) pay more attention to the problem of deformities and health education activities. As for the side effects of the drugs, 54 patients showed alterations in their liver function tests, which were usually mild and which resolved despite continuation of the treatment. Of the reactional episodes observed during MDT, it would not appear that the therapeutic regimens contributed to their occurrence or aggravation.