Características clínico-histopatológicas dos estados reacionais na hanseníase em pacientes submetidos à poliquimioterapia (PQT) / Clinical and histopathological characteristics of reactional states in leprosy patients submitted to multi-drug therapy

O objetivo deste estudo foi analisar os aspectos clínicos e histopatológicos dos estados reacionais em 169 pacientes multibacilares submetidos à poliquimioterapia. Em adiçäo foram avaliadas a frequência e a distribuiçäo desses episódios reacionais. Os casos foram classificados, com base nos dados clínicos e histopatológicos, em eritema nodoso hansênico - ENH (51 porcento), reaçäo reversa - RR (42 porcento) e neurite isolada (7 porcento). Verificou-se que os episódios reacionais säo complicaçäo freqüente (59 porcento) e ocorrem em qualquer momento no curso da doença. Observou-se que 77 porcento dos pacientes que desenvolveram ENH e 43 porcento dos pacientes com RR apresentaram manifestaçöes sistêmicas. A RR predominou entre os pacientes portadores da forma borderline-borderline (74 porcento), enquanto o ENH predominou naqueles diagnosticados pela forma lepromatosa-lepromatosa (86 porcento). O ENH foi significativamente mais recorrente do que a RR, que predominou no primeiro ano de PQT, enquanto o ENH no segundo ano

Reactional states in multibacilary hansen disease patients during multidrug therapy

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI 3

Reactional states in multibacillary Hansen disease patients during multidrug therapy

Reacoes sao ocorrencias comuns no curso da hanseniase e sao responsaveis pelo agravamento das lesoes neurais. Uma coorte de 162 pacientes recem-diagnosticados, baciloscopicamente positivos, em acompanhamento no Ambulatorio de Hanseniase da Fundacao Oswaldo Cruz (FIOCRUZ) foi selecionada para estudo. Observou-se que 46 por cento dos pacientes multibacilares submetidos a 24 doses fixas de poliquimioterapia (PQT) apresentaram reacoes durante o tratamento; todos multibacilares eram suscetiveis e cuidados e atencao constantes eram necessarios. Quatorze por cento foram classificados como BB, 52 por cento como BL e 33 por cento foram classificados como LL. Nenhuma das variaveis em estudo, tais como: sexo, idade, forma clinica, tempo de doenca, extensao das lesoes dermatologicas, indice baciloscopico (IB), ou grau de incapacidade associaram-se a reacao entre os pacientes estudados...