Leprosy treatment dropout: a systematic review.

BACKGROUND: Leprosy is a chronic infectious disease endemic in some undeveloped areas, and still represents a public health problem in Brazil. Therefore, the control of this endemic disease depends necessarily on the institution of correct treatment and containment of treatment dropout. This study aims to conduct a systematic review of published studies on treatment dropout of leprosy. METHODS: We conducted a systematic review of articles on treatment dropout of leprosy, published between january 2005 and april 2013, on MEDLINE and SciELO databases. The search was performed using the MeSH terms: "leprosy"; "patients dropouts" and the keywords: "leprosy, treatment" and "noncompliance, leprosy" in association, beside the equivalents in Portuguese. RESULTS: There were originally 196 references. After analyzing the titles and abstracts of articles, 20 articles were obtained and included in the final sample. DISCUSSION: Leprosy is a notifiable disease known as its disfiguring capability and the high rate of non-compliance to treatment. The low adhesion is responsible for the remaining potential sources of infection, irreversible complications, incomplete cure and, additionally, may lead to resistance to multiple drugs. Many factors are responsible for the interruption or dropout treatment: socioeconomic factors, education level, knowledge about the disease, lack of efficiency of health services, demographics, side effects of drugs, alcoholism, among others. CONCLUSION: The recent scientific literature about the subject diverge regarding the factors that most affect the dropout problem in treating leprosy patients. However, better integration between professionals and users, and greater commitment of the patient, are common points among the authors of the studies.

Hanseníase tuberculóide em paciente com Aids / Tuberculoid leprosy in aids patient

Relata-se o caso de uma criança de oito anos, portadora de Aids, que desenvolveu hanseníase tuberculóide antes do início da terapia anti-retroviral. Apresentava lesões ulceradas nos membros, Mitsuda de 8,5mm, hipoestesia em perna esquerda, e o diagnóstico de hanseníase foi definido pela imuno-histoquímica antiproteína S-100, que mostrou fragmentos de ramos nervosos no interior dos granulomas. A incidência da hanseníase não aumentou com o advento da Aids, e não há modificações na apresentação clínica ou na resposta terapêutica nos casos de hanseníase associados à Aids. Também não se observou neste caso o desenvolvimento da reação tipo 1 como resultado da reconstituição imunológica devido ao tratamento anti-retroviral.

The authors present a 8 year-old child with AIDS who developed tuberculoid leprosy prior the beginning of the anti-retroviral treatment. The pacient presented ulcered lesions in arms and legs, the Mitsuda reaction was 8,5 mm, there was hypostesia of the left leg and the leprosy diagnosis was reached mainly supported by the anti-S100 protein immunohistochemistry staining that showed fragments of nerve branches inside granulomas. The incidence of leprosy has not increased because of AIDS. There havenÆt been changes in the clinical presentation and in the response to therapy in cases of leprosy associated with AIDS. We havenÆt also observed development of type 1 reaction in this patient resulting from restoring of the immune response after the anti-retroviral treatment.

Hanseniase tuberculoide em paciente com aids / Tuberculoid leprosy in aids patients

Os autores apresentam o caso de uma crianca de 8 anos, portadora de aids por transmissao vertical, que desenvolveu as primeiras manifestacoes da hanseniase tuberculoide, antes do inicio do tratamento anti-retroviral. As lesoes iniciais percebidas eram ulceras de bordas endurecidas, que cicatrizavam e ulceravam novamente. Nesta epoca apresentava 0,3 celulas CD4+. As lesoes permaneceram com esta evolucao ate o momento em que foram realizados os primeiros exames para confirmacao do diagnostico de hanseniase. Nesta ocasiao estava fazendo tratamento anti-retroviral, apresentava 270 celulas CD4+. Foi realizada uma biopsia da lesao cutanea. Quando retornou, as ulceras estavam cicatrizadas, podendo se notar mais nitidamente o aspecto sarcoidico das lesoes. A reacao de Mitsuda foi de 8,5mm, havia hipoestesia em perna esquerda, e o diagnostico de hanseniase foi definido, principalmente atraves da imunoistoquimica anti-proteina S100, que demonstrou fragmentos de ramos nervosos no interior dos granulomas. A incidencia da hanseniase nao aumentou com o advento da aids e tambem nao ha modificacoes na apresentacao clinica, nem resposta a terapeutica nos casos de hanseniase associado a aids. Tambem nao observamos neste paciente o desenvolvimento da reacao tipo 1, como resultado da reconstituicao imunologica em decorrencia do tratamento anti-retroviral