Fatores associados à recidiva em hanseníase em Mato Grosso / Factors associated to relapse of leprosy in Mato Grosso, Central-Western Brazil / Factores asociados a recidiva en hanseníasis en Mato Grosso, Centro-oeste de Brasil

OBJETIVO: Analisar fatores associados à ocorrência de recidiva em hanseníase. MÉTODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseníase em cinco municípios do estado de Mato Grosso, cujas unidades de saúde eram consideradas de referência para o atendimento. O grupo de casos incluiu 53 indivíduos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificação operacional. Foram usados dados do Sistema de Informação de Agravos de Notificação, prontuários e entrevistas. Utilizou-se regressão logística condicional e abordagem hierárquica. RESULTADOS: Após análise ajustada, mostraram-se associados à ocorrência de recidiva: indivíduos residentes em casas alugadas (OR = 4,1; IC95 por cento:1,43;12,04), em domicílio de madeira/taipa (OR = 3,2; IC95 por cento: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95 por cento : 1,03;4,36), com transtorno de uso de álcool (OR = 2,8; IC95 por cento: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95 por cento: 1,44;10,02), sem esclarecimento sobre a doença/tratamento (OR = 2,6; IC95 por cento: 1,09;6,13), que usavam transporte coletivo para o acesso à unidade de saúde (OR = 5,5; IC95 por cento: 2,36;12,63), forma clínica da doença (OR = 7,1; IC95 por cento: 2,48;20,52) e esquema terapêutico (OR = 3,7; IC95 por cento: 1,49;9,11). CONCLUSÕES: Os fatores preditivos de recidiva relacionam-se com condições de moradia, hábitos de vida, organização dos serviços de saúde, formas clínicas e esquemas terapêuticos. Cabe aos serviços de saúde oferecer orientações adequadas aos pacientes, bem como garantir a regularidade do tratamento.

OBJECTIVE: To analyze factors associated with relapse of leprosy. METHODS: Retrospective case-control study including 159 patients older than 15 diagnosed with leprosy attending reference centers for leprosy in five municipalities in the state of Mato Grosso, central-western Brazil. Cases (n=53) were patients with relapsed leprosy diagnosed from 2005 to 2007 who were compared with controls (n=106) matching for gender and operational classification who were considered cured after treatment in 2005. Data was obtained from the local Notifiable Diseases Database, medical records and interviews. For the analyses conditional logistic regression and hierarchical approaches were used. RESULTS: After adjustment, the following factors were associated with relapse of leprosy: living in rental housing (OR = 4.1; 95 percentCI: 1.43;12.04); living in houses constructed of wood and mud (OR = 3.2; 95 percentCI: 1.16;8.76); living with dwellings with more than five people (OR = 2.1; 95 percentCI: 1.03;4.36); alcohol use disorder (OR = 2.8; 95 percentCI: 1.17;6.79); irregular treatment (OR =3.8; 95 percentCI: 1.44;10.02); lack of knowledge about the disease/treatment (OR = 2.6; 95 percentCI: 1.09;6.13); use of public transportation to get to the clinic (OR = 5.5; 95 percentCI: 2.36;12.63); clinical form of the disease (OR = 7.1; 95 percentCI: 2.48;20.52), and treatment regimen (OR = 3.7; 95 percentCI: 1.49;9.11). CONCLUSIONS: The predictive factors of relapse are associated with housing conditions, living habits, organization of health services, clinical forms of leprosy and treatment regimen. Health services should educate patients on the disease as well as ensure consistent treatment.

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseníasis. MÉTODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 años diagnosticados con hanseníasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyó 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificación operacional. Se usaron datos del Sistema de Información de Agravios de Notificación, Prontuarios y entrevistas. Se utilizó regresión logística condicional y abordaje jerárquico. RESULTADOS: Posterior al análisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95 por ciento:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95 por ciento:1,16;8,76), que moraban con más de cinco personas (OR=2,1; IC95 por ciento:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95 por ciento:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95 por ciento: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95 por ciento:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95 por ciento: 2,36;12,63), forma clínica de la enfermedad (OR= 7,1;IC95 por ciento: 2,48;20,52) y esquema terapéutico (OR= 3,7; IC95 por ciento:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, hábitos de vida, organización de los servicios de salud, formas clínicas y esquemas terapéuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, así como garantizar la regularidad del tratamiento.

Factors associated to relapse of leprosy in Mato Grosso, Central-Western Brazil.

OBJECTIVE: To analyze factors associated with relapse of leprosy. METHODS: Retrospective case-control study including 159 patients older than 15 diagnosed with leprosy attending reference centers for leprosy in five municipalities in the state of Mato Grosso, central-western Brazil. Cases (n=53) were patients with relapsed leprosy diagnosed from 2005 to 2007 who were compared with controls (n=106) matching for gender and operational classification who were considered cured after treatment in 2005. Data was obtained from the local Notifiable Diseases Database, medical records and interviews. For the analyses conditional logistic regression and hierarchical approaches were used. RESULTS: After adjustment, the following factors were associated with relapse of leprosy: living in rental housing (OR = 4.1; 95%CI: 1.43;12.04); living in houses constructed of wood and mud (OR = 3.2; 95%CI: 1.16;8.76); living with dwellings with more than five people (OR = 2.1; 95%CI: 1.03;4.36); alcohol use disorder (OR = 2.8; 95%CI: 1.17;6.79); irregular treatment (OR =3.8; 95%CI: 1.44;10.02); lack of knowledge about the disease/treatment (OR = 2.6; 95%CI: 1.09;6.13); use of public transportation to get to the clinic (OR = 5.5; 95%CI: 2.36;12.63); clinical form of the disease (OR = 7.1; 95%CI: 2.48;20.52), and treatment regimen (OR = 3.7; 95%CI: 1.49;9.11). CONCLUSIONS: The predictive factors of relapse are associated with housing conditions, living habits, organization of health services, clinical forms of leprosy and treatment regimen. Health services should educate patients on the disease as well as ensure consistent treatment.

Mini outbreak of Kaposi's varicelliform eruption in skin ward: a study of five cases.

BACKGROUND: Kaposis varicelliform eruption (KVE) represents widespread cutaneous herpes simplex virus (HSV) infection in patients with preexisting dermatoses. Occasionally, this infection can present as a nosocomial infection in skin wards, if adequate bed-spacing and barrier nursing methods are not followed. We are reporting five cases of KVE; four cases acquired the infection in a makeshift ward after admission of the first case in May 2005, due to the renovation work of the regular skin ward. AIM: The purpose of this study is to create clinical awareness about this uncommon dermatologic entity and to stress upon the importance of bed-spacing and barrier nursing in skin wards. METHODS: Five cases of KVE, three females and two males with different primary dermatoses (pemphigus foliaceus--one, pemphigus vulgaris--two, paraneoplastic pemphigus--one and toxic epidemal necrolysis--one) were included in this study. Diagnosis was made clinically and supported with Tzanck smear and HSV serology. All the cases were treated with oral acyclovir. RESULTS: Four out of five cases of KVE recovered with treatment, one case of extensive pemphigus vulgaris with KVE succumbed to death. CONCLUSION: Mini outbreaks of KVE can occur in skin wards with inadequate bed-spacing and overcrowding of patients. Therefore adequate bed-spacing, barrier nursing and isolation of suspected cases are mandatory to prevent such life-threatening infections.

Role of paucibacillary leprosy in the transmission of disease.

The objective of this study was to establish that paucibacillary leprosy also carried increased risk of infection to the community. All members of 100 families with an index paucibacillary case were clinically, bacteriologically and immunologically examined. The "comparison" group was sampled from suspect register. Fifty-six cases occurred among 944 contacts of index paucibacillary cases; of these, four were multibacillary and 52 were paucibacillary. In the "comparison" group, two contacts out of 760 developed paucibacillary leprosy. This difference, between the two groups, was statistically significant. All the 56 cases in the index case families were under 20 years of age; and 50 of them were aged under 15 years. Male/female ratio was 2.1:1. Of the 56 cases, 28 shared the same bed with the index patient, 20 shared the same room and eight lived in the same house. Lepromin positivity rate was higher in "comparison" families (92.2%) than in index case families (74.6%), the difference being statistically significant (x = 6.09, P < 0.001). Contacts of index case families, therefore, were immunologically at higher risk than contacts of "comparison" families.