Multidrug Therapy for Leprosy Can Cure Patients with Lobomycosis in Acre State, Brazil: A Proof of Therapy Study.

Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective.

Geographic and socioeconomic factors associated with leprosy treatment default: An analysis from the 100 Million Brazilian Cohort.

BACKGROUND: Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25-1.97) and Northeast (OR = 1.44; 95%CI 1.17-1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01-1.69), no income (OR = 1.41; 95%CI 1.07-1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13-1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28-1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10-1.66). CONCLUSIONS: The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.

Leprosy in elderly people and the profile of a retrospective cohort in an endemic region of the Brazilian Amazon.

BACKGROUND: Leprosy has a global presence; more than 180 thousand new cases were registered in 2013, 15% of which were found in the Americas. The elderly are a very susceptible demographic in terms of developing illnesses, mainly because of characteristics natural to the senescence of the human organism. This study's goals were to analyze leprosy in an elderly population from a hyperendemic region of the Brazilian Amazon in a historical series from 2004 to 2013 and to determine the clinical and epidemiological profile of a series of leprosy cases of elderly people in the period spanning from 2009 to 2013. METHODS: To achieve these goals, an observational, longitudinal, retrospective and descriptive study was put together to analyze leprosy in elderly people from data acquired from the Notification Aggravations Information System. Furthermore, a profile of the disease from a retrospective cohort based on data collected from medical records was developed. RESULTS: The number of new cases and the leprosy detection rate decreased across the observed period but remained stable among the elderly. The trend for the next ten years indicates decreases in the number of cases and in the detection rate in the general population and an increase in only the elderly. The overall profile was characterized by a predominance of males (64.32%), the multibacillary clinical form (87.57%), Type 1 reaction episodes (37.50%) and some physical incapacity at diagnosis (49.19%). The risk of reaction was greater in the first six months of multidrug therapy, and the positive result from the skin smear was associated with the greater chance of reactional condition development. CONCLUSIONS: The resulting data demonstrate that leprosy amongst the elderly deserves attention because of the increased susceptibility to disability in this age group, with their higher risk of reaction and their greater level of co-morbidity.

Poliquimioterapia de la lepra. Experiencia del Hospital Nacional Baldomero Sommer / Multidrug therapy of the leprosy

En el Hospital Nacional Baldomero Sommer se evaluaron retrospectivamente 93 pacientes que completaron por lo menos 2 años de poliquimioterapia según esquema OMS. El 82,9%de los 70 pacientes clínicamente activos mejoraron. El 12,8%permanecieron estacionarios. Se negativizó la baciloscopia del 93,4%de los 43 pacientes positivos al inicio. Los estados reaccionales mejoraron en el 66%de los pacientes que los presentaron. Un 24%de los enfermos realizó tratamiento irregular. La tolerancia fue buena en el 89%de los casos. Sólo se registraron efectos colaterales menores. Se observó una tasa de recaídas del 3,5%por año. Se discute el significado de estos hallazgos

Poliquimioterapia de la lepra. Experiencia del Hospital Nacional Baldomero Sommer / Multidrug therapy of the leprosy

En el Hospital Nacional Baldomero Sommer se evaluaron retrospectivamente 93 pacientes que completaron por lo menos 2 años de poliquimioterapia según esquema OMS. El 82,9%de los 70 pacientes clínicamente activos mejoraron. El 12,8%permanecieron estacionarios. Se negativizó la baciloscopia del 93,4%de los 43 pacientes positivos al inicio. Los estados reaccionales mejoraron en el 66%de los pacientes que los presentaron. Un 24%de los enfermos realizó tratamiento irregular. La tolerancia fue buena en el 89%de los casos. Sólo se registraron efectos colaterales menores. Se observó una tasa de recaídas del 3,5%por año. Se discute el significado de estos hallazgos

Seguimiento de pacientes hansenianos con esquema multidroga de la OMS (modificado) / Follow-up of hanseniasis patients with a modified multidrug (OMS) scheme

Se evalúa la aplicación a lo largo de seis años del MDT en 120 pacientes hansenianos, comprobando que se trata de un esquena útil con aceptables resultados. Se cuestiona si la duración del tratamiento en las formas multibacilares y su alta, sin control hispopatológico previo, son adecuadas. Los autores prefieren continuar indefinidamente con dos drogas. (AU)

Seguimiento de pacientes hansenianos con esquema multidroga de la OMS (modificado) / Follow-up of hanseniasis patients with a modified multidrug (OMS) scheme

Se evalúa la aplicación a lo largo de seis años del MDT en 120 pacientes hansenianos, comprobando que se trata de un esquena útil con aceptables resultados. Se cuestiona si la duración del tratamiento en las formas multibacilares y su alta, sin control hispopatológico previo, son adecuadas. Los autores prefieren continuar indefinidamente con dos drogas.