Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

OBJECTIVE: We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. METHODS: This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. RESULT: Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. CONCLUSION: The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

Diagnostic challenges of single plaque-like lesion paucibacillary leprosy.

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.

Diagnostic challenges of single plaque-like lesion paucibacillary leprosy

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.

Diagnóstico da hanseníase paucibacilar com lesão única / Leprosy diagnosis with single plaque skin lesions

Introdução: Apesar do recente declínio dos coeficientes de detecção de casos novos, a hanseníase permanece endêmica no Brasil e em outros países do mundo. O diagnóstico da doença se baseia nos aspectos clínicos, embora o índice baciloscópico e a histopatologia sejam usados como suporte para o diagnóstico. Nas formas paucibacilares, bacilos são raramente detectados e o exame histopatológico pode ser inconclusivo. Neste estudo,analisamos os aspectos clínicos e histopatológicos de pacientes com suspeita de hanseníase paucibacilar e estabelecemos a contribuição do PCR no manejo clínico destes casos.Pacientes e Métodos: Foram estudados 66 pacientes com lesão cutânea única em placa,atendidos no Ambulatório Souza Araújo (ASA) da Fundação Oswaldo Cruz, Rio de Janeiro,Brasil, no período de janeiro de 2008 a dezembro de 2011. Dois patologistas independentes,que não tinham informações sobre a história clínica dos pacientes, realizaram a reanálisehistopatológica. Os pacientes foram classificados como Alta (A), Média (M) e Baixa (B)probabilidade do diagnóstico de hanseníase ou outras dermatoses (O). O DNA foi extraído defragmentos de biópsias de pele e os níveis de M. leprae Ag85B e 16S rDNA foram estimadosusando a amplificação por PCR quantitativo (qPCR). Resultados: O qPCR foi positivo em 46/66 (69.7 por cento) das amostras de pele. Dos 66 pacientes, 57 (86.3 por cento) tinham recebidotratamento com poliquimioterapia (PQT) baseado nos aspectos clínicos e histopatológicos. Aassociação entre o resultado do PCR e a variável tratamento mostrou que entre os 19pacientes classificados como L+O, 2 pacientes com PCR positivo não tinham recebidotratamento e 6 pacientes com PCR negativo tinham sido tratados com PQT por 6 meses.Conclusão: Concluímos que o qPCR é uma ferramenta útil para o diagnóstico e o manejoclínico dos pacientes com suspeita de hanseníase paucibacilar, nos casos em que ahistopatologia não é conclusiva...

Background: Despite recent decline in detection rates, leprosy remains endemic in Brazil andin others countries around the world. Frequently, the disease diagnosis is based only onclinical aspects, although the bacteriological index in skin smears and histopathologicalexamination are used to support conclusions. In paucibacillary forms, bacilli are rarelydetected, and histopathological examination may not be conclusive. In this study, we analisedthe clinics and histopathological aspects of patients suspected of paucibacillary leprosy andtry to establish the contribution of PCR to the clinical management of these cases. Methods:We evaluated 66 patients with single-plaque skin lesions who attended the Leprosy OutpatientUnit of Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, between 2008 and 2011. Twoindependent pathologists who were blinded to the patients’ clinical details performedpathological reanalysis of slides. Patients were classified as High (H), Medium (M), and Lowprobability (L) for the diagnosis of leprosy or another dermatosis (O). DNA was extractedfrom the fragments of skin biopsies, and the levels of M. leprae Ag85B and 16S rDNA wereestimated using qPCR amplification. Findings: The qPCR was positive in 46/66 (69.7 percent) ofskin samples. Out of 66 patients, 57 (86.3 percent) received multidrug therapy (MDT) based onclinical and histopathological examination. The association between previous treatment andqPCR results showed that among 19 patients classified as L+O, 2 qPCR-positive patientswere not treated, whereas 6 patients with negative qPCR results were treated with MDT for 6months. Conclusion: In conclusion, qPCR is a useful tool to diagnosis and clinicalmanagement in suspected cases of paucibacilary leprosy in cases with inconclusivehistopathology...