Type 2 leprosy reaction resembling Sweet syndrome: Review of new and published cases.

A leprosy reaction resembling Sweet syndrome was first described in 1987. This cutaneous manifestation can be classified as the type 2 reaction which arises from antigen-antibody interaction. It can occur in patients with diagnosed or undiagnosed leprosy, and men with borderline leprosy tend to exhibit this type of reaction. Triggering factors may include WHO multibacillary treatment or prescription antibiotics. Several reports of this clinical phenomenon have been published, making physicians consider it as part of this spectrum of the disease. Treatment regime can include systemic steroids and thalidomide.

Deficiências após a alta medicamentosa da hanseníase: prevalência e distribuição espacial / Leprosy-related disabilities after release from multidrug treatment: prevalence and spatial distribution / Deficiencias posteriores a alta medicamentosa de hanseniasis: prevalencia y distribución espacial

OBJETIVO: Estimar a frequência das deficiências físicas em pacientes tratados de hanseníase após alta medicamentosa e analisar sua distribuição espacial. MÉTODOS: Estudo descritivo transversal com 232 pessoas tratadas de hanseníase de 1998 a 2006. As deficiências físicas foram avaliadas pelo Grau de Incapacidades da Organização Mundial da Saúde (GI/OMS) e pelo Eye-Hand-Foot (EHF). Os ex-pacientes foram geocodificados pelo endereço de residência e os serviços de reabilitação pelo endereço de sua sede. Foram apresentadas as frequências para o total e para os grupos grau 0, grau 1 e grau 2 do GI-OMS, considerando-se as variáveis clínicas e sociodemográficas na análise descritiva. Foram utilizados os testes t de Student, qui-quadrado (χ2) ou de Fisher, conforme apropriado, considerando-se significativos p < 0,05. RESULTADOS: Cerca de 51,6% era do sexo feminino, com média de idade de 54 anos (dp15,7); 30,5% tinha menos de dois anos de educação formal; 43,5% trabalhava e 26,9% estava aposentado; a forma dimorfa predominou (39,9%). As deficiências avaliadas pelo GI-OMS e pelo EHF atingiram 32% dos ex-pacientes. A presença de deficiências foi maior com o aumento da idade (p = 0,029), em casos multibacilares (p = 0,005) e com julgamento ruim do paciente sobre sua saúde física (p < 0,001). Os que necessitavam de prevenção/reabilitação percorreram distância média de 5,5 km até o serviço de reabilitação. As pessoas com deficiência física estavam distribuídas em todo o município, mas concentravam-se na área mais populosa e de maior carência socioeconômica. CONCLUSÕES: A frequência de deficiências é elevada após a alta medicamentosa. Os ex-pacientes mais velhos, os que tiveram formas multibacilares da doença, os de baixa escolaridade e os que julgam mal a própria saúde física merecem atenção especial para a prevenção e reabilitação de deficiências. A distância entre os serviços de reabilitação e as residências dos pacientes requer reorganização da rede de atendimento no município.

OBJECTIVE: To estimate the frequency of people with leprosy-related physical disabilities after release from multidrug treatment and to analyze their spatial distribution. METHODS: Descriptive cross-sectional study with 232 leprosy patients treated between 1998 and 2006. Physical disabilities were assessed using the World Health Organization disability grading and the eye-hand-foot (EHF) sum score. The residential address of patients and rehabilitation centers were geocoded. It was estimated the overall frequency of physical disability and frequency by disability grade (grade 0, grade 1, and grade 2) according to the WHO disability grading taking into consideration clinical and sociodemographic variables in the descriptive analysis. Student's t-test, chi-square test (χ2), and Fisher's test were used as appropriate at a 5% significance level. RESULTS: Of the patients studied, 51.6% were female, mean age 54 years old (SD 15.7), 30.5% had less than 2 years of formal education, 43.5% were employed, and 26.9% were retired. Borderline leprosy was the most prevalent form of leprosy (39.9%). A total of 32% of these patients had disabilities according to the WHO disability grading and the EHF score. Disabilities increased with age (p = 0.029), they were more common in patients with multibacillary leprosy (p = 0.005) and poor self-rated physical health (p < 0.001). Those who required prevention/rehabilitation care traveled on average 5.5 km to the rehabilitation center. People with physical disabilities lived scattered across the city but they were mostly concentrated in the most densely populated and socioeconomically deprived area. CONCLUSIONS: There is a high frequency of people with leprosy-related disabilities after release from multidrug therapy. Prevention and rehabilitation actions should target uneducated and older patients, those who had multibacillary forms of leprosy and poor self-rated physical health. The travel distance to rehabilitation centers calls for reorganization of local care networks.

OBJETIVO: Estimar la frecuencia de las deficiencias físicas, en pacientes tratados por hanseniasis, posteriores a alta medicamentosa y analizar su distribución espacial MÉTODOS: Estudio descriptivo transversal con 232 personas tratadas por hanseniasis de 1998 a 2006. Las deficiencias físicas fueron evaluadas por el Grado de Incapacidades de la Organización Mundial de Salud (GI/OMS) y por el Eyes-Hand-Feet (EHF). Los ex -pacientes fueron geocodificados por la dirección de residencia y los servicios de rehabilitación por la dirección de su sede. Se presentaron las frecuencias para el total y para los grupos grado 0, grado 1 y grado 2 del GI-OMS, considerándose las variables clínicas y sociodemográficas en el análisis descriptivo. Se utilizaron las pruebas t de Student, Chi-cuadrado (?2) o de Fisher, conforme apropiado, considerándose significativos p= 0,05. RESULTADOS: Cerca de 51,6% eran del sexo femenino, con promedio de edad de 54 años (de 15,7); 30,5% tenían menos de dos años de educación formal; 43,5% trabajaban y 26,9% estaban jubilados; la forma dimorfa predominó (39,9%). Las deficiencias evaluadas por el GI-OMS y por el EHF alcanzaron 32% de los ex -pacientes La presencia de deficiencias fue mayor con el aumento de la edad (p=0,029), en casos multibacilares (p=0,005) y con diagnóstico equivocado del paciente sobre su salud física (p?0,001). Los que necesitaban de prevención/rehabilitación recorrieron distancia promedio de 5,5km hasta el servicio de rehabilitación. Las personas con deficiencia física estaban distribuidas en todo el municipio, pero se concentraban en el área más populosa y de mayor carencia socioeconómica. CONCLUSIONES: La frecuencia de deficiencias es elevada posterior al alta medicamentosa. Los ex -pacientes más viejos, los que tuvieron formas multibacilares de la enfermedad, los de baja escolaridad y los que presentaron diagnóstico equivocado de la propia salud física merecen atención especial para la prevención y rehabilitación de deficiencias. La distancia entre los servicios de rehabilitación y las residencias de los pacientes requiere reorganización de la red de atención en el municipio.

Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects

This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.

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.

BORDERLINE TUBERCULOID LEPROSY: CLINICOPATHOLOGICAL EVALUATION OF MULTIDRUG THERAPY.

Efficacy of multi-drug therapy as per WHO recommendation in 125 fresh cases of borderline tuberculoid (BT) leprosy was evaluated. There were 116 (92.8%) male and 9 (7.2%) female patients. Age of the patients ranged from 18-50 years but the majority (80.8%) were young adults in the age group 21-35 years. The commonest site of lesion was the upper extremity in 65 (52%) cases. Skin smear for acid fast Mycobacterium leprae was positive in 11 (8.8%) patients. All patients were given multidrug therapy consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for 6 months. At the end of 6 months, 42 (33.6%) patients had shown marked improvement, 14 (11.2%) had increase in activity, 51 (45.6%) had shown regression and 12 (9.6%) cases became clinically inactive. Histologically complete clearance of the infiltration was not observed in any patient. Compact granulomas persisted in 30 (24%) cases. In 1 (0.8%) patient M. leprae were found in the skin smear at the end of 6 months. This study indicates that treatment with MDT for 6 months is inadequate to treat all types of BT leprosy cases.