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1.
J Pak Med Assoc ; 71(3): 838-842, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34057932

RESUMEN

OBJECTIVE: To determine the occurrence and characteristics of the two types of lepra reactions in new leprosy cases at initial diagnosis. Methods: The retrospective descriptive study was conducted at the Marie Adelaide Leprosy Centre, Karachi, and comprised all new leprosy cases registered from January 1, 2016, to June 30, 2018. Data was collected from the medical record database using a predesigned proforma. RESULTS: Of the 50 cases, 2(4%) were children and 48 (96%) were adults, with overall age ranging from 12 to 85 years. There were 41(82%) males and 9(18%) females.. Of the total, 30(60%) cases presented with type 1 reaction and 20(40%) with type 2. Further, 30(60%) cases were classified as borderline lepromatous. Among them, 17(57%) had type 2 reaction. Inflamed plaques were the main feature in 27(90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19(95%) cases of type 2. Conclusion: Lepra reactions were found to be a presenting feature in a significant number of new leprosy cases at initial diagnosis.


Asunto(s)
Lepra , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Grupos Étnicos , Femenino , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Adulto Joven
2.
JMIR Mhealth Uhealth ; 9(4): e23718, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33825685

RESUMEN

BACKGROUND: According to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease. OBJECTIVE: The main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN). METHODS: Leprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System. RESULTS: We mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was "operational classification does not match the clinical form." After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively. CONCLUSIONS: The proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians.


Asunto(s)
Lepra , Aplicaciones Móviles , Inteligencia Artificial , Brasil/epidemiología , Humanos , India/epidemiología , Lepra/diagnóstico , Lepra/epidemiología
3.
BMC Infect Dis ; 21(1): 347, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849463

RESUMEN

BACKGROUND: Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases. METHODS: We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression. RESULTS: The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000-0.00266; I2 = 0%, p = 0.55). CONCLUSION: Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions. TRIAL REGISTRATION: This review is registered in PROSPERO with the registry number CRD42018116275 .


Asunto(s)
Enfermedades Gastrointestinales/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lepra/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades Gastrointestinales/patología , Humanos , Inmunosupresores/efectos adversos , Lepra/etiología , Estudios Longitudinales , Enfermedades Reumáticas/patología , Enfermedades de la Piel/patología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/inmunología
4.
An Bras Dermatol ; 96(3): 301-308, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33838953

RESUMEN

BACKGROUND: Leprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae. OBJECTIVE: To analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service. METHODS: An analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines. RESULTS: Two-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ2 = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ2 = 7.23; 4 degrees of freedom; p = 0.12). STUDY LIMITATIONS: Use of recorded data, with incomplete medical records and lack of patient follow-up. CONCLUSIONS: The study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.


Asunto(s)
Lepra , Brasil/epidemiología , Hospitales , Humanos , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Lepra/epidemiología , Atención Primaria de Salud , Estudios Retrospectivos
6.
BMC Infect Dis ; 21(1): 282, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33740912

RESUMEN

BACKGROUND: Brazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has 'hyperendemic' leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers' roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management. METHODS: 27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval. RESULTS: Two homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: 'personal factors'; 'external factors'; 'clinical factors'; and 'the healthcare professional (HCP)-patient-carer relationship'. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy's negative socio-economic impact on employment - together with stigma, dependency and changing relationships - caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support. CONCLUSION: This study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.


Asunto(s)
Cuidadores/psicología , Personal de Salud/psicología , Lepra/terapia , Pacientes/psicología , Adulto , Anciano , Brasil , Femenino , Humanos , Entrevistas como Asunto , Conocimiento , Lepra/diagnóstico , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Percepción , Retratamiento , Adulto Joven
7.
BMC Infect Dis ; 21(1): 290, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752632

RESUMEN

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Lepra/diagnóstico , Adolescente , Adulto , Brasil/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Escolaridad , Femenino , Humanos , Incidencia , Lepra/epidemiología , Lepra/patología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Población Rural , Adulto Joven
8.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-48034

RESUMEN

Em alusão ao Janeiro Roxo, mês de enfrentamento da hanseníase, o Ministério da Saúde divulga campanha Conhecer para não discriminar para minimizar a discriminação e estigma sobre a doença e alertar para a importância do diagnóstico precoce para interromper a transmissão.


Asunto(s)
Lepra/prevención & control , Lepra , Lepra/diagnóstico
9.
PLoS Negl Trop Dis ; 15(1): e0008956, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33411800

RESUMEN

BACKGROUND: After the elimination of leprosy in 1995, there were 10-30 newly detected leprosy cases every year in Zhejiang Province, and the epidemiological characteristics of the newly detected leprosy cases have changed. While most of the newly detected cases came from other provinces in China, not Zhejiang, it brought a new challenge for leprosy prevention and control in post- elimination era in Zhejiang, China. This study was aimed to understand the temporal-spatial distribution characteristics of newly detected leprosy cases, and provide the scientific rationales for the development of leprosy control strategy. METHODS: Data on the demographic of Zhejiang Province from 2011 to 2019 were obtained from the China Information System for Disease Control and Prevention, and the epidemiological data on leprosy cases newly detected in Zhejiang Province from 2011 to 2019 were obtained from the LEPROSY MANAGEMANT INFORMATION SYSTEM IN CHINA (LEPMIS), and temporal-spatial distributions were described. The geographic information system software-ArcGIS 10.4 was used to draw the statistical maps, and Geoda 1.14.0 was used for local spatial autocorrelation analysis (local Getis coefficient method). Ridley-Jopling classification was used to classify the clinical types into I, TT, BT, BB, BL or LL. Two-group classification system developed by the World Health Organization (WHO) was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. RESULTS: A total of 167 leprosy cases were reported in Zhejiang Province during 2011-2019, including 107 cases in males and 60 in females. The mean age at diagnosis was 37.99±14.81 years, and 94.01% of the cases were detected through the examination at skin-clinics. The number of workers, MB cases, G2D cases were 81 (48.50%), 159 (94.01%), 24 (14.37%) respectively, and the rate of early detection increased from 45.16% in 2011 to 90.91% in 2019. Leprosy cases were reported in all the prefectures of Zhejiang except Zhoushan City. The cases in local population accounted for 23.35% (39 cases), and the cases in floating population (especially coming from high epidemic provinces in China) accounted for 76.65% (128 cases). The annual number of newly detected cases showed a decreasing trend, from 31 cases in 2011 to 11 in 2019. Time of the floating population living in Zhejiang Province ranged from several months to more than 10 years. The annual proportion of new cases with G2D declined from 22.58% in 2011 to 9.09% in 2019. The results of local indicators of autocorrelation (LISA) analysis showed that the high-high areas were mainly concentrated in the middle and northeast of Zhejiang Province, while the low-low areas were in the east and southwest. CONCLUSION: A few scattered cases still can be seen in post-elimination era, and there was a spatial clustering of the newly detected leprosy cases in Zhejiang Province. Most of the cases in Zhejiang Province were from other high epidemic provinces in China, which brought a new challenge for leprosy control and prevention in post- elimination era in Zhejiang, and it is also necessary to strengthen the early detection and standard management of the leprosy cases in floating population in Zhejiang.


Asunto(s)
Lepra/epidemiología , Lepra/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , China/epidemiología , Ciudades , Diagnóstico Precoz , Epidemias , Femenino , Sistemas de Información Geográfica , Humanos , Lepra/diagnóstico , Masculino , Persona de Mediana Edad , Análisis Espacial , Adulto Joven
10.
Acta Trop ; 215: 105791, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33310076

RESUMEN

BACKGROUND: Leprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil. METHOD: Exploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003-2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level. RESULT: A total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51-1.66)], children [OR: 1.49 (1.36-1.64)]; paucibacillary [OR: 1.08 (1.02-1.13)], indeterminate clinical forms [OR: 2.37 (2.15-2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09- 3.73)] and contact examination [OR: 2.30 (2.13-2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19-2.77)] when compared with those presenting both skin lesion and affected nerves. CONCLUSION: Misdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.


Asunto(s)
Errores Diagnósticos , Lepra/diagnóstico , Adolescente , Adulto , Anciano , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
11.
J Neurol Sci ; 420: 117288, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33360424

RESUMEN

Neuropathies form an integral part of the symptomatology of leprosy. Neuropathies of leprosy take various forms and shapes. At one end is the cutaneous nerve involvement adjacent to the anaesthetic skin patch and the other is of symmetrical pansensory neuropathy and the devastating sensory ataxia of leprous ganglionits. Lepra reactions add to the spectrum. Hosts immunological status largely decides the clinical manifestations seen in nerves and skin. A wide array of diagnostic techniques like ultrasonography, magnetic resonance neurography, serological markers, molecular tests, skin biopsy and in selected cases, the nerve biopsy with special stains and electron microscopy are obtainable to help the clinical diagnosis. The unsuspecting clinician, lack of community awareness and limited availability of diagnostic tests are important adverse factors in the total outcome. Multi drug therapy is efficacious and corticosteroids reduce the impact of nerve damage in leprosy. The efficacy, dose and duration of corticosteroid therapy are presently inexact and other immune suppressants like azathioprine are being evaluated. Chronic disabilities and residual deficits require attention of multiple specialties. In the coming time, focus on prevention could lead to favourable results. This review will discuss the classification systems, common and uncommon clinical features, diagnostic armamentarium and therapeutic and preventive aspects of neuropathies of leprosy.


Asunto(s)
Lepra , Enfermedades del Sistema Nervioso Periférico , Biopsia , Humanos , Lepra/complicaciones , Lepra/diagnóstico , Lepra/tratamiento farmacológico , Procedimientos Neuroquirúrgicos , Piel
13.
Lancet Infect Dis ; 20(11): 1236-1237, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33098775
15.
An Bras Dermatol ; 95(6): 743-747, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33010990

RESUMEN

The objective of this study was to analyze the trend of epidemiological and operational indicators of leprosy in Brazil, from 2001 to 2017. This was a time series study involving nine indicators. The inflection point regression model was used. Decreasing trends were observed for the following: general detection (-4.8%), children under 15 (-3.7%), prevalence (-7.0%), and grade 2/million inhabitants (-3.5%). The proportion of individuals with grade 2 disability showed an upward trend (2.0%) from 2001 as well as contacts examined from 2003 (5.0%). The proportions of cure and of individuals with a degree of disability assessed at the time of the diagnosis and the cure showed a stationary behavior. Although advances are noted, there are still challenges to be overcome.


Asunto(s)
Personas con Discapacidad , Lepra , Brasil/epidemiología , Niño , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Prevalencia
16.
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1338-1343, Oct. 2020. tab, graf
Artículo en Inglés | LILACS, Sec. Est. Saúde SP | ID: biblio-1136146

RESUMEN

SUMMARY OBJECTIVE: We compared the hidden prevalence of leprosy in two Brazilian cities with distinct differences regarding geographic region and socio-economic development profile, namely, Juazeiro, Bahia and Joinville, Santa Catarina. METHODS: A retrospective epidemiological study based on secondary data obtained from leprosy case notifications in the cities of Juazeiro-BA and Joinville-SC, 2007-2017. To calculate hidden prevalence, we used the method proposed by Gil Suárez and Lombardi. RESULTS: Joinville had 105 cases of leprosy that went undiagnosed (addition of 42.0% to the registered prevalence). For Juazeiro, it was estimated that 295 cases went undiagnosed (addition of 18.9%). CONCLUSION: Joinville presents a higher hidden prevalence than Juazeiro.


RESUMO OBJETIVO: Comparar a prevalência oculta de hanseníase entre duas cidades brasileiras com diferenças distintas quanto à região geográfica e perfil de desenvolvimento socioeconômico, como Juazeiro, Bahia e Joinville, Santa Catarina. MÉTODOS: Estudo epidemiológico retrospectivo baseado em dados secundários obtidos nas notificações de casos de hanseníase nos municípios de Juazeiro-BA e Joinville-SC, 2007-2017. Para o cálculo da prevalência oculta foi utilizado o método proposto por Gil Suárez e Lombardi. Resultados: Joinville teve 105 casos de hanseníase que não foram diagnosticados no período (adição de 42,0% à prevalência registrada). Para Juazeiro, estimou-se que 295 casos não foram diagnosticados (adição de 18,9%). CONCLUSÃO: Joinville apresentou maior prevalência oculta que Juazeiro.


Asunto(s)
Humanos , Lepra/diagnóstico , Lepra/epidemiología , Brasil/epidemiología , Prevalencia , Estudios Retrospectivos , Ciudades/epidemiología
17.
Rev. inf. cient ; 99(5): 435-441, tab
Artículo en Español | LILACS | ID: biblio-1139205

RESUMEN

RESUMEN * Introducción: La lepra es un problema de salud con elevado impacto biopsicosocial, sin embargo, no se encuentra un estudio que la caracterice en el municipio de Guantánamo. Objetivo: Caracterizar aspectos clínicos de la lepra en el municipio Guantánamo en el periodo de 2015-2019. Método: Se realizó un estudio observacional, retrospectivo, descriptivo y longitudinal de todos los pacientes (N=117) con este diagnóstico. Se precisó la frecuencia del diagnóstico por años, formas clínicas, modo de detección, momento del diagnóstico y grado de discapacidad secundaria a esta enfermedad. Resultados: Fue 2017 el año durante el cual se diagnosticaron más pacientes con lepra (25,7 %), la forma clínica más frecuente fue la lepromatosa (56,4 %). De manera más común, la lepra se detectó de modo espontáneo (83,8 %), el diagnóstico de lepra fue precoz (92,3 %) y en el 93,1 % de los pacientes no generó ningún grado de discapacidad. Conclusiones: La lepra no constituye actualmente un problema de salud en el municipio Guantánamo, pero el diagnóstico no suele ser con la precocidad que se demanda pues aún se realiza tardíamente, con un pobre reconocimiento de las manifestaciones clínicas por la atención primaria de salud y la población, lo que revela la importancia de las acciones dirigidas al pesquisaje de esta enfermedad.


* ABSTRACT * Introduction: Leprosy is a health problem with a high biopsychosocial impact, however, there is no study that characterizes it in the municipality of Guantánamo. Objective: To characterize clinical aspects of leprosy in the Guantánamo municipality in the period 2015-2019. Method: An observational, retrospective, descriptive and longitudinal study of all patients (N = 117) with this diagnosis was carried out. The frequency of diagnosis by years, clinical forms, detection method, time of diagnosis and degree of disability secondary to this disease were specified. Results: 2017 was the year during which more patients with leprosy were diagnosed (25.7%), the most frequent clinical form was lepromatous (56.4%). More commonly, leprosy was detected spontaneously (83.8%), the diagnosis of leprosy was early (92.3%) and in 93.1% of the patients it did not generate any degree of disability. Conclusions: Leprosy is not currently a health problem in the Guantánamo municipality, but the diagnosis is not usually with the precociousness that is demanded since it is still carried out late, with poor recognition of the clinical manifestations by primary health care and population, which reveals the importance of actions aimed at screening for this disease.


Asunto(s)
Humanos , Lepra Lepromatosa/epidemiología , Lepra/diagnóstico , Lepra/epidemiología , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios Longitudinales , Estudio Observacional
18.
PLoS Negl Trop Dis ; 14(8): e0008563, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32797081

RESUMEN

OBJECTIVE: Early diagnosis remains the primary goal for leprosy management programs. This study aims to determine whether active surveillance of patients with leprosy and their contact individuals increased identification of latent leprosy cases in the low-endemic areas. METHODS: This cross-sectional survey was carried out between October 2014 and August 2016 in 21 counties throughout Shandong Province. The survey was conducted among patients with leprosy released from treatment (RFT) and their contacts from both household and neighbors. RESULTS: A total of 2,210 RFT patients and 9,742 contacts comprising 7877 household contacts (HHCs), including 5,844 genetic related family members (GRFMs) and 2033 non-genetic related family members and 1,865 contacts living in neighboring houses (neighbor contacts, NCs), were recruited. Among identified individuals, one relapsed and 13 were newly diagnosed, giving a detection rate of 0.12%, corresponding to 120 times the passive case detection rate. Detection rates were similar for HHCs and NCs (0.114% vs. 0.214%, P = 0.287). Analysis of the family history of leprosy patients revealed clustering of newly diagnosed cases and association with residential coordinates of previously-diagnosed multibacillary leprosy cases. CONCLUSION: Active case-finding programs are feasible and contributes to early case detection by tracking HHCs and NCs in low-endemic areas.


Asunto(s)
Composición Familiar , Lepra/diagnóstico , Lepra/epidemiología , Lepra/terapia , Características de la Residencia , Espera Vigilante , Adolescente , Adulto , Niño , Preescolar , China/epidemiología , Análisis por Conglomerados , Estudios Transversales , Familia , Femenino , Humanos , Lactante , Recién Nacido , Lepra Multibacilar , Masculino , Persona de Mediana Edad , Adulto Joven
19.
PLoS Negl Trop Dis ; 14(8): e0008521, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32750059

RESUMEN

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.


Asunto(s)
Programas de Gobierno , Lepra/tratamiento farmacológico , Lepra/prevención & control , Profilaxis Posexposición/economía , Quimioprevención/economía , Análisis Costo-Beneficio , Humanos , India , Leprostáticos/economía , Leprostáticos/uso terapéutico , Lepra/diagnóstico , Lepra/economía , Profilaxis Posexposición/métodos , Años de Vida Ajustados por Calidad de Vida , Rifampin/economía , Rifampin/uso terapéutico
20.
Fontilles, Rev. leprol ; 32(5): 361-370, mayo-ago. 2020. tab
Artículo en Español | IBECS | ID: ibc-198461

RESUMEN

OBJETIVO: El objetivo del estudio es cribar convivientes de personas diagnosticadas de lepra con un elevado índice bacteriológico en un centro de referencia. MÉTODOS: El estudio hospitalario incorporo a 334 personas recién diagnosticadas de lepra con un elevado índice bacteriológico. El hospital de referencia es el de Champa, Chhattisgarh, India. Se anotaron todos los convivientes de estos casos registrados de lepra y se les ofreció ser examinados. RESULTADOS: De 334 casos con un índice bacteriológico elevado (IB), 252 (75%) eran varones y 82 (25%) mujeres, con edades comprendidas entre los 12 y los 75 años. Sesenta y dos (18%) presentaron discapacidad Grado 2 y un 32% presentaron un índice bacteriológico mayor de 5 en el momento del diagnóstico. Se registraron un total de 1,397 convivientes para cribaje y 678 (49%) fueron examinados clínicamente para detectar lepra. Ciento dieciséis convivientes presentaron signos de lepra y, de entre ellos, 57 (44%) se identificaron como nuevos casos, 11 (10%) como casos conocidos en tratamiento y 48 (41%) habían sido tratados anteriormente por la enfermedad. CONCLUSIÓN: El estudio revela que el cribaje de convivientes de pacientes con elevados IB es un método efectivo para la detección de posibles nuevos casos y enfatiza la necesidad continua de cribaje y seguimiento. La educación sanitaria y la motivación de los convivientes incrementara su presentación voluntaria para ser cribados y así detectar nuevos casos


OBJECTIVE: The study aimed to screen household contacts of persons diagnosed with leprosy having a high bacterial index, at a tertiary referral centre. METHODS: This hospital based study involved 334 persons who were newly diagnosed as leprosy with a high bacterial index, attending a tertiary referral hospital, Champa, Chhattisgarh, India. We enumerated all the household contacts of registered cases and invited them to be screened for leprosy. RESULTS: Of 334 high BI cases, 252 (75%) were male and 82 (25%) were female, with ages ranging from 12 to 75 years. Sixty two (18%) had Grade 2 disability and 32% had a bacterial index of above 5+ at the time of diagnosis. A total of 1,397 household members were enrolled for screening and 678 (49%) were examined for leprosy. One hundred and sixteen household members were found to have signs of leprosy, and among these, 57 (49%) were identified as new cases, 11 (10%) were known cases on treatment and 48 (41%) had been previously treated for leprosy. CONCLUSION: This study showed that screening of household contacts of high BI cases is an effective method of leprosy case detection and emphasizes the continuing need to screen and follow up. Continued health education and motivation of household contacts will enhance voluntary reporting for periodical screening


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Trazado de Contacto/estadística & datos numéricos , Lepra/diagnóstico , Lepra/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Familia , Lepra/tratamiento farmacológico , Carga Bacteriana , Distribución por Edad y Sexo , India/epidemiología
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