Porcentajes variables de casos de lepra paucibacilar en la noticación global de casos de lepra / No disponible

OBJETIVOS: La clasificación de nuevos casos de lepra en los grupos Paucibacilar (PB) o Multibacilar (MB) es importante ya que determina la duración del tratamiento farmacológico y predice tanto las complicaciones de la enfermedad como el riesgo de infección en contactos. Durante las últimas cuatro décadas han variado los criterios. Se han revisado las estadísticas de lepra globales para descubrir cualquier cambio temporal significativo en la proporción de casos PB. RESULTADOS: Los datos globales publicados por la OMS durante los últimos 40 años presentan una disminución continua en el porcentaje de nuevos casos de lepra clasificados como paucibacilares (PB) desde casi un 80% hasta el 40% del total. Se necesita una validación independiente y consistente de la clasificación. CONCLUSIONES: La disminución de casos PB puede ser un artefacto más que un fenómeno epidemiológico. Mientras que no podamos estar seguros, sospechamos que hay una combinación de cambios en criterios y "sobreclasificación" respecto al grupo MB por el personal sanitario en el campo

OBJECTIVES: Classification of new cases of leprosy into Paucibacillary (PB) or Multibacillary (MB) groups is important as it determines the duration of the treatment regimen, and predicts both complications of leprosy and risk of infection to contacts. Criteria have changed over the past 4 decades. We studied the published global leprosy statistics to reveal any major temporal changes in the proportion of PB cases. RESULTS: Global data published by WHO over the past 40 years demonstrate a continuous decrease in the proportion of newly reported leprosy cases who are classified as paucibacillary (PB) from nearly 80% to around 40%. Independent validation of consistent and accurate classification is lacking. CONCLUSIONS: The decrease in PB proportion may be an artefactual, rather than an epidemiological, phenomenon. Whilst it is impossible to be certain, we suspect that a combination of changes in criteria and "overclassifying" to the MB group by field staff is the cause

Trends of leprosy and multibacillary infection in the state of Georgia since the early 1900s.

Few investigations to date have analyzed the epidemiology of Hansen's disease (leprosy) in the United States, and in particular, if birth location is related to multibacillary versus paucibacillary leprosy. We collected data on 123 patients diagnosed with leprosy in Georgia from the National Hansen's Disease Program from 1923-January 2018. A logistic regression model was built to examine the relationship between country of origin (U.S.-born or immigrant) and the type of leprosy. While the model showed no significant relationship between country of origin and type of leprosy, being Asian or Pacific Islander was associated with a higher odds of multibacillary disease (aOR = 5.71; 95% CI: 1.25-26.29). Furthermore, since the early 1900s, we found an increasing trend of leprosy reports in Georgia among both domestic born and immigrant residents, despite the overall decrease in cases in the United States during the same time period. More research is therefore necessary to further evaluate risk for multibacillary leprosy in certain populations and to create targeted interventions and prevention strategies.

Calidad de vida de las personas con enfermedad de Hansen asistidas en un hospital de referencia, Paraíba-Brasil / Quality of life of people with hansen's disease assisted in a reference hospital, Paraíba-Brazil / Qualidade de vida de pessoas com hanseníase atendidas em um hospital de referência, Paraíba-Brasil

Objetivo: Evaluar el grado de deterioro de la calidad de vida de las personas con enfermedad de Hansen, de acuerdo con las variables sociodemográficas y clínicas Método: Estudio descriptivo, transversal, cuantitativo, que involucró a 45 pacientes de un hospital de referencia en João Pessoa, Paraíba, Brasil. Para la obtención de datos, las entrevistas se realizaron a partir de un cuestionario semiestructurado que incluyó las variables sociodemográficas y clínicas de los participantes; para evaluar su calidad de vida se utilizó el instrumento Dermatology Life Quality Index, luego de su aprobación en el Comité de Ética en Investigación de la Universidad Federal de Paraíba. En el análisis de los datos, se utilizó la Prueba no paramétrica del Qui-cuadrado de Pearson con un nivel de significación del 5% (p <0,05), usándose la continuidad de corrección de Yates, cuando fue necesario. Resultados: Se destaca la prevalencia de individuos varones, pardos, solteros, de entre 18 y 40 años, con ingresos familiares inferiores a tres salarios mínimos y baja escolaridad. De este total, el 88,9% presentó la forma clínica multibacilar de la enfermedad de Hansen y el 60% de ellos, con un nivel de deterioro de la calidad de vida que varía entre moderado y muy grave, según los puntajes del instrumento utilizado. Conclusión: Se confirma el importante impacto de la enfermedad de Hansen en la calidad de vida de sus portadores, como lo indican los altos puntajes obtenidos en la aplicación del DLQI

Objective: Evaluate the degree of impairment of the quality of life of people with Hansen's disease, according to social demographic and clinical variables Method: Descriptive, transversal, quantitative study, involving 45 patients from a reference hospital located in João Pessoa, Paraíba, Brazil. For obtaining data, interviews were performed based on a semi-structured questionnaire, including social demographic and clinic variables of the participants; to evaluate their life quality the instrument Dermatology Life Quality Index was used, after approval in the Committee of Ethics in Research of the Federal University of Paraíba. In the data analysis, the non-parametric Test of the Chi-square of Pearson was used with level of significance of 5% (p<0,05), being used the Yates correction continuity, when necessary. Results: It is highlighted a prevalence of male, brown, single, aged 18 to 40 individuals, with family income lower than three minimum salaries and low schooling. From this total, 88,9% presented the clinical multibacillary form of the Hansen's disease and 60% of them, with level of impairment of quality of life varying between moderate and very serious, according to scores of the instrument used. Conclusion: It is reassured the important impact of the Hansen's disease in the quality of life of their carriers, as indicated by the high scores obtained in the application of the DLQI

Objetivo: Avaliar o grau de comprometimento da qualidade de vida de pessoas com hanseníase, segundo variáveis sociodemográficas e clínicas. Método: Estudo descritivo, transversal, quantitativo, envolvendo 45 pacientes de um hospital de referência, localizado em João Pessoa, Paraíba, Brasil. Para obtenção dos dados, realizou-se entrevistas a partir de questionário semiestruturado, contemplando variáveis sociodemográficas e clínicas dos participantes; para avaliar sua qualidade de vida foi utilizado o instrumento Dermatology Life Quality Index, após aprovação do Comitê de Ética em Pesquisa da Universidade Federal da Paraíba. Na análise dos dados, utilizou-se o Teste não-paramétrico do Qui-quadrado de Pearson com nível de significância de 5% (p<0,05), sendo utilizado a Correção de Continuidade de Yates, quando necessário. Resultados: Evidencia-se uma prevalência dos indivíduos do sexo masculino, pardos, solteiros, com idade entre 18 e 40 anos, com renda familiar inferior a três salários mínimos e baixa escolaridade. Desse total, 88,9% apresentavam a forma clínica multibacilar da hanseníase e 60% deles, com grau de comprometimento da qualidade de vida vaiando de moderado a muito grave, segundo escores do instrumento utilizado. Conclusão: Reafirma-se o importante impacto da hanseníase na qualidade de vida de seus portadores, tal como indicado pelos altos escores obtidos na aplicação do DLQI

Leprosy survey among rural communities and wild armadillos from Amazonas state, Northern Brazil.

There is evidence that in southern US, leprosy is a zoonosis infecting wild Dasypus novemcinctus armadillos but the extent of this finding is unknown. This ecological study investigated leprosy in rural communities and in wild armadillos from the Brazilian Amazon. The study area was the Mamiá Lake of Coari municipality, Amazonas State, Northern region, a hyper endemic leprosy area where residents live on subsistence farming, fishing and armadillo hunting and its meat intake are frequent. The leprosy survey was conducted in sixteen communities by a visiting team of specialists. Local partakers provided wild armadillos to investigate M. leprae infection. Volunteers had complete dermato-neurological examination by a dermatologist with expertise in leprosy diagnosis, suspect skin lesions were biopsied for histopathology (Hematoxylin-eosin/HE, Fite-Faraco/FF staining); slit skin smears were collected. Armadillos' tissue fragments (skins, spleens, livers, lymph nodes, adrenal glands, others) were prepared for histopathology (HE/FF) and for M. leprae repetitive element-RLEP-qPCR. Among 176 volunteers, six new indeterminate leprosy cases were identified (incidence = 3.4%). Suspect skin sections and slit skin smears were negative for bacilli. Twelve wild D. novemcinctus were investigated (48 specimens/96 slides) and histopathological features of M. leprae infection were not found, except for one skin presenting unspecific inflammatory infiltrate suggestive of indeterminate leprosy. Possible traumatic neuroma, granuloma with epithelioid and Langhans cells, foreign-body granuloma were also identified. Granulomatous/non-granulomatous dermatitides were periodic-acid-Schiff/PAS negative for fungus. M. leprae-RLEP-qPCR was negative in all armadillos' tissues; no bacillus was found in histopathology. Our survey in rural communities confirmed the high endemicity for leprosy while one armadillo was compatible with paucibacillary M. leprae infection. At least in the highly endemic rural area of Coari, in the Brazilian Amazon region where infectious sources from untreated multibacillary leprosy are abundant, M. leprae infected armadillos may not represent a major source of infection nor a significant public health concern.

Leprosy survey among rural communities and wild armadillos from Amazonas state, Northern Brazil

There is evidence that in southern US, leprosy is a zoonosis infecting wild Dasypus novemcinctus armadillos but the extent of this finding is unknown. This ecological study investigated leprosy in rural communities and in wild armadillos from the Brazilian Amazon. The study area was the Mamia´ Lake of Coari municipality, Amazonas State, Northern region, a hyper endemic leprosy area where residents live on subsistence farming, fishing and armadillo hunting and its meat intake are frequent. The leprosy survey was conducted in sixteen communities by a visiting team of specialists. Local partakers provided wild armadillos to investigate M. leprae infection. Volunteers had complete dermato-neurological examination by a dermatologist with expertise in leprosy diagnosis, suspect skin lesions were biopsied for histopathology (Hematoxylin-eosin/HE, Fite-Faraco/FF staining); slit skin smears were collected. Armadillos' tissue fragments (skins, spleens, livers, lymph nodes, adrenal glands, others) were prepared for histopathology (HE/FF) and for M. leprae repetitive elementRLEP-qPCR. Among 176 volunteers, six new indeterminate leprosy cases were identified (incidence = 3.4%). Suspect skin sections and slit skin smears were negative for bacilli. Twelve wild D. novemcinctus were investigated (48 specimens/96 slides) and histopathological features of M. leprae infection were not found, except for one skin presenting unspecific inflammatory infiltrate suggestive of indeterminate leprosy. Possible traumatic neuroma, granuloma with epithelioid and Langhans cells, foreign-body granuloma were also identified. Granulomatous/non-granulomatous dermatitides were periodic-acid-Schiff/ PAS negative for fungus. M. leprae-RLEP-qPCR was negative in all armadillos' tissues; no bacillus was found in histopathology. Our survey in rural communities confirmed the high endemicity for leprosy while one armadillo was compatible with paucibacillary M. leprae infection. At least in the highly endemic rural area of Coari, in the Brazilian Amazon region where infectious sources from untreated multibacillary leprosy are abundant, M. leprae infected armadillos may not represent a major source of infection nor a significant public health concern.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil

Abstract INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Leprosy: clinical and epidemiological study in patients above 60 years in Espírito Santo State - Brazil

Abstract: Background: Leprosy is a chronic infectious disease that is endemic in Brazil and little studied in patients over 60 years old. Objective: The aim of this study was the epidemiological and clinical description of cases of leprosy in individuals older than 60 years, notified in the State of Espírito Santo - Brazil. Methods: It was an observational, descriptive and retrospective study of leprosy patients notified between 2001 and 2011. Results: Out of 16,025 notifications, 2,510 (15.6%) were of patients over 60 years of age; the distribution among the period was egalitarian except in the last 2 years, when there was a mild reduction of cases; the average was 70 years of age (±7 years); 46% were women, being 62% of those paucibacillary cases; 1,145 (50.5%) were dark-skined people in particular among paucibacillary cases; 1,638 (72.9%) were illiterates or poorly instructed n particular among multibacillary cases (P=0.022); 59.9% patients were clinically multibacillary cases and 37.4% had positive bacilloscopy; 37.9% patients had clinical alterations on peripheral nerves, 36.7% of all the multibacillary cases were classified as grade I and 15.3% as grade in assessment of disability. Study limitations: This was a retrospective study, which used secondary data generated by physicians and notified by other professionals, whar could have enabled possible errors on original data. Conclusions: Leprosy in this age group suggests a long incubation period with reactivation of latent focus or late infection. Men were more affected, as well as the afro descendent race was statistically significant in the paucibacillary cases (P=0.000) and illiterate/poor education in multibacillary cases (P=0.022). Nearly 40% of patients had positive bacilloscopy and grade I/II disability, demonstrating a late diagnosis.

Leprosy: clinical and epidemiological study in patients above 60 years in Espírito Santo State - Brazil.

BACKGROUND: Leprosy is a chronic infectious disease that is endemic in Brazil and little studied in patients over 60 years old. OBJECTIVE: The aim of this study was the epidemiological and clinical description of cases of leprosy in individuals older than 60 years, notified in the State of Espírito Santo - Brazil. METHODS: It was an observational, descriptive and retrospective study of leprosy patients notified between 2001 and 2011. RESULTS: Out of 16,025 notifications, 2,510 (15.6%) were of patients over 60 years of age; the distribution among the period was egalitarian except in the last 2 years, when there was a mild reduction of cases; the average was 70 years of age (±7 years); 46% were women, being 62% of those paucibacillary cases; 1,145 (50.5%) were dark-skined people in particular among paucibacillary cases; 1,638 (72.9%) were illiterates or poorly instructed n particular among multibacillary cases (P=0.022); 59.9% patients were clinically multibacillary cases and 37.4% had positive bacilloscopy; 37.9% patients had clinical alterations on peripheral nerves, 36.7% of all the multibacillary cases were classified as grade I and 15.3% as grade in assessment of disability. STUDY LIMITATIONS: This was a retrospective study, which used secondary data generated by physicians and notified by other professionals, whar could have enabled possible errors on original data. CONCLUSIONS: Leprosy in this age group suggests a long incubation period with reactivation of latent focus or late infection. Men were more affected, as well as the afro descendent race was statistically significant in the paucibacillary cases (P=0.000) and illiterate/poor education in multibacillary cases (P=0.022). Nearly 40% of patients had positive bacilloscopy and grade I/II disability, demonstrating a late diagnosis.

[Leprosy trends following implementation of an intervention project in a state capital in the North of Brazil, 2002-2016]. / Tendências da hanseníase após implementação de um projeto de intervenção em uma capital da Região Norte do Brasil, 2002-2016.

The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.

O projeto Palmas Livre da Hanseníase foi implementado para o incremento dos indicadores e o enfrentamento da doença, visto que a capital do Tocantins é a mais hiperendêmica do país. Este estudo mede o impacto da intervenção do projeto por meio da análise da tendência de indicadores prioritários em Palmas, 2002-2016. Baseia-se em análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN) e de relatórios de capacitações aplicadas com metodologia de problematização. Os indicadores dos casos novos de hanseníase residentes em Palmas foram investigados, e suas tendências foram identificadas por análise de regressão joinpoint para avaliação dos resultados. No ano de implementação do projeto de intervenção (2016), o coeficiente de detecção de casos novos na população geral foi de 236,3/100 mil habitantes, e esse indicador apresentava decréscimo significativo de -7,5% no período de 2002 a 2014. Nos anos entre 2014 e 2016, houve aumento significativo de 104,6% para a detecção geral. O coeficiente de detecção em menores de 15 anos também apresentava queda de -4,6%, mas nos anos de 2014, 2015 e 2016, houve aumento de 111,1%, juntamente com os coeficientes de detecção de casos com grau 0, 1 e 2, com 59,3%, 225,2% e 121,7%, respectivamente. A proporção de casos detectados por avaliação de contatos teve acréscimo significativo de 201,1% no período de 2014 a 2016. Os dados comprovaram a efetividade e potencialidade da estratégia de intervenção do projeto para as ações de diagnóstico e controle da hanseníase em Palmas. Trouxe evidências de que a agilidade diagnóstica dos serviços de atenção primária resulta em indicadores que refletem a incidência real de casos.

El proyecto Palmas Libre de Hanseniasis se implementó para el incremento de indicadores y combate a la enfermedad, dado que la capital de Tocantins es la más hiperendémica de Brasil. Este estudio mide el impacto de la intervención del proyecto, mediante el análisis de la tendencia de indicadores prioritarios en Palmas, 2002-2016. Se basa en un análisis de datos procedentes del Sistema de Información sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués) y de informes de capacitaciones, aplicadas con metodología de problematización. Se investigaron los indicadores de casos nuevos de hanseniasis, en residentes de Palmas, y se identificaron sus tendencias mediante análisis de regresión joinpoint para la evaluación de los resultados. En el año de implementación del proyecto de intervención (2016), el coeficiente de detección de casos nuevos en la población general fue de 236,3/100 mil habitantes, y ese indicador presentaba una disminución significativa de un -7,5%, durante el período de 2002 a 2014. Entre los años de 2014 a 2016, hubo un aumento significativo de un 104,6% en la detección general. El coeficiente de detección en menores de 15 años también presentaba una bajada de -4,6%, pero durante los años de 2014, 2015 y 2016, hubo un aumento de 111,1%, junto a los coeficientes de detección de casos con grado 0, 1 y 2, con un 59,3%, 225,2% y 121,7%, respectivamente. La proporción de casos detectados por la evaluación de contactos tuvo un aumento significativo de un 201,1%, durante el período de 2014 a 2016. Los datos comprobaron la efectividad y potencialidad de la estrategia de intervención del proyecto para las acciones de diagnóstico y control de la hanseniasis en Palmas. Hubo evidencias de que la agilidad diagnóstica de los servicios de atención primaria se traduce en indicadores que reflejan la incidencia real de casos.

Leprosy among schoolchildren in the Amazon region: A cross-sectional study of active search and possible source of infection by contact tracing.

BACKGROUND: The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing. METHODOLOGY/PRINCIPAL FINDINGS: This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children's cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate. CONCLUSIONS/SIGNIFICANCE: This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization's goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease's transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.

Tendências da hanseníase após implementação de um projeto de intervenção em uma capital da Região Norte do Brasil, 2002-2016 / Leprosy trends following implementation of an intervention project in a state capital in the North of Brazil, 2002-2016 / Tendencias de la hanseniasis tras la implementación de un proyecto de intervención en una capital de la región norte de Brasil, 2002-2016

Resumo: O projeto Palmas Livre da Hanseníase foi implementado para o incremento dos indicadores e o enfrentamento da doença, visto que a capital do Tocantins é a mais hiperendêmica do país. Este estudo mede o impacto da intervenção do projeto por meio da análise da tendência de indicadores prioritários em Palmas, 2002-2016. Baseia-se em análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN) e de relatórios de capacitações aplicadas com metodologia de problematização. Os indicadores dos casos novos de hanseníase residentes em Palmas foram investigados, e suas tendências foram identificadas por análise de regressão joinpoint para avaliação dos resultados. No ano de implementação do projeto de intervenção (2016), o coeficiente de detecção de casos novos na população geral foi de 236,3/100 mil habitantes, e esse indicador apresentava decréscimo significativo de -7,5% no período de 2002 a 2014. Nos anos entre 2014 e 2016, houve aumento significativo de 104,6% para a detecção geral. O coeficiente de detecção em menores de 15 anos também apresentava queda de -4,6%, mas nos anos de 2014, 2015 e 2016, houve aumento de 111,1%, juntamente com os coeficientes de detecção de casos com grau 0, 1 e 2, com 59,3%, 225,2% e 121,7%, respectivamente. A proporção de casos detectados por avaliação de contatos teve acréscimo significativo de 201,1% no período de 2014 a 2016. Os dados comprovaram a efetividade e potencialidade da estratégia de intervenção do projeto para as ações de diagnóstico e controle da hanseníase em Palmas. Trouxe evidências de que a agilidade diagnóstica dos serviços de atenção primária resulta em indicadores que refletem a incidência real de casos.

Abstract: The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.

Resumen: El proyecto Palmas Libre de Hanseniasis se implementó para el incremento de indicadores y combate a la enfermedad, dado que la capital de Tocantins es la más hiperendémica de Brasil. Este estudio mide el impacto de la intervención del proyecto, mediante el análisis de la tendencia de indicadores prioritarios en Palmas, 2002-2016. Se basa en un análisis de datos procedentes del Sistema de Información sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués) y de informes de capacitaciones, aplicadas con metodología de problematización. Se investigaron los indicadores de casos nuevos de hanseniasis, en residentes de Palmas, y se identificaron sus tendencias mediante análisis de regresión joinpoint para la evaluación de los resultados. En el año de implementación del proyecto de intervención (2016), el coeficiente de detección de casos nuevos en la población general fue de 236,3/100 mil habitantes, y ese indicador presentaba una disminución significativa de un -7,5%, durante el período de 2002 a 2014. Entre los años de 2014 a 2016, hubo un aumento significativo de un 104,6% en la detección general. El coeficiente de detección en menores de 15 años también presentaba una bajada de -4,6%, pero durante los años de 2014, 2015 y 2016, hubo un aumento de 111,1%, junto a los coeficientes de detección de casos con grado 0, 1 y 2, con un 59,3%, 225,2% y 121,7%, respectivamente. La proporción de casos detectados por la evaluación de contactos tuvo un aumento significativo de un 201,1%, durante el período de 2014 a 2016. Los datos comprobaron la efectividad y potencialidad de la estrategia de intervención del proyecto para las acciones de diagnóstico y control de la hanseniasis en Palmas. Hubo evidencias de que la agilidad diagnóstica de los servicios de atención primaria se traduce en indicadores que reflejan la incidencia real de casos.

Avaliação do desempenho de um teste rápido imunocromatográfico no diagnóstico de hanseníase em uma região endêmica no norte do Brasil / Evaluation of the performance of a rapid immunochromatographic test in the diagnosis of leprosy in an endemic region in northern Brazil

Introdução: A hanseníase é de grande importância para a saúde pública, devido à sua epidemiologia e a seu poder incapacitante. A eficiência no diagnóstico desta doença é limitada. O objetivo deste estudo foi o de analisar o desempenho de um teste rápido imunocromatográfico para hanseníase multibacilar (MB) e paucibacilar (PB), em amostras positivas e negativas pela baciloscopia de raspado dérmico em pacientes diagnosticados com hanseníase, comparando analiticamente com os critérios da Organização Mundial da Saúde (OMS). Métodos: O estudo foi realizado no município de Ji-Paraná/RO, entre 2015 e 2016, sendo avaliados 140 indivíduos. A análise comparativa entre os métodos foi realizada pelo cálculo de sensibilidade e especificidade utilizando o software SPSS®. Foi estimado o índice de Kappa (k) para avaliação da concordância entre os métodos. Valores de p <0,05 foram considerados significativos. Resultados: O índice de concordância entre o teste rápido e a classificação da OMS foi de k= 0,94 (p <0,01). Quando comparado a baciloscopia de indivíduos com hanseníase PB e o teste rápido, foi verificada concordância não significante (k= 0,01; p= 0,59). Comparando a concordância entre a baciloscopia de indivíduos com hanseníase MB e o teste rápido, foi detectado um índice de k= 0,64 (p <0,01). Além disso, sensibilidade de 94% e especificidade de 98% foram detectadas para hanseníase PB. Para hanseníase MB a sensibilidade foi de 95% e a especificidade de 98%. Conclusão: O teste rápido avaliado é uma ferramenta útil, rápida e eficaz no auxílio do diagnóstico da hanseníase. (AU)

Introduction: Leprosy is of great importance for public health because of its epidemiology and disabling power. Efficiency in the diagnosis of this disease is limited. The objective of this study was to evaluate the performance of a rapid immunochromatographic test for multibacillary (MB) and paucibacillary (BP) leprosy, in positive and negative samples by skin smear examination in patients with leprosy, and to compare the rapid test analytically with World Health Organization (WHO) criteria. Methods: The study was conducted in the municipality of Ji-Paraná/RO, Brazil, between 2015 and 2016. In total, 140 individuals were evaluated. For a comparative analysis of the methods, sensitivity and specificity were calculated using SPSS® software. The Kappa (k) index was used to evaluate agreement between the methods. A p-value < 0.05 was considered significant. Results: Regarding agreement between the rapid test and WHO classification, k index was 0.94 (p < 0.01). When skin smear of individuals with BP leprosy was compared to the rapid test, agreement was non-significant (k = 0.01; p = 0.59). For agreement between skin smear of individuals with MB leprosy and the rapid test, a k index of 0.64 (p < 0.01) was detected. In addition, for PB leprosy sensitivity was 94% and specificity was 98%, while for MB leprosy sensitivity was 95% and specificity was 98%. Conclusion: The rapid test is a useful tool, fast and effective in aiding the diagnosis of leprosy. (AU)

Pauci- and Multibacillary Leprosy: Two Distinct, Genetically Neglected Diseases.

After sustained exposure to Mycobacterium leprae, only a subset of exposed individuals develops clinical leprosy. Moreover, leprosy patients show a wide spectrum of clinical manifestations that extend from the paucibacillary (PB) to the multibacillary (MB) form of the disease. This "polarization" of leprosy has long been a major focus of investigation for immunologists because of the different immune response in these two forms. But while leprosy per se has been shown to be under tight human genetic control, few epidemiological or genetic studies have focused on leprosy subtypes. Using PubMed, we collected available data in English on the epidemiology of leprosy polarization and the possible role of human genetics in its pathophysiology until September 2015. At the genetic level, we assembled a list of 28 genes from the literature that are associated with leprosy subtypes or implicated in the polarization process. Our bibliographical search revealed that improved study designs are needed to identify genes associated with leprosy polarization. Future investigations should not be restricted to a subanalysis of leprosy per se studies but should instead contrast MB to PB individuals. We show the latter approach to be the most powerful design for the identification of genetic polarization determinants. Finally, we bring to light the important resource represented by the nine-banded armadillo model, a unique animal model for leprosy.

Leprosy among children under 15 years of age: literature review.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.

Leprosy among children under 15 years of age: literature review

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.

Reacciones lepromatosas en pacientes adultos y pediátricos en un centro de referencia. Programa Nacional de Lepra, Paraguay / Lepromatous reactions in adults and pediatric outpatients in a reference center. National Lepra Program, Paraguay

Introducción la lepra, llamada también enfermedad de Hansen, es una afección de la piel y de los nervios periféricos, infectocontagiosa, causada por Mycobacterium leprae. Las reacciones lepromatosas se presentan aún con tratamiento y son expresiones de respuesta inmunitaria. Conocerlas es importante a fin de facilitar el abordaje. Objetivo determinar la frecuencia y tipo de reacciones lepromatosas en pacientes con diagnóstico de lepra que acuden al centro de referencia de Enfermedad de Hansen en el Hospital Distrital de San Lorenzo, de enero 2013 a diciembre 2015. Metodología observacional, descriptivo, retrospectivo de corte transverso. Resultados se incluyeron 217 pacientes, 72% presentaban lepra MB y 63% era de sexo masculino. La prevalencia de reacción lepromatosa fue 44%, siendo más frecuentes las de tipo 2 (65%). Se presentó reacción lepromatosa como debut de la enfermedad en 27 %. Treinta y tres pacientes presentaron de tres a doce episodios de reacción lepromatosa. El tratamiento fue talidomida y corticoides. Conclusiones la prevalencia de leprorreacciones fue cercana al 50%, predominando las de tipo 2. El tratamiento utilizado fue talidomida y/o corticoides dependiendo del tipo de reacción lepromatosa.

Introduction leprosy, wich is cause by Mycobacterium leprae, also known as Hansen's Disease, affects skin and peripheral nerves. Lepromatous reactions (LRs) are expressions of an immune reaction and remain as a major persistent problem. LRs are present even with appropriated treatment. Emphasis must be made in early diagnosis and prevention of the catastrophic consequences of LRs. Objective to determine the frequency and type of lepromatous reactions in leprosy patients with leprosy attending to reference center of Hansen´s Disease in the District Center Hospital in San Lorenzo, from January 2013 to December 2015. Methodology observational, retrospective cross sectional study. Results 217 patients were included, 72% with multibacillary leprosy. 63% were male. Lepromatous reactions were found in 44%, been more frequent Type II reaction, in 65% of cases. LRs as oset disease occurred in 27%. 33 patients presented from 3 to 12 episodes of lepromatous reaction. The number of LRs episodes per patient were 3 to 12. Thalidomide was used as treatment in Erithema Nodosum Leprosum (ENL) and corticosteroids for the other types de LRs. Conclusions prevalence of PRs were 50%, been more frecuent the type II. Reaction the treatment used was Thalidomide and/or corticosteroids depending on the type of lepromatosus reaction.

Epidemiological aspects of leprosy in Juazeiro-BA, from 2002 to 2012

Abstract: BACKGROUND: Leprosy is an infectious disease caused by Mycobacterium leprae, able to infect large numbers of people. This work is relevant to Juazeiro-BA, a hyper-endemic area for leprosy, since unravel the behavior of the disease in the area, may suggest the decision making for sectors of surveillance, establishing strategies, organizing and evaluating programs and services. OBJECTIVES: To analyze the epidemiology of leprosy in Juazeiro-BA, from 2002 to 2012. METHODS: A descriptive, cross-sectional study was conducted based in data of the Diseases Notification System, assigned by the service of Epidemiology from Juazeiro-BA, between 2002 and 2012. RESULTS: 1,916 new cases of leprosy were detected between 2002 and 2012, of which 921 (48.07%) represented male sex, 995 (51.93%) female, and there was a reduction in the incidence rate of leprosy per 100,000 inhabitants. Most carriers were brown individuals, with low levels of education, living in the urban area, being more prevalent in the economically active age group. Through statistical analysis we found that there are more chances of developing sequelae among men, and multibacillary individuals older than 45 years. CONCLUSIONS: The work serves to direct efforts to control this disease, and highlights the importance of active search for new cases to achieve an early diagnosis, reducing the number of sequels and allowing breaking the chain of disease transmission.