Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy

Abstract

BackgroundLeprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D.MethodsWe performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression.ResultsIn total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07).ConclusionsThis study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures.

Sensitive Damage in Leprosy: A Longitudinal and Retrospective Study

“…It is worth noting that this study also found a strong relationship between the evolution to disability with multibacillary forms, as well as the correlation between disease chronicity and the presence of leprosy reactions, in agreement with the data found in the present study. [20] Moreover, among the group of patients with involvement of the right tibial and ulnar nerves, 50% of patients who did not improve after MDT evolved with leprosy reaction. This observation demonstrates what had already been observed by Kamath et al (2014) [16], who states that reactions play an important role in the chronicity of Hansen's disease and is another reason for long-term follow-up of these patients.…”

Physical Disabilities Caused by Leprosy in 100 Million Cohort in Brazil

“…Higher education has been shown to be associated with better understanding of the disease and, consequently, better access and utilization of health services. Regular treatment and evaluation, as well as self-care, are aspects that prevent the worsening of leprosy cases [17,25].…”

Lepra: sospecha diagnóstica en área no endémica. Serie de casos y revisión de la literatura

“…La ENL presenta una frecuencia del 50% en pacientes con LL y del 5-10% en lepra borderline [15] . La importancia de las lepro-reacciones radica en que son la principal causa de daño axonal nervioso y, por ende, de discapacidad [17] .…”

“…La EH se ha relacionado a distintos grados de discapacidad y desempleo, especialmente en pacientes con lepro-reacciones y engrosamiento o afección de la sensibilidad de nervios troncales [17] . En el 2003, la OMS clasificó los grados de discapacidad en Grado 0: sensibilidad conservada, no alteraciones visuales; Grado 1: alteraciones sensitivas, no alteración visual; y Grado 2: alteraciones sensitivas y visuales [18] .…”