Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil

Abstract

Background Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. Methodology/principal findings A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7–2.9) and low schooling level (HR: 1.5; 95% CI: 1.2–1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40–55 years. Conclusions/significance Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals.

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis

“…Hence, it is possible to integrate the training, active case detection, and management of the diseases, which will be timely and cost-effective. [107][108][109] Similarly, though different in aetiology, people with poorly controlled diabetes are also at risk of injuring their extremities and developing insensitive ulcers due to neuropathic foot lesions. Both these diseases can have nerve damage even at the time of diagnosis.…”

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

“…On the other hand, patients diagnosed with ATL should be timely investigated for leprosy to prevent the development of severe conditions due to this disease, which apparently are enhanced in cases of co-diagnosis. For that, it is essential to strengthen diagnostic networks, the role of health services in the active detection of new cases and continued training of health professionals, especially those from primary health care facilities 2,7,22 .…”

“…We included all new cases of leprosy and ATL reported and confirmed by clinical-epidemiological and/or laboratory criteria from 2008 to 2017. Relapses, duplicate entries, non-autochthonous patients, misdiagnosed cases, records with inconsistencies, transfers, reinsertion into the system for a new round of treatment after a previous treatment abandonment and/or failure were excluded 7 .…”

“…A total of 28,204 and 24,771 cases of leprosy and ATL, respectively, met these criteria. As previously described 7 , a probabilistic linkage procedure between leprosy and ATL databases was performed by means of the Link Plus 3.0 beta software (Centers for Disease Control and Prevention, Atlanta, GA, USA) in order to identify patients diagnosed with both diseases. In summary, the probabilistic linkage employed blocking variables (patient's name, gender and date of birth) and matching variables (patient's name, gender, date of birth, mother's name and municipality of residence).…”

“…However, in a retrospective cohort, our research group has recently reviewed and identified a relevant number of patients who were diagnosed with both diseases over a 10-year period in a hyperendemic area for leprosy and ATL in Brazil. The time elapsed between the diagnosis of both diseases was associated with sociodemographic characteristics, namely male gender, age group between 40-55 years and low level of education 7 . However, the clinical aspects of leprosy and ATL in patients affected by both diseases were not comprehensively reviewed.…”