<p>Leprosy Reactions In Childhood: A Prospective Cohort Study In The Brazilian Amazon</p>

Abstract

Background and objectiveIn highly endemic areas, severe multibacillary forms of leprosy and reactional episodes are not rare in children. The objective of the present study was to describe the clinical and epidemiological aspects of leprosy reactions in children from the Brazilian Amazon.MethodsThis was a prospective cohort study of 34 leprosy patients aged under 15 years diagnosed at a health referral unit in northern Brazil between April 2014 and June 2015. Follow-up medical consultations were performed during multidrug therapy (MDT) and one year after the end of treatment. Participants underwent a simple neurologic examination and answered a structured questionnaire.ResultsOf the 34 recruited patients, 18 (52.9%) had leprosy reactions and/or neuritis. Among these, 10 (55.6%) had reactions at diagnosis, 13 (72.2%) had reactions after MDT, and 14 (77.8%) had two or more reactional episodes. Type I reactions occurred in 14 (77.8%) cases. Complications, such as disabilities, necrotizing erythema nodosum, or Cushing’s syndrome, occurred in six (33.3%) patients. The following variables showed significant associations (p ≤ 0.05) with leprosy reactions: age 8–14 years, number of doctors seen (≥3), multibacillary classification, number of skin lesions (≥10), or borderline and lepromatous clinical forms. The high frequency of type I reactions resulted in prolonged corticosteroid therapy, which may cause deficient bone maturation in childhood.ConclusionOlder age in children, consulting many physicians for diagnosis, severe clinical forms, and numerous skin lesions were positively associated with reaction development. Reactions after MDT highlight the need for continuity in healthcare of children with leprosy.

Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study

“…According to World Health Organization (WHO) guidelines, single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) can be used in children and adolescents 36 . SDR-PEP can be studied by policy makers and/or health managers based on WHO recommendations and effectiveness and feasibility 36,43,44 .…”

Aglomerados de risco para ocorrência de hanseníase e as incapacidades em menores de 15 anos em Cuiabá: um estudo geoespacial

“…De acordo com as diretrizes da Organização Mundial da Saúde (OMS), a rifampicina em dose única (SDR) como profilaxia pós-exposição (PEP) pode ser usada em crianças e adolescentes 36 . A SDR-PEP pode ser estudada por formuladores de políticas e/ou gestores de saúde com base nas recomendações da OMS e na eficácia e viabilidade 36,43,44 .…”

Hanseníase Na Infância: Uma Série De Casos / Leprosy in Childhood: A Case Series

“…As complicações podem variar de acordo com a forma clínica e o tempo de diagnóstico, e incluem a ocorrência dos estados reacionais, que incidem em até 30% das crianças infectadas (em especial nas formas multibacilares), e evoluções mais raras, como o abscesso neural 17,18 . Outro impacto importante, embora pouco considerado na prática clínica, são os impactos psicológicos da doença nas crianças contaminadas e nas suas famílias, podendo se manifestar na forma de depressão, transtornos de ansiedade, medo e baixa autoestima 19 .…”

“…Outro impacto importante, embora pouco considerado na prática clínica, são os impactos psicológicos da doença nas crianças contaminadas e nas suas famílias, podendo se manifestar na forma de depressão, transtornos de ansiedade, medo e baixa autoestima 19 . Nos casos relatados neste trabalho, três crianças com a forma dimorfa apresentaram reação do tipo I, o que pode ser justificado pela maior prevalência de reações nas formas multibacilares 17 .…”