Leprosy classification methods: a comparative study in a referral center in Brazil (original) (raw)
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Indian Journal of Dermatology, Venereology and Leprology, 2005
Background and Aims: WHO guidelines classify leprosy patients for therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy based on the number of skin lesions. An alternative system of classification has been in practice in Nepal from 1985 onwards, based on the number of body areas involved in patients of leprosy. We attempted a clinicopathological approach for comparison of these two systems of classification in leprosy patients for their ability to demarcate patients into groups of PB and MB leprosy. Materials and Methods: The study included 108 leprosy patients (80 males and 28 females). Complete clinical examination and body charting was carried out in each patient noting the count of skin lesions and the number of body areas involved. Slit skin smears and skin biopsies were taken from an active skin lesion in all patients. Results: On analysis, it was observed that there was good clinicopathological correlation between patients with 5 or <5 skin lesions and 2 or <2 body areas involved. (Clinical 95% and histological 96%) A similar correlation was also observed in the other group of patients with > 5 skin lesions and > 2 body areas involved, (Clinical 94% and histological 96%). There were almost identical numbers of patients represented in these two groups of classification.Conclusions: Our findings suggest that patients with involvement of 2 or less body areas can be classified as PB leprosy and those with more than 2 body areas involved can be classified as MB leprosy for the purposes of therapy. The study of areas of involvement in leprosy patients not only provides additional patient information but also adds another parameter as a basis for the study of leprosy patients.
Revista da Sociedade Brasileira de Medicina Tropical, 2012
INTRODUCTION: Operational classification of leprosy based on the number of skin lesions was conceived to screen patients presenting severe forms of the disease to enable their reception of a more intense multidrug regimen without having to undergo lymph smear testing. We evaluated the concordance between operational classification and bacilloscopy to define multibacillary and paucibacillary leprosy. METHODS: We selected 1,213 records of individuals with leprosy, who were untreated (new cases) and admitted to a dermatology clinic in Recife, Brazil, from 2000 to 2005, and who underwent bacteriological examination at diagnosis for ratification of the operational classification. RESULTS: Compared to bacilloscopy, operational classification demonstrated 88.6% sensitivity, 76.9% specificity, a positive predictive value of 61.8%, and a negative predictive value of 94.1%, with 80% accuracy and a moderate kappa index. Among the bacilloscopy-negative cases, 23% had more than 5 skin lesions. A...
American Journal of Tropical Medicine and Hygiene, 2015
The uniform multidrug therapy clinical trial, Brazil (U-MDT/CT-BR), database was used to describe and report the performance of available tools to classify 830 leprosy patients as paucibacillary (PB) and multibacillary (MB) at baseline. In a modified Ridley and Jopling (R&J) classification, considering clinical features, histopathological results of skin biopsies and the slit-skin smear bacterial load results were used as the gold standard method for classification. Anti-phenolic glycolipid-I (PGL-I) serology by ML Flow test, the slit skin smear bacterial load, and the number of skin lesions were evaluated. Considering the R&J classification system as gold standard, ML Flow tests correctly allocated 70% patients in the PB group and 87% in the MB group. The classification based on counting the number of skin lesions correctly allocated 46% PB patients and 99% MB leprosy cases. Slit skin smears properly classified 91% and 97% of PB and MB patients, respectively. Based on U-MDT/CT-BR results, classification of leprosy patients for treatment purposes is unnecessary because it does not impact clinical and laboratories outcomes. In this context, the identification of new biomarkers to detect patients at a higher risk to develop leprosy reactions or relapse remains an important research challenge.
Revista da Sociedade Brasileira de Medicina Tropical, 2008
Hansen's disease, also known as leprosy, is an infectious disease still prevalent in Brazil. It is a chronic illness with acute immunological phenomena known as leprosy reactions. In the Federal District of Brazil, the University Hospital of Brasília is the reference centre for leprosy care. The study aimed to characterize the clinical and epidemiological profile of Hansen's disease patients at the University Hospital of Brasília, by descriptive, retrospective analysis of 1,124 patients over the period from 1985 to 2005. The pattern of leprosy in this study demonstrated that type 2 leprosy reactions were common, especially in the lepromatous form and presented a direct correlation with the bacilloscopic index. The prevalence and frequency of severe complications, such as leprosy reactions, emphasize the importance of the ongoing study of leprosy and the need for continual improvement in the scope of knowledge concerning its treatment.
Cases of leprosy notified in the municipality of Parnaíba, state of Piauí, Brazil, 2007-2016
Acta Scientiarum. Health Science, 2021
This study aimed to describe the epidemiological and clinical characteristics of leprosy cases reported in the municipality of Parnaíba, State of Piauí. This was a cross-sectional study of leprosy cases, living in Parnaíba, State of Piauí, reported to the National System of Notifiable Diseases (SINAN), from 2007 to 2016. There were 582 cases of leprosy with hyperendemic detection in the general population in 2008, 2009 and 2016; and under < 15 years of age in 2008, 2014 and 2016, with a predominance of females (53.1%), brown (62.2%), aged 20-64 years (74.7%), complete and incomplete elementary school (56.4%), housewives (20.7%), living in the urban area (87.1%), reported by primary care (69.2%). The most frequent clinical and therapeutic findings were: multibacillary operational classification (53.8%); clinical forms: undetermined (30.6%) and virchowian (24.3%); single lesion (34.8%); no affected nerves (86.7%); degree of disability zero (70.6%); bacilloscopy not performed (26.7%...
Clinical and epidemiological profile of Central-Western region of Brazil leprosy patients
Brazilian Journal of Health Review
Leprosy is a chronic bacterial granulomatous disease that affects skin and peripheral nerves and shows slow progression. This study was to trace the epidemiological and clinical profile of leprosy among cases reported in the Information System for Notifiable Diseases in Anápolis, Goiás, Central-West region of Brazil. This is an epidemiological, descriptive and a cross-sectional study. Between January 2011 and December 2016, assistance was provided to 484 patients with leprosy. Among the patients, 59.5% male and the most prevalent age group was between 20-40 years old. Brown population in 47.3% of the cases and 51.7% of the patients completed elementary education. The majority of the cases were multibacillary and Virchowian clinical forms were prevalent, with zero degree of disability detected in 79.56% of the patients. There was no death due to leprosy during the study period. The epidemiological data indicates that a greater integration between the population and primary care must be encouraged, a crucial step for health education and strategies in order to combat the disease.
2004
* Trabalho realizado na Fundação Alfredo da Matta, centro de referência em hanseníase e doenças sexualmente transmissíveis, em Manaus, AM. / Work done at Fundação A l f redo da Matta, leprosy and sexually transmitted disease re f e rence center, in Manaus, AM 1 Médica dermatologista da Fundação Alfredo da Matta. / MD, dermatologist at Fundação A l f redo da Matta. 2 Médico dermatologista da Fundação Alfredo da Matta/Mestre em patologia tropical / MD, dermatologist at Fundação A l f redo da Matta/MSc in tropical pathology. 3 Médica dermatologista da Fundação Alfredo da Matta/Mestre em Saúde Pública/epidemiologia / MD, dermatologist at Fundação Alfredo da Matta/ MSc in Public health/epidemiology. 4 Médica dermatologista da Fundação Alfredo da Matta/Mestre em medicina tropical/epidemiologia / MD, dermatologist at Fundação A l f redo da Matta/ MSc in Public health/epidemiology. ©2 0 0 4 by Anais Brasileiros de Dermatologia Correlação clínico-laboratorial baseada em dados secundários dos casos de hanseníase atendidos no período de 01/2000 a 03/2001 na Fundação Alfredo da Matta, Manaus-AM, Brasil * Correlation between clinical and laboratorial findings of the leprosy cases followed at the "Alfredo da Matta"
Delay in the diagnosis of leprosy in the Metropolitan Region of Vitória, Brazil
Leprosy review, 2006
This paper reports on the time between the onset of the first lesion and diagnosis, defined as delay, and is based on results obtained by interviewers from a survey carried out amongst 450 leprosy patients in a leprosy endemic area in the Metropolitan Region of Vitória (MRV), state of Espirito Santo, Brazil. The mean age at diagnosis in all cases was 41.47 years and the median was 42.5 years. The mean age at diagnosis in MB (42.9 years) was greater than in PB (38.5 years). The mean of the delay in all cases was 25.25 months, median 12 months and range 0-360 months. The mean of the delay in MB (27.2 months) was greater than in PB (21.3 months). The results of this study suggest that although the delay in leprosy diagnosis in this region of Brazil was not too long when it was compared with other studies in endemic countries, it is still a problem: 65.4% of patients were diagnosed after a delay of 6 months. The Leprosy Control Programme in this state needs more effective health educati...