O retratamento por recidiva em hanseníase

Abstract

FUNDAMENTOS: Estudos sobre os pacientes hansenianos retratados justificam-se pela dificuldade do diagnóstico diferencial entre quadro reacional após alta do tratamento específico de hanseníase e recidiva, devido às limitações de critérios clínicos e laboratoriais para diferenciá-los. OBJETIVOS: Verificar os procedimentos diagnósticos clínicos e laboratoriais que subsidiaram o retratamento por recidiva e a ocorrência de episódios reacionais, em especial os que ocorreram após o término do tratamento. MÉTODOS: Mediante o estudo retrospectivo de série de casos foram estudados 155 pacientes hansenianos retratados por recidiva em duas unidades de referência em hanseníase, no município de Recife/PE, Brasil. RESULTADOS: O critério clínico foi o mais utilizado para a decisão de retratamento por recidiva, e as lesões novas descritas foram principalmente do tipo mácula e infiltração. Os episódios reacionais após alta ocorreram em 34% desses pacientes, e 33,9% relatavam a presença de comunicantes com hanseníase. Dos 155 pacientes estudados apenas 14,9% realizaram exame histológico e 18,1% não realizaram a baciloscopia antes de reiniciar a terapia específica. CONCLUSÃO: Este estudo evidenciou que os episódios reacionais após o tratamento e a presença de comunicantes com hanseníase ocorreram em torno de 30% nos pacientes retratados por recidiva e que se fazem necessários outros estudos controlados para o melhor entendimento desses fatores.

Compreendendo a “alta em hanseníase”: uma análise de conceito

“…Analyzing the selected articles, a predominance of publications in English (6,(11)(12)(13)(14)(15)(16)(17) was observed, totaling 61.53% (8 items), and the others (18)(19)(20)(21)(22) were in English, highlighting the periodic with the highest number of publications being from the Revista da Sociedade Brasileira de Medicina Tropical (Journal of the Brazilian Society of Tropical Medicine), with a total of 15.38% (2 articles) (6,12) . Based on the visibility achieved by the review, the steps proposed are performed according to the Concept Analysis Model (9) : concept selection; determination of the objectives of the conceptual analysis; identification of possible uses of the concept; determining attributes; identifying concept antecedents and consequents; presentation of a model case and an opposing case.…”

“…In the review conducted for this specific case, four possibilities of use were found related to the term patient discharge in leprosy: patient discharge by cure (12,14,21) , drug discharge (6,15,19) , bacteriological discharge (21)(22) and post-discharge (11,(15)(16)(17) . The four terms (patient discharge by cure, drug discharge, bacteriological discharge and post-discharge) refer to the mental construct of patient discharge in leprosy and refer to the period that starts after completion of MDT, whose pattern layout is composed of two groups of drugs, depending on the operational classification of leprosy cases: dapsone and rifampin or dapsone, rifampicin and clofazimine (31) .…”

“…Once excluded from the ministerial record, there is the continuity of health care (11,(14)(15)(16)18,(20)(21)(22) , considered another consequent of the concept patient discharge in leprosy. The need for follow-up takes place due to the possibility of worsening the degree of disability (6,11,(13)(14)(15)(16)(21)(22) , development of leprosy reactions (12,14,17,(21)(22) and any recurrence episodes (12,17,19) . Professionals, including managers, often associate drug discharge from follow-up discharge for uses who have concluded leprosy treatment, as they are focused on management, planning and evaluation, under a procedural perspective (34) .…”

Análise contextual da atenção à saúde na alta em hanseníase: uma revisão integrativa

“…The search was made without using a temporal cut-off related to the year of publication of the studies and was performed using the indexed descriptors Leprosy and dis-charge (or Leprosy and Patient Discharge, for selection via MeSH), associated with the Boolean operator AND, obtaining a total of 145 publications. After exclusion according to the eligibility criteria and repeated publications, 14 articles (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) were included for the study, as explained in Flowchart 1. In order to carry out the analysis, in addition to the articles selected, we also searched for convenience, in a non-systematized way, publications (4,(28)(29)(30)(31)(32)(33)(34) of the authors' knowledge, because it is seen necessary and relevant for contextual analysis.…”

Spatial distribution of leprosy cases in Ribeirão Preto, Brazil, 2004

“…It is important to emphasize the need for interventions by the Leprosy Control Program, including procedures to supervise contacts of people with Hansen's Bacillus, as well as interventions in endemic areas (12) .…”