Clinical and epidemiological study of leprosy cases in the University Hospital of Brasília: 20 years - 1985 to 2005

Abstract

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. Key-words:Hansen's disease. Leprosy. Epidemiology. Leprosy reaction. Histopathology. RESUMOHanseníase, também conhecida como lepra, é doença infecciosa prevalente no Brasil. Caracteriza-se por curso crônico, com fenômenos imunológicos agudos denominados episódios reacionais. No Distrito Federal, o Hospital Universitário de Brasília é referência na assistência da hanseníase. O objetivo do estudo foi caracterizar o perfil clínico-epidemiológico dos doentes portadores de hanseníase do Hospital Universitário de Brasília. Foi realizada análise descritiva e retrospectiva de 1124 doentes portadores de hanseníase no período de 1985 a 2005. O padrão da hanseníase no nosso estudo concretizou-se por apresentar maior prevalência de reações do tipo 2, especialmente na forma lepromatosa e correlacionando-se diretamente com o índice baciloscópico. A significativa prevalência e freqüência de complicações graves como os episódios reacionais ressaltam a importância do estudo da doença e a necessidade de aprimoramento contínuo dos conhecimentos sobre a mesma. Palavras-chaves:Hanseníase. Lepra. Epidemiologia. Reação hansênica. Histopatologia.

Clinical, immunological, and genetic aspects in leprosy

“…Demographic data indicated that patients during this period were mostly women, in contrast with previous reports in the literature, which generally shows a predominance of leprosy in men [Feuth et al, 2008;Penna et al, 2008;Ranque et al, 2007]. However, another study did not find differences in the prevalence of the disease in relation to gender [Penna et al, 2008].…”

“…Smear examination shows a large number of bacteria, which are also responsible for the strong positivity of serum antibodies against PGL-I (80-100%). LL patients possess a large number of bacilli in the nasal passages and can represent a source of transmission and perpetuation of the disease until adequate and full treatment is provided [Bakker et al, 2006;Britton and Lockwood, 2004;Lockwood et al, 2007;Moura et al, 2008;Penna et al, 2008].…”

“…However, studies suggest that the presence of high bacterial load after discharge by cure is a risk factor for the development of post-treatment reactions [Brito Mde et al, 2008]. Other risk factors attributed to the development of reactional states are occurrence of borderline subtypes [Lockwood, 2007;Penna et al, 2008;Ranque et al, 2007]; extensive disease, estimated by the number of body areas involved; number of lesions; neurological involvement; and positive smear [Motta et al, 2010;Roche et al, 1991;Van Brakel et al, 1994]. Although these risk factors are known, the mechanisms responsible for the reactions are not yet fully understood.…”

“…Consistent with the immunopathogenesis of ENL (reviewed below), immunomodulators that regulate tumor necrosis factor-a (TNF-a) gene expression can be used for therapy Penna et al, 2008;Scollard et al, 2006a]. Thalidomide, by acting on TNF, is effective in controlling cutaneous and systemic symptoms of ENL [Kahawita and Lockwood, 2008].…”

Perfil Clínico E Terapêutico Da Neurite Causada Pela Hanseníase

“…Seu agente etiológico é o Mycobacterium leprae 1 um bacilo ácido álcool resistente (BAAR) 1,2 . O Brasil apresentou uma prevalência de 1,56 para 10.000 habitantes em 2010, ocupando o segundo lugar mundial em número de casos 2,3,4 .…”