Leprosy in elderly people and the profile of a retrospective cohort in an endemic region of the Brazilian Amazon

Abstract

BackgroundLeprosy has a global presence; more than 180 thousand new cases were registered in 2013, 15% of which were found in the Americas. The elderly are a very susceptible demographic in terms of developing illnesses, mainly because of characteristics natural to the senescence of the human organism. This study’s goals were to analyze leprosy in an elderly population from a hyperendemic region of the Brazilian Amazon in a historical series from 2004 to 2013 and to determine the clinical and epidemiological profile of a series of leprosy cases of elderly people in the period spanning from 2009 to 2013.MethodsTo achieve these goals, an observational, longitudinal, retrospective and descriptive study was put together to analyze leprosy in elderly people from data acquired from the Notification Aggravations Information System. Furthermore, a profile of the disease from a retrospective cohort based on data collected from medical records was developed.ResultsThe number of new cases and the leprosy detection rate decreased across the observed period but remained stable among the elderly. The trend for the next ten years indicates decreases in the number of cases and in the detection rate in the general population and an increase in only the elderly. The overall profile was characterized by a predominance of males (64.32%), the multibacillary clinical form (87.57%), Type 1 reaction episodes (37.50%) and some physical incapacity at diagnosis (49.19%). The risk of reaction was greater in the first six months of multidrug therapy, and the positive result from the skin smear was associated with the greater chance of reactional condition development.ConclusionsThe resulting data demonstrate that leprosy amongst the elderly deserves attention because of the increased susceptibility to disability in this age group, with their higher risk of reaction and their greater level of co-morbidity.

Presence of Senescent and Memory CD8+ Leukocytes as Immunocenescence Markers in Skin Lesions of Elderly Leprosy Patients

“…The social impact of leprosy is high due to the physical sequelae that it may render, which are even more serious in the elderly population. Our work identified the increased frequency of physical incapacity in elderly, especially in MB patients, which is in agreement with other findings in the Brazilian population ( 38 – 40 ). Similarly, the greater frequency of males among MB patients has also been documented previously due to the progressive increase in MB leprosy with age ( 38 , 39 ).…”

“…Our work identified the increased frequency of physical incapacity in elderly, especially in MB patients, which is in agreement with other findings in the Brazilian population ( 38 – 40 ). Similarly, the greater frequency of males among MB patients has also been documented previously due to the progressive increase in MB leprosy with age ( 38 , 39 ). It is known from experimental models of intracellular pathogens such as Leishmania ( 41 ), Mycobacterium tuberculosis ( 42 ), and Paracoccidioides brasiliensis ( 43 ) that testosterone is capable of increasing the levels of Th2 anti-inflammatory cytokines, such as IL-10 and IL-4, while estrogen induces a Th1 response, such as IL-2 and IFN-γ.…”

“…Considering that M. leprae is capable of infecting a large amount of people, and only a minority will progress toward the disease ( 1 ), factors behind delayed disease onset that could be associated with changes in T lymphocyte subpopulations remain unclear. Studies in this area are even more relevant considering epidemiological tendencies of increased disease detection in the population over 60 years of age and stabilization in those between 15 and 60 years ( 38 , 39 ), which could be increased in a transition from high-endemic to middle-endemicity.…”

Trends and forecasts of leprosy for a hyperendemic city from Brazil’s northeast: Evidence from an eleven-year time-series analysis

“…In Imperatriz, in 2006, the estimated population aged 60 years old or over was 16,055 inhabitants, and in 2015 it increased to 21,0731 inhabitants, representing an increase of 31.25% in the period [40]. Considering the rapid aging process of the Brazilian and Imperatriz population, when leprosy is diagnosed and treated late, it leads to the functional loss of peripheral nerves and physical impairment, which, combined with the aging process and other comorbidities, contribute to elderly individuals' greater vulnerability and loss of autonomy [41].…”

Leprosy in Elderly and Children among New Cases – A 3-Year Retrospective Study

“…MB leprosy is more common in elderly patients as noted in a recent large population-based study in Brazil. [ 9 ] Similar focused population-based studies are required in India as well.…”