Progression of leprosy disability after discharge: is multidrug therapy enough?

Abstract

ObjectiveTo evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO).MethodsCohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics.ResultsThe total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02–2.56), when disability was 2, the risk was 2.37 (95% CI 1.35–4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07–3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08–2.52]).ConclusionImpairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.

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) .…”

“…However, it is necessary to reinforce the importance of early diagnosis, as the means of control in the Brazilian reality and the immediate start of treatment to reduce the consequences and break the transmission chain (21) . Such measures have been identified in some publications selected for this concept analysis (6,(13)(14)(17)(18)(21)(22) , and is an antecedent of the high diagnosis of leprosy.…”

“…In response to the inquiry, listed are some attributes of the concept of patient discharge in leprosy: completion of MDT (6,(11)(12)(17)(18)21) ; completion of MDT regimen for paucibacillary cases (PB) (6,14,17) ; completion of MDT regimen for multibacillary cases (MB) (6,14,17,22) ; and curing leprosy (6,(11)(12)17,(21)(22) . Cases considered as PB are those with up to 5 body lesions, negative smear and does not transmit the bacillus.…”

“…2017;38(4):e63290 daily), as well as a supervised monthly dose of rifampicin, whose recommendation is 12 cartouches within 18 months (31,33) . The number of doses and duration of multidrug therapy recommended to treat leprosy, is regarded as the only criterion for discharge by cure of the disease (22) . With respect to antecedents, they refer to events that have occurred prior to the concept (9) and have been identified in the literature searched from the following question: what events or situations are present before discharge in leprosy?…”