Recidivas de casos de hanseníase no estado de Mato Grosso

Abstract

OBJECTIVE:To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS:This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifi able Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the signifi cance level of 5% was used. RESULTS:Among the new registrations of recurrences, 20% were confi rmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy fi ndings (c2 = 12.34; p = 0.002). Seventyone per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classifi cation or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS:The new registrations of cases of recurrence in Mato Grosso were infl uenced by the diagnoses made at PHUs, thus suggesting that there is a defi ciency within the healthcare services in recognizing cases of recurrence.

Características clínico-laboratoriais no retratamento por recidiva em hanseníase

“…A higher proportion of cases of recurrence with physical disability at level 0 was found, although data also show recurrence with physical disability at level 2 and patients without neurological assessment. The higher proportion of males at an economically productive age was similar to other studies 5,12,16,20,21 . The risk of development of leprosy is two times higher in men than women 22 .…”

Fatores associados à recidiva em hanseníase em Mato Grosso

“…The choice of treatment regimen should be based on careful evaluation of leprosy cases which can ensure more accurate treatment and higher cure rates; however, a defi nite diagnosis without laboratory confi rmation and/or negative results, especially in bacilliferous cases, can lead to misdiagnosis and subsequent disease reactivation. 6 Short-term treatment with insuffi cient number of drugs to treat patients with low immune response can favor relapse. 17 Alternatively serological tests can be used for the classifi cation of PB and MB leprosy in the initial treatment and to confi rm suspected relapse.…”

“…The controls were matched by gender and operational classifi cation to minimize or eliminate the confounding effect due to the predominance of relapse among MB and male cases. 6 The criteria for the diagnosis of relapses in leprosy were based on the Interviews were carried out to collect information on socioeconomic and epidemiological factors (individual and family monthly income in minimum wages, occupation status, housing status, types of home construction materials, sewage system, garbage collection, number of people living in the dwelling, type of household contact, comorbidities/concurrent conditions and hospitalization); habits (smoking and alcohol use), organization of health services (home visits, guidance, drug availability at the facility, type of transportation to get to the health facility) and variables related to skin color/ethnicity. BI and skin biopsies were performed at reference laboratories in the state of Mato Grosso and at the Instituto Lauro de Souza Lima, in Bauru, Southeastern Brazil, which is a national reference center.…”

“…d The state of Mato Grosso, central-western Brazil, accounted for 6% to 20% of relapsed cases between 2004 and 2006. 6 Studies on factors associated with relapsed leprosy are relatively scant in Brazil and most have focused on clinical/laboratory and treatment factors overlooking socioeconomic aspects and those related to health services. They have pointed out the following determinant factors: household contacts, 10,24 persistence of bacillus (bacterial index [BI] ≥2+), 4,9,10,24 interval between initial treatment and relapse, clinical form of leprosy, duration/type of MDT and drug reaction events.…”

Análise espacial da endemia hansênica no município de Bayeux (PB) mediante técnicas de SIG

“…O Brasil mantém, nas últimas décadas, a situação mais desfavorável na América Latina e o diagnóstico da segunda maior quantidade de casos do mundo, depois da Índia. A hanseníase entre os brasileiros é, portanto, um problema de Saúde Pú-blica cujo programa de eliminação está entre as ações prioritárias do Ministério de Saúde (MAGALHÃES; ROJAS, 2007 (DIAS et al, 2005), e Mato Grosso do Sul (FERREIRA et al, 2010). Todavia, são poucos os estudos sobre a distribuição espaço-temporal da hanseníase no Estado da Paraíba (MAGALHÃES; ROJAS, 2007).…”