- Volume 70 , Number 4
- Page: 3–372
Abstracts of Congress for Papers and Posters
PCA 110
MULTIFORM ERYTHEMA: RETROSPECTIVE ANALYSIS
Garcia Afonso, M.C.Z; Sales, A.M.; Coutinho, Z.; Vieira, L.M.M.; Nery, J.A.C; Gallo, M.E.N.
Leprosy Laboratory - Oswaldo Cruz Institute -FIOCRUZ - Rio de Janeiro - RJ.
Introduction: Multiform Erythema (ME) - like lesions are manifestation of a reactional episode in lepromatous patients and can delay its recognition as a leprosy reaction. Its early diagnosis is crucial to present disabilities due to the peripheral neuropathy that complicate these acute inflammatory episodes.
Objective: Evaluate the distribution of Multiform Erythema as part of reaction episodes of leprosy.
Materials and Methods: This study has included a retrospective analysis of 56 patients with reactional patient condition of a multiform erythema type in patients with leprosy submitted to multibacillar multidrugtherapy (MDT) according to the scheme of the WHO. All those patients who presented this reactional patient condition, whether during the period when they received the PCT or during the observation period after therapeutic discharge, were selected for this study. Sex, age, bacilloscope indices (BI), incapacity degree (ID) as well as the classifications of patients with reference to clinical form, moment the first episode occurred, number of episodes and occurrence of episodes, whether associated or not to other patient conditions.
Results: We have observed a predominance of the reactional patient condition of the multiform erythema type in the male sex (87,5%) and in the age group between 20 and 39 years old (55.4%). There has been a tendency of a multiform erythema occurring in association with higher BI indices as well as a decrease of BI after treatment. There has been an improvement in ID, should we compare the initial ID with the final ID (51,8%) degree at the beginning of treatment and 63,4% degree zero at the end of treatment. 76% of the patients presented only one episode of multiform erythema, 40% presented their first episode after medication discharge and 17,9% presented it before having begun therapy (at the moment of diagnosis). 41% of the patients presented multiform erythema in association with nodal erythema, 1,8% presented association with reverse reaction, and 26,8% of patients presented isolated multiform erythema.
Conclusion: M.E. episodes were not frequently found in multibacillary patients. However, those episodes are very important for identification of leprosy patients and in several occasions, they are the main reason for patients to seek medical care.
PCA 111
Mycobacterium leprae-HIV CO-INFECTION: RELEVANT CLINICAL ASPECTS AND PROGRESSION
Gomes, A.P.; Sales, A.M.; Nery, J.A.C.; Sampaio, E.P.; Galhardo, M.C.G.; Sarno, E.N.
Introduction: To date, published research regarding M. leprae -HIV co-infection has been scarce. Leprosy is endemic in Brazil and HIV infection rates, while, generally speaking, have been kept somewhat under control, require constant vigilance. Even so, co-infection has remained a largely ignored subject.
Objective: To evaluate the evolution of leprosy in co-infected HIV patients. Material and Methods: This is a retrospective descriptive case study of 30 patients with M. leprae -HIV co-infection that were treated in 1991 to 2000 at the leprosy Outpatient Clinic, Oswaldo Cruz Foundation, Rio de Janeiro. R.J., Brazil. Statistical analyses were performed via EPIINFO 2000 (CDC). The Qui-square Test and Fisher Exact lest were also carried out.
Results: there was no indication in this study that HIV was a risk factor for the development of the multbacillary forms (60% of the cases under treatment in the clinic were paucibacillary). Reactional episodes occurred in 70% of patients (57,1% had reversal reaction). It can, therefore, be postulated that the capacity for reactivation of the cell-mediated immune response remained strong regardless of existing CD4+ levels. All 30 patients responded satisfactorily to multidrug therapy despite their being co-infected and having an altered immune slate (AIDS/HIV). Moreover, no relapses were seen to occur.
Conclusions: None of the patients demonstrated an increased susceptibility to M. leprae or progression toward a multibacillary or disseminated form of leprosy. In addition, there was likewise no indication of impairment in the immune response to M. leprae in spite of the AIDS co-infection.
PCA 112
NERVE CONDUCTION STUDIES OF MULTI-BACILLARY-LEPROSY PATIENTS: ANALYSIS OF 35 PATIENTS AT THE BEGINING OF MULTIDRUG THERAPY
Patricia S. Penna; Marcia M. R. Jardim; Osvaldo J.M. Nascimento; Jose A.C. Neri; Anna M. Sales; Euzenir N. Sarno
Fundação Oswaldo Cruz and Dept of Neurology. Universidadc Federal Fluminense (UFF), Rio de Janeiro, Brazil.
Objective: To observe the frequency of evidences of nerve damage in multibaccilary (MB) leprosy patients at the beginning of multidrug therapy (MDT).
Background: We did not found at the literature any study that determine how are frequency of peripheral neuropathy at the beginning of MDT in MB patients and when the axonal or demyelinated lesions appear during these treatment.
Design/method: We examined 35 patients classified as having the MB form of leprosy. These patients were submitted to clinical and neurological examination followed by nerve conduction studies at the beginning of multidrug therapy. We divided these patients into groups: Group I A - Patients with signs and symptoms of peripheral nerve lesion; Group I B - Patients without complain of paresthesias or pain, but with signs of peripheral nerve lesion; and Group 2 - Patients without peripheral nerve complaints and without signs. Nerve conduction studies were done according to standard techniques.
Results: Out of the 35 multibacillary leprosy patients. 11 (31%) were female and 24 (69%) male. The mean age was 39,5 years. The neurological examination revealed sensory alterations in 22 (66%) cases; motor alterations in 7 (20% ) of and nerve thickeness in 19 (54%) patients. Nerve conduction studies (NCS) were normal in only 50% of group 2 patients. Out of the 28 remaining patients only in 1 (3.5%) from group 1A there were findings consistent with purely demyelination with conduction block, without reaction. Most of the patients (62.8%) has purely axonal alterations in NCS and 2 (5.7%) patients have axonal ami demyelinating findings in NCS.
Conclusions: Leprosy neuropathy in multibaccillary patients is typically of the axonal type, and the small libers are primarily involved, even in most of the patients with no neurological alterations at the beginning of die MDT. Nevertheless, in rare cases we can verify superimposed demyelinating features with conduction block, an alteration frequently observed in demyelinating neuropathies
PCA 113
NEUROCRIPTOCOCOSE EM PACIENTES COM HANSENÍASE VIRCHOWIANA
Ana Cláudia Lyon de Moura; Dayse Vidal D'ávila; Jane Venlury Leal; Maria Alice Ribeiro Ozório; Paula Pimentel Carvalho; Raquel Virgínia Rocha Vilela; Roberta Leste Motta; Rosimeire Arcanjo Hosken; Rozana Castorina da Silva; Samira Lyon
Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Centro Colaborador de Referência em Dermatologia Sanitária, Av. Dr. Cristiano Rezende 2213. Bonsucesso, Belo Horizonte - MG.
A hanseníase é uma doença infecto-contagiosa causada pela Mycobacterium leprae que acomete pele e, sobretudo, nervos periféricos, levando a neurites muitas vezes severas. Essas neurites são tratadas durante sua vigência e nos surtos reacionais através da corticoterapia, que pode se prolongar por meses. As reações adversas do uso sistêmico dos corti-costeróides tornam-se inevitáveis. Os autores apresentam o caso de um paciente do sexo masculino, 45 anos, encaminhado da cidade de Prata, MG, para tratamento de neurites persistentes, pós tratamento de Hanseníase multibacilar em uso de 80 mg de Prednisona há 2 anos. O paciente relatava que há 1 ano e 6 meses vinha apresentando quadros repetitivos de "abscessos" em cotovelos, drenando secreção expontaneamente, recebeu antibióticos várias vezes, com períodos de melhora e de exacerbação do quadro. Durante a internação, o paciente apresentou cefaléia persistente. O exame neurológico e a tomografia computadorizada de crânio foram normais. O exame micológico direto e a cultura de fungos do líquido cefalorraquiano identificaram a presença de Cryptococus neoformans. Foi iniciado Anfotericina B, mas o paciente evoluiu para o óbito no 7° dia após o início do tratamento.
Motivo da apresentação: alertar para as possíveis complicações com a corticoterapia prolongada em pacientes hansenianos.
PCA 114
NEUROPATIA PERIFÉRICA SENSORIAL CONGÊNITA SIMULANDO HANSENÍASE VIRCHOVIANA
Thomas de Aquino Paulo Filho
Universidade Federal do Rio G. do Norte - Natal - RN - Brasil. thomasfi@uol.com.br
Criança de 10 anos do sexo masculino que desde os 5 anos de idade vem apresentando diminuição da acuidade visual com opacificação das córneas, auto-mutilações nas extremidades dos membros com formação de úlceras plantares, destruição da pirâmide nasal, distúrbios de comportamento, anemia crônica e infecções secundárias nas lesões úlcero-tróficas nos membros. Não há relato de casos semelhantes na família.
O autor apresenta este caso clínico raro com todas as suas manifestações clínico-laboratoriais simulando caso de Hanseníase Virchoviana e comenta a dificuldade de abordagem terapêutica neste caso
PCA 115
NUTRIÇÃO E HANSENÍASE
Gubert, Muriel B.; Alvares, Rosicler R.A.
Hospital Universitário de Brasília, UnB- Avenida L2 Sul, Quadra 605 norte - Brasília DF
Introdução: Uma alimentação inadequada está relacionada a doenças carenciais (1) e em um aspecto mais amplo, a imunidade de um indivíduo é diretamente influenciada pelo seu estado nutricional (2, 3, 4). Pesquisadores mostraram que a desnutrição proteica está relacionada com alterações na imunidade mediada por células, função fagocítica. atividade sistema complemento, ação das imunoglobulinas secretórias e produção citocinas e citam como nutrientes envolvidos com sistema inume o zinco, selênio, ferro, cobre. Vit. A, Vit. C, Vit. E, Vit. B6 e ácido fólico (2). Estudos mostram, ainda, que a desnutrição proteica afeta mais IMC do que imunidade humoral. Torna-se, portanto, evidente a relação entre Hanseníase e Nutrição.
Objetivos: Este trabalho tem como objetivo relacionar Hanseníase e Nutrição. Metodologia: Foi feita revisão da literatura entre os anos 1960 a 2000, nos bancos de dados MEDLINE e LILACS.
Resultados: Rees (1981) mostra que a desnutrição protéica diminui a resposta mediada por células e aumenta o risco para MH e que em experimentos com ratos (com défict calórico/protéico) verificava-se a maior disseminação da doença. Existem relatos que na segunda Guerra, em Leprosário na Malásia (com 2500 doentes) submetidos a uma dieta com menos de 700 Kcal/dia houve maior mortalidade (IVA) contudo, desapareceram estados reacionais neste período (5). Rao e cols (1986) demosntram que a desnutrição não está relacionada com a doença e sim com a pobreza e privação de comida. Pesquisadores como Rao e Saha (1986; 1987 e 1988). Chattopadhya e cois (1992); Mennem e cols (1993). Vidal et al (1993) e Foster et al (1988) demostraram que pacientes de MU tem níveis séricos alterados pia alguns micronutrieiites. Em experimentos com ratos, verilicou-se que a gordura da dieta relacionada com multiplicação do M.leprae(6).AIém dos aspectos alimentares levantados, cabe ainda ressaltar a importância dos efeitos adversos da PQT para estes pacientes (7), o que pode levar a um estado de desnutrição, se não controlados.
PCA 116
OCORRÊNCIA DE ERITEMA NODOSO HANSÊNICO
Lastória, J.C.; Maccharelli, C.A.; Puttinatti, M.S.M.A.
Faculdade de Medicina de Botucatu- UNESP, Depto de Dermatologia.
A evolução crônica da hanseníase em pacientes portadores da forma multibacilar pode ser interrompida por surtos reacionais denominados tipo 2 ou de Eritema Nodoso Hansênico (ENH),principalmente após o início do tratamento. Com o intuito de se observar a ocorrência destes surtos, avaliou-se 40 pacientes multibacilares em tratamento no Ambulatório de Hanseníase da Disciplina de Dermatologia da Faculdade de Medicina de Botucatu- UNESP, no período de 3 anos, sendo 18 da forma dimorfa (D) e 22 da forma virchoviana (V). Observou-se que 18 (45%) pacientes apresentaram surtos de ENH, sendo 3 (7,5%) D e 15 (37,5%) V. Os surtos ocorreram em número de vezes variável de 1 a 8 por paciente, sendo que 8 (44,4)% pacientes apresentaram apenas um surto; 1 (5,5%), 2 surtos e 9 (50%) pacientes mais de 2 surtos; 22 (55%) dos pacientes não apresentaram surtos reacionais. Estes surtos ocorreram entre a 1ª. e a 23ª. dose da PQT, sendo a maior freqüência entre a 1ª. e a 12ª. dose, em 8 (22%) pacientes. Observou-se, ainda que 12 (30%) pacientes apresentaram surtos após a alta, com variação de ocorrência de 1 a 52 meses, até o momento, sendo que 5 (12,5%) apresentaram apenas uma vez; 2 (5%) duas vezes e 5 (12,5%) apresentaram mais de dois surtos. Em 2 (5 %) dos pacientes o ENH manifestou-se antes mesmo do início do tratamento. Interessante notar que os pacientes que apresentaram surtos após a alta foram praticamente os mesmos que apresentaram durante o tratamento e, ainda, que em 6 (15%) destes, que não haviam apresentado durante o tratamento, o fizeram a partir do 6° mês após o mesmo, sendo em 3 deles, cerca de 40 meses após a alta. Os autores chamam a atenção para a alta freqüência de surtos de ENH e que muitos pacientes continuam a apresenta- los após a alta, ou seja, após o término do tratamento, por longos períodos, além do fato dos mesmos poderem ocorrer, também, após longos períodos após a alta em pacientes que não os apresentaram durante o tratamento.
Houve ou não correlação do número de surtos com o IB, tanto durante o tratamento como após.
PCA 117
OCORRÊNCIA DE HEPATITES B E C EM PACIENTES COM PATOLOGIAS PASSÍVEIS DE TERAPÊUTICA COM IMUNOSSUPRESSORES
Joel Carlos Lastória; Milena Cerchiaro; Fábio C. Iuan, Nádia R. Carvalho
Faculdade de Medicina de Botucatu - UNESP
Dentre as diversas etiologias da hepatite crônica, temos a infecção pelo vírus da hepatite C (HCV), na qual a cronicidade da infecção é a regra, como sugerido por estudos de hepatite pós-transfusional. A condição de portador assintomático para formas graves da doença pode ser modificada pela terapia com imunossupressores como, da mesma forma que pela infecção pelo HIV. Esse fato motivou o presente estudo em pacientes com doenças dermatológicas passíveis dessa terapêutica mas que. no entanto, poderiam, eventualmente, serem tratados com medicamentos alternativos, entre as quais a psoríase, a micose fungóide e a hanseníase virchoviana reacional. Como a hepatite C parece ser transmitida de uma forma semelhante à da hepatite B, realizou-se a sorologia para ambas em 54 pacientes portadores dessas doenças dermatológicas. A mesma foi positiva em 4 (7,41%) pacientes. Destes, apenas 1 (1,85%) apresentava o vírus para hepatite C, sendo que os outros 3 (5,56%) apresentavam apenas o contato com o vírus da hepatite B ou eram falso positivos, o que não acarretaria problemas com o uso desse tipo de medicação. Embora em pequeno percentual (7.41%), os autores defendem a realização do teste sorológico para hepatite em geral, pois nos casos positivos, poder-se-ia optar por medicações alternativas, analisando-se, evidentemente, o fator risco-benefício, não incorrendo em possível prejuízo ao paciente. Além disso, diante de situações de impossibilidade da realização dos testes, sugerem a avaliação das condições epidemiológicas associadas ao risco da doença, antes da introdução dessas medicações.
PCA 118
OCULAR LESIONS AMONGST THE MB LEPROSY SUFFERERS UP TO TWENTY FIVE YEARS OF AGE GROUP WITH THE DURATION OF THE DISEASE UNDER FIVE YEARS
Swapan K Samanta; I S Roy; Asim K Dey; Amitava Chattaraj
B.S.Medical College & Gouripore State Leprosy Hospital, Bankura, West Bengal, PIN 722101, India
One hundred MB leprosy sufferers up lo twenty five years of age group with the duration of the disease under five years were examined randomly between July 2001 to January 2002 in Eastern India in search of the ocular lesions most probably related to the disease process. Two third of them were under active treatment and the rest hail completed the scheduled MDT regime. 20 of them were from the leprosorium, 25 of them were the residents of the alter care leprosy colonies and the other 55 leprosy sufferers were in the society. 70% of the patients were male and 30% female. Only 2% of them had minor physical deformity arising out of leprosy. 11% of this group of patients had ocular complications most probably related to leprosy. The ocular leprosy included Lagophthalmos in 3%, Peresis of Orbicularis Oculi in 1%, Complicated Cataract amongst 3%, and Recurrent Uveitis in 3% and Episcleritis in 1%. Otherwise non specific ocular lesions like Pterygium, Chronic Conjunctivitis, Pinguicula, Chronic Dacryocystitis, Refractive errors and Bitots Spots were encountered in 12% of the patients of the group. Here lagophthalmos was not associated with any exposure keratitis and responded well with a course of systemic steroid for six weeks. Uveitis responded effectively with local ocular medication along with a course of systemic steroid. The Cataract had a good visual out come following Extra Capsular Cataract Extraction with Intra Ocular Lens Implantation.
Ocular Leprosy in MB patients of younger age group is not an uncommon phenomenon in this era of MDT but it is well controlled by appropriate therapy keeping aside the dread full complications of incurable blindness.
PCA 119
ONE MONTH PREVALENCE OF MENTAL DISTRESS AMONG PEOPLE AFFECTED BY LEPROSY AT ALERT. ETHIOPIA. 2002
Ruth Leekassa; Elizabeth Bizuneh; Atalay Alem
ALERT (All Africa Leprosy Rehabilitation Training Centre) P.O. Box 165, Addis Ababa, Ethiopia.
Leprosy is a disease that results in handicap as a result of nerve damage. The society has negative feeling towards the affected people. The disability and the negative feeling of the society affect patients' emotional state and behaviour. Many patients attend clinic frequently without specific medical reason and the hypothesis was that they might be doing so because of psychological problems.
Objective: To estimate the prevalence of mental distress in people affected by leprosy and to suggest ways to deal with this problem.
Subjects: 471 persons affected by leprosy attending the different clinics at ALERT were systematically sampled and interviewed using The Self Reporting Questionnaire (SRQ).
Instrument: SRQ is an instrument developed by WHO to detect mental health problem in primary health care attendees in low-income countries. Twenty questions that contain emotional and somatic symptoms were used to identify emotional problems.
Result: Those who had at least 11 positive scores out of twenty symptoms from SRQ were regarded as having mental distress. The prevalence of mental distress in the study subjects was 51%. Those patients with handicap reported symptoms of mental distress more often than those without handicap. Over 18 % had suicidal ideation over the past one month.
Conclusion: These findings are much higher than findings of similar studies done in Ethiopia and elsewhere, both in clinical and community settings. People affected by leprosy seem to have more mental distress than the general population and people attending clinics for other diseases. The findings emphasize the great need for addressing Ihe psychosocial aspect of the problem with the medical treatment to help these people. Training in leprosy work should also include this as an important component in the management of leprosy. Since SRQ is meant to detect the presence of symptoms of general mental ill health, another study needs to be done to diagnose specific mental disorders in this population.
PCA 120
OUR EXPERIENCE OF ANTILEPROSY PREVENTIVE TREATMENT
A.A. Juscenko; N.G. Urlyapova; V.V. Anokhina; V.V. Duiko
Leprosy Research Institute, Astrakhan, Russian Federation
In Astrakhan endemic zone leprosy incidence among relatives of leprosy patients, long living together with index cases and having no preventive treatment, was 8- 10% in pre-sulphonic era. Since the 50th of the 20th century preventive antileprosy treatment was introduced in Russia. Preventive treatment was administered to persons aged 2-60 years old and having a close household contact with index leprosy case as well as with relapsed case of leprosy with high BI. As preventive treatment DDS was used at doses, usually administered to leprosy patients. Duration of preventive treatment was 6-12 months. In the period of 1958-1998 preventive treatment was given to 531 persons, among them 13 (2.4%) developed leprosy (7 females and 6 males). It should be noted that 12 out of the 13 cases accounted for the 60th-70th years. All the diseased had close household contacts with lepromatous leprosy patients. Index cases were as follows: mother - 4 cases, father, son, and brother-by 2 cases each, husband - 3 cases. By Ridley-Jopling classification patients were distributed as follows:. LL- 3-, BL-1, TT-7, I- 2. i.e. paucibacillary forms of leprosy prevailed. During preventive treatment no complications were observed. Intolerance of sulphones was rare. In control group (contacts having no preventive treatment) leprosy was developed in 8%. The data obtained suggested rather high effect of preventive treatment. While in the 50th in Astrakhan zone populated about 1 million 50—60 cases were registered annually, now, thanks to a set of antileprosy measures, including preventive treatment of leprosy contacts, prevalence of leprosy infection sharply decreased and primary incidence of leprosy has become sporadic
PCA 121
OVERT NEURITIS INFLUENCING THE INDUCTION AND/OR WORSENING OF PHYSICAL DISABILITIES IN MULTIBACILLARY LEPROSY PATIENTS
Pimentel, Maria Inês Fernandes; Nery, José Augusto da Costa; Borges, Esther; Gonçalves, Rosângela Rolo; Sarno, Euzenir Nunes
Laboratório de Hanseníase, Fundação Oswaldo Cruz, Avenida Brasil no. 4365 - Manguinhos - Rio de Janeiro - RJ - CEP: 21045 - 900.
With the goal of studying the role of the overt neuritis (pain, spontaneous or by palpation, in peripheral nerves) in the development and / or worsening of physical disabilities in multibacillary leprosy patients, 103 patients (18.4% BB; 47.6% BL; and 34% LL) were followed-up for an average period of 64.6 months, from the start of multidrug therapy (MDT), 24 doses. They were evaluated in relation to physical disabilities through disability grade and through disability index, before treatment, at the end of the treatment, and at the end of the follow-up period.
Forty six patients (44.7%) had overt neuritis episodes during follow-up (34% during MDT). The overt neuritis episodes were associated mainly with erythema nodosus leprosus reactions (55.3%), when compared to reversal reactions (33.3%), although this was not statistically significant. There was a significant correlation between the occurrence of overt neuritis and the development of disabilities, evaluated through disability grade at the end of treatment (p = 0.000274), as well as al the end of whole follow-up period (p = 0.006886). Similarly, disabilities measured through the disability index at the end of the treatment (p = 0.002165) and through the final disability index (p = 0.006274) were significantly correlated with the occurrence of overt neuritis. These data suggest that health professionals must pay attention to the early diagnosis of oven neuritis, giving prompt and adequate therapy, to prevent the development of physical disabilities in multibacillary leprosy patients.
PCA 122
PALPAÇÃO DE RAMO NERVOSO CUTÂNEO COMO UMA ESTRATÉGIA PARA A REDUÇÃO DA PREVALÊNCIA OCULTA DA HANSENÍASE
Alexandre Castelo Branco1; Luiz Cosme Cotta Malaquias2; Francisco Carlos Félix Lana3; Regina Lúcia Barbosa Cypriano1; Francisco Carlos Pereira1; Mara Firmato Esteves1; Simone Teixeira4; Andressa Masiero Santos4; Maria Cristina Souza Felipe da Silva5; Sebastião Fontes Santiago1
1- Policlínica Central Municipal de Saúde, Gov. Valadares. MG, Brasil.
2 - Faculdade de Ciências. Educação e Letras/UNlVALE. Gov. Valadares, MG. Brasil.
3 - Escola de Eníermagem/UFMG. Belo Horizonte, MG, Brasil.
4 - Secretaria Municipal de Saúde. Gov. Valadares. MG. Brasil.
5 - Diretoria Regional de Saúde. Gov. Valadares. MG, Brasil.
Expõe-se o quadro clínico inicial encontrado em contato de hanseníase descoberto a partir da palpação de ramo nervoso cutâneo. Enfatizam a utilização também da palpação de ramos nervoso cutâneos associado com a utilização do exame com monolila-mentos como uma estratégia para a detecção precoce e redução da prevalência oculta da hanseníase.
PCA 123
PAUCIBACILLARY HANSEN'S: COMMON CLINICAL TYPES
Melo. S.; Chaves, M.S.R.; Sailaja, K.S.; Souza, P.F.; Cavalcante, CM.; Abreu. F.; Nery, J.A.C.; Azulay. R. D.
Department of Leprosy. Institute of Dermatology. Santa Casa de Misericórdia. Rio de Janeiro, Brazil.
Introduction: Hansen's is an infectious disease with an inconsistent incubation period. The peripheral nerves are affected frequently and cause physical deformities. The incidence of the disease by mycobacterium leprae can be determined by two factors i.e. by the resistance of the patient and by the quantity of the bacilli.
Materials and Methods: 938 patients had been evaluated in the out patient department and out of that 103 were diagnosed as paucibacillary. All the patients were submitted for the following clinical examinations Neurodermatological, Bacilloscope, Lepromin test. Histopathological examination of skin. All of them received the Hansen's treatment for the lirsl time in their life. A study was done on the basis of age, sex, clinical classification, type and number of lesions.
Results: Out of 103 patients evaluated, 70 patients (68%) were females and 33 patients (32%) were males; the age incidence was from 1 year to 75 years. As per the clinical presentation 76 patients (74%) were tuberculoid type, 17 patients (16.5%) were inderminate type. 8 patients (8%) were infantile nodular, 2 patients (2%) were absolute neural type. As per the types of lesions 62 patients (60%) were macular, 30 patients (29%) were plaques, 8 (8%) were nodular and 2 (2%) were with out any dermatological lesions but presented with neurological deficit. In relation with number of lesions 61 patients (59%) had single lesion and 18 patients (17%) had two lesions.
Conclusion: In spite of the sound clinical knowledge of paucibacillary Hansen's type, the similar features are seen in the other types of clinical manifestations of the cutaneous plaques, infantile nodular Hansen's and absolute neural type. A keen attention should be given to the paucibacillary form, which has typical characteristics with other existing variable clinical entities.
PCA 124
PEROXIDASE AND SUPEROXIDE DISMUTASE LEVELS IN THE LYMPHOCYTES OF LEPROSY PATIENTS
Ravi, P.; Suribabu. C.S.S.
Central Leprosy Teaching & Research Institute. Tirumani, Chengalpattu - 603 001.
Tamil Nadu, India.
Leprosy become more complicated due to acute inflammatory episodes called "Reactions" during the natural course of the diseases while treatment and even after treatment. It is known that CMI is defective in infection with M. leprae . This abnormality has been correlated with defect in both numbers and proliferation of T-lymphocytes. The change that occurs in the physiology of Lymphocytes might be one of the reasons for the depressed functions, especially in the effector limb. We have studied a number of enzymes like LDH, Arginase, ADA. Aldolase besides rate of translation by labeled amino acids. In the present study we have studies SOD and Peroxidase levels in leprosy patients throughout the spectrum. We have analysed the above enzyme levels in both RBC as well as purified lumphocytes using standard procedures. These enzymes showed varying trends in both RBCs and Lymphocytes. Results will be presented and discussed.
PCA 125
POSSIBLE FACTORS AND THEIR COUNTER-MEASURES OF LEPROSY MISDIAGNOSIS AND MISSED DIAGNOSIS
Chen Jiakun; et al.
Shanghai Skin Disease & STD Hospital. 200435, Shanghai, China.
Abstract: The disability resulted from leprosy make the public develop apprehensiveness and discrimination on leprosy. Therefore it is very important to diagnoses early and accurately. Never establish diagnosis unless there are enough evidences. If it happen, the distress will drop the patients and their relatives mentally and physically. Once patients are misdiagnosed or missed diagnosed, irreversible disability and social public problem will be produced. Possible factors include 1) low precautions of leprosy presence, 2) absence of leprosy knowledge and do not master main points of diagnosis. 3) imperfect, careless or not enough synthetic analysis for examination. 4) leprosy with other skin diseases or peripheral nerve diseases. 5) variation of leprotic symptoms and signs. 6) incorrect preliminary diagnosis results in return visit as usual, especially for senior. 7) taboo leprosy and hide the truth. We discuss their countermeasures.
PCA 126
POST RELEASE REACTIONS AND SKIN SMEAR RESULTS
Albuquerque, E.C.A.; Gallo. M.E.N.: Nery, J.A.C.; Vieira, D.M.
National Collaborating Center in Leprosy -FIOCRUZ - RJ
The occurrence of reaction manifestations following release from treatment in leprosy patients remains as one of the most worrisome matters and of difficult solution. With the objective of better understanding the problem, we correlated the skin smears results with the presence of reactions in cases submitted to multidrug therapy destined to multibacillary leprosy patients (WHO/MDT). 164 cases were evaluated that presented reactions following release, where 124 cases had received 24 doses and 40 cases had received 12 doses of WHO/MDT. In the evaluation of the results, we used the system of Word processing, data bank and statistics for epidemiology in microcomputers EPI INFO 6.01. From the total of cases, 51.2% (84/164) presented positive skin smears at the moment of reaction. When we separately evaluated in relation to the number of doses, we observed that, following 24 doses. 53.2% (66/124) and after 12 doses, 45.0% (18/40) developed post release reactions with negative skin smears. The statistical tests showed no significant statistical difference between positive and negative skin smears and the occurrence of reactions in leprosy patients following release from WHO/MDT for multibacillary signaling the need for treatment with anti-inflammatory drugs and strengthening the participation of the immune system in the etiology of reaction episodes.
PCA 127
PREVALENCE OF OCULAR COMPLICATIONS IN NEWLY DIAGNOSED AND RELAPSED LEPROMATOUS PATIENTS
Ebenezer Daniel; Sheena Koshy; P S S Sundar Rao
Schieffellin Leprosy Research and Training Center, Karigiri, India - 632106
Results on the ocular complications of 301 lepromatous patients, newly diagnosed (238) and relapsed (63), male (213) (71%) and female (88) (29%), polar lepromatous (LL) (41) (14%) and borderline (BL) (260) (86%) with age ranging from 7 to 78 years with 41.5 (14) mean (SD) and duration of disease from 1 year to 32 years with 6.2 (7.8) mean (SD), belonging to a geographically defined leprosy control area program in South India who had base-line anterior-segment ophthalmic examination is presented.
Ocular complications, categorized as leprosy related complications (lagophthalmos, ectropion, entropion, trichiasis, corneal opacities, corneal sensory impairment, corneal ulcer, episcleritis, scleritis, iridocyclitis and iris atrophy) (LRC) and general complications (nasolacrimal duct block, pterygium and cataract) (GC), were found in 213 (71%) patients. 88 (29%) patients had no ocular complications. 30 (10%) had only GC. 111 (37%) had only LRC and 72 (24%) had both. More elderly patients had ocular complications (P=0.000) as did LL patients (85%) compared with BL (68%) (P=0.03). Limb deformity (P=0.000) and smear positivity at any one site at enrollment (P=0.02) and visual loss (P=0.()()2) were associated with ocular complications. Ocular complications were not significantly different in relapsed patients compared with newly diagnosed lepromatous patients. Similar associations were found when LRC were analyzed separately. More cataract was present in those who had LRC (30%) than those who did not (12%)(P=0.000). GC were associated with increasing age (P=0.000), were more in LL patients (49%) than BL(32%) (P=0.03) and were associated with increased limb deformity (P=0.006). Corneal opacity with vision loss was more in patients with GC (P=0.01).
PCA 128
PRIOR THE START AND AFTER TREATMENT WITH MULTIDRUG THERAPY IN LEPROSY: A HISTOLOGICAL AND IMMUNOHISTOCHEMISTRY STUDY
M.C. Floriuno; J. Tomimori-Yamashita; O. Rotta
Department of Dermatology, Paulista School of Medicine - Federal University of São Paulo, Brazil.
Rua Botucatu, 740. Vila Clementine-. São Paulo (SP), Brasil.
The fixed-duration multidrug therapy (MDT) has been of a great value in the control of leprosy. Its effectiveness is basically shown through clinical and bacterioscopic parameters. The goal of this study was tissue analysis by histological and immunohistochemistry techniques for populations of lymphocytes T helper, lymphocytes T suppressor, macrophages and Mycobacterium leprae antigens on the patients undergone MDT.
Twenty-eight patients with leprosy were studied. They were classified according Madri classification. Seven out of them were tuberculoid leprosy (T) and they were classified as paucibacillary group to be treated. Twenty-one were classified as multibacillary group, twelve of the borderline leprosy (B) and nine of the lepromatous leprosy (L). All patients were treated with MDT.
Skin biopsies were made alter the end of the treatment at same site that it had been made before lhe beginning of the therapy and histological and im-muhistochemistry analysis with anti-OPD4, anti-CD8, anti-CD68 and anti-BCG antibodies were made.
The decrease of the inflammatory cells in the infiltrate was noticed of leprosy after the treatment. The CD4+cells were more expressive in T leprosy than in B and L leprosy before treatment. After treatment this difference was not noticed.
The distribution of CD8+ cells and CD68+ cells was similar in different forms of leprosy, before as well as after treatment.
The demonstration of the mycobacterial antigens in lhe tissues through the BCG+ cells was more sensitive than the demonstration of acid-fast bacilli in the tissue through the Fite-Faraco stain.
PCA 129
REAÇÃO DE REVERSÃO REVELANDO DOENÇA DE HANSEN
Mohamed A. Azzouz; Francisca Estrêla Maroja Dantas; Carla Wanderley Gayoso; Mª das Graças V. A. Almeida; Francimary de Souza Buriti; Carlos Alberto F. Ramos
UFPB/ Hospital Universitário Lauro Wanderley.
R.M.S. 32 anos, masculino, branco, casado, natural e procedente dc João Pessoa- Pb, apresentava há 1 ano lesões no corpo tipo urticariana, que melhorava com corticoide sistêmico e com aparecimento das lesões após a suspensão da medicação. Ao exame apresentava nervos espessados e lesões em placa eritematosas e infiltrada em tórax e abdome. Confirmado o diagnostico através da biopsia. Baciloscopia negativa, iniciamos tratamento com o esquema paucibacilar e corticoterapia. Trata-se de manifestação aguda da Doença de Hansen. Cerca de 20% da doença é diagnosticada a partir da reação.
PCA 130
REAÇÃO HANSÊNICA TIPO I EXUBERANTE SIMULANDO FENÔMENO DE LÚCIO
Ana Célia de A. Mesquita; Heitor de Sá Gonçalves; Ana Fátima P. Teixeira; Francisco José Dias Branco; Maria Araci P. Aires Centro de Dermatologia Dona Libãnia - SESA - CE Av. Pedro I. 1033 - Centro -Forateza - CE
AMS, masculino, 71 anos, agricultor, procedente de Quixadá - CE. Paciente portador de hanseníase virchoviana, diagnosticada pela associação de clínica com a baciloscopia (IB = 2.5), além de hislopatologia compatível. Na consulta inicial apresentava extenssa placa eritêmato-infiitrada, com ausência de sensibilidade térmica e dolorosa na lace medial do braço esquerdo, e inúmeras lesões semelhantes, am menores dimensões, disseminadas pelo tegumento, predominando em tronco e membros superiores. Iniciou esquemaq poliquimioterápico para mutlibacilares da OMS, e cerca de 15 dias após, apresentou exuberante quadro de ração tipo I, com aumento da infiltração de numerosas lesões. Foi medicado com prednisona, na dose de 0,8 mg/kg/dia, evoluindo com resposta terapêutica bastante satisfatória. Motivo da apresentação: exuberância dc reaçã tip I em hanseníase, sumulando fenômeno de lúcio, e a pronta responsta terapêutica á doses moderadas de corticoterapia.
PCA 131
REAÇÃO TIPO I GRAVE, COM LESÕES INCOMUNS EM CRIANÇA DE 7 ANOS COM HANSENÍASE DIMORFA - RELATO DE CASO
Grossi, M.A.F.; Freire, H.B.M.; Teixeira. M.L.G.; Villarroel. M.F.; Pires. R.P.; Lyon. S.
Centro Geral De Pediatria (Cgp) and Hospital Eduardo De Menezes (Hem) Fundação Hospitalar Do Estado De Minas Gerais. Alameda Ezequiel Dias N° 345 Cep: 30130 110 Belo Horizonte, Mg - Brasil
Relato de Caso: D.N.L.C., 07 anos, sexo masculino, faioderma, natural e procedente de Teófilo Otoni, Minas Gerais, internado no C.G.P em 10/01, com história de há 03 anos ter apresentado mácula hipocrômica no tórax, com posterior aumento do número das lesões. Diagnóstico de Hanseníase Dimorfa em 09/01, com Grau Zero de Incapacidade, no Centro de Saúde de sua cidade, aonde iniciou PQT/MB. Passou a apresentar exacerbação das lesões que ficaram eritemato-infiltradas e edematosas, com posterior necrose e ulceração em face, orelhas, tronco e membros. Enviado para o Centro de Referência do HEM em Belo Horizonte quando foi feito o diagnóstico de Reação Tipo 1 Necrótica com infecção secundária e encaminhado para o CGP, aonde manteve a PQT/MB, iniciou Prednisona, Oxacilina e Cloranfenicol, limpeza e proteção da pele com Ácidos Graxos Essenciais e Curativos Interativos com Hidrocoloide nas lesões ulceradas. A criança evoluiu com melhora progressiva das lesões cutâneas e piora sensitiva e motora em Ulnares e Tibiais, comprovada pelo monitoramento da função neural: força muscular, estesiometria e eletroneuromiografia, sendo indicada Neurolise de Ulnares, Medianos, Fibulares e Tibiais. Após cirurgia e melhora inicial a criança vem sendo acompanhada pelo serviço de origem e pelo CGP.
Motivo da Apresentação: Caso pouco usual e grave da Reação Tipo I em criança de 7 anos.
REAÇÕES ADVERSAS À PQT. NUM PERÍODO DE DEZ ANOS.
Dalila Filomena Mohalem; Maria do Rosário Vidigal; Mônica Nóbrega Cunha
Centro de Saúde Tranqüilidade. Secretaria de Saúde de Guarulhos.
Av. Emílio Ribas, n° 1845 - Guarulhos - SP.
Uma Avaliação Da Incidência De Reações Adversas A Poliquimioterapia Ocorridas Num Período De Dez Anos (1992 A 2002), No Centro De Saúde Tranquilidade; Entre Elas: Anemia Hemolítica, Hepatite, Insuficiência Renal, Síndrome Pseudo Gripal, Vômitos Incoercíveis E Púrpura Trompocitopênica.
PCA 132
REAÇÕES ADVERSAS À PQT. NUM PERÍODO DE DEZ ANOS
Dalila Filomena Mohalem. Maria do Rosário Vidigal, Mônica Nóbrega Cunha
Centro de Saúde Tranqüilidade
Secretaria de Saúde de Guarulhos
Av. Emílio Ribas, n" 1845 - Guarulhos - SP.
Uma Avaliação da Incidência de Reações Adversas à Poliquimioterapia ocorridas num período de dez anos (1992 a 2002), no centro de saúde tranquilidade: entre elas: Anemia Hemolítica. Hepatite. Insuficiência Renal, Síndrome Pseudo Gripal, Vômitos Incoercíveis e Púrpura Trompocitopênica.
PCA 133
REACTIONAL STATES IN CO-INFECTED LEPROSY X HIV POSITIVE PATIENTS
Nery, J.A.C.; Sá, R.P; Guatierrez, M.C.; Sales. A.M.; Machado, A.M.; Gomes, A.P.; Sampaio, E.P.
Leprosy Laboratory - Oswaldo Cruz. Foundation -RJ - Brazil.
Introduction: Although endemic in Brazil, leprosy disease is uncommon in HIV+ individuals. HIV+ patients present the same stable forms and reactional episodes described in the HIV negative leprosy patients. As the disease develops into HIV-positive individuals, a variety of other opportunistic infections may develop, some of which are directly related to deficiencies in the cellular immune response. However, leprosy does not seem to be related to the immune status of HIV+ patients.
Objective: Describe the reactional episodes among the co-infected leprosy × HIV+ patients.
Methods: With the intent to evaluate the frequency of reactional episodes in co-infected leprosy × HIV+ patients, we followed 38 patients. They were treated at Outpatient Unit of Leprosy Laboratory / Oswaldo Cruz Foundation / Rio de Janeiro / Brazil with multidrugtherapy (OMS).
Results: Out of 38 cases, 24 (63%) patients were paucibacillary (PB) and 14 (37%) were multibacil-lary (MB). Eighteen patients (47%) were male and 20 (53%) were female, ranging from 17 to 64 years of age. Twenty-three (60%) patients presented reactional episodes, and 20 patients developed type 1 reaction and 3 developed type II reaction. Among the PB patients, 21 (87%) presented reactional states and in the MB, 11 (78% ) patients. Nineteen (825) developed a reaction during the first 6 months of treatment, 3(13%) during the first year and only 1 (4%) after this. Only 8 (34%0 patients presented more than one episode of reaction.
Conclusion: The HIV co-infection does not seem to change the natural course of leprosy, nor to interfere on the specific immune response to M. leprae , but the frequency of reaction in PB patients is higher than in HIV negative patients.
PCA 134
REACTIONS IN LEPROSY: AN EPIDEMIOLOGICAL STUDY OF 2600 PATIENTS FROM NORTH INDIA
Bhushan Kumar; lnderjeet Kaur; Sunil Dogra
Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
Although leprosy reactions are a very common phenomenon, very limited data has been published on their epidemiology from India, which harbours the largest number of case load in the world. This paper presents epidemiological data over a period of 15 years on reversal reactions (RR) and erythema nodosum leprosum (ENL) from retrospective analyses of 2600 new leprosy patients registered and followed up at our clinic. Average period of follow up was for 72 months (range 24-156 months). There were 1634 males (mean age 37 ± 3.2years) and 966 female patients (mean age 4 ± 12.3years). 1494 (57.4%) of them had multibacillary and 1106 (42.5%) had paucibacillary disease labelled on the basis of slit skin smear.
The prevalence of RR at registration was 24% and that of ENL was 6.8%. The overall incidence rates among patients available for follow-up were 8.2%/100 persons years (PYAR) at risk for RR and 4.1%/100 PYAR for ENL. The most significant risk factor for RR was extent of clinical disease measured by count of body areas involved. The observation of other investigators that most RRs occur during first year of treatment was confirmed in our study. Lepronialous disease and high bacteriological index (BI≥3) were significant risk factors for INL reactions. A total of 226/507 (26.4% of all LNL cases) patients had > 4 episodes over a period of > 3 years and the reactions continued to occur in decreased frequency till 7.2 years in lew patients. Late RR was seen in 7.1% of all leprosy patients. The incidence of RR declined steadily after the start of the treatment but recurrent episodes continued to occur even up to 6 years after diagnosis.
PCA 135
RECIDIVA PAUCIBACILAR - RELATO DE UM CASO
Flávio Marcondes Hercules; Mónica Duarte da Cunha; Maria Leide Wand Del Rey de Oliveira
Serviço de Dermatologia do Hospital Universitário Clementino Fraga Filho - UFRJ.
Os novos esquemas terapêuticos para hanseníase e redução no tempo da poliquimioterapia (PQT), torna a recidiva um tema cada vez mais importante. A OMS (1994) detectou coeficiente cumulativo de recidiva paucibacilar de 1,7% . Segue a descrição de I caso de recidiva paucibacilar: paciente, feminina, 46 anos. parda, MG. do lar. Início do quadro em 07/1990 com surgimento de 3 lesões eritemato-infiltradas, hipoestésicas, situadas nas regiões malares, acompanhadas de espessamento ulnar bilateral. A biopsia cutânea evidenciou hanseníase tuberculóide, o Mitsuda foi positivo (10mm), e a baciloscopia negativa. Foi iniciado tratamento com PQT PB, sem intercorrências até o seu término. Permaneceu assintomática, porém 9 anos após surgiu nova lesão eritemato-infiltrada e hipoestésica, na região frontal, associada à neurite fibular direita. Foi submetida a 60mg de prednisona com melhora da lesão (hipercromia residual) e desaparecimento da neurite. A biopsia revelou denso infiltrado linfoplasmocitário e histiocitário, circundando nervo com células epitelióides c gigantes formando granulomas. A baciloscopia foi negativa. Desde então evoluiu com períodos de piora e melhora da lesão, de acordo com curso oscilante de corticoterapia. Não apresentou surgimento de novas lesões ou recidiva da neurite. Em 01/2002 foi reiniciado tratamento com esquema PQT MB. Ressalta-se que pelas regras aluais do Ministério tia Saúde esla paciente deveria ler sitio tratada no primeiro episódio com esquema multibacilar. pois apresentava acometimento neural de 2 troncos.
PCA 136
RECOMBINANT HUMAN PLATELET-DERIVED GROWTH FACTOR FOR TREATMENT OF NEUROPATHIC ULCERS IN LEPROSY PATIENTS
Winnie Ooi
Lahey Clinic. Burlington. MA USA
Data from the World Health Organisation indicates that the global prevalence rate for leprosy at the end of 2000 has been reduced to less than 1 per 10.000: an eighty nine percent drop over the past 15 years. This has been achieved through early detection and free effective multidrug therapy (MDT). Leprosy remains a public health problem however, in six endemic countries that represent approximately eighty three percent of prevalence worldwide. Nerve lesions, which are often progressive and irreversible may develop in one third of patients despite effective multidrug therapy. Therefore, clinicians treating leprosy patients will continue to have to deal with the complications from nerve damage including deformities and anaesthetic ulcers for many years to come.
Recombinant human platelet derived growth factor (PDGF) gel has been shown to increase the healing of diabetic neuropathic ulcers through fibroblast activation and stimulation of granulation tissue formation. A small number of patients in our clinic with lower extremity neuropathic ulcers secondary to leprosy were treated successfully with PDGF after failing to respond to conventional therapy including topical or oral antibiotics. All four patients had successfully completed MDT for lepromatous leprosy but had significant residual peripheral neuropathy and deformities. Three patients developed full thickness plantar ulcers from chronic pressure and one had a traumatic ulcer in an anaesthetic area on the lower leg. All four ulcers were rendered free of necrotic and infected tissue after debridement and were treated with once daily topical application of 0.01% PDGF gel and good wound care until complete wound closure for three patients. The fourth patient had a marked decrease in ulcer size but was temporarily lost to follow up for nine months. The duration of treatment ranged from 8 weeks to 7 months in which no side effects were observed. None of the ulcers has recurred after a follow-up of 8 to 30 months. Our results support the use of PDGF in nonhealing neuropathic ulcers in leprosy patients and it warrants further study.
PCA 137
REVERSAL REACTIONS IN AN OUTCOME LEPROSY CLINIC IN SALVADOR/BAHIA
Vitória Rêgo; Isabela Martins; Paulo Machado
Serviço de Imunologia e Serviço de Dermatologia. Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia.
293 patients with leprosy were followed between 4 to 9 years after start of multidrugtherapy (MDT), to characterize reversal reactions (RR). RR were documented in 79 patients (27%), and begun during treatment in 47 patients (59.5%). Twenty patients (25%) had clinical presentation of RR alter MDT and during the follow-up period. Neuritis with or without skin involvement occurred in 73% of patients, and cutaneous manifestations without neuritis were found in 27%. The majority of the patients (49/79) were paucibacillary, while the average bacillary index was 2.4 in the 27 multibacillary patients. Our data shows that the beginning of MDT is an important risk factor for the development of RR, which presents with neuritis in the majority of the patients. Due to the morbidity associated with neuritis, all leprosy patients should be carefully monitored during MDT in order to provide an early detection of reversal reactions.
PCA 138
REVIEW OF 100 PATIENTS WITH CHRONIC AND RECURRENT NEURITIS TREATED IN A SPECIAL NEURITIS CLINIC
Elizabeth Bizuneh; Ruth Leekassa; Ronald Kazen
All Africa Leprosy Rehabilitation Training Center (ALERT), P.O. Box 165. Addis Ababa, Ethiopia. Fax: 251 1711 199.
Leprosy is a chronic disease that affects skin and nerves. Nerve damage is the main cause of disability and stigma. Therefore, prevention and management of nerve damage is pivotal in leprosy control. ALERT as a referral center deals with a large number of leprosy patients with complications. Most of them present with recurrent and chronic neuritis. A group of these patients were managed with individualized dose regimen of steroid in a special neuritis clinic. One hundred patients with an average of two years follow up were reviewed. Of these, 59 were'males and the age of these cases ranged from 15 to 70. Thirty-seven were PB and 63 MB according to WHO classification. Ninety-eight of the cases were released from MDT and 2 were on MDT at the time of review. The outcome of treatment was measured by VMT/STG; 75 improved, 20 remained the same and live deteriorated. Of the 75 who improved. 20 had only motor improvement, 30 improved in only sensory function and 25 had both motor and sensory nerve function improvement. The results indicate thai leprosy patients with recurrent and chronic neuritis cold be better managed with individualized dose steroids and long tern follow up.
PCA 139
SECUELAS DE LA LEPRA EN EL ÁREA OTORRINOLARINGOLOGICA
Menchades Guardiola, MI; Lafarga Vázquez, J; Gómez Echevarría, JR
Sanatorio San Francisco de Borja. Dirección: Sanatório San Francisco de Borja. 03791 FONTILLES -VALL DE LAGUART (ALICANTE) ESPAÑA Telefono: 96 558 33 50 Fax: 96 558 33 76. E-mail: sanatoria@fontilles.org
La Lepra afecta al territorio otorrinolaringológico con frecuencia. La lesión nasal aparece hasta en el 90% de los casos en las formas multibaciles. También se afecta la apófisis alveolar anterior del maxilar, la laringe, etc. Se revisan los enfermos del Sanatorio San Francisco de Borja, 80 internos y 150 externos, realizándose una exploración otorrinolaringológica completa. Se trata de enfermos inactivos actualmente en su mayoría, y en los cuales sólo hallamos las secuelas de la enfermedad. Se presenta iconografía de las secuelas más representativas y los resultados de la revisión.
PCA 140
SERUM ZINC LEVEL AND LEPROMIN (MITSUDA) TEST IN NONREACTIONAL MULTIBACILLARY LEPROSY PATIENTS
lndah Handayani; Sri Linuwih; A. Djuanda; Retno W Soebaryo; I.M. Wisnu and Emmy Sjamsoe
Dep. of Dermato-venereology Faculty of Medicine University of Indonesia Jakarta
Serum zinc level in leprosy patients is lower than in healthy people. The decreasing level is in accordance with clinical spectrum and cellular immune response in leprosy. It is still not clear whether people with Zn deficiency are more susceptible to leprosy or M. leprae metabolism will cause low serum Zn level, and whether leprosy treatment can increase serum Zn level and cellular immune response. A cross-sectional study was done on 1999. The subjects were non-reactional MB leprosy patients which are divided into 3 groups, each group consists of 20 patients i.e. untreated patients, 6-12 months therapy and more than 18 months. Determination of serum Zn level and a lepromin test were conducted in all subjects. Sixty live percent of the subject were between 14-30 years old, male were more common (78.33%) than female. There were no statistically significant differences in distribution of starling treatment age, sex, leprosy type, body mass index, and duration of illness among the three groups. The serum Zn level of the 3 groups were not signilcantly different (p = 0.998), neither were the lepromin test result between the subjects with and without treatment (p > 0.05). Serum Zn level and lepromin test result were not influences by the duration of leprosy treatment. The serum Zn level was in accordance and significantly correlated with the lepromin test result (p = 0.045).
PCA 141
SILENT NEURITIS IN MULTIBACILLARY LEPROSY: STUDY OF PATIENTS DURING AND AlTER MULTIDRUG THERAPY
Pimentel, Maria Inês Fernandes; Nery, José Augusto da Costa; Borges, Esther; Gonçalves, Rosângela Rolo; Sarno, Euzenir Nunes
Laboratório de Hanseníase, Fundação Oswaldo Cruz. Avenida Brasil no. 4365 - Manguinhos, Rio de Janeiro - RJ - CEP: 21045 - 900
In an effort to evaluate the frequency of silent neuritis, 103 multibacillary leprosy patients (18.4% BB, 47.6% BL, and 34% LL) were followed-up during an average period of 64.6 months from diagnosis, during and alter multidrug therapy (24 doses), in relation to physical disabilities, according to the disability grade. Studying twelve patients'who presented a worsening of the disability grade at the end of the treatment, or at the end of the follow-up, in comparison with the disability grade before treatment, we found two patients who experienced a worsening of physical disabilities without overt neuritis. We further analysed in detail four patients who developed final disability grade of 2, who had no disabilities or had disability grade of 1 at the beginning of the treatment, and we observed two other patients with silent neuritis. Three patients who presented a worse disability grade at the end of follow-up, in comparison with the end of treatment, were studied, and one of them had also silent neuritis. We found that five patients (4.9% ) developed silent neuritis, during or alter multidrug therapy. We recommend a careful neurological examination during the whole follow-up of multibacillary patients, aiming the detection and prompt treatmenl of silent neuritis
PCA 142
SOME LABORATORY INDICES IN LEPROSY NEUROPATHIES
M.N. Dyachina; Y.G. Androsjuck; O.V. Degtyarev; E.I. Shats
Leprosy Research Institute, Astrakhan, Russian Federation
Exacerbations of leprosy neuroparthies often occur without clinical manifestations, but they result in decreased functional ability of the damaged extremities and accelerated invalidization. Over 3 years 97 patients with leprosy duration of 5-20 years and clinically proved neuropathies were under study (74 patients with MB and 23 patients with PB-leprosy). According to the degree of nerve damage patients under study were divided into two groups: 1) patients with deep invalidizing disturbances (contractures, mutilations, neurotrophic ulcers), and 2) patients with minimal clinical manifestations limited by hypertrophy of nerve trunks and pain syndrome. For prognostic assessment of course of leprosy neuropathies certain clinical and laboratory indices were studied. With using ELISA in blood sera antibodies towards PGL-1 and protein antigens of M. leprae as well as against sonicate of rabbit sciatic nerves (AgPN) were determined. Besides, concentrations of lactoferrin (LF) and C-reactive protein (CRP) were estimated. Conduction velocity in skin areas supplied with leprosy-damaged nerves was estimated according to Nakatani. Active clinical manifestations of neuropathies are the most often correlated with increased levels of antibodies against M. leprae antigens and AgPN as well as with high concentrations of LF in blood serum. These indices are correlated with the results of testing biologically active skin /ones. CRP levels are widely varied in patients and did not always correspond lo other indices. Thus, a set of laboratory and clinical tests: levels of antibodies against M. leprae antigens, AgPN, blood LF as well as conduction velocity in /ones innervated by damaged nerves might be used for prognosis of the course of leprosy neuropathies.
PCA 143
SQUAMOUS CELL CARCINOMA AND CHRONIC LOWER LEG ULCER IN LEPROSY
YU Aim
Zhejiang Provincial Institute of Dermatology, 313200. Deqing. Zhejiang. China
Objective: To further determine the epidemiological status, clinical features and prognosis of neuoplastic transformation in chronic lower leg ulcers of leprosy.
Methods: Cases with neuoplastic transformation in chronic lower leg ulcers of leprosy, which were diagnosed and admitted to a provincial leprosy hospital for operation, in the recent 20 years were retrospectively reviewed anil analyzed.
Results: Between Jun 1980 and Sep 2001, 21 cases were diagnosed and treated. There were 15 males and 6 females with average age of 59.1 years (48-71 years) and mean ulcer duration of 16.2 years (8-30 years; tumors located 16 in sole, 4 in leg and 1 in ankle. Squamous cell carcinoma was the only neoplasia in this group with well to moderate tumor differentiation (grade 1-2), however metastasis is common (10 cases) and fatal. Above-knee amputation had been performed on all cases (10 cases) before Sep 1993, and in the remaining cases below-knee amputation were performed on. By Sep 2001. there were 10 alive, 9 died of cancer metastasis and .3 lost follow-up. fhe average postoperative survial was 37.1 months.
[Key Words] Squamous Cell Carcinoma; Ulcer; Lower Leg; Leprosy
PCA 144
STUDY OF REACTION IN THE HANSEN'S -AGED BETWEEN 0 TO 14 YEARS
Barcelos, D.L.; França JR.; Spinelli, L.P.; Silva, R.T.; Cavalcante, CM.; Melo S.; Nery, J.A.C.; Azulay. R.D.
Department of Leprosy, Institute of Dermatology, Santa Casa de Misericórdia, Rio de Janeiro, Brazil.
Introduction: Hansen's is an infectious disease; it is well known that it can present as acute and sub-acute types according to reaction state. Various authors has investigated and inferred about this. How ever very few studied in the age group between the 0 to 14 years. In this study we observed the incidence of reaction in children and followed up them from June 1992 to June 1998.
Materiasl and Methods: Out of total 938 patients with Hansen's, 55 patients were in this particular age group of 0 to 14 years. According to the classification of Madrid these were divided into infantile nodular and tuberculoid types. All the patients were treated for the first time in their life for the Hansen's and all of them had the laboratory examinations before the treatment.
Results: Out of 55 patients studied 9 (16%) had episodic reactions. 5 (56%) had Type-I reaction, 2 (22%) had Type-11 reaction and 2 (22%) had localized neuritis. As per these statistics males and females are equally affected and reactions were frequently noted in the more than 5 years age group. Out of 9 patients who had reactions, 6 (67%) were multibacillary. Significant reactions noted in the patients with disseminated cutaneous lesions. At the first consultation none of them presented with any reaction where as during the treatment period. 3 patients showed up with episodic reactions.
Conclusion: All though the risk of having these episodic reactions in children are very low but this should be always considered as a factor of morbidity during the treatment.
PCA 145
STUDY OF REACTIONAL STATES IN CHILDREN UNDER 15 YEARS OF AGE
Maria de Fátima Marója; Angelila Akemi Nakamuta; Valderiza Pedrosa; Lúcio Tshuyoki Ihára
Fundação Alfredo da Malta - Rua Codajás, 25 -Manaus - Amazonas
Detection of Hansen's disease in children under 15 years of age in the State of Amazonas, has presented a gradual reduction comparing the co-efficiencies of 3.52/10.000 inhabitants in 1988 and 1.29/10.000 inhabitants in 2000. However, it still remains hyperendemic. Reactional states occur frequently in Hansen's disease, especially in it's multi-bacillar forms. Hansen's disease in childhood shows the same aspects of the disease as in the adult. However, few studies on reactional states in Hansen's disease-have been related in known literature in age groups below 15 years. Reactional States represent a great problem in the management of patients receiving treatment and after discharge. They are also the largest cause of nerve damage, and consequently incapacity. The general objective of this work is to study reactional states in children under 15 years of age diagnosed with Hansen's disease, determining the frequency of Type 1 and Type 2 reaction, relationship with clinical forms and evolution of treatment. A descriptive study of Hansen's disease in children under 15 years of age. diagnosed and treated at the Fundação Alfredo da Malta between January 1998 and January 2001 was carried out using Patient's notes of 216 patients, of these 57,4% were male and 42.6% female. The most frequent age group was between 11 and 15 years old, representing 60.6% of the patients. In relation to clinical form. 59.7% were indeterminate and tuberculoide forms, 17.5% Borderline Tuberculoide, 7.4% Borderline Borderline, 8.3% Borderline Virchoviana and 6.9% Virchoviana. Of the 216 cases studied, 55 presented reactional episodes, representing a frequency of 25.4%. Hansen's reaction was the most frequent in dimorphic forms. Pure Neuritis had a frequency of 58.6% and was associated with other types of reaction in 31.0%. These episodes appeared most frequently during treatment. The drug most frequently used was prednisilone with a moan period of use being 4 months. In odier patients who used prednisilone only I presented a decrease in growth.
PCA 146
SURTO REACIONAL TIPO MACULOSO EM HANSENÍASE DIMORFA
Ana Paula de Almeida Costa; Jane Ventury Leal; Maria Alice Ribeiro Ozório; Roberta Leste Motta; Rosimeire Arcanjo Hosken; Rozana Castorina da Silva; Sandra Lyon
Fundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes, Centro Colaborador de Referência em Dermatologia Sanitária. Av. Dr. Cristiano Rezende 2213, Bonsucesso, Belo Horizonte. MG.
A hanseníase e uma doença granulomatosa inflamatória crônica causada pelo Micobacterium leprae, também denominado bacilo de Hansen, e acomete pele e nervos periféricos. Evolui lenta e insidiosamente, sendo, muitas vezes, interrompida por episódios inflamatórios agudos e subagudos, cutâneos ou extracutâneos, chamados surtos reacionais, que guardam relação com o terreno imunológico do indivíduo. São fenômenos reacionais do tipo I e II. As reações tipo 1 são mediadas por células (imunidade celular) e ocorre nos tuberculóides e dimorfos. As reações tipo II são mediadas por anticorpos (imunidade humoral). Nos pacientes dimorfos ocorre edema e eritema de lesões preexistentes e o aparecimento de lesões novas, pápulas e placas eritematosas em pequeno número, na maioria das vezes em sua vizinhança. Pode haver comprometimento neural acentuado com possibilidade de graves neurites. Quando a reação regride, as novas lesões podem persistir e a doença retoma seu curso. Os autores apresentam o caso de uma paciente de 43 anos, sexo feminino, com o diagnóstico clínico e histopatológico de hanseníase da forma diforma (Índice Baciloscópico = zero) tratada com esquema de poliquimioterapia multibacilar por 12 meses. A partir desse período, começou a apresentar lesões maculosas hipocrômicas localizadas na face. tronco, nádegas e coxa direita c também neurite dos nervos periféricos. A paciente foi medicada com Prednisona I mg/kg/dia até a regressão total das lesões, quando se iniciou a retirada gradativa do corticóide.
Motivo da apresentação: as reações hansênicas fogem muitas vezes do padrão habitual.
PCA 147
SURVEILLANCE ON UVEA DISEASE IN LEPROSY
Yan Lianghin; Zhang Guocheng; Ye Ganyun; et al.
Institute of Dermatology. Chinese Academy of Medical Sciences and Peking Union Medical College. National Center for STD and Leprosy Control. Nanjing 210042
To determine the prevalence and characteristic of the uvea disease in leprosy, 1045 persons cured of leprosy and active cases of leprosy in Taixing, Jiangsu were checked by specially trained ophthalmologists. Uvea disease caused by direct invasion of M. leprae, Type-2 reaction, and secondary corneal disorders were found in 7.85% of the all investigated cases. The prevalence rate of the disease was found significantly higher in active cases (25% ), multi-bacillary cases (24.47% ) and those with long duration of the disease (38.93% ). It was characterized by granulomatous iridocyclitis, with presenting of redness of the cilary body (18.29%), irregular pupil (56.1%). diminished light reaction (50%), irisposterior synechiae (43.9%), small pupil (36.59), blocked pupil (23.17%), synechia iridis anterior (20.73%), de-pigmentation (20.73%), and iridoleptynsis (19.51% ). Secondary cataract was found in 81.54% of those with chronic iridocyclitis, of which 60% with reduced vision, 40.24% blindness, and 52.73% curable blindness. The uvea disease in leprosy could be caused either by direct invasion of the M. leprae or type-2 reaction. It was commonly found in active cases, multi-bacillary cases and those with long duration of the disease. Granulomatous iridocyclitis is its clinical characteristic, and most of them develop cataract and loss of vision
PCA 148
THE ASSOCIATION OF SKIN PATCHES OVER SUPERFICIALLY LOCATED NERVE TRUNKS AND NEURITIS IN LEPROSY
Rajgopal Reddy; Suman Jain; Syed Muzalfarullah; Sujai Suneetha
LEPRA India - Blue Peter Research Centre. Cherlapally, Hyderabad - 501301
We have previously shown the strong association between facial patches located over the eye and the development of lagophthalmos. The aim of this study was to identify any such association between the presences of skin patches over superficially located trunk nerves at known sites of prediliction and the development of neuritis/nerve damage.
All the records of leprosy patients registered at the centre over a 2 year period (Jan. 2000 to Dec.2001) were analysed with regard to the location and size of skin patches over the trunk nerves and the presence of nerve damage. The areas considered were the skin over the olecranon fossa at the elbow (for ulnar nerve), the front of wrist (for Median nerve), the head of fibula (for lateral popleteal nerve) and around the eyes (for facial nerve). The patches were arbitrarily divided into small patches (≥5 cm) and large patches (> 5cm). Neuritis was defined in terms of motor nerve damage as evidenced by a weak VMT score (≥4/5). 92 patient charts were analysed (TT4, BT 43, BB 2. BL 34 and LL 9). Overall it was observed that neuritis was present in 135 nerves. Out of this 126(93.3%) had associated patches over the trunk nerve, 65 (51.6%) of them were large patches and 61(48.4%) were small patches. 19 of the patients also had type I reaction. In these 19 patients 37 nerves were involved as result of the RR in the overlying skin patches. This association between the presence of skin lesions and the development of neuritis was highest in the ulnar nerve followed by the lateral popleteal nerve, facial nerve and median nerve.
PCA 149
THE EFFECT OE THE ACTIVITY OF MICROSOMAL ENZYMES AND ACETILATION ON METHEMOGLOBIN RATE IN LEPROSY PATIENTS
V.Z. Naumov; VP. Tsemba; E.A. Zadneprovskaya;
Leprosy Research Institute, Astrakhan, Russian Federation
As it is known, dapsone at certain doses may induce hemolysis, especially in persons with glucose-6-phosphate dehydrogenase (G6PDH) deficiency, occurring in about 10% of leprosy patients. However, DDS-induced hemolysis might be due to other factors among which peculiarities and intensity of drug metabolism, including rate of sulphone acctylating and hydroxylation, play an important role. Patients with lepromatous leprosy were given various schemes of MDT with dapsone 100 mg daily as a main component. Activity of microsomal enzymes by the time of antipyrine half-secretion (T1/2) and acetylation rate of sulfadimizine was studied. All the patients studied had no G6PDH-deficiency. It was observed that in patients showing rather high activity of microsomal enzymes (Tl/2 =12.5 h in average) blood methemoglobin rate was significantly higher (P<0,05) than in those with low activity of these enzymes (T1/2=23,5 h in average). Though methemoglobin rate in the most patients did not exceed 1.5%, it approached 2.5-3.9% in persons with a combination of low acetylating rate and high activity of microsomal enzymes. It might be a consequence of increase in derivatives of N-hydroxylation of dapsone with methemoglobin-forming properties in persons with predominance of oxydative phenotype of xenobiotic biological transformation.
PCA 150
THE FOLLOWING OBSERVATION FOR EFFECT OF 251 LEPER CASES IN THE MONITOR PRIOD AFTER MDT
LI Long
Shangrao station for dermatosis and venereal disease control, 334000, Jiangxi, China
Objection: analysis 251 leper cases which is cured jointly and finish monitoring the observation of curative effect from clinicopathology, bacteriology, histopathology. Ways: We analysis comprehenly from clinicopahology, bacteriology, histopathology according to 251 leper cases which is cured jointly and the changes of curative effect in the monitor period. Conclusion: The rate of basically curing in clinical reaches 81.27%. The marked progress and the common progress are 18.73% after the course. The MB rates of basically curing in clinical, which are monitored 5 years, have reached 88.85%. The PB has been cured after their monitor period of five years.
The evaluation of bacteriology: The average BI about 2.80¡ À 1.5 of 118 cases of MB has come down to 65 cases after the course. It covered 55.08% of all and decreased 0.98 average annual. The BI of 48 cases of PB. which infected covered 39.33%. has come down to 32 cases, covered 66.67% of all. and the decrease rate of bacteria was 60% after course. The BI of MB has come down to 87 cases, covered 73.73% of all and decreased 0.09 average annual after finishing monitoring in 3 years later. The BI of 45 cases of PB has come down to zero, covered 93.75% of all after monitoring in 3 years later. They all revered after finished monitoring 5 years later. The 103 cases of MB has come down to zero, covered 87.29% of all, decreased 0.11 average annual after finishing monitoring 6 years later. The bacteria revered after finishing monitoring 10 years later.
The curative effect evaluation of histopathology: we cured 103 cases and it covers 41.04% of all, 73 case of curing nearly covered 29.08% of all, 75 cases have gone down partly and greater partly and it covered 29.88%. The rate of curing and nearly curing reached 86.26% after monitoring 3 years later. 32 cases have gone down in early period, middle period and later period and it covered 13.74%. The rate of curing and nearly curing has reached 94.35% after monitoring 6 years later, 13 cases have gone down incompletely and it covered 5.65% of all. They all revered after monitoring in 10 years.
The indication of the article is that jointly curing is the best clinical curative effect to PB and MB. and the plan of jointly curing is the best valuable and feasible way to control leprosy according to changes of the bacteriology and histopathology.
[Key words] Leprosy. MDT Bl. Histopathology, Curative effect
PCA 151
THE REPORT FOR THE SKIN SMEARS QUALITY CONTROL ON LEPRESY IN SICHUAL PROVINCE IN THE PAST 15 YEARS
WANG Rongmao; LIU Xueming; ZHENG Yiqiang; YU Linchong
Sichuan Institute of Dermatology, Chengdu, 610031, China
The skin smears quality control on leprosy was implemented in the leprosy epidemic counties in Sichuan Province, in order to improve the quality of skin smears and implementation of MDT. 10% of skin smears, came from the leprosy epidemic counties, were selected randomly with double-blind method and evaluated in smears, stain and diagnosis in Sichuan Leprosy Laboratory on the basic of the criterion of the skin smears quality on leprosy in the Handbook of MDT on Leprosy. Meanwhile, the skin smears came from Sichuan Leprosy Laboratory were also checked and contrasted by the paramedical workers. In the past 15 years, the skin smears quality control was implemented and the quality of skin smears was improved between 17 and 97 leprosy epidemic counties in Sichuan. 4529 pieced of skin smears were checked. The average qualified rate of smears, stain and diagnosis was 96.88%, which was 86.97% in 1986. The implementation of skin smears quality control could improve professional level of paramedical workers and the quality of leprosy control
PCA 152
THE REPORT OF HISTOID LEPROMA 1 CASE
ZHANG Jianlin; HUANG Ganjun; LIAO Yanzhen; et al.
Hezhou Skin Hospital, 542800 Hezhou, Guangxi, China
A sick man is fifty years old. He has been sick for four years. The clinical appearance is just like a drunk with universal infiltrated lupus, various sized and shaped nodules. There is a "fointed met" which like a hemisphere in each of the elbow joint. He has "ape-hands," elcosis at the bottom of his feet. Shallow nerve is bulky all over the body. Mycobacterium leprae is found from the eruption (2+- 5+). Pathological diagnosis conform to HL.
Key words LLp HL
PCA 153
THE USE OF PILOCARPINE TEST FOR DIFFERENTIAL DIAGNOSIS BETWEEN TUBERCULOID LEPROSY AND GRANULOMATOUS DISEASES
Authors: Miranda, J.A.P.P.; Chumpitaz, S.A.; Lyra, MR.; Lima, R.B.; Valle, H.A.; Coutinho, Z.; Nery. J.A.C.; Lowy, G.
Dermatology Department of Gaffrée e Guinle University Hospital; Leprosy Laboratory/IOC-FIOCRUZ. Rio de Janeiro, Brazil.
Background: Tuberculoid leprosy is often easily diagnosed on clinical aspects, but in some situations the signs and symptoms are not clear enough bringing difficulties and consequently delayed diagnosis, which may facilitate the installation of chronic disabilities. For this reason, the use of complementary procedures becomes fundamental for early diagnosis.
Subject and methods: we have studied six patients presenting a long term unique lesion suggesting granulomatous diseases in which several tests were made to elucidate the diagnosis. All of the patients had had previous topical treatments without improvement.
Results: the patients were between the ages twenty-eight and sixty-nine years, five of them were female, three were white and three were dark skin colored. All of them presented with infiltrated erythematous annular lesions with a variable course from two months top three years. The histopathological examination's findings were unspecific granulomatous inflammation. Four patients with facial lesions had incomplete pilocarpine test on suspected area. All of the six patients who receive paucibacillary therapy achieve great improvement.
Conclusions: pilocarpine test seems to be a very helpful complementary diagnostic method when differential diagnosis between Tuberculoid leprosy and other granulomatous diseases is not possible through clinical and histopathological examinations.
PCA 154
TRABALHO EM UMA COMUNIDADE DE EX-HANSENIANOS COM INTEGRIDADE DA PELE PREJUDICADA E COM ISOLAMENTO SOCIAL
Noemi Garcia de Almeida Galan
Instituto Lauro de Souza Lima (ILSL) - Bauru - SP.-Brasil.
Trabalho do enfermeiro desenvolvido há 4 anos em uma comunidade que possui um grupo de pessoas com sequelas da Hanseníase caracterizadas por úlceras crônicas.
Objetivos: Identificar os fatores interferentes na recuperação da integridade da pele prejudicada relacionada a sequelas da hanseníase caracterizados por úlceras em MMII. Campo de trabalho e instrumentos utilizados: desde 1997; em Bauru/SP- Centro Comunitário do Parque Santa Terezinha, 27 adultos com sequelas de Hanseníase (úlceras de MMII): compromisso social do Instituto Lauro de Souza Lima (fornecedor de material); teoria do autocuidado de Orem; Histórico, diagnóstico, intervenção e evolução de enfermagem.
Resultados: o trabalho permitiu a investigação de vários fatores interferentes na cicatrização das úlceras crônicas. Esses foram agrupados nos seguintes diagnósticos dc enfermagem propostos por NANDA (North American Nursing Diagnosis Association): 1-Integridade da pele prejudicada. 2-Risco para Integridade da pele prejudicada. 3-Isolamenlo social. 4-Perfusão tissular alterada periférica.5-Risco para infecção. 6-Nutrição alterada menos do que as necessidades corporais. 7-Risco para trauma. 8-lntegridade tissular prejudicada. 9-Mobilidade física prejudicada. 10-Andar prejudicado. 11-Intolerância a atividade. 12-Dor crônica. 13-Medo. 14-Disfunção sexual. 15-Processos familiares alterados. I6-Enfrentamento comunitário ineficaz. 17-Controle ineficaz do regime terapêutico. 18-Déficit de atividades de recreação. 19-Distúrbio da imagem corporal.
Conclusão: a cicatrização das úlceras crônicas constitui um grande desafio aos profissionais dc saúde em decorrência da imensidade tios fatores interferentes.
PCA 155
TREATMENT OF MILD SENSORY IMPAIRMENT IN LEPROSY: A RANDOMISED CONTROLLED TRIAL (TRIPOD 2)
W.H. van Brakel; A.M. Anderson; S.G. Withington; R.P. Croft; P.G. Nicholls; J.H. Richardus; W.C.S. Smith
TLM Research Resource Centre, 5 Amrita Shergill Marg, New Delhi - 11003
Aim: To investigate whether leprosy patients diagnosed with mild sensory impairment have a better prognosis when treated with steroids than similarly impaired patients treated with placebo.
Methods: A multicentre, randomised, double-blind, placebo-controlled trial was conducted in Nepal and Bangladesh. Patients were eligible if they had a confirmed leprosy diagnosis, were between 15 and 50 years old, had mild sensory impairment of the ulnar or posterior tibial nerve of less than 6 months duration and did not require steroids for other reasons. 'Mild impairment' was defined as "impaired on the Semmes-Weinstein monofilament (SWM) test, but testing normal on the ballpen sensory test". Subjects were randomised to either prednisolone treatment starting at 40 mg per day, tapering over 4 months, or placebo. Nerve function was monitored monthly. Any patient who deteriorated was taken out of the trial and was put on full-dose steroid treatment. Outcome assessment was done at 4, 6, 9 and 12 months from the start of the treatment. Outcome measures were the proportion of patients needing full-dose prednisolone and the SWM sum scores. Each patient contributed only one nerve to the analysis.
Results: 75 patients had nerves eligible for analysis, of whom 41 (55%) and 34 (45%) were allocated to the prednisolone and placebo arms, respectively. At 4 months, 3 patients in the prednisolone arm (7%) and 6 in the placebo arm (18%) had an outcome event requiring full dose steroids. At 12 months, these proportions had almost reversed, 11 (27%) and 6 (18%) in the treatment and placebo arms, respectively. In the latter group, 15 (44%) recovered completely without treatment.
Conclusions: Treatment of mild sensory impairment of the ulnar and posterior tibial nerves with prednisolone does not improve the long-term outcome in terms of recovery, nor does it reduce the risk of leprosy reactions or nerve function impairment beyond the initial 4-month treatment phase.
PCA 156
TREATMENT WITH CORTICOSTEROIDS OF LONG-STANDING NERVE FUNCTION IMPAIRMENT IN LEPROSY: A RANDOMISED CONTROLLED TRIAL (TRIPOD 3)
J.H. Richardus; S.G. Withington; A.M. Anderson; R.P. Croft; P.G. Nicholls; W.H. van Brakel; W.C.S. Smith
Department of Public Health, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
Aim: Some leprosy patients with long-standing nerve function impairment (NFI) appear to have responded favourably to treatment with corticosteroids. This study investigated whether patients with untreated NFI between 6 and 24 months duration and who are given standard regimen corticosteroid therapy, will have a better treatment outcome than a placebo group.
Methods: A multicentre, randomised, double-blind placebo-controlled trial was conducted in leprosy control programmes in Nepal and Bangladesh. Treatment with prednisolone started with a dose of 40 mg/day, tapered by 5 mg every 2 weeks, and completed after 16 weeks. Outcome assessments were at completion of treatment at 4 months, and at 6, 9, and 12 months after the start of treatment.
Results: A total of 92 MB patients on MDT were recruited, of which 40 (45%) received prednisolone and 52 (55%) placebo treatment. No demonstrable additional improvement in nerve function, or in preventing further leprosy reaction events was seen in the prednisolone group. Overall, improvement of nerve function at 12 months was seen in about 50% of patients in both groups. Analysis of sub-groups according to nerve (ulnar and posterior tibial), duration of NFI, and sensory and motor function, also did not reveal any differences between the treatment and placebo groups.
Conclusion: The trial confirms current practice not to treat long-standing NFI with prednisolone. Spontaneous recovery of nerve function appeal's to be a common phenomenon in leprosy. Leprosy reactions and new NFI occurred in a third of the study group, emphasising the need lor regular nerve assessment.
PCA 157
ULCERATED LESIONS IN LEPROSY
Solange M. Maeda; Marcos C. Floriano; Alessandra Yoradjian; Jane Tomimori-Yamashita
Department of Dermatology - UNIFESP- Escola Paulista de Medicina
Erythema Nodosum Leprosum (ENL) or type II reaction is believed to be an immune complex reaction seen in multibacillary leprosy in which the dead bacilli and their products react with antibody in the tissue or blood. Although ENL occasionally develops in untreated patients, it occurs more commonly alter initiation of therapy. This presents most commonly as small papules or larger nodules which are painful and tender to touch. In some cases they may ulcerate, and the histological analysis may show vasculitis pattern affecting superficial and mid-derma vessels, leading to epidermal necrosis, bulla formation and ulceration. Therefore it has been proposed that ENL is a manifestation of immunecomplex-mediated vascular injury. A clinical and histopathological overview of ulcerated lesions in lepromatous leprosy patients will be presented. These patients had necrotizing lesions on the limbs similar as described in "Lucio's phenomenon" and also acute eonstitucional symptoms. The Lucio's phenomenon is observed in diffuse nonnodular lepromatous leprosy most commonly in Mexico and Central America. Histopathologic studies of Lucio's phenomenon have shown leucocytoclastic vasculitis, endothelial cell proliferation, thrombosis, ischemic necrosis. Is Lucio's phenomenon and Type II reaction a unique variant of cutaneous vasculitis separated only by distinctive clinical settings?
EPIDEMIOLOGY
PE 1
A ENDEMIA HANSÊNICA NO NOROESTE DO ESTADO DE SÃO PAULO
Ferreira. E.A.R.; Mencaroni, D.A.; Oliveira, M.H.P.; Pinto Neto, J.M.; Villa, T.C.S.
Escola de Enfermagem de Ribeirão Preto/ Universidade de São Paulo
Av. Bandeirante, 3900, Campus Universitário - Ribeirão Preto - CEP 14040-902 São Paulo, Brasil.
O Brasil após onze anos da implantação da MDT ocupa a segunda posição mundial em relação a prevalência com 4,6 casos /10 mil habitantes. A distribuição da endemia é irregular. O estado de São Paulo, considerado um dos mais desenvolvidos do país, apresenta uma prevalência de 1,6 casos/10 mil habitantes. Há regiões dentro desse estado com prevalências maiores, como por exemplo a região noroeste. Essa região serviu de cenário para esse estudo descritivo, tendo como objetivo analisar a endemia de acordo com alguns indicadores. Foram analisados dados epidemiológicos do período de 1994 a 2001 de 99 municípios "totalizando 1.311.763 habitantes (76,9% dos municípios com até 10 mil habitantes) que compõem uma das 24 regiões administrativas da Secretaria de Estado da Saúde de São Paulo, denominada Direção Regional de Saúde XXII. Em 2001, o coeficiente de detecção variou de zero (47.5% dos municípios) a municípios com 10 casos/ 10 mil habitantes. O coeficiente de prevalência variou, no período, de 6,58 a 2,40 casos/10 mil habitantes, encontrando municípios acima de 10 casos/ 10 mil habitantes. As formas clínicas polarizadas representam atualmente mais de 80% dos casos. Do total dos casos, 95% estão em MDT. Há necessidade de intensificação das ações de controle na região, especialmente o diagnóstico precoce.
PE2
A MULTICENTRIC TRIAL FOR TREATMENT OF 2-5 LESIONS PB LEPROSY WITH SINGLE DOSE OF ROM
M.D. Gupte; B. Nagaraju; S.Balasubramaniam; V.N. Mahalingam; S. Anitha; K. Sarojamma; S.V. Subbaroyulu; N.K. Nanda; Margery Emmanuel; Jayarama; Subbaiah
National Institute of Epidemiology (ICMR). Chenna, 31. Tamil Nadu, India. Chennai & CLT&RI in Tamil Nadu.
Our experience in conducting a multicentric trial for treatment of 2-5 lesions PB leprosy with single dose of ROM and under programme conditions is discussed. This study is a double blind randomized controlled clinical trial.
The objective of the study is to evaluate, the efficacy of a combination of Rifampicin, Ofloxacin and Minocycline (ROM) administered as a single dose for the treatment of skin smear negative 2-5 lesions PB leprosy compared to the standard 6 monthly doses of WHO PB MDT regimen.
Six centres for 2-5 lesions PB leprosy had been selected. 1596 skin smear negative patients with not more than one peripheral nerve trunk involvement (adults 1 167; children 429) were included.
The total duration of the study is 48 months (six months of intake phase, six months of treatment phase and 36 months of post treatment follow-up).
During intake phase Medical Officers from NIE helped the investigators in selection of patients and documentation. Frequent visits to the participating centres by Medical Officers and Statisticians from NIE are made in order to help the staff in clinical examination, data collection.
Detailed report with reference to the progress of the study will be discussed.
Collaborating Centres: National Institute of Epidemiology (ICMR) and WHO
Participating Centres: Chittoor and Cuddapah districts in Andhra Pradesh: Naini (TLM) in Uttar Pradesh; Champa (TLM) in Madhya Pradesh
PE 3
A MULTICENTRIC TRIAL FOR TREATMENT OF MONO LESION PB LEPROSY WITH SINGLE DOSE OF ROM
M.D. Gupte; B. Nagaraju; S. Balasubramaniam; V.N. Mahalingam; S. Anitha K. Sarojamma; S.V. Subbarayulu
National Institute of Epidemiology (ICMR). Chennai -31, Tamil Nadu. India.
NIE is conducting an open trial for treatment of mono lesion PB leprosy with single dose of ROM in order to find out relapse rate under programme conditions. A total duration of the study is 48 months. The intake phase commenced in April 1998 and the study is expected to be completed by January 2003.
1263 untreated smear negative single skin lesion leprosy patients (adults 820; children 443) were included and followed up once in six months after completion of treatment. During intake phase Medical Officers from NIE helped the staff in participating centres in clinical examination, selection of patients, documentation of clinical findings and related research methodology. Monitoring is done by making field visits by Medical Officers and Statisticians from NIE to assess the progress of the trial. During follow-up patients who developed new lesions are examined by Medical Officers from NIE. The detailed report on progress of the trial will be discussed.
Collaborating Centres: National Institute of Epidemiology (ICMR) and WHO
Participating Centres: Chittoor and Cuddapah districts in Andhra Pradesh
PE4
A MUNICIPALIZAÇÃO DA SAÚDE E O CONTROLE DA HANSENÍASE
Cintra, Ivete A.1; Altuy, Leni P.2; Bertolini, Maria S.3
Direção Regional De Saúde De Araçatuba. Rua Oscar Rodrigues Alves, 1296, Vila Mendonça. CEP 16015031. Araçatuba, SP - Brasil
1. Médica Sanitarista.
2. Enfermeira.
3. Educadora De Saúde Pública.
Este trabalho pretende analisar o impacto da municipalização dos serviços de saúde nas ações de controle da hanseníase.
O universo a ser abordado é constituído pelos quarenta municípios que compõem a área de abrangência da Direção Regional de Saúde de Araçatuba-DIR VI-SP.
O estudo pretende verificar o grau de variação de alguns indicadores epidemiológicos e operacionais e o comportamento da endemia no período de 1990 a 2000.
Dentre esses serão focalizados, principalmente, coeficiente de detecção, coeficiente de prevalência, taxa de abandono e alta por cura.
A observação desse quadro comparativo tem como principal finalidade a verificação da interferência da mudança do modelo assistencial no desenvolvimento das ações de controle da hanseníase.
PE 5
A RECIDIVA DA HANSENÍASE NOS DADOS OFICIAIS DO RJ: VALIDAÇÃO NO ARQUIVO LOCAL DA UNIDADE DE REFERÊNCIA DO MUNÍCIPIO DE DUQUE DE CAXIAS
Hercules. F.M.; Cunha. M.D.; Oliveira. M.L.W.
Curso de Pós-Graduação em Dermatologia /FM/ HUCFF / UFRJ e SMS-DC
O presente trabalho compara base dados de nível central e local do Município de Duque de Caxias no Sistema de Informações de Agravos de Notificação (SINAM). A variável do estudo foi a recidiva de casos de hanseníase, analisada através do modo de entrada no arquivo central e validada com as informações dos prontuários dos respectivos pacientes, no registro local. De acordo com a análise dos dados secundários de nível central municipal, no período de 1990 á 2001, foram registrados no banco de dados 3.112 casos de hanseníase residentes e tratados em DC. Dos 191 casos de recidiva registrados no banco de dados da SMS-DC no período de 1990 à 2000, um total de 180 casos (94,2%) tinham no registro local (prontuario) modo de entrada como caso novo. A grande maioria, correspondendo a 165 (91.6%), tinha ficha de notificação antiga na qual não existe uma formatação compatível com a ficha atual de notificação do SINAN. Apenas 11 casos foram diagnosticados como recidiva (5,8%) de fato, e todos foram casos recentes.
Ao que parece a mudança da ficha de notificação, parece justificar os erros na entrada dos dados. Esse trabalho permitiu a correção do dado oficial de recidiva no município, de 6.1% para 0,0035%, reforçando o baixo percentual geral de recidiva dos esquemas oficiais de tratamento de hanseníase. Faz-se ressalva ao fato de que outros casos de recidiva tratados no município estejam sendo diagnosticados em unidades de referência da cidade do Rio de Janeiro, não constando no registro municipal. Esse dado portanto pode não mostrar a magnitude do problema, especialmente tratando-se de evento raro. E importante que as três esferas de atuação governamental adotem diretrizes e práticas que permitam a utilização das informações existentes nos três segmentos e, o livre fornecimento de dados, de modo a contribuir, para a ampliação e aperfeiçoamento do relacionamento entre as estruturas que compõem o SUS.
PE 6
A SURVEY OF THE KNOWLEDGE AND ATTITUDE TOWARDS LEPROSY OF THE HEALTH WORKER IN THE EPIDEMIC AREA
Wu Xinsheng; Wang rongmao; Ning Yong; Hu Lufang; Li Binyu; Wang Kai; Shi Ling; Hei Lu
Sichuan provincial Institute of Dermatology & Venereology. China
Objective: in order to find out the knowledge and altitude towards leprosy of the health workers in the epidemic area and the factors influence on it.
Methods: Health workers are surveyed in the field by questionnaire at county, district and village level, analyzed the data by computer.
Results: 292 received valid questionnaire showed that health workers fear leprosy in different extent, and detest the leprosy patients.
Conclusion: Health workers who are not belonging to the professional leprosy control have wrong knowledge and attitude on leprosy. It is the major step to train these workers about the knowledge of leprosy, changing the pattern in order to eliminate leprosy.
[Key words] health workers leprosy knowledge attitude
PE7
A SURVEY OF THE KNOWLEDGE AND ATTITUDE TOWARDS LEPROSY OF THE RESIDENTS IN THE EPIDEMIC AREA
Wu Xinsheng; Wang rongmao; Ning Yong; Hu Lufang; Li Binyu; Wang Kai; Shi Ling; Hei Lu
Sichuan provincial Institute of Dermatology & Venereology, China
Objective: in order to find out the knowledge and attitude towards the leprosy from the residents in the epidemic area and try to find the best method of health education on leprosy.
Methods: 300 random residents are selected to fill the questionnaire out in the field. Analyzed the data by computer.
Results: 292 received valid questionnaires, showed that it is common phenomenon for the residents to fear leprosy and discriminate against leprosy patients and many factors influence on it.
Conclusion: We should carry out the health education, widely and deeply, focus on that leprosy is preventable and curable, not fearful, let the patients and cured patients return to the community. This is the basic condition as well as important procedure to eliminate leprosy as a social problem.
[Key words] residents, leprosy, knowledge, attitude
PE8
AN ANALYSIS OF THE BENEFITS OF PREVENTION AND TREATMENT OF LEPROSY IN SAN-MING CITY
Zheng Xingzhao1 Wu Xianming1 Dai Yansheng2 Chen Qiujin3
1. Sanming Dermatology Hospital (365001).
2. Sanming Epidemic Prevention Station.
3. Sanming Municipal Health Bureau
Situated in the Northwestern part of Fujian Province, Sanming City is part of the inland mountainous region; during the reformation of institutions in 1983, the Municipal Dermatology Prevention Institute was formed and a prevention and treatment network established. Beginning from 1986, it implemented MDT scheme and adopted such various means as "live checks", outpatient service and disease reporting to discover patients at an early stage; it also extensively conducted such comprehensive measures of prevention and treatment as health education; as a result, the prevention and treatment were stepped up and the goal of basically eradicating leprosy was reached in 1993. The benefits were quite obvious. We herewith make the following report so as to valuate the economic benefits of the prevention and treatment of leprosy in a scientific way and provide useful economic information: we selected the benefits of the two situations in the periods of 1973~1982 and 1983~1992 for evaluation and made calculations using such methods as cost-profit and cost-benefit. Financial investment: in the period of 1983~1992, the allocation of fiscal fund totaled 1,248,400 yuan, which was a 114.66% increase from that in the period of 1973~1982. Social benefits: the adoption of comprehensive prevention and treatment resulted in significant drop in "three rates", reduction in epidemic range and early achievement of goals. Compared with the previous period, the period of 1983~1992 saw a reduction of 169 patients in incidence. Economic benefits: The reduction in the incidence of 169 patients saved 1,334,400 yuan in the cost of providing health service and receiving health service and 1,827.100 yuan of non-incidence earning; a reduction of disabilities for 59 patients due to prevention and treatment and 1.350,900 yuan of economic loss due lo disease and disability. Since the MDT scheme was promoted, a total of 320 patients were cured during the period of 1983~1992, shortening courses of treatment and saved treatment expenses of 1,114,000 yuan and 5,766,100 yuan was earned by shortening the courses of treatment. In summary, the economic benefits created by the prevention and treatment of leprosy in the period of 1983~1992 totaled 11,392,500 yuan, excluding the invisible expenses in the economic losses resulted from diseases, i.e. the losses—social expenses resulted from such life quality issues as pain, depression, sadness and social segregation suffered by the patients and their relatives. Therefore, this paper is based on an underestimation of calculation. The ratio of total benefits and total investment reported by this paper is 7.48:1, BCR>I. This manifests that the benefits of prevention and treatment service of leprosy are tremendous and the prevention of leprosy is an undertaking with effective investment and high benefits. However, the basic eradication of leprosy is not the ultimate goal and further efforts need to be made. Therefore, the authors suggested that:
1. Increase the investment for fund of prevention and treatment.
2. Enhance follow-up monitoring of prevention and treatment and strengthen such work as rehabilitation.
3. Consolidate the construction of teams of leprosy prevention personnel, elevate professional proficiency and improve the work quality of service and prevention and treatment.
[Key words] leprosy prevention and treatment analysis of benefits
PE9
ANÁLISE DA IMPLANTAÇÃO DA ESTRATÉGIA DO CONASEMS NA ELIMINAÇÃO DA HANSENÍASE NO MUNICÍPIO DE PALMAS -TOCANTINS
Eliane Ignoiti; Joaquim Gonçalves Váleme; Vera Andrade
Universidade Estadual de Mato Grosso/Escola de Saúde Pública -MT; eignotti@uol.com.br
Escola Nacional de saúde Pública/Universidade Estadual do Rio de Janeiro; jvalene@ensp.fiocruz.br.br
OMS: vandrade@sade.gov.br
Avaliação da implantação da intervenção do CONASEMS na eliminação da hanseníase no município de Palmas (TO), por meio de enfoques epidemiológico e operacional desenvolvidos em séries de tendências temporal; acompanhamento do nível de autonomia em gestão, de mudanças estruturais que possam modificar a assistência ao doente de hanseníase. Ressalta a importância dos indicadores da redução no coeficiente de detecção em menores de 15 anos e da taxa de prevalência em conseqüência da detecção precoce principalmente nos casos com lesão única. A intervenção do CONASEMS resulta na articulação entre os gestores municipais em assumir o atendimento ao doente de hanseníase como ação básica de saúde. Tem como hipótese o fato de O "grau de autonomia" técnico-gerencial e financeira na gestão do Sistema Único de Saúde, em nível local condicionar a integralidade da implantação da Estratégia de Aceleração da Eliminação da Hanseníase em nível municipal. Intervenção é considerada uma variável dependente em relação âs características contextuais tio meio de implantação. Se o contexto é favorável â intervenção, será possível fazer a predição do tempo necessário para a eliminação tia hanseníase. Nesse caso, o grau de implantação da intervenção é a variável independente e as variáveis dependentes serão os resultados ou efeitos esperados. As informações foram colhidas na perspectiva de três metodologias diferenciadas em função do propósito a que foram elaboradas:
1. Indicadores epidemiológicos e operacionais propostos como instrumento no controle da endemia (MS. 2000);
2. Indicadores-chave para o monitoramento de eliminação da hanseníase (OPAS, 1998);
3. Indicadores do Independem Evaluatitm of Indían Leprosy. (WHO, 2000).
Palavras-chave: avaliação, eliminação, hanseníase.
PE 10
ANÁLISE EPIDEMIOLÓGICA DOS CASOS NOVOS DE HANSENÍASE RESIDENTES NO MUNICÍPIO DE BELO HORIZONTE, MINAS GERAIS, BRASIL, NO PERÍODO DE 1999 A 2001
Paulo De Tarso Silveira Fonseca; Renato César Ferreira
Secretaria Municipal Da Saúde - SMSA-BH.
Av. Afonso Pena 2336, 5° Andar, Atenção Saúde Do Adulto. CEP: 30.130-007. Belo Horizonte -Brasil. Telefone: (31) 3277-9532. Fax: (31) 32779530. E-mail: ptsf@bol.com.br
São apresentados e analisados os dados epidemiológicos dos casos novos de hanseníase, residentes em belo horizonte, no período de 1999 a 2001, utilizando-se as informações do SINAN (sistema de informação nacional de agravos notificáveis), implantado nesta secretaria no final do ano 2000.
Esta análise é feita com relação à idade, sexo, forma clinica da doença, grau de incapacidade e baciloscopia ao diagnóstico.
PE 11
ANALISIS ON NERVE IMPAIRMENT OF THE UPPERLIMB IN 8578 LEPROSY PATIENTS
Pan Liangde; He Xinguo; Kuang Yanfei; Gao Xiaoling, Di Xiaodan; Mo Jiangling
Hunan Institute of Dermatology Venereology, Changsha, Hunan Province. 225700 China
In order to make clear the situation of nerve impairment of the upper limb in leprosy cases, we selected 8578 leprosy non-active and active cases who are still living in Hunan province as the study samples. The result showed that about 40.29% of the upper limb in all cases developed nerve impairment. The lateral nerve impairment was 23.15%. It is higher than that of bilateral nerve impairment (17.14%). The verve impairment among active and relapsed cases was 54.03%. It is higher than that of non-active cases (19.51%). The MB cases developed more nerve impairment (50.15%) which is higher than that of PB cases (21.15%). We also find that 36.55% of the ulna nerve developed nerve impairment, the medium nerve. 16.68% and the radial nerve, 1.64%. The claw hand with the stiff lingers was seen in 73.03% of cases. The nerve impairment has relation with leprosy reaction counted for 41.06%. Most of active and relapsed leprosy cases have the single nerve impairment. The frequency of nerve impairment developed is as following. The first is in ulna nerve, the second, medium verve and radial nerve. Two third of nerve impairment is in reversible. The nerve impairment in upper limbs is significantly different due to delay of diagnosis of leprosy, leprosy reaction and different type of clinical leprosy
PE 12
ANALYSIS OF NEWLY FOUND LEPROSY PATIENT FORM 1990 TO 2000 YEAR IN GANSU PROVINCE
WANG Deving; MU Taojun; QIU Yaowen
Center of Prevention and Control Disease of Gansu, 730030, Lanzhou. China
Objective: To explore epidemological feature of newly found leprosy patient and relapse leproy patient in low endemic areas.
Methods: A retrospective epidemiological date of leprosy from 1990 to 2000 year in Gansu Province was made.
Results: The data analysis showed that newly found leprosy patient 138 cases and the average annual found rate was 0.058/100000, of which MB was 116 cases and PB was 22 cases, MB:PB rate was 5.6:1.The relapse leprosy patient was 52 cases and the relapse rate was 2.64% during 1990 and 2000 year, of which MB was 46 cases and PB was 6 cases. MB:PB rate was 7.7:1. 50 cases were relapsed after cure with DDS monotherapy and 3 cases were relapsed after cure with MDT.
Conclusion: The found rate in the early of 1990's was a little higher than that then and it has declined tendency. Leprosy patients should be timely detected and treated so as to eliminate infiectious resource.
[Key words] Multibacillary Paucibalillaryt!» Newly found leprosy patient£» Relapse leprosy patient
PE 13
ANALYSIS OF QUALITY CONTROL OF LEPROUS BACILLI MICROSCOPY
Liu Zuosheng
Institute of Dermatosis Prevention and Control. Hubei Provincial Academy of Medical Sciences 430079
Objective: To understand the quality status of Leprous Bacilli Microscopy.
Method: 2594 specimens smear were detected at lower level and checked by provincial laboratory during 1990-2001.
Result: The quality rate of smear membrane, quality rate of stain, quality rate of BI, medium quality rate of three indices were 94.48%. 94.63%. 93.52%, 94.20%.
Conclusion: The quality of leprous bacilli microscopy was high, and the results were creditable in our province. This was favorable to diagnose leprosy and evaluate the treatment effect.
[Key word] Leprosy microscopy quality control
PE 14
ARREST OF LEPROSY MORBIDITY AND DISEASE TRANSMISSION IN URBAN AREAS - A MOP UP OPERATION
V.V. Pai; S. Kingsley; H.O. Bulchand; V. Gaikwad; R. Ganapati
Bombay Leprosy Project. Sion-Chunabhatti, Mumbai-400 022, India
Currently available chemotberapeutic agents undoubtedly have offered bacteriological cure to leprosy patients in the shortest possible time. But the sporadic occurrence of relapses in small numbers has been a matter of concern in the context of disease transmission. Transmission due to relapses adds a new dimension to the disease burden and delays the goal of elimination. Relapses are encountered in all types of treatment regimens including the short course chemotherapy regimens with newer drugs. In addition about 10 % of PB leprosy patients develop delayed clinical problems and about 20 - 30 % present with reaction and neuritis leading to nerve damage. This phenomenon increases the morbidity and poses a challenge to the programme managers. Therefore, mopping up of all 'cured' leprosy patients, particularly MB patients, is necessary to identify the complications likely to be encountered so that proper interventions can be taken to minimize the morbidity. We conducted a mopping-up exercise in urban areas mainly to identify relapses and related clinical problems among the cured leprosy patients.
The clinical details of 2664 leprosy patients registered with the clinics of Bombay Leprosy Project from 1-3-2001 to 28.2.2002 and who have completed treatment were collected from the patients' records. An attempt was made to contact these patients. Community Volunteers were given task-oriented training with the help of a pocket card to suspect clinical problems in the field, to be confirmed later by supervisory staff, 968 patients (37%) were physically assessed to identify relapses and other clinical events in the field. Skin smears and skin biopsies were done in 605 cases. Twelve relapses were detected and all of them were confirmed by investigations. 143 (15%) patients had signs of reaction. These were treated with a standard course of steroid therapy. Patients with physical disabilities were provided with necessary disability services.
This mopping-up exercise indicates that patients cured earlier tend to have the risk of developing late reaction as well as relapses, especially in a long-term follow-up. Since this is not a population-based study, one cannot derive any epidemiological observations. It is concluded that leprosy patients who have completed treatment may develop clinical problems and can be assured of relief, if they are given prompt attention at the appropriate time, through a mopping-up exercise. Such an exercise is particularly more relevant in view of relaxation of active surveillance in the leprosy programmes.
PE 15
ARTICULAÇÃO DAS AÇÕES DE CONTROLE DA HANSENÍASE AO PROGRAMA SAÚDE DA FAMÍLIA NO MUNICÍPIO DE SÃO JOÃO DO PIAUÍ. BRASIL
Maria Goretti S. Pereira ; Márcia L. Amorim; Sônia M. Oliveira; Vânia C. Santos; Virgílio M. Miranda; Adriana V. P. Assunção; Alberto N. Ramos Jr.
Núcleo de Vigilância Epidemiológica da Secretaria Municipal de Saúde de São João do Piauí. Rua Rodrigo Carvalho s/n°, Centro. São João do Piauí, Piauí, Brasil - CEP: 64760-000.
Introdução: O Ministério da Saúde vem adotando como estratégica a implantação do PSF objetivando ampla mudança do modelo assistencial em saúde. Neste sentido, programas verticais, como o de Controle da Hanseníase (PCH), também vêm passando por intensas modificações que necessitam serem avaliadas de forma contínua.
Objetivo: Descrever o processo da implantação e os primeiros resultados da inserção do PCH no PSF do Município de São João do Piauí, visando otimizar a assistência integral ao paciente com hanseníase.
Métodos: Estudo descritivo, operacional, baseado nos dados epidemiológicos e de serviço do Município de São João do Piauí, no período de 1999 a 2001.
Resultados: O PCH foi implantado no Município no início dos anos 90,centralizando suas ações no Hospital Regional (Estado) e, posteriormente, alcançando o nível municipal. Mesmo a este nível, apenas em meados dos anos 90 foi possível estabelecer estratégias para avaliação clínica geral, diagnóstico baciloscópico, realização de PQT e prevenção de incapacidades de forma efetiva. Em 2001, com a articulação com a SES, deslocaram-se as atividades do nível Estadual para as duas unidades do Município. Como resultado, observou-se: maior número de profissionais envolvidos (incluindo agentes comunitários de saúde), aumento da detecção de casos, maior cobertura da PQT, melhor abordagem dos estados reacionais e menor grau de incapacidades no diagnóstico.
Conclusões: Esta primeira avaliação mostra que ainda é precoce para se ter uma resposta mais clara sobre o impacto deste novo modelo assistencial em saúde. Mesmo assim, importantes mudanças foram alcançadas no Município e trazem uma perspectiva positiva da intensificação das ações do PSF. Estão sendo programados estudos a longo prazo para uma avaliação mais acurada deste processo
PE 16
ASPECTOS EPIDEMIOLÓGICOS DA HANSENÍASE NO ESTADO DA PARAÍBA
Rose Mary Barros Araújo Madruga; Clélia Albino Simpson de Miranda; Teresa Cristina Moura Rodrigues
O estudo trata de uma seria historia compreendida entre 1990 - 2001 salve Hanseníase. Teve como objetivo analisar a situação epidemiológica da hanseníase no estado da Paraíba, com vistas a estabelecer ações prioritárias que possibilitem a intervenção buscando a eliminação.
Os dados foram obtidos através do SINAM (sistema de informação de agravos e denotifícação), no total de 5.621 fichas, obedecendo ao fluxo: serviço de saúde, Séc. municipal de saúde, coordenação de vigilância epidemiológica da Séc. estadual de saúde, onde está inserido o núcleo de dermatologia sanitária.
A analise dos dados deu-se a partir dos coeficientes de detecção de prevalência e avaliação do grau de incapacidade física da casuística analisada. Conclui-se que na Paraíba a hanseníase distribui-se de forma heterogênea em aproximadamente 50% dos 223 municípios do estado, com áreas de concentração em municípios do litoral agreste e sertão. Apresentando assim uma media endêmicidades com palavras chaves: hanseníase. epidemiologia, eliminação.
PE 17
AVALIAÇÃO CLÍNICA EPIDEMIOLÓGICA DE PACIENTES COM HANSENÍASE ACOMPANHADOS EM UM AMBULATÓRIO DE DERMATOLOGIA SANITÁRIA
Nery, J.A.C.; Novellino, A.B.C.; Tanaka, R.M.; LEAL, .F; Turiel. A.F.A.H.L.; Twardowski, G.; Melo, S.; Azulay, RD.
Ambulatório de Dermatologia Sanitária do Instituto de Dermatologia da Santa Casa de Misericórdia do Rio de Janeiro. Chefia: Prof. Rubem David Azulay. Secretaria Municipal de Saúde / Superintendência de Saúde Coletiva / Hanseníase - Rio de Janeiro - Coordenação Drª Raquel Tardin
Introdução: A hanseníase é uma doença infecciosa considerada problema de saúde pública em nosso país, sendo o quarto no mundo em número de casos, ficando atrás apenas da índia. Birmânia e Nigéria.
Objetivo: Conhecer a distribuição epidemiológica dos pacientes com hanseníase acompanhados no Ambulatório de Dermatologia Sanitária do Instituto de Dermatologia da Santa Casa de Misericórdia.
Material e Métodos: Participaram do estudo todos os pacientes de ambos os sexos com o diagnóstico clínico e/ou laboratorial de hanseníase baseados na classificação de Madrid, que estavam em acompanhamento no Setor de Dermatologia Sanitária, no período entre janeiro de 1999 a dezembro de 2001. Todos os pacientes foram avaliados pelos médicos residentes e quando disponível, foram realizados alguns dos seguintes exames: biópsia cutânea, teste de mitsuda e baciloscopia. Após confirmação diagnostica foram tratados com esquema poliquimioterápico (PQT).
Resultados: Foram avaliados 184 (100%) pacientes, sendo 89 (48,3%) provenientes do Município do Rio de Janeiro e 95 (51.6% ) de outros municípios: sendo classificados nas seguintes formas clínicas: 79 dimorfo (42,9%); 11 indeterminado (6,0%); 1 não classificado (0,5%); 62 tuberculóides (33,7%); 31 virchovianos (16.8% ); totalizando 94 (51.1 %) pacientes do sexo feminino e 90 (48,9%) do sexo masculino. Dos casos novos detectados foram observados os seguintes graus de incapacitação: grau 0- 137 casos (74,5%); grau 1-18 casos (9,8%); grau 2- 18 casos (9,8%); grau 3-1 caso (0,5%); NC-10 casos (5.4%).
Comentários Finais: No Brasil a hanseníase ainda mantém-se endêmica, e o controle desta doença deve ser realizado por todos profissionais da saúde, sua divulgação portanto, se faz necessária principalmente nos meios universitários onde acreditamos ser um ponto fundamental deste conhecimento e divulgação.
PE 18
AVALIAÇÃO DO PREENCHIMENTO DO GRAU DE INCAPACIDADE NA FICHA DO SINAN
Maria Ana A. Leboeuf ; Maria Aparecida de Faria Grossi: Eni S.B. Magalhães
Secretaria de Estado da Saúde de Minas Gerais - hanseniase@saúde.mg.gov.br
Avenida Afonso Pena 2300 - CEP: 30130-007 - Belo Horizonte - Mg, Brasil
Introdução: O Grau de Incapacidade - GI que o caso de Hanseníase apresenta na detecção é o indicador mais importante para avaliar a endemia, por falar da precocidade do diagnóstico, da endemia oculta e da necessidade de medidas de combate à principal causa do estigma social da Hanseníase. A avaliação e o registro do GI, já estão incorporados à rotina na detecção de quase 100% dos casos. O correto registro desta informação na Ficha do Sistema Nacional de Agravos de Notificação - SINAN, padronizada no Brasil, que utiliza codificação que pode induzir a erros de preenchimento, onde o grau Zero recebe código 1, o I é = 2 e o II = 3, foi o principal motivo que nos levou realizar o presente estudo.
Metodologia: Foram comparados o GI registrado no Quadro de Avaliação e a informação registrada na Ficha do SINAN de 6.774 notificações ocorridas em Minas Gerais de 06/1999 a 12/2001.
Resultados: Das 6.774 Fichas, 99% tinham o Quadro de GI preenchido e destes 1995 tinham a anotação incorreta do GI no SINAN. Das 1.297 preenchidas com erro, 43% informaram o Grau no lugar do Código, 36% deixaram em branco e 21% preencheram outro código. Dos que não preencheram o Quadro de GI, 82% informaram algum código no SINAN. Por esta possibilidade de erro recomendamos que o SINAN apresente alternativa de informar o GI e não o Código e o Quadro do GI na própria ficha.
PE 19
AVALIAÇÃO DO PROGRAMA DE CONTROLE DA HANSENÍASE NO MUNICIPIO DE CARUARU/PE
Aílton Romero dos Santos1, Maria Jesus Barbosa1, Erika Virginia Lima1, Otamires Alves da Silva2
1. Centro de Saúde Amelia de Pontes/CSAP - Caruaru/PE
2. Centro de Pesquisas Aggeu Magalhães/ CPqAM/ FIOCRUZ- Recife/PE
A hanseníase é uma doença infecto-contagiosa, e endêmica em varios países, causada pelo Mycobacterium leprae ou bacilo de Hansen, um parasita intracelular obligatorio que apresenta afinidade por células cutâneas e nervos periféricos. A hanseníase é um sério e importante problema de saúde pública por causar incapacidade física e permanente, apresentando altos índices de prevalência em diferentes regiões do Brasil, com mais de 12 milhões de casos reconhecidos em todo mundo e cerca de 600 mil casos novos por ano. Trata-se de uma doença de transmissão interpessoal cuja fonte principal é o homem, através das formas contaminantes, que não estejam em tratamento, dificultando assim o controle epidemiológico. Procuramos avahar o programa de controle da hanseníase no Centro de Saúde Amélia de Pontes/CSAP, referência em dermatologia sanitária localizado no agreste pernambucano. Trata-se de um estudo realizado a partir do levantamento de dados comidos nos prontuários dos pacientes tratados e em tratamento no CSAP, compreendendo um período de cinco anos (1996 à 2000). Foram revisados 474 prontuários de pacientes atendidos por demanda espontânea ou indicados. Destes, 133 com residência fixa no município (28.05%), sendo 121 na zona urbana (90.97%) e 12 na zona rural (9.02%). Observamos que indivíduos apresentando boa resposta imunológica exibem lesões em menor quantidade e bem delimitadas, ao contrário dos pacientes com comprometimento da capacidade imunológica que apresenta lesões numerosas e sem limites precisos. Graças ao trabalho multidisciplinar exercido na comunidade, o diagnóstico precoce e o início do tratamento imediato fazem com que a população busque com maior freqüência o serviço de referência em hanseníase.
PE 20
AVALIANDO A COBERTURA DE BCG EM CONTATOS DE HASENÍASE, NO BRASIL
Maria da Conceição Cavalcanti Magalhães
ATDS / SPS / DAB / MS
A vacina BCG confere proteção contra hanseníase em todas as populações estudadas. Os últimos estudos, sobre vacinas para hanseníase,realizados mostram que o BCG ainda é a melhor opção disponível, no momento. Deste 1993, a norma nacional através da portaria n° 814/GM de 22 de julho de 1993, recomenda a aplicação de duas doses de vacina BCG intradérmica a lodos os contatos intradomiciliares dos casos de hanseníase independente de forma clínica.
Objetiva-se neste trabalho, avaliar a cobertura de vacina BCG, no Brasil, no período de 1993 a 2001.
Utiliza-se como fonte de dados o Programa Nacional de Imunizações. Os resultados mostram que a cobertura da vacina BCG tem aumentado no período, porém o nível atingido parece ser insuficiente para interferir no aparecimento de casos novos da doença. A baixa cobertura da vacina BCG esta relacionada a um baixo percentual de contatos examinados, atividade que necessita ser priorizada nas ações de controle da hanseníase.
PE 21
BCG EM COMUNICANTE: EFICÁCIA E SUSCETIBILIDADE
Nakahodo, P; Tanno, L. K.; Techelsk, A.
Unidade Básica de Saúde 4 (UBS) - Município de Itapevi - São Paulo
Av. Nove de Julho, n° 39 - Itapevi (Rainha) - São Paulo.
A Hanseníase é uma doença infecto-contagiosa ainda presente em nosso meio. Muitos casos não são notificados levando a uma desatenção por parte da vigilância sanitária e da população.
Como uma das profilaxias da Hanseníase, utiliza-se a vacinação com BCG.
Neste trabalho fizemos um levantamento de todos os casos de pacientes comunicantes hansênicos da Unidade Básica de Saúde IV no município de Itapevi (São Paulo) no período de 1997 â 2001.
Foram registrados 214 prontuários de comunicantes neste período de 6 anos procurando definir e separar nas famílias estudadas a eficácia do BCG dentro da mesma.
Por este trabalho concluímos que: 1 dose parece ser suficiente para a profilaxia da Hanseníase, no entanto aconselhamos manter a imunidade ativa fazendo um reforço (segunda dose); dos casos que receberam BCG e desenvolveram a patologia, concluímos que possivelmente já estavam no período de incubação ao receberem a vacinação; quando separados por grupos etários, observamos que os comunicantes que receberam BCG e desenvolveram a moléstia tiveram forma paucibacilar (90% deste grupo); e, para finalizar, concluímos com a população estudada, que a vacinação com BCG continua eficaz na profilaxia da Hanseníase.
PE 22
BCG REVACCINATION ON LEPROSY CONTACTS: PRELIMINARY RESULTS
Duppre, N.C.; Nery, J.A.C.; Sales. A.M.; Pereira, R.M.O; Matos, H.; Sarno, E.N.
Leprosy Laboratory, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro. R.J., Brazil
Introduction: Studies of large-scale field trials on BCG carried out in Uganda, Burma, Papua New Guinea and India demonstrated that BCG was indeed capable of preventing leprosy, but that its protective efficacy varied widely from about 207 to more than 80%. In Venezuela, studies indicated that the protective efficacy of BCG was directly proportional to the number of doses given. In a 1996 study realized in Africa. Fine postulated that an initial BCG vaccination imparted a minimum 50% protection rate, while two-doses increased protection to around 75%. The Brazilian Ministry of Healthy has recommended two doses of BCG-ID in household contacts of leprosy patients since 1990, however, to date no studies on the efficacy of BCG in preventing leprosy have been carried out.
Objective: Evaluate the efficacy of BCG revaccination in conferring protection against leprosy disease in contacts of leprosy patients.
Material and Methods: All the contacts (4,055) aged 1 to 75 examined during 10 consecutive years (June 1987 - December 1999) were enrolled in the study. The healthy contacts, numbering 1.927, who were examined before 1991 were not administered a BCG vaccination at their initial exam irrespective of the presence/absence of a BCG scar. Another 2,128 contacts were examined after 1991. The contacts in this group who upon examination were found to have a BCG scar were then revaccinated with BCG. On the other hand, the contacts without a previous BCG scar were given their first dose at the initial exam and scheduled to receive a second six months later, in accordance with the Brazilian Ministry of Health guidelines.
Results: The vaccine efficacy rate among contacts without a previous BCG scar was 70% (95% CI 29.6-87.3) whereas among contacts with previous BCG scar, it was 55%. (95% CI 8.76-77.8). The protective effect of BCG was higher for the multibacillary forms of leprosy, at 89.2 % (95% CI 57.0 - 97.3) than for the paucibacillary forms of the disease, at 81,2% (95%. CI 70,4-88,0).
Conclusion: In view of the results, a second dose of the BCG vaccine confers protection against leprosy among household leprosy contacts.
PE 23
CAMPANHA DE COMBATE A HANSENÍASE -SÃO CARLOS - SP - 2001: ANÁLISE DOS DADOS
Ana Cláudia Cianflone; Edeltraut N. Zóia; Elisete S. Pedrazzani; Isabela Geriu de Oliveira; Maria Tereza Claro; Mariangela Pioto
Secretaria Municipal de Saúde - Divisão de Vigilância Epidemiológica. Rua Conde do Pinhal, n° 2161 - Centro. Fone/Fax: 016 - 270-7405. E-mail: salvepi@saocarlos.sp.gov.br
O município de São Carlos - SP, participou da Campanha Estadual de Combate a Hanseníase de 23 a 27 de abril de 2001, desenvolvendo atividades de divulgação e estratégias de detecção de casos novos, envolvendo diversos segmentos da comunidade local.
A Campanha teve início com reuniões da equipe de saúde para planejamento e organização das ações e posteriormente com alunos dos cursos de graduação na área de saúde e professores do Departamento de Enfermagem da Universidade Federal de São Carlos, representantes das associações de bairros e das indústrias, profissionais da saúde, religiosos entre outros, com o objetivo de uma grande mobilização social. Os alunos receberam treinamento para aplicação do teste de sensibilidade para atendimento da população durante a Campanha.
Foram desenvolvidas ações educativas na comunidade, testes de sensibilidade em qualquer mancha na pele nos Postos de Saúde e exames clínicos com Dermatologistas, para as pessoas encaminhadas após avaliação sensorial.
Os resultados foram: de 290 pessoas examinadas com manchas, 112 foram encaminhadas para consulta com Dermatologista, dos quais 48 foram avaliados na semana, sendo que 46 foram negativos, 01 positivo e 01 com suspeição diagnóstica.
Espera-se com esta campanha dar continuidade ao processo de divulgação da doença e desta forma contribuir para a melhoria dos indicadores epidemiológicos, sendo que o município de São Carlos, apresentou em 2001 um coeficiente de prevalência de 0.9 por 10.000 habitantes, enquanto que no Estado, no ano de 2000 foi de 1.74.
PE 24
CAN WE PREVENT LEPROSY AMONG HOUSEHOLD CONTACTS OF LEPROSY PATIENTS ? -A PRELIMINARY REPORT FROM INDIA
Vijayakumaran P; Krishnamurthy P; Etienne Declercq; Prabhakar Rao T
Damien Foundation India Trust, 27, Venugopal Avenue, Spurtank Road, Chennai 600 031 India. E-mail: damienin@vsnl.com
Studies indicate that the relative risk of leprosy among household contacts varies from 4 to 9 when compared to the population who do not have household contact with leprosy patient. This randomised double blind controlled trial is undertaken to determine protective efficacy of single dose of Rifampicin as chemoprophylaxis to household contacts in reducing the risk of developing clinical leprosy among them. The protective efficacy is measured in terms of reduction in incidence of leprosy among household contacts. Nine NGO leprosy projects supported by Damien Foundation India Trust (DFIT) are participating in the study. All the newly registered leprosy patients during the years 2000 and 2001 were considered as index cases and their houlsehold contacts were examined for clinical evidence of leprosy. Families allocated randomly lo study and control groups. The followup examination (reexamination) is done annually. There were 1958 newly registered leprosy patients. Among these, 14.8% of families had more than one case at intake and 23.8% of the families had MB cases. A total of 8063 household contacts were enrolled till Dec 2001. Among them 391 had leprosy (previously treated and new) at the time of intake. There were 7672 eligible contacts. The first group of eligible contacts (3271) was re-examined in April 2001 and three new eases were detected giving an overall New Case Detection Rate of 0.9 per 1000. Details of methodology and updated re-examination findings will be presented.
PE 25
CASE DETECTION AMONG NON-HOUSEHOLD CONTACTS OF NEW SMEAR POSITIVE MB CASES
Pratibha Kathe2; U.H.Thakar; Dnyanshwar Kholgade1; W.S. Bhatki2.
1. Kushtarog Niwaran Samiti. Shantivan. Taluka Panvel.
2. Acworth Leprosy Hospital Society for Research. Mambai.
Household contacts of smear positive MB cases are generally considered as high-risk population and hence covered in routine case detection activity. However, leprosy cases like other people also spend much more time outside their homes, thereby having contact with people residing in surrounding houses, at the place of work and at the place of social activities. In taluka Panvel, 7946 people have been indentified for having contacts with 46 new smear positive MB cases by virtue of their slaying in the surrounding houses (4612 people), working with the index cases (1548 people) and having social contact' with the index cases (1786 people). Of these 7324 (92%) had been examined to reveal 27 new cases (4 SSL. 16 PB and 7 MB). The New Case Detection Rate) NCDR), observed among extra-household contacts of smear positive MB cases (37/10000) was found to be much higher than that is seen in routine surveys. Among three categories of non-household contacts, the maximum NCDR of 66 cases per 10000 population was observed among the people having social contacts with smear positive MB cases. The results suggest that the non-household contacts of smear positive MB cases should also be considered as high-risk population.
PE 26
COMPARE OF NEWLY DETECTED LEPROSY CASES BETWEEN BEFORE MDT AND AFTER MDT IN NANKANG CITY
ZHANG Shengwei; HE Shengxing; LIAO Qinyan; ZHANG Xiaocheng
Nankang Institute of Dermatology, 341400. Nankang, China
Objective: To compare the profiles of case-finding and the clinicale characteristics of new leprosy cases detected after MDT with that before MDT.
Methods: Materials of cases detected before MDT and after MDT in Nankang City were compared.
Results: In comparison with before MDT, detection rate has decreased dramatically (0.75/100000) after MDT. The rate of early detection cases in newly detected patients has increased (57.41%). The rate of cases with positive skin smears was higher (74.07% ) than that before MDT£"53.72%£©. The rates of cases with single skin lesion and with Grade II disability were similarities between before MDT and after MDT. The way that cases were detected through dermatologic clinic was main mode yet.
Conclusion: Detection rate has decreased dramatically after MDT. It suggests that extensive health education of leprosy is the main one of measures on early detection of cases.
PE 27
COMPORTAMIENTO DE LA LEPRA MUNICIPIO CAMAGUEY. CUBA 1984 - 1998
Dra Nieves Atrio Mouriño; Dr. Rene David Sifontes Mejias; Lic. Iris Vidal Camero.; Dr. Miguel Rivero Sánchez
Asesora Programa de Lepra Centro Provincial de Higiene y Epidemiología Camagüey. Cuba.
Se realizó un estudio descriptivo transversal del comportamiento de la lepra en el municipio Camagüey durante los últimos quince años (1984 - 1998), el universo de estudio estuvo representado por 260 casos, diagnosticados como tal en las historias clínicas familiares e individuales. Como registro primario se utilizaron los informes anuales del departamento municipal de estadísticas de Camagüey y el modelo de encuesta epidemiológica del enfermo de lepra, con los datos obtenidos, se confecciono una encuesta según bibliografía revisada la cual una vez llenada pasó a ser el registro primario de datos. Los aspectos analizados fueron, la incidencia de la enfermedad su tasa × 100 000 hab, la distribución según grupo etáreo, sexo, color de la piel, nivel de escolaridad, ocupación, condiciones de la vivienda, formas clínicas, primeros síntomas y signos referidos de la enfermedad, localización de los mismos, modo de detección, grado de incapacidad, fuente de infección, tiempo de diagnostico y los resultados de la situación del enfermo con relación al foco.
Entre los resultados obtenidos se observó una tendencia hacia la disminución de la incidencia y su tasa, ligero predominio del sexo femenino, bajo nivel escolar, mayor numero de desocupados y de pacientes mayores de 35 años, porcentaje superior de las formas clínicas multibacilares y predominio de la LD y LL.
En los casos de LL predominan los nodulos cutáneos y en la LD. LI y LT las manchas anestésicas. El modo de detección espontáneo y el diagnóstico tardío aportaron el mayor porcentaje, la fuente de infección fue desconocida en el mayor número de enfermos. Predominaron los casos sin incapacidades en el momento del diagnóstico y en los casos discapacitados predominó el Grado I.
PE 28
CONSTRUÇÃO DO PERFIL EPIDEMIOLÓGICO DE PACIENTES DE 0 A 14 ANOS, COM HANSENÍASE, EM UM HOSPITAL ESCOLA NO RECIFE
Lea Fradique Lucena; Marta Ribeiro da Silva; Tatiana Luciano Freire; Vera Rejane do Nascimento Gregório
Universidade de Pernambuco - UPE. Centro Integrado de Saúde Amaury de Medeiros- CISAM. Rua, Visconde de Mamanguape s/n, Encruzilhada. Fone: 3427-3911 Ramal-259. Recife-PE; CEP: 52030-010
A Hanseníase, uma das mais antigas doenças humanas, ainda é um problema de Saúde Pública no Brasil, as condições sanitárias e de nutrição deficientes são responsáveis pela pré disposição em crianças. Este trabalho, trata-se de um estudo quantitativo do tipo descritivo e retrospectivo, cujo objetivo é conhecer o perfil da hanseníase em crianças de 0 a 14 anos de idade diagnosticadas num hospital escola do Município de Recife, no ano de 2001. As variáveis estudadas foram idade, sexo, forma clínica, basciloscopia, grau de incapacidade, modo de detecção e situação atual desses pacientes. Os dados coletados estão cm processo de análise.
PE 29
DADOS CLÍNICOS E DEMOGRÁFICOS DE UM SERVIÇO DE ATENÇÃO PRIMÁRIA A HANSENÍASE EM RIBEIRÃO PRETO-SP
Dr. Stenio Miranda: Maria Luiza Freires Lopes: Elisabete Paganini; Liliane Batista Franco; Adriana Teixeira Renosto; Rute Aparecida Casas Garcia
Programa de Hanseníase da UBDS - Vila Virgínia
Nosso objetivo é apresentar dados clínicos/demográficos dos pacientes em tratamento de Hanseníase, de janeiro de 1998 a dezembro de 2001 e as peculiaridades do serviço que estão relacionadas aos resultados obtidos. O trabalho é desenvolvido na Unidade Distrital de Saúde - Zona Sul, da Secretaria Municipal de Saúde, responsável por 81.541 habitantes. Neste período incluímos 37 pacientes, 28 (75,6%) homens e 9 (24.4%) mulheres, com idade média de 37 anos (menor = 6 anos e maior = 70 anos), sendo 94.5% de Ribeirão Preto, a maioria migrantes (67.5% de outros estados e 27% de outras cidades do Est.S.Paulo). Em relação às formas clínicas, 16 (43.2%) com Hanseníase virchowiana, 6 (16,2% ) foram dimorfos, 9 (24.4% ) tuberculóides e 6 (16.2% ) indeterminados, conforme diagnóstico apoiado em características clínicas, baciloscópicas e anátomo-patológicas (59.4% multibacilares e 40.6% paucibacilares). Apresentaram grau de incapacidade zero 23 pacientes (62,2% ), grau de incapacidade I 9 pacientes (24.4% ), grau de incapacidade II 2 (5.4% ) e grau III 2 pacientes (5,4%). Do total 12 pacientes (32.4% ) apresentaram alguma forma de reação durante o tratamento e 5 (13.5% ) persistiram com sintomas reacionais, fazendo uso contínuo de medicação específica após alta medicamentosa. No encerramento dos casos em 31.12.2001 tínhamos alta cura em 23 (62.2% ) pacientes, tratamento em curso para 13 (35.1% ), onde uma paciente foi transferida (2.7% ) foi transferida e nenhum abandono. Consideramos que os bons resultados obtidos pelo serviço, notadamente o índice de abandono zero nos 4 nos incluídos resultam de metodologia de trabalho participativa desenvolvida a partir da abordagem abrangente do paciente e de seus familiares, com efetivo acolhimento pelos membros da equipe.
PE 30
DETECTION OF Mycobacterium leprae DNA BY PCR IN BLOOD AND SKIN FROM NINE BANDED ARMADILLO (Dasypus novemcinctus): PRELIMINARY RESULTS
Patrícia Deps; Adalberto Rezende; Jane Yaniashita Tominiori
Santa Casa of Misericórdia Hospital, Vitória - ES. Leprosy Laboratory, Oswaldo Cruz Foundation, Rio de Janeiro - RJ. AV. Nossa Senhora da Penha, 2190, CEP 29045-402, Vitória - ES, Brazil.
Introduction: and purpose: The multiple drug therapy (MDT) is highly effective in killing M. leprae in this human reservoir, i.e infected person. In many countries and in spite of a dramatic fall in prevalence, the number of new cases detected annually does not show a marked decline, maybe, because the sources didn't eliminate. Wlash et al (1974) described a leprosy-like infection in seven armadillos form Lousiana (EUA). We studied the wild armadillos from Espirito Santo State, Brazil, a hyperendemic leprosy area
Methods: Fourteen armadillos, Dasypus novemcintus species, were examined. Blood samples were collected. For amplification of specific M. leprae DNA, a set of primers ML-1 and ML-2.
Results: Those animals were assymtomatic and none of them presented clinical diagnose of leprosy. Blood from five of fourteen animals had a positive PCR.
Conclusion: These are first results in the medical literature and are in accordance with that from American resercher's that also reported the presence of M. leprae in armadillos from Texas and Lousiana States of USA. Anyway, these preliminary results suggest that in the Espírito Santo Slate, Brazil, the nine-banded armadillos could be considered a natural reservoir of M. leprae.
PE 31
DISTRIBUIÇÃO DA HANSENÍASE SEGUNDO O SEXO NO MUNICÍPIO DE GOVERNADOR VALADARES - MINAS GERAIS / BRASIL
Lana, F.C.F.; Meléndez, JGV; Lanza, F.M.; Branco, A.C.; Teixeira, S.; Malaquias, L.C.
Escola de Enfermagem da UFMG, Av. Alfredo Balena, 190, Santa Efigênia, CEP 30.130-100. Belo Horizonte, Minas Gerais. Brasil, xicolana@enf.ufmg.br
Introdução: A hanseníase em Governador Valadares é considerada hiperendêmica. O nosso pressuposto é o de que a taxa de detecção se distribui desigualmente nos espaços urbanos e também entre os sexos.
Objetivo: Analisar a distribuição da hanseníase segundo o sexo em Governador Valadares.
Metodologia: Estudo epidemiológico de natureza descritiva de tipo operacional.
Resultados: Observamos uma maior proporção de casos em mulheres do que homens, respectivamente 55.3% e 44,7%. Proporção confirmada pela maior taxa de detecção em mulheres, 10,20/10.000 contra 9,27/10.000 em homens. Verificamos que 56.6% dos casos diagnosticados por demanda espontânea são de mulheres. Observamos que o número de casos de hanseníase no sexo feminino é maior nas formas tuberculóide, dimorfa e indeterminada e a virchoviana no sexo masculino. Isto justifica a maior proporção encontrada de casos com incapacidade nos homens, 19.7% contra 9% nas mulheres. Estes dados confirmam a ocorrência de uma maior proporção de diagnóstico tardio em homens.
Conclusão: A hanseníase em Governador Valadares incide desigualmente entre homens e mulheres, acarretando maior repercussão nos homens em termos de incapacidades físicas. Desta maneira, este estudo aponta para a necessidade dos serviços de saúde deste município implementarem estratégias que considerem as diferenças de necessidades biológicas e sociais entre homens e mulheres de modo a proporcionar equidade no acesso e proteção à saúde.
PE 32
DISTRIBUIÇÃO GEOGRÁFICA DOS CASOS NOVOS DE HANSENÍASE DIAGNOSTICADOS NO MUNICÍPIO DE BELO HORIZONTE, MINAS GERAIS. BRASIL, NO PERÍODO DE 1999 A 2001
Paulo de Tarso Silveira Fonseca; Renato César Ferreira
Secretaria Municipal da Saúde. Av. Afonso Pena 2336. Belo Horizonte. Minas Gerais, Brasil. CEP: 30.130-007
Os pacientes de Hanseníase diagnosticados em Belo Horizonte, no período de 1999 a 2001, foram distribuídos geograficamente segundo os respectivos Distritos Sanitários de residência.
Utilizou-se o banco de dados do Setor de Epidemiologia da Secretaria Municipal da Saúde de Belo Horizonte (Sistema de Informação Nacional de Agravos Notificáveis), e o programa Map-Info da Prefeitura Municipal de Belo Horizonte.
Foram analisados os aspectos socioeconômicos dos Distritos Sanitários em relação ao diagnostico da Hanseníase.
PE 33
EFFECTIVENESS OF BCG VACCINATION IN PROTECTING AGAINST LEPROSY IN VIETNAM
Tran Hau Khang; Le Kinh Due
National Institute of Dermato-Venereology
In order to assess the effectiveness of BCG vaccination in protecting against leprosy, a prospective case-control siudy was carried out in the North of Vietnam. The objective of the study was to determine the frequency of positive reaction to the BCG vaccine in the patients and in the control groups. If leprosy cases were found to have BCG reactions, this would be evidence lor a protection against leprosy by successful immunization with BCG.
90 leprosy patients and ISO controls (2 controls for one case) were paired according to their identical parameters. All patients was investigated by the same clinician. Laboratory tests (BI, Histopathology) was also done for all cases. Patients and controls was matched first for height, weight and sex, living condition, changes of residence. The main feature checked for was the presence or absence of a vaccination scar, this being the physical manifestation of a positive reaction to vaccination with BCG in the past.
The results obtained are shown as below:
1. BCG vaccination seems to provide protection against non-lepromatous leprosy in the North of Vietnam.
2. The BCG vaccine does not have any clear protective effect against lepronialous leprosy.
PE 34
EPIDEMIOLOGIA DA HANSENÍASE EM MAIORES DE 60 ANOS, MUNICÍPIO DO RECIFE-PE DE 1995/2001
Márcia L.G. De Melo; Miguel Vasconcelos C. De Melo
Centro De Saúde Lessa De Andrade. Est. Dos Remédios 2416 Benfica, Recife -Pe.
A Hanseníase é considerada um importante problema de saúde pública para o municipio do Recite. Na década de 90, o coeficiente de prevalência da hanseníase manteve-se em níveis elevados, variando entre 12.48 e 32.90/10.000 hab. com tendência linear crescente. Na mesma década o coeficiente de detecção da doença manteve-se elevado, variando de 4.47 a 8.61/10.000 hab. sendo o municipio considerado hiperendêmico para hanseníase, segundo parâmetros do Ministério da saúde. Considerando que o número de idosos vem aumentando em todo o país, esta apresentação tem por objetivo focalizar as características epidemiológicas da hanseníase em maiores de 60 anos, em uma unidade de referência do município do Recife-Pe, no período de 1995 a 2001, através de informações obtidas de prontuários de pacientes acima de 60 anos no período, tendo sido consideradas as seguintes variáveis: sexo: modo de detecção; comunicantes; forma clínica: grau de incapacidade física: classificação operacional e Baar.
PE 35
EPIDEMIOLOGIA DAS FORMAS DE HANSENÍASE NUM PERÍODO DE TRÊS ANOS EM UM MUNICÍPIO DO ESTADO DE SÃO PAULO (1999/2001)
Lima, S.S.; Oliveira, M.C.F.; Matsubayashi, HM.; Sousa, M.A.S.; Romanini, E.
USB 4 - Itapevi (Rainha)
Os autores mostram a distribuição da patologia HANSENÍASE nas suas diversas formas, na população de um município da Grande São Paulo: segundo a classificação de Madri, isto é, formas indeterminadas dimorfas tuberculóides e vischovianas. Estudaram-se neste período assinalado 52 casos com a seguinte distribuição:
- formas instáveis: 36.5%
-
formas estáveis: 63.5%
Mostram, os autores que as formas bacilíferas correspondem a 50% de todos os casos, compreendendo-se assim, a importância do paciente multibacilar na manutenção da endemia.
Especificamente os 52 casos revistos apresentam a seguinte freqüência absoluta:
- forma 1:13 casos
- forma BD: 6 casos
- forma T: 1 3 casos
- forma V: 20 casos
PE 36
EPIDEMIOLOGIA DO PROGRAMA DE HANSENÍASE DO MUNICÍPIO DE ROSÁRIO OESTE - MT. NO PERÍODO DE 1992 A 2001
José Luiz Rainho Cunha
Centro De Saúde De Rosário Oeste - MT.
A hanseníase constitui importante problema de saúde pública no Estado de Mato Grosso apresentando elevados índices de prevalência e de detenção anual de casos. Este estudo objetiva a apresentar as características epidemiológicas do Programa de Controle da Hanseníase do município de Rosário Oeste - MT, no período de 1992 a 2001, através de levantamento de informações obtidas do registro do total de 504 prontuários de pacientes diagnosticados e inscritos no referido programa, sendo consideradas as seguintes variáveis: forma clínica, idade, sexo, árcade residência, modo de detecção, tempo de aparecimento de sinais e/ou sintomas, número de pacientes examinados e com BCG id 2ª dose, grau de incapacidade, ocorrência de reações e situação de registro ativo.
PE 37
EPIDEMIOLOGICAL ANALYSIS IN THE URBAN AREA OF WUHAN DURING THE PERIOD FROM 1949 TO 1999
Liu Daozhong
Dermatology Institute of Wuhan City, China
2441 leprosy patients have been accumulated in the urban area of Wuhan from 1949 to 1999, during which two periods have dominated the peak of onset. The first peak reached 29.04 1/100000 in 1949, incidences before 1949 included.The second one was seen within the years from 1950 to 1957 with the average incidence of 8.76/100,000. Since 1957, the incidence has shown a tendency of decrease every year. By the end of 1999, 2.296 patients have been totally cured.
With the development of MDT in 1987, it has shortened the duration and raised the cure rate. And only 14 present MB patients have been detected by the end of 1999. Incidence and prevalence in 1999 was reported respectively as 0.05/100.000 and 0.006. The aim of "leprosy elimination" has been accomplished after the examination and evaluation given by Health Department in Hubei Province and Evalution Group from Provincial Dermatology Research Department. Pour years watch leads to a constantly decreasing tendency of incidence and prevalence in Wuhan.
[Key Words] Leprosy Epidemiological Analysis
PE 38
EPIDEMIOLOGICAL ANALYSIS OF ACTIVE LEPER IN HEILONGJIANG PROVINCE FROM 1990 TO 1999
Qian Liu; Yi Zhang; Jianhua Li
Heilongjiang Institute of Dermatology, 150001, Haerbin, China
Heilongjiang province is situated in the north of China and its average temperature is 1.3¡æ which belongs to frigid temperate zone. 1.034 lepers had been diagnosed by the end of 1999 since leprosy ease was registered in 1949, so it is part of the non-prevalent area. 891 patients had been cured after fifty-year positive prvention and cure, and now only 24 patients were still in active, morbidity of the leper was 0.006/10000. Recent five-years average morbidity was less than 0.00l/l00000, but also it throughoutly kept a lower level in recent ten years. Now we will make a epidemiological analysis of lepers detected from 1990 to 1999 year as follow:
During ten years, 37 cases (male 23 cases, female 14 cases; M:F= 1.57:1) were reported, which contained 29 new patients and 8 relapsed patients and relapse rate was 21.6%. Among them the youngest sufferer was 13 years old, the oldest was 69 years old and the average was 40.1 years old. Main profession were peasants (22 cases,75.9%), the others were workers (2 cases), cadres (2 cases) and the resident of city(3 cases). Of 29 new patients, 3 cases were LL. 19 cases were BL, 4 cases were BB, 3 eases were BT and nobody was TT. the ratio of type was 89.6%; moreover. 19 patients were diagnosed within six years. 8 patients were diagnosed whinthin six to ten years and 2 patients were detected more than ten years. Before they were reported, the shortest course was 1 year, the longest was 12 years, and the average was 4.6 years. There were 28 patients who had got disability in varying degrees when they detected, accounting for 96.3%. 25 sufferers had ever been to different levels medical units (including countryside, county city and province), accounting for 86.1%. 16 persons of them had been to the provincial rank hospitals and 12 persons had been to the several provincial rank hospitals. Of the reported ways, multiple hospitals diagnosed 16 cases (11 cases in the provincial rank hospitals and 5 eases in the city rank hospitals). 11 cases were reported by the special medical institution and 8 cases in the provincial rank institution and 8 cases in the city rank institution), and two persons were reported by themselves. 29 new patients were distributed over 2.3 countries (or cities) in Heilongjiang province, which were highly scattered condition. Those who were born in other province accounted 89.6 percentage. The minimum times that patients lived in ancestral home was 8 years, the maximum times was 55 years and the average times was 28.9 years. In ten years, the lowest yearly diagnosed number was I case, the most was 6 cases and the average was 2.9 cases. There was only one who got leprosy in family. There were 8 patients who relapsed in all in ten years, of which 7 lepers recurred after the treatment or D.D.S and 1 leper recurred after the treatment of D.D.S+R.F.P. The type of relapse were respectively 2 cases of LL. 4 cases of BB, but also they were all polybacteria kind of lepers. The youngest lepers who recurred was 43 years old, the oldest was 65 years old, and the average was 52 years old. Among 29 new lepers, 8 sufferers had family history, 17 sufferers had contacted with lepers before, and 4 sufferers were unknow contact history.
Heilongjiang province is non-prevalent region of leprosy in history and its character of distribution has close correlation with migration. On one hand leprosy highly scattered, on the other hand, the number of patients is close correlate with number of migration. Polybacteria kind of patients are absolutely predominance, which show that polybacteria kind of patients are chief in low prevalent condition. Average age of attacking leprosy rose, it was 32.9 years old in 1980s, however, it rose to 40.1 years old in 1990s.
lepers can not be detected for long time after leprosy came on shows that medical personnels are generally short of the ability of early cognition to leprosy in our province, which is quite disadvantage to diagnosing lepers earlily. Training medical personnels for leprosy's knowledge is an important task of preventing and curing leprosy in heilongjiang province.
PE 39
EPIDEMIOLOGICAL ANALYSES OF CHILDREN LEPROSY IN GANSU PROVINCE (19492001)
Xu ChunMao; Qui Yaowen; Bai Li et al.
Control Disease Center of Gansu, 730030, Lanzhou, China
Objective: To study epidemiological features of children leprosy in Gansu province.
Methods: The data of children leprosy from 1949 to 2001 in Gansu province were analyzed in terms of gender, age, duration of the disease, infection source, detection modes, regional distribution, incidence.
Results: A total of 4801 leprosy cases were detected during 1949-2001, of which 518 (10.79%), lucre child cases (324 males and 194 females).Average delay in detection was 3.91 years. The main source of infection was directly contact with families, accounting for 94.58%,MB were 399 cases,and PB were 119 cases, the chief age of children were 14 years. The majority of cases were detected through active modes. There have been different degree epidemiological of 12 regions in 14 regions of Gansu province. Epidemiological features of children leprosy in Gansu province were basic respondence with epidemiological trends of adults leprosy in Gansu province, the top of incidence was 1.01/100 000 in 1954, the degression of incidence was I case in 2001.
Conclusion: The present study shows the proportion of children leprosy is one of the sensitive indicators of leprosy endemicity, which is one of reference according as evaluation of effectiveness of leprosy in one region.
[Key words] Children Leprosy Duration of Disease
PE 40
EPIDEMIOLOGICAL ANALYSIS OF LEPROSY IN JIANGX1 PROVINCE
Wang Lamei; Li Zhiyi; Qiu Yingxi; et al.
Jiangxi Province Leading Group of Leprosy Control, Nanchang 330046, China
Objective: To summarize the achievement and experience in leprosy control in Jiangxi Province and provide scientific basis for formulation of leprosy strategics.
Methods: Based on the National Leprosy Recording and Reporting System. Epidemiological data of leprosy in Jiangxi Province were analyzed using computer.
Results: Jiangxi Province was a leprosy medium endemic area with a higher distribution of leprosy in the south than the north. The prevalence, incidence and detection rates were highest in the 1959s or 1960s and had decreased annually since then. Average incidence rate for the recent 5 years (0.1604 per 100 000) and prevalence rate (0.049 per 10 000) in 1998 reached the criteria of basic elimination of leprosy at provincial level, however, still 15 counties of cities not reaching the criteria.
Conclusion: The comprehensive measures including early detection of cases, immediate treatment with multidrug therapy and effective health education arc helpful and important for leprosy control.
[Key words] Leprosy Incidence Prevalence Epidemiologic factors
PE 41
EPIDEMIOLOGICAL ASPECTS OF THE LEPROSY'S TRANSMISSION AND ARMADILLO MEAT CONSUME
Patricia Deps; Lorena V. Faria; Christini G. Ventura; Débora A. Silva; Valéria C. Gonçalves
Dermatology, medical School of Anta Casa Of Misericórdia.
Av. Nossa Senhora da Penha, 2190, CEP 29045-402, Vitoria - ES- Brazil.
Introduction: and purpose: The leprosy transmission still now a days is a polemic question. Some authors demontred the possibility of the armadillos. Dasypus novemcinctus species, be a environmental source of Mycobacterium leprae. The epidemiologic inquiry realized to check the correlation between the being human's contact with armadillos and the incidence of leprosy.
The objective of this research is check the frequence of the leprosy cases contacts with armadillos and also the interhuman contact before of the own diagnose.
Methods: The inquiry was realized with 107 patients ex-leprosy cases (leprosy cases that had tineshed the treatment with PQT) thai lived in Pedro Pontes Colony - Hospital, in Cariacica, Espirito Santo State. Brazil 29 leprosy cases and 173 no leprosy case from Dermatology Service of the Santa Casa Hospital. Vitoria- Brazil. The inquiry included Batas about the armadillo meal consume before own diagnosed, the existence of known cases and/or familial leprosy cases. It was realized Qui-square test, correlation and Exact Fischer Test.
Results: 90.4% of the leprosy's cases or ex-leprosy's cases had ever eaten armadillo meat in their diet before their leprosy diagnose, while 9.6% of the no leprosy's cases had ever eaten armadillo meal. It didn't have correlation between the armadillo meat consume and it has familial and know cases of leprosy before the leprosy diagnose.
Conclusion: This research revealed a direct correlation between the armadillo meat consume and leprosy cases.
PE 42
EPIDEMIOLOGICAL TRENDS OF LEPROSY IN GUIZHOU PROVINCEE
Li Jinlan; Ye fuchang; Bao xia. Ke wei
Guizhou provincial institute of dermatology, 550001. Guiyang, China
Objective: To analyze the epidemiological trends of leprosy and evaluate the effectiveness of leprosy control with fixed duration MDT in Guizhou province.
Methods: used for the National leprosy data annual report and computer recording system of leprosy in Guizhou province, each epidemiological data were analyzed.
Results: Leprosy endemic areas had obviously changed in Guizhou. All 87 counties prevalence were >0,01% and 66 counties were >0,01% among them in 1986. ln 2000, only 3 counties were >0.1% prevalence.49 counties prevalence were during 0.01-0.1% and others were <0.01%.The detection rate decreased from 0.22/10 000 in 1986 to 0.066/10 000 in 2000. The prevalence decreased from 0.24% in 1986 to 0.021% in 2000. During 1986-2000, there were 7 405 leprosy patients treated with faxed duration MDT, regular rate of MDT 95.88%. Three were 18 leprosy relapsed with a relapse rate of 0.24%. The incidence of leprosy in children and the disability rate of new case were still no change trends.
Conclusion: The faxed duration MDT was effective to treat leprosy patients. The endemic of this disease has been evidently under control in Guizhou.
[Key words] Leprosy, Incidence, Prevalence, Recurrence
PE 43
EPIDEMIOLOGICAL TRENDS OF LEPROSY IN SEVAGRAM CONTROL UNIT
Avinash Kale1; Dr. V.V. Dongre2, P.C. Sarkar3
Gandhi Memorial Leprosy Foundation. Ramnagar. WARDHA-442 001 (Maharashtra State) INDIA
1. Statistical Assistant
2. Director
3. Asstt. Director
Sevagram Leprosy Control Unit has been the first control unit in the country started in 1952. Since the inception till 2001 a total of 2050 cases have been detected from a population of 27875. This paper is intended to present the epidemiological scenario of the control unit, after implementation of MDT programme for two decades which needs serious attention while declaring the elimination of leprosy.
The prevalence rate of leprosy was 234/10.000 in the year 1952 which declined to 12.9/10,000 (94.5% reduced) in the year-2001. The deformity rate declined from 9.1% to 2.4% (73.6% reduced). Percent MB cases which include LL, BL & BB also declined from 21.8 to 15.6 (28.4% reduction), while percent PB cases which include TT, BT, IND & PN increases 78.2% to 84.4%. While number of positive cases with BI- 1&2 is decreased the number of cases with BI-3 and above increased from 2.1% to 5.2%. The new case detection rate also declined from 54/10,000 to 13.6/10,000 (74.8% reduced). It is recent observation that NCDR is more than PR and NCDR has been almost static since last two decades.
The above observations show that the MDT could reduce the number of accumulated active cases in the society but could not hinder the occurrence of new cases and suggest the need for further epidemiological and bacteriological studies which may throw some light on transmission mechanism of leprosy
PE 44
EPIDEMIOLOGIST AS THE DISTRICT LEPROSY MANAGER: THE SRI LANKAN EXPERIENCE
Nimal D. Kasturiaratchi; Sunil Settinayake, Penny Grewal
University of Peradeniya (Sri Lanka), Anti-Leprosy Campaign (Sri Lanka), Novartis Foundation (Switzerland)
Integrating leprosy in the general health services represents an immense organizational and logistical challenge. Sri Lanka, like many other countries, only has a small leprosy team who were responsible for the vertical programme. It was crucial to identify a counterpart within the regional health services to help carry out the numerous activities planned. The regional epidemiologists were selected as the "managers" of the integration process as well as for the monitoring of the integrated programme in their respective district. It was envisaged that they would work in close collaboration with the leprosy worker of the area. A goal oriented project planning workshop was conducted to actively seek their input in formulating the detailed plan.
This paper discusses how and why the epidemiologists were identified as the most appropriate counterparts. The paper will also critically examine the expectations al the outset and the reality of their role alter 18 months experience. It will also discuss the challenges faced in translating the concept of empowerment and teamwork into reality. It also addresses the problems encountered in shifting responsibility from a highly committed small team to new players.
PE 45
EPIDEMIOLOGY ANALYSIS OF LEPROSY IN ZHEJIANG PROVINCE
YAO Jianjun; XU Yaping; LUO Chi; et al.
Zhejiang Provincial Institute of Dermatology. Wukang, 313200£-China
Objective: To evaluate the effectiveness of leprosy epidemic and control in Zhejiang Province.
Methods: To adopt the analysis of retrospective sluily.
Results: By the end of 1999, 16461 leprosy patients have been registered, of which 11935 had been cured and only 97 were still active cases. Compare 1999 with 1973, active cases decreased 99.0291. The main character of epidemiology: the mean age of attack increased, the value of type ratio increased, and the incidence of children decreased, accorded with the character of leprosy control later stage.
Conclusion: The tendency of leprosy epidemic dropped continuously in Zhejiang province, effect of control is notable and fruit is solid.
[Key words] Leprosy, Epidemiology, Analyze
PE 46
EPIDEMIOLOGY AND CONTROL OF LEPROSY IN VIETNAM
Tran Hau Khang; Nguyen Thi Hai Van
National Institute of Dermato-Venereology, Hanoi. Vietnam
In Vietnam, leprosy is considered as one of social diseases which must be eliminated before the year 2000. Before 1982 (the year of MDT implementation), the prevalence rate was very high and the distribution of leprosy patients was uneven. In mountainous areas, the prevalence was 20 per 10.000, while in the delta provinces, the rate was only 2 per 10.000. The proportion of children and women cases was 8% and 36% respectively. However, after implementation of MDT, the National Leprosy Control Programme has proved to be very fruitful. The epidemiological status of the disease has remarkably also changed. The national prevalence rate has considerably decreased from 6.7 per 10,000 in 1982 to 0.2 per 10,000 in 2001. By the end of 2001, all provinces of the country have reached already the goal of leprosy elimination.
However, while the prevalence rate has continued to reduce in the recent years, the number of newly detected cases has remained steadily ranging from 1500 lo 2000 with a detection rate less than 3 per 100.000. In order to attain the final goal, the national criteria for leprosy eradication are set up and implemented in 2002.
PE 47
ESTADOS REACIONAIS NAS DIFERENTES FORMAS CLÍNICAS DE HANSENÍASE
Rosa Maria Cordeiro Soubhia; Geysa Canarim; Denise Rodrigues; Prof. Dr João Roberto Antônio
Faculdade Estadual de Medicina de São José do Rio Preto. Ambulatório de Dermatologia do Hospital de Base. Av. Brigadeiro Faria Lima n. 5416 São José do Rio Preto - SP Brasil.
Os estados reacionais (ER) são intercorrências comuns no curso da hanseníase, sendo fundamental para o manejo e prevenção de incapacidades o diagnóstico precoce e a conduta terapêutica adequada. O objetivo deste estudo foi analisar os tipos de ER mais freqüentes em cada espectro da doença, bem como a época do aparecimento dos mesmos. Neste contexto, foram estudados retrospectivamente 87 pacientes com diagnóstico histopatológico de hanseníase, submetidos a poliquimioterapia (PQT). Os pacientes foram classificados, de acordo com os critérios de Ridley-Jopling (1962), em 29% de tuberculóide-tuberculóite (TT). 1% de dimorfo-tuberculóide (DT), 15% de dimorfo-dimorfo (DD). 5% de dimorfo-virchowiano (DV). 35% de virchowiano-virchowiano (VV) e 15% de forma indeterminada. Veriticou-se que os ER foram complicações freqüentes (64%), sendo classificados com base nos dados clínicos e histopatológicos em: tipo I (27% reação reversa): tipo II (28% eritema nodoso hansénico e 3% fenômeno de Lúcio); e 47% neurite isolada. A reação tipo I predominou entre os pacientes portadores de forma DD (80%), a reação tipo II nos VV (68%), enquanto a neurite isolada na forma TT (83%). Quanto ao aparecimento do primeiro episódio reacional, veriticou-se que 46% dos pacientes (50% neurite isolada: 27% tipo I: 23% tipo II) já se encontravam com reação no momento da admissão: em 37% (42% neurite isolada, 33% tipo II, 25% tipo I) a reação surgiu no primeiro ano de PQT. Apenas 1 paciente (4%) apresentou reação tipo II (Fenômeno de Lúcio) durante o segundo ano de PQT e após PQT 2 pacientes (8%) apresentaram reação, sendo uma do tipo I e outra do tipo II, De acordo com estes dados clínicos, pode-se concluir que os estados racionais são complicações comuns nas diferentes formas clínicas de hanseníase, havendo predomínio de reação tipo I na forma DD, reação tipo II nos VV e neurite isolada nos TT. Cabe ressaltar que, devido ao risco aumentado de alterações permanentes nos sistema nervoso periférico durante a reação tipo I e a neurite isolada, estas são consideradas condições emergênciais na hanseníase necessitando portanto de diagnóstico e tratamento precoces.
PE 48
ESTUDIO COMPARADO DE LA ENFERMEDAD DE HANSEN Y TUBERCULOSIS PULMONAR EN LA SEGUNDA MITAD DEL SIGLO XX EN ESPAÑA
Almela Vich, Fernando; Vilata Corell, Juan José; Alfonso Sánchez, José Luis; Terencio de las Aguas, José; Salazar Cifre, Antonio; Navarro Gosalbez, María
Organismo Público Valenciano de Investigación (OPVI) - Instituto de Medicina Tropical. C/ Salamanca N° 68, pta lª, 46005-Valencia, España
Objetivo: Evaluar la asociación entre hanseniasis y tuberculosis determinando si sus evoluciones siguen un patrón en sus presentaciones, que puede ser competitiva hacia el mismo nicho ecológico, o paralela en cuanto que comparten factores de riesgo.
Material y métodos: El material ha sido el conjunto de anuarios del Instituto Nacional de Estadística de España, los informes del Registro Estatal de Lepra y los Registros de Enfermedades de Declaración Obligatoria. Para la recogida de datos y presentación de resultados se ha utilizado el programa informático Excel y para el análisis estadístico el PSPS. La metodología estadística ha consistido, en una primera fase, presentación descriptiva: Comparacion de medias globales anuales entre las Comunidades Autonoma de España en el periodo 1950-2000 para incidencia de lepra e incidencia de tuberculosis respiratoria y evolución comparada de ambas incidencias a lo largo del periodo señalado, en una segunda fase, análisis estadístico de las variables utilizando la pruebas de correlacion, regresion lineal simple con tranformacion logaritmica y valoracion previa de requisitos de normalidad de distribucion y homogeneidad de la varianza.
Resultados: Los datos han sido recogidos por provincias, comunidades autonomas y globales para España. Mostraremos los resultados correspondientes a las tasas anuales nacionales presentadas a intervalos de 5 años. La lepra se expresa como incidencia acumulada cada 5 años dado el impreciso periodo de incubación y la baja incidencia. Se ha encontrado un Coeficiente de Determinación R2 de 0,64, y un valor p < 0,01.
Conclusiones: La asociación encontrada entre ambas variables es significativa a mas del 1 %, y es de es carácter directo, con presentación gráfica en paralelo, por lo que apuntaría, en nuestro caso, hacia la segunda hipótesis de coparticipación de mismos factores de riesgo. Sin embargo, hay amplias variaciones entre provincias y comunidades autónomas.
PE 49
ESTUDIO ESTADÍSTICO Y EPIDEMIOLÓGICO DE CASOS DE LEPRA DETECTADOS EN CONTACTOS EN UN PERÍODO DE 5 AÑOS EN SANTA FE
Dras. Mónica Recarte; Silvia Paredes; Silvia Barraza; Alejandra Kervin; Dra. Est. Isabel Janulevicius
Programa de Dermatología Sanitaria de la Provincia de Santa Fe. Bv. Avellaneda 1400 – (2000) Rosario –: Santa Fe ̵ I: Argentina: Tel. 54-341-4804155; Fax 54-341-4516882; E-mail: mcrecarte@hotmail.com
Santa Fe es una provincia situada en el área endémica de lepra de la República Argentina. La distribución de los casos no se dan de manera uniforme y las tasa de prevalência y detección a fines del 2001 fueron de o.6 × 10.000 y 2.2 × 100.000 respectivamente, habiendo bolsones epidemiológicos que superan tasas de 4 × 10.000 hab. Dentro de la provincia.
A la luz de los conocimientos actuales se sabe que la mayoría de los casos nuevos detectados provienen de contactos tanto intra como extra domiciliarios. Es por ello que nuestro objetivo es conocer el porcentaje de contactos que han enfermado después del diagnostico del foco principal.
Se presenta un trabajo estadístico y epidemiológico, realizado entre los casos detectados desde enero de 1996 hasta diciembre de 2000, que arrojó cifras significativas, por lo que se propone “ el control de convivientes “, como estrategia destacada para arribar a la meta de la eliminación de la Lepra como problema de Salud Pública.
PE 50
ESTUDIO SEROEPIDEMIOLOGICO DE UN FOCO DE LEPRA EN EL HOSPITAL "CELIA SANCHEZ MANDULEY", MUNICIPIO MANZANILLO, GRANMA
Dr. Leonel Alejo Gutierrez.; Dr. Eduardo Rodes Santiesteban
Centro Provincial de Higiene, Epidemiología y Microbiología de Granma, Parada # 6 e Martí y Marmol. Municipio: Bayamo Provincia: Granma.
Se realizó un estudio en el Hospital "Celia Sanchez Manduley" del Municipio Manzanillo donde fueron estudiadas 447 personas contatos extradomiciliarios compañeros de trabajo de 6 pacientes de Lepra multibacilar mediante estudio serológico con el antígeno PGL-I por el método Ultramicroanalitico (SUMA) y de acuerdo a los resultados e la serología, prueba de Lepromina y Baciloscopia. El 19.2% de los estudiados mostró niveles de anticuerpos superiores al nivel de corte establecido. Los resultados fueron analizadosd en relación al sexo, la edad, el tiempo de relación con los enfermos. Se naliza la conducta seguida al final de la Investigación, concluyendo que estos studios resultan de gran utilidad en el control de la Lepra.
PE 51
ESTUDO DE INCIDÊNCIA E PREVALÊNCIA DE HANSENÍASE EM MENORES DE 15 ANOS NO MUNICIPIO DE PARACATU-MG DURANTE UM PERÍODO DE CINCO ANOS
Isaias Nery Ferreira; Rosicler Rocha Aiza Alvarez.
Fundação Nacional de Saúde/MS. Av. Olegario Maciel 660 - Centro. 38600-00 Paracatu - MG
Paracatu/MG é considerada pela Secretaria Estadual de Saúde como município prioritário para o controle da hanseníase devido aos altos coeficientes de incidência e prevalência desta nosología em sua população. Foi realizado um estudo de incidência e prevalência de hanseníase em menores de quinze anos diagnosticados e tratados neste município por um período de cinco anos. analisando diversas variáveis como forma clínica, idade, sexo, grau de incapacidade, escolaridade, cicatriz vacinal, contatos, entre outras. O objetivo deste estudo é obter um panorama epidemiológico desta doença visando subsidiar os serviços e secretarias de saúde municipal e estadual em suas ações, contribuindo para eliminar a hanseníase como doença de saúde pública
PE 52
ESTUDO RETROSPECTIVO DA OCORRÊNCIA FAMILIAR DA HANSENÍASE EM UNIDADE DE REFERÊNCIA NO MUNICÍPIO DE ITAPEVI - SP
Lima, S.S.; Kanagusuko.T; Techelsk, W.; Becker, O. M.; Gloria, I
Instituição: UBS IV - Rainha. Av. Nove de Julho, 39, Itapevi - São Paulo. Fone: (11) 426-3555 - ramal 45.
A hanseníase é uma moléstia que nos acompanha desde a antiguidade e ainda está longe de ser erradicada.
O Brasil é responsável por 85% dos casos das Américas, ocupando o 2lugar em número de doentes em todo o mundo.
Praticamente o único reservatório é o homem, dificultando pesquisas laboratoriais e fazendo com que o contato pessoal seja a principal forma de transmissão. Estudos epidemiológicos tornam-se então instrumentos importantes para compreensão da doença.
Este é um trabalho retrospectivo que se baseou no levantamento de dados de prontuários de doentes e seus respectivos familiares, acompanhados durante o período de 1996 a 2001 no UBS Rainha, unidade de referência para hanseníase, localizada no município de Itapevi - São Paulo. Enfatizamos os comunicantes familiares como integrantes do principal ambiente de propagação da moléstia. Avaliamos 78 casos com 642 comunicantes. A maioria destes últimos era assintomática. Porém. 9% apresentou hanseníase. Destes comunicantes doentes, 66% possuíam forma infectante (Borderline ou Virchoviana) perpetuando assim a transmissão domiciliar.
Variáveis como sexo, relação familiar dos comunicantes e forma do caso índice (multibacilar ou paucibacilar) foram analisados como fatores de risco para aquisição da doença.
PE 53
EVOLUÇÃO DA DETECÇÃO E PREVALÊNCIA DA HANSENÍASE REGISTRADAS DO CENTRO DE SAÚDE DONA LIBÂNIA- REFERÊNCIA EM DERMATOLOGIA SANITÁRIA - FORTALEZA -CEARÁ PERÍODO 1995 - 2001
Tavares, C. M.; Ferreira, M. L. L. T.; Alencar, T. M.; Araujo, M. A.; Santos. R.
Centro De Saúde Dona Libânia - Referência Em Dermatologia Sanitária - Fortaleza - Ceará
Ao realizar este trabalho, acerca de evolução da endemia hansênica utilizando indicadores de morbidade (incidência e prevalência) no município de Fortaleza, não podemos deixar de pensar na situação preocupante da referida endemia em algumas secretarias regionais de Saúde da capital cearense. Hanseníase, doença endêmica em todo território nacional, tem colocado o Brasil na incômoda posição de segundo país do mundo e primeiro das Américas em número de casos registrados. A meta preconizada pela OMS para o ano 2000 e postergada para 2005 é redução de 1 caso de hanseníase para cada 10.000 habitantes. O objetivo deste trabalho é estudar a situação epidemiológica e operacional da hanseníase no município de Fortaleza registrados no centro de referência Dona Libania no período 1995 - 2001.
A metodologia utilizada é de um estudo descritivo e analítico de uma série histórica, no período de 1995 - 2001. A casuística é constituída de todos os casos notificados no período. Os dados foram obtidos do S1NAN. Os resultados parciais encontrados foram que a média de casos por ano era de 700 casos e a distribuição por secretarias regionais de saúde -SER, observa-se um grande número de casos na regional VI (30% dos casos da capital), região do Conjunto Ceará e Grande Bom Jardim.
Concluímos que é imperativa a implantação de todas as ações de eliminação de hanseníase, previstas na Norma Operacional de Assistência a Saúde - NOAS para todas as unidades básicas de saúde do município de Fortaleza, e a unidade de referência apoiando esta descentralização, ficando a referência ocupando o seu verdadeiro papel de apoio para - Unidades Básicas de Saúde da Família - UBASF nos municípios de Fortaleza nos casos de difícil diagnóstico e controle.
PE 54
EVOLUCIÓN COMPARADA DE EL PRODUCTO INTERIOR BRUTO Y LA INCIDENCIA DE HANSENIASIS EN LA SEGUNDA MITAD DEL SIGLO XX, EN ESPAÑA
Almela Vich, Fernando; Vilata Corell, Juan José; Alfonso Sánchez, José Luis; Terencio de las Aguas, José; Salazar Cifre, Antonio
Organismo Público Valenciano de Investigación (OPVI) - Instituto de Medicina Tropical. C/ Salamanca Nº 68, pta 1ª, 46005-Valencia, España
Objetivo: Determinar si el Producto Interior Bruto y la lepra presentan una asociación en su evolución, haciendo especial hincapié en el análisis por Comunidades Autónomas.
Material y métodos: El material ha sido el conjunto de anuarios del Instituto Nacional de Estadística de España, el Registro de Enfermedades de Declaración Obligatoria y el Registro Estatal de Lepra del Instituto de Salud Carlos III. Para la recogida de datos y presentación de resultados se ha utilizado el programa informático Excel y para el análisis estadístico el PSPS.
Resultados: Los datos han sido recogidos por provincias, comunidades autónomas y globales para España. Mostraremos los resultados correspondientes a las tasas anuales nacionales presentadas a intervalos de 5 años. La lepra se expresa como incidencia acumulada cada 5 años dado el impreciso periodo de incubación y la baja incidencia. Se ha encontrado una correlación de Pearson de 0,82. El valor de p es < 0,01.
Discusión y Conclusiones: La correlación encontrada entre ambas variables es significativa a mas del 1 %, y es de es carácter inverso. Por tratarse de un estudio ecológico, no podemos considerar la asociación como causal; así mismo es necesario considerara la posibilidad de sesgos y factores de confusión.
PE 55
FATORES QUE INFLUENCIARAM A INADEQUAÇÃO DO DIAGNÓSTICO E DO ACOMPANHAMENTO DAS REAÇÕES EM PACIENTES COM HANSENÍASE EM RONDÔNIA, BRASIL
Carmelita R. Oliveira; Maria de Jesus F. Alencar; Sônia C. Santana; Gerson F. Nascimento; Sebastião A. Sena Neto; Alberto N. Ramos Jr.
Coordenação Estadual de Controle de Hanseníase e Tuberculose do Estado de Rondônia - Avenida Padre Ângelo Cerri s/n°. Porto Velho - Rondônia - CEP: 78903-400 - E-mail: hanse-ce-ro@ronet.com.br
Introdução: Os episódios reacionais em hanseníase mantêm-se como um grande desafio para os PCH. Apesar de se conhecerem os aspectos clínicos das reações e sua relação com lesão neural, ainda persistem questões a respeito de sua epidemiologia, o que dificulta a definição de estratégias para o controle efetivo.
Objetivo: Caracterizar os fatores que influenciaram a inadequação do diagnóstico e acompanhamento dos pacientes com hanseníase com reações e que tiveram alteração ou não do grau de incapacidade.
Métodos: Estudo descritivo, operacional, baseado nos casos novos diagnosticados em 1997 em Rondônia e com alta por cura. Estudaram-se 684 casos, dados demográficos e informações sobre a evolução da doença, considerando início da PQT e alta. Realizou-se pesquisa em prontuários para avaliação da conduta e caracterização de reações. Para a entrevista foram selecionados pacientes com reações apenas após a alta e os com progressão do grau de incapacidade durante tratamento, com avaliação clínica. Foi avaliada a estrutura do PCH nos municípios selecionados.
Resultados: Apesar dos avanços gerais obtidos pelo PCH no Estado, mantêm-se as dificuldades da abordagem dos estados reacionais. Foram identificadas falhas em vários aspectos operacionais da conduta das reações. A caracterização desta situação no Estado reflete a predominância de casos novos classificados operacionalmente como PB. Identificou-se a centralização do PCH e a necessidade de articulação com o PACS e PSF. As entrevistas refletem a inadequação dos serviços e mostram a necessidade de trabalho articulado para o efetivo controle das reações.
Conclusões: Faz-se necessária a redefinição de prioridades no Estado incorporando a abordagem das reações como medida estratégica para se alcançar a atenção integral dos pacientes.
PE 56
GENDER ISSUES AND LEPROSY FROM THE SLUM OF DHAKA
(The effectiveness of female LCA and volunteers in increasing urban slum population)
Christopher A. Baroi; David Khan; Prince Das
Dhaka leprosy Control Project, 9/4 Iqbal Road Mohammadpur Dhaka 1207 Bangladesh
Background: Dhaka leprosy Control Project was initialed by the Leprosy Mission to improve the quality of life of the people residing in the city of Dhaka. It is a joint venture by the government of Bvangladesh and the Leprosy Mission. The Lepropsy Mission is working in half of the Dhaka city. This project was initiated in 1996 where 80% of the leprosy control assistants were male. Later on it was felt that the workers mainly the male workers were going under difficulty to enter into the houses as during their visits mainly the témale portion of the population were in the house and the male were either working or roaming about. And we felt that female wlorkers/volunters should be recruited for smooth efficient and effective leprosy control activities.
Observation: The statistics of the years from 1996 to 2001 were observed and the following statistical reports were found regarding the achieved activities.
Result: A differtiation was before and after 1997. And athe results show clearly that percentage of diagnosis of new cases are quite high after 1997. This was due to the female 5-6 female volunteers, to make the balance of gender among the field workers. The increase in the per head of the new patients were some times 50-70% of the previous years. The disability rate came down from 12% to 5-6 % . The involvement of the female in credit proghram are 70% and which has resulted much improvement in their family economy.
Conclusion: Inclusion of female worker in the control services of leprosy bis critically important as it helps the group of workers easy access into the houses of the slum dwellers where female members of the family mainly in the houses. Involvement of the female workers has resulted in per head diagnosis of new patients, decreased the disability rate, ami increase in treatment compliance.
PE 57
GENDER, LEPROSY AND LEPROSY CONTROL: FOUR CASE STUDIES IN ACEH, INDONESIA; PLATEAU STATE, NIGERIA: PAR WEST AND EASTERN NEPAL; AND RIO DE JANEIRO STATE, BRAZIL
C.M. Varkevisser, O. Alubo, K. Burathoki; C. Idawani; P. Lever; P. Patrobas; T.A.M. Moreira; M. Yulizar;
Royal Tropical Institute, PO Box 95001. Amsterdam, The Netherlands
This study was carried out in the four countries to identify to what extent biological, sociocultural/economic and health service factors played a role in gender differences in case finding of leprosy patients. The quantitative part of the study consisted of analysis of a cohort of at least 500 patients registered in 1994 and followed up till declared cured in ultimately 1998. Qualitative interviews and FGDs with patients, RFTs. relatives, community leaders and leprosy staff followed in 1998-99. The M/F ratio was 1.5 and 1.7 in Indonesia and Nepal but roughly 1 in both Nigeria and Brazil. Despite these differences, males in all four countries were more seriously affected than females with MB leprosy, deformities and reactions. Biological (hormonal) factors appear to protect women. Only in the Ear Western Region of Nepal where services are rather inaccessible, both sexes were equally seriously affected. Where services had invested in decentralisation of treatment (Brazil, Indonesia) more women started reporting. Other service factors were sensitivity of stall in treating patients of opposite sex (80% F staff in Brazil; 75-80% M staff in the other countries), and adequate health education to community and patients', responding to their needs and stressing the strong points of MDT.
Mobility of men (financial and social) appeared in all four countries a positive factor in case finding, but women scored better in alertness to bodily signs. Yet, this not necessarily resulted in early case finding, because women opted sometimes for the 'wrong' healer: untrained private practitioner (Brazil), traditional healer (Nepal). In Aceh. where beliefs in traditional causes are strong, visits to dukun delayed men and women alike. In all four countries leprosy is a stigmatising disease at community and (less) family level, but predominantly in case of deformity and reactions. Involving well-coping, non-deformed ex-leprosy patients in community education proved a powerful instrument in combating the stereotypes of leprosy and promoting early case finding.
PE 58
GEOGRAPHICAL INFORMATION SYSTEMS AND LEPROSY CONTROL: USEFUL TOOL OR GIMMICK?
Jacques van den Broek; J.S.R.K. Sastry; Erica Hackenitz
Netherlands Leprosy Relief (NLR), The Netherlands, E-mail: jacvdbroek@planet.nl
Enviplan. Health-GIS Consultant, Hyderabad, India. E-mail: enviplan@vsnl.com
SBW INFRA. The Netherlands. E-mail: eha@shwinfra.nl
Concept and capabilities of Geographical Information Systems (GIS)
Significance in health care systems and (infectious) disease control, with special emphasis on leprosy control.
Review of the most important characteristics of some commonly used GIS software packages and GIS applications.
A GIS is a computer-based system for data input, data management, data manipulation and analysis, and display of all and any type of geo-referenced data.
Therefore, in leprosy control a GIS is a useful tool for planning and management (decision support); Epidemiology and surveillance; Education, persuasion and lobbying (advocacy): Complex analysis and research.
With the advent of Internet Mapping Servers (IMS) like ARCIMS, it is now possible to have the data at a central server and the GIS data can be accessed, queried and printed over the internet on the local computer.
PE 59
HANSENÍASE EM MUNICÍPIO DA GRANDE SÃO PAULO: CASOS AUTÓCTONES X CASOS IMPORTADOS
Anunciata F. S. Toniolo; lsabela M. Vincenzi; Raphael S. Campolim Almeida; Sidney Souza Lima; Teresa C. S. Ribas
Serviço De Dermatologia Do Hospital Darci Vargas - SP. Rua Dr. Seraphico De Assis Carvalho; 34: Morumbi; São Paulo
Objetivo: Demonstrar a prevalência e incidência de pacientes hansênicos num município da grande São Paulo- Itapevi - com população de 162.421 habitantes (IBGE 2000) com ênfase para os virchovianos, comparando os casos nativos (autóctones) o os "importados" e analisar sua influência sobre a população atual.
Método: Os autores examinaram 96 prontuários de pacientes matriculados no setor de hansenologia no município de Itapevi-SP num período de 6 anos, analisando fatores como: sexo, idade, naturalidade e procedência.
Resultados: Observou -se que 52 % dos casos são oriundos de outras localidades, em sua maioria de outros estados, sendo que 48% são casos autóctones. O índice de prevalência para os autóctones no ano de 2000, quando o número total de casos era de 41, foi de 1,6: 10.000 Hab e para os "importados" 1,3: 10.000 Hab.
Conclusões: Considerando-se, e tendo como média de 5 anos o período de incubação para a hanseníase, traduzindo esta média talvez um período mais curto para o pólo T e mais longo para 0 pólo L, estamos mostrando, no município de ltapevi- SP, como a influência de imigrantes hansênicos, sobretudo os virchovianos, interfere nos coeficientes de incidência e prevalência da patologia, aumentando aqui os números absolutos e relativos e diminuindo estes na sua origem. Este fato também indica a eficácia dos nossos indicadores de detecção.
PE 60
HANSENÍASE NA INFÂNCIA: ASPECTOS CLÍNICOS- EPIDEMIOLÓGICOS EM UMA ÁREA INDUSTRIAL
Lúcia Mioko Ito; Ferrucio Fernando Dall'Áglio; Rodrigo Sestito Proto; João C. S. Chiti
Departamento de Dermatologia da Faculdade de Medicina do ABC. Av Príncipe de Gales. 821- -09060-650-Santo André - SP- Brasil.
Introdução: O objetivo deste estudo é considerar deforma concisa os aspectos clínicos o epidemiológicos da hanseníase na infância na região do Grande ABC. As crianças parecem ser mais susceptíveis sendo que estas correm o risco pela presença de hanseníase pela família. Quase 60% dos adultos desenvolvem a moléstia na infância ou no início da idade adulta, portanto, relatos de longo período de incubação devem ser encarados com cautela, pois sinais físicos iniciais, podem ser discretos, além de que muitas lesões podem desaparecer espontaneamente.
Casuística: Foi realizado um estudo transversal retrospectivo, de casos de hanseníase na infância, abrangendo doentes de 0 a 14 anos, através da análise das notificações compulsórias e prontuários médicos arquivados no Centro de Vigilância Epidemiológica e Postos de Saúde credenciados nos municípios da região tio Grande ABC, no período de janeiro de 1990 a 1999.
Resultados e discussão: Nesse período, foram registrados um total de 571 casos novos de hanseníase, sendo que destes, 35 correspondiam a crianças de 0 a 14 anos. Notou-se que no período de 1990 a 1997, a hanseníase infantil permaneceu com uma incidência estável e após 1997, houve um aumento significativo do número de crianças acometidas, correspondendo à perda do poderio econômico da região, caracterizando assim a correspondência de hanseníase e pobreza.
PE 61
HANSENÍASE NA INFÂNCIA E ADOLESCÊNC1A
Lima S.S.; Balizardo D.; Caldeira F.P; Mendes M.S.; Valencio M.C.S.
Departamento de Dermatologia, Hospital Infantil Darcy Vargas, Rua Dr. Seraphico de Assis Carvalho 34, Morumbi, SP. Brasil.
Foram revisados 308 prontuários de comunicantes e doentes do dispensário de hansenologia de uma Unidade Básica de Saúde do município de Itapevi no período de 5 anos (1997 à 2001), constatando-se o diagnóstico de 94 casos de pacientes com Hanseníase distribuídos nas formas paucibacilares e multibacilares. Deste total, 16 eram crianças e adolescentes, constituindo elas 17% do total dos casos. Dos 214 comunicantes, 110 eram menores de 18 anos. Dos 16 menores hansênicos, 60% apresentavam pelo menos contato com um familiar portador da patologia, geralmente multibacilar. 32% destes menores receberam duas doses de BCG id e desenvolveram, mesmo assim, Hanseníase; porém sempre foram de formas paucibacilares. Conclusões: A) Hanseníase abaixo dos 18 anos é problema de saúde pública grave. Segundo nossa casuística, 17% do total de nossos pacientes estão neste grupo etário. B) Destes 16 pacientes com MH, os que receberam duas doses de BCG (5 pacientes), sempre foram paucibacilares. C) A prevalência e a incidência da patologia neste grupo etário obriga a ações mais enérgicas de controle, já que são comunicantes de comunidades "fechadas" (a família), permitindo-se. assim, maior contágio. Ressalta-se que 51% do total de comunicantes são menores de 18 anos.
PE 62
HANSENÍASE NA INFÂNCIA
Antonio René D. de Souza; Rose Porto O. Guilhon; Francisco José D. Branco; Maria Luci Landin T. Ferreira
Centro de Dermatologia Dona Libânia- SESA-CE. Av. Pedro I, 1033, Centro. Fortaleza - CE
De um total de 878 casos novos detectados pelo serviço no ano de 2001. 78 (8.8% ) pertenciam à faixa etária de menores de 18 anos. Destes casos, 3 (0.3% ) tinham 5 anos ou menos, 19(2.1 % ) tinham 10 anos ou menos; e 64 (7,2%) tinham 15 anos ou menos. Quanto ao sexo, 47 (57,3% ) eram masculinos: e 35 (42.7% ) eram femininos. No que se refere às formas clínicas, 2 (2.4% ) eram indeterminadas (I): 37 (45% ) eram tuberculóides (T); 34 (41%) eram dimorfas (D); 8 (9,8%) eram virchowianas (V); e 1 (1,2%) foi não especificado. De acordo com a classificação operacional, 89 (47.6%) eram paucibacilares e 43 (52,4%) eram multibacilares, sendo 22 (26.8% ) portadores de baciloscopia positiva, 58 (70.7% ) portadores de baciloscopia negativa e 2 (2.4%) com baciloscopia não especificada. Quanto ao grau de incapacidade física. 67 (81.7%) tinham grau zero: 8 (9.8% ) tinham grau I e 7 (8.5% ) tinham grau II ao início do tratamento.
PE 63
HANSENÍASE NO RIO GRANDE DO NORTE UMA ENDEMIA OCULTA?
Mauricio Lisboa Nobre; Luiz Antônio Bastos Camacho; Euzenir Nunes Sarno
Universidade Federal Fluminense - Av. Marquês do Paraná, SN. Niterói - RJ
Criou-se um banco de dados com informações sobre 2.799 casos de hanseníase, notificados no Rio Grande do Norte entre 1928 e 2000. As informações dos casos registrados foram conferidas pelas suas respectivas unidades de tratamento. Ao mesmo tempo, as medidas de controle da endemia no Estado foram estudadas através de livros históricos, documentos arquivados na Secretaria Estadual de Saúde e de entrevistas com os 6 coordenadores do Programa no período de 1977 e 2000. Neste trabalho apresenta-se a série histórica da detecção de casos novos nos últimos 20 anos e comparam-se estes resultados com a detecção registrada para o país no mesmo período. O trabalho demonstrou que os coeficientes anuais de detecção registrados no Estado mantêm íntima relação com o desenvolvimento de atividades mínimas de controle da endemia. Destacam-se quatro picos importantes registrados em 1984, 1988, 1992 e 1997; nestes anos o incremento observado para este coeficiente foi respectivamente de 57%, 65%, 31% e 52% em relação aos anos anteriores: enquanto para o país o incremento no coeficiente de detecção registrado nestes anos foi de -4%, 30%, 12% e 9%. Destaca-se que no Rio Grande do Norte, após os picos observados a detecção de casos novos não cai para os níveis dos anos anteriores às intervenções, mostrando que os serviços implantados e os profissionais treinados permanecem contribuindo para o aumento da detecção nos anos posteriores. Apesar do Estado apresentar coeficientes de detecção da hanseníase ainda considerados médios pelos parâmetros do Ministério da Saúde, este trabalho aponta para uma situação preocupante com relação ao controle da doença no Rio Grande do Norte, uma vez que o rápido e contínuo aumento na detecção de casos de hanseníase, nitidamente dependentes da implantação de atividades de controle, pode apontar para a existência de um importante reservatório de casos ainda sem diagnóstico (endemia oculta).
PE 64
HANSENÍASE: REAÇÃO REVERSA X FORMA CLÍNICA
Heitor de Sá Gonçalves; Ricardo Américo de A. Lima; Ana Célia de A. Mesquita; Ruth Helena O. Menezes; Francisco José Dias Branco
Centro de Dermatologia Dona Libânia - SESA - CE. Av. Pedro I, 1033, Centro. Fortaleza - CE
Em um total de 341 pacientes que deram entrada, como casos novos, no primeiro semestre de 2001, tivemos 77 (22,5 %) com reação reversa. Destes, 23 (29,9 %) apresentavam somente reação cutânea e 54 (70,1%) manifestavam somente reação neural. Com relação às formas clínicas predominantes tivemos: 5 pacientes (6,4 %) da forma tuberculóide (T); 50 (65 %) da forma dimorfa (D); 19 (24,6 %) da forma virchowiana (V) e 3 casos (4 %) sem forma clínica especificada. Vale ressaltar a maior predominância de formas neurais reacionais, principalmente nos casos dimorfos, como descrito a seguir: (T) - 40 % cutâneas e 60 % neurais; (D) - 24 % cutâneas e 76 % neurais; (V) - 57 % cutâneas e 43 % neurais.
PE 65
HANSENÍASE, INCAPACIDADES FÍSICAS APÓS PQT, NO PERÍODO DE 1994 A 1998 EM TERESINA - PIAUÍ
Ana Lúcia França da Costa
A hanseníase, doença crônica que acomete pele e nervos periféricos, é um dos mais antigos males da humanidade. As deformidades que causa são responsáveis por estigmas e tabus que ainda hoje persistem. A contribuição da poliquimioterapia (PQT) na diminuição da prevalência da doença no mundo é aceita por todos especialistas na área. Mas, qual a situação dos pacientes que receberam alta após tratamento com poliquimioterapia em relação às incapacidades físicas? Neste estudo procurou-se investigar a prevalência e a evolução dessas incapacidades cm pacientes com hanseníase, que receberam PQT, no período de 1994 a 1998, em Teresina, Piauí, Brasil. Por meio de amostragem probabilística sistemática, constituiu-se uma amostra de 617 desses pacientes. Nesta foi aplicada um inquérito de morbidade em duas etapas: teste de rastreamento e subsequentemente avaliação clínica de incapacidade. A amostra final foi de 319 pessoas, sendo 161 do sexo masculino e 158, do feminino. As idades variavam de 6 a 94 anos, com idade média de 43, 19 anos. De 135 pacientes avaliados segundo o grau de incapacidade (OMS/1988), 30,4% apresentaram incapacidade. Destes. 63,4% pacientes tinham grau 1 e 36,5%, grau 2, de 17 pacientes, que apresentavam grau 0 no momento do diagnóstico, 88,2% evoluíram: 70,5% para grau 1 e 29,5% para grau 2. De 15 pacientes que tinham grau 1 no diagnóstico, 73,3% mantiveram-se no grau 1 e 26,7% evoluíram para o grau 2. Finalmente, de 8 pacientes que apresentaram grau 2 ou 3 no diagnóstico, 25% regrediram para grau 1 e 75% mantiveram a graduação anterior. O tempo médio (em anos) de evolução desde o diagnóstico até a avaliação atual (1994 - 2001) foi de 4.32 anos, com período máximo de 9,79 e mínimo de 2,08 anos. A prevalência de incapacidades físicas em pacientes com hanseníase após tratamento com PQT, foi de 12,8%. Houve agravamento do grau de incapacidades em 28,8% dos pacientes examinados. Os idosos, os homens, e os pacientes multibacilares apresentarem maior risco para o desenvolvimento de incapacidades.
PE 66
ILEP-ORGANISATIONS SHOULD STRIVE FOR HIGH BCG COVERAGE IN THE COMMUNITIES UNDER THEIR CARE
Johan P. Velema
Evaluation & Monitoring Service, The Leprosy Mission International. PO Box 902, 7301 BD Apeldoorn, Netherlands.
A single BCG vaccination at birth or in the 1st year of life provides partial protection against leprosy. Nine case-control studies showed a vaccine efficacy of 20% to 81%, median 60%. It is reasonable to think that these studies underestimated the true effect since in some children the BCG scar does not persist. A prospective study and 3 randomised community trials showed efficacies of 36% to 80%, median 47%. Studies from India showed 20%, 42% and 60%. The duration of this protection is at least 10 to 15 years. Some studies suggest that BCG results in a shift from lepromatous to tuberculous forms of leprosy. BCG coverage is better than 80% in most countries in Asia but lower in Africa. Coverage in local communities may be much lower than the national average.
Systematic vaccination of all newborns will reduce the child ratio but will not noticeably reduce the NCDR. Repeated vaccination and vaccination at older ages would have more impact on NCDRs but is contraindicated in persons infected with HIV and may precipitate clinical disease in those infected with M. leprae . A special programme would be needed for vaccination at oldei ages, while BCG-vaccination at birth is a standard component of the MCH services in most countries.
ILEP organisations should monitor BCG coverage and advocate for provision of standard MCH services in all communities in which they arc involved thus reducing the risk of leprosy for children up to 10-15 years of age.
PE 67
IMPLEMENTAÇÃO DA POLIQUIMIOTERAPIA NAS RESERVAS INDÍGENAS DE DOURADOS E BRASILÂNDIA-MS
Antônio Carlos Modesto; Dra. Maria Angélica Gorga; Dra. Elza Garcia Dias; Dr. Pedro Lúcio Zanúncio; Dr. Joaquim Vilela; Dr. Adriano Cangussú Silva
Gerencia de Área de Saúde de Três Lagoas-MS. Av. Clodoaldo Garcia, 280, B° Santos Dumont, 79.630-180. Três Lagoas - MS. Fone: (67) 524-8012 ou FAX (67) 524-6000. E-mail: acm3l@terra.com.br
Trabalho realizado nas Aldeias Bororó e Jaguapirú, da Reserva Indígena de Dourados-MS e na Aldeia Ofaié-Xavante, no município de Brasilândia-MS.
O objetivo principal deste trabalho foi o de implementar a PQT nas Reservas Indígenas de Dourados e Brasilândia-MS. Muitos fatores contribuem para o limitado acesso das comunidades indígenas aos serviços de saúde: dificuldades causadas pela localização geográfica, problemas culturais, sociais e carência de profissionais de saúde treinados para suspeitar de casos novos de Hanseníase em seu meio. A estratégia foi a de treinar agentes de saúde indígenas, da FUNASA, professores indígenas, auxiliares de enfermagem dos programas locais, para atuarem na detecção precoce de casos novos e na administração da PQT nos casos confirmados mediante avaliação médica, realizada através de mutirões de atendimento médico. Foram treinados na Reserva Indígena de Dourados-MS: 10 Agentes Comunitários Indígenas de Saúde, 01 agente de saúde da FUNASA, 02 enfermeiras do PSF Indígena, 01 estagiária de enfermagem, 01 coordenador pedagógico da Escola Indígena Jaguapirú, 10 professores indígenas de 5 Escolas Indígenas locais. Ao todo foram 25 pessoas treinadas nesta Reserva. Na Reserva Indígena de Brasilândia foram treinados: 04 agentes de saúde da FUNASA, 03 servidores do Programa de Hanseníase local, 01 funcionária da Secretaria Municipal de Saúde local, 02 Agentes Comunitários de Saúde, 02 lideranças indígenas da Aldeia Ofaié-Xavante, ao todo 12 pessoas treinadas. Foram detectados 1 caso da forma clínica tuberculóide na Reserva Indígena de Dourados-MS (Incidência de l,4/10.000hab.)e 3 casos da forma clínica indeterminada na Reserva Indígena de Brasilândia-MS (Incidência de 576,9/ 10.000 hab.)
PE 68
IMPORTANCE OF CONTACT CHECKING FOR CASE FINDING OF LEPROSY IN A LOW ENDEMIC SITUATION
M.A. Hamid Salim1; Priojit Kumar Nandi1; Satyajit Naha1; Amir Ali1; Declercq Etienne2
1. Damien Foundation Bangladesh. House 33, Road 43, Gulshan II, Dhaka, Bangladesh.
2. Damien Foundation Belgium. Boulevard Leopold II. 263, 1081 Brussels, Belgium.
Introduction: Contact checking is the only active case finding method used by most of the Leprosy Control programmes. However, there is no definite guideline for how long contact survey should be continued. Damien Foundation Bangladesh follows the strategy to check the household contacts of smear positive cases once in a year for 5 years and for other cases only once. The question arose whether 5 years contact checking is necessary?
Material and methods: The results of the annual examination of household contacts of smear positive patients detected in 1995 in the greater Mymensingh district have been analyzed retrospectively. Out of 135 smear positive patients, the contacts of 129 cases could be examined for 5 successive years. Among these 129 cases. 86 had a Bacillary Index (BI) of 4+ or more.
Results: The data show that a total of 5,518 contact examinations were done in 5 years. The mean case detection rate among contacts was 87/10.000 population per year, with a maximum of 202 in 1st year and 134, 130, 21 and 54 respectively in the following years. The case detection rate was in average five times higher among the contacts of cases with a BI of 4+ or more, compared to those of smear positive cases with a BI of 3+ or less.
The case detection rate was 0.22/10.000 only in the general population in 1995.
Conclusions: The above data show the usefulness of the regular examination of contacts of smear positive leprosy patients. Although incidence seems to decrease over time, it remains high even 4 years after the diagnosis of the index case. Since it is not possible to extend the period of active contact examination indefinitely, it is extremely important to take benefit of these examinations to increase awareness on lhe early signs of leprosy among lhe contact population.
PE 69
INCIDÊNCIA E PREVALÊNCIA DE HANSEN (ASE NA CIDADE DE ARACAJU. NO ANO DE 1999
M. L. N., Pedrini3; M. C. P., Santana2,3; J. F. de, Santana1,2; M. S. de LIMA1,2
1. Fundação Hospital São Lucas: Aracaju-SE.
2. Universidade Federal de Sergipe.
3. Laboratório de Referência de Micobactérias: Instituto Parreiras Horta / Rua Campo do Brito, 551, Bairro São José. 49020-380. Aracaju-SE
Considerando a situação epidemiológica da hanseníase no mundo e considerando a inexistência de dados coletados e tratados em relação a casos novos e antigos de hanseníase no município de Aracaju-SE, este trabalho propôs conhecer o perfil de incidência e prevalência da referida patologia neste município, no ano de 1999. Para isso, adotamos os parâmetros: sexo, faixa etária e forma clínica predominante no diagnóstico. As fontes de informações foram os prontuários de pacientes cadastrados no Programa Estadual de Controle da Hanseníase e dados do Laboratório de Relerência de Micobactérias do Instituto Parreiras Hortas (Lacen-SE). O método utilizado foi o quantitativo, ao qual aplicamos o leste estatístico do quiquadrado (χ2) para responder às seguintes hipóteses formuladas: A ocorrência das formas clínicas da hanseníase não está associada ao sexo, As formas clínicas de hanseníase ocorrem independentemente do local onde as pessoas moram; Não há associação entre a idade e as formas clínicas de hanseníase. Escolhemos o teste quiquadrado (χ2) pela possibilidade de verificar a significância dos afastamentos entre as freqüências observadas nas amostras e as freqüências esperadas se as hipóteses nulas fossem verdadeiras, e porque nos interessava verificar a proporção de indivíduos com o atributo hanseníase em uma dada população. Concluímos que não existe associação quanto a incidência u prevalência da doença em relação às formas clínicas, sexo e faixa etária na amostra analisada
PE 70
INFLUENCE OF MULTIDRUG THERAPY ON SMEAR POSITIVE CASES IN TALUKA PANVEL
P.N.Gogate; U.H.Thakar; S.S.Naik; Pratibha Kathe
Kushtarog Niwaran Samiti, Shanlivan, Taluka Panvel. Acworth Leprosy Hospital for Research, Rehabilitation and Education in Leprosy. Wadala, Mambai -400031 INDIA.
Punvel Taluka has its unique features, such as surrounded by costal and hilly area where the residents are uneducated, in low socio-economic group of tribal and fishermen community and generally meales among them are out of homes six months in year to earn their liveligood. At the other hand there are several developed and developing big industrial packets in same Taluka, where residents around are highly educated, economically well setteled but under the influence of constant influx of semi and unskilled persons.
MDT was initiated in Panvel Taluka in 1990. The comparison of newly detected cases in pre and post MDT era in centres different regional and population set up was made. During last 5 years (1988-1992), total 1597 new cases (234 MB and 1363 PB) registered by conventional methods of SET. The analysis showed that there is a no change in child rate, deformity rate and smear positive cases rate in newly detected cases in pre and post MDT era but bacterial quantum based on B.I.of smear positive cases (n=166) reduced considerably after MDT and brought to the negligible state irrespective of regional and population variation. It is further noticed that the results are more impressive in area of educated and stable population.
PE 71
INTEGRATING DATA FROM HEALTH INFORMATION SYSTEM
Tadiana Maria Alves Moreira1; Elizabeth Moreira dos Santos2; Vera Andrade3
1. Secretary of Health. Rio de Janeiro State.
2. National School of Public Health
3. WHO
Epidemiological surveillance in leprosy is based in the evaluation and monitoring of the activities of the Brazilian program. It includes epidemiological and operational indicators constructed from data of the National System of Notilicable Diseases (SINAN) collected at the local level. Analysis of these indicators are used to the understanding of the epidemiological pattern of the endemic and also to subsidize managerial interventions in the Leprosy Control Program. The information related to the indicators by each state of the federation, which represents the foundations of the control, are analyzed from tabulations of aggregate data that are discussed in the text. In practical terms, there is not yet basic information such as the number of leprosy patients assisted by the SUS/MS, as well as the financial expenditure on these patients by the Federal Government, faking into consideration that the Notification Form is the only source of information existing today, it is observed some limitation regarding the type, quality and analysis of these data, making it difficult to know the concrete situation of the endemic in the country.
The aim of this study is to stress the importance of information related to medical services (SIA/SUS, SIAB, SIH/SUS and SIM) as a contribution to the epidemiological surveillance of leprosy. It is discussed also the need for updating data from health services to attain a systematic situational diagnosis, with periodical evaluation and patroni/ation in order to reorient decisions al the local level.
PE 72
INTEGRATION OF LEPROSY IN GENERAL HEALTH SYSTEM IN BIHAR
Dr. P. Krishnamurthy; Dr. Bishwanath Prasad; Dr. T. Prabhakar Rao. Dr. G. Ramakrishna Raju and Dr. P. Vijayakumaran
Damien Foundation India Trust
Prevalence rate of leprosy in Bihar was 29 and 15 in June 1998 and 2000 respectively. At present 29% of caseload of India is from Bihar. National Leprosy Eradication Programme in Bihar Stale was carried out by vertical staff only till 1998. After detection of 2,05,569 new cases in MLEC-I during 1998 and 1,11,609 new cases from on going activities, on conclusion of State level conference of Civil Surgeons and District Leprosy Officers for strengthening NLEP. Govt, of Bihar issued instructions for one day weekly leprosy clinic at all Health facilities on Tuesday and Drug distribution by General Health staff at DDP. (5000 Population) where vertical staff is not posted to ensure treatment compliance of all leprosy cases under treatment.
Keeping in view W.B assistance till March 2004 and good number of cases detected by on going regular performance and campaigns. Govt, of Bihar decided and issued orders in August 2001 to integrate leprosy work in General Health system (defining the work of each category of General Health and NLEP workers). Leprosy patients to be examined and treated at all health facilities on all working days in OPD and follow up treatment to continue through near by HSC on fixed day every week.
So far 22 districts are having Damien Foundation India Trust Support team. Out of these 22 districts 33.48% of Health facilities and 31.12% of HSCs have been integrated for leprosy work till December 2001 and complete integration of all health facilities and HSCs is expected by 2003.
PE 73
INTEGRATION OF LEPROSY SERVICES: EPIDEMIOLOGICAL IMPACT AFTER A YEAR OF ACTIVITY
Sunil Settinayake
Director. Anti-Leprosy Campaign, Central Leprosy Clinic. Room 21, O.P.D., General Hospital, Colombo 8, Sri Lanka
Leprosy integration into the general health services was completed in February 2001 and is already starling to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventive health services had to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities.
Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. The new case load rate has increased from 0.89/10.000 inhabitants in 2000 (1700 new cases) to 1.2 /10.000 in 2001 (2398). The prevalence has increased from 1.158 in 2000 (0.6/10.000 inhabitants) to 1,583 (0.8 per 10.000 inhabitants). These figures have been corrected lor about 5 % of re-registration. Almost every district has registered an increase of case detection, though it was more significant in low endemic areas.
A few areas still need more attention, such as integrating MDT supplies within existing systems as well as improving the flow of information. The paper will focus primarily on the epidemiological impact of integration, experience with the Mow of information and future plans to further simplify the system.
Integration has definitely brought treatment closer to patients throughout the country, and is paving the way for the sustainable elimination of leprosy.
PE 74
LA LEPRA EN CIUDAD DE LA HABANA, CUBA AÑO 1997-2001
Dra. Olenia Hernández Gutiérrez; Dra. María Elena Alonso Gómez; Dra. Olenia Pesant Hernández
Centro Provincial de Higiene y Epidemiología. Ave. 31 # 7617 Entre 76 y 82 Marianao CP: 11400 Cuidad de La Habana. Cuba
Se analiza la situación de la endemia de la lepra en Ciudad de la Habana, capital del país. Donde la detección de casos nuevos en el último lustro 1977-2001, ha ido descendiendo, como promedio se detectaron 48 casos nuevos en los primeros 5 años y 27 en los últimos cinco. La ciudad tiene tina población de 2181395 hbtes. distribuidos en 15 municipios, siendo la Región Sur, (Arroyo Naranjo, 10 de Octubre y Boyeros) la de mayor detección y la liste (Cotorro) la más baja.
Finalizando 2001 con 34 enfermos y una tasa de prevalencia 0.2 × 104 habitantes, se reduce la tasa de 1993 en 4 puntos.
Las acciones del programa de control están descentralizadas e integradas en la Atención Primaria de Salud (APS), los enfermos y población en vigilancia son atendidos por medico y enfermera de la Familia, alcanzando a examinarse el 80.1% de la población total de riesgo.
En las estrategias actuales, Post eliminación hay sostenibilidad de las acciones, dirigidas fundamentalmente a la capacitación y desarrollo de recursos humanos (APS) y fortalecimiento del componente educativo del programa para lograr incrementar el diagnóstico precoz, y la interrupción de la transmisión como objetivo final.
PE 75
LEPRA EN GUINEA ECUATORIAL. SITUACIÓN EPIDEMIOLÓGICA 1999-2001
Dr. José Ramón Gómez Echevarría; Fátima Moll Cervera. Fisioterapeuta; J. M. Hernández; P. Simarro; J. M. Rodríguez; J.R. Franco; S. Elé
Sanatorio San Francisco de Borja.Fontilles. 03791 FONTILLES-VALL DE LAGUART (ALICANTE). Telf. 96 558 33 50. Fax. 96 558 33 76. E-mail: sanatorio@fontilles.org
Tras tres años de trabajo colaborando con el Ministerio de Sanidad y Bienestar Social de Guinea Ecuatorial, se consigue un Censo de casos nuevos, en tratamiento y enfermos discapacitados. Se realiza una valoración por Distritos, tanto en la zona continental como en la zona insular, reflejando las carcterísticas epidemiológica de los pacientes.
Se realiza una valoración comparativa con Censo de años anteriores.
Se recogen las principales características de los enfermos discapacilados. para lo cual se realiza una exploración neurológica simplificada.
PE 76
LEPROSY ELIMINATION PROGRAM: EPIDEMIOLOGICAL TREND IN EAST KALIMANTAN
Dr. Asik (nlrkaltim@hotmail.com and kingasik@hotmail.com )
Objective: to study the epidemiological trend of leprosy in East Kalimantan province from 1990 to 2000.
Material and Method: data were obtained from compilation of regular quarterly reports in line to lhe operational definition of WHO.
Result: a total of 1254 cases detected during 1990 to 2000, in which 152 cases of them were children, accounting for 12.12% of all cases. For disability grade-2 of the WHO grading system, there were 230 of cases detected (18.34). For the clinical classification, 891 were MB (71.05%) and 363 were PB (28.95%). About 56.70% of cases were found through active case finding. At the end of the year 2000, the prevalence rate was 0.86 per 10000 with case detection rate of 5.54 per 100000 populations. The peak of prevalence (3.61 per 10000 population) was occurred in 1992 then decreased annually till 0.73 per 10000 populations in 1998 and then slightly increased (1.04 per 10000 populations) in 1999. Meanwhile, the peak of detection was occurred in 1992 (9.93 per 10000 populations), then decreased till at the lowest level (2.32 per 100000 population) in 1995. In 1996, the detection tends lo increase and reach lhe second peak at 1999 (6.88 per 100000).
Conclusion: this study figured out that leprosy control in East Kalimantan province WHO target of elimination by year 2000 at provincial level, but at district level, there was uneven distribution. There were 5 of 12 district did not reach the target. The special effort should be addressed to reach elimination status at every district.
PE 77
LEPROSY ENDEMY CHARACTERIZATION IN UBERLÂNDIA-MINAS GERAIS, BRAZIL, 1996-2000
Goulart, I.M.B.; Barbosa, F.M.; Chaves, J.G.M.: Guedes, J.T.; Muni z D.L.O.; Netto, J.C.; Queiroz, L.B.; Silva, Y.A.
Centro de Referência Estadual em Hanseníase / Dermatologia Sanitária Faculdade de Medicina / Universidade Federal de Uberlândia. Av. Pará, 1720, CEP 38400-902. Uberlândia - MG. Brasil. Fax: +55-343218 2349: E-mail: imbgoulart@ufu.br
Aiming to eliminate leprosy as a public health problem in Brazil until 2005, the SUS (Unique Health System) in each city, with the purpose of decentralization of leprosy's control actions, has the necessity of knowing the aggravation through operational and epidemiological indicators and prevalence estimates undetected, in order to plan new strategies and evaluate their results, respecting local and regional realities. To characterize the leprosy endemy and estimate the occult prevalence in Uberlândia, a retrospective analytic study was realized with a survey of 613 leprosy patient's records during the period from January, 1996 to December, 2000, by SINAN (Complaint's System of Information and Notification).
The results showed an occult prevalence estimative of 146 cases until 2000, increasing the official prevalence from 4,47/10.000 inhabitants to a real prevalence rate of 7,39/10.000 inhabitants. The sanitary districts with higher occult prevalence estimative also demonstrated an increase of the detection coefficient in people under 15 years old and coincided with those areas where predominated the old disease focus. With an identification of prioritary areas, technical and operational factors were listed as factors which prevent the leprosy control. Therefore, it's craved to touch the SUS managers in the city, in the direction of proposing a health policy which prioritizes the quality of assistance and its hierarchy by a resolutive capacity consolidated in the health professional's competence and in the development of articulation and society mobilization mechanisms to eliminate leprosy until 2005.
PE78
LEPROSY IN CHILDREN - A RETROSPECTIVE STUDY OF CHILD CASES DETECTED IN NORTH EASTERN SUBURBS OF GREATER MUMBAI FROM 1995 - 2001
Sachin, R. Salunkhe; Samy, A. A.; Joy, M.; Dewarkar, P. R.; Vincent, A. K.
Alert-India; Association For Leprosy Education, Rehabilitation & Treatment - India.
B-9 Mira Mansion, Sion (West), Mumbai - 400 022. India.
Early detection of large number of child leprosy cases is one of the significant indicators of the continued presence of leprosy infection in a given geographical region. This study is based on the data of child leprosy cases detected over a five year period (1995 to 2001) at ALERT-INDIA's urban leprosy control projects in North Eastern suburbs of Mumbai.
The cases were studied from the epidemiological and clinical aspects as well. Case detection was initially done through School Surveys and Mass Surveys. As high as 36% were child leprosy cases. Follow-up examination of the family contacts of these children revealed that sizeable number of them were members of multiple leprosy case families.
Critical analysis of the data confirms the persistence of the chain of transmission as a primary factor leading to the appearance of new cases in the community.
PE79
LEPROSY SITUATION IN ENDEMIC STATES OF INDIA AT THE THRESHOLD OF ELIMINATION
Sathish Kumar, E; Subramanian, M.; Showkath Ali, M.K
Central Leprosy Teaching & Research Institute. Tirumani, Chengalpattu - 603 001, Tamil Nadu, India.
Although there is no reduction of NCDR in India, there is a significant reduction observed in two endemic states of Andhra Pradesh and Tamil Nadu. The ratio of PR and NCDR is declining and reveals at the elimination could be reached even when NCDR is at the higher level i.e. 4 to 5 per 10000 population with SSL proportion among new cases above 50%.
The significant number of cases detected in Bihar and Orissa during MLEC reveals that the lacunae in operational activities of new detection would result in a large number of undetected cases in the community. The voluntary reporting hovering about one-third only. This underscores the need for relying on active case detection for breaking the transmission, so has to achieve sustained elimination of leprosy.
The influence of socio-economic factor on continued occurrence of leprosy could not be ruled out. One of the reasons for the failure of models that projected the decline of leprosy by 2000 A.D. could be due to exclusion of economic status and health care seeking status as contributory factors.
The operation efficiency should be ensured by complementing NLEP with Health Management Information System (HMIS) at State/National level (Macro) and at selected district level (Micro) to gain in-depth knowledge of leprosy parameters especially on double entry / recycling of case.
In view of this situation, NLEP should adopt a more realistic approach for declaring the attainment of elimination level.
PE 80
NEMATÓIDES INTESTINAIS: AUMENTO DO RISCO PARA HANSENÍASE MULTIBACILAR?
Lucia Martins Diniz; Eliane Zandonade; Reynaldo Dietze; Fausto E. L. Pereira; Rodrigo Ribeiro-Rodrigues
Núcleo de Doenças Infecciosas, Centro Biomédico, Universidade Federal do Espírito Santo. Av. Marechal Campos, 1468, Maruípe, Vitória - E.S.
Introdução: Os nematóides intestinais induzem uma imunomodulação no hospedeiro caracterizada por predomínio da ativação de células Th2 e redução de algumas atividades das células Th1, o que pode interferir no curso de outras doenças, como na hanseníase, que para evolução benigna depende do estímulo da resposta Th1.
Objetivos: Estudo caso-controle para verificar a presença de nematóides intestinais em pacientes portadores de hanseníase atendidos em um centro de saúde.
Pacientes e métodos: Revisão de prontuários de 477 pacientes portadores de hanseníase com anotação de um resultado de exame parasitológico de fezes. Como controles: prontuários de 470 pacientes atendidos no mesmo posto, período e faixa etária, sem hanseníase, e com um resultado de exame parasitológico de fezes.
Resultados: A freqüência de nematóides intestinais foi maior nos pacientes com hanseníase do que nos controles, porém a diferença estatisticamente significante foi quando comparamos as formas multibacilares com as paucibacilares e os controles.
Conclusões: Os resultados sugerem uma associação significativa entre a presença de nematóides intestinais e as formas multibacilares da hanseníase, talvez possibilitando uma imunomodulação exercida pelos parasitas intestinais, favorecendo a progressão da hanseníase para as formas multibacilares.
PE 81
NON-CONDITIONAL LOGISTIC REGRESSION ANALYSIS OF RISK FACTORS ON DISABILITIES OF LEPROSY
Yuejun Shi; Shunpeng Song; Zhenguo Zhang; et al.
Dalian Provincial Institute of Dermatology, Dalian 116021, China
Objective Analysis of factors impacting on the disability of leprosy and provide the scientific basis for formulating the preventive strategies.
Methods Based upon the individual records of the living leprosy cases were collected by local leprosy workers of liaoning, using non-conditional logistic-regression analysis model to analysis effective factors on disability of leprosy.
Results the results of single factor non-conditional logistic regression analysis are: leprosy type, marriage, education, native place, standard of living, the reaction. The results of multiple factor nonconditional logistic regression analysis are: native place, standard of living, the reaction, leprosy type.
Conclusion the reaction, leprosy type, native place, standard of living, can signilicantly effect the disability of leprosy. It is very effective t o prevent the disability of leprosy through controlling the reaction, treating the patient in time, made their life rich and increasing the standard of living to made economical rehabilitation.
[Key words] Leprosy Disability non-conditional logistic regression analysis
PE 82
PERFIL DA HANSENÍASE EM ALFENAS (MG)
Avani Soares Almeida Magalhães; Cláudio de Lélis Filgueira de Souza; Wendel Antonio Fagundes; Elisa Oliveira Gonçalves Antunes; Mariza Bárbara Rissuto
Serviço de Hanseníase da S.M.S. de Afenas (MG). Pça. Dr. Fausto Monteiro, 300, Centro. Alfenas - MG. CEP 37130-000.
Os autores apresentam um estudo retrospectivo de 100 pacientes ingressos no Serviço de Hanseníase da S.M.S. de Alfenas (MG) no período de outubro de 1997 a maio de 2001. Tal estudo mostra a característica da hanseníase nesta região do estado de Minas Gerais, tais como incidência de homens 58% sobre 42% de mulheres e adultos 96% sobre 4% de crianças menores de 15 anos de idade. Nosso estudo mostra também outros dados epidemiológicos como a média baciloscópica, exames complementares, esquemas terapêuticos empregados e reações como eritema nodoso e neurite.
Motivo da Apresentação: Demonstração de que pequenos serviços públicos, com grandes esforços, estão fazendo para a eliminação da hanseníase em Minas Gerais.
PE 83
PERFIL DO DOENTE DE HANSENÍASE NO MUNICÍPIO DE JOÃO PESSOA - PB
Leila de Cássia Tavares da Fonseca; Clélia Simpson de Miranda
O presente trabalho descreve um estudo exploratório descritivo com abordagem quantitativa, realizado em João Pessoa, entre Abril e Maio de 2000, com o objetivo de traçar o perfil do doente de Hanseníase no município estudado. A amostra foi coletada a partir de 101 prontuários de caso notificados em pacientes no ano 1999, no Hospital Clementino Fraga. O estudo evidenciou que no município estudado os homens adoecem mais de Hanseníase do que as mulheres, com uma percentagem de 54% e 46% respectivamente, atingindo mais os casados com 547 e em seguida os solteiros com 41%; já os viúvos com 5%. Considerando o parâmetro grau de instrução, verificou-se que 507 dos pacientes da amostra estudada, possuíam o nível fundamental, bem como, com relação a faixa etária, os resultados revelam um índice altíssimo na população entre 25 e 60 anos com mais de 60% dos casos. Quanto aos bairros mais atingidos, a relação com a doença pesquisada é equitativa, a exceção dos bairros do Cristo Redentor, Mangabeira e Centro.
PE 84
PERFIL EPIDEMIOLÓGICO DA HANSENÍASE
Heitor de Sá Gonçalves; Ricardo Américo de A. Lima; Ana Célia de A. Mesquita; Francisco José D. Branco; Maria Luci Landin T. Ferreira
Centro de Dermatologia Dona Libânia - SESA - CE. Av. Pedro I. 1033, Centro. Fortaleza - CE.
Em um total de 878 casos novos detectados pelo serviço em 2001, 82 ( 8.8 %) tinham menos de 18 anos; 305 (34,7 %) tinham entre 18 e 38 anos; 377 (42,9 %) tinham entre 39 e 65 anos: e 114 (13.6%) tinham mais de 65 anos de idade. Quanto à forma clínica, 41 (4,6 %) eram indeterminadas (I); 234 (26,6 %) eram tuberculóides (T); 452 (51,4%) eram dimorfas (D); 148 (16,8 %) eram virchowianas (V); e 3 (0,3 %) não especificadas. Quanto ao grau de incapacidade, 452 (51,5 %) tinham grau zero; 151 (17.2%) tinham grau I; 47 (5,4%) tinham grau II; e 228 (26 %) tinham grau de incapacidade física não-avaliado. Quanto à baciloscopia, 345 (39.3 %) foram positivos; 500 (57%) foram negativos; e 33 (3.7 %) foram não especificados.
PE 85
PERFIL EPIDEMIOLÓGICO DA HANSENÍASE NO MUNICÍPIO DE TAUBATÉ - SP NO ANO DE 1999
Fátima de Oliveira Rabay; Lays Patryce Santos; Samuel Henrique Mandelbaum; Daniela Katayama; Erico Pampado Di Santis
Universidade de Taubaté. Av. Granadeiro Guimarães, 270, Taubaté - SP
O Brasil ocupa o segundo lugar do mundo em número absoluto de casos de Hanseníase. Em reunião promovida pela O.M.S., em 1999, o Brasil assumiu novo compromisso de reduzir os coeficientes de prevalência a níveis inferiores a um paciente em cada 10000 habitantes até o final de 2005.
Avaliou-se, retrospectivamente, a situação epidemiológica e operacional do controle da Hanseníase no Município de Taubaté - SP no ano de 1999.
Detectou-se coeficiente médio de prevalência (3.24 / 10000 habitantes) e alto coeficiente de detecção anual de casos novos para o ano de 1999 (1,27 /10000 habitantes). Cerca de 83,507 eram formas multi-bacilares e o esquema terapêutico predominante foi o da Poliquimioterapia em 80,037 dos pacientes. Dos que receberam alta por cura e foram avaliados quanto à incapacidade, 20.83% apresentaram graus II e III da mesma.
É proposto o atendimento pelas U.B.S., por estarem mais próximas da comunidade, oferecendo oportunidade de diagnóstico precoce e tratamento para todos os doentes. Encaminhamento a serviços de nível secundário e terciário seria feito para detecção diagnóstica mais apurada e na ocorrência de complicações.
PE 86
PRELIMINARY STUDY OF LEPROSY AMONG BRAZILIAN JAPANESE ORIGIN PEOPLE, IN SÃO PAULO, PARANA (BRASIL) AND LEPROSY RESEARCH CENTER (NIID) -JAPAN
Mitie Tada L.R.F. Brasil1; Lúcia E. Takaoka2; Norihisa Ishii3
1. Centro de Vigilância Epidemiológica - SES-SP -Brazil - dvhansen@saude.sp.gov.br
2. Sociedade Filantrópica Humanitas - PR - Brazil - sfhs@asahinet.com.br
3. Leprosy Research Center. NIID - Japan .
In the 90's decade, the emigration of Brazilian of Japanese origin people to Japan, in order fo work, has been in large number, netting 250.000 persons in the year 2000. It is a question of some concern, considering that Brazil is a leprosy high endemic country and Japan is considered a residual endemic country of leprosy. According to the Leprosy Research Center data, 56 new cases were diagnosed in Japan among Japanese people since 1993 up to 2000, including Okinawa Islands. In the same period of time, 75 new cases were detected among foreign persons and among them 33 were Brazilians. In Japan the notification is made without case identification, so it is impossible to find out if these cases are also in Brazilian Files. In order to measure the actual magnitude of the leprosy among the Brazilian people of Japanese origin in Brazil, a search was performed in São Paulo and Paraná States. These two states probably have the most of Japanese origin people living and may provide the most of emigrants to Japan, also. In the São Paulo State Surveillance System, three different files were searched, to cover the period since 1982 up to 2000 (19 years). Those informations are not easily accessible and it demanded a lot of manual work. After all, 578 notified cases were founded and 533 of them were new cases. An annual notified average of 28.05 new cases. The clinical classification was: 118 indeterminate, 147 tuberculoid. 68 bordeline. 140 lepromatous and 60 none classified. The information of Parana State was accessed using the SINAN -DOS data file, which has 202 cases recorded since 1954 up to 2000. The clinical classification was: 38 indeterminate, 65 tuberculoid, 26 bordeline, 71 lepromatous and 2 non classified. The coefficients were not calculated because the data about the number of Japanese descendents is not reliable. More details of this study will be presented during the Congress. The authors intend to continue with the search in order to know more about the transmission among these people in spite of the low number of cases (less than 1% of the total files researched). The problem exists and it seems to be worthy of more studies.
[Key words] - leprosy, surveillance system
PE 87
PREVALÊNCIA OCULTA DA HANSENÍASE NA DIRETORIA DE SAÚDE DE BELO HORIZONTE
Lana, F.C.F.; Melendez, J.G.V; Araújo, M.G.; Magalhães, E.G.
Escola de Enfermagem da UEMG, Av. Alfredo Balena, 190, Santa Efigênia. CEP 30130-100. Belo Horizonte - Minas Gerais - Brasil. xicolana@enf.ufmg.br
Esta investigação teve como objetivo analisar a prevalência da hanseníase na Diretoria Regional de Saúde de Belo Horizonte (DRS-BH), no período de 1995 a 1999. Trata-se de estudo epidemiológico, descritivo, que utilizou dados das fichas de notificação dos casos residentes na DRS-BH. As taxas de prevalência e detecção tem sofrido queda nos últimos anos, o que poderia significar uma tendência declinante da doença; entretanto, deve-se analisar se não se trata de problemas operacionais na detecção de casos novos, já que observamos que há uma prevalência oculta da hanseníase nos municipios da DRS-BH, sendo significativa em Belo Horizonte, Betim, Contagem e Santa Luzia: com estimativa, nos últimos 5 anos, de 247, 105, 82 e 58 casos, respectivamente. Os 492 casos que deixaram de ser diagnosticados são responsáveis por 82% da prevalência oculta da DRS-BH. O alto percentual de casos notificados com grau de incapacidade confirma que há prevalência oculta na região e que o diagnóstico está sendo tardio, podendo comprometer as metas de eliminação da hanseníase como problema de saúde pública, sendo necessário, intensificar as ações de controle, especialmente, exame de contatos.
PE 88
PROGRESS ON FIELD TREATMENT OF REACTION IN NORTHEASTERN STATES OF NIGERIA
Philip Patrobas
Office of the Representative, Netherlands Leprosy Relief, PO Box 759, Bukuru-Jos, Plateau State. Nigeria.
Efforts of the National Tuberculosis and Leprosy Control Programme in Nigeria (NTBLCP) and the Non-Governmental Organization (NGO) have resulted in a dramatic reduction in the registered prevalence 0.8 per 10.000 in 2001. Despite this achievement, leprosy remains a public health problem due to the back load of disabled ex-patients and stable Case Detection Rate (CDR) 0.7 per 10.000) over the last five years. Disability grate 2 among new patients is more than 10%.
Complications of leprosy (reactions and nerve damage) remain the most important causes of impairment and disability in Nigeria. It was the policy that all patients with reactions be referred to the referral hospital. Due to distance and other personal reasons, most patients when referred do not arrive at the hospital. It is well documented that about 15 - 30% of leprosy registered for MDT treatment develop reactions leading to nerve impairment or disability. No study has been carried out to ascertain the level of reactions in the field in 13 Northern states of Nigeria. It is also well documented that majority of patients who develop nerve function impairment after registration do so in the first year (about 809, reported in Indonesia and 67 - 91% in Bangladesh). As a result of the problems encounter by the patients and the field programme, the policy of treating reaction patients only in the hospitals was changed and field treatment of patients with steroid was started in 1998. This is aimed al making steroid treatment more accessible to patients.
The objective of this paper is, to access the actual magnitude of reactions in the field, to determine the actual number of patients who started steroid treatment and completed according to the standard guideline, to identify problems encounter with implementation of the field treatment with steroids, to make recommendations on ways of improving field treatment with steroids.
The method used in the study was the evaluation of reports received from the field, quarterly reports sent to the office by the programme officers, interviews with some leprosy control staff and Primary Health Care staff on their experiences.
In the period under study (1998 -2000). 13.148 new patients were treated with MDT out of which 581 patients were treated in the field with steroids. Of the total patients reported, 62% were males and 38% were females. Out of the 581 patients that were treated with steroids, treatment results were obtained for only for 499 patients showing 459 (91%) had their condition improved with steroids (reactions subsided or disability reversed) while 40 (9%) had their condition remain the same or had their condition deteriorated. Those who deteriorated were referred to the referral hospital for further management by the Medical Officer. Out of the results analysed, 201 (40% ) were females and 298 (60% ) were males. Treatment completion and improvement in condition was better with the females (95%) than the males (83.9%).
PE 89
PROGRESS TOWARDS SUB-NATIONAL LEPROSY ELIMINATION, BANGLADESH
Dr. Jalal Uddin Ahmed. Dr; Safir Uddin Ahmed; Dr. Vikarunnessa Begum; Dr. A.N. Maksuda; Dr. S.A. Hadi; Dr. A.H. Salim
National Leprosy Elimination Programme, Directorate General of Health Services. Leprosy Control Institute it Hospital Compound. Mohakhali, Dhaka 1212, Bangladesh.
Bangladesh has made considerable progress in achieving the goal towards elimination of leprosy at National level. At the end of December 1998, the registered prevalence of the country for the first time fall below 1/10.000 population and become 0.87 and further declined to 0.66 at the end of December 2001. Virtually Bangladesh have achieved the goal of elimination of leprosy al National level two years ahead of WHO target date. One of the major indicators of efficiency of case finding, the visible deformity/disability rate declined from 21.40% in 1993. 7% at the end of December 2001.
Eight NGOs are assisting the Government in MDT implementation in 29 districts (231 upazilas) of the country and has created an exemplary partnership record, where the resources from the Government and NGOs are pooled and optimally utilized. The NGO collaborative areas are endemic and contribute over 80% of the country caseload at any point of time. From 1985 to December 2001 a total of 130555 cases have completed MDT and declared cured. As of end of December 2001, 8540 cases are under treatment and the estimated prevalence of leprosy is about 12.000. The gap between the estimated and registered cases has reduced and is expected to reduce further each year.
Leprosy is not evenly distributed in Bangladesh in conformity with world pattern. The leprosy endemicity varies widely within the country. Eight (8) northern districts of Rajshahi division, two metros - Dhaka and Chittagong and 2 (two) district of Chittagong division - total 12 (twelve) areas contributing over 70% of the total cases and still having prevalence > 1/10,000 population. After achieving the elimination goal at National level the major attention of NLHP is to achieve elimination at sub-national level. More details including strategic plan 2002 - 2003 will be presented
PE 90
"REACHING THE UN-REACHED" IN RANDOMLY SELECTED URBAN AREAS OF ORISSA - A STRAETEGIC INTERVENTION BASED COMMUNITY PARTNERSHIP
Dr. D.N. Nayak; Dr T.P. Patro
DANLEP, Orissa, 24 VIP Area. Ekamrakanan Road, Nayapalli, Bhubaneswar, Orissa, India
Introduction: Orissa is situated along the east coast of India with a population of 36.7 million with 13% urban population. Leprosy elimination looks nearly achieved in Orissa. But if we analyze leprosy elimination parameters for the urban segments, it seems highly improbable to achieve this. This is because the PR in urban areas is roughly double ( 13.7/10000) the over all PR of the state (6.9/10000: This could be due to inadequate health infrastructure at grass root level to address the health issues in rapidly growing urban and periurban slums; lack of coordination between available service providers and systems. This needs timely interventions.
Objective:
- To reach the un-reached population involving decision makers, health providers and community leaders and other allied players working in developmental sectors to facilitate leprosy elimination process.
Strategy:- Team (consensus) building of all players and partners to gain their commitment and enhance level of motivation.
- Capacity building of all health providers.
- Sensitization of key players.
- Door to door search with community participation.
- Strengthening the institutional capacity of health facilities lo promote voluntary reporting and integrated MIS.
- Follow for six months.
Activities and Process:- Identification and interaction with all the major stakeholders have been done in five urban areas.
- Team building workshops have been conducted in three urban areas and other activities are in progress in remaining areas.
Conclusion:
- Preliminary results show very good participation from decision makers, health providers and other players including community leaders.
- This approach will definitely help us to reach the under privileged sections of the community.
- Replication will he possible after impact assessment.
PE 91
RECIDIVAS NO CENTRO DE REFERENCIA DE ESPECIALIDADES METROPOLITANO NO PERÍODO DE JAN/99 A FEV/02 - CURITIBA/PR
Stahlke, Ewalda V. R. S.
Secretaria Estadual da Saúde do Paraná. R Barão do Rio Branco 465 -1° andar. 80230 - 010. Curitiba - Pr, Brasil. Telefone: (41) 322 2299 R: 258 e 262 6374. Fax: (41) 322 2299 e 262 63 74
A recidiva nos pacientes de hanseníase é motivo de preocupação entre as equipes de saúde, especialmente quando corresponde a 10% dos casos cadastrados no período. O objetivo deste levantamento é fazer o diagnóstico dos casos de recidiva a partir de janeiro de 1999 até fevereiro de 2002 através da revisão dos prontuários, tendo sido compiladas as informações sobre tempo decorrido entre a alta e o 2° cadastro, tratamento prévio, grau de incapacidade e situação dos comunicantes. Não houve diferença quanto a sexo, o tempo médio decorrido entre a alta e o novo cadastro foi de 5 anos, o grau de incapacidade avaliado como II e III correspondeu a 2l.87% no 1° tratamento e 18,75% no 2°, a média de comunicantes por paciente foi de 3,06, dos quais 69.38% foram examinados. Dos 11 casos que receberam PQB PB previamente, 9 foram classificados erroneamente 1 recebeu ROM e foi insuficiente e 1 foi indevido.
Das 21 formas MB, 19 apresentaram IB em um sítio = ou > 2 e/ou atividade clínica e/ou EM ou EM persistentes, 2 não tinham justificativa para o tratamento A conclusão demonstra diagnóstico tardio, com GI alto no 1° cadastro e evolução para médio no 2° e que num universo de 309 casos novos cadastrados 32 foram por recidiva e dos quais somente 3 não se encaixariam nos critérios preconizados.
PE 92
REDIRECIONANDO ESTRATÉGIAS: META - A ELIMINAÇÃO DA HANSENÍASE NO MUNICÍPIO DE PIMENTA BUENO - RO
Eliana Pasini; Roberto Cláudio Correia; Rosemary Aparecida Passador Sanches De Giuli
Secretaria Municipal de Saúde de Pimenta Bueno - RO
Introdução - O município de Pimenta Bueno está localizado ao longo da rodovia Br 364. estado de Rondônia sendo considerado hiperêndemico para hanseníase, segundo critérios da OMS, com prevalência de 38,18/10000 hab. e 44,42/1000 hab.de detecção no ano de 1996, quando houve então priorização pelo gestor local com ações específicas para a sua eliminação.
Objetivo: Este trabalho tem como objetivo a reflexão da importância do envolvimento do gestor municipal para a Eliminação da Hanseníase,realizando ações simples.
Materiais e Métodos: Estudo dos indicadores epidemiológicos dos anos de 1996 a 2000, relacionando-os as ações desencadeadas pela equipe municipal durante o mesmo período, as fontes são dados da Coordenação Estadual. Secretaria Municipal de Saúde Gerência Municipal do Programa.
Discussão: Durante o período de 1996 a 2000, o município de Pimenta Bueno desencadeou ações estratégicas como treinamentos para guardas de endemias, profissionais de saúde de vários setores, líderes comunitários, agentes do PACS/PSF, agentes de saúde escolar, agentes de saúde rurais e outros, tendo como meta a eliminação da hanseníase.
Resultados: Contribuir com a experiência, despertando gestores e gerentes municipais para implementação de ações viáveis em nível Municipal, redirecionando serviços e estratégias para atingir a eliminação da hanseníase.
Conclusão: A determinação política do gestor municipal em eliminar a hanseníase é fator essencial, pois buscando estratégias baseadas na realidade local, reduzimos a prevalência para 12.63/10000 hab. a detecção para 11.69/1000 hab. no ano de 2000, ainda muito longe do almejado mas visualizando um caminho a ser trilhado, juntos, dirigentes e população.
PE 93
RESEARCH OF LEPROSY SPREADING AND CONTROL IN CHINESE WHITE-TROUSERS YAO NATIONALITY
LONG Zuguang1; WANG Baojun2; LUO Jiuvi3; YAN Zhiwei1
1. Nandan Skin and Venereal Disease Prevention and Cure Hospital. China
2. Centre for Skin Disease Prevention and Cure in Libo County. Guizhou, China
3. Hechi Sanitation and Ant epidemic Station. Guangxi, China
The White-trousers Yao Nationality is one of the branches of the Yao nationality in South China. They mainly live in Lihu, Baxu of Nandan County and in Bagong of Hechi, Guangxi province and also in Yao Mountains of Libo County. Guizhou province. This nationality has its own original language, habits and customs. They never marry out and completely keep the features of its tribal history.
Leprosy has been so popular in the White-trousers Yao nationality that it has made Nandan the third most popular county in leprosy in Guangxi province. In order to make a research on the spreading law of leprosy and the characteristics of its prophylaxes and cure in this nationality, we have had the research data of leprosy epidemiology in the White-trousers Yao nationality counted and analyzed. As a result, we found 364 cases of leprosy among the 290 thousand total While-trousers population, and the case rate of accumulation was l3.25%. That's 8 times higher than other nationalities in the same areas.
The incidence of this disease in the most serious years (1952-1956) was 129.15 cases in 100 thousand people. The disease was distributed over a large area. There were lepers in 130 villages of the White-trousers Yao nationality (its total villages were 268) and the rate in other national villages was 48.51%. But the rate in other national villages was 9.56%. The incidence of the disease of families was very high, coming lo 5.77%. While other national villages was 0.59%. There were 61 families which had more than two lepers, which made up 22.34% of the total leper families, while other national families 11.25%. The female sex suffered from the disease more often than the male sex and the rate was ten to one (other nationality was three to zero point two). We have also found that the period of illness was long, on an average of 6.24 years, while the Zhuang nationality was 4.49 years. Therefore it had evident national spreading traits. Analizing through the grey-model relation finds that the related degree is the highest in the consanguineous marriages and it is believed that a closed marriage of the same clan probably leads to the increase of the leprosy susceptible gene. Besides the housing conditions of the White-trousers Yao nationality, their life, economy, culture and sanitation are poor. So it is very hard to reach the prevention and cure of leprosy and result in this disease spreading quickly, far and wide. Although we have taken active measures to prevent and treat it, the result is still not satisfied and even the spreading tendency of the disease is upward again and again. The clothing customs of white-trousers Yao nationality make their skin exposed outside too much and ibis makes it easier to be infected by the disease and it will also increase the rate of the female's suffering from the disease. According to the dynamic calculation through the grey model instrument, it will take about 40 years to reach the aim of wiping out leprosy in the White-trousers Yao nationality.
[Key words] the White-trousers Yao Nationality. Leprosy Spreading and Control
PE 94
RESULTS AND LONG -TERM IMPACT OF LECHODEIDAH (YEMEN)
Dr. Abdul Baset M. Al Dobai; Dr. Yasin Al-Qubati
National Leprosy Control Program, P.O. Box. No. 55722 - TAIZ, Republic of Yemen, Tel: 967-4242306/7/9 and 967 792976 (Mobile) Fax: 967-4242308.
Leprosy elimination Campaign (LEC) was implemented from 15th Nov'97 to 3rd May'98, in 22 districts of Hodeidah province in Yemen, which is an endemic governorate in Yemen which is known as a low endemic country, The Campaign was concentrated on the Health Education, Intensive Community Mobilization and training the local health personnel to detect hidden Leprosy cases. During the period of 11 weeks, 276 cases of leprosy were detected and placed on MDT. 192 (70%) of new cases delected and they confirmed as Leprosy cases classified as MB and the remaining 84 were PB, 69 cases (25%) suffered by visible deformities and 22 patients (8%) were children.
Follow up made in December'99 the patients, who were placed on MDT revealed (93% and 92%) cure rates for both MB and PB cases respectively.
PE 95
REVERSAL REACTIONS - PARAMETERS CLINICAL AND EPIDEMIOLOGICAL ASSOCIATED TO ITS OCCURRENCE
Nery J.A.C.; Chumpitaz, S.A.; Miranda. J.A.P.P.; Guerra, S.G.; Coutinho, Z.; Lyra, MR.; Vieira, L.M.M.; Galo, M.E.N.
Leprosy Laboratory/IOC - FIOCRUZ; Dermatology Department of Gaffree e Guinle University Hospital. Rio de Janeiro. Brasil.
Background: the study discusses the clinical and epidemiological parameters associated to the occurrence of reversal reactions in patients undergoing multibacillary therapy. Subject and Methods: the authors present forty-two patients with multibacillary disease treated with twenty-four doses of PQT-WHO at the Souza Araújo Outpatient Unit of FIOCRUZ from January of 1986 to January of 1991. They had clinical, dermatological, neurological and histopathological examination, bacillary index (BI) and lepromin skin testing. All of them had no prior treatment and where classified as primary cases.
Results: there were thirty-two male patients (76%) and ten females (24%), a sex ratio was approximately 3:1. Seventy-four percent were between second and sixth decades. Twenty five patients (60%) were classified as borderline-borderline (BB), fourteen patients (33%) as borderline-lepromatous (BL) and three patients (7%) as lepramatous-lepramatous form (LL). Thirty-three percent had BI under 3+ while twenty-six percent had BI up to 3+. Clinically, in twenty-eight patients (67%) there were multiple lesions at the diagnostic time. In seventy-two percent of patients the reversal reactions started until the first six months of specific treatment. Forty-two percent of patients presented several episodes. Approximately fifty percent of newly diagnosed patients had no chronic disability. Commentaries: the reversal reaction is an important medical problem due to the risk of permanent damage, which impose a health and economic burden particularly in developing countries like Brazil. For this reason is of fundamental importance to dermatologists to know the clinical and epidemiological parameters, the immunopathogenic mechanisms and the correct medical management of these cases.
PE 96
SELF-ERADICATION OF LEPROSY?
Andreas Kalk
German Leprosy Relief Association. Mariannhillstr. 1c. 97074 Würzburg. Germany. Tel. +49-9317948123. E-mail: andreas.kalk@dahw.de
The study investigates epidemiological prerequisites for the 'endemic fading-out' of a contagious disease and applies these findings to the particular features of leprosy. It identifies the 'basic reproductive rate' of an infection, the duration of latency and infectiousness, the life expectation and the size of the host population as factors determining the number of both latent and infectious infections in this population. It intends to demonstrate that once one single index case is given, leprosy can survive in an isolated population of approximately 30 persons only. It is concluded that the 'endemic fading-out' of a contagious disease does not depend on its prevalence, but either on the basic reproductive rate or on the host population size. If the reproductive rate is smaller than 1 (e.g. due to the decreasing susceptibility of the host population), or if a minimum popualtion size for continuous transmission is not given, the disease will eventually 'fade out'. As long as this rate is above the value of 1, leprosy can - due to its lasting infectiousness - survive in extremely small host populations.
PE 97
SENSITIVITY AND SPECIFICITY OF THE W.H.O OPERATIONAL CLASSIFICATION BASED ON NUMBER OF SKIN LESIONS
Gift Norman; Geetha S Rao; J Richard; Raja Samuel
Schieffelin Leprosy Research and Training Center, Karigiri, India
The WHO Sludy Group on Chemotherapy of Leprosy Committee in 1993 concluded that approaches based on clinical classification may be required where reliable facilities for the bacteriological examination of skin smears are not available or reliable. The Committee recommended that leprosy patients be classified according to the number of skin lesions, into pauci-bacillary leprosy (2-5 skin lesions) and multi-bacillary (more than 5 skin lesions). However, the sensitivity and specificity of classification based solely on the number of skin lesions, using skin smear positive patients as a gold standard has not been reported.
The Schieffelin Leprosy Research and Training Center has been carrying out leprosy control activities in Gudiyatham Taluk since 1962 as part of the NLEP. Using data from the control area, the sensitivity and specificity of operational classification based on number of patches was studied, using skin smear as the gold standard. The sensitivity of classifying five and above lesions as multi-bacillary leprosy is 97.0% while the specificity is 52.2%. The positive predictive value is 32.3% and the negative predictive value is 98.6%. The ROC curve shows that a cut-off of live lesions is the best option. The WHO criterion for operational classification of leprosy based on number of patches seems vindicated. The effect of including additional clinical signs such as size of the largest lesion or nerve trunk involvement on the sensitivity and specificity of the operational classification will be reported.
PE 98
SERO-PREVALENCE RATES OF ANTIBODIES TO PHENOLIC GLYCOLIPID-1 BY ELISA AMONG WILD NINE BANDED ARMADILLOS (Dasypus novemcinctus) IN ESPIRITO SANTO STATE - BRAZIL
Patrícia Deps; Zoilo P. Camargo; Jane Yamashita-Tomimori
Santa Casa of Misericórdia Hospital. Vitória-ES. Av. Nossa Senhora da Penha. 2190 CEP 29045-402. Vitória ES-Brazil.
Introduction and purpose: The human being has, for a long lime, been considered the only reservoir of Micobacterium leprae. However, the armadillo infection, Dasypus novemcinctus species, was first reported in 1975 and natural transmission among armadillos in the southern parts of the United States has been described by Walsh and co-workers. Truman and co-workers found IgM antibodies to the PGL-1 antigens of M. leprae in 16% of the armadillos from Lousiana and Texas. In the Brazil, natural infection of M. leprae in armadillos wasn't reported.
The enzyme-linked imunosorbenl assay (ELISA) test detect PCL-I antibodies is a useful tool confirm Ihe diagnosis of leprosy. We analysed Ihe natural infection with M. leprae in wild nine-banded armadillos, Dasyous novemcinctus, from hyperendemic leprosy area of Brazil, Espirito Santo State.
Methods: We analysed forty-seven armadillos captured from wild by hunter. Those animals were anesthesiated and collected the blood by intracardiac punction. The ELISA was performed for IgM antibodies to PGL-I antigen of M. leprae. The pre-coated plates and the others reagents were given from Royal Tropical Institute in Amsterdam The cut-off value for posilivity was an OD of 0.200.
Results: Were captured armadillos from country area of 6 cities of Espirito Santo State. The weight ranged between 350-5200g. The armadillo's sex, 24 were male and 23 ere female. In 47 animals, antibodies and PGL-I were detected in 5 (10,6%) animals by ELISA method.
Conclusion: It is known now that about 10,6% of the armadillos front Espirito Santo State were M. leprae carrier. The discovery of M. leprae in the wild armadillo has not only raised many question about the transmission and host range of leprosy, but identified a possible public health risk.
PE 99
SERUM ZINC LEVEL AND ZINC INTAKE IN NON-REACTIONAL LEPROSY PATIENTS
Yudhistirawati, I; Made Wisnu; Unandar Budimulya; Sjaiful Fahmi Daili; Emmy S. Sjamsoe; Sri Linuwih.
Dep. Of Dermato-venereology Faculty of Medicine University of Indonesia. Jakarta - Indonesia
A case control study was performed on 56 leprosy patients and 56 controls, aged 15-59 years, during January untill August 1999. The objectives were to describe variability of serum zinc level and dietary zinc intake in nonreactional leprosy patients compared with the controls, and to find out whether there-was a correlation between serum zinc level and dietary zinc intake by nonreactional leprosy patients.
Serum zinc level was estimated by Atomic Absorption Spectrophotometry and dietary zinc intake was estimated by Food Frequency Questionnaire. The mean of zinc serum level in nonreactional leprosy patients was significantly lower than the controls and the mean of zinc serum level in multibacillary leprosy patients was also lower than paucibacillary which was statistically significant. Dietary zinc intake of nonreactional leprosy patients appeared lower than their controls (p = 0.008). There was no correlation between zinc serum level and dietary zinc intake on nonreactional leprosy patients.
PE 100
SITUAÇÃO DA CICATRIZ VACINAL DE BCG-ID EM PACIENTES DE HANSENÍASE
Tardin, R.T.; Paltroco. M.A.A.; Nogueira. V.V.; Mello. L.L.S.; Silva. M.C.D.; Esteves, V.G.
Secretaria Municipal de Saúde do Rio de Janeiro. Rua Afonso Cavalcanti, 455 sala 856, Cidade Nova. CEP 20 211- 901 - Rio de Janeiro, Brasil
No período 2000-2001 a Gerência do Programa de Controle de Hanseníase da Secretaria Municipal de Saúde do Rio de Janeiro implantou na ficha de investigação de casos novos a inclusão do dado: presença/ausência de cicatriz vacinal BCG-ID.
Foram analisadas as notificações de 2001 em relação ao registro de presença ou ausência de cicatriz vacinai considerando faixas etárias e formas paucibacilares (PB) e multibacilares (MB).
Registros de presença de cicatriz vacinal foram detectados em 213 casos PB e em 114 casos MB e registros de ausência de cicatriz em 222 casos PB e 251 casos MB. Efeito protetor da vacinação contra formas multibacilares foi evidenciada na análise multi-variada: OR= 2,11 (IC: 1,56-2,86).
PE 101
SITUAÇÃO DE CONTROLE DA HANSENÍASE EM ÁREA URBANA DE DESCENTRALIZAÇÃO DAS ATIVIDADES DE CONTROLE
Maria Cristina Dias da Silva; Lea Luíza Souza e Mello; Verônica Vital Nogueira; Nélia Maria Figueiredo; Valéria Gomes Esteves
Secretaria Municipal de Saúde do Rio de Janeiro. Rua Afonso Cavalcanti, 455, sala 456, Cidade Nova. Rio de Janeiro-RJ. CEP 20 110- 901. Tel: 021 -2503 2234/021-2503 2235/ Fax: (021) 2293-3210
São avaliados resultados de intervenção na Área de Planejamento 5.3 do município do Rio de Janeiro, a partir do final de 1995, realizadas com o objetivo de melhorar o acesso da população ao diagnóstico e tratamento da hanseníase. Com população estimada de 313 390 habitantes em 2001, o nível socioeconómico da população situa-se entre os mais baixos do município. Até 1995, apenas uma das 14 UBS realizava o Programa. Registra-se como principais investimentos, o aumento da oferta de consultas, a descentralização das atividades de diagnóstico e tratamento, alcançando 9 UBS em 2001, capacitação continuada de profissionais, inquérito sobre mancha na pele aos que demandam as UBS, e divulgação periódica de informação sobre hanseníase para a população. O déficit e a rotatividade de pessoal representam sérios obstáculos à expansão das atividades de controle.
Comparando-se os períodos de 1990 a 1995, anterior à intervenção, com o período de 1996 a 2001, observou-se um aumento do total de novos casos detectados, com variação proporcional relativa de 89,5 %; a razão H/M variou de 1,12 a 0.82; a proporção de casos MB, de 53 a 46%, sem redução significativa entre os homens; a media dos coeficientes de detecção e em menores de 15 anos variou de 2,63 a 4.73 /10 000 habitantes, e de 0.84 a 1.94/10 000 habitantes, respectivamente; a proporção de novos casos sem incapacidades físicas permaneceu praticamente inalterada, variando de 88.7 a 88,3%, enquanto a proporção de deformidades físicas caiu de 5,2 para 3,5%. Entre os homens, esta proporção caiu de 8.3 para 5.6% e entre as mulheres, de 1,9 para 1,8%. Os coeficientes de prevalência mostraram queda progressiva, alcançando 3,66/ 10 000 habitantes em 2000: neste ano o abandono na prevalência do período foi de 6.4%.
Conclui-se que é necessário intensificar investimentos na área, ressaltando-se a importância de se aplicar estratégias visando ao aumento da oportunidade diagnostica para os homens.
PE 102
SITUAÇÃO EPIDEMIOLÓGICA E CLÍNICA DA HANSENÍASE EM MENORES DE 15 ANOS EM TRÊS MUNICÍPIOS DE MINAS GERAIS -BRASIL DE 1996 A 2000
Magalhães, E.S.B; Grossi, M.A.F.; Lebouef, M.A.A.; Branco, A.C.; Ferreira, I.N.
Secretaria Da Saúde De Minas Gerais. Av. Afonso Pena 2300. Cep:30130 007. Belo Horizonte, Mg - Brasil. hansenase@saude.mg.gov.br
Introdução: Foram estudados os aspectos epidemiológicos e clínicos dos casos de Hanseníase menores de 15 anos diagnosticados de 1996 a 2000, em 3 municípios hiperêndemicos, de diferentes portes em Minas Gerais. Foram identificados os casos de Governador Valadares (231.875 Hab.), Paracatu (74.637 Hab.) e Itamogi (10.238 Hab.) e levantados aspectos relacionados a sexo, idade, forma clínica, grau de incapacidade, reações e/ou neurites durante o tratamento e vigilância de contatos.
Resultados: Foram estudados 174 casos de Hanseníase < 15 anos. 56% do sexo feminino, a menor idade foi 2 anos, 68% entre 9 e 14 anos e 54% Paucibacilares. Moravam com os pais 99% das crianças: 90% estudavam e 2 crianças trabalhavam fora. O Grau de incapacidade foi avaliado no diagnóstico em 99%- dos casos (92% grau 0) e na alta em 94% (89% grau 0). Reações e/ou neurites durante o tratamento foram observadas em 12 crianças (7%) e a ocorrência pós-alta em 6 (3%). Exame de Contato foi o principal modo de descoberta (43%). A fonte provável de Contágio foi identificada em apenas 53%.
Conclusão: Um caso de Hanseníase em criança deve ser considerado um evento sentinela capaz de desencadear ações efetivas de investigação da fonte de contágio, como também ações educativas intensivas incluindo as escolas, como veículo de informação para os familiares.
PE 103
SITUAÇÃO EPIDEMIOLÓGICA E ESTIMATIVA DA PREVALÊNCIA OCULTA DE HANSENÍASE NO DISTRITO FEDERAL EM 2000
Roseane Pereira de Deus; Márcia Helena Rodrigues de Souza; Maria Liz Cunha de Oliveira; Maria Madalena
Secretaria de Estado de Saúde do Distrito Federal. Gerência de Dermatologia Sanitária 8 andar. SMHS Quadra 301, Bloco B, Edifício das Pioneiras Sociais. CEP 710334-900
Durante os anos de 1996 a 2000 foram desenvolvidas várias atividades de capacitação em ações básicas de controle da hanseníase e sensibilizações com o objetivo de atingir a taxa de prevalência de 1 caso por 10.000 habitantes em 2002.
Em 2001 realizou-se um estudo retrospectivo comparativo de 1996 a 2000 para avaliar a situação epidemiológica do DF. Neste estudo foi observado um índice de detecção de 323 casos novos e uma prevalência oculta de 119 casos.
Concluindo, foi proposto uma intensificação das ações de educação e sensibilização com o objetivo de aproximar ao máximo da taxa de prevalência estabelecida para 2002.
PE 104
SITUACIÓN EPIDEMIOLÓGICA LEPRA 2 MUNICIPIOS DE NICARAGUA
Dres. Nelson Caballero Hernández; Oscar Guerrero Aburto; Montserrat Pérez López; José Ramón Gómez Echevarría
Sanatorio San Francisco de Borja, Fontilles.Sanatorio San Francisco de Borja, 03791, FONTILLES -VALE DE LAGUART (ALICANTE), ESPAÑA. Teléfono: 96 558 33 50. Fax: 96 558 33 76. E-mail: fontilles.org
Se recoge la situación epidemiológica de esta enfermedad en 2 municipios de Nicaragua, San Francisco Libre y Chinandenga. Observamos la muy alta casuística entre niños menores de 14 años y la muy alta frecuencia de Formas Paucibacilares.
Destacamos el importante trabajo para el control y prevención de discapacidades de los promotores de salud.
PE 105
STRATEGIES OF LEPROSY CONTROL USED IN LOW ENDEMIC SITUATIONS IN GUANGDONG PROVINCE
Xu Yue-hua
Si'an Hospital. Guangdong, 510500, China.
The number of the total registered leprosy patients in Guangdong province is 94.667. It ranks the first in china. The highest annual prevalence rate is 1,14‰. Guangdong was once the high endemic area FCR leprosy. In 1999, there were only 370 active patients; the prevalence rate decreased to 0.005‰.Guangdong has become a low endemic area for this past live years. However, there are still about 130 active patients appeared every year and the number decreased slowly. The following measures are taken under the low endemic situations to maintain the achievement of leprosy control: to lay stress on the key points and provide different directions to different areas; to implement special action programmers in the high endemic areas: to strengthen the surveillance for die Moating population and the management of leprosy patients; to establish a system of rewards for the early case-finding and the use of MDT: to strengthen the training of paramedical workers of the leprosy prevention nets; to widely launch leprosy knowledge propaganda and health education. We have gained much experience in the work and the achievements of leprosy control are solidified.
PE 106
STUDIES ON EPIDEMIOLOGY OF LEPROSY FOR 50 YEARS IN GANSU PROVINCE
Qiu Yao Wen; Wu Deqiang; Cai Junfang; et al.
Gansu Provincial Institute of Endemic Diseases, 730020. Lanzhou, China
Objective: To study epidemiological trends of leprosy for 50 years in Gansu Province.
Methods: Epidemiological indicators and their trends were analyzed.
Results: By the end of 1998, a total of 4773 leprosy cases had been detected in Gansu province, of which 77.76% distributed in 24 counties in Longnan, Gannan and Linxia prefectures, and 3507 cases were cured and other dropped out or died. Type ratio of MB to PB was more than 60% during the period. Since the mass surveys and comprehensive control were implemented in the 1960s, prevalence and detection rates had decreased continuously and the number of endemic counties reduced from 84.88% in 1986 to 24.14% in 1998. There were 42 active cases at the end of 1998 with a prevalence rate of 0.0017 per 1000.
Conclusion: Through the efforts lor 50 year running, leprosy has been successfully controlled in Gansu Province.
[Key words] Leprosy Prevalence Incidence
PE 107
STUDY ON CASE-FINDING IN A LOW EPIDEMIC SITUATION OF LEPROSY
Huang Xiuyun . Huang Peiyong, Chen Bodong, Fuzhizhi. Wu Pinvan
Guangxi Institute of Dermatology, 530003. Nanning, China
Objective: To study the epidemiological feature and the strategies of leprosy control.
Methods: The new leprosy cases detected in GuangXi Autonomous Region in the last 10 years were analyzed retrospectively.
Results: 745 new leprosy cases were detected in the last 10 years. The average detection rate of this period was 0.43/100 000. The mean age at onset of the disease increased. The unknown infection source cases and MB cases increased, the period of the disease was shortened and the grade II disability rate decreased.
Conclusions: Developing health education, improving people's idea of self care, speeding up early diagnosis at country level are important.
|Key words) detection of leprosy cases; epidemiological analysis
PE 108
STUDY ON THE OTHER HEALTH SERVICES UTILIZED BY MULTI BACILLARY CASES
Murugesan. N. Dr.
State Project Co-ordinator, DANIDA/DANLEP. Tamil Nadu, India.
Though effective Multi Drug Treatment services are provided to leprosy patients, they are likely to get other ailments too. No doubt they need medical attention for these ailments also. In the context of integration in Tamil Nadu, it was found necessary to find out where these leprosy patients went for medical treatment lor these ailments. Since integration efforts were already on as early as 1996 in Tamil Nadu, this study was carried out in 1996-97. to find out the health seeking behaviour of leprosy patients for other ailments to incorporate the findings in deciding integration strategies.
Only Multi Bacillary (MB) cases selected to get valid and reliable information.
Objectives:
1. To find out the morbidity pattern of MB cases other than leprosy.
2. To study the pattern of other health services utilized by them if any.
3. To study the relationship between demographic and socio economic characteristics of MB cases and the type of other health services utilized by them.
Methodology: It is an exploratory study conducted in Salem district in Tamil Nadu. India. Salem had a population of 4.3 million as per projection of 1996. As of October 1995. 4694 MB eases were there in Salem who formed the universe for the sample.
By scientific sampling procedures, MB eases were selected for the study. Pre tested schedules were used for data collection and the data were collected from 204 respondents by trained investigators. They were analysed, interpreted and reported.
Highlights of the study:
- Data were collected in a systematic way on the type of other healthy services utilized by MB patients who are under treatment and cured.
- Pattern of relationship between demographic and socio-economic characteristics of MB patients and the type of other health services used by them was studied.
- Suggestions and recommendations in the context of integration of leprosy with General Health Care services in Tamil Nadu were given.
PE 109
SURVEY OF NEWLY DIAGNOSED LEPROSY PATIENTS IN JAPAN FROM 1981 TO 2000
Norihisa lshii1, Shin Sasaki1, Eiichi Matsuo1; Motoaki Ozaki2
1. Leprosy Research Center, National Institute of Infectious Diseases, Tokyo
2. Department of Dermatology, Amagasaki Prefectual Hospital, Hyogo
We analyzed the medical and social problems of newly registered leprosy patients in the past 20 years from 1981 to 2000 in a low endemic country, Japan. There were 385 registered Japanese patients (males, 333; females, 152), and III registered foreign patients (males, 80; females, 31). The number of Japanese patients in each 5-year period was 187 ('81-'85), 119 (*86-'90), 48 ('91-'95), and 31 C96-2000), and has been decreasing steadily. But the number of foreign patients in each 5-year period was 7, 10, 45, and 49, respectively, and has been increasing. The number of foreign patients was greater than that of Japanese patients in the latter half, 1991-2000. The male/female ratio was 333/152 in Japanese patients, and 80/31 in foreign patients. Male/female ratio has decreased among the Japanese but increased among foreigners.
PE 110
TEMPO DE DEMORA PARA O INÍCIO DO TRATAMENTO DE HANSENÍASE NO MUNICÍPIO DE BETIM - MG
Bernadete Azevedo, Priscila Fuzikawa , Regina Coeli Honório, Silvana Lott, Valéria Mourão, Dulcinéia Nacif, Cássia Nardel, Leila Cristina Alves de Souza
Secretaria de Saúde de Betim, Rua Prof. Osvaldo Franco, 55 - Betim - MG - Brasil
Sabe-se que a demora para o início do tratamento de hanseníase é um dos fatores de risco para o desenvolvimento de incapacidades. Realizou-se um levantamento com os pacientes em PQT no município de Betim (N=50) para determinar o tempo decorrido entre a percepção dos primeiros sintomas e o início do tratamento com PQT. Foram excluídos do estudo pacientes que já haviam feito tratamento anterior. Procurou-se determinar, separadamente, o tempo decorrido até a busca por atendimento em um serviço de saúde e o tempo decorrido dentro de serviços de saúde até o diagnóstico e início do tratamento efetivo. Buscou-se identificar razões que levam um indivíduo a finalmente buscar um serviço de saúde e fatores, dentro dos serviços, que dificultam ou aumentam o tempo de demora. Essa informação poderá ser utilizada no desenvolvimento de campanhas e ações educativas, bem como no planejamento e adequação da rede de saúde para favorecer o diagnóstico precoce da hanseníase
PE 111
THE ANALISIS AND PROGRESS FOR LEPROSY REHABILITATION SITUATION OF HUNAN PROVINCE
Wei Zhonghe . MoJiangling
Hunan Institute of Dermatology, 410005, Changsha, China
By the end of 2000, the accumulated number of leprosy cases mounted to 16234 and healed leprosy cases mounted to 13845. There are 10000 leprosy alive cases and 4808 cases which need rehabilitation.
In the past, we had developed rehabilitation surgeon in 5 or 6 counties, however, the number of patients who receive rehabilitation is few because of funds' lacking. In march 2000, assisted by the Netherlands Leprosy Relief, we developed Hunan Leprosy Rehabilitation project in Len Shui Tan and Dao county. An approximate of 261 patients receive the rehabilitation. The result is satisfactory. Bui there are only two pilot project counties and because of funds' shortage, a lot of cases who need the rehabilitation immediately can't get access.
This article impresses us about drawing more governmental attention, support and financial input, making connection with foreign organizations, establishing the province leprosy rehabilitation center, improving skill training. As a result, the leprosy rehabilitation work in Hunan province will develop in an actual anil all-round way.
PE 112
THE ANALYSIS ABOUT THE EPIDEMIOLOGY OL LEPROSY OF GUANGFENG COUNTRY, JIANGXI. CHINA
Zhou Changfu . Jiang Changguang
Guangfeng Station for dermatosis and venereal disease control. Jiangxi. China
Analyze the Leprosy epidemic trend and evaluate the eftection of leprosy control this county from the station being set up in 1961. taking in leper to the end of 2001. We analyzed according to the material of epidemiology and found the lepers and cured effetely by varied ways. The prevalence rate and detection rate has come down. In 1997. We passed the checking and being accepted by Jiangxi pubic health department and reached the standard of eliminating basically leprosy.
[Key words] Leprosy Incidence rate Detection rate Prevalence rate Infection control
PE 113
THE ANALYSIS OF DEATH FOR 343 LEPROSY CASES IN MOUNTAINOUS AREA OF ZHUSHAN, CHINA
Zhao Shichang, Zhu Wenjun. Gao Jigen
Dermatology Institute of Zhushan County. Hubei Province. China
The inquiry of death causes of 343 lepers in the mountain areas showed that 13.7% deaths were mainly caused by malpractices and suicides. Of all the deaths. 45.48% were the result of diseases hard to cure and the problems which are caused by aging. 21.28% were caused by illnesses that we have no idea. Another 7.87% were caused by cardiovascular diseases, urinary organs diseases, urinary organs diseases, digestive diseases, and malignant tumors. They are of the following respective statistics: 7.87%. 3.20%. 3.49%. 2.62%. From the data above, we should insist on propagating the scientific knowledge about the leprosy, strengthen the education of the safely measures, improve the consciousness of sell protection, the whole professional skills of the medical workers gradually, instruments and Ihe conditions of medical apparatus order to reduce the death rate and avoid artificial accidents.
PE 114
THE ANALYSIS OF LEPROSY ENDEMIC IN HEBE1 PROVINCE
Li Heshan, Mu Yansheng, Zhang linzhuo, Zhang Huibin. Qie Yonglao. Wang Jianhui, GaoTietao. Zuo .liandong. .lia Fushou
Hebei Institute of Dermatology, 072450, Wangdu, China.
Objective: To analysis ol'Hebei province leprosy endemic for providing the bases how to conduct ilk-leprosy control working and full of eradication of leprosy in the future.
Methods:According to the data of leprosy control in the province past years.
Results: Hebei province was in low endemic area of leprosy, until to 1999 a total of cases detected was 1289. The distribution of leprosy was big different in various places. The leprosy control working was stared at begging of 1950s actively. A lot of leprosy eases had been cured in 50 years by hard working, so that the endemic indicators of prevalence, detection rales and incidence rates have been reduced under 0.5/100 000. Last decade, child cases were not found and the area of leprosy endemic was reduced.
Conclusion: The leprosy endemic trends indicated continuity reduced, leprosy control represented markedly effect and but the achievement needs to do the best of continue our working.
[Key words] Leprosy control.