Ref.: About early diagnosis of lepromatous leprosy
From: M Leide W. de Oliveira, Rio de Janeiro, Brazil
From: M Leide W. de Oliveira, Rio de Janeiro, Brazil
Dear Dr Noto,
I share the same point of view of my colleagues regarding the last discussion on the LML about early diagnosis of lepromatous (LL) leprosy. Despite some advanced multibacillary (MB) cases still being diagnosed everywhere in Brazil, the great majority of them are early mid borderline (BB) or LL Hansen´s Disease. I have also seen cases presenting single nodular lesion, located mainly in the buttocks or Achilles tendon, without any infiltration or nerve involvement. Other patients only present episodes of a few erythema nodosum leprosum (ENL) reaction lesions.
However, one of the great results
of household contact examinations and continuous local campaigns in Brazil, is
a large number of indeterminate leprosy, as well as borderline leprosy
diagnosed before nerve damage, in a stage of evanescent skin patches. In
Rio de Janeiro state for instance, the regional Society of Dermatology (SBD-RJ)
has been working with the state program manager to insert skilled professors of
dermatology in local campaigns at the peripheral municipalities of the
metropolitan region. Also, at the most prevalent municipalities in the
minor cities over the last 3 years. This is justified by the weakness of
the primary health care in these areas and it is not only useful to find new
leprosy cases but also to train family health teams and medical residents on
dermatology.
In fact this strategy started in
1998 in Rio de Janeiro city and in the beginning of the years 2000, expanded to
municipality of Duque de Caxias next to Rio de Janeiro city, where I performed
a project funded by the Netherlands Leprosy Relief (NLR) from 2003-2007.
The results can be observed in Graphic 1: the detection rate of Hansen´s
Disease in the whole state of Rio de Janeiro shows a 46.8% reduction from 2001
to 2010 and, at the same period, the reduction achieved in Duque de Caxias
municipality was 56.35%. However, this peripheral municipality is
presenting now the same detection rate of the whole state at the beginning of
the decade.
The fluctuation observed in this
municipality could be related to the sporadic but also continuous case finding
activities, as the basic care network of Duque de Caxias covers only 30% of its
population in addition to management weaknesses. The decrease in the
detection rate of course influenced the current prevalence rate of the state to
be less than 1/10,000 inhabitants. Nevertheless, local case finding
activity to allow early diagnosis and interruption of the transmission of the
source of infection in the peripheral area, is mandatory in order to sustain
the decline.
The state detection rate decrease
(Graphic 1) was gradual, without fluctuation in accordance with the
epidemiological behaviour of this endemic disease. So that I believe on
its sustainability, if the peripheral and poorest areas continuing receiving
efforts to Hansen´s Disease control advocacy. No less important is the
social and economic development of these municipalities.
Maria Leide W. de Oliveira
Medical School-Dermatology Sector/Federal
University of Rio de Janeiro (UFRJ)
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