Friday, August 9, 2013

New Case Detection and Continuous Education


Leprosy Mailing List – June 17,  2013 

Ref.:    (LML) New Case Detection and Continuous Education

From:  Aline Serruya Elmann, Lara Braga Oliveira, José Augusto da Costa Nery.

            Rio de Janeiro, Brazil

Dear Pieter,

We have followed with interest the recent discussions about new case detection, delay in diagnosis and diagnosis in small children. In this letter we want to stress the  important role of continuous education in diagnosing Hansen's Disease.

First we present a case report. In March 2013, a 31 year old male came to a campaign known as "Ação Global" in Rio de Janeiro, Brazil. The goal is to help the less fortunate by providing free health and social support. The patient arrived for orientation about his complaints. For two years he had been looking for an answer and no doctor had suspected Hansen's disease, in spite of  numerous consultations.

The patient, a Brazilian man that lived in a Hansen's disease endemic neighborhood of Rio de Janeiro, presented with nodules all over the body, specially over the arms (image 1), abdomen (image 2), back (image 3) and outer ears (image 4) that came to his attention about two years ago.  He claimed he had arthralgia, stiffness of hand joints, blurred vision and a burning feeling of the eyes, and he also had episodes of epistaxis and nasal crust formation. Two medical students who joined the campaign examined him and making a diagnostic hypothesis of Hansen's disease. They referred him to one of the main Hansen's disease centers in the city of Rio de Janeiro, where he could get specialized consultations, diagnostic tests and treatment. After confirmatory tests such as bacilloscopy, Mitsuda's test and biopsy he was diagnosed with lepromatous leprosy.

The two students who examined the patient above participate in a Hansen's Disease/STD program where they learn to diagnose said illnesses. Student training plays a significant part in breaking the chain of infection, preparing them, as they are planning to become dermatologists. These students clinically diagnosed a disease that in two years of looking for medical help, no doctor was able to diagnose, making him grow more anxious and allowing the illness to evolve.

When asked to bring his family members for testing, one of his two daughters presented with a hypochromic patch on the upper back area. After doing a sensibility test, the diagnostic hypothesis of tuberculoid leprosy was brought up by students that diagnosed the first patient, the father. The diagnosis was confirmed with the results of the additional tests, the biopsy and bacilloscopy. Today, the two patients, father and daughter, are receiving treatment based on the World Health Organization recommended multidrug therapy (MDT), the father with multibacillary type MDT and the daughter with paucibacillary type MDT.


Best regards,

Aline Serruya Elmann – Medicine student

Lara Braga Oliveira – Medicine student

José Augusto da Costa Nery - Hansenologist

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