About early diagnosis of lepromatous leprosy

Ref.:   About early diagnosis of lepromatous leprosy
From: M Leide W. de Oliveira, Rio de Janeiro, Brazil

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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)

Graphic 1.