Controle da Hanseníase: Detecção precoce através do exame de contatos e avaliação do tratamento dos pacientes submetidos a 12 doses de poliquimioterapia (PQT/OMS)

Abstract

Early diagnosis and treatment are essential for the control of leprosy disease, since they aim to eliminate as soon as possible sources of transmission. The main criterion for cure of the disease is the treatment time, related to fixed doses of multidrug therapy. The duration of treatment of multibacillary patients was reduced from 24 to 12 doses up to 18 months in 1998. The aim of this thesis is to evaluate the detection of leprosy among contacts of patients and to evaluate risk factors associated with worsening of physical disability in patients after discharge from the treatment with 12 monthly doses. Two articles have been prepared. The first article evaluated characteristics of leprosy patients and their contacts related to risk of disease among the contacts. The second article evaluated risk factors related to the worsening of the physical disabilities of patients with multibacillary leprosy, undergoing treatment with fixed doses of 12 multidrug therapy. The results showed that the risk for leprosy among contacts was related to the type of relationship with the index case. Among the factors of the index cases, the bacterial load was the only factor associated with the disease among contacts. Besides these factors, the contacts that are related to consanguinity with the index case and contacts of patients with lower education level showed a greater chance of presenting patients at diagnosis of the index case. The scar and the BGC vaccine received after the diagnosis of the index case contributed independently as protective factors. Neuropathy worsened in 40% of patients during the 10 years after the discharge of treatment. This worsening was associated with the presence of physical disabilities and number of lesions at time of diagnosis as well as the presence of neuritis during monitoring.