Maria Aparecida de Faria Grossi

Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy

INTRODUCTION The purpose of this study was to evaluate risk factors for physical disability at the moment of leprosy diagnosis. METHODS This is a retrospective, descriptive and exploratory investigation of 19,283 patients with leprosy, registered in the State of Minas Gerais, Brazil, between 2000 and 2005. RESULTS The risk of Grade 2 disability was 16.5-fold higher in patients with lepromatous leprosy, and 12.8-fold higher in patients presenting the borderline form, compared to patients presenting indeterminate leprosy. The occurrence of more than one thickened nerve increased the odds of a patient developing Grade 2 disability, 8.4-fold. Age <15 years, multibacillary leprosy and no formal education presented 7.0, 5.7 and 5.6 odds of developing physical disability, respectively. CONCLUSIONS These factors should be considered as strong prognostic indicators in the development of physical disability at diagnosis.

Leprosy control strategies and the integration of health services: an international perspective

Integration of leprosy services into the general health services is regarded as the core strategy to ensure that leprosy control remains cost-effective and equitable, and, thus, sustainable in the coming years. In this article an extensive review is presented of the integration of leprosy services into the general health services. After the rationale of integration is discussed, the article highlights several recent developments within leprosy control and the health sector that are in support of the integration process. An overview is presented of recent experiences in countries that have already embarked on the integration process. Based on these experiences important lessons can be learned and incorporated into a model for the process of integration. This model, which is presented at the end of the article, will assist countries to successfully integrate leprosy services into the general health services.

Doenças dermatológicas de notificação compulsória no Brasil

The development of a Brazilian National Surveillance System in 1975 led to a compulsory reporting of selected infectious diseases aiming to reduce the burden of these events in the country. However, shifts in the epidemiology of these diseases associated with modern life style, demand constant revision of surveillance activities. In this manuscript we present the epidemiology, trends and differential diagnosis of the following compulsory notifiable diseases in Brazil: Aids, dengue fever, hanseniasis, American tegumentary leishmaniasis, measles, rubella and congenital rubella syndrome and syphilis. Additionally, the current challenges for control and prevention of each disease are presented

Leprosy control: knowledge shall not be neglected

In May 1991, the 44th World Health Assembly (WHA) adopted the resolution 44.9, declaring the commitment of the WHO to attain the goal of global elimination of leprosy as a public health problem by the year 2000. The goal was to reduce the known prevalence of leprosy to below 1/10 000 inhabitants. The implementation of multidrug therapy (MDT) turned, at the global level, a previously lifelong disease into a curable one. An important reduction of known prevalence was anticipated, given shorter disease duration. The WHOs secretariat also predicted that a significant decrease in incidence is to be reflected in the case detection rate (CDR),1 despite the absence of any previous evidence of huge impact on transmission in consequence of leprosy or tuberculosis isolation or treatment programmes. From 1990 to 1999, the CDR increased in all regions of the world except in Eastern Mediterranean and Western Pacific regions, where the CDR was low since the beginning of the period.1 2 In 1997, without strong evidence, the WHO recommended the reduction of multibacillary (MB) leprosy treatment from 24 to 12 months (it was rated grade D, evidence according to Oxford Centre). This new disease duration reduction allowed the global elimination target to be achieved by the end of the year 2000. Without further WHA resolution and ignoring that after many years of using MDT there was no evidence of its impact on transmission, the CDR magnitude and its influence on prevalence, WHO then ‘ established its …

Lesões dermatológicas em pacientes infectados pelo vírus linfotrópico humano de células T do tipo 1 (HTLV-1)

Human T-cell Lymphotropic virus type I (HTLV-1) was the first human retrovirus described. Some time after its discovery a group of diseases were related to this virus, such as, adult T-cell leukemia lymphoma (ATLL), HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 associated uveitis (HAU). In the nineties, HTLV-1 was associated to a severe eczema of children, called infective dermatitis (ID). Since then, several other skin manifestations have been observed in HTLV-1-infected individuals, particularly in patients with ATLL or HAM/TSP. However, according to some reports, dermatologic lesions are also common in asymptomatic HTLV-1 carriers. Besides ID, all other skin lesions reported are nonspecific. The aim of this review is to outline the dermatologic manifestations reported in HTLV-1 infected patients, emphasizing the clinical and epidemiological value of these findings.

Associação do teste sorológico ML Flow com a baciloscopia

A descriptive, exploratory study was conducted analyzing the association of covariables in the results of the ML Flow serological test and slit skin smear. A total of 60 leprosy cases diagnosed at the state Sanitary Dermatology Referral Center were investigated. Slit skin smear samples were collected from four sites and the results were expressed by the bacillary index. ML Flow was registered in both qualitative and semi-quantitative terms. Cohens kappa coefficient was used to study the agreement with Landis and Kochs observer criteria for interpretation. For statistical analysis, the logistic regression model and Kruskal-Wallis test were used. ML Flow showed a strong association with slit skin smear results, since a gradual increase in BI was accompanied by a semi-quantitative rise in antibody levels measured by ML Flow, with 100% positivity in cases presenting a positive slit skin smear. Given its strong correlation to slit skin smear, the results of this study provide evidence that the ML Flow test could be a valuable auxiliary tool in the classification and treatment of leprosy patients.

Seroprevalence of ML Flow test in leprosy contacts from State of Minas Gerais, Brazil

Leprosy is a public health problem in Brazil. Epidemiological control actions are based on the diagnosis and treatment of leprosy patients and household contact surveillance. Serological tests for leprosy could identify from among the contacts those at greater risk of developing leprosy in the future. ML Flow was administered to 2,840 household contacts of new leprosy cases diagnosed from October 2002 to March 2004, in State of Minas Gerais. ML Flow was positive in 20.5% of leprosy contacts, with high seropositivity among males (22.4%), individuals aged over 15 years-old (21.7%) and individuals in contact with multibacillary cases (23.9%). The chances of a household contact presenting a seropositive test was related to household contact with a multibacillary index case (OR=1.75), age over 15 years-old (OR=1.38) and male gender (OR=1.25). Follow-up of these contacts is necessary to evaluate the real role of seropositivity in the development of leprosy disease.

Fatores de risco para a soropositividade do ML Flow em pacientes com hanseníase

The early diagnosis of leprosy, its correct classification and the risk factors related to seropositivity have become important for patient treatment and disease control, especially where the responsibility for treatment has been transferred to basic health care centers. This descriptive, exploratory study using logistic regression was undertaken to evaluate the association between the variables of sex, age, mode of detection, number of skin lesions and affected nerves, disability grade and bacilloscopy with the results of the ML Flow serological test in 1,072 new leprosy cases in 13 municipalities in Minas Gerais State. Seropositivity (50.7%) was statistically associated with patients 15 years-old or over (OR:2.6) and those with more than five skin lesions (OR:7.5), more than one affected nerve (OR:2.4) and a positive bacilloscopic index (OR:5.5 for 0or=2), thus contributing to the appropriate classification and treatment of patients.

Comportamento dos testes sorológicos ML Flow e ELISA (PGL-I) em áreas endêmica e não endêmica de hanseníase

ML Flow and anti-PGL-I ELISA are serological tests that detect IgM antibodies against the phenolic glycolipid I (PGL-I), specific to Mycobacterium leprae. To evaluate the outcomes of ML Flow and ELISA (PGL-I) serological tests in leprosy-endemic areas in comparison to non-endemic ones, a total of 351 volunteers from Brazil and Chile were examined, including leprosy patients, healthy controls and others affected by other infectious or non-infectious diseases that are common differential diagnoses for leprosy. The ELISA cut-off point was established using the ROC Curve method (>or= 0.157). In endemic areas, 70% of leprosy patients present positive ML Flow results and 53.3% were ELISA-positive. In non-endemic areas, ML Flow was negative in all the subjects tested and ELISA was positive in 4 volunteers. ML Flow is faster and more easily performed and, therefore, a more adequate test for use in basic, primary-level health care centers. ELISA requires trained personnel, in addition to a more complex laboratory infrastructure.

Correlation between ELISA and ML Flow assays applied to 60 Brazilian patients affected by leprosy

Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The investigation involved 60 patients with newly diagnosed leprosy. Together with the application of the serological assays, selected demographic, clinical and epidemiological data relating to the study population were recorded. ML Flow detected anti-PGL1 antibodies in 70% of the leprosy patients, while ELISA was positive in 53.3%. The degree of concordance between the tests was substantial (83.3%). A positive correlation was demonstrated between the results obtained in the semi-quantitative ML Flow test and ELISA absorbance values. We concluded that both serological assays were found to be efficient in detecting anti-PGL1 antibodies. The ML Flow test may be a cheaper and easier to perform alternative to ELISA in leprosy patients.