Abstract
BackgroundLeprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up. Given the complexities of leprosy management, a safety tool was developed and implemented in the Tropical Disease Unit at Toronto General Hospital. Our objective was to evaluate the utility of the tool using a retrospective chart review.MethodsWe reviewed the charts of patients with leprosy treated over a 3.5-year period: up to 3 years prior to tool implementation, and 6-months following implementation. Pre-determined outcomes of interest included: loss to follow-up; monitoring of laboratory parameters; allied health services engagement; baseline ophthalmologic assessment; and risk mitigation interventions.ResultsOf 17 patients enrolled, 8 were treated pre-implementation, and 9 post-implementation. Five (29.4%) pre-implementation patients were lost to follow-up compared to none post-implementation (p = 0.009). One (12.5%) pre-implementation patient was sent for baseline ophthalmologic assessment versus 8 (88.9%) post-implementation (p = 0.0034). Only post-implementation patients received referrals for occupational therapy and social work, with 77.8% (n = 7) receiving occupational therapy (p = 0.0023) and 33.3% (n = 3) social work (p = 0.2059). Laboratory parameters such as hemoglobin, hepatic transaminases, and methemoglobin were routinely monitored for patients on dapsone irrespective of tool implementation.ConclusionsImplementation of a leprosy-specific safety tool has established a user-friendly method for systemizing all elements of care, and ensuring the involvement of allied health services necessary for optimizing health outcomes.
Highlights
Leprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up
Treatment of leprosy requires the use of multidrug therapy (MDT), typically consisting of two or three antibiotics administered for 6 months to 2 years
We have developed and implemented a safety tool in our unit to systematize the care of leprosy patients, a group who are at increased risk of adverse clinical outcome due to the constellation of socioeconomic marginalization, chronic debilitating neuropathy, and medication toxicities
Summary
Leprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up. In many non-endemic countries, a general lack of disease awareness leads to delayed diagnosis and treatment, which increases the likelihood of leprosy causing serious and irreversible nerve damage [4]. Selecting an effective treatment plan requires consideration of manifold factors including the spectrum of clinical disease, individual past medical and social history ( occupation), the occurrence of “reactions” Treatment of leprosy requires the use of multidrug therapy (MDT), typically consisting of two or three antibiotics administered for 6 months to 2 years. Common side effects include hemolysis and methemoglobinemia from dapsone; liver toxicity from rifampin; tendinopathy and C. difficile colitis from ofloxacin; and severe hyperpigmentation and rash from clofazimine [7]
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