Innovative tracking, active search and follow-up strategies for new leprosy cases in the female prison population.

Claudia Maria Lincoln Silva,Carmem Sílvia Vilela Pinese,Patricia Toscano Barreto Nogueira Onofre,Glauber Voltan,Natália Aparecida De Paula,Wilson Marques-Junior,Marco Andrey Cipriani Frade,Fred Bernardes Filho,Filipe Rocha Lima,Jaci Maria Santana,Vanessa Aparecida Tomaz,Luisiane De Avila Santana,Marcel Nani Leite,Carlos Franco-Paredes

doi:10.1371/journal.pntd.0009716

Claudia Maria Lincoln Silva, Carmem Sílvia Vilela Pinese + Show 12 more

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https://doi.org/10.1371/journal.pntd.0009716

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Abstract

Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1-numbness (5.6), Q3-anesthetizes areas in the skin (7.5), Q5-Stinging sensation (5.8), and Q7-pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.

Highlights

Leprosy is a chronic disease characterized by neurological and dermatological manifestations that lead to disability [1]
We evaluated 404 female inmates, 14 new cases were diagnosed (LG-leprosy group), and 390 constituted the Non-Leprosy group (NLG), a new case detection rate of 3.4%
After undergoing dermato-neurological clinical examination by the team, fourteen new leprosy cases were diagnosed among the 404 women initially evaluated, resulting in a 3.5% new case detection rate (NCDR) at the Ribeirão Preto Female Penitentiary

Summary

Introduction

Leprosy is a chronic disease characterized by neurological and dermatological manifestations that lead to disability [1]. It is caused by Mycobacterium leprae, a bacillus of high infectivity and low pathogenicity [2] and it is mainly associated with social inequality, affecting the most underprivileged areas in the world [3]. Transmission occurs through the upper airways of the patients with a high bacillary load, depending essentially on the relationship with the host and the degree of endemicity of the environment [4, 5]. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene among confined women

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