Abstract
ObjectiveTo evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO).MethodsCohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics.ResultsThe total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02–2.56), when disability was 2, the risk was 2.37 (95% CI 1.35–4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07–3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08–2.52]).ConclusionImpairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.
Highlights
Leprosy is a major public health problem and epidemiological burden
We evaluated 368 multibacillary patients who completed the WHO-recommended treatment of 12 supervised doses of multidrug therapy (MDT)
The duration of multidrug therapy (MDT) treatment of leprosy is considered the sole criterion for the cure of the disease, assuming that 12 months of MDT will be sufficient to induce a bacteriological cure (ILEP 1998)
Summary
Leprosy is a major public health problem and epidemiological burden. It is a chronic infectious disease with acute and sometimes severe clinical presentations. In addition to its characterisation as an infectious transmissible disease, it causes neurological disorders and, physical disabilities, which can occur at any stage of the disease even after the patient has been released from chemotherapy treatment and is considered bacteriologically cured. The disease primarily affects the skin and peripheral nerve fibres. The damage to peripheral nerves results in sensory and motor impairment with characteristic deformities and disabilities. Studies show that approximately 20% of patients with leprosy present physical disabilities and social and psychological restrictions (Deepak 2003)
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