Situation of the foot at risk due to leprosy in the municipality of Rio de Janeiro

Caroline Abreu,Silvana Teixeira De Miranda,Antônio José Ledo Alves Da Cunha,Maria Katia Gomes,Maria Cristina Dias Da Silva,Eduardo Alexander,Marja Vilhena

doi:10.47276/lr.92.2.124

Caroline Abreu, Silvana Teixeira De Miranda + Show 5 more

Open Access

https://doi.org/10.47276/lr.92.2.124

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Abstract

Management of tibial neuritis is often hindered by silent neuropathy. The morbidity could be easily detected when the healthcare provider uses the systematic approach of simplified neurological evaluation recommended by the Brazilian Ministry of Health. Evolution from grade 1 disability (G1D) to grade 2 disability (G2D) is not uncommon after treatment with WHO/MDT owing to the development of plantar ulcers, osteomyelitis, and the need for surgical amputation. Objective: We aimed to analyze the clinical course of patients with leprosy who presented with plantar anesthesia and G1D in the feet. Methods: This is a retrospective longitudinal observational case study. We reviewed the records of Hansen’s disease between 2004 and 2018 in four healthcare units in the Municipality of Rio de Janeiro. The sample comprised patients with leprosy (G1D or G2D) and anesthetic foot who underwent treatment and completed follow-up until discharge from WHO/MDT. Descriptive analysis and comparison between variables were performed using Fisher’s exact test with p < 0.05. Results: Forty-nine patients were selected from 135 medical records. There was an increase in the physical disability grade in 20.4% of the cases due to the occurrence of plantar ulcers in 10.2% and in 49% of the patients with post-discharge complications. Chronic pain was the most reported symptom (22.4%). Conclusion: Inadequate and prolonged use of glucocorticoids for chronic pain, noncompliance in the use of orthosis and adequate footwear, and nonreferral for surgical decompression of the tibial nerve suggest the need for professional training in the therapeutic approach to nerve damage in leprosy.

Highlights

Leprosy is a chronic infectious disease with an immunological background in which Mycobacterium leprae affects primarily the skin and peripheral nerves, with the development of sensory and motor changes and potential risk of permanent sequelae
Studies have evaluated indirect clinical complications of leprosy, both related to physical disability and the psychosocial impact related to the stigma of the disease.[5]
The study sample consisted of patients with official mandatory notification records of Hansen’s disease, classified as grade 1 disability (G1D) or grade 2 disability (G2D), and were associated with anesthetic foot who underwent treatment and complete follow-up until discharge from World Health Organization (WHO)/MDT in healthcare units of the city of Rio de Janeiro, from 2004 to 2018

Summary

Introduction

Leprosy is a chronic infectious disease with an immunological background in which Mycobacterium leprae affects primarily the skin and peripheral nerves, with the development of sensory and motor changes and potential risk of permanent sequelae. Nerve damage is responsible for physical disabilities; systematic follow-up of patients and the search for effective therapies are necessary.[1,2]. It is noteworthy that 23% of patients exhibit disability grade progression even after discharge from WHO/MDT.[4] In the last decade, studies have evaluated indirect clinical complications of leprosy, both related to physical disability and the psychosocial impact related to the stigma of the disease.[5] Chronic pain in leprosy is one of the most frequent post-discharge complications (PDC); it is disabling and sometimes neglected, and its pathophysiology remains to be elucidated.[6,7]

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