Caracterização clínico-epidemiológica de pacientes com reações hansênicas em serviço de atenção secundária de Parnaíba, Piauí

Abstract

Leprosy, a disease caused by Mycobacterium leprae, is a neglected tropical disease, reaching its highest prevalence in developing countries such as India and Brazil, first and second in number of cases in the world. It is a historically stigmatizing disease due to the deformities it causes in the long term, as long as it is not treated. Its treatment exists and is widely disseminated in the Unified Health System, multidrug therapy (MDT). However, reaction states, immune exacerbation reactions can still occur even when the patient is properly treated, and clinical cure is defined. These states are mainly responsible for long-term deformities. Thus, the objective was to evaluate the clinical and epidemiological characteristics of patients with leprosy reactions (HR) treated at the Health Specialties Center (CES) Dr. Odival Coelho de Rezende, in Parnaíba-PI. For this research, 2560 medical records of patients treated at the CES dermatology service were analyzed, of which 54 met the inclusion and exclusion criteria of the study. Data (demographic, epidemiological and clinical characteristics) were compiled and evaluated in terms of prevalence and compared between the types of reactions presented (types 1 and 2) using, for this purpose, the chi-square test and Fisher's exact test. Patients were mostly male (66.7%), aged between 30-69 years (65%) and from Parnaíba-PI (65%); none of these characteristics showed a statistically significant difference regarding the type of reaction presented. As for the clinical and epidemiological characteristics, the presence of type 1 RH was more associated with paucibacillary patients, whereas type 2 RH was associated with multibacillary patients (p < 0.014); 63% of the patients had already finished MDT when they presented RH, with a median of 24 (0-264) months between the diagnosis and the presentation of the first reactional episode and 59% presented Functional Disability Degree 1. The Simplified Neurological Assessment (ANS) was more frequently performed in patients with RH type 2 (p = 0.010). No statistically significant association was observed between changes observed in the ANS and the type of reactional state. Finally, the treatment of the evaluated patients, according to Ministry of Health guidelines, consisted of isolated corticosteroid therapy for patients with type 1 RH and isolated thalidomide or associated with corticosteroids for those with type 2 RH (p < 0.001). Thus, further research is imperative on the profile of Leprosy in the Piauiense Litoraneal Plain (region that encompasses Parnaíba) on the epidemiological and clinical profile of patients affected by leprosy reactions, as well as greater training of professionals involved in the Primary health care to identify and treat these reactional conditions, aiming to reduce the prevalence of physical disabilities in this population.