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Title

LEPROSY IN THE ERA OF IMMUNOSUPPRESSION: DO WE NEED TO WORRY? EPIDEMIOLOGICAL DATA IN BRAZIL FROM 2015-2017

Background

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, its main sites being the skin and peripheral nerves. Brazil is the second country in number of cases, losing only to India. Due to the high number of cases and the possibility of musculoskeletal manifestations of the disease, rheumatologists should be aware of the possibility of this diagnosis both as primary disease and in patients immunosuppressed by other rheumatic diseases or use of medications.
The objective of this study was to evaluate the number of new cases in Brazil from 2015 to 2017.

Materials and methods

Descriptive, ecological study, in a time series, based on data obtained from the SINAN and the General Coordination of Leprosy and Diseases in Elimination (CGHDE). Data were collected on patients with leprosy in the period 2015 to 2017. Variables analyzed: new cases per state, cutaneous lesions, clinical forms and therapeutic schemes.

Results

In the period 2015-2017, 76.919 new cases of leprosy were reported in Brazil, with the highest number of cases occurring in the Northeast region (TABLE 1). There was a prevalence of 2-5 cutaneous lesions (TABLE 2), and the clinical form with the largest number of cases was dimorphic (TABLE 3). As for the therapeutic scheme, the most used was the MDT / MB / 12 doses (TABLE 4).

TABLE 1: New cases of leprosy by region of Brazil in the period 2015-2017
Region New cases 2015-2017
TOTAL 76.919
North 14.817
Northeast 33.750
South 2.555
Southeast 10.322
Midwest 14.942


TABLE 2: Skin lesions of leprosy in the period 2015-2017.
SKIN LESION NUMBER OF CASES
TOTAL 76.919
0 3.845
1 18,185
2-5 27.529
>5 lesões 11.341
Ignored 16.019

TABLE 3: Clinical forms of leprosy in the period 2015-2017
CLINICAL FORMS NUMBER OF CASES
TOTAL 76.919
Ignored 2.932
Undetermined 10.707
Tuberculoid 11.715
Dimorph 34.899
Virchowiana 12.307
Unclassified 4.359

TABLE 4: Therapeutic schemes of leprosy in the period 2015-2017
THERAPEUTIC SCHEMES NUMBER OF CASES
TOTAL 76.919
Ignored 135
PQT 6 doses 21.877
PQT 12 doses 54.424
Other alternative schemes 483

Conclusions

Brazil is an endemic country in leprosy and has presented a considerable number of new cases in three years. It is up to the rheumatologist to have a high level of suspicion for proper management and prevention of sequelae.