Neural complications and physical disabilities in leprosy
               in a capital of northeastern Brazil with high endemicity

Araújo, Ana Eugênia Ribeiro de Araújo e; Aquino, Dorlene Maria Cardoso de; Goulart, Isabela Maria Bernardes; Pereira, Silma Regina Ferreira; Figueiredo, Ivan Abreu; Serra, Humberto Oliveira; Fonseca, Poliana Cristina de Almeida; Caldas, Arlene de Jesus Mendes

doi:10.1590/1809-4503201400040009

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Original Articles • Rev. bras. epidemiol. 17 (4) • Dec 2014 • https://doi.org/10.1590/1809-4503201400040009 copy

Neural complications and physical disabilities in leprosy in a capital of northeastern Brazil with high endemicity

Authorship SCIMAGO INSTITUTIONS RANKINGS

INTRODUCTION:

Leprosy is an infectious disease whose etiologic agent is Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms.

OBJECTIVE:

To investigate neural changes and the degree of physical disability in the eyes, hands and feet before and after treatment, as well as sociodemographic and clinical profile of patients affected by leprosy.

METHOD:

A longitudinal epidemiological study comprising 155 patients with leprosy, from a spontaneous demand, diagnosed between March 2010 and February 2011, and treated with multidrug therapy (MDT) between March 2010 and July 2012 in a program for leprosy eradication in São Luis (MA), Brazil.

RESULTS:

Before treatment, 46.5% of patients were considered as borderline, 51.6% had some alteration in the eyes and 52.3% in the feet, and the radial nerve (18.7%) was the most affected. There was a statistically significant difference between the changes in the radial nerve at the beginning of and after treatment.

CONCLUSIONS:

The analysis points to late diagnosis, as some patients have had abnormal neural and physical disabilities before treatment.

Leprosy; Therapeutics; Disabled persons; Mycobacterium leprae; Nerve degeneration; Epidemiology

Variables	n	%
Gender
Male	69	44.5
Female	86	55.5
Age (years)
≤ 15	19	12.2
16 – 30	46	29.7
31 – 45	42	27.1
46 – 60	28	18.1
> 60	20	12.9
Marital status
Without partner	66	42.6
With partner	89	57.4
Education
Illiterate	5	3.2
Primary school	51	32.9
High school	75	48.4
Higher education	24	15.5
Occupation
Student	40	25.7
Salaried worker	29	18.7
Self employed	29	18.7
Retired	7	4.5
Other	50	32.3
Household income (minimum wage)
< 1	18	11.6
1 – 2	56	36.1
≥ 3	81	52.3
Type of housing
Stucco	5	3.2
Wood	1	0.7
Brick	149	96.1
Waste disposal
Sewer network	87	56.1
Cesspool	55	35.5
Ditch	13	8.4
Garbage disposal
Public collection	147	94.8
Burning	5	3.2
Open-air dump	2	1.3
Burying	1	0.7
Clinical form
Unspecified	26	16.8
Tuberculoid	45	29.0
Borderline	72	46.5
Lepromatous	12	7.7
Total	155	100.0

Complications*
	Before		After		Total n (%)	95%CI	p-value
	n	%	n	%	Total n (%)	95%CI	p-value
Eyes
Absent	55	65.5	20	28.2	75 (48.4)		0.1985
Present	29	34.5	51	71.8	80 (51.6)	0.79 – 2.70
Total	84	54.2	71	45.8	155 (100.0)
Nose
Absent	130	94.2	14	82.3	144 (92.9)		0.2863
Present	8	5.8	3	17.7	11 (7.1)	0.21 – 1.46
Total	138	89.0	17	11.0	155 (100.0)
Hands
Absent	77	74.0	15	29.4	92 (59.4)		0.1985
Present	27	26.0	36	70.6	63 (40.6)	0.79 – 2.70
Total	104	67.1	51	32.9	155 (100.0)
Feet
Absent	56	68.3	18	24.7	74 (47.7)		0.2278
Present	26	31.7	55	75.3	81 (52.3)	0.76 – 2.80
Total	82	52.9	73	47.1	155 (100)

Nerves*
	Before		After		Total n (%)	95%CI	p-value
	n	%	n	%	Total n (%)	95%CI	p-value
Radial
Absent	99	90.8	27	58.7	126 (81.3)		0.005
Present	10	9.2	19	41.3	29 (18.7)	0.16 – 0.79
Total	109	70.3	46	29.7	155 (100)
Median
Absent	128	95.5	12	57.1	140 (90.3)		0.157
Present	6	4.5	9	42.9	15 (9.7)	0.15 – 1.44
Total	134	86.4	21	13.6	155 (100)
Ulnar
Absent	129	92.1	9	60.0	138 (89.0)		0.655
Present	11	7.9	6	40.0	17 (11.0)	0.46 – 3.34
Total	140	90.3	15	9.7	155 (100.0)
Fibular
Absent	118	92.2	11	40.7	129 (83.3)		0.827
Present	10	7.8	16	59.3	26 (16.8)	0.35 – 2.36
Total	128	82.6	27	17.4	155 (100)
Tibial
Absent	123	89.1	9	52.9	132 (85.2)		0.221
Present	15	10.9	8	47.1	23 (14.8)	0.68 – 4.32
Total	138	89.0	17	11.0	155 (100)

Physical disabilities*
	Before		After		Total n (%)	95%CI	p-value
	n	%	n	%	Total n (%)	95%CI	p-value
Eyes
Zero	127	92.7	9	50.0	136 (87.7)		0.818
Grade 1 or 2	10	7.3	9	50.0	19 (12.3)	0.41 – 3.09
Total	137	88.4	18	11.6	155 (100)
Hands
Zero	133	94.3	5	37.5	138 (89.0)		0.405
Grade 1 or 2	8	5.7	9	64.3	17 (11.0)	0.46 – 6.22
Total	141	91.0	14	9.0	155 (100)
Feet
Zero	100	90.1	15	34.1	115 (74.2)		0.433
Grade 1 or 2	11	9.9	29	65.9	40 (25.8)	0.30 – 1.71
Total	111	71.6	44	28.4	155 (100)

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[1] Corresponding author: Ana Eugênia Ribeiro de Araújo e Araújo. Rua dos Juritis, s/n, Edifício Mirela, apto. 903, Renascença, CEP: 65075-120, São Luís, MA, Brasil. E-mail: euggenia@hotmail.com