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An. Bras. Dermatol. vol.80 no.3 Rio de Janeiro May/June 2005
Terminology related to hansen's disease*
Paula Araujo OpromollaI; Antonio Carlos Ceribelli MartelliII
IBiologist. MSc Degree in Public
Health from the Faculdade de Medicina de Botucatu - UNESP. Ph.D. Student in
Epidemiology, Faculdade de Saúde Pública - USP. Health Technical
IIDermatologist. Head of the Health Technical Division - Sector of Dermatology
The international standardization of diseases is a complex process that requires a specialized team. The aim of this work is to clarify and suggest some corrections for a probable misunderstanding during the translation of ICD-10 code A30 into Portuguese, in which the terms borderline and dimorfo (dimorphous) are used as different subcategories and not as synonyms; moreover, the designation lepromatosa (lepromatous) should be replaced by virchoviana (virchowian) considering that in Brazil, the word lepra (leprosy) was abolished from official texts by a Federal Act in 1995.
Keywords: International classification of diseases; Leprosy; Terminology
Classifying means to distribute into classes and in their respective groups, according to a classification system or method; to put in a certain order; to sort out. Classifying a disease is a manner to know it better. The more knowledge about a disease, the more its classification changes and is completed.1
The standardization of the International Classification of Diseases (ICD) dates back to the 18th century and it is periodically reviewed by several World Health Organization (WHO) collaborating centers from various countries. The review provides new term updating, better systematization of diseases to improve diagnosis, and inclusion of new pathologies found out.2
The classification of leprosy adopted by the 10th Review of the International Statistical Classification of Diseases and Related Health Problems - ICD-10, was approved by the WHO ICD-10 International Conference, in 1989, and sanctioned by the 43rd World Health Assembly. It is encoded A30 and employs the nomenclature used in Ridley-Jopling classification3 for this disease. The current translation into Portuguese presents the following:2
A30 Hansen's disease [leprosy]
It includes: infection by Mycobacterium leprae
It excludes: sequela of Hansen's disease (B92)
A30.0 Indetermined Hansen's disease [leprosy]
Hansen's disease I
A30.1 Tuberculoid Hansen's disease [leprosy]
TT Hansen's disease [leprosy]
A30.2 borderline tuberculoid Hansen's disease [leprosy]
BT Hansen's disease [leprosy]
A30.3 Dimorphous Hansen's disease [leprosy]
Hansen's disease [leprosy]:
A30.4 borderline lepromatous Hansen's disease [leprosy]
BL Hansen's disease [leprosy]
A30.5 Lepromatous Hansen's disease [leprosy]
LL Hansen's disease [leprosy]
A30.8 Other forms of Hansen's disease [leprosy]
A30.9 Unspecified Hansen's disease [leprosy]
The following recommendations are made regarding this document:
1. The terms borderline and dimorfo (dimorphous) are used as distinct subcategories, although having the same meaning.
2. In A30.2, borderline is the English term and dimorfo (dimorphous) is the corresponding term in Portuguese; therefore, the word borderline should, at least, be written enclosed in inverted commas, and the acronym for this subcategory should be DT.
3. In A30.3 the main terminology is correct. However, why is there a colon? And why are the acronym BB and the word borderline used as sub-items? In this case, the term could come be enclosed in inverted commas as a sub-item, but as a simple correspondence to the term dimorfo (dimorphous) in Portuguese. Hence, the acronym used should be DD.
4. In A30.4, apart from the same considerations about the term borderline, which should be replaced by dimorfo (dimorphous), the term lepromatosa (lepromatous) should not be used according to Law No. 9,010. This law provides replacing the term lepromatosa (lepromatous) by virchovian (virchowian) and the acronym for this subcategory should be DV.
5. In A30.5, the word lepromatosa (lepromatous) by virchovian (virchowian) should be replaced by virchovian (virchowian), for the same reasons mentioned above, and the corresponding acronym should be VV.
These misunderstandings might be related not only to the Portuguese translation, but also to the nomenclature implemented as of the 1970's, which aimed to reduce the stigma of this disease, when Prof. Abrão Rotberg proposed replacing the term lepra (leprosy) by hanseníase (Hansen's disease).5
This change put forwarded by Prof. Abrão Rotberg was corroborated by the Secretary of Health of the State of São Paulo at that time, Prof. Valter Leser and by the technical committee of this agency. The Secretariat published a resolution determining the creation of a new vocabulary to classify this disease, in December 1970.6 Since then, the disease officially became hanseníase (Hansen's disease) for the Secretariat of Health of the State of São Paulo.5
In 1975, The Ministry of Health adopted the term hanseníase (Hansen's disease) according to the Decree No. 76,078, of August 4, 1975 (published in the Official Union Gazette - DOU, of August 5, 1975),7 during President Geisel term.8
Gradually this new terminology was accepted by other health services; on March 29, 1995, the Federal Law No. 9,010 made compulsory the use of the term hanseníase (Hansen's disease) instead of lepra (leprosy).
Having said that, and since the Ministry of Health and the official documents related to leprosy complied with the Madrid classification (1953)9 and used the ICD-10 A30 code and its subcategories,10 we suggest reviewing this terminology and the use of terms to classify it in ICD-10, in the Portuguese version, as provided in Law No. 9,010. q
1. Opromolla DVA, editor. Noções de hansenologia. Bauru: Centro de Estudos "Dr. Reynaldo Quagliato"; 2000. [ Links ]
2. Organização Mundial da Saúde. CID-10; tradução Centro Colaborador da OMS para a Classificação de Doenças em Português. 1. 3ed. São Paulo: EDUSP; 1996. [ Links ]
3. Ridley DS, Jopling WH. Classification of leprosy according to immunity: a five-group system. Int J Lepr. 1966; 34:255-71. [ Links ]
4. Brasil. Lei Federal nº 9.010 de 29 de março de 1995. Dispõe sobre a terminologia oficial relativa à hanseníase e dá outras providências. Brasília. (DF); 1995. [ Links ]
5. Forgerini E, Rossini C, org. Mestres da Dermatologia Paulista. São Paulo: Editora JSN; 2002. [ Links ]
6. São Paulo (Estado). Deliberação SS/CTA nº 7: Terminologia referente à hanseníase. 10/12/70. Publicada no Diário Oficial do Estado de São Paulo de 11 de dezembro de 1970. [ Links ]
7. Brasil, Decreto Federal nº 76.078 de 04 de agosto de 1975. Altera a denominação de órgãos do Ministério da Saúde e dá outras providências. Brasília. (DF); 1975. [ Links ]
8. Rotberg A. O pejorativo "lepra" e a grande vítima de grave erro médico-social-histórico: a indefesa América Latina. Rev Hist. 1975;101:293-305. [ Links ]
9. Brasil. Ministério da Saúde. Secretaria de Políticas de Saúde. Departamento de Atenção Básica. Guia para o controle da hanseníase. Cadernos de Atenção Básica nº10. Série A. Normas e Manuais Técnicos; nº 111. 1ª Edição. Brasília. (DF); 2002: p 66-9. [ Links ]
Paula Araujo Opromolla
Instituto Lauro de Souza Lima - Bauru - SP
Caixa Postal 3021
17034-971 - Bauru - SP
Tel.: (14) 3103-5852 / Fax: (14) 3103-5914
Received on November 21, 2003.
Approved by the Consultive Council and accepted for publication on December 08, 2004.
* Work done at Instituto Lauro de Souza Lima - Bauru (SP) - Brazil.