Leprosy Reactions In Childhood: A Prospective Cohort Study In The Brazilian Amazon
Authors Bandeira SS, Pires CA, Quaresma JAS
Received 26 May 2019
Accepted for publication 8 August 2019
Published 17 October 2019 Volume 2019:12 Pages 3249—3257
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Suresh Antony
Sabrina Sampaio Bandeira,1,2 Carla Avelar Pires,2,3 Juarez Antonio Simões Quaresma2,3
1Sanitary Dermatology Referral Unit “Dr. Marcello Cândia”, Secretary of State for Public Health, Marituba, PA, Brazil; 2Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil; 3Center of Health and Biological Sciences, State University of Para, Belem, PA, Brazil
Correspondence: Juarez Antonio Simões Quaresma
Tropical Medicine Center, Federal University of Para, Av. Generalissimo Deodoro 92, Umarizal, Belem, PA 66055-240, Brazil
Background and objective: In highly endemic areas, severe multibacillary forms of leprosy and reactional episodes are not rare in children. The objective of the present study was to describe the clinical and epidemiological aspects of leprosy reactions in children from the Brazilian Amazon.
Methods: This was a prospective cohort study of 34 leprosy patients aged under 15 years diagnosed at a health referral unit in northern Brazil between April 2014 and June 2015. Follow-up medical consultations were performed during multidrug therapy (MDT) and one year after the end of treatment. Participants underwent a simple neurologic examination and answered a structured questionnaire.
Results: Of the 34 recruited patients, 18 (52.9%) had leprosy reactions and/or neuritis. Among these, 10 (55.6%) had reactions at diagnosis, 13 (72.2%) had reactions after MDT, and 14 (77.8%) had two or more reactional episodes. Type I reactions occurred in 14 (77.8%) cases. Complications, such as disabilities, necrotizing erythema nodosum, or Cushing’s syndrome, occurred in six (33.3%) patients. The following variables showed significant associations (p ≤ 0.05) with leprosy reactions: age 8–14 years, number of doctors seen (≥3), multibacillary classification, number of skin lesions (≥10), or borderline and lepromatous clinical forms. The high frequency of type I reactions resulted in prolonged corticosteroid therapy, which may cause deficient bone maturation in childhood.
Conclusion: Older age in children, consulting many physicians for diagnosis, severe clinical forms, and numerous skin lesions were positively associated with reaction development. Reactions after MDT highlight the need for continuity in healthcare of children with leprosy.
Keywords: Mycobacterium leprae, leprosy, children, clinical aspects, Brazil, Amazon
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