Nerve Damage in Young Patients with Leprosy Diagnosed in an Endemic Area of the Brazilian Amazon: A Cross-Sectional Study

• Published in: The Journal of pediatrics 2017-06, Vol.185, p.143-148
• Main Authors: Bandeira, Sabrina Sampaio, MSc, Pires, Carla Avelar, MD, PhD, Quaresma, Juarez Antonio Simões, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Amazonia; Brazil; Brazil - epidemiology; Child; Child, Preschool; Cross-Sectional Studies; Disability Evaluation; Endemic Diseases; Female; Humans; Infant; leprosy; Leprosy - epidemiology; Male; nerve damage; Neurologic Examination; Pediatrics; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - epidemiology; Peripheral Nervous System Diseases - microbiology
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.02.035

Objective To describe nerve damage and its association with clinical and epidemiologic characteristics in young patients with leprosy diagnosed in an endemic area of the Brazilian Amazon. Study design All 45 patients with leprosy younger than 15 years of age and diagnosed at a health referral unit in northern Brazil were invited to participate in a cross-sectional, descriptive, analytical study. Subjects were submitted to a templated simple neurologic examination of the peripheral nerves and answered a structured questionnaire. Results Of 41 cases, referral was the mode of detection in 33 participants (80.5%); 19 (46.3%) had been seen by 3 or more physicians to obtain a diagnosis, and 26 (63.4%) had received other diagnoses. The interval between the onset of symptoms and diagnosis was more than 1 year in 30 cases (73.2%). Borderline leprosy was the predominant clinical form (48.8%); 63.4% of the participants had multibacillary leprosy, 31.7% had nerve damage, and 17.1% exhibited disabilities. The following variables showed a statistically significant association ( P  ≤ .05) with nerve damage at diagnosis: home visit by the community health worker, number of doctors seen, number of skin lesions (>5), and lesions along the path of nerve trunks. Conclusion Centralized healthcare, a low frequency of home visits by community health workers, and the difficulty in diagnosing leprosy in children are factors that contribute to late treatment initiation and an increased risk of peripheral nerve damage. In addition, multiple skin lesions and lesions along the path of nerve trunks require rigorous monitoring.