Single lesion paucibacillary leprosy: baseline profile of the Brazilian Multicenter Cohort Study.
In Brazil, there is little information about the clinical and epidemiological characteristics of paucibacillary, single skin lesion leprosy patients (SSL-PB). Only recently has the official notification system distinguished leprosy patients with a single lesion as a clinical entity, for whom the single-dose ROM (rifampin, ofloxacin and minocycline) regimen has been recommended. In this paper, we describe the baseline clinical features and the immunological background of a multicenter cohort of SSL-PB leprosy cases enrolled between December 1997-1998. Patients were recruited at health centers located in the following regions: Southeast = Rio de Janeiro; North = Amazon and Rondônia states and Center-West = Goiás state. Eligible cases were newly detected, untreated single-lesion leprosy patients without thickened nerve involvement, and were assessed by clinical, bacilloscopic and histopathological exams. The Mitsuda skin test and anti-PGL-I serology (ELISA) were also performed. Of the 299 SSL-PB leprosy patients, 259 (86.6%) fulfilled the criteria for single-dose ROM intervention. Our results showed that patients recruited from different sites had similar features, considering the clinical and immunological profiles. There was a predominance of adults (mean age 32.4; S.D. = 16.0), and a BCG scar was detected in 76.7% of the children (< or = 15 years old). Only 7 cases were diagnosed as the multibacillary type, representing less than 3% of the patients being misclassified. Our data indicate that in Brazil SSL-PB case ascertainment based on clinical and bacilloscopic criteria can be accurately defined under a routine control program; 75.0% of SSL-PB cases were Mitsuda positive (> or = 5 mm) and seropositivity for anti-PGL-I was detected in 17.3% of the patients. These data are compatible with effective cell-mediated immunity and low bacillary load, suggesting favorable clinical outcomes for most SSL-PB participants of this cohort.
Martelli
C M
CM
Universidade Federal de Goias, Instituto de Patologia Tropical e Saude Publica, Rua Delenda Rezende de Mello, S/N, Setor Universitario, Goiania/GO, Brazil. martelli@cultura.com.br
Stefani
M M
MM
Gomes
M K
MK
Rebello
P F
PF
Peninni
S
S
Narahashi
K
K
Maroclo
A L
AL
Costa
M B
MB
Silva
S A
SA
Sacchetim
S C
SC
Nery
J A
JA
Salles
A M
AM
Gillis
T P
TP
Krahenbuhl
J L
JL
Andrade
A L
AL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D001938:Brazil / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004522:Educational Status; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015440:Leprosy, Lepromatous / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000627:therapeutic use; D009166:Mycobacterium leprae / Q000254:growth & development / Q000302:isolation & purification*; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D018579:Patient Selection; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use
D000890:Anti-Infective Agents; D007917:Leprostatic Agents; D015242:Ofloxacin; D008911:Minocycline; D012293:Rifampin