The cure for leprosy, made available in the form of free medicines in public health networks, has not been sufficient to eradicate the disease in the country. Last year alone, 1,537 cases were registered in Bahia, according to data from the State Department of Health (Sesab). Between 2019 and 2022 there were 6,608. To fight prejudices and raise awareness of early diagnosis, World Leprosy Day is celebrated on the last Sunday (29) of January in purple.
A dot noticed under one of the breasts was the initial alarm for Patricia* to begin tracing the path of the leprosy diagnosis. The year was 2015 and the woman noticed that as her spot grew and fell off, she felt pain in her joints and muscles. After undergoing medical treatment, she discovered that she had developed the disease, which was formerly known as leprosy.
In addition to the signs that the skin is numb, tingling sensations in the hands and feet, lumps in the body, and decreased muscle strength are common symptoms. The bacterium called Mycobacterium leprae is responsible for leprosy, but only 5% of people who come into contact with the microorganism develop the disease in Brazil, according to the Ministry of Health.
Read more: In Bahia there are six cases of leprosy a day
“About 90 percent of people are immune, but there appears to be a genetically inherited predisposition in people who develop the disease,” explains dermatologist Gleison Duarte. In Bahia, the number of people affected by the disease remains stable, with a small reduction between 2019 and subsequent years, which may be the result of underreporting during the pandemic.
The patient with leprosy can develop serious sequelae if diagnosis is delayed. Hence the importance of knowing the initial symptoms of the disease and being attentive, as Patricia did. Among the most serious consequences are physical disability, hand and foot deformities, and blindness.
The Leprosy Epidemiological Bulletin of the Health Surveillance Secretariat of the Ministry of Health, released this month, points out that Bahia was the fourth state with the highest number of new cases of the disease between 2010 and 2021, after Maranhão, Mato Grosso and Pernambuco.
transmission and treatment
The transmission of leprosy occurs through the respiratory system of infected people. But the dermatologist and leprologist Laila de Laguiche, creator of the Instituto Aliança contra a Leprosy, explains that the transmission is not simple.
“It is difficult to contract leprosy because you need a prolonged exposure of at least 20 hours per week and a corresponding genetic profile”, clarifies.
Those who are diagnosed with the disease are entitled to free treatment, carried out with the use of three antibiotics made available by the Unified Health System (SUS). After two weeks, when first medicated, the patient stops transmitting the disease. Experts, however, caution that continued treatment is essential to eradicating the disease in the body.
In Salvador, 236 patients are being treated in the municipal network. Of all the people who initiate the procedure, 85.6% complete it, according to data from the Municipal Health Department (Sms). The network offers nine different types of medicines to combat leprosy in the capital.
“When signs of skin lesions are noticed, the patient should immediately seek a dermatologist or an infectologist so that he can be examined. In the case of leprosy, treatment can be carried out for periods ranging from six months to two years,” explains Antônio Bandeira, director of the Brazilian Society of Infectious Diseases.
Although the vast majority of the population has no predisposition to leprosy, Brazil ranks second in the number of cases, behind only India, as indicated by the latest World Health Organization (WHO) report released in 2019.
Capital on alert
Of the 6,600 cases registered in Bahia over the past four years, 759 were in Salvador, which represents 11% of all diagnoses. The sample districts for number of registrations are Subúrbio Ferroviário (132), Itapuã (153) and São Caetano/Valéria (106). Boca do Rio and Centro Histórico are instead the localities with the lowest number of cases, with 20 and 15 respectively.
Hansenologist Laila de Laguiche analyzes that cases of the disease occur more frequently in places where access to health is difficult. “It is a disease directly linked to the lack of accessibility to health care because diagnosis is delayed in these places,” she says. Furthermore, sharing rooms with other people and poorly ventilated environments favors the transmission of the disease.
Prejudice contributes to underestimation, says expert
Of the total number of cases registered in Bahia over four years, 273 were in children under 15, which represents 4% of the 6,600. For the specialists heard by the report, the data reveals an underreporting of cases of people who have not treated the disease properly and have passed it on to younger people.
The lack of correct information on the disease, together with unprepared health professionals and prejudices from society, contribute to cases not being diagnosed at the beginning, analyzes Laila Laguiche.
“Prejudice is still very strong in Brazil and in the world. There is a difficulty in dealing with the disease like any other. Doctors, for example, think that in some cases it may be leprosy, but they don’t make the diagnosis out of prejudice ”, she reveals.
To avoid underreporting and exacerbation of cases, the infectious disease specialist Antônio Bandeira defends the implementation of public policies: “The data reinforces the need for a diagnostic program, which is essential that it occurs as soon as possible.”
Despite the special attention paid to information on the disease during the Purple January campaign, Salvador has the municipal leprosy control program. The action makes use of multidisciplinary teams and operates permanently in 121 health centers in the capital, from Monday to Friday, from 8 to 17.
symptoms of leprosy
- Spots (white, reddish, brownish or brownish) and/or areas of the skin with alteration of thermal sensitivity (to heat and cold) and/or sore (to pain) and/or tactile (to touch)
- Peripheral nerve(s) impairment – usually thickening (thickening) – associated with sensory and/or motor and/or autonomic impairment
- Areas with decreased hair and sweat
- Tingling and/or pins and needles, especially in the hands and feet
- Decreased or absent sensation and/or muscle strength in the face and/or hands and/or feet
- Lumps (nodules) on the body, sometimes red and painful
form of transmission
Transmission occurs when a person affected by leprosy, in the infectious form of the disease, without treatment, eliminates the bacillus in the external environment, infecting other susceptible people, i.e. those with a greater probability of falling ill. The way the patient clears the bacillus is through the upper airways (through sneezing, coughing, or talking), and not through objects used by the patient. Close and sustained contact is also needed. Patients with few bacilli – paucibacillary (PB) – are not considered important sources of disease transmission, due to their low bacillary burden.
Treatment
The pharmacological treatment of leprosy involves the association of three antimicrobials: rifampicin, dapsone and clofazimine. This partnership is called Single Multidrug Therapy (U-MDT) and is available in presentations for adults and children. It is available free of charge and exclusively in the Unified Health System – SUS.
*With the guidance of sub-editor Fernanda Varela.
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