Development and Evolution of Nerve Damage in Individuals with Leprosy during Medical Treatment, at Completion of MDT and After Release from Treatment

摘要

Nerve damage in leprosy is related to the appearance of disabilities, the worst sequel of the disease. This study's objective was to study the evolution of nerve damage and estimate the risk of development of disabilities, during the medical treatment, as well as after completion of treatment and during post treatment follow-up. A cohort study was conducted, during period of 2006 to 2014, involving 85 new leprosy cases, treated in a reference service centre of leprosy. Data was collected from medical records and control books from the centre. The cases with or without nerve damage at the time of leprosy diagnosis were st udied during treatment (three months after MDT was started), at the time of completion of MDT and one year after release from treatment for evolution of nerve damage. It was observed that in most (60/85) cases of this cohort, at the time of diagnosis of the disease clinical signs of nerve damage were present. There was predominance of a moderate stage of the sensory damage that did not decrease even at the end of the treatment and post treatment follow-up. It was observed that multibacillary cases had a higher risk of deterioration and or development of nerve damage. Cases with leprosy reactions showed higher risk of developing new nerve damage after completion of treatment and during the follow-up after release from treatment. In some cases the nerve damage was also aggravated during treatment. The presence of neuritis, during presentation and treatment increased the risk of worsening of the neural status. It was a observed that cases with more severe sensory damage and also those having disabilities at discharge presented a greater risk rate of deterioration and worsening of nerve damage up to one year after release from treatment. It is concluded that some factors like presence of nerve damage at the time of diagnosis, reactions and neuritis and MB classification are associated with increased risk of development and/or aggravation of nerve damage, emphasizing the importance of the proper monitoring of leprosy cases during treatment and also in the follow up period after completion of treatment.