Post-treatment recurrences of multibacillary leprosy
Recidivas postratamiento de la lepra multibacilar
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URI: http://hdl.handle.net/10818/57847Visitar enlace: http://www.scielo.org.co/sciel ...
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Rodríguez, Gerzaín; Pinto, Rafael; Laverde, Carlos; Sarmiento, Martha; Riveros, Angélica; Valderrama, Jessika; Ordóñez, NellyDate
2004Abstract
Leprosy relapses are mainly due to bacillary persistence and diamino-diphenyl-sulphone (DDS)
monotherapy. Case histories were examined for 33 patients with lepromatous leprosy (LL),
diagnosed 7-48 years before the relapse and treated only with DDS during 4 to 38 years.
Twenty-eight patients received irregular non-supervised polychemotherapy (PCT) since 1983.
Five patients received only DDS, and presented relapses 13-20 years after the treatment was
stopped. Relapses were diagnosed by clinical methods, including the reappearance of lesions
or presence of new anesthetic areas. All cases were confirmed by bacilloscopy, and a subset of
20 cases by skin biopsy. Four patients presented indeterminate leprosy (IL) and one patient
borderline tuberculoid leprosy (BT) in the biopsy. The latter 5 demonstrated presence of
intraneural bacilli; the remainder were LL. Two patients relapsed even with PCT treatment. The
others were cured with supervised PCT. Predisposing factors for relapses were as follows: DDS
monotherapy, irregular PCT with inadequate dosage, unsupervised treatment, treatment
uncompliance, and inadequate relationship between the patient and the health staff. Inspections
for relapse in leprosy is recommended for in all multibacillary patients that were treated with
DDS. The clinical appearance of new lesions or new anesthetic zones, the bacilloscopy and
skin biopsy, used together, are effective in establishing the presence of relapses. La persistencia de bacilos viables y la monoterapia con diamino-difenil-sulfona (DDS) son los
principales factores que favorecen las recidivas de la lepra. Presentamos 33 pacientes con
lepra lepromatosa (LL) diagnosticada 7 a 48 años antes de la recidiva, que recibieron
monoterapia con DDS durante 4 a 38 años. Veintiocho fueron tratados, además, con
poliquimioterapia (PQT) irregular, no supervisada, desde 1983. Cinco sólo recibieron DDS.
Éstos presentaron la recidiva entre 13 y 20 años después de suspenderla. Las recidivas se
diagnosticaron por reaparición de las lesiones clínicas o por la presencia de nuevas zonas
anestésicas; todas se confirmaron con la baciloscopia y, en 20 casos, por la biopsia de piel.
Cuatro pacientes presentaron en la biopsia de la recidiva, lepra indeterminada (LI) y uno lepra
dimorfa tuberculoide (LDT), todos con presencia de bacilos intraneurales; los demás fueron
LL. Dos pacientes recidivaron, aun con PQT razonablemente supervisada. Los demás curaron
con PQT supervisada. Los factores predisponentes para la recidiva fueron: monoterapia con
DDS por varios años; PQT irregular con dosis inadecuadas, sin supervisión del tratamiento;
abandono de la PQT, y relación inadecuada entre el paciente y el personal de salud. Las
recidivas de la lepra se deben buscar en todos los pacientes colombianos con lepra multibacilar
que fueron tratados con DDS solo durante años. La clínica, la baciloscopia y la biopsia
individualmente o en conjunto son métodos confiables para establecer las recidivas.
Ubication
Biomédica vol.24 no.2 Bogotá June 2004
Collections to which it belong
- Facultad de Medicina [958]