Recidiva em hanseníase após o término da poliquimioterapia padrão entre 2013-2018 em um centro de referência brasileiro: introduzindo e atualizando conceitos

Abstract

Introduction: Leprosy relapse refers to situations in wich patients who underwent regular treatment with standardized official multidrug therapy (MDT) regimens, and were discharged by cure, present new signs and symptoms of disease activity. Such cases generally occur more than five years after cure, although they can occur at any time after release from treatment. It is important to recognize this condition, and to differentiate it from therapeutic failure and therapeutic insufficiency. Objectives: To analyze the profile of leprosy relapse cases diagnosed in the service, and to investigate the influence of the type of previous MDT and initial clinical form for the development of relapse, establishing an algorithm for the follow-up of patients after release from treatment. Material and methods: A retrospective study carried out at the Center of Reference in Sanitary Dermatology and Leprosy (CREDESH), which identified all patients reported as leprosy relapse between January 2013 and December 2018. The patients had their clinical, epidemiological and laboratory characteristics at relapse diagnosis evaluated. Time to relapse and its variation according to the type of previous MDT and initial clinical form were analyzed using the survival curve with the Kaplan Meier method. Results: A total of 126 patients were identified, corresponding to 11.89% (126/1059) of the total number of patients with leprosy at the same period. There was a predominance of multibacillary (MB) patients (96.03% - 121/126), with the predominant clinical form of borderline-tuberculoid (BT) (40.47% - 51/126). The majority of relapsed patients used the 12-dose MDT-MB at baseline. The median time to relapse was 10 years among all patients, with shorter time among patients treated with 6 dose MDT-paucibacillary and 12-dose MDT-MB (median of 8 years), and 24-dose MDT-MB treatment being statistically associated with a better prognosis for relapse in survival analysis (median of 14 years). At the curve that grouped the patients according to the initial clinical form, the time for relapse was shorter in BT patients (mean 5 years) and patients with primary neural leprosy (mean 8.6 years). Conclusion: Leprosy relapse in our service had a higher incidence than reported in most of the literature, with a long time for relapse, which justifies the recommendation of prolonged follow-up in patients after MDT, with emphasis at the importance of differentiation from therapeutic failure and therapeutic insufficiency. Clinical forms at initial treatment and the different types of previous MDT appear to influence the time for relapse, with a better prognosis for patients treated with 24-dose MDT-MB.