Leprosy serology (ML Flow test) in borderline leprosy patients classified as paucibacillary by counting cutaneous lesions: an useful tool

Diagnosis of the leprosy laboratory care network in Regional Health Department XV, São José do Rio Preto, São Paulo, Brazil

OBJECTIVE

To present the situational diagnosis of the leprosy laboratory reference network in the region of São José do Rio Preto, SP, Brazil.

METHODS

This was an evaluation study with a descriptive design. The data were collected by means of an online form filled in by those in charge of the leprosy program in 2018.

RESULTS

All 102 municipalities that make up the region provided the requested data, 82.4% (84/102) requested slit-skin smear microscopy and of these 68 received training. Of the total, 11.7% sent slit-skin smears to other laboratories outside the reference network. Only 57.8% (59/102) requested a biopsy, of these 47 had a doctor responsible for taking the biopsy sample and 31 did not send biopsy samples for analysis in the reference network. Lack of an adequate room, few trained professionals, absence of material for transportation and absence of printed test requisitions were described as aspects that hinder leprosy case diagnosis in the region.

CONCLUSION

The laboratory network is fragile and needs to be restructured.

Evaluation of the social, clinical and laboratorial profile of patients diagnosed with leprosy in a reference center in São Paulo

BACKGROUND

Leprosy is the main infectious cause of disability. It is said to be eradicated in São Paulo since 2005, but diagnosis is still late.

OBJECTIVES

To investigate the social, clinical and laboratorial profile of leprosy patients diagnosed between 01/2007 and 12/2011, in a reference center in São Paulo.

METHODS

Retrospective descriptive study. Data of all new leprosy cases diagnosed between 01/2007 and 12/2011 were raised in São Paulo.

RESULTS

103 men and 71 women were diagnosed, most of them were multibacillary. Mean age at diagnosis was 49 yrs; 2,2% were children; 70% had incomplete primary education; 50% were referred without diagnostic suspicion of leprosy. Mean time since first symptoms/signs and diagnosis was 2 years; 64% of patients had some degree of disability, and 26% had grade 2. 23 cases were diagnosed only after being summoned, and 80% of these had no disability. Agreement between the Ridley and Jopling and the WHO classification was 75% (kappa index = 0.44). Serology for IgM anti-PGL1 (87 patients) showed a mean value of 0.25, and an association between MB classification and test positivity (p <0.001).

CONCLUSIONS

Leprosy diagnosis in São Paulo is late. The disease mainly affected the socially disadvantaged and economically active population. Failure to detect the disease (41% in the last 10 years) could be due to the lack of suspicion and to decentralization. For the classification of patients with advanced leprosy, both the WHO and R&J classifications proved to be helpful tools.