Hanseníase: Determinantes clínicos e epidemiológicos para ocorrência de lesão nervosa, reação e incapacidade física em pacientes diagnosticados no Norte do Tocantins

Abstract

Leprosy is a disease caused by Mycobacterium leprae, an intracellular parasite that affects the skin and peripheral nerves and can cause physical disabilities in sick individuals, remaining a public health problem in Brazil. Aiming to assist in the implementation of preventive public policies for physical disabilities, this study is focused on the epidemiological clinical characterization and the identification of determining factors for the occurrence of nerve injury, leprosy reactions and physical disability in individuals affected by this disease in the northern region of Tocantins. A cross-sectional analytical and descriptive study was carried out using data from 174 patients never treated and diagnosed during the years from 2017 to 2020 in a hospital of reference for the treatment of leprosy in Tocantins. The information was collected from the Notifiable Diseases Information System (SINAN), from medical records and from the Simplified Neurological Assessment Form in Leprosy. Sociodemographic and clinical variables were collected and the analysis was performed by using the Epi Info program. Subsequently, the description of the variables and the use of the Chi-squared and Fisher's Exact tests were performed to determine the variables with statistical significance. The Odds Ratio (OR) with a 95% Confidence Interval (CI) (p ≤ 0.05) was used to identify risk factors for nerve damage, leprosy reaction and physical disability. The majority of the samples consisted of male individuals, brown/black with a low level of education and from different occupations living in an urban area in the city of Araguaína. The multibacillary classification (118/174) and the presence of any physical disability at diagnosis (95/174) were frequent. The association of sociodemographic variables and the occurrence of neural damage and leprosy reactions did not show statistical significance; however, the clinical variables: multibacillary classification (OR 6.96; p<0.001), borderline form (OR 21.67; p=0.021) and having multiple lesions (OR 10.94; p=0.012) showed statistical relevance for nerve injury; and the variables lepromatous form (OR 4.64; p=0.009) and positive bacilloscopy (OR 6.14; p<0.001) were statistically significant for reactions. As for physical disabilities, risk factors were the age range 30-59 years old (OR=3.33; p=0.028) and ≥ 60 years old (OR=16; p<0.001), retired (OR=13.87); p<0.001), farmer (OR=4; p=0.038), multibacillary classification (OR=4.47; p<0.001), lepromatous (OR=8.33; p=0.009) and primary neural (OR= 27; p<0.001), having more than 5 skin lesions (OR=2.24; p=0.022), absence of leprosy reaction (OR=5.87), nerve damage (OR=9.15; p=0.002) and having more than 2 nerves affected (OR=2.87; p=0.012), highlighting the radial nerve (OR=2.70; p=0.002). There was a predominance of multibacillary cases with neurological disorders, presence of reactions and physical deficiencies in the diagnosis. The high risk of disability stands out in individuals with primary neural leprosy and in the elderly with severe clinical forms. Such findings demonstrate a failure in early detection, disease progression and continued transmission. It emphasizes the necessity of more awareness campaigns on leprosy and its neurological complications in the community, early diagnosis and constant training of health professionals with attention to nervous assessment and monitoring.