Aspectos epidemiológicos da hanseníase na cidade de Recife, PE em 2002 Epidemiologic aspects of leprosy in the city of Recife, Pernambuco state, 2002

FUNDAMENTOS: Ainda é de grande importância a hanseníase como problema de Saúde Pública no Brasil, devido a sua alta endemicidade. OBJETIVO: Determinar as principais características dessa enfermidade na cidade de Recife no ano de 2002. MÉTODOS: Realizou-se estudo observacional retrospectivo, mediante o preenchimento de um questionário específico, analisando-se 100 prontuários de pacientes assistidos em centro de referência do Recife em 2002. Elaborou-se um banco de dados, e a análise foi feita utilizando-se o software EPI-Info-6. Obtiveram-se as freqüências simples das variáveis, e realizou-se análise bivariada, estudando-se as diferenças entre as proporções por meio do qui-quadrado. O ponto de corte foi p<0,05. RESULTADOS: Observou-se aumento da freqüência dos casos de hanseníase com a idade (7% dos casos ocorreram em crianças e adolescentes, e 11% em maiores de 65 anos) (p<0,001). A distribuição por sexo mostrou diferença significativa (masculino 57%, feminino 43%) (p<0,001). A forma tuberculóide possui a maior prevalência, com 42% dos casos (p<0,001) e maior incidência no sexo feminino, enquanto no sexo masculino prevaleceu a dimorfa (x²=18,83; p<0,001). As formas paucibacilares (tuberculóide e indeterminada) apresentaram lesão única ou variação de duas a cinco lesões em 55,4% e 37,5% dos casos, respectivamente (x²=37,04; p<0,001). CONCLUSÕES: Foi possível constatar que a cidade ainda é uma região endêmica devido à grande incidência da forma tuberculóide no meio, indicador epidemiológico sugestivo de tendência crescente da endemia na região. Só o diagnóstico e o tratamento precoce dos casos poderão quebrar a cadeia de transmissão da doença.<br>BACKGROUND: As a problem of Public Health in Brazil, leprosy is still important due mainly to its high endemicity. OBJECTIVES: Determine the main characteristics of this disease in the city of Recife, Pernambuco state (PE), in 2002. METHODS: Based on data acquired from a questionnaire completed by patients, a retrospective study was carried out to analyze 100 handbooks of patients attended to in a reference center of Recife in 2002. A data base was elaborated and EPI-INFO-6 software was used for the analysis. Simple variable frequencies were obtained and a bi-varied analysis was made by studying ratio differences by means of chi-square. The cut off point was p<0.05. RESULTS: An increase of leprosy was observed to occur with age (7.0% of cases in children and adolescents and 11.0% in adults over 65 years of age), (p<0.001). Distribution per sex showed significant differences (male 57.0%, female 43.0%), (p<0.001). The tuberculoid form had the highest prevalence in all of the age ranges studied, with 42.0% of cases (p<0.001), and its incidence was highest in females, while borderline cases predominated in males (x²=18.83; p<0.001). The paucibacillary forms (tuberculoid and indeterminate) showed only one lesion or two-to-five lesions in 55.4% and 37.5% of the cases, respectively (x²=37.04; p<0.001). CONCLUSIONS: It was possible to demonstrate that Recife is still an endemic region due to a high incidence of the tuberculoid form, i.e. the epidemiological pointer suggestive of increased endemic diseases in the region. Only with the diagnosis and early treatment of the cases can the transmission of the illness chain be broken

Association of leprosy with HLA-DR2 in a Southern Brazilian population

The association between HLA specificities and leprosy was investigated in a Southern Brazilian population. One hundred and twenty-one patients and 147 controls were typed for HLA-A, B, Cw, DR and DQ. Patients were subdivided into the following subgroups, according to clinical, histological and immunological criteria: lepromatous (N = 55), tuberculoid (N = 32), dimorphous (N = 20), and indeterminate (N = 14). The frequencies of HLA specificities were compared between the total group of patients and controls, and between the same controls and each subgroup of patients. After correction of the probabilities, deviations were not significant, except for the DR2 specificity, which presented a frequency of 44.2% in the total group of patients and 56.3% in the subgroup of individuals with the tuberculoid form of the disease, compared to 23.3% in the controls. Stratified analysis showed that the increased DR2 frequency in the total group of patients was due to the subgroups with the tuberculoid and dimorphous forms. The relative risk of tuberculoid leprosy for DR2-positive individuals was 4.2, and the etiologic fraction of DR2 was 0.429. In conclusion, a positive association of the DR2 specificity with the tuberculoid form of leprosy, but not with the lepromatous, dimorphous, or indeterminate forms, was demonstrated in this Southern Brazilian populatio