REACTIONAL STATES IN MULTIBACILLARY HANSEN DISEASE PATIENTS DURING MULTIDRUG THERAPY

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI < 3, while ENL predominated among those patients with BI > 3.<br>Reações são ocorrências comuns no curso da hanseníase e são responsáveis pelo agravamento das lesões neurais. Uma coorte de 162 pacientes recém-diagnosticados, baciloscopicamente positivos, em acompanhamento no Ambulatório de Hanseníase da Fundação Oswaldo Cruz (FIOCRUZ) foi selecionada para estudo. Observou-se que 46% dos pacientes multibacilares submetidos a 24 doses fixas de poliquimioterapia (PQT) apresentaram reações durante o tratamento; todos multibacilares eram suscetíveis e cuidados e atenção constantes eram necessários. Quatorze por cento foram classificados como BB, 52% como BL e 33% como LL. Nenhuma das variáveis em estudo, tais como: sexo, idade, forma clínica, tempo de doença, extensão das lesões dermatológicas, índice baciloscópico (IB), ou grau de incapacidade associaram-se a reação entre os pacientes estudados. Reação Reversa (RR) ocorreu em 45% e Eritema Nodoso Hansênico (ENH) em 55% dos casos. Entre os pacientes BB que desenvolveram reação (15 pacientes), 93% apresentaram RR, enquanto entre os pacientes LL que tiveram reação (34 pacientes), 91% apresentaram ENH. Por outro lado, ENH foi mais frequente entre aqueles com lesões difusas, enquanto RR foi mais frequente em pacientes com lesões localizadas. O RR ocorreu principalmente nos primeiros meses de tratamento. A taxa de recorrência do ENL foi significativamente maior que a do RR. Nenhum grau de incapacidade nem IB esteve associado com RR e ENL. Entretanto a taxa de RR foi significativamente maior entre pacientes mostrando IB < 3, enquanto que o ENH predominou entre os pacientes com IB > 3