The Central Public Health Laboratory of the Federal District (Lacen-DF) developed a protocol to understand why some leprosy patients do not respond adequately to treatment. The study was born due to a need presented by public health teams, who often have doubts regarding the lack of results from drug interventions.
To answer this question, the research carries out genetic sequencing of the microorganism to detect mutations that lead the bacteria to have resistance to antimicrobials used in treatment. “Leprosy has a peculiarity”, explains Lacen’s Medical Biology manager, Fabiano Costa. “We are unable to culture the microorganism in the laboratory, as is done with other bacteria, and this also does not allow us to carry out a sensitivity test to establish the profile.”
The protocol, continues the manager, will be able to verify the profile of the Hansen’s bacillus using a molecular technique, indicating whether or not there has been a mutation. “Often, doctors are expecting a negative result from a sputum smear test after a year or three of treatment, and when the patient returns for control, the disease continues to be positive”, he explains. “This protocol is to resolve the doubt as to whether the bacteria have developed resistance.”
For now, the process is still in the study phase and only with samples from the DF. The expectation is that it will soon be used in the daily lives of patients and doctors in the public network. “We hope that we will soon be accredited to be a reference in leprosy”, says the manager.
Caused by bacteria Mycobacterium leprae, leprosy is transmitted through droplets of saliva eliminated by speaking, coughing and sneezing. Symptoms can take two to seven years to appear in the patient after infection. Furthermore, the first signs are often indeterminate, making it difficult to diagnose the problem.
“One of the most common signs are patches of a different whitish or reddish color that progress to local hair loss and sensitivity”, points out the manager of Family Health Support at the Department of Health (SES-DF), the nurse Geandro de Jesus Dantas. “There are other stages, such as increased sensitivity and nerve changes. In the most complicated phases, [os pacientes] they present deformities, nerve atrophy and important changes in the movements of the hands and feet”.
Human resources manager Andréia Barros, 24, discovered the disease by chance. At 17, she suffered a burn on one of her legs and only realized minutes later. The injury was treated at the Taguatinga Regional Hospital (HRT), but, even after using medication and bandages, it did not progress. That was when a nurse suspected that Andréia had leprosy and referred her to the Basic Health Unit (UBS) 1 in Águas Claras.
At the time, the young woman no longer had sensitivity in her legs – which is why she did not feel the burn – and she had a high level of leprosy bacteria in her body. Treatment began shortly after diagnosis and ended at the end of last year. “I think that if I hadn’t seen a nurse who knew the disease, I would still be having a reaction today without knowing what it was”, reports the resident of Recanto das Emas.
Andréia suspects that she acquired the disease in Tocantins, where she lived for part of her adolescence, considering that there are no other cases in the family. Today, she is free from the disease, but lives with a lack of sensitivity in both legs, from knee to toe. Furthermore, she dreams of graduating in nursing so she can care for more people who have this problem. “Those of you who are going through treatment, remember that the bad part will be worth it,” she says. “Don’t give up, keep fighting, because if you go after it, everything will be fine.”
Andréia was monitored by the nurse and leprosy clinical supporter Maria José Neiva Silveira e Leite, together with a doctor. “If there is no connection and empathy, the patient ends up abandoning treatment”, points out Maria José. “It is not easy to take medicine every day and every month having to go to a health unit to get more medication. On the day the person shows up, they need to take six tablets at the supervised dose, and take the rest home, taking two a day.”
The specialist also reminds that the patient must complete the prescribed treatment, since, if interrupted, the disease will be considered untreated. “The Ministry of Health defines that only those who undergo treatment until the end are considered treated and cured of leprosy – and there is still the risk of serious consequences, such as vision problems”, she warns.
“If the patient has up to five injuries and no nerves are compromised, they undergo six-month treatment; but, if there is a compromised nerve, regardless of the number of lesions, or six spots or more on the body, the treatment will last for one year”, explains the nurse. “Until the dead bacteria are eliminated from the body, the patient has many leprosy reactions; It is as if a dust of dead bacilli remains in the body. Sometimes it takes five years or more to finish everything.” All medicines are offered by the public network.
Where to look for help
The disease can be diagnosed and monitored in one of the 176 basic health units in the DF. Polyclinics and reference hospitals – Hospital Universitário de Brasília (HUB), Hospital Regional da Asa Norte (Hran) and Hospital de Base de Brasília (HBB) – also monitor and rehabilitate patients.
The diagnosis is made by applying the test. In case of positivity, a medicinal cocktail is offered that must be used for up to 18 months. The medication ensures the stagnation of the development of the disease, as well as preventing the patient from transmitting the disease. During treatment, patients are also offered participation in support groups.
“These are interesting strategies to help reintegrate the patient socially and recover their self-esteem”, reinforces manager Geandro. “In some units, we also have rehabilitation services to help people with more serious sequelae.”
This year, the DF has already qualified 35 Primary Care doctors from the public network for the diagnosis and management of leprosy. “It is a disease that worries us a lot because we know the consequences and physical disability it can cause, which is why we need to attack it in every way possible”, argues the manager.