Challenges in diagnosis and treatment of leprosy in Brazil

Leprosy is considered a neglected tropical disease that remains a major public health problem. Brazil is a country with a high leprosy new case detection rate. Key obstacles in Brazil include poor access to diagnosis and late treatment.

Prof. Caroline Talhari (Amazonas State University, Brazil) explained that India, Brazil, and Indonesia account for 80% of leprosy cases worldwide [1]. The incidence of leprosy has decreased by 37% since 2017. This might look like a victory in eradicating leprosy, but the decrease was associated with decreased diagnosis due to the COVID-19 pandemic. From 2010 to 2019, the incidence of leprosy remained stable in Brazil, indicating that many people still get diagnosed with leprosy every year. Although leprosy is a curable disease, it lacks good diagnostic tools, preventive and therapeutic strategies. Misdiagnosis, delay in diagnosis, and mistreatment often occur leading to ongoing transmission.

Leprosy is common in adults, but leprosy in children is more frequent than generally thought. Household contact is the most likely source of leprosy transmission. An increase in the number of children with leprosy in the past 40 years is alarming and makes Brazil a highly endemic country.

Another challenge in combatting leprosy is the need for new diagnostic tools as the disease is easy to confuse with other skin diseases. Serological tests may differentiate leprosy but its sensitivity is low.

In addition, patients with leprosy co-infected with HIV may present a more severe form of the disease. To classify patients suffering from both leprosy and HIV, the authors proposed to separate leprosy and HIV co-infection from opportunistic leprosy disease and highly active antiretroviral therapy-related leprosy.

The currently recommended treatment regimen is a combination of dapsone, rifampicin, and clofazimine. Individuals with paucibacillary leprosy are treated for 6 months and those with multibacillary leprosy for 12 months.

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   1. Talhari C, et al. Tropical Diseases. Session Global Unmet Needs in Dermatology, ICD 2021, 10-13 November 2021.

 

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Posted on 2 December 20212 December 2021