Dr. Claudio Salgado warns for lack of leprosy diagnostics in Brazil and in the world

Publicação: 12 de December de 2018

The President of the Brazilian Society of Leprology (SBH), Claudio Salgado, also drew attention to the increase in the number of cases of the disease, which bring other challenges

The biggest challenge remains diagnosing the disease that, for some time, was considered extinct and was removed from universities curricula

Although the situation of leprosy in West Africa is important, we don’t have to go that far to see the reality of the disease. The 15th edition of the Brazilian Congress of Leprology, held in Palmas for the first time, discussed the progress and treatment alternatives. The event highlighted the panorama of leprosy in Brazil, a situation that concerns authorities and employees of the unified health system (SUS) who act to control the disease, disclosing information and encouraging the public policies able to guarantee early diagnosis and adequate treatment.

During the opening ceremony lecture, the president of the Brazilian Society of Leprology (SBH), Dr. Cláudio Salgado, stressed that the entity has been emphatic about the lack of diagnostics in Brazil and in the world. Dr. Salgado recalled that in face of the goal established by the World Health Organization (WHO) to eliminate leprosy as a public health problem until the year 2000, many countries and many states were certified to have eliminated the disease, what resulted in a serious side effect: patients were easily found clustered in leprosaria and therefore drew attention, but instead, they returned to the shadows of society, fated to live with their disease without being diagnosed and, even after being diagnosed, to live with their inabilities, solely for having acquired a disease that no longer exists, and therefore, is unable to be properly treated and cured; in fact, what must actually be treated and cured is the prejudice ingrained into the heart of society.

The specialists pointed out that the increase in the number of cases brings other challenges: to train basic attention health professionals. To him, the system is not ready yet. Dr. Salgado says contact examinations in Brazil are precarious. “We [Brazilians] either don’t examine well or simply don’t examine. But the official data show more than 80% of contact examinations happen, exactly as agreed, and this builds resources to the cities. We examine over 80% of the patients, but no more than 8% of leprosy cases are diagnosed among them. There is no relationship between how many people were observed and the percentage of diagnosis”, he said. According to him, there is a flaw somewhere, and it should be reviewed immediately.

“We research very much and apply very little. We are surely among the countries that conducts most researches is leprosy in the world. We research since the clinical aspects to chemoprophylaxis, from serology to molecular biology, but we are simply unable to translate this into tools to be used by the Unified Health System (SUS) and help our colleagues diagnosing the disease.  More than simply asking, we must require that the tools used for other diseases, as serology and PCR, electromyography and ultrasound are also available to help diagnosing leprosy, wherever the patient is, whether in the center of the country’s largest city or in the Northeastern backlands, places that don’t even have doctors”, he stressed.

The disease in Brazil

Brazil currently is second place in the world rankings of leprosy with 26,875 new notified cases, behind India. The numbers were presented by the General Coordinator of leprosy and other diseases in elimination process, of the Ministry of Health, Carmelita Ribeiro.

The states in the Midwest, North and Northeast are hyperendemic. In Tocantins, between January and October 2018, 1,362 new cases were diagnosed. The number is nearly three times greater than those recorded in 2017, summing 529 cases. In 2016, 645 cases were recorded. Only 27 of the 139 municipalities did not report new cases. The SBH estimates that the number of patients is 3 to 5 times higher than the official data point and that the greatest concerns refer to regions where the notifications show the disease is under control, proving that leprosy is not being perceived.

Dermatologist Livia Bessa, who works in the leprosy control program in São Paulo State capital, stressed that in there are no records of the disease in the city, which has been under control since the year 2000. However, according to her, what draws attention is the active transmission within the municipality. She said that in 2017, 125 new leprosy cases were reported, a low index given the city’s population.

Around the world, the number of new diagnosed cases is about 210 thousand.

Model for combating the diseas

Palmas records more than 600 cases of leprosy. All patients diagnosed with the disease are treated by the Unified Heath System (SUS) through the “Palmas leprosy-free” program. To Dr. Salgado, the program is a model for combating the disease. Since deployed, over 300 professionals have engaged in the training in service with experts. All 34 Community Health Centers have professionals trained to diagnose and treat the disease. The program holds 857 patients enrolled in treatment. Of these, 317 feature grade 1 incapacity and 52, grade 2.