Severity of ENL in Luanda- Angola. Severity of ENL in Luanda Angola. Introduction

Transcription

1 Severity of ENL in Luanda Angola Drª Alice Miette Sicato Dermatologist of Américo Boavida Hospital Ministry of Health of Angola Severity of ENL in Luanda- Angola Introduction Material and Methods Results Severity of ENL Treatment Conclusions and Recomendations Introduction The face of leprosy in Luanda New Cases detected The face of leprosy is changing in Angola Prevalence is dropping in Angola but also in the Luanda Province (3,5 in 21 to,82/1 in 24) Complications still give the horrible image of the disease (leprosy reactions, neuritis and resulting ulcers on face, hands and feet) New case detection is reducing from 499 in 21 to 373 in 24 (DR 1.8 to 4.9/1 ) New cases are diagnosed early and appear with less Grade 2 deformity (15.7% in 21 to 8.7 % in 24) Children in new cases has increased from 5.7 % in 21 to 12.7 % in 24 as a result improved awareness. Proportion of MB, Deformity Grade 2 and Children in New Cases of Leprosy - Luanda % MB % Def G % Children

2 Complications Leprosy Reactions Complications estimated at 2% of patients for the country are treated with Prednipac. 7. In the Province of Luanda 6. in fact we found them in 5. 13,8% of registered 4. cases. 3. ENL reactions, clinical 2. presentation and severity 1. as well as Steroid compliance are described. Proportion of Complications in Leprosy - Luanda Province TOTAL ENL % Other Reaction % Incomplete records % Material and Methods Anual reports and statistics compiled (21 to 24) for Luanda Province were consulted 32 Clinical records of patients with reaction (type l or ll and neuritis) were analysed (47 incomplete records removed from study) 11 records with ENL analysed and severity criteria identified ENL clinical presentation of a few cases is shown 6. Results ENL Percentage % % SEVERITY OF ENL Severity of ENL 32 cases of reaction with ENL or neuritis are reported from 21 to 24 representing 13.6% of the total Cases registered. Prednipac for 3 months at least has been prescribed to all cases Incomplete records are not analysed (47). ENL is described in 11 cases (33.4% of reactions and 1% of all MB cases) 2 Severe cases 65 Moderate cases 11 light cases are few Age ENL Distribution by age < 15 years Moderate ENL in 68 cases is most frequent Light ENL in 13 Severe in 11 cases Very severe in 9 Num be r ENL Distribution by severity Light E Modera Severe Very s < 15 years

3 Réactions Type 2 ENL inflammatory Nodules and alteration of General physical condition Iritis Arthritis Orquitis Severity criteria 16 Criteria of severity include : Nerve function (5) Aspect of skin lesions (5) Other syptomons (6) Clinical presentation and histology are useful in complicated cases Light ENL cases Localized inflammatory ENL Nodules No alteration of General Condition (No fever, arthralgia, edema, or neuritis) Only 13 out of 11 ENL Reactions Moderate ENL 68 cases Nodules associated with: generally 2 other symptoms: Neuritis (53) Elevated patches (25) Arthralgia (19) Edema (9) Fever (4)

4 Severe Cases of ENL 2 cases Nodules over extremities, body and face (2) Edema of extremities and face (2) Tender and enlarged nerves (19) muscle weakness, and loss of sensitivity Fever and Arthralgia (19) Elevated patches (12) Confluent and necrotic nodules (7) Other complications (4 iritis, lymphadenitis, purpura, orchitis, glomerulonephritis) Severe ENL M.F Recurrent ENL (1) Nodules, necrosis, edema, arthritis, lymphadenopathy, and neuritis Prednipac 1 courses, with Clofazimine unable to control reactions recurring Developped Sec. effects of steroid treatment (acné, asp cushingoid, HTA, edema, osteoporose and muscle weakness) Histology confirms ENL reaction and shows elements of reversal reaaction associated. Dead bacilly are fragmented. Thalidomide was introduced and steroids stopped with favourable outcome and no more reaction over the last 6 months. 6 Prednipac treatment (corticosteroids) Only 43 % completed treatment of Prednipac 57 % did not complete the 6 Blisters of Prednipac 28 one ENL 33 (2-4 recurrent ENL) 28 (5-9 recurrent ENL) 12 (1 + recurrent ENL) Number of cases Number of cases TOTAL Recurrent ENL and Steroid treatment Treatment Severity of reaction helps to adap prescription of supportive drugs other than corticosteroids In light cases of ENL nodules only NSAID Paracetamol Prednipac is not necessary 2

5 Treatment of ENL Treatment of ENL In moderately severe ENL (2-3 symptoms) Prednipac Clofazimina Chloroquine In Severe ENL Repeat Prednipac Clofazimine In very severe cases Consider prescribing Thalidomide under strict medical surveillance for 3-9 months Conclusion Recommendation Moderate reactions are the most common clinical presentation de ENL ENL Severity is useful to identify patients at risk of having recurrent severe episodes Leprosy Reactions are treated with Prednipac with a favourable outcome however compliance is poor. Treatment of ENL needs to be adapted to the severity of the reaction To improve quality of care, clinical observations (neurological and dermatological) need to be registered regularily and especifically. Dermatologists need to be involved in the assessment of severity and prescription of medication in ENL. Severe and very severe cases require hosptialization.

6 Severity of ENL Thank you for your attention