Sequeira J, Martins C, Marques C, Machado A, Baptista A P
Clínica de Dermatologia e Venereologia, Hospitais da Universidade de Coimbra.
Acta Med Port. 2000 Jan-Apr;13(1-2):13-7.
Leprosy represented, until a few decades ago, an important public health problem in mainland Portugal. According to the data of the General Directorate of Primary Health Care, the incidence and prevalence rates of the disease have been decreasing progressively and in a significant way during the last years. In view of the fact that it is an endemic disease in regression, we decided to estimate if there were significative changes in the clinical manifestations of the new cases. Therefore, we carried out a comparative study based on the clinical data of 18 patients (13 males and 5 females) with Leprosy who were being followed up in the Dermatology Clinics of Coimbra University Hospital. We differentiated two groups: patients with the diagnosis of the disease before 1990 (old patients), and those diagnosed after 1990 (new patients). The first group had only 8 subjects while the second group had the other 10. We recorded the patients' age, sex, nationality and residence, age at the onset of the disease, number of cases that began before the age of 20, clinical manifestations (according to Ridley and Jopling's classification), and the presence of incapacity determined by the consequences of the disease. We carried out the Student's-t test to appreciate some of the study parameters. We verified that the old patients were on average 11 years younger than the new patients. Leprosy in new patients occurred 11 years later than in the old patients and this difference was statistically significant after the Student's-t test (p < 0.05). Almost one half of the new cases (4 patients in 10) were possible cases of leprosy brought from Brazil, while all the old individuals had an autochthonous origin. The multibacillary forms were predominant in both groups, representing 89% of all patients. The frequency of handicaps was similar in both groups. Although it is based on a small number of patients, our study suggests that the clinical and epidemiological manifestations of leprosy have been changing significantly in the last years and that the changes observed in the form of presentation of the new cases are consistent with the present epidemiological situation. Our study also seems to suggest an increase in the importance of leprosy imported by immigrants from leprosy endemic countries. We point out that this phenomenon, as in the case of AIDS, can theoretically create the conditions for a recrudescence of leprosy, as currently observed with tuberculosis.
直到几十年前，麻风病在葡萄牙大陆还是一个重要的公共卫生问题。根据初级卫生保健总局的数据，在过去几年中，该疾病的发病率和患病率一直在显著且逐步下降。鉴于它是一种呈消退趋势的地方性疾病，我们决定评估新病例的临床表现是否有显著变化。因此，我们基于在科英布拉大学医院皮肤科诊所接受随访的18例麻风病患者（13名男性和5名女性）的临床数据进行了一项对比研究。我们将患者分为两组：1990年之前确诊的患者（旧患者）和1990年之后确诊的患者（新患者）。第一组仅有8名受试者，而第二组有另外10名。我们记录了患者的年龄、性别、国籍和居住地、发病年龄、20岁之前发病的病例数、临床表现（根据里德利和乔普林分类法）以及由疾病后果导致的残疾情况。我们进行了t检验以评估一些研究参数。我们发现旧患者的平均年龄比新患者小11岁。新患者患麻风病的时间比旧患者晚11年，经过t检验，这种差异具有统计学意义（p < 0.05）。几乎一半的新病例（10例中有4例）可能是从巴西传入的麻风病病例，而所有旧患者均为本地发病。两组中多菌型均占主导，占所有患者的89%。两组的残疾发生率相似。尽管我们的研究基于少数患者，但它表明在过去几年中麻风病的临床和流行病学表现一直在发生显著变化，并且新病例呈现形式的变化与当前的流行病学情况一致。我们的研究似乎还表明，来自麻风病流行国家的移民输入的麻风病的重要性在增加。我们指出，如同艾滋病的情况一样，从理论上讲，这种现象可能为麻风病的复发创造条件，就像目前观察到的结核病那样。
