Da Silva Souza Cacilda, Bacha Juliana Totti
Foundation for the Support of Teaching, Research and Assistance, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Lepr Rev. 2003 Sep;74(3):249-58.
This study identifies possible obstacles to the early diagnosis of leprosy. Semi-structured interviews were held with 40 patients at a secondary health service in upstate São Paulo, Brazil. The data concerning the sample were: 75% males, age range 13-76 years, 85% with elementary school education, 85% multibacillary. Skin lesions associated with sensory alterations had been noticed by 55% of the patients; 32.5% of the patients had been misdiagnosed as having conditions other than leprosy. The diagnosis was made 1 year after the awareness of signs/symptoms in 55% of the patients. In this group, 54% had impairment grade 1, while 23% had no disabilities. Forty-five percent of all patients interviewed had some information about the disease prior to diagnosis. Eleven patients (27.5%) had previous contact with leprosy patients, but this did not prevent late diagnosis in 64%. After the disease was confirmed, about half of the interviewed patients (47.5%) showed mainly positive feelings due to the prospect of treatment and cure. Our results suggest that misdiagnoses and unawareness of the disease were the main factors that influenced the delayed diagnosis. We consider the effective involvement of various segments of society, particularly the integration and partnership of the public health services and health education centres to be valuable tools for the planning and execution of educational activities directed at risk groups and the community.
本研究确定了麻风病早期诊断可能存在的障碍。在巴西圣保罗州北部的一家二级卫生服务机构对40名患者进行了半结构化访谈。有关样本的数据如下：75%为男性，年龄范围在13至76岁之间，85%接受过小学教育，85%为多菌型。55%的患者注意到了伴有感觉改变的皮肤损害；32.5%的患者被误诊为患有除麻风病之外的其他疾病。55%的患者在意识到体征/症状1年后才得以确诊。在这组患者中，54%的患者损伤等级为1级，而23%的患者没有残疾。在所有接受访谈的患者中，45%在诊断之前就已了解一些有关该疾病的信息。11名患者（27.5%）曾与麻风病患者有过接触，但这并未阻止64%的患者被延迟诊断。在疾病确诊后，约一半接受访谈的患者（47.5%）由于有望得到治疗和治愈而主要表现出积极的情绪。我们的研究结果表明，误诊和对该疾病的不了解是影响诊断延迟的主要因素。我们认为社会各阶层的有效参与，尤其是公共卫生服务机构与健康教育中心的整合及合作，是针对高危人群和社区开展教育活动的规划与实施的宝贵工具。
