Bandeira Sabrina Sampaio, Dos Anjos Andressa Bocalon, Pires Carla Avelar, Quaresma Juarez Antonio Simões
Sanitary Dermatology Referral Unit "Dr. Marcello Cândia", Secretary of State for Public Health, State of Pará, Marituba, Brazil.
Postgraduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Para, Belem, PA, Brazil.
PLoS Negl Trop Dis. 2024 Dec 19;18(12):e0012772. doi: 10.1371/journal.pntd.0012772. eCollection 2024 Dec.
Leprosy reactions being closely related to damage to peripheral nerves and physical disabilities associated with disease progression. Disabilities in childhood can have a devastating effect with impaired children's cognitive, emotional, social, and educational development. We followed up the progression of leprosy reactions in children identifying associated factors with the emergence and/or worsening of nerve damage.
A prospective longitudinal cohort study was performed in patients under 15 years of age affected by leprosy reactions diagnosed at the Leprosy referral unit in the Amazon region of Brazil. The follow-up time was a cohort for 2 years from diagnosis. A clinical evaluation and the simplified neurological were performed at diagnosis and every 6 months, until the end of the follow-up period.
Of the 77 children monitored, 38 had reactions and were recruited. Only 23.7% (9/38) of patients improved their initial neurological impairment and 42.1% (16/38) had progression of the leprosy reaction with worsening of the initial nerve damage. Two or more reaction episodes, nerve damage and two or more nerves affected at diagnosis, isolated neuritis, silent neuritis and low educational level of caregiver had a significant association with the emergence and/or worsening of neural damage.
A high proportion of children had progression of the leprosy reaction with worsening neural damage. The absence of warning signs of inflammation, such as pain and exacerbation of skin lesions, appears to contribute to the worse prognosis of reactions. Early diagnosis, systematic monitoring especially of neural function, beyond the educate caregivers to recognize the reactional episode early and to helping with children's self-care are very important measures to minimize the emergence or worsening of neural damage resulting from leprosy reactions.
麻风反应与周围神经损伤以及疾病进展相关的身体残疾密切相关。儿童时期的残疾会对儿童的认知、情感、社交和教育发展造成毁灭性影响。我们对儿童麻风反应的进展进行了随访，以确定与神经损伤出现和/或恶化相关的因素。
对巴西亚马逊地区麻风转诊单位诊断为麻风反应的15岁以下患者进行了一项前瞻性纵向队列研究。随访时间为从诊断开始的2年队列研究。在诊断时以及随访期结束前每6个月进行一次临床评估和简化神经学检查。
在监测的77名儿童中，38名有反应并被纳入研究。只有23.7%（9/38）的患者改善了最初的神经损伤，42.1%（16/38）的患者麻风反应进展，初始神经损伤恶化。两次或更多次反应发作、神经损伤、诊断时两条或更多条神经受累、孤立神经炎、无症状神经炎以及照顾者教育水平低与神经损伤的出现和/或恶化显著相关。
很大一部分儿童的麻风反应进展且神经损伤恶化。缺乏炎症预警信号，如疼痛和皮肤病变加重，似乎导致了反应的预后更差。早期诊断、系统监测尤其是神经功能监测，以及教育照顾者尽早识别反应发作并帮助儿童自我护理，是将麻风反应导致的神经损伤出现或恶化降至最低的非常重要的措施。
