Frequência de Dor e Comprometimento Ocular em Pacientes Portadores de Hanseníase em Região Hiperendêmica do Norte do Brasil.

Abstract

Leprosy is an endemic infectious disease in the North of Brazil, hyperendemic in the State of Tocantins and considered a public health problem. It is related to low educational level and unfavorable socioeconomic conditions, being more frequent in the black race and in male individuals. It is caused by the bacillus Mycobacterium leprae, which has an affinity for the skin, peripheral nerves, eyes and mucous membranes. Pain and ocular involvement are common findings in leprosy patients and are causes of stigmatization, isolation and decreased quality of life. Despite this, ophthalmological and pain assessment is not routinely performed in the management of these patients. This study allowed to detect the frequency of pain, neuropathic pain, chronic pain, severe pain and ophthalmological findings in patients with leprosy. This is a cross-sectional observational study in which leprosy patients treated at the Hospital of Tropical Diseases of the Federal University of Tocantins were referred for evaluation and data collection at the Eye Hospital of Tocantins, from September to November 2019. Data were collected through questionnaire, physical exam and medical record research. In this study, 68.75% of the individuals were male, 81.25% of the patients reported income up to a minimum wage, 68.75% reported being illiterate or having incomplete elementary school and 100% declared themselves to be black. These data reveal a high frequency of leprosy in male, black and socially vulnerable individuals. A high frequency of ophthalmic findings (100%), pain (87.5%), chronic pain (68.75%), neuropathic pain (87.71%) and severe pain (71.43%) was observed. These findings are related to an important impairment of the functional capacity of these patients. There is a general understanding of the association of leprosy with negative sensory phenomena, however, data from this study show that pain is a common complaint among leprosy patients as well as ocular involvement occurs at an alarming rate. Most ophthalmic changes in leprosy can be avoided. They impair the individual's independence and, when added to other common sensory and motor disorders in the course of the disease, worsen the quality of life. In addition, the late diagnosis of ophthalmic lesions can result in blindness. Ophthalmological and pain assessment as a component of the multidisciplinary approach to leprosy patients collaborate with the prevention of disabilities related to the disease. Thus, their inclusion in the care routine of these individuals contributes to the prevention and control of these sequelae. The North Region of Brazil and Legal Amazon lack studies on the occurrence of pain and ocular impairment in leprosy patients, and the high frequency of these findings found in this study shows the relevance of these changes in these patients. This research demonstrates the need for the inclusion of ophthalmological and pain assessment in leprosy patients, and new studies can guide public health measures to prevent and control these conditions with high disabling power, which are often neglected even by health professionals.

Leprosy is an endemic infectious disease in the North of Brazil, hyperendemic in the State of Tocantins and considered a public health problem. It is related to low educational level and unfavorable socioeconomic conditions, being more frequent in the black race and in male individuals. It is caused by the bacillus Mycobacterium leprae, which has an affinity for the skin, peripheral nerves, eyes and mucous membranes. Pain and ocular involvement are common findings in leprosy patients and are causes of stigmatization, isolation and decreased quality of life. Despite this, ophthalmological and pain assessment is not routinely performed in the management of these patients. This study allowed to detect the frequency of pain, neuropathic pain, chronic pain, severe pain and ophthalmological findings in patients with leprosy. This is a cross-sectional observational study in which leprosy patients treated at the Hospital of Tropical Diseases of the Federal University of Tocantins were referred for evaluation and data collection at the Eye Hospital of Tocantins, from September to November 2019. Data were collected through questionnaire, physical exam and medical record research. In this study, 68.75% of the individuals were male, 81.25% of the patients reported income up to a minimum wage, 68.75% reported being illiterate or having incomplete elementary school and 100% declared themselves to be black. These data reveal a high frequency of leprosy in male, black and socially vulnerable individuals. A high frequency of ophthalmic findings (100%), pain (87.5%), chronic pain (68.75%), neuropathic pain (87.71%) and severe pain (71.43%) was observed. These findings are related to an important impairment of the functional capacity of these patients. There is a general understanding of the association of leprosy with negative sensory phenomena, however, data from this study show that pain is a common complaint among leprosy patients as well as ocular involvement occurs at an alarming rate. Most ophthalmic changes in leprosy can be avoided. They impair the individual's independence and, when added to other common sensory and motor disorders in the course of the disease, worsen the quality of life. In addition, the late diagnosis of ophthalmic lesions can result in blindness. Ophthalmological and pain assessment as a component of the multidisciplinary approach to leprosy patients collaborate with the prevention of disabilities related to the disease. Thus, their inclusion in the care routine of these individuals contributes to the prevention and control of these sequelae. The North Region of Brazil and Legal Amazon lack studies on the occurrence of pain and ocular impairment in leprosy patients, and the high frequency of these findings found in this study shows the relevance of these changes in these patients. This research demonstrates the need for the inclusion of ophthalmological and pain assessment in leprosy patients, and new studies can guide public health measures to prevent and control these conditions with high disabling power, which are often neglected even by health professionals.