Tesis
Caracterização do erro de diagnóstico na hanseníase : fatores associados e impacto epidemiológico
Fecha
2021-09-08Registro en:
NEVES, Karine Vila Real Nunes. Caracterização do erro de diagnóstico na hanseníase: fatores associados e impacto epidemiológico. 2021. 91 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, 2021.
Autor
Ignotti, Eliane
Nobre, Mauricio Lisboa
http://lattes.cnpq.br/3783750960673079
http://lattes.cnpq.br/4407130301215869
Ignotti, Eliane
559.548.479-91
http://lattes.cnpq.br/4407130301215869
Silva, Pãmela Rodrigues de Souza
022.925.591-45
http://lattes.cnpq.br/4334445500631835
559.548.479-91
538.184.744-00
Ferreira, Silvana Margarida Benevides
275.095.241-72
http://lattes.cnpq.br/8502773887053597
Lana, Francisco Carlos Félix
201.308.806-04
http://lattes.cnpq.br/2240473693664819
Fontes, Cor Jesus Fernandes
199.869.476-34
http://lattes.cnpq.br/5971254060419331
Institución
Resumen
Introduction: Cases identified as misdiagnoses in leprosy should have treatment
stopped immediately. Leprosy manifests itself through a variation of signs and
symptoms that can make clinical diagnosis difficult. Objective: To analyze the
magnitude of the error of diagnosis by leprosy in Brazil from 2003 to 2017, with
emphasis on the clinical characteristics of patients with misdiagnosis in the State of
Mato Grosso. Methods: A study developed in two stages 1. spatial and temporal
analysis on the records of leprosy cases diagnosed in Brazil between 2003 and 2017
and that had their MDT treatment terminated due to "misdiagnosis"; 2. analysis of
the reports of individuals who were diagnosed as new leprosy cases in the period
from 2016 to 2019, and after starting treatment with multidrug therapy (MDT) were
discharged due to misdiagnosis, according to the SINAN records of the state of Mato
Grosso. Results: The detection rates of new leprosy cases in Brazil decreased in 15
years from 29.0 to 12.8 per 100,000 inhabitants, while the proportion of leprosy exits
due to misdiagnosis remained stable and showed no spatial correlation with the
detection rates or change in the spatial distribution pattern. Female gender, age group
under 15 years, undetermined clinical form, absence of skin lesions at diagnosis,
presence of affected nerves at diagnosis, and mode of detection by collective
examinations and by contact examinations were associated with high diagnostic
error. The 162 interviewees reported fibromyalgia, back problems, and absence of
any disease as conclusive diagnosis most frequently. Among those without any
disease, most were contacts of a leprosy case. The individuals with misdiagnosis
sought other health services with some dissatisfaction with the diagnosis or
treatment, including presenting adverse effects to medication. Conclusion: The
proportion of misdiagnoses in leprosy is not related to the level of endemicity in
Brazil, but rather to patient characteristics and clinical manifestations, being more
likely for those whose clinical manifestations are less evident. The conclusive
diagnosis, reported by the participants, resulted in aggravations not always
considered as a differential diagnosis - such as fibromyalgia and back problems - in
addition to the absence of disease. It is noteworthy that those who reported having
no disease were mostly contacts of someone with leprosy, which points to flaws in
the understanding of the surveillance protocol regarding contacts. The study points
to failures in the diagnosis, in the treatment follow-up as to adverse effects. It is
suggested continued training of health professionals, complementary tests in more
complex and doubtful diagnoses to reduce false diagnoses in leprosy.