Recidivas associadas à resistência a drogas na hanseníase

A poliquimioterapia/Organizacao Mundial da Saude foi implantada efetivamente no Brasil em 1991, contribuindo drasticamente para reducao da taxa de prevalencia e cura da hanseniase. No entanto, a sua comprovada eficacia nao tem impedido a ocorrencia de recidiva da doenca. Falha no tratamento, persistencia bacilar ou resistencia a drogas sao fatores que podem ou nao estarem associados a ela. O objetivo deste estudo foi verificar a ocorrencia de recidiva e associa-la com a presenca de cepas resistentes do Mycobacterium leprae entre 28 individuos que apresentaram suspeita clinica de recidiva apos tratamento por monoterapia sulfonica, esquema da Divisao Nacional de Dermatologia Sanitaria ou poliquimioterapia. Biopsias das lesoes de pacientes multibacilares, com diagnostico clinico de recidiva, atendidos por demanda espontânea, foram coletadas para avaliar resistencia a drogas por meio da tecnica de inoculacao em pata de camundongo. Dentre as amostras avaliadas 42,8% apresentaram bacilos sensiveis a dapsona e rifampicina e 10,7% apresentaram resistencia a dapsona; nao foram isolados bacilos resistentes a rifampicina. A emergencia de bacilos resistentes, especialmente a rifampicina, e um alerta para os programas de controle da hanseniase. Monitorar a disseminacao destas cepas e importante, pois elas apresentam um serio obstaculo para a eliminacao da doenca, principalmente em paises onde a hanseniase ainda e endemica. The multidrugtherapy proposed by the World Health Organization has been effectively implemented in Brazil in 1991. It helped reduce the prevalence and achieve the cure of leprosy. However, its proven efficacy has not prevented the occurrence of relapses in some leprosy patients. Irregular treatment, bacillary persistence or resistance of Mycobacterium leprae to drugs are factors that may be associated with relapse. The objective of this study was assess the occurrence of relapse and associate it with the presence of Mycobacterium leprae resistant strains. In order to do that, 28 individuals who were clinically diagnosed as relapse after treatment with sulphone monotherapy, the National Division of Sanitary Dermatology scheme or multidrugtherapy. Biopsies from lesions of multibacillary patients attended by spontaneous demand were collected to verify resistance to drugs through the mouse foot pad inoculation technique. Among the samples evaluated 42.8% had bacilli susceptible to dapsone and rifampicin and 10.7% showed resistance to dapsone. No rifampicin resistant bacilli were isolated. The emergence of resistant strains, especially to rifampicin, is a threat to leprosy control programs, therefore, monitoring the spread of these strains is important because resistance pose a serious obstacle to the elimination of disease, particularly in countries where the disease is endemic.