Daijiworld Media Network - Maceio

Maceio, Jul 14: A leprosy screening programme conducted in a high-security prison in northeastern Brazil has uncovered previously undiagnosed cases of the disease, with all affected inmates already showing nerve damage and physical disability at the time of diagnosis.

The findings emerged from an observational cross-sectional study carried out at a male penitentiary in Maceio, Alagoas, where 915 inmates were housed in a facility built to accommodate 773 prisoners.

Researchers used a 14-item Leprosy Suspicion Questionnaire as an active case-finding tool. Of the 842 inmates who completed the questionnaire, 240 (28.5 per cent) reported signs or symptoms suggestive of possible leprosy.

Neurodermatological examinations were subsequently conducted on 260 inmates, including participants with both positive and negative questionnaire responses. Eight new cases of leprosy were diagnosed, resulting in an overall case detection rate of 3.08 per cent. Among the 92 inmates with positive questionnaire findings who underwent clinical evaluation, six were diagnosed with the disease, giving a detection rate of 6.52 per cent.

The questionnaire identified 75 per cent of the confirmed cases, compared with 34.1 per cent of inmates without leprosy. The most commonly reported symptoms among those diagnosed were numbness in the hands and feet and nerve pain.

All eight newly diagnosed patients were found to have multibacillary leprosy with peripheral nerve involvement. Six were diagnosed with borderline forms of the disease, while two had pure neural leprosy.

Researchers noted that 62.5 per cent of the affected inmates experienced dysesthesia, or abnormal sensation, without the classical skin lesions associated with leprosy, making diagnosis more challenging.

All diagnosed inmates had already developed physical disability by the time the disease was detected. Seven had Grade 1 disability, while one had Grade 2 disability, indicating progression of the disease before diagnosis. All were referred for standard multidrug therapy.

Blood samples from 244 clinically evaluated inmates were also analysed. Anti-Mce1A IgA antibodies were detected in all eight diagnosed cases, while anti-Mce1A IgM and IgG antibodies were found in 37.5 per cent and 25 per cent of cases, respectively. Anti-PGL-I antibodies were not detected in any of the confirmed patients.

Among inmates without a clinical diagnosis of leprosy, 37.7 per cent tested positive for anti-Mce1A IgM antibodies compared with 19.9 per cent for anti-PGL-I antibodies. Researchers said the findings could indicate exposure to the bacterium or subclinical infection, although the small number of confirmed cases limited conclusions about the diagnostic accuracy of the tests.

The researchers concluded that structured leprosy screening and regular follow-up in prison populations could help identify hidden cases earlier and reduce disability. However, they noted that only 260 of the 842 inmates who completed the questionnaire underwent clinical examination after the study was suspended due to a potential prison riot, suggesting that additional undiagnosed cases may have remained undetected.