Resistência medicamentosa em hanseníase: vigilância de pacientes atendidos na Fundação Alfredo da Matta, Manaus -Am

Abstract

Leprosy is a chronicinfectiousdisease with slow evolution that results in dermatoneurological disorders. It is caused by Mycobacterium leprae, an obligateintracellular parasite. In 2018, 208,619 new cases of the disease were diagnosed in the world, with Brazil being the second country with the highest number of cases, just behind India. In 2009, the World Health Organization proposed the creation of a drug resistance surveillance network in leprosy, since the emergence and spread of resistant strains pose a serious threat to disease control strategies. In view of this, the objective of this work was to evaluate the occurrence ofM. lepraeresistant strains through the investigation of polymorphisms in thefolp1, rpoBand gyrAgenes, which confer resistance tothe drugs dapsone, rifampicin and ofloxacin respectively. This was a descriptive, retrospective study in leprosy patients,attended at Fundação Alfredo da Matta, Manaus -AM, during the period from 2017 to 2019.The patients selected for the study (N=65)were divided into two groups: new casesand relapse, for the evaluation of primary and secondary resistance. There was a predominance of males, with an average age of 50 years, mixed race and low level of education. The Virchowian clinical form was the most prevalentand all new cases were multibacillary patients. Of the studied genes, the folp1 gene obtained the highest amplification index (98,46%), followed by the rpoBgene (88,15%) and the gyrAgene (81,54%). One sample showeda mutation in the studied genes, it was a point mutation in codon 55 of the folp1 gene, conferring secondary resistance to dapsone in a sample of a relapsed patient.This is not an isolated report of a resistancecasein patients from the AmazonasState, whether it is a new case or a relapse. Therefore, the continuity of surveillance on leprosy drug resistance is extremely important. Due to the small number of samplesanalyzed in the present research, it is believed that does not represent the real scenario of resistant strains circulation in the region