Background

Leprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil.

Method

Exploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003–2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level.

Result

A total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51–1.66)], children [OR: 1.49 (1.36–1.64)]; paucibacillary [OR: 1.08 (1.02–1.13)], indeterminate clinical forms [OR: 2.37 (2.15–2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09– 3.73)] and contact examination [OR: 2.30 (2.13–2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19–2.77)] when compared with those presenting both skin lesion and affected nerves.

Conclusion

Misdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.

中文翻译：

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2003年至2017年巴西对麻风病的误诊：空间格局和相关因素

背景

麻风病会引起一系列症状，大多数诊断是根据临床情况确定的。因此，假阴性和阳性诊断相对普遍。我们分析了巴西麻风病误诊的空间格局及相关因素。

方法

巴西，2003-2017年，新病例检出率（NCDR）的内核密度和误诊比例的探索性分析。通过Logistic回归以5％的显着性水平确定与误诊相关的因素。

结果

在研究期内，巴西总共记录了574181例新的麻风病病例，其中有7477例（1.3％）被误诊。在误诊的比例和NCDR之间未观察到空间相关性。女性[OR：1.58（1.51–1.66）]，儿童[OR：1.49（1.36-1.64）]的误诊可能性增加；脓疱性[OR：1.08（1.02–1.13）]，不确定的临床形式[OR：2.37（2.15–2.62）]，用于大规模筛查[OR：3.36（3.09–3.73）]和接触检查[OR ：2.30（2.13–2.49）]，并且与同时出现皮肤病变和神经受损的神经相比，神经受累但没有皮肤病变的情况[OR：2.47（2.19–2.77）]。

结论

麻风病的误诊与巴西的流行程度无关，而与个人的，诊断相关的疾病特征有关。