A Study of Leprosy Reactions in a Tertiary Hospital in Delhi

Abstract

A retrospective study of 531 leprosy patients was undertaken to study the profile of reactions in the post Multi-Drug-Therapy period in a tertiary hospital in Delhi. BT was the most common group. The prevalence of reactions was found to be 8.09% for the Type 1 and 4.70% for the Type 2 reactions for a male:female ratio of 2.2. The Type 1 reaction was most frequently observed in the BB group followed by BL, BT and LL groups respectively. More than half of the patients had reactions at the time of presentation. In only 39.8% of the patients did reaction follow Multi-Drug-Therapy. In 4.5% of the patients with Type 1 reactions (T1R), concomitant infections were noted. The most common presentation of T1R was cutaneous lesions (74.41%) followed by cutaneous lesions and neuritis (53.6%), neuritis alone (12.1%), and only edema of hands and feet (7.31%) respectively. The Type 2 reactions (T2R) presented chiefly as papulo-nodular (92%) lesions followed by pustulonecrotic (8%) lesions. Associated neuritis was found in 40% and periosteitis and iritis in 8% and 4%, respectively. In 8.6% of the patients with T2R, precipitating factors could be observed. The prevalence of deformities in patients with reaction was 25%, and was more common in females. Deformities were observed in 23.25% of the T1R patients and 28% of the T2R patients.

Age Is an Important Risk Factor for Onset and Sequelae of Reversal Reactions in Vietnamese Patients with Leprosy

“…Moreover, geographic and ethnic variation among the proportions of leprosy subtypes also contributes to significant heterogeneity in reported prevalences, because T1Rs occur predominantly in patients with borderline leprosy. Consistent with observations in previous studies [10][11][12], the T1R prevalence was highest among patients with the BB and BL types of leprosy in this sample of Vietnamese case patients with leprosy (prevalence of 49% and 43%, respectively). Importantly, multivariate analysis revealed that borderline forms of leprosy are independent risk factors for T1Rs, as is a positive BI at leprosy diagnosis.…”

“…Importantly, multivariate analysis revealed that borderline forms of leprosy are independent risk factors for T1Rs, as is a positive BI at leprosy diagnosis. Finally, the number of skin lesions at diagnosis was also an independent risk factor for T1R in our sample, which is consistent with the documented impact of the extent of clinical disease on the risk of a T1R [9][10][11][12].…”

“…Type 2 reactions are systemic inflammatory responses to the deposition of immune complexes, and are clinically characterized by dermo-hypodermal nodules (erythema nodosum) that are associated with neuritis and general signs of disease (fever, discomfort, and edema of extremities). Type 2 reactions are infrequent (they occur in !5% of leprosy patients) and occur almost exclusively in patients with BL and LL leprosy [8][9][10][11][12]. Type 1 reversal reactions (T1Rs) are more common and can be associated with any leprosy subtype, although they are most prevalent in patients with borderline leprosy.…”

“…The prevalence of T1Rs differs widely among different geographical and epidemiological circumstances and ranges from 6% to 67% of patients with leprosy [7][8][9][10][11][12][13][20][21][22][23]. Three types of risk factors for the occurrence of T1Rs have been reported, the most commonly observed of which is leprosy subtypethat is, the borderline forms (BT, BB, and BL) according to the Ridley-Jopling classification [20,23] or the MB form according to the WHO classification [12,23].…”

Coinfection of leprosy and tuberculosis

“…However, one systematic review of ENL cases noted that the incidence of ENL is at least twice as high during MDT than at the time of the initial diagnosis, with the highest incidence in the first year of MDT 15. One study16 has noted leprosy reactions with concurrent TB infection; however, precipitating factors could not be elicited.…”