Epidemiological Characteristics of Leprosy Reactions: 15 Years Experience from North India1

Abstract

A retrospective analysis of patient's leprosy clinic records at PGIMER, Chandigarh, India for the period 1983 to 1998 was undertaken to study the frequency, time of onset, and risk factors for leprosy reactions. Of the 2600 cases analyzed, 1494 were multibacillary and 1106 had paucibacillary disease. Presentation with reaction was common with 30.9% of our patients having reactions at the time of first visit. The incidence of reversal reaction (RR) was highest during 6 to 12 months after starting multi-drug therapy (MDT), thereafter declining gradually. Late RR occurred in 9.5% of all cases and was noted up to 7 years after treatment. Female gender, widespread disease, and multibacillary disease were identified as risk factors for RR. Erythema nodosum leprosum (ENL) reactions were noted to occur mostly during second or third year after starting MDT. Of the total number of patients who experienced ENL, 64.3% had recurrent episodes which continued for up to 8 years after the start of treatment. Lepromatous leprosy, female gender, and high Bacterial Index (>/=3) were recognized as risk factors for developing ENL. Occurrence of recurrent and late reactions, even though of mild severity, highlights the importance of recognizing and treating them promptly to prevent or reduce morbidity, complications, and further deterioration in the disability status. Although it is hoped that leprosy will have been eliminated at all levels by 2005, the recognition and management of these reactions will continue to be the most essential/significant task in the post elimination era.

Características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares, atendidos em dois centros de referência para hanseníase, na Cidade de Recife, Estado de Pernambuco

“…No presente estudo, o surgimento da reação tipo II ainda durante o tratamento pareceu contrariar os achados de uma grande coorte 26 , de que essa reação é mais frequente no primeiro ou segundo ano após alta da terapia multidroga. O fato de clofazimina ter sido utilizada durante o tratamento e ter efeito antiinflamatório poderia justificar o surgimento tardio do quadro reacional na forma lepromatosa.…”

Leprosy type 1 reactions and erythema nodosum leprosum

“…10,11 The detection of Mycobacterium leprae DNA by PCR in skin patches at the time of diagnosis is associated with an increased risk of T1R in Brazilian patients with a single skin lesion. 12 Increasing age has also been reported to be a risk factor for T1R in Vietnamese and Brazilians.…”

“…The majority of patients with ENL go on to develop several episodes over many years, as multiple acute episodes or chronic ENL. 11,31 Less than 10% of patients in a large cohort in India had only a single episode of ENL while 62.5% had chronic ENL. 31 The cutaneous manifestation of ENL is widespread crops of erythematous, inflamed nodules and papules, which may be superficial or deep.…”

Description of Leprosy Classification at Baseline Among Patients Enrolled at the Uniform Multidrug Therapy Clinical Trial for Leprosy Patients in Brazil

“…Indeterminate leprosy patients were excluded. patients with high BI have a higher risk of developing reactions, [10][11][12] but besides the high BI other unknown factors play a role in the susceptibility to leprosy reactions. Previous results of U-MDT/CT-BR trial showed that there is no statistical difference between U-MDT or regular-MDT (R-MDT) treatment regimen regarding frequency of reactions among MB patients, even when BI was stratified as BI or 3.0.…”

“…E-mail: samira@buhrer.net to the prompt identification of MB leprosy patients, 6,8,9 which are the ones with higher risk to develop reactions. [10][11][12] This study used the U-MDT/CT-BR database to describe and report the performance of available tools to classify PB and MB leprosy patients at baseline. Anti-PGL-I serology, bacterial load, and the number of skin lesions were evaluated considering a modified R&J classification criteria as the gold standard.…”