Five-year Experience with Type 1 and Type 2 Reactions in Hansen Disease at a US Travel Clinic

Jacob, Jesse T; Kozarsky, Phyllis E.; Dismukes, Roberta; Bynoe, Vicki; Margoles, Lindsay; Leonard, Michael P.; Téllez, Ildefonso; Franco‐Paredes, Carlos

doi:10.4269/ajtmh.2008.79.452

Cited by 16 publications

(18 citation statements)

References 9 publications

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“…leprosy frequency of reaction was higher. Similar result was found in other studies [9][10][11][12][13]. So these groups of patients are in need of strong surveillance for development of reaction.…”

Section: Discussionsupporting

confidence: 80%

“…Frequency of reaction was observed to be higher in other studies than that observed in present one [7][8][9][10][11] which may be due to variability in follow up period. Our study found that, around 2/3 of patients having reaction was identified at diagnosis of leprosy; rest 1/3 developed features of reaction during or even after successful treatment of leprosy.…”

Section: Discussioncontrasting

confidence: 57%

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Leprosy Reactions: Frequency and Risk Factors

Quyum¹

2016

CDT

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Objective: To observe the frequency and risk factors of reactions in different category of leprosy patients. Methods:In this observational study 722 leprosy patients [77.8% Paucibacillary (PB) and 22.2% Multibacillary (MB)] were included over a period of 2 ½ years. The clinical & epidemiological details of the patient were recorded during diagnosis and subsequent follow up.Results: 10.5% patients had leprosy reaction; 7.6% type I and 2.9% type II. 7.1% had reaction at diagnosis and 3.4% during or after completion of treatment. 2.3% (13/562) PB patients had reaction all of which were type I, whereas 39.4% (63/160) of MB patients had reaction (26.3% type I and 13.1% type II). Lepromatous end of the spectrum of leprosy had higher frequency of reaction (71.0% in LL and 64.0% in BL in comparison to 6.0%, 5.3% and 23.1% in TT, BT and BB respectively). Males had higher frequency of type I reaction in comparison to females (male female: 11.3% 3.3%, p<0.001) whereas MB patients had significantly higher frequency in comparison to PB patients (MB PB: 26.3% 2.3%, p<0.001); which was also true for type II reaction (male female: 4.6% 0.9%, p=0.003; MB PB: 13.1% 0.0%, p<0.001). Heavy skin infiltration, higher bacillary load and disability were observed in type II reaction. Conclusion:Male MB patients at the lepromatous end of spectrum of leprosy had higher frequency of reaction. Type II reaction was less frequent than type I reaction, but was associated with higher degree of skin infiltration and disability along with higher bacillary index.Citation: Farhana-Quyum, Mashfiqul-Hasan, Chowdhury WK, Wahab MA (2016) Leprosy Reactions: Frequency and Risk Factors. J Clin Dermatol Ther 3: 022. • Page 2 of 3 •

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 57%

Leprosy Reactions: Frequency and Risk Factors

Quyum¹

2016

CDT

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“…Individuals who exhibit reactive outbreaks of leprosy are more susceptible to neural damage and possible sequelae [6,20,23]. In this study, although only 13.3% of the samples had a leprosy reaction, this variable was significant for the development of disability.…”

Section: Discussionmentioning

confidence: 69%

“…The impairment of nerve trunks has the potential to cause physical disabilities due to the immune system's action against the bacillus [6]. Its extent depends on the clinical form of the disease and the exacerbation phenomena during leprosy reaction episodes [7,8] Information on the number of people with disabilities/deformities due to leprosy remains limited.…”

Section: Introductionmentioning

confidence: 99%

Clinical variables associated with disability in leprosy cases in northeast Brazil

Santos

Matos

Oliveira

et al. 2015

J Infect Dev Ctries

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All authors contributed equally to his work. AbstractIntroduction: The clinical outcomes of leprosy include complications such as physical disabilities and deformities that vary according to the degree of impairment of nerve trunks. Knowledge of the factors that lead to the development of these complications is important for disability prevention programs. This study aimed to evaluate clinical factors associated with the occurrence of physical disability in leprosy cases. Methodology: This was a retrospective study of 2,358 cases of leprosy in Aracaju, northeast Brazil, between 2001 and 2011. Analysis was done using the Chi-square test and logistic regression model. Results: Significant factors associated with disability were found to be male gender, having more than two affected nerves, multibacillary leprosy classification, leprosy reaction, and lepromatous leprosy. The multivariate analysis revealed that the associated factors included having more than two affected nerves, leprosy reaction (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.36 to 3.01), the multibacillary form (aOR: 2.74, 95% CI: 1.84 to 4.08), and lepromatous leprosy (aOR: 4.87, 95% CI: 2.86 to 16.08). Conclusions: The number of affected nerves, leprosy reaction, operational classification, and clinical presentation were identified as the main factors associated with the development of disability in leprosy patients.

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“…One of the main reasons for requiring medical care is to manage permanent neurological disability and its consequences, such as skin and soft tissue infections, chronic nonhealing ulcers associated with neuropathic (Charcot) joints secondary to peripheral nerve dysfunction, and chronic leprosy reactions, which can take place months or even years after the completion of MDT (82). If diagnosis is delayed because of problems of access to health care and unfamiliarity with HD among physicians in the host country, long-term problems associated with nerve damage are more likely.…”

Section: International Migrationmentioning

confidence: 99%

Leprosy in the 21st Century

2015

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SUMMARY Despite significant improvements in leprosy (Hansen's disease) treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high, and patients often have long-term complications associated with the disease. In this article, we discuss recent findings related to genetics, susceptibility, and disease reservoirs and the implications of these findings for Hansen's disease control and health outcomes for patients. We describe the continued difficulties associated with treatment of inflammatory episodes known as “leprosy reactions,” which cause much of the disability associated with the disease and can affect people for many years after MDT is complete. We also discuss some of the contemporary challenges for physicians and patients, including international and internal migration of people affected by the disease. We suggest some important areas of focus for future Hansen's disease research.

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Five-year Experience with Type 1 and Type 2 Reactions in Hansen Disease at a US Travel Clinic

Cited by 16 publications

References 9 publications

Leprosy Reactions: Frequency and Risk Factors

Leprosy Reactions: Frequency and Risk Factors

Clinical variables associated with disability in leprosy cases in northeast Brazil

Leprosy in the 21st Century

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