Leprosy reactions: coinfections as a possible risk factor

Abstract

OBJECTIVE:This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes.METHOD:A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections.RESULTS:Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%).CONCLUSIONS:Coinfections may be involved in the development and maintenance of leprosy reactions.

The oral cavity in leprosy: what clinicians need to know

“…We found that ENL was the most prevalent reaction type, especially in MB patients with any coinfection. We verified that oral infections, including periodontal diseases and dental abscess, were the most prevalent coinfections, followed by urinary tract infection, sinusopathy, and viral hepatitis (Motta et al , , ). These findings suggest that the presence of coinfections may be involved in the development and maintenance of leprosy reactional episodes and raise the need to screen these patients for chronic systemic and local infections.…”

“…The relationship between these reactional episodes and infectious process has been investigated. We studied the role of coexisting factors that could be related to exacerbation of M. leprae infection (Motta et al , ). First, we determined the frequency of leprosy reactional episodes and coinfections in LPs to evaluate whether there was a relationship between these conditions.…”

Faktor Risiko Potensial Reaksi Kusta Pada Etnis Asli di Dua Kantong Kusta – Papua

“…2,13 Namun ada juga penelitian yang berkesimpulan sebaliknya, bahwa kusta lebih banyak pada laki-laki. 8,14 Beberapa kebiasaan menunjukkan adanya keterbatasan perempuan dalam pencarian pengobatan dan keluhan kusta terkait dengan stigma dalam masyarakat, sehingga jumlah penderita kusta perempuan yang tercatat lebih sedikit dan seringkali ditemukan sudah dalam keadaan cacat. 2,12,13 Pada penelitian ini didapatkan dua kelompok subyek berdasarkan jenis kusta, yaitu PB dan MB.…”

“…Hal yang sama juga diungkapkan oleh beberapa hasil penelitian di dunia. 6,8,14,15 Reaksi kusta merupakan reaksi hipersensitivitas, sehingga sangat dipengaruhi oleh respon imun dan status imunitas seseorang. 2,16 Sebuah studi menunjukkan adanya peningkatan aktifitas sel T helper 17 pada kelompok orang yang mengalami reaksi kusta, dimana sel ini memegang peranan penting dalam proses autoimun dan reaksi inflamasi.…”

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

“…Cytokine measurement during the reactional episodes has been reported in many studies, especially T cell biomarkers analyzed in plasma, serum, skin lesions and saliva [3][4][5][6][7][8][9][10] , demonstrating their potential to play a significant role in the classification, prognosis and evolution of leprosy. We have been studying the relationship between these episodes and infectious processes such as chronic oral infections 11 . Since oral infections can induce over-stimulation of the host immune system through the release of inflammatory peptides 12,13 , it is reasonable to consider the possibility that these infectious processes act as an inducing and exacerbating or maintaining factor of leprosy reactions.…”