Severe type 2 leprosy reaction with COVID-19 with a favourable outcome despite continued use of corticosteroids and methotrexate and a hypothesis on the possible immunological consequences

Saxena, Snigdha; Khurana, Ananta; Bathula, Savitha; Sardana, Kabir; Agarwal, Aastha; Muddebihal, Aishwarya; Raina, Alok; Paliwal, Purnima

doi:10.1016/j.ijid.2020.12.024

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…Although confounding factors likely influenced this association, this result may support the hypothesis that relative immunosuppression in leprosy could increase susceptibility to SARS-CoV-2. [ 25 ] If this assumption is true, multibacillary patients may have a higher risk of acquiring COVID-19. However, our sample of active leprosy patients was not adequate for testing this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study

et al. 2021

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Background Protective effects of Bacillus Calmette–Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. Methodology/Principal findings We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93–13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04–4.06) were significant risk factors for COVID-19. Conclusions/Significance Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.

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Section: Discussionmentioning

confidence: 99%

The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study

et al. 2021

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“…33 , 34 Interestingly, a report of nosocomially acquired SARS-CoV-2 infection in a 26-year-old man with erythema nodosum leprosum treated with methotrexate and systemic corticosteroids describe a mild COVID-19 illness and favourable outcome. 35 Since our data were collected, short-course dexamethasone has been shown to reduce mortality in hospitalized patients with COVID-19. 36 …”

Section: Discussionmentioning

confidence: 99%

An assessment of the reported impact of the COVID-19 pandemic on leprosy services using an online survey of practitioners in leprosy referral centres

Barros

Lambert

Negera

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. Methods We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. Results Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. Discussion This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.

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“…Despite concerns about the severity of M. leprae /SARS-CoV-2 co-infections, curiously, the drugs used in MDT have been associated with a favorable outcome for COVID-19 patients ( Arora et al, 2021 ; de Barros et al, 2021 ; Saxena et al, 2021 ). Clofazimine, an anti-leprosy drug, may have a role in the control of SARS-CoV-2 and MERS-CoV in the Middle East since it has been demonstrated to antagonize SARS-CoV-2 replication in multiple in vitro and ex vivo human systems, as well as in a hamster model of SARS-CoV-2 pathogenesis ( Yuan et al, 2021 ).…”

Section: Co-infection Leprosy and Covid-19mentioning

confidence: 99%

Kynurenines in the Pathogenesis of Peripheral Neuropathy During Leprosy and COVID-19

Oliveira

Athaide

RAHMAN

et al. 2022

Front. Cell. Infect. Microbiol.

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Inflammatory disorders are associated with the activation of tryptophan (TRYP) catabolism via the kynurenine pathway (KP). Several reports have demonstrated the role of KP in the immunopathophysiology of both leprosy and coronavirus disease 19 (COVID-19). The nervous system can be affected in infections caused by both Mycobacterium leprae and SARS-CoV-2, but the mechanisms involved in the peripheral neural damage induced by these infectious agents are not fully understood. In recent years KP has received greater attention due the importance of kynurenine metabolites in infectious diseases, immune dysfunction and nervous system disorders. In this review, we discuss how modulation of the KP may aid in controlling the damage to peripheral nerves and the effects of KP activation on neural damage during leprosy or COVID-19 individually and we speculate its role during co-infection.

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Severe type 2 leprosy reaction with COVID-19 with a favourable outcome despite continued use of corticosteroids and methotrexate and a hypothesis on the possible immunological consequences

Cited by 16 publications

References 13 publications

The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study

The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study

An assessment of the reported impact of the COVID-19 pandemic on leprosy services using an online survey of practitioners in leprosy referral centres

Kynurenines in the Pathogenesis of Peripheral Neuropathy During Leprosy and COVID-19

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