The Time Interval Between the Start of Anti-Leprosy Treatment and the Development of Reactions in Borderline Patients

Naafs, Bernard; Hw, Wheate

doi:10.5935/0305-7518.19780019

Cited by 15 publications

(13 citation statements)

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“…Nevertheless, reactions are part of the normal course of the disease and may therefore also occur in patients without treatment. 9 We hereby report two patients with leprosy and TB co-infection, an association that is rarely reported at present, even in areas where both diseases are endemic. We discuss possible reasons for this phenomenon, and the interplay between these two infections, a matter not yet clear, and review the literature on this coinfection.…”

Section: Introductionmentioning

confidence: 99%

Leprosy and Tuberculosis Co-Infection: Clinical and Immunological Report of Two Cases and Review of the Literature

Trindade¹,

Miyamoto²,

Benard³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. A review of the records of patients seen between 2004 and 2011 at the Dermatology Clinic of the Sã o Paulo University Medical School showed that only two leprosy patients had been co-infected with tuberculosis (TB). One patient showed a type 1 leprosy reaction during the first 3 months of treatment of pleural TB and in the other patient, pulmonary TB was diagnosed during the first 3 months of treatment of a type 1 leprosy reaction. Both patients showed normal cellular immune response tests, including those of the interferon-gamma (IFN-γ)/interleukin 12 (IL-12) axis. Although both mycobacterial infections are endemic in developing countries like Brazil, the co-infection has hardly been reported in the last decade. There is no suitable explanation for this observation. The reports on the interaction between the two mycobacteria are highly speculative: some studies suggest that leprosy, especially the anergic form, would predispose to TB, whereas other investigations suggested an antagonism between the two diseases.

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Section: Introductionmentioning

confidence: 99%

Leprosy and Tuberculosis Co-Infection: Clinical and Immunological Report of Two Cases and Review of the Literature

Trindade¹,

Miyamoto²,

Benard³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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“…This is probably a consequence of the rapid bactericidal activity of the drug [13]. This granulomatous reactional (Rc) aspect was also found, albeit less frequently, in the initial biopsy of some patients before treatment; in these cases it was considered to be the result of changes in the immune status of the patients, due to as yet unknown host factors [4], [8], [14], [15].…”

Section: Discussionmentioning

confidence: 99%

“…This occurs in some coinfected patients, in whom, due to the AIDS-associated cellular immunesuppression, leprosy remains a latent infection and clinically manifests as type 1 reaction after immune restoration is induced with HAART [23]–[29]. The reactions that appear after the start of leprosy treatment, specially MDT, may represent a similar immune restoration phenomenon [13], [14], [30]. In these cases the bacilli are destroyed by the granulomatous reactivation during the reactional episodes (reversal or type 1 reaction).…”

Section: Discussionmentioning

confidence: 99%

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Trindade¹,

Benard

Ura

et al. 2010

PLoS Negl Trop Dis

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BackgroundLeprosy is a chronic granulomatous infectious disease and is still endemic in many parts of the world. It causes disabilities which are the consequence of nerve damage. This damage is in most cases the result of immunological reactions.ObjectivesTo investigate the differences between a type 1 leprosy (reversal) reaction and relapse on using histopathology.MethodsThe histopathological changes in 167 biopsies from 66 leprosy patients were studied. The patients were selected when their sequential biopsies demonstrated either different patterns or maintained the same pattern of granulomatous reaction over more than two years during or after the treatment of leprosy.ResultsIn 57 of the patients studied, a reactivation was seen which coincided with a decrease in the bacteriological index (BI), suggesting that this reactivation (reversal reaction or type 1 leprosy reaction) coincides with an effective capacity for bacteriological clearance. In nine patients, an increase of the bacteriologic index (IB) or persistence of solid bacilli occurred during the reactivation, indicating proliferative activity, suggestive of a relapse. The histopathological aspects of the granulomas were similar in both groups.ConclusionBacterioscopy provided the only means to differentiate a reversal reaction from a relapse in patients with granulomatous reactivation. The type 1 leprosy reaction may be considered as a part effective immune reconstitution (reversal, upgrading reaction) or as a mere hypersensitivity reaction (downgrading reaction) in a relapse.

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“…This case report also emphasizes the importance of searching for co-infections, such as Chagas disease and other parasitic diseases, in patients with leprosy because reactions develop in up to 50% of these patients while they receive MDT, which require prolonged therapy with immunosuppressive drugs. 5 This finding is an issue not only for areas to which diseases are endemic, but also for developed countries, which are increasingly assisting patients with these diagnoses because of increased migration. …”

Section: Discussionmentioning

confidence: 99%

“…4 Between these polar forms are the borderline patients, who may have variable degrees of specific cellular immune response. 5 Patients at the lepromatosus pole may undergo episodes of acute reaction because of flareups of their immune responses, usually during specific treatment. These reactions are characterized by abrupt eruption of erythematous and painful nodules, usually on skin, but may involve any organ or tissue infected by bacilli, and systemic manifestations, known as erythema nodosum leprosum (ENL).…”

Section: Introductionmentioning

confidence: 99%

A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature

Trindade¹,

Carvalho²,

Belfort³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

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The Time Interval Between the Start of Anti-Leprosy Treatment and the Development of Reactions in Borderline Patients

Cited by 15 publications

References 1 publication

Leprosy and Tuberculosis Co-Infection: Clinical and Immunological Report of Two Cases and Review of the Literature

Leprosy and Tuberculosis Co-Infection: Clinical and Immunological Report of Two Cases and Review of the Literature

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature

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