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 •
Background: Bone health can be seriously affected by the leprosy reaction itself and steroids used in its treatment. Objective: To assess the bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) scan and fracture risk by the fracture risk assessment tool (FRAX) in steroid treated patients with leprosy reaction. Methods: This study involved 25 patients with leprosy reaction treated with steroids (prednisolone) and 22 healthy family members attending the urban leprosy clinics of The Leprosy Mission International -Bangladesh (TLMI-B) Dhaka program in January-March, 2018. Socio-demographic and clinical information was recorded and BMD was measured in the spine, femur neck and forearm by DXA. Fracture risk was calculated by FRAX. Results: Both the T-score and Z-score of the spine were lower in the leprosy group in relation to those of the control group [leprosy vs. control: T-score −1.7 (−3.2-1.3) vs. −1.2 (−2.5-0.8), p =0.030 and Z-score −1.9 (−3.3 to −1.4) vs. −1.2 (−2.3 to −0.2), p =0.038; median (interquartile range). In other regions (femur neck, forearm) both scores were similar between the two groups, except for Z-score of the left femur neck which was lower in the leprosy group (p =0.036). Although the frequency of osteopenia and osteoporosis in different sites was similar between groups, the 10-year probability of major osteoporotic fracture [leprosy vs. control: 2.2% (1.6-4.7) vs. 1.1% (0.9-2.0); p <0.001] or hip fracture [leprosy vs. control: 0.4% (0.1-1.7) vs. 0.1% (0.0-0.2); p =0.001] by FRAX was higher in the leprosy group. Conclusions: Participants with leprosy reactions and steroid treatment had lower BMD related parameters in lumber spine and higher risk of osteoporotic fracture.
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