Reactional States in Multibacillary Hansen Disease Patients During Multidrug Therapy

Abstract

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI < 3, while ENL predominated among those patients with BI > 3.

Leprosy type 1 reactions and erythema nodosum leprosum

“…In Brazil 37% of new BL and LL cases experience ENL. 8 In Asia reported figures vary between 19-26% of BL and LL cases in Nepal, India and Thailand. 8,13,31,32 ENL reactions occur most commonly during the first year of MDT.…”

“…8 In Asia reported figures vary between 19-26% of BL and LL cases in Nepal, India and Thailand. 8,13,31,32 ENL reactions occur most commonly during the first year of MDT. [31][32][33] One third of patients with ENL have the diagnosis of leprosy made at the same time as their reaction.…”

“…Twenty-six per cent of Brazilian patients in Rio de Janeiro who had positive slit-skin smears experienced a T1R during the two year period they were taking MDT. 8 A retrospective study of individuals with borderline leprosy attending a leprosy referral centre in Nepal showed that 30% developed a T1R. 5 Half of the individuals who experienced a T1R had demonstrable new nerve function impairment.…”

Double-blind trial of the efficacy of pentoxifylline vs thalidomide for the treatment of type II reaction in leprosy

“…In a previous study, it was demonstrated that 57% of patients undergoing multibacillary multidrug therapy presented reaction, with 55% having ENL (2). Type II reaction, characterized by the appearance of tender, erythematous, subcutaneous nodules located on apparently normal skin, is frequently accompanied by systemic symptoms such as fever, malaise, enlarged lymph nodes, anorexia, weight loss, arthralgia, and edema (3,4).…”

Erythema multiforme in leprosy

“…The clinical course of chronic leprosy is often interrupted by reactions, which are acute inflammatory responses that can occur before, during or after chemotherapy. The estimated risk of a LP experiencing at least one reaction episode during medical follow-up can be as high as 60% in multibacillary (MB) patients who are undergoing multidrug therapy (MDT) (Nery et al 1998). These reactions have been broadly classified as type I or reversal reactions (RRs), which most commonly affect borderline patients [borderline tuberculoid, borderline-borderline and borderline lepromatous (BL)], or type II or erythema nodosum leprosum (ENL), which affects the lepromatous patients [BL and lepromatous forms (LL)].…”