Chronic type 2 reaction possibly triggered by an asymptomatic Bartonella henselae infection in a leprosy patient

Abstract

As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselae in this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.

Bartonella henselae as a putative trigger for chronic type 2 leprosy reactions

“…In this region, the rate of patients with permanent sequelae disabilities is greater and higher than in regions of the country where the rates of leprosy detection are higher. 23 , 25 Infection with B. henselae may be indirectly associated, among other factors, with physical disabilities in patients with leprosy by triggering leprosy reactions.…”

“…The previously described patient with M. leprae and B. henselae coinfection had two blood samples collected during retreatment with MDT for leprosy with detection of Bartonella sp.-DNA in both samples. 23 In this case of coinfection, the patient had been treated for leprosy with 24 doses of the MDT regimen (in which dapsone had been replaced by ofloxacin by anemia), maintained chronic T2R for 33 months after the end of this first treatment and had started retreatment with the same regimen for six months when B. henselae infection was effectively treated. The patient completed 12 doses for his multibacillary leprosy and had no recurrence of leprosy, even after 60 months of follow-up after B. henselae treatment.…”

“…The patient completed 12 doses for his multibacillary leprosy and had no recurrence of leprosy, even after 60 months of follow-up after B. henselae treatment. 23 …”

“…In this patient, there was complete improvement of the reactions with the treatment for B. henselae . 23 Other cases of the association of leprosy with B. henselae have also been cited in an article on the detection of bacterial DNA in paraffin material. 24 …”