A Study of Reversal Reactions in Leprosy

Abstract

Reversal reactions (RRs) are the leading cause of deformities and disabilities in leprosy. A comprehensive data on the magnitude of RR is crucial in implementing and evaluating the leprosy control strategy. Therefore, we had undertaken this study to find out the rate of reversal reaction (RR) and the key features associated with it, so that a comprehensive strategy could be adopted for their early detection and management.In this prospective study, all untreated newly diagnosed cases of leprosy that attended a tertiary level urban hospital from April 2012-March 2017, were examined for RR at the time of diagnoses as well as during the course of their treatment.RR was recorded in 13.61% (84/617) of patients, of these 73.80% (62/84) presented in RR at the time of the first visit (at the time of diagnoses) to the hospital, while the remaining 26.20% (22/84) developed it during the course of multidrug therapy (MDT). Majority of RR were seen in multi-bacillary (MB) cases (78/84, 92.85%), in comparison to pauci-bacillary (PB), where it was seen only in 7.15% (6/84). Another important finding was the declining trend of RR, from 21.15% (22/104) in 2012-13 to 2.34% (3/128) in 2016-17. MB cases and MDT were found to be the two key features associated with reversal reactions.Although a significant declining trend of RR was recorded in the study, yet they are still prevalent, particularly in the MB cases, and most of them were detected at the time of the patient's first visit. Therefore, a strategy to further augment the public awareness program regarding the features of RR, as well as explaining these features to patients before starting treatment should be emphasized.