Identification of clinical, epidemiological and laboratory risk factors for leprosy reactions during and after multidrug therapy

Abstract

This cross-sectional retrospective study evaluated 440 leprosy patients; 57% (251/440) had leprosy reactions during and/or after multidrug therapy, 80.5% (202/251) of whom presented with multibacillary leprosy. At diagnosis, positive bacterial index (BI) [odds ratio (OR) = 6.39; 95% confidence interval (CI): 4.1-10.1)] or polymerase chain reaction (PCR) (OR = 9.15; 95% CI: 5.4-15.5) in skin smears, anti-phenolic glycolipid-1 (anti-PGL-1) ELISA (OR = 4.77; 95% CI: 2.9-7.9), leucocytosis (OR = 9.97; 95% CI: 3.9-25.7), thrombocytopenia (OR = 5.72; 95% CI: 2.3-14.0) and elevated lactate dehydrogenase (OR = 2.38; 95% CI: 1.4-4.0) were potential markers for the development of reactions during treatment. After treatment, positive BI (OR = 8.47; 95% CI: 4.7-15.3) and PCR (OR = 6.46; 95% CI: 3.4-12.3) in skin smears, anti-PGL-1 ELISA (OR = 2.25; 95% CI: 1.3-3.9), anaemia (OR = 2.36; 95% CI: 1.2-4.5), leucocytosis (OR = 4.14; 95% CI: 1.5-11.6) and thrombocytopenia (OR = 3.70; 95% CI: 1.3-2.2) were risk factors for the occurrence of reactions during the study period. The identification of groups with an increased risk for developing reactions will allow for the timely development of a treatment plan to prevent nerve damage and, therefore, the appearance of the disabling sequelae associated with the stigma of leprosy.

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

“…In this study, reactions were more frequent during the course of MDT, as previously reported [2, 27, 43]. However, patients mainly developed ENL during follow-up.…”

“…Moreover, the great majority of patients who developed reactions were MB patients with high BIs, and these variables have been previously associated with a high probability of developing leprosy reactions [2, 27, 28]. Our results confirm that MB patients have a higher risk of developing leprosy reactions as compared with PB patients.…”

“…Bacillary load is known to directly correlate with antibody levels and with the development of leprosy reactions [2, 16, 27, 28]. Moreover, antibodies, which are abundant in MB patients, probably play a role in the pathophysiology of ENL [15–17, 39].…”

Number of leprosy reactions during treatment: clinical correlations and laboratory diagnosis

“…This is because of the diffi culty in monitoring these individuals and the lack of criteria for determining the beginning and end of a reaction. In the present study, we calculated the mean number of reactions during treatment in more detail, similar to recent studies (16) (17) . In this study, the LLs and LL forms were more likely to develop reactions; both had a mean number of >2 leprosy reactions per patient during treatment (3) .…”

Leprosy reactions: The predictive value of Mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR)

“…Also, higher BI has been shown to be an important factor for the development of reactions [12, 37, 38]. To understand the impact of patients´ BI in this different serologic pattern observed from reaction-free to ENL, serology data of reactional (RR, ENL) and reaction-free patients was analyzed according to distinct BI range.…”