Leprosy type 1 reactions and erythema nodosum leprosum

Kahawita, Indira; Walker, Stephen L.; Lockwood, Diana N. J.

doi:10.1590/s0365-05962008000100010

Cited by 82 publications

(116 citation statements)

References 51 publications

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“…Assim os pacientes paucibacilares, não sujeitos à reação tipo II, estiveram menos expostos a complicações, mas é importante ressaltar que tal achado não é tranquilizador, pois essas reações são acompanhadas de neurite que é responsável por danos e sequelas importantes 1,9,13 .…”

Section: Agradecimentos Conflito De Interesseunclassified

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Características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares, atendidos em dois centros de referência para hanseníase, na Cidade de Recife, Estado de Pernambuco

Teixeira

Silveira

França

2010

Rev. Soc. Bras. Med. Trop.

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RESUMOIntrodução: As reações são frequentes e importantes no contexto da hanseníase, representando uma significativa parcela de pacientes com incapacidades e submetidos ao retratamento da hanseníase. A caracterização clínico-epidemiológica dos padrões reacionais é primordial para o manejo dos pacientes. O objetivo desse trabalho é descrever as características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares. Métodos: Estudo transversal onde foram avaliados 201 pacientes com história de quadro reacional, atendidos em dois centros de referência para tratamento da hanseníase. Variáveis como baciloscopia inicial, sexo, idade, fototipo, procedência, forma clínica, tipo de tratamento e de reação, índice baciloscópico final e período de surgimento da reação em relação ao tratamento foram avaliados. A análise estatística foi realizada usando-se frequências simples. Para cálculo dos fatores de risco para as formas multibacilares, foram realizadas análises univariada e multivariada. Resultados: Sexo masculino, idade entre 30-44 anos, fototipo V, a forma clínica borderline, tratamento regular, reação tipo I, neurite, presença de 10 a 20 nódulos e surgimento da reação hansênica durante o tratamento foram os achados mais frequentes. Conclusões: Predominaram os indivíduos do sexo masculino que se associaram a um maior risco de desenvolvimento da forma multibacilar. As reações hansênicas foram mais frequentes durante o tratamento, os pacientes multibacilares foram mais propensos ao retratamento da hanseníase e aqueles com reações tipo I e II, apresentaram maior frequência de neurite, linfadenopatia, artrite e irite do que aqueles com reação isolada. Palavras-chaves: Hanseníase. Reações hansênicas. Epidemiologia. Sinais e sintomas. ABSTRACTIntroduction: Significant reactions frequently occur among leprosy cases, and thus a significant proportion of leprosy patients present disabilities and undergo leprosy retreatment. Clinicalepidemiological characterization of reaction patterns is essential for managing such patients. Objective to describe the epidemiological and clinical characteristics of leprosy reactions among paucibacillary and multibacillary individuals. Methods: In this cross-sectional study, 201 patients with histories of reactions who were attended at two reference centers for leprosy treatment were evaluated. Variables such as initial bacilloscopy, sex, age, skin phototype, origin, clinical presentation, type of treatment, type of reaction, final bacilloscopy index and time of reaction onset in relation to the treatment were evaluated. Statistical analysis was performed using simple frequencies. To calculate risk factors for multibacillary forms, univariate and multivariate analyses were performed. Results: Male sex, age between 30 and 44 years, phototype V, borderline clinical form, regular treatment, type I reaction, neuritis, presence of 10 to 20 nodules and onset of the leprosy reaction during the treatment were the most frequent findings. Conclusions: Male patients ...

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Section: Agradecimentos Conflito De Interesseunclassified

“…A duração e o número desses surtos reacionais dependem muitas vezes da forma clínica, bem como do índice baciloscópico inicial 8,9 .…”

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Características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares, atendidos em dois centros de referência para hanseníase, na Cidade de Recife, Estado de Pernambuco

Teixeira

Silveira

França

2010

Rev. Soc. Bras. Med. Trop.

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“…This is a major concern because: 1) leprosy sequelae such as nerve function impairment and disabilities are in most cases linked to these episodes and 2) treatment of these episodes is based on prolonged use of drugs with potential severe side effects, such as corticosteroids and thalidomide. 1 These episodes represent an exacerbation of the inflammatory responses and can appear before, during, or after chemotherapy for Mycobacterium leprae. Two types of reactions are recognized, with distinct clinical and histopathological features.…”

Section: Introductionmentioning

confidence: 99%

“…Dr. Enéas de Carvalho Aguiar 470, São Paulo, SP, 05403, Brazil. E-mail: mahong@usp.br mechanisms, 1 it is clear that they both result from exacerbation of an ongoing immune response and, as such, from lack of immune regulation. However, the participation of Tregs in the development of leprosy reaction episodes remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells

Vieira¹,

Trindade²,

Pagliari³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Leprosy is frequently complicated by the appearance of reactions that are difficult to treat and are the main cause of sequelae. We speculated that disturbances in regulatory T-cells (Tregs) could play a role in leprosy reactions. We determined the frequency of circulating Tregs in patients with type 1 reaction (T1R) and type 2 reaction (T2R). The in situ frequency of Tregs and interleukin (IL)-17, IL-6, and transforming growth factor beta (TGF)-β-expressing cells was also determined. T2R patients showed markedly lower number of circulating and in situ Tregs than T1R patients and controls. This decrease was paralleled by increased in situ IL-17 expression but decreased TGF-β expression. Biopsies from T1R and T2R patients before the reaction episodes showed similar number of forkhead box protein P3 + (FoxP3+) and IL-17+ cells. However, in biopsies taken during the reaction, T2R patients showed a decrease in Tregs and increase in IL-17+ cells, whereas T1R patients showed the opposite: Tregs increased but IL-17+ cells decreased. We also found decreased expansion of Tregs upon in vitro stimulation with Mycobacterium leprae and a trend for lower expression of FoxP3 and the immunosuppressive molecule cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) in T2R Tregs. Our results provide some evidence to the hypothesis that, in T2R, downmodulation of Tregs may favor the development of T-helper-17 responses that characterize this reaction.

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“…Leprosy presents a spectrum of immunological groups between the two poles, the tuberculoid pole (TT) with increased cell-mediated immunity, which gradients towards the lepromatous pole (LL) through a series of borderline forms (BT, BB and BL) with simultaneous increase in humoral immune response and increase in the bacillary load. Type1 Reaction (T1R) also called Reversal Reaction (RR), particularly occurs in BT through BL types of leprosy with exacerbations of the pre-existing skin and nerve lesions due to up-gradation of Cell-Mediated Immunity (CMI) more often during and after Multidrug Therapy (MDT) [2]. Dynamics of immunological reactions could reflect changes in the levels of certain circulatory molecules that could act as possible biomarkers for predicting reactions in leprosy (20).…”

Section: Discussionmentioning

confidence: 99%

Alpha 1 Acid Glycoprotein: Increased Serum and Localized mRNA Expression as a Monitor for Reactions in Leprosy

Nigam¹,

Singh²,

Turankar³

et al. 2015

SOJMID

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Leprosy type 1 reactions and erythema nodosum leprosum

Cited by 82 publications

References 51 publications

Características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares, atendidos em dois centros de referência para hanseníase, na Cidade de Recife, Estado de Pernambuco

Características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares, atendidos em dois centros de referência para hanseníase, na Cidade de Recife, Estado de Pernambuco

Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells

Alpha 1 Acid Glycoprotein: Increased Serum and Localized mRNA Expression as a Monitor for Reactions in Leprosy

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