The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Abstract

Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.

Associations between occupation, leprosy disability and other sociodemographic factors in an endemic area of Brazil

“…A p-value of <0.05 was taken as statistically significant. For this paper, we performed a post-hoc analysis to look at this research question of disability, understanding that the original question was looking at risk factors for leprosy reactions [29]. The sample size (48 cases of disability, 25 without disability) was sufficient to detect about an odds ratio of 4.5 assuming that about 15-18% of controls would report being a manual laborer (as per a prior study [27]) and using a power of 0.80 and alpha of 0.05.…”

“…Between July and December 2015, adult cases (18 years and older) of multibacillary (MB) leprosy who presented for care to a dermatologic reference center in Belo Horizonte, Minas Gerais, Brazil, were enrolled in a study to study risk factors for leprosy reactions [29]. Eligible participants included patients with multibacillary (MB) disease as defined by the World Health Organization (WHO), with some cases of borderline tuberculoid (BT) (5 or more skin lesions), and all cases of borderline borderline (BB), borderline lepromatous (BL) and lepromatous (LL).…”

“…Since the analysis is one-point in time, causation is not possible to assess. The original scope of the study was to investigate the association of leprosy reactions with co-infections [29] but given the large burden of disability in this study sample, we chose to do an exploratory analysis of social determinants of health and disability. While the sample size was only adequate for a finding of a strong association between our primary exposure of manual labor and disability (predicted OR of 6), which we did not find, it was large enough to show the association of education and disability, (at a power of 80% and alpha of 0.05), attesting to the validity of the association in addition to the literature supporting this finding.…”

Reviews of Science for Science Librarians: Vitamins and Trace Elements that May Be Preventive or Ameliorating in This Age of Contagion

“…While vitamin D levels are thought to be easy for most adults to maintain during high sunshine seasons (Haines and Park 2012), 16% of hepatitis patients in tropical Brazil were nonetheless demonstrably deficient, with a consequent higher risk for poorer outcomes. Likewise, vitamin D is the most prominent deficiency in Brazilian leprosy cases and correlates with additional vulnerabilities to opportunistic parasites (Fairley et al 2019).…”

Strongyloidiasis gastritis and colitis in a patient with leprosy

“…Disseminated strongyloidiasis in patients with intermittent leprosy reactions and chronic steroid use should be considered 1 , 2 .…”