Th17 Cells and Cytokines in Leprosy: Understanding the Immune Response and Polarization

ABSTRACT While there are conflicting data concerning interleukin (IL)-17 levels in the serum of patients with leprosy compared with those in healthy controls, higher levels have been more evident in the tuberculoid clinical form of leprosy and type 1 reactions. This review aimed to highlight the role of Th17 cells and their cytokines in leprosy. Cytokines such as IL-1β and IL-23 induce Th17, while transforming growth factor beta and IL-10 inhibit Th17, indicating that the balance between Th17 and regulatory T cells is crucial for leprosy polarization. However, more comprehensive paired studies are required to better elucidate the role of Th17 cells in leprosy.

Fenómeno de Lucio como forma de presentación de enfermedad de Hansen / Lucio's phenomenon as a presentation of Hansen disease / Fenômeno de Lucio como forma de apresentação da hanseníase

Resumen: Introducción: la enfermedad de Hansen es una enfermedad infecciosa crónica, causada por Mycobacterium leprae, que afecta principalmente piel y nervios periféricos. Las reacciones leprosas son eventos agudos que se asocian a un aumento de la morbimortalidad de la enfermedad. Objetivo: presentar el caso clínico de un paciente con fenómeno de Lucio, a través del cual se llegó al diagnóstico de enfermedad de Hansen, y remarcar la importancia de tener presente esta enfermedad, poco frecuente en nuestro país, para su correcto diagnóstico. Discusión: el fenómeno de Lucio es un tipo de reacción leprosa mediada por inmunocomplejos. Se caracteriza clínicamente por máculas o placas eritematovioláceas, de aparición súbita, que evolucionan a úlceras necróticas y curan dejando cicatrices estrelladas atróficas. De no mediar tratamiento, puede ser fatal, debido a sobreinfección y sepsis. Este se basa en el tratamiento específico de la infección, asociado a prednisona y un correcto manejo de las heridas.

Summary: Introduction: Hansen disease is a chronic infectious disease caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves. Leprosy reactions are acute events associated to an increase in the morbimortality of the disease. Objective: the study aims to present the clinical case of patient with Lucio´s phenomenon, which allowed the diagnosis of Hansen disease, and to emphasize on the importance of having this disease in mind for an appropriate diagnosis, despite it being rather unusual in our country. Discussion: Lucio´s phenomenon is a kind of leprosy reaction mediated by immune complexes. Clinically, it is characterized by the sudden onset of macules or blue hemorrhagic plaques, with a rapid evolution to necrotic ulcers, and it heals leaving star-shaped atrophic scars. If it is not treated, it may be fatal due to superinfection and sepsis. Treatment is based on specific medication for the infection, associated to prednisone and the correct handling of injuries.

Resumo: Introdução: a hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que acomete principalmente pele e nervos periféricos. As reações hansênicas são eventos agudos que estão associados ao aumento da morbimortalidade da doença. Objetivo: apresentar o caso de um paciente com fenômeno de Lúcio, por meio do qual se chegou ao diagnóstico de hanseníase, e ressaltar a importância de se ter em mente esta doença, rara em nosso meio, para seu correto diagnóstico. Discussão: o fenômeno de Lúcio é um tipo de reação hansênica mediada por imunocomplexos. Caracteriza-se clinicamente por máculas ou placas eritêmato-violáceas de início súbito que evoluem para úlceras necróticas e cicatrizam, deixando cicatrizes estreladas atróficas. Sem tratamento pode ser fatal, devido a superinfecção e sepse; a terapia está baseada no tratamento específico da infecção, associado à prednisona e no manejo correto da ferida.

A case report of leprosy reaction combined with bullous pemphigoid after treatment of paucibacillary leprosy / 上海预防医学

ObjectiveTo investigate the clinical characteristics of leprosy-related neuritis with bullous pemphigoid after treatment of paucibacillary leprosy. MethodsThe treatment of leprosy reaction combined with bullous pemphigoid of a cured case of leprosy was analysed. ResultsFive years after standard treatment for leprosy， erythema and vesicles appeared in the limbs without obvious inducement， and the disease became more and more severe. With clinical diagnosis and pathological examination， pemphigoid was confirmed， and the patients were given hormone treatment for leprosy reaction and anti-immunotherapy， as well as symptomatic supportive treatment. ConclusionLeprosy reaction and pemphigoid are both related to immunity， but the occurrence of both at the same time is relatively rare， so in the clinical process we should attach great importance to early detection， early diagnosis and prompt treatment to prevent further harm to the patient.

HIV and leprosy in a 27-year-old Filipino male: A case report

Introduction@#Hansen’s disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae associated with inflammation that may damage the skin and peripheral nerves. In countries where leprosy is still endemic, an increasing preva- lence of human immunodeficiency virus (HIV) can be seen, hence increasing the possibility of HIV-leprosy co-infection. Hansen’s disease, if not treated promptly, can cause scars and deformities associated with leprosy reaction. Immunosuppressive drugs like corticosteroids used in the treatment of leprosy reaction may put the patient at risk of opportunistic infections.@*Case report@#This is a case of a 27-year-old Filipino male with HIV-leprosy co-infection, who manifested with erythema nodosum leprosum reaction, treated with tapering dose of oral corticosteroids and multidrug therapy (MDT) for multibacillary leprosy showing good response to treatment after 5 months without recurrence of reaction. The use of chronic oral corticosteroids, despite its immunosuppressive effects, has been beneficial in the management of reactions in this patient with HIV-leprosy co-infection.@*Conclusion@#Considering that both Hansen’s disease and HIV directly affects T helper CD4+ lymphocytes in its pathogenesis, there seems to be little to no alteration in the course of patients with HIV-leprosy co-infection. Hence, treatment of HIV-leprosy co-infection does not differ from that of a seronegative leprosy patient. This case highlights the occurrence of erythema nodo- sum leprosum reaction in HIV-leprosy co-infection and the need for immunosuppressive drugs to control reaction and prevent nerve damage. Close monitoring is imperative to weigh the risk-benefit ratio of medications given to patients with HIV-leprosy co-infection.

A Case of Type 2 Leprosy Reaction in Borderline Lepromatous Leprosy Masquerading as Orbital Cellulitis in an Immigrant Worker / 나학회지

Hansen's disease(HD) is a chronic infectious disorder acquired by inoculation of Mycobacterium leprae. With the establishment of complex multidrug therapy, the incidence rate of leprosy patients has continually shown to decline by 90% compared to the incidence rate in the 1990s. However, the prevalence of the disease still remains high in southeast asian countries. Due to the rarity and diverse nature of cutaneous presentation, HD is often misdiagnosed with other dermatoses or infectious conditions. Especially, when a patient presents with unusual presentation with leprosy reaction with no classical feature such as sensory disorders and skin lesion, the diagnosis is further delayed with misguided treatments. Herein we present a 27-year-old Indonesian immigrant who displayed clinical features mimicking that of orbital cellulitis who was later diagnosed with borderline lepromatous leprosy through histologic and PCR confirmation, in light of alerting the probability of leprosy in immigrants with intractable skin presentations.

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS:Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

The role of human T cell lymphotrophic virus type 1, hepatitis B virus and hepatitis C virus coinfections in leprosy

Leprosy spectrum and outcome is associated with the host immune response against Mycobacterium leprae. The role of coinfections in leprosy patients may be related to a depression of cellular immunity or amplification of inflammatory responses. Leprosy remains endemic in several regions where human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) or hepatitis C virus (HCV) are also endemic. We have evaluated the evidence for the possible role of these viruses in the clinical manifestations and outcomes of leprosy. HTLV-1, HBV and HCV are associated with leprosy in some regions and institutionalization is an important risk factor for these viral coinfections. Some studies show a higher prevalence of viral coinfection in lepromatous cases. Although HBV and HCV coinfection were associated with reversal reaction in one study, there is a lack of information about the consequences of viral coinfections in leprosy. It is not known whether clinical outcomes associated with leprosy, such as development of reactions or relapses could be attributed to a specific viral coinfection. Furthermore, whether the leprosy subtype may influence the progression of the viral coinfection is unknown. All of these important and intriguing questions await prospective studies to definitively establish the actual relationship between these entities.

Genetics of leprosy reactions: an overview

Type-1 (T1R) and Type-2 (T2R) leprosy reactions (LR), which affect up to 50% of leprosy patients, are aggressive inflammatory episodes of sudden onset and highly variable incidence across populations. LR are often diagnosed concurrently with leprosy, but more frequently occur several months after treatment onset. It is not uncommon for leprosy patients to develop recurring reactional episodes; however, they rarely undergo both types of LR. Today, LR are the main cause of permanent disabilities associated with leprosy and represent a major challenge in the clinical management of leprosy patients. Although progress has been made in understanding the immunopathology of LR, the factors that cause a leprosy patient to suffer from LR are largely unknown. Given the impact that ethnic background has on the risk of developing LR, host genetic factors have long been suspected of contributing to LR. Indeed, polymorphisms in seven genes [Toll-like receptors (TLR)1, TLR2, nucleotide-binding oligomerisation domain containing 2, vitamin D receptor, natural resistance-associated macrophage protein 1, C4B and interleukin-6] have been found to be associated with one or more LR outcomes. The identification of host genetic markers with predictive value for LR would have a major impact on nerve damage control in leprosy. In this review, we present the recent advances achieved through genetic studies of LR.

Leprosy reactions: coinfections as a possible risk factor

OBJECTIVE: This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes. METHOD: A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections. RESULTS: Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p,<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%). CONCLUSIONS: Coinfections may be involved in the development and maintenance of leprosy reactions.

Tratamento clínico das reações da Hanseníase com repercussão neurológica – revisão histórica / Clinical treatment of leprosy reactions affecting nerves - historical review

Foi realizada uma busca na literatura sobre o tratamento da neuropatia da hanseníase durante episódios reacionais, no tocante às reações tipo 1 e tipo 2. O levantamento refere-se ao período 1976-2010. Foram consultadas as bases de dados LILAU, MEDLINE e LILACS. O enfoque principal foi o tratamento das reações hansênicas, com esteróides via oral empregado nos Programas de Controle da Hanseníase.

An extensive search on the treatment of leprosy reactions in nerves is presented. It covers almost four decades, from 1976 to 2010. The data bases screened were the LILAU, MEDLINE and LILACS. The focal point was to review the steroid treatment indication in the Leprosy Control Programs.

Efficacy comparison of uniform versus routine multidrug therapy for the treatment of multi-bacillary leprosy patients based on bacterial index and leprosy reactions / 中华皮肤科杂志

Objective To compare the efficacy of uniform multi-drug therapy (UMDT) versus routine multi-drug therapy (RMDT) for the treatment of multi-bacillary (MB) leprosy patients based on bacterial index changes and frequencies of leprosy reaction.Methods This study recruited newly diagnosed leprosy patients after taking informed consent in three districts of Guizhou province as well as in one district of Yunnan province from November 2003 to June 2005.The patients received 6-month UMDT or 2-year RMDT.Clinical follow up and bacterial reexamination were carried out once a year.Changes of bacterial index (BI) and frequencies of leprosy reaction were compared between the patients receiving RMDT and UMDT.Results A total of 166 patients received UMDT and 170 received RMDT in this study.Among the UMDT-treated patients,114 were skin smear positive,and 83 had been followed up for 42 months; of the RMDT-treated patients,149 underwent all the bacterial examinations during a 48-month follow up.The mean bacterial index decreased from 2.84 before treatment to 0.33 at the end of the 42-month follow up in the 83 patients,and from 2.55 to 0.26 at the end of the 48-month follow up in the 149 patients,with no significant difference in the changes of bacterial index between the two groups (t =0.77,P ＞ 0.05).Bacterial index became negative in 73.5％ (61/83) of the UMDT-treated patients and in 77.2％ (115/149) of the RMDT-treated patients (x2 =0.40,P＞ 0.05)at the end of follow up.During the follow up peroid,the incidence of type Ⅰ leprosy reaction was 14.6％ (13/89) in the UMDT group,significantly higher than that in the RMDT group (3.4％ (5/149),x2 =10.08,P＜ 0.01 ).Conclusions There is no significant difference in mean bacterial index changes and bacterial clearance rate during the follow up peroid between UMDT- and RMDT-treated patients.The incidence of type Ⅰ leprosy reaction is higher in the UMDT group than in the RMDT group,and further investigation is needed to clarify the mechanisms underlying the phenomenon.

Could leprosy reaction episodes be exacerbated by oral infections? / Episódios reacionais da hanseníase podem ser exacerbados por infecções orais?

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.

INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.

The recurrence of leprosy reactional episodes could be associated with oral chronic infections and expression of serum IL-1, TNF-á, IL-6, IFN-ã and IL-10

The aim of this study was to determine whether the presence of leprosy reactional episodes could be associated with chronic oral infection. Thirty-eight leprosy patients were selected and divided into 2 groups: group I - 19 leprosy patients with oral infections, and group II - 19 leprosy patients without oral infections. Ten patients without leprosy, but presenting oral infections, were assigned to the control group. Leprosy patients were classified according to Ridley and Jopling classification and reactional episodes of the erythema nodosum type or reversal reaction were identified by clinical and histopathological features associated with serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels. These analyses were performed immediately before and 7 days after the oral infection elimination. Patients from group I presenting oral infections reported clinical improvement of the symptoms of reactional episodes after dental treatment. Serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels did not differ significantly before and after dental treatment as determined by the Wilcoxon test (p>0.05). Comparison of the 2 groups showed statistically significant differences in IL-1 and IL-6 at baseline and in IL-1, IL-6 and IL-10 on the occasion of both collections 7 days after therapy. Serum IL-6 and IL-10 levels in group I differed significantly at baseline compared to control (Mann-Whitney test; p<0.05). These results suggest that oral infection could be involved as a maintenance factor in the pathogenesis of leprosy reactional episodes.

O objetivo deste estudo foi determinar se os episódios reacionais da hanseníase podem estar associados a infecções orais crônicas. Trinta e oito pacientes com hanseníase foram selecionados e divididos em dois grupos: grupo I & 19 pacientes com hanseníase apresentando infecções orais, e grupo II & 19 pacientes com hanseníase sem infecções orais. Os pacientes foram classificados, quanto à forma clínica da doença, de acordo com Ridley and Jopling, e os episódios reacionais, tipo eritema nodoso e reação reversa, foram identificados pelas características clínicas, histopatológicas associadas à quantificação no soro de IL-1, TNF-?, IL-6, IFN-? e IL-10. Estas analises foram realizadas imediatamente antes e 7 dias após a resolução dos focos de infecção. Pacientes do grupo I aprentando infecções orais relataram melhora clínica dos sintomas dos episódios reacionais após o tratamento odontológico. Os níveis séricos de IL-1, TNF-?, IL-6, IFN-? e IL-10 não diferiram significantemente antes e após o tratamento odontológico, como determinado pelo teste Wilcoxon (p>0,05). As comparações entre os grupos mostrou diferenças estatisticamente significantes nos níveis de IL-1 e IL-6 na coleta inicial e nos níveis de IL-1, IL-6 e IL-10 nas duas coletas 7 dias após o tratamento (teste Mann-Whitney; p<0,05). Estes resultados sugerem que infecções orais estão envolvidas na patogênese dos episódios reacionais da hanseníase, como fatores mantenedores.

Cytokine Production in Patients With Leprosy / 나학회지

No abstract available.

Clinical and epidemiological study of leprosy cases in the University Hospital of Brasília: 20 years - 1985 to 2005 / Estudo clínico-epidemiológico dos casos de hanseníase do Hospital Universitário de Brasília: 20 anos - 1985 a 2005

Hansen's disease, also known as leprosy, is an infectious disease still prevalent in Brazil. It is a chronic illness with acute immunological phenomena known as leprosy reactions. In the Federal District of Brazil, the University Hospital of Brasília is the reference centre for leprosy care. The study aimed to characterize the clinical and epidemiological profile of Hansen's disease patients at the University Hospital of Brasília, by descriptive, retrospective analysis of 1,124 patients over the period from 1985 to 2005. The pattern of leprosy in this study demonstrated that type 2 leprosy reactions were common, especially in the lepromatous form and presented a direct correlation with the bacilloscopic index. The prevalence and frequency of severe complications, such as leprosy reactions, emphasize the importance of the ongoing study of leprosy and the need for continual improvement in the scope of knowledge concerning its treatment.

Hanseníase, também conhecida como lepra, é doença infecciosa prevalente no Brasil. Caracteriza-se por curso crônico, com fenômenos imunológicos agudos denominados episódios reacionais. No Distrito Federal, o Hospital Universitário de Brasília é referência na assistência da hanseníase. O objetivo do estudo foi caracterizar o perfil clínico-epidemiológico dos doentes portadores de hanseníase do Hospital Universitário de Brasília. Foi realizada análise descritiva e retrospectiva de 1124 doentes portadores de hanseníase no período de 1985 a 2005. O padrão da hanseníase no nosso estudo concretizou-se por apresentar maior prevalência de reações do tipo 2, especialmente na forma lepromatosa e correlacionando-se diretamente com o índice baciloscópico. A significativa prevalência e freqüência de complicações graves como os episódios reacionais ressaltam a importância do estudo da doença e a necessidade de aprimoramento contínuo dos conhecimentos sobre a mesma.

Nerve function impairment in leprosy reaction

Background: Nerve damage in leprosy reaction occurs very quickly, that can lead to paralysis for many peripheral nerves within 24 hours. Objective: To survey nerve function impairment in leprosy reactions. Subjects and method: 285 new leprosy patients treated from 1996 to 2000 at 22 districts in Ho Chi Minh city had leprosy reaction and estimated nerve functions. This was retrospective cross-section descriptive study. Results: This study included 70.2% men, age 15-45 years (71.9%) and most patients were manual laborers. There were 83.5% multibacillary (MB) and 16.5% paucibacillary (PB). 86.3% Reversal Reaction (RR), Erythemal Nodosum Leprosy (ENL) 13% and both 0.7%. 53% of leprosy reaction happened during Multi-Drug Treatment (MDT), at diagnosis 37.5%, before MDT 7.7% and after MDT 1.8%. Nerve function impairment was 38.2% in leprosy reaction; men had impaired nerve function 1.7 times higher than women (p<0.05). Nerve function impairment in RR and ENL as well as MB and PB were the same (p>0.05). MB (42%) has impaired nerve function higher than PB (26.1%) in RR (p<0.05, OR = 2.05). Conclusions: Leprosy reaction happened to men more frequent than women, essentially in MB and during MDT. One third of cases had nerve function impairment in leprosy reaction and also had a link between sex and nerve function impairment. MB was 2 times the impaired nerve function higher than PB in RR.

Reação hansênica em pacientes portadores de hanseníase em centros de saúde da área de planejamento 3. 2 do município do Rio de Janeiro / Leprosy reaction in patients of health centers from the planning area 3. 2 of Rio de Janeiro municipality

A reação hansênica é um dos maiores problemas no manejo dos pacientes portadores de hanseníase, no programa de controle da endemia. Muitos pacientes, durante o tratamento ou mesmo após a alta, buscam a unidade de saúde com complicações clínicas caracterizadas por processo inflamatório, acompanhado de dor, mal estar e, algumas vezes, piora do grau de incapacidade. O desconhecimento da magnitude do problema da reação hansênica no município do Rio de Janeiro dificulta o planejamento de seu efetivo controle pelo programa de controle desta endemia. Este estudo demonstrou a freqüência dos estados reacionais em pacientes de unidades básicas de saúde da Área de Planejamento (AP.) 3.2, tratados para hanseníase com poliquimioterapia padrão OMS no período de 1991 - 2004. Neste estudo verificou-se o perfil sócio-demográfico e clínico associados à ocorrência de episódios reacionais nos pacientes do estudo. Trata-se de estudo do tipo coorte não concorrente, cuja fonte de dados foi 667 prontuários. Identificou-se que a maioria dos portadores de hanseníase tinha idade entre 35 e 54 anos; eram mulheres (52,3%), casadas e referiram baixo nível de escolaridade. A presença de reação foi constatada em 43,5% dos prontuários avaliados. A freqüência de reações foi mais elevada entre as seguintes características: homens 49,4% (157), formas clínicas dimorfa e virchowiana, baciloscopia positiva, graus de incapacidade ?zero? e ?um? e tratamento acima de 12 doses. Estas características deveriam ser levadas em conta no cuidado aos portadores de hanseníase, para que a detecção precoce das reações e a instituição do tratamento específico pudessem diminuir a possibilidade de instalação de incapacidades físicas e seqüelas.

Leprosy reaction is one of the greatest problems in leprosy control programs. During treatment or even after end of treatment, many patients return to the healthcare unit with reactions characterized by inflammatory process, pain, malaise and at times a increased grade of incapacity. The inability to estimate the magnitude of leprosy reaction in the Rio de Janeiro municipality difficulted the planning of effective leprosy control program. This study demosntrated the frequency of reactions in patients from the basic health units who were treated with multidrugtherapy (MDT) from 1991 to 2004. The study also characterized the socio-demographic and clinical profile associated to the occurrence of reactional episodes in patients of the study. This is a cohort non-concurrent study using as data source 667 medical charts. The majority of leprosy patients were between 35 and 54 year, they were mostly married womem (52.3%) with low schooling levels. During the evaluation period 43.5% patients presented reactions. The reaction rate was higher among: males (49.4%, n=157, patients with borderline or lepromatous forms, positive bacillary index, grade of incapacity zero and one and patients who received over 12 doses of treatment. These characteristics should be taken into account when caring for leprosy patients, so that early detection of reactions and initiation of specific treatment may diminish the onset of physical incapacities and sequels.