ABSTRACT
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.
Subject(s)
Humans , Biomarkers , Leprosy , Leprosy/genetics , Leprosy/immunology , Leprosy/pathologyABSTRACT
Introduction Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. Drug treatment is effective in eradicating the bacilli but does not prevent lepra reaction. Despite much attention being focused on the problem of lepra reactions, very limited data has been published on the epidemiology of lepra reactions especially this part of the world. The aim of the study is to improve the understanding of lepra reaction and to determine the demographics and clinical patterns of lepra reactions in Penang General Hospital. Materials and Methods This retrospective study covers a 10-year period from 1997 to 2006. Demographic characteristic and clinical patterns of lepra reactions were analysed with SPSS 13.0 version. Results Of the 95 patients who were enrolled in the study, 67 (70.5%) were male and 28 (29.5%) were females. The mean age at presentation was 40.4 ± 17.9 years (range 3-91 years). There were 35 Malays (36.8%), 34 Chinese (35.8%), 5 Indians (5.2%) and 21 foreigners (22.2%). 35.8% of patients presented with LL (n=34), 18.9% BT (n=18), 17.9% TT (n=17), 13.7% BB (n=13) and 13.7% BL (n=13). In our series, the lepra reaction rate among leprosy patient was 51.6% (n=49). Among those with lepra reaction, 53.1% cases were type 1 reaction (n=26), 44.9% cases were type 2 reaction (n=22) and 2.0% cases were Lucio phenomenon (n=1). Common manifestations observed in lepra reaction were worsening of skin lesions (100%), inflammatory oedema of hands, feet and face (53.1%), nerve pain (46.9%), fever (20.8%) and nerve tenderness (20.4%). Only 4 cases had involvement of other organs like the eye and joint. 30.6% of the reactions observed in our cohort were severe. Type 1 reaction commonly involved those in borderline spectrum whereas type 2 reaction commonly involved those in the lepromatous spectrum. Lepra reactions occurred before treatment (24.5%), during treatment (71.4%) or even after treatment has been stopped (4.1%). Most of the lepra reactions occurred during the treatment period especially the first 12 months of therapy. Conclusion Our study showed a more severe and higher reaction rate compared to other studies. Lepra reaction is a common presentation of leprosy. Type 1 reaction commonly involved those with borderline disease but type 2 reaction commonly involved those with lepromatous spectrum of disease. Lepra reaction occurred before, during and even after the treatment has stopped. Most of the lepra reactions occurred during treatment period especially the first 12 months of therapy.
ABSTRACT
O episódio reacional tipo 1 ou reação reversa é ocorrência inflamatória aguda que atinge a pele e nervos periféricos, encontrada em até 30 por cento dos pacientes com hanseníase, sendo causa comum de incapacidade física. Fatores de risco associados incluem uso de poliquimioterapia e infecções virais. Neste estudo, foram avaliados 620 pacientes com hanseníase. Reação reversa foi diagnosticada em 121 (19,5 por cento) casos, sendo mais freqüente nos indivíduos borderlines (48 por cento). Início da poliquimioterapia foi considerado fator de risco para reação reversa, com 52 por cento dos casos apresentando o primeiro episódio neste momento. Neurite foi documentada em 73 por cento dos casos. A presença de vírus B ou C da hepatite foi documentada em 9 por cento de 55 pacientes com reação reversa e em nenhum dos 57 pacientes sem reação (p = 0, 026; teste exato de Fisher), sugerindo possível papel destes agentes como fatores de risco para desenvolvimento de reação reversa na hanseníase.
Type 1 reaction or reversal reaction is an acute inflammatory episode in the skin and peripheral nerves that is found in up to 30 percent of leprosy patients and commonly causes physical disabilities. Multidrug chemotherapy and viral infections are associated risk factors. In this study, 620 leprosy patients were evaluated. Reversal reactions were diagnosed in 121 cases (19.5 percent) and were most frequently found in borderline patients (48 percent). Starting on multidrug chemotherapy was considered to be a risk factor for reversal reaction: 52 percent of the cases presented their first episode at this time. Neuritis was found in 73 percent of the cases. The presence of hepatitis B or C virus was documented in 9 percent of the 55 patients with reversal reaction, while it was not detected in any of the 57 patients without reaction (p = 0.026, Fishers exact test). This suggests that these agents may have a role as risk factors for developing reversal reactions.