DP08: Leprosy unmasked by COVID‐19 infection: a new diagnosis of leprosy with development of type 1 reversal reaction

Objectives: To observe the frequency, precipitating factors and outcome ofdiabetic ketoacidosis (DKA) in adults with established and newly diagnosed type 1 diabetesat a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore GeneralHospital, Lahore. Period: From January 2013 through December 2015. Methods: Patients whowere admitted with a diagnosis of DKA. The clinical presentations, laboratory investigations,management, time of recovery and outcome were compared. Data were collected viaretrospective chart review. Results: A total of 202 patients were included who fulfilled the criteriaof DKA, of which 160 (79.2%) were less than 26 years of age with a male predominance of 156(97.5%). Out of all cases 72 (35.6%) had established Type 1 diabetes and 130 (64.4%) werenewly diagnosed. The most common presenting complaints in both groups were sepsis 105(52%). The comparison of clinical improvement and laboratory investigations between the twogroups showed that newly diagnosed Type 1 diabetes patients had lower pH, low bicarbonateand high BSR at presentation as compared to those with established type 1 diabetes. Thepatients with established diabetes improved earlier, required lesser duration of intravenousfluids and IV insulin was changed to subcutaneous in less time. Hospital stay of more than 7days was observed in patients with new diagnosis. Conclusion: It can be concluded from theabove data that earlier diagnosis of type 1 diabetes mellitus, appropriate treatment, regularscreening for complications and infections will result in less hospital admissions and betteroutcome.

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Borderline tuberculoid leprosy with type 1/reversal reaction

BMJ Case Reports ◽

10.1136/bcr-2013-202921 ◽

2014 ◽

Vol 2014 (jan30 1) ◽

pp. bcr2013202921-bcr2013202921 ◽

Cited By ~ 1

Author(s):

S. Khardenavis ◽

A. Deshpande

Keyword(s):

Tuberculoid Leprosy ◽

Reversal Reaction

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Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20132004 ◽

2013 ◽

Vol 88 (5) ◽

pp. 787-792 ◽

Cited By ~ 24

Author(s):

Jose Augusto da Costa Nery ◽

Fred Bernardes Filho ◽

Juliana Quintanilha ◽

Alice Miranda Machado ◽

Soraya de Souza Chantre Oliveira ◽

...

Keyword(s):

Early Diagnosis ◽

Skin Lesions ◽

Diagnosis And Treatment ◽

Clinical Aspects ◽

Histopathological Features ◽

Efficient Management ◽

Polar Forms ◽

Reversal Reaction ◽

Motor Alterations

A type 1 reaction or reversal reaction is expressed clinically by inflammatory exacerbation of the skin lesions and nerve trunks, consequently leading to sensory and motor alterations. It occurs in non-polar forms of leprosy, although it can occur in a small percentage of sub-polar LL treated patients. Disabilities, deformities and morbidity, still present in leprosy, are mainly caused by these acute episodes. The recognition of reactional states is imperative for an early approach and efficient management, to avoid the emergence of disabilities that stigmatize the disease. This review aims to describe the clinical aspects, immunopathogenesis, epidemiology, histopathological features and therapeutics of type 1 reactions.

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The Process of Adaptation Following a New Diagnosis of Type 1 Diabetes in Adulthood: A Meta-Synthesis

Qualitative Health Research ◽

10.1177/1049732317745100 ◽

2017 ◽

Vol 28 (2) ◽

pp. 245-258 ◽

Cited By ~ 11

Author(s):

Mette Due-Christensen ◽

Vibeke Zoffmann ◽

Ingrid Willaing ◽

David Hopkins ◽

Angus Forbes

Keyword(s):

Type 1 Diabetes ◽

New Diagnosis

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Glucocorticoids in Leprosy Reversal reaction

Serbian Journal of Dermatology and Venerology ◽

10.2478/sjdv-2019-0011 ◽

2019 ◽

Vol 11 (3) ◽

pp. 77-83

Author(s):

Renni Yuniati ◽

Matthew Brian Khrisna

Keyword(s):

Corticosteroid Therapy ◽

Mycobacterium Leprae ◽

Alternative Therapies ◽

Reaction Type ◽

Therapy Regimen ◽

Key Points ◽

Who Guideline ◽

Reversal Reaction

Abstract Leprosy is a disease that is caused by Mycobacterium leprae which results in lots of disabilities in the patients. Leprosy is treated by multi-drug therapy regimen; however, this therapy might cause leprosy reactions in the patients. There are several types of lepromatous reaction: type 1 reaction, type 2 reaction and neuritis. Type 1 reaction mainly occurs in BB, BL and BT forms of leprosy and is characterized by exacerbation of preexisting lesions. The therapy of this reaction according to the WHO guideline is corticosteroid therapy. This article will explain several key points related to the corticosteroid therapy in leprosy reversal reactions, including the side effects and alternative therapies available.

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Host-Related Laboratory Parameters for Leprosy Reactions

Frontiers in Medicine ◽

10.3389/fmed.2021.694376 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yuqian Luo ◽

Mitsuo Kiriya ◽

Kazunari Tanigawa ◽

Akira Kawashima ◽

Yasuhiro Nakamura ◽

...

Keyword(s):

Erythema Nodosum ◽

Clinical Symptoms ◽

Type I ◽

Leprosy Reactions ◽

Erythema Nodosum Leprosum ◽

Precise Diagnosis ◽

Reversal Reaction

Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.

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