REACTIONAL STATES IN MULTIBACILLARY HANSEN DISEASE PATIENTS DURING MULTIDRUG THERAPY

It is well known that reactions are commonplace occurrences during the course of leprosy disease. Stigmatization may even be attributable to reactions which are also responsible for the worsening of neural lesions. A cohort of 162 newly-diagnosed baciloscopically positive patients from the Leprosy Care Outpatient Clinic of the Oswaldo Cruz Foundation (FIOCRUZ) was selected for this study. While 46% of the multibacillary (MB) patients submitted to the 24 fixed-dose multidrug therapy (MDT) regimen suffered reactions during treatment, it was found that all MBs were susceptible and that constant attention and care were required at all times. Fourteen per cent were classified as BB, 52% as BL, and 33% as LL. None of the variables under study, such as, sex, age, clinical form, length of illness, length of dermatological lesions, baciloscopic index (BI), or degree of disability proved to be associate with reaction among the patients studied. Reversal Reaction (RR) occurred in 45%, and Erythema Nodosum Leprosum (ENL) occurred in 55%. Among BB patients who developed reactions (15 patients), 93% presented RR; while among the LL patients who developed reactions (34 patients), 91% presented ENL. Likewise, ENL was very frequent among those with disseminate lesions, while RR was most often observed in patients with segmentary lesions. RR was also most likely to occur during the initial months of treatment. It was demonstrated that the recurrence rate of ENL was significantly higher than that of RR. Neither grade of disability nor BI was shown to be associated with RR and ENL reaction. However, the RR rate was significantly higher among patients showing BI < 3, while ENL predominated among those patients with BI > 3.

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Profil Penderita Morbus Hansen (MH) di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado Periode Januari – Desember 2013

e-CliniC ◽

10.35790/ecl.v8i2.30132 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Andiswati Desrina ◽

Grace M. Kapantow ◽

Renate T. Kandou

Keyword(s):

Retrospective Study ◽

Physical Disability ◽

Erythema Nodosum ◽

Multidrug Therapy ◽

Erythema Nodosum Leprosum ◽

Reversal Reaction

Abstract: Morbus Hansen (MH) is still a public, social, and rehabilitation problems due to the physical disability resulted from delayed or inadequate treatment. This study was aimed to obtain the profile of MH patients at the Dermatovenerology clinic, Prof. Dr. R. D. Kandou Hospital Manado in the period of January to December 2013. This was a descriptive and retrospective study. The results showed that there were 98 MH patients consisting of 69 males (70.4%) and 29 females (29,6%). The majority of patients were 25-44 years old (47.0%) with multibacillary type (93.9%). Most patients did not show lepra reaction (67.3%); erythema nodosum leprosum (ENL) reaction was found in 29.6% of patients, and reversal reaction in 3.1% of patients. As many of 29.6% had been treated with multidrug therapy (MDT), and 10.2% did not, meanwhile, 60,2% of patients did not have any data of treatment. In conclusion, the majority of MH patients at the Dermatovenerology clinic, Prof. Dr. R. D. Kandou Hospital Manado in the period of January to December 2013 were males, aged 25-44 years, had multibacillary type with ENL reaction, and had been treated with MDT.Keywords: Morbus Hansen profile Abstrak: Morbus Hansen (MH) masih merupakan masalah kesehatan, sosial, dan rehabilitasi oleh karena kecacatan fisik yang terjadi akibat pengobatan yang terlambat atau tidak memadai. Penelitian ini bertujuan untuk mengetahui profil penderita MH di Poliklinik Kulit dan Kelamin RSUP Prof. R. D Kandou Manado periode Januari-Desember 2013. Jenis penelitian ialah deskrip-tif retrospektif. Hasil penelitian mendapatkan 98 penderita MH (6,72%) dari total 1457 pasien, terdiri dari 69 laki-laki (70,4%) dan 29 perempuan (29,6%). Mayoritas penderita berada pada rentang usia 25-44 tahun (47,0%) dengan tipe MH multibasiler (93,9%). Pada sebagian besar pen-derita tidak didapatkan reaksi lepra (67,3%); reaksi erythema nodosum leprosum (ENL) didapatkan pada 29,6% penderita dan reaksi reversal pada 3,1% penderita. Mengenai riwayat pengobatan, sebesar 29,6% telah mendapat pengobatan multidrug therapy (MDT) sebelumnya dan 10,2% belum pernah mendapatkan pengobatan MDT, namun sebesar 60,2% penderita tidak memiliki data pengobatan. Simpulan penelitian ini ialah mayoritas penderita MH di Poliklinik Kulit dan Kelamin RSUP Prof. R. D Kandou Manado periode Januari-Desember 2013 berjenis kelamin laki-laki, usia 25-44 tahun, tipe MH multibasiler, dengan reaksi ENL, dan pernah mendapat pengobatan MDT.Kata kunci: profil Morbus Hansen

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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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Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report

Tropical Doctor ◽

10.1177/00494755211068661 ◽

2022 ◽

pp. 004947552110686

Author(s):

Pallavi Hegde ◽

Deepti Jaiswal ◽

Varsha M Shetty ◽

Kanthilatha Pai ◽

Raghavendra Rao

Keyword(s):

Case Report ◽

Erythema Nodosum ◽

Immunological Response ◽

Lepromatous Leprosy ◽

Multidrug Therapy ◽

Cutaneous Lesions ◽

Erythema Nodosum Leprosum

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11–25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT). 1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

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Erythema Nodosum Leprosum and Reversal Reaction in 2 Cases of Imported Leprosy

Actas Dermo-Sifiliográficas (English Edition) ◽

10.1016/j.adengl.2012.09.024 ◽

2013 ◽

Vol 104 (10) ◽

pp. 915-919

Author(s):

A. Pulido-Pérez ◽

M.D. Mendoza-Cembranos ◽

J.A. Avilés-Izquierdo ◽

R. Suárez-Fernández

Keyword(s):

Erythema Nodosum ◽

Erythema Nodosum Leprosum ◽

Reversal Reaction

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Reversal reaction with nodules that initially diagnosed as erythema nodosum leprosum in borderline lepromatous leprosy

Journal of General-Procedural Dermatology & Venereology Indonesia ◽

10.19100/jdvi.v5i1.159 ◽

2020 ◽

Vol 5 (1) ◽

pp. 68-73

Author(s):

Laila Tsaqilah ◽

Pati Achdiat ◽

Hendra Gunawan

Keyword(s):

Erythema Nodosum ◽

Lepromatous Leprosy ◽

Erythema Nodosum Leprosum ◽

Reversal Reaction

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Lucio’s phenomenon: A systematic literature review of definition, clinical features, histopathogenesis and management

Indian Journal of Dermatology Venereology and Leprology ◽

10.25259/ijdvl_909_19 ◽

2021 ◽

Vol 0 ◽

pp. 1-14

Author(s):

Marco Andrey Cipriani Frade ◽

Pedro S. Coltro ◽

Fred Bernardes Filho ◽

Grazielle S. Horácio ◽

Antônio A. Neto ◽

...

Keyword(s):

Chronic Disease ◽

Literature Review ◽

Erythema Nodosum ◽

Clinical Laboratory ◽

Multidrug Therapy ◽

Review Of The Literature ◽

Erythema Nodosum Leprosum ◽

Clinical Presentations ◽

Rare Manifestation ◽

Lucio’S Phenomenon

Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility and risk of causing disabilities. Lucio’s phenomenon is a rare manifestation among lepromatous patients with a rapid and severe evolution and high mortality. It is difficult to differentiate from ulcerative/necrotic erythema nodosum leprosum and has no consensus on how it should be treated. This article is a qualitative review of the literature after the introduction of multidrug therapy, aiming to bring consensus related to the clinical, laboratory and histopathological diagnostic criteria of the disease and its management.

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Differential immunoglobulin and complement levels in leprosy prior to development of reversal reaction and erythema nodosum leprosum

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0007089 ◽

2019 ◽

Vol 13 (1) ◽

pp. e0007089 ◽

Cited By ~ 4

Author(s):

Francianne M. Amorim ◽

Maurício L. Nobre ◽

Larissa S. Nascimento ◽

Alesson M. Miranda ◽

Glória R. G. Monteiro ◽

...

Keyword(s):

Erythema Nodosum ◽

Erythema Nodosum Leprosum ◽

Reversal Reaction

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Thalidomide and its analogues in prostate cancer therapy: A scientific update

The Biochemist ◽

10.1042/bio03205036 ◽

2010 ◽

Vol 32 (5) ◽

pp. 36-39

Author(s):

Carlton R. Cooper ◽

Cliff Poindexter ◽

Benjamin Rohe ◽

Robert A. Sikes

Keyword(s):

Prostate Cancer ◽

Erythema Nodosum ◽

Chemotherapeutic Agent ◽

West Germany ◽

Newly Diagnosed ◽

Brand Name ◽

Small Children ◽

Erythema Nodosum Leprosum ◽

Prostate Cancer Therapy ◽

High Doses

Thalidomide (Figure 1) was derived from alpha-phnthaloylisoglutamine, a derivative of glutamic acid1 by Chemie Grünenthal GmbH, a West German Company in 1954. Thalidomide has a low level of toxicity and no LD50 could be established. Indeed, high doses of thalidomide did not cause respiratory or cardiac failure, suggesting that accidental death or suicide with this compound was highly unlikely. As a matter of fact, 17 patients, including small children and one suicide attempt, survived ingestion of excessive amounts of thalidomide. In 1957, thalidomide was approved for commercial use in West Germany as a sedative and sold under the brand name Kevadon. About this time, the anti-emetic (anti-nausea) activity was discovered and the drug was prescribed to counteract morning sickness in pregnant women. Unfortunately, the teratological effects of thalidomide were not revealed through studies in rodents and approximately 12,000 children were born deformed before thalidomide was banned for clinical use in March 1962 by the Canadian Food and Drug Directorate2. In 1998, thalidomide was approved to treat erythema nodosum leprosum, a painful inflammatory dermatologic reaction of leprosy. In 2006, the FDA approved thalidomide under the brand name Thalomid (Celgene Corp) for treatment of newly diagnosed multiple myeloma As a result of these approvals, the interest in thalidomide as a chemotherapeutic agent for other cancers, including prostate cancer (Figure 2), has emerged.

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