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The effect of corticosteroid usage on the bacterial killing, clearance and nerve damage in leprosy: a prospective cohort study: part 1--study design and baseline findings of 400 untreated multibacillary patients.
Lepr Rev. 2008 Jun; 79(2):134-53.LR

Abstract

OBJECTIVE

To investigate possible adverse effects of therapeutic usage of corticosteroids on the killing and clearance of M. leprae and the clearance of granuloma, in patients with multibacillary (MB) leprosy.

DESIGN

A cohort of 400 untreated MB patients were sub-grouped into those to be treated with corticosteroids (prednisolone 40 mg daily tapered to 5 mg over 12 weeks) along with MB-MDT for reaction and/or neuritis or silent neuropathy (SN) of <6 months duration (group A), and those with no reaction and to be treated with MDT only (group B). Clinical, bacteriological, histopathological and neurological test findings at fixed time points were compared. Analysis was performed using SPSS version 10.0. The significance of association was tested using Chi-square test. In the current report, we describe the study design and baseline findings of 400 untreated MB patients, with special emphasis on differences between patients in groups A and B.

RESULTS

At baseline, applying Ridley-Jopling classification, 39% patients were BT, 20% BB, 24% BL, 12% sub-polar LL and 5% pure neural (PN). Overall, 60% patients were slit skin smear (SSS) negative and 33% presented with disability either grades 1 or 2. Overall 140/400 (35%) patients presented with reaction and/or neuritis and 11/400 (3%) presented with SN of <6 months duration. Comparing groups A and B, the percentage of patients presenting with DG2 was significantly higher in group A (43%). By clinical tests, monofilaments (MF) and voluntary muscle testing (VMT), the percentage of patients and nerves showing functional impairment was also significantly higher in group A. However, in the more sensitive nerve conduction velocity (NCV) test, the percentage of patients that showed nerve abnormalities was closely comparable; 94% and 91% in groups A and B respectively while number of affected nerves was higher in group A.

CONCLUSION

At baseline, as recorded by NCV, peripheral nerve function abnormality was observed in almost all the MB patients regardless of reaction; but among those presenting with reaction or neuritis, the nerve damage was more severe and extensive.

Authors+Show Affiliations

Foundation for Medical Research, Mumbai, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18711936

Citation

Khambati, Fatema Abbas, et al. "The Effect of Corticosteroid Usage On the Bacterial Killing, Clearance and Nerve Damage in Leprosy: a Prospective Cohort Study: Part 1--study Design and Baseline Findings of 400 Untreated Multibacillary Patients." Leprosy Review, vol. 79, no. 2, 2008, pp. 134-53.
Khambati FA, Shetty VP, Ghate SD, et al. The effect of corticosteroid usage on the bacterial killing, clearance and nerve damage in leprosy: a prospective cohort study: part 1--study design and baseline findings of 400 untreated multibacillary patients. Lepr Rev. 2008;79(2):134-53.
Khambati, F. A., Shetty, V. P., Ghate, S. D., Capadia, G. D., Pai, V. V., & Ganapati, R. (2008). The effect of corticosteroid usage on the bacterial killing, clearance and nerve damage in leprosy: a prospective cohort study: part 1--study design and baseline findings of 400 untreated multibacillary patients. Leprosy Review, 79(2), 134-53.
Khambati FA, et al. The Effect of Corticosteroid Usage On the Bacterial Killing, Clearance and Nerve Damage in Leprosy: a Prospective Cohort Study: Part 1--study Design and Baseline Findings of 400 Untreated Multibacillary Patients. Lepr Rev. 2008;79(2):134-53. PubMed PMID: 18711936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of corticosteroid usage on the bacterial killing, clearance and nerve damage in leprosy: a prospective cohort study: part 1--study design and baseline findings of 400 untreated multibacillary patients. AU - Khambati,Fatema Abbas, AU - Shetty,Vanaja Prabhakar, AU - Ghate,Sunil Dattatraya, AU - Capadia,Gospi Dolly, AU - Pai,Vivek Vasudev, AU - Ganapati,Ramaswamy, PY - 2008/8/21/pubmed PY - 2008/11/19/medline PY - 2008/8/21/entrez SP - 134 EP - 53 JF - Leprosy review JO - Lepr Rev VL - 79 IS - 2 N2 - OBJECTIVE: To investigate possible adverse effects of therapeutic usage of corticosteroids on the killing and clearance of M. leprae and the clearance of granuloma, in patients with multibacillary (MB) leprosy. DESIGN: A cohort of 400 untreated MB patients were sub-grouped into those to be treated with corticosteroids (prednisolone 40 mg daily tapered to 5 mg over 12 weeks) along with MB-MDT for reaction and/or neuritis or silent neuropathy (SN) of <6 months duration (group A), and those with no reaction and to be treated with MDT only (group B). Clinical, bacteriological, histopathological and neurological test findings at fixed time points were compared. Analysis was performed using SPSS version 10.0. The significance of association was tested using Chi-square test. In the current report, we describe the study design and baseline findings of 400 untreated MB patients, with special emphasis on differences between patients in groups A and B. RESULTS: At baseline, applying Ridley-Jopling classification, 39% patients were BT, 20% BB, 24% BL, 12% sub-polar LL and 5% pure neural (PN). Overall, 60% patients were slit skin smear (SSS) negative and 33% presented with disability either grades 1 or 2. Overall 140/400 (35%) patients presented with reaction and/or neuritis and 11/400 (3%) presented with SN of <6 months duration. Comparing groups A and B, the percentage of patients presenting with DG2 was significantly higher in group A (43%). By clinical tests, monofilaments (MF) and voluntary muscle testing (VMT), the percentage of patients and nerves showing functional impairment was also significantly higher in group A. However, in the more sensitive nerve conduction velocity (NCV) test, the percentage of patients that showed nerve abnormalities was closely comparable; 94% and 91% in groups A and B respectively while number of affected nerves was higher in group A. CONCLUSION: At baseline, as recorded by NCV, peripheral nerve function abnormality was observed in almost all the MB patients regardless of reaction; but among those presenting with reaction or neuritis, the nerve damage was more severe and extensive. SN - 0305-7518 UR - https://www.unboundmedicine.com/medline/citation/18711936/The_effect_of_corticosteroid_usage_on_the_bacterial_killing_clearance_and_nerve_damage_in_leprosy:_a_prospective_cohort_study:_part_1__study_design_and_baseline_findings_of_400_untreated_multibacillary_patients_ L2 - https://medlineplus.gov/mycobacterialinfections.html DB - PRIME DP - Unbound Medicine ER -