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Leprosy reactions in postelimination stage: the Bangladesh experience.
J Eur Acad Dermatol Venereol. 2017 Apr; 31(4):705-711.JE

Abstract

BACKGROUND

Leprosy reactions are immunologically mediated conditions and a major cause of disability before, during and after multidrug therapy (MDT). Little data have been published on the epidemiology of leprosy reactions in Bangladesh.

OBJECTIVES

To describe the pattern and prevalence of leprosy reactions in the postelimination stage.

METHODS

A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients in the period between 2004 and 2013.

RESULTS

Of the 670 patients with leprosy, 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was in 300 (44.78%) patients with a male:female ratio of 3.55 : 1. The age-specific cumulative reaction cases at >40 years were 115 (38.33%) among all age groups. The prevalence of reaction was found to be in 166 (55.33%) patients for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum (ENL) and 85 (28.33%) for the neuritis. Borderline tuberculoid was most common (106, 35.33%)in the reversal reaction group, while lepromatous leprosy was most common (37, 12.33%) in ENL group. More than half of the patients (169, 56.33%) had reactions at the time of presentations, while 85 (28.33%) and 46 (15.33%) patients developed reaction during and after MDT, respectively. The reversal reaction group presented with ≥six skin lesions in 96 (57.83%) patients and ≥two nerve function impairments (NFIs) in 107 (64.46%) patients. The ENL was present chiefly as papulo-nodular lesions in 45 (91.84%) patients followed by pustule-necrotic lesions in four (8.16%), neuritis in 33 (67.35%), fever in 24 (48.98%), lymphadenitis in six (12.24%), arthritis in five (10.20%) and iritis in two (4.08%). Bacterial index ≥3 had been demonstrated in 34 (60.71%) patients in ENL group.

CONCLUSION

The incidence of leprosy reaction seemed to be more than three times common in borderline tuberculoid (52.33%) group than in lepromatous leprosy (14%) group. Reactions with NFI and disability still occur among multibacillary patients during and after MDT. Early detection and management of leprosy reaction are very important in preventing disability and deformity, and patients should be educated to undergo regular follow-up examinations. Developing reinforced new therapies to curb leprosy reactions is crucial for improving leprosy healthcare services.

Authors+Show Affiliations

Department of Dermatology & Venereology, Chittagong Medical College, Chittagong, Bangladesh.Chittagong Medical College, Chittagong, Bangladesh.Chittagong Medical College, Chittagong, Bangladesh.Chittagong Leprosy Control Project, Chittagong, Bangladesh.Department of Medicine, Chittagong Medical College, Chittagong, Bangladesh.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27859670

Citation

Mowla, M R., et al. "Leprosy Reactions in Postelimination Stage: the Bangladesh Experience." Journal of the European Academy of Dermatology and Venereology : JEADV, vol. 31, no. 4, 2017, pp. 705-711.
Mowla MR, Ara S, Mizanur Rahman AFM, et al. Leprosy reactions in postelimination stage: the Bangladesh experience. J Eur Acad Dermatol Venereol. 2017;31(4):705-711.
Mowla, M. R., Ara, S., Mizanur Rahman, A. F. M., Tripura, S. P., & Paul, S. (2017). Leprosy reactions in postelimination stage: the Bangladesh experience. Journal of the European Academy of Dermatology and Venereology : JEADV, 31(4), 705-711. https://doi.org/10.1111/jdv.14049
Mowla MR, et al. Leprosy Reactions in Postelimination Stage: the Bangladesh Experience. J Eur Acad Dermatol Venereol. 2017;31(4):705-711. PubMed PMID: 27859670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leprosy reactions in postelimination stage: the Bangladesh experience. AU - Mowla,M R, AU - Ara,S, AU - Mizanur Rahman,A F M, AU - Tripura,S P, AU - Paul,S, Y1 - 2016/12/07/ PY - 2016/07/11/received PY - 2016/10/25/accepted PY - 2016/11/20/pubmed PY - 2017/11/8/medline PY - 2016/11/19/entrez SP - 705 EP - 711 JF - Journal of the European Academy of Dermatology and Venereology : JEADV JO - J Eur Acad Dermatol Venereol VL - 31 IS - 4 N2 - BACKGROUND: Leprosy reactions are immunologically mediated conditions and a major cause of disability before, during and after multidrug therapy (MDT). Little data have been published on the epidemiology of leprosy reactions in Bangladesh. OBJECTIVES: To describe the pattern and prevalence of leprosy reactions in the postelimination stage. METHODS: A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients in the period between 2004 and 2013. RESULTS: Of the 670 patients with leprosy, 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was in 300 (44.78%) patients with a male:female ratio of 3.55 : 1. The age-specific cumulative reaction cases at >40 years were 115 (38.33%) among all age groups. The prevalence of reaction was found to be in 166 (55.33%) patients for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum (ENL) and 85 (28.33%) for the neuritis. Borderline tuberculoid was most common (106, 35.33%)in the reversal reaction group, while lepromatous leprosy was most common (37, 12.33%) in ENL group. More than half of the patients (169, 56.33%) had reactions at the time of presentations, while 85 (28.33%) and 46 (15.33%) patients developed reaction during and after MDT, respectively. The reversal reaction group presented with ≥six skin lesions in 96 (57.83%) patients and ≥two nerve function impairments (NFIs) in 107 (64.46%) patients. The ENL was present chiefly as papulo-nodular lesions in 45 (91.84%) patients followed by pustule-necrotic lesions in four (8.16%), neuritis in 33 (67.35%), fever in 24 (48.98%), lymphadenitis in six (12.24%), arthritis in five (10.20%) and iritis in two (4.08%). Bacterial index ≥3 had been demonstrated in 34 (60.71%) patients in ENL group. CONCLUSION: The incidence of leprosy reaction seemed to be more than three times common in borderline tuberculoid (52.33%) group than in lepromatous leprosy (14%) group. Reactions with NFI and disability still occur among multibacillary patients during and after MDT. Early detection and management of leprosy reaction are very important in preventing disability and deformity, and patients should be educated to undergo regular follow-up examinations. Developing reinforced new therapies to curb leprosy reactions is crucial for improving leprosy healthcare services. SN - 1468-3083 UR - https://www.unboundmedicine.com/medline/citation/27859670/Leprosy_reactions_in_postelimination_stage:_the_Bangladesh_experience_ L2 - https://doi.org/10.1111/jdv.14049 DB - PRIME DP - Unbound Medicine ER -