Reactional states in multibacillary Hansen disease patients during multidrug therapy

Area of Science:

• Medical Science
• Infectious Diseases
• Dermatology

Background:

• Leprosy reactions are frequent complications impacting disease progression and nerve damage.
• These reactions can lead to stigmatization and require careful management during treatment.

Purpose of the Study:

• To investigate the incidence and characteristics of leprosy reactions in newly diagnosed multibacillary patients undergoing multidrug therapy (MDT).
• To identify associations between patient variables and the occurrence of Reversal Reaction (RR) and Erythema Nodosum Leprosum (ENL).

Main Methods:

• A cohort of 162 newly diagnosed, bacilloscopically positive leprosy patients receiving 24-dose fixed MDT was studied.
• Data on patient demographics, clinical form, disease duration, bacilloscopic index (BI), and disability were collected.
• Incidence, type (RR or ENL), and recurrence rates of reactions were analyzed.

Main Results:

• 46% of multibacillary patients experienced reactions during MDT.
• Reversal Reaction (RR) occurred in 45% and Erythema Nodosum Leprosum (ENL) in 55% of patients with reactions.
• ENL showed a significantly higher recurrence rate than RR. RR was more common in early treatment and with segmentary lesions, while ENL predominated with disseminate lesions and higher BI.
• Specific reaction types were associated with different leprosy forms (BB with RR, LL with ENL).

Conclusions:

• Leprosy reactions are common in multibacillary patients on MDT, necessitating continuous monitoring.
• ENL is more recurrent than RR, and both reactions exhibit distinct clinical associations.
• While some factors like lesion type and BI correlate with specific reactions, overall disability and age did not predict reaction occurrence.