Volume 92, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The objective of this study was to ascertain risk factors for complications (reactions or neuritis) in leprosy patients at the time of diagnosis in three leprosy-endemic countries. Newly diagnosed patients were enrolled in Brazil, the Philippines, and Nepal, and risk factors for reactions and neuritis were assessed using a case-control approach: “cases” were patients with these complications, and controls were patients without complications. Of 1,972 patients enrolled in this study, 22% had complications before treatment. Type 1 reaction was diagnosed in 13.7% of patients, neuritis alone in 6.9.%, and type 2 reaction in 1.4%. The frequency of these complications was higher in Nepal, in lepromatous patients, in males, and in adults versus children. Reactions and neuritis were seen in patients at diagnosis, before treatment was started. Reactions were seen in adults and children, even in patients with only a single lesion. Neuritis was often present without other signs of reaction. Reactions and neuritis were more likely to occur in lepromatous patients, and were more likely to be seen in adults than in children.


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  1. Becx-Bleumink M, Berhe D, , 1992. Occurrence of reactions, their diagnosis and management in leprosy patients treated with multidrug therapy; experience in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT) in Ethiopia. Int J Lepr Other Mycobact Dis 60: 173184.
  2. Scollard DM, Smith T, Bhoopat L, Theetranont C, Rangdaeng S, Morens DM, , 1994. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis 62: 559567.
  3. Kumar B, Dogra S, Kaur I, , 2004. Epidemiological characteristics of leprosy reactions: 15 years experience from north India. Int J Lepr Other Mycobact Dis 72: 125133.[Crossref]
  4. Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL, , 2006. The continuing challenges of leprosy. Clin Microbiol Rev 19: 338381.[Crossref]
  5. Davey TF, Schenck RR, Cochrane RG, Davey TF, , 1964. The endocrines in leprosy. , eds. Leprosy in Theory and Practice. Bristol, UK: John Wright and Sons, Ltd., 198.
  6. Duncan ME, , 1993. An historical and clinical review of the interaction of leprosy and pregnancy: a cycle to be broken. Soc Sci Med 37: 457472.[Crossref]
  7. Saunderson P, Gebre S, Byass P, , 2000. Reversal reactions in the skin lesions of AMFES patients: incidence and risk factors. Lepr Rev 71: 309317.
  8. Dash RJ, Samuel E, Kaur S, Datta BN, Rastogi GK, , 1978. Evaluation of male gonadal function in leprosy. Horm Metab Res 10: 362.[Crossref]
  9. Saporta L, Yuksel A, , 1994. Androgenic status in patients with lepromatous leprosy. Br J Urol 74: 221224.[Crossref]
  10. Chrousos GP, , 1995. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 332: 13511362.[Crossref]
  11. Leal AM, Magalhaes PK, Souza CS, Foss NT, , 2006. Pituitary-gonadal hormones and interleukin patterns in leprosy. Trop Med Int Health 11: 14161421.[Crossref]
  12. Leal AM, Foss NT, , 2009. Endocrine dysfunction in leprosy. Eur J Clin Microbiol Infect Dis 28: 17.[Crossref]
  13. Ridley DS, Jopling WH, , 1966. Classification of leprosy according to immunity: a five-group system. Int J Lepr Other Mycobact Dis 34: 255273.
  14. Lockwood D, Scollard DM, , 1999. Report of workshop on nerve damage and reactions. Int J Lepr 67: 612.
  15. Saunderson P, Gebre S, Desta K, Byass P, Lockwood DN, , 2000. The pattern of leprosy-related neuropathy in the AMFES patients in Ethiopia: definitions, incidence, risk factors and outcome. Lepr Rev 71: 285308.
  16. WHO, 1995. Physical Status: The Use and Interpretation of Anthropometry. Geneva: World Health Organization.
  17. Lockwood DN, Sinha HH, , 1999. Pregnancy and leprosy: a comprehensive literature review. Int J Lepr Other Mycobact Dis 67: 612.
  18. van Brakel WH, Nicholls PG, Das L, Barkataki P, Suneetha SK, Jadhav RS, Maddali P, Lockwood DN, Wilder-Smith E, Desikan KV, , 2005. The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Lepr Rev 76: 1434.
  19. Sousa AL, Fava VM, Sampaio LH, Martelli CM, Costa MB, Mira MT, Stefani MM, , 2012. Genetic and immunological evidence implicates interleukin 6 as a susceptibility gene for leprosy type 2 reaction. J Infect Dis 205: 14171424.[Crossref]
  20. Macdonald M, Berrington WR, Misch EA, Ranjit C, Siddiqui MR, Kaplan G, Hawn TR, , 2010. Association of TNF, MBL, and VDR polymorphisms with leprosy phenotypes. Hum Immunol 71: 992998.[Crossref]
  21. Ranque B, Nguyen VT, Vu HT, Nguyen TH, Nguyen NB, Pham XK, Schurr E, Abel L, Alcaïs A, , 2007. Age is an important risk factor for onset and sequelae of reversal reactions in Vietnamese patients with leprosy. Clin Infect Dis 44: 3340.[Crossref]
  22. Sousa AL, Stefani MM, Pereira GA, Costa MB, Rebello PF, Gomes MK, Narahashi K, Gillis TP, Krahenbuhl JL, Martelli CM, , 2007. Mycobacterium leprae DNA associated with type 1 reactions in single lesion paucibacillary leprosy treated with single dose rifampin, ofloxacin, and minocycline. Am J Trop Med Hyg 77: 829833.

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  • Received : 25 Apr 2013
  • Accepted : 21 Oct 2014

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