Volume 83, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We evaluated the incidence, severity, and duration of reactional states in 139 multibacillary (MB) leprosy patients in the first 2 years after the completion of the 1 year regimen of multidrug therapy (MDT) currently recommended by the World Health Organization (WHO) and compared those findings with 295 MB leprosy patients treated with the same regimen previously recommended for 2 years. During the first year after the completion of 1 year MDT, patients experienced 1 or more reactional states 27% of the time, the vast majority being lepra type 1 reactions (reversal reactions, RR), whereas patients who received 2 year MDT experienced a reactional state during that time period only 8% of the time ( < 0.001). Furthermore, during the first year after the completion of therapy, and during the first 2 years, both the number of reactional states and reversal reactions were significantly ( ≤ 0.004) more frequent, severe, of longer duration, and more commonly associated with neuritis.


Article metrics loading...

Loading full text...

Full text loading...



  1. Britton WJ, , 1998. The management of leprosy reversal reactions. Lepr Rev 69: 225234.
  2. Little D, Khanolkar-Young S, Coulthart A, Suneetha S, Lockwood DNJ, , 2001. Immunohistochemical analysis of cellular infiltrate and gamma interferon, interleukin-12, and inducible nitric oxide synthase expression in leprosy type 1 (reversal) reactions before and during prednisolone treatment. Infect Immun 69: 34133417.[Crossref]
  3. Khanolkar-Young S, Rayment N, Brickell PM, Katz DR, Vinayakumar S, Colston MJ, Lockwood DN, , 2001. Tumour necrosis factor-alpha (TNF-alpha) synthesis is associated with the skin and peripheral nerve pathology of leprosy reversal reactions. Clin Exp Immunol 99: 196202.[Crossref]
  4. Manandhar R, Sherestha N, Butlin CR, Roche PW, , 2002. High levels of inflamatory cytokines are associated with poor clinical response to steriod treatment and recurrent episodes of type 1 reactions in leprosy. Clin Exp Immunol 128: 333338.[Crossref]
  5. Sarno EN, Grau GE, Vieira LM, Nery JA, , 1991. Serum levels of tumour necrosis factor-alpha and interleukin-1β during leprosy ractional states. Clin Exp Immunol 84: 103108.
  6. Lienhardt C, Fine PEM, , 1994. Type 1 reaction, neuritis and disability in leprosy. What is the current epidemiological situation? Lepr Rev 65: 933.
  7. 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: 125130.[Crossref]
  8. Schreuder PAM, , 1998. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1978–1995. II. Reactions. Int J Lepr Other Mycobact Dis 66: 159169.
  9. Lockwood DN, Vinayakumar S, Stanley JN, McAdam PW, Colston MJ, , 1993. Clinical features and outcome of reversal (type 1) reactions in Hyderabad, India. Int J Lepr Other Mycobact Dis 61: 815.
  10. De Rijk AJ, Gebre S, Byass P, Berhanu T, , 1994. Field evaluation of WHO-MDT of fixed duration ALERT, Ethiopia: the AMFES project, Part 2. Reactions and neuritis during and after MDT in PB and MB leprosy patients. Lepr Rev 65: 320333.
  11. Naafs B, , 1996. Treatment of reactions and nerve damage. Int J Lepr Other Mycobact Dis 64: S21S28.
  12. Lockwood DN, , 1996. The management of erythema nodosum leprosum: current and future options. Lepr Rev 67: 253259.
  13. Wemambu SN, Turk JL, Waters MF, Rees RJ, , 1996. Erythema modosum leprosum. A clinical manifestation of the Arthus phenomemon. Lancet 2: 933935.
  14. Rea TH, Shen JY, Modlin RL, , 1986. Epidermal keratinocyte la expression. Langerhans cell hyperplasia and lymphocytic infiltration in skin lesions of leprosy. Clin Exp Immunol 65: 253259.
  15. Modlin RL, Hofman FM, Horowitz DA, Husmann LA, Gillis S, Taylor CR, Rea TH, , 1984. In situ identification of cells in human leprosy granulomas with monoclonal antibodies to interleukin 2 and its receptor. J Immunol 132: 30853090.
  16. Cooper CL, Mueller C, Sinchaisri TA, Pirmez C, Chan J, Kaplan G, Young SM, Weissman IL, Bloom BR, Rea TH, , 1989. Analysis of naturally occurring delayed-type hypersensitivity reactions in leprosy by in situ hybridization. J Exp Med 169: 15651581.[Crossref]
  17. Lockwood DN, Sinha HH, , 1999. Pregnancy and leprosy: a comprehensive literature review. Int J Lepr Other Mycobact Dis 67: 612.
  18. Jopling WH, McDougall AC, , 1996. Handbook of Leprosy. Fifth edition. New Delhi: CBS Publisher, 1047.
  19. WHO Study Group, 1982. Chemotherapy of leprosy for control programs. Geneva: World Health Organization Technical Report Series, 675.
  20. WHO Expert Committee on Leprosy, 1998. Seventh report. Geneva: World Health Organization Technical Report Series, 874.
  21. Saunderson P, Gebre S, Byass P, , 2000. Reversal reactions in the skin lesions of AMFES patients: incidence and risk factors. Lepr Rev 71: 309317.
  22. Sauderson P, Gebre S, Byass P, , 2000. ENL reactions in the multibacillary cases of the AMFES cohort in central Ethiopia: incidence and risk factors. Lepr Rev 71: 318324.
  23. Publishing SAS, , 2004. SAS/STAT 9.1 User's Guide., Volumes 1–7. Cary, NC: SAS Institute, Inc.
  24. Publishing SAS, , 2004. SAS Online Doc 9.1.3: PDF Files. Cary, NC: SAS Institute, Inc.
  25. Taverne J, Reichlin M, Turk JL, Rees RJW, , 1976. Detection of immune complexes in mice infected with Mycobacterium lepraemurium . Clin Exp Immunol 24: 157167.
  26. Boerrigter G, Ponninghaus JM, Fine PEM, Wilson RJ, , 1991. Four years follow-up results of a WHO-recommended multidrug regimen in paucibacillary patients in Malawi. Int J Lepr Other Mycobact Dis 59: 255261.
  27. Van Brakel WH, Khawas IB, Lucas S, , 1994. Reactions in leprosy: an epidemiological study of 386 patients in West Nepal. Lepr Rev 65: 190203.
  28. Vijaykumaran V, Manimozhi N, Jesudasan K, , 1995. Incidence of late lepra reaction among multibacillary leprosy after MDT. Int J Lepr Other Mycobact Dis 63: 1822.
  29. World Health Organization, 1994. Risk of Relapse in Leprosy. The Leprosy Unit. Division of Tropical Diseases, 94.1. Geneva: World Health Organization.
  30. Cellona RV, Balagon MV, Dela Cruz EC, Burgos JA, Abalos RM, Walsh GP, Topolski R, Gelber RH, Eash DS, , 2003. Long-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients. Int J Lepr Other Mycobact Dis 71: 308319.[Crossref]
  31. Gelber RH, Balagon MVF, Cellona RV, , 2004. The relapse rate in MB leprosy patients treated with 2-years of WHO-MDT is not low. Int J Lepr Other Mycobact Dis 72: 493500.[Crossref]
  32. Girdhar BK, Girdhar A, Kumar A, , 2000. Relapses in multibacilliary leprosy patients: effect of length of therapy. Lepr Rev 71: 144153.
  33. Jamet P, Ji B, , 1995. Relapse after long-term follow-up of multibacillary patients treated by WGO multidrug regimen. Marchoux Chemotherapy Study Group. Int J Lepr Other Mycobact Dis 63: 195201.

Data & Media loading...

  • Received : 27 Sep 2009
  • Accepted : 28 Apr 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error