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-
1
Bryceson AD, Pfalzgraff RE, 1990. Leprosy. Third edition. Edinburgh: Churchill Livingstone.
-
2
Wemambu SN, Turk JL, Waters MF, Rees RJ, 1969. Erythema nodosum leprosum: a clinical manifestation of the arthus phenomenon. Lancet 2 :933–935.
-
3
Sarno EN, Grau GE, Vieira LM, Nery JA, 1991. Serum levels of tumour necrosis factor-alpha and interleukin-1 beta during leprosy reactional states. Clin Exp Immunol 84 :103–108.
-
4
Waters MF, Rees RJ, Sutherland I, 1967. Chemotherapeutic trials in leprosy. 5. A study of methods used in clinical trials in lepromatous leprosy. Int J Lepr Other Mycobact Dis 35 :311–335.
-
5
Cellona RV, Fajardo TT Jr, Kim DI, Hah YM, Ramasoota T, Sampattavanich S, Carrillo MP, Abalos RM, de la Cruz EC, Ito T, 1990. Joint chemotherapy trials in lepromatous leprosy conducted in Thailand, the Philippines, and Korea. Int J Lepr Other Mycobact Dis 58 :1–11.
-
6
Nery JA, Vieira LM, de Matos HJ, Gallo ME, Sarno EN, 1998. Reactional states in multibacillary Hansen disease patients during multidrug therapy. Rev Inst Med Trop Sao Paulo 40 :363–370.
-
7
Schreuder PA, 1998. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1987–1995 [correction of 1978–1995]. II. Reactions. Int J Lepr Other Mycobact Dis 66 :159–169.
-
8
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 :173–184.
-
9
Levy L, Fasal P, Levan NE, Freedman RI, 1973. Treatment of erythema nodosum leprosum with thalidomide. Lancet 2 :324–325.
-
10
Teo SK, Resztak KE, Scheffler MA, Kook KA, Zeldis JB, Stirling DI, Thomas SD, 2002. Thalidomide in the treatment of leprosy. Microbes Infect 4 :1193–1202.
-
11
Saunderson 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 :318–324.
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12
Chattopadhyay SP, Gupta CM, Bhate RD, Bhate RP, Sreevatsa, 1989. Evaluation of two multidrug regimens in hospitalised multibacillary cases. Indian J Lepr 61 :196–205.
-
13
Helmy HS, Pearson JM, Waters MF, 1971. Treatment of moderately severe erythema nodosum leprosum with clofazimine—a controlled trial. Lepr Rev 42 :167–177.
-
14
Expert WHO Committee on Leprosy, 1998. World Health Organ Tech Rep Ser 874 :1–43.
-
15
Plock H, Leiker DL, 1976. A long term trial with clofazimine in reactive lepromatous leprosy. Lepr Rev 47 :25–34.
-
16
Lockwood D, Bryceson A, 2003. The return of thalidomide: new uses and renewed concerns–reply. Lepr Rev 74 :290–294.
-
17
Global leprosy situation, 2005. Wkly Epidemiol Rec 80 :289–295.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 167 | 92 | 13 |
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CLINICAL COURSE OF ERYTHEMA NODOSUM LEPROSUM: AN 11-YEAR COHORT STUDY IN HYDERABAD, INDIA
LEONOR POCATERRA
LEONOR POCATERRA
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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SUMAN JAIN
SUMAN JAIN
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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RAJGOPAL REDDY
RAJGOPAL REDDY
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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SYED MUZAFFARULLAH
SYED MUZAFFARULLAH
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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OBDULITA TORRES
OBDULITA TORRES
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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SUJAI SUNEETHA
SUJAI SUNEETHA
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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DIANA N. J. LOCKWOOD
DIANA N. J. LOCKWOOD
Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Blue Peter Research Centre, Cherlapally, Hyderabad, India; Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela
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Erythema nodosum leprosum (ENL) or type 2 lepra reactions complicate lepromatous leprosy and borderline lepromatous leprosy. We report an 11-year retrospective case record analysis of 481 outpatients with borderline lepromatous and lepromatous leprosy at the Dhoolpet Leprosy Research Center in Hyderabad, India. The overall prevalence of ENL was 24%, 49.4% among cases of lepromatous leprosy (LL) and 9% among cases of borderline lepromatous (BL) leprosy. Logistic regression analysis identified LL (odds ratio [OR] = 8.4, 95% confidence interval [CI] = 4.6–15.4, P < 0.001) and BL with a bacterial index ≥ 4+ (OR = 5.2, 95% CI = 2.1–12.9, P = 0.001) as major risk factors. The average patient with ENL was male, 34.7 years of age, and had multiple episodes of ENL (mean = 3.1) over an 18.5-month period. Three types of ENL were identified: single acute ENL, multiple acute ENL (repeated discrete episodes), and chronic ENL (continuous episodes). Acute single ENL is rare, accounting for only 8% of cases. Chronic ENL accounted for 62.5% of the cohort. Chronic ENL was of longer duration and more severe. An age ≥ 35 years was a risk factor for developing chronic ENL. Patients with chronic ENL were more compliant with multi-drug therapy, especially during the first six doses of multi-drug therapy. Distinguishing these different types of ENL would be useful for patient management and developing improved treatment of these debilitating reactions. Improved strategies for treatment and management of these reactions need to be developed.
Author Notes
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Reference Manager
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-
1
Bryceson AD, Pfalzgraff RE, 1990. Leprosy. Third edition. Edinburgh: Churchill Livingstone.
-
2
Wemambu SN, Turk JL, Waters MF, Rees RJ, 1969. Erythema nodosum leprosum: a clinical manifestation of the arthus phenomenon. Lancet 2 :933–935.
-
3
Sarno EN, Grau GE, Vieira LM, Nery JA, 1991. Serum levels of tumour necrosis factor-alpha and interleukin-1 beta during leprosy reactional states. Clin Exp Immunol 84 :103–108.
-
4
Waters MF, Rees RJ, Sutherland I, 1967. Chemotherapeutic trials in leprosy. 5. A study of methods used in clinical trials in lepromatous leprosy. Int J Lepr Other Mycobact Dis 35 :311–335.
-
5
Cellona RV, Fajardo TT Jr, Kim DI, Hah YM, Ramasoota T, Sampattavanich S, Carrillo MP, Abalos RM, de la Cruz EC, Ito T, 1990. Joint chemotherapy trials in lepromatous leprosy conducted in Thailand, the Philippines, and Korea. Int J Lepr Other Mycobact Dis 58 :1–11.
-
6
Nery JA, Vieira LM, de Matos HJ, Gallo ME, Sarno EN, 1998. Reactional states in multibacillary Hansen disease patients during multidrug therapy. Rev Inst Med Trop Sao Paulo 40 :363–370.
-
7
Schreuder PA, 1998. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1987–1995 [correction of 1978–1995]. II. Reactions. Int J Lepr Other Mycobact Dis 66 :159–169.
-
8
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 :173–184.
-
9
Levy L, Fasal P, Levan NE, Freedman RI, 1973. Treatment of erythema nodosum leprosum with thalidomide. Lancet 2 :324–325.
-
10
Teo SK, Resztak KE, Scheffler MA, Kook KA, Zeldis JB, Stirling DI, Thomas SD, 2002. Thalidomide in the treatment of leprosy. Microbes Infect 4 :1193–1202.
-
11
Saunderson 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 :318–324.
-
12
Chattopadhyay SP, Gupta CM, Bhate RD, Bhate RP, Sreevatsa, 1989. Evaluation of two multidrug regimens in hospitalised multibacillary cases. Indian J Lepr 61 :196–205.
-
13
Helmy HS, Pearson JM, Waters MF, 1971. Treatment of moderately severe erythema nodosum leprosum with clofazimine—a controlled trial. Lepr Rev 42 :167–177.
-
14
Expert WHO Committee on Leprosy, 1998. World Health Organ Tech Rep Ser 874 :1–43.
-
15
Plock H, Leiker DL, 1976. A long term trial with clofazimine in reactive lepromatous leprosy. Lepr Rev 47 :25–34.
-
16
Lockwood D, Bryceson A, 2003. The return of thalidomide: new uses and renewed concerns–reply. Lepr Rev 74 :290–294.
-
17
Global leprosy situation, 2005. Wkly Epidemiol Rec 80 :289–295.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 167 | 92 | 13 |
| Full Text Views | 206 | 7 | 0 |
| PDF Downloads | 101 | 6 | 0 |