Leprosy Reactions in Post-elimination stage: the Bangladesh experience

Abstract

Background

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

Objectives

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

Methods

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

Results

Of the 670 leprosy patients 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was 300 (44.78%) with a male: female ratio of 3.55:1. The age specific cumulative reactions cases at >40 years was high 115 (38.33%) among all age groups. The prevalence of reaction was found to be 166 (55.33%) for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum and 85 (28.33%) for the neuritis. Borderline tuberculoid was the most common 106 (35.33%) group in reversal reaction while lepromatous leprosy was the most common 37 (12.33%) in erythema nodosum leprosum. More than half of the patients 169 (56.33%) had reactions at the time of presentations while 85 (28.33%) and 46 (15.33%) of patients developed reaction during and after multidrug therapy respectively. The reversal reaction group presented with ≥ 6 skin lesions in 96 (57.83%) and ≥ 2 nerves involvement in 107 (64.46%) patients. The erythema nodosum leprosum presented chiefly as papulo-nodular 45 (91.84%) lesions followed by pustule-necrotic 4 (8.16%) lesions, neuritis 33 (67.35%), fever 24 (48.98%), lymphadenitis 6 (12.24%), arthritis 5 (10.20%) and iritis 2 (4.08%). Bacterial index ≥ 3 had been demonstrated in 34 (60.71%) patients of erythema nodosum leprosum.

Conclusion

The incidence of leprosy reaction seemed to be more than three times common in borederline tuberculoid (52.33%) than in lepromatous leprosy (14%). Reactions with nerve function impairment and disability still occur among multibacillary patients during and after multidrug therapy. Early detection and management of leprosy reaction is 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 health care services.

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