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Epidemiological and Clinical Features of Leprosy Reactions and Associated Risk Factors in Malagasy People from 2012 to 2021

Introduction: Leprosy is a transmissible infectious disease while cutaneous and neurological manifestations vary according to the patient's immunity. It is a chronic disease with acute immunological complication called leprosy reactions. Leprosy remains endemic in Madagascar. The objective of this study is to characterize the epidemiological and clinical profile of leprosy and leprosy reactions and to determine the risk factors for leprosy reactions. Methods: This was a retrospective, case-control study over a period of 10 years from January 2012 to December 2021 conducted among leprosy patients of the University Hospital Joseph Raseta Befelatanana. Univariate and multivariate logistic regression was used to determine the risk factors for leprosy reactions. Results: Of the 161 patients selected, 53 patients had a leprosy reaction. There were 91 males and 70 females with a mean age of 35.8 years (±15,47). The borderline lepromatous type was the most common clinical form. The prevalence of lepromatous reaction was 33%. Type 1 and type 2 reactions were found in 41.50% and 45.28% of cases respectively. The average time to develop leprosy reactions after the initiation of multidrug therapy was 5.80 months (±3.91). From multivariate analysis, the risk factors identified were: male gender [OR=2.64 (95% CI: 1.80-9.57), p=0.02], positive BI [OR=3.53 (95% CI: 2.41-48.98), p=0.02], MB treatment regimen [OR=8.87 (95% CI: 1.23-3.57), p=0.008)], and poor adherence to treatment [OR=1.97 (95% CI: 1.34-12.95), p=0.0354]. Conclusion: The knowledge of these risk factors allows for early diagnosis and treatment of leprosy reactions to prevent the morbidities due to leprae disease such as amputations and disabilities that are a source of stigma.

Epidemiology, Leprosy, Leprosy Reaction, Madagascar, Risk Factors

APA Style

Mendrika Fifaliana Rakotoarisaona, Malalaniaina Andrianarison, Onivola Raharolahy, Fandresena Arilala Sendrasoa, Volatantely Ratovonjanahary, et al. (2023). Epidemiological and Clinical Features of Leprosy Reactions and Associated Risk Factors in Malagasy People from 2012 to 2021. International Journal of Clinical Dermatology, 6(1), 1-9. https://doi.org/10.11648/j.ijcd.20230601.11

ACS Style

Mendrika Fifaliana Rakotoarisaona; Malalaniaina Andrianarison; Onivola Raharolahy; Fandresena Arilala Sendrasoa; Volatantely Ratovonjanahary, et al. Epidemiological and Clinical Features of Leprosy Reactions and Associated Risk Factors in Malagasy People from 2012 to 2021. Int. J. Clin. Dermatol. 2023, 6(1), 1-9. doi: 10.11648/j.ijcd.20230601.11

AMA Style

Mendrika Fifaliana Rakotoarisaona, Malalaniaina Andrianarison, Onivola Raharolahy, Fandresena Arilala Sendrasoa, Volatantely Ratovonjanahary, et al. Epidemiological and Clinical Features of Leprosy Reactions and Associated Risk Factors in Malagasy People from 2012 to 2021. Int J Clin Dermatol. 2023;6(1):1-9. doi: 10.11648/j.ijcd.20230601.11

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Smith WCS, Nicholls PG, Das L, Barkataki P, Suneetha S, Suneetha L. Predicting neuropathy and reactions in leprosy at diagnosis and before incident events results from the INFIR Cohort Study. Plos Neglec Trop Dis. 2009; 3: 1-8.
2. Britton WJ. Immunology of leprosy. Trans R Soc Trop Med Hyg. 1993; 87 (5): 508-14.
3. Lastoria JC, de Abreu MAMM. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects-part 1. An Bras Dermatol. 2014; 89 (2): 205–28.
4. Jannin J, Solano P, Quick I, Debré P. The francophone network on neglected tropical diseases. PLoS Negl Trop Dis. 2017; 11 (8): 1-5.
5. Gaschignard J, Scurr E, Alcaїs A. Leprosy, a pillar of human genetics of infectious diseases. Pathol Biol. 2013; 61 (3): 120–8.
6. Aubry P, Gaüzère B-A. Leprosy or Hansen’s disease. Med Trop, University of Bordeaux, 33076 Bordeaux (France), 2020.
7. World Health Organization. Leprosy disabilities: magnitude of the problem. Wkly Epidemiol Rec 1995; 70: 269-75.
8. Bührer-Sékula S, Smits HL, Gussenhoven GC, van Leeuwen J, Amador S, Fujiwara T et al. Simple and fast lateral flow test for classification of leprosy patients and identifi cation of contacts with high risk of developing leprosy. J Clin Microbiol. 2003; 41: 1991-5.
9. Scollard DM, Martelli CM, Stefani MM, Maroja Mde F, Villahermosa L, Pardillo F et al. Risk factors for leprosy reactions in three endemic countries. Am J Trop Med Hyg. 2015; 92: 108-14.
10. Nery JA, Bernardes Filho F, Quintanilha J, Machado AM, Oliveira Sde S, Sales AM. Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy. An Bras Dermatol. 2013; 88: 787-92.
11. Wu J, Boggild AK. Clinical pearls: Leprosy reaction. J Cut Med and Surg. 2016; 20: 484-5.
12. Fischer M. Leprosy: an overview of clinical features, diagnosis, and treatment, J. Dtsch Dermatol Ges. 2017; 15 (8): 801–27.
13. Duncan ME. An historical and clinical review of the interaction of leprosy and pregnancy: a cycle to be broken. Soc Sci Med. 1993; 37: 457–72.
14. Trindade MAB, Varella TCN, Cisneron CGC, Bottini V, Mour AKA. Delayed diagnosis of multibacillary leprosy: a report of eigth cases. Braz J Infect Dis 2009; 13: 155-7.
15. Balagon MVF, Gelber RH, Abalos RM, Cellona R. Reactions following completion of 1- and 2-years multidrug therapy (MDT). Am J Trop Med Hyg. 2010; 83: 637-44.
16. Voorend CGN. A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. PLoS Negl Trop Dis 2013; 7: e2440.
17. Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL. The continuing challenges of leprosy. Clin Microbiol Rev. 2006; 19: 338–81.
18. Suchonwanit P, Triamchaisri S, Wittayakornrerk S, Rattanakaemakorn P. Leprosy Reaction in Thai Population: A 20-Year Retrospective Study. Dermatol Res Pract. 2015.
19. Ambrosano L, dos Santos MAS, Machado ECFA, Pegas ES. Epidemiological profile of leprosy reactions in a referral center in Campinas (SP), Brazil, 2010-2015. An Bras Dermatol. 2018; 93 (3): 460-1.
20. Azulay RD, Azulay DR. Micobacterioses. In: Azulay RD, Azulay DR (eds) Dermatologia, 2nd edition, Editora Guanabara Koogan, Rio de Janeiro, 1997. 174-89.
21. Oliveira DT, Bezerra MM, Almeida JAP, Duthie M, Reed S, Jesus AR. Neurological disability in leprosy: incidence and gender association in Sergipe, Brazil. Geospatial Health. 2012; 6: 125-9.
22. Biya Nkizinkiko R, Mashako Ruhanga M. The epidemiological, clinical and therapeutic profile of leprosy in eastern Democratic Republic of Congo. Rev Hig Inst Med Techn-Goma. 2019; 1 (1): 4-11.
23. Olanrewaju P, Mordi M. Concurrent, convergent, divergent validity and stability reliability of Igbo version of screening of activity limitation and safety awareness scale among people living with Hansen’s disease in South –East Nigeria. Lepr Rev. 2018; 89 (2): 139-47.
24. Oummou S, Diatta B, Wadih M. Leprosy in Senegal. Derm Report. 2013; 3 (2): 18.
25. Penna GO, Pinheiro AM, Nogueira LSC, de Carvalho LR, de Oliveira MBB, Carreiro VP. Clinical and epidemiological study of leprosy cases in the University Hospital of Brasília: 20 years - 1985 to 2005. Rev Soc Bras Med Trop. 2008; 41 (6): 575-80.
26. Emy A. Thomas, Abhilasha Williams, Niharika Jha3, Clarence J Samuel. A Study on Lepra Reactions from a Tertiary Care Center in North India. Int J Med Res Prof. 2017; 3 (3); 162-6.
27. Moschioni C, Antunes CMF, Grossi MAF, Lambertucci JR. Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy. Rev Soc Bras Med Trop. 2010; 43: 19-22.
28. Mastrangelo G, Silva Neto J, Silva GV, Scoizzato L, Fadda E, Dallapicola M, et al. Leprosy reactions: the effect of gender and household contacts. Mem Inst Oswaldo Cruz 2011; 106: 92-6.
29. Richardus JH, Nicholls PG, Croft RP, Withington SG, Smith WCS. Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up. Inter J Epid. 2004; 33: 337-43.
30. Guerra JG, Penna GO, Castro LCM, Martelli CMT, Stefani MMA. Erythema leprosum nodosum: clinical and therapeutic update. An Bras Dermatol. 2002; 77: 389-407.
31. Mish E, Macdonald M, Ranit C et al. Human TLR1 defincieny is associated with impared mycobacterial signaling and protection from leprosy reversal reaction. Plos Negl Trop Dis. 2008; 25: e231.
32. Cardoso CC, Pereira AC, Brito- De- Senza VN, Dias-Baptisa IM, Maniero VC, Venturini J et al. TFNG + 874. A single nucleotide polymorphism is associated with leprosy among Brazilians. Hum Genet. 2010; 128 (5): 481-90.
33. Kumar K, Kaur S, Kataria S, Roy SN. Concomitant occurrence of leprosy and tuberculosis: a clinical bacteriological and radiological evaluation. Leprosy in India, 1982; 54 (4): 671–6.
34. Sendrasoa FA, Ranaivo IM, Raharolahy O, Adrianarison M, Ramarozatovo LS, Rapelanoro Rabenja F. Pulmonary tuberculosis and lepromatous leprosy coinfection. Case Rep Dermatol Med. 2015.
35. Agarwal DK, Mehta AR, Sharma AP. Coinfection with leprosy and tuberculosis in a renal transplant recipient. Nephrol Dial Transplant. 2000; 5 (10): 1720–1.
36. Ranque B, Nguyen VT, Vu HT, Nguyen TH, Nguyen NB, Pham XK et al. Age Is an Important Risk Factor for Onset and Sequelae of Reversal Reactions in Vietnamese Patients with Leprosy. Clin Infect Dis. 2007; 44: 33-40.
37. Keita M, Soumaha MM, Tounkara TM, Dianea BH, Balde H, Camara A et al. Reactionary states during a multidrug leprosy treatment regimen in leprosy managment sites in Conakry. Ann Dermatol Vénérol. 2013.
38. Cuellar-Barboza A, Cardenas-de la Garza JA, Garcia-Lozano JA, Vera-Pineda R, Cruz-Gomez LG, Irabien-Zuniga M et al. Leprosy reactions in North-East Mexico: epidemiology and risk factors for chronic erythema nodosum leprosum. JEADV 2020; 34, e210–40.
39. Jacob JT, Kozarsky P, Dismukes R, Bynoe V, Margoles L, Leonard M et al. Short Report: Five-year Experience with Type 1 and Type 2 Reactions in Hansen Disease at a US Travel Clinic. Am J Trop Med Hyg. 2008; 79 (3): 452–4.
40. Rodrigues LC, Lockwood DNJ. Leprosy now: epidemiology, progress, challenges, and research gaps. Lancet Infect Dis. 2011; 6: 464-70.
41. Lockwood DNJ, Suneetha S. Leprosy: too complex a disease for a simple elimination paradigm. Bulletin of the World Health Organization. 2005; 83: 230-5.
42. Sousa ALOM, Stefani MMA, Gisner ASP, Costa MB, Rebello PF, Gomes MK, et al. 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 2007; 77: 829-33.
43. Macdonald M, Berrington WR, Misch EA, Ranjit C, Siddiqui MR, Kaplan G et al. Association of TNF, MBL and VDR polymorphisms with leprosy phenotypes. Hum Immunol. 2010; 71: 992–8.
44. Tabassum S, Zia M, Khoja AA, David J, Iqbal M, Junaid M. Lepra reactions: A study of 130 cases from Pakistan. J Pak Med Assoc. 2021; 71 (10): 2317-20.
45. Van Brakel WH, Khawas IB, Lucas SB. Reactions in leprosy: an epidemiological study of 386 patients in West Nepal. Lepr Rev. 1994; 65: 190–203.
46. Antunes DE, Ferreira GP, Candeiro Nicchio, Araujo S, Rodrigues da Cunha AC, Gomes RR et al. Number of leprosy reactions during treatment: clinical correlations and laboratory diagnosis. Rev Soc Bras Med Trop. 2016; 49 (6): 741-5.
47. Schreuder PA. 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]. Int J Lepr Other Mycobact Dis. 1998; 66: 159–69.
48. Sharma N, Koranne RV, Mendiratta V, Sharma RC. A study of leprosy reactions in a tertiary hospital in Delhi. J Dermatol. 2004; 31: 898–903.