02747nas a2200349   4500000000100000008004100001260001300042653002700055653001100082653001100093653001200104653000900116653001600125653002300141653002400164653001700188653001600205100001800221700001700239700001300256700001600269700001200285700001800297700001500315700001400330245006800344856005700412300000900469490000800478520189700486022001402383       2011                            d  c2011 Feb10aFamily Characteristics10aFemale10aHumans10aleprosy10aMale10aMiddle Aged10aModels, Biological10aRegression Analysis10aRisk Factors10aSex Factors1 aMastrangelo G1 aSilva Neto J1 aSilva GV1 aScoizzato L1 aFadda E1 aDallapicola M1 aFolleto AL1 aCegolon L00aLeprosy reactions: the effect of gender and household contacts.  uhttp://memorias.ioc.fiocruz.br/106(1)/106_1_2272.pdf  a92-60 v1063 a<p>Various host-related factors have been reported as relevant risk factors for leprosy reactions. To support a new hypothesis that an antigenic load in local tissues that is sufficient to trigger the immune response may come from an external supply of Mycobacterium leprae organisms, the prevalence of reactional leprosy was assessed against the number of household contacts. The number of contacts was ascertained at diagnosis in leprosy patients coming from an endemic area of Brazil. The prevalence of reactions (patients with reactions/total patients) was fitted by binomial regression and the risk difference (RD) was estimated with a semi-robust estimation of variance as a measure of effect. Five regression models were fitted. Model 1 included only the main exposure variable "number of household contacts"; model 2 included all four explanatory variables ("contacts", "fertile age", "number of skin lesions" and "bacillary index") that were found to be associated with the outcome upon univariate analysis; models 3-5 contained various combinations of three predictors. Male and female patients were analyzed separately. In females, household contacts were a significant predictor for leprosy reactions in model 1 [crude RD = 0.06; 95% confidence interval (CI) = 0.01; 0.12] and model 5 (RD = 0.05; CI = 0.02; 0.09), which included contacts, bacillary index and skin lesions as predictors. Other models were unsatisfactory because the joint presence of fertile age and bacillary index was a likely source of multicollinearity. No significant results were obtained for males. The likely interpretation of our findings might suggest that in female patients, leprosy reactions may be triggered by an external spreading of M. leprae by healthy carrier family members. The small number of observations is an obvious limitation of our study which requires larger confirmatory studies.</p>  a1678-8060