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The scenario of Lepra reaction at the Tertiary Level Hospital in a Hilly State and our experience with its management

Abstract
Background: Leprosy is a curable disease but, due to the presence of bacilli in the tissues, altered immune response hypersensitivity reactions may develop, which can increase the morbidity rates of the disease. We planned this study to observe the types of leprosy hypersensitivity reactions, their onset, presentation and response to treatment. This retrospective study was conducted over a 2-year period - from January 2015 to December 2016 - to evaluate the scenario of Lepra reaction in Hansen patients in Indira Gandhi Medical College in Shimla, Himachal Pradesh, India. Results: A total of 66 patients were registered as new cases of Hansen’s disease. Lepromatous leprosy (LL) was the most common spectrum. A total of 41 patients (62.1%) developed a reaction either at presentation or during the course of the disease. Infection as a trigger of the reaction was elucidated in 6 patients, while trauma and vaccination triggered a reaction in 2 patients. Type 1 reaction (T1R) was observed in 18.18% of patients, while type 2 reaction (T2R) appeared in 43.93% of patients. The most common age group for T1R was 30-45 years, while for T2R it was the ages of 15-30. Grade 1 deformity (G1D) was present in 30 patients, grade 2 deformity (G2D) was present in 26 patients, while grade 2 deformity of eyes was diagnosed in 6 patients. A significant number of patients (36.5%) who developed reactions were relieved by the standard World Health Organisation’s (WHO) regimen of prednisolone. Adjuvant drugs in the form of clofazimine, thalidomide and methotrexate were given to non-responders. Limitation: Due to the short follow up period, we did not observe late reactions. Conclusion: In our study, multibacillary leprosy was more common, and the younger age group was involved, thus leading to more deformities, stigma and impaired quality of life. Hansen’s disease is a slowly progressive, curable disease, but an interruption by hypersensitivity reactions can alter the course of the disease, which may lead to deformities, hence the need for it to be managed vigorously.

More information

Type
Journal Article
Author
Verma K
Gupta M
Sharma RK