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Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

DOI: 10.1371/journal.pntd.0000921

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Abstract:

Background Leprosy is a chronic granulomatous infectious disease and is still endemic in many parts of the world. It causes disabilities which are the consequence of nerve damage. This damage is in most cases the result of immunological reactions. Objectives To investigate the differences between a type 1 leprosy (reversal) reaction and relapse on using histopathology. Methods The histopathological changes in 167 biopsies from 66 leprosy patients were studied. The patients were selected when their sequential biopsies demonstrated either different patterns or maintained the same pattern of granulomatous reaction over more than two years during or after the treatment of leprosy. Results In 57 of the patients studied, a reactivation was seen which coincided with a decrease in the bacteriological index (BI), suggesting that this reactivation (reversal reaction or type 1 leprosy reaction) coincides with an effective capacity for bacteriological clearance. In nine patients, an increase of the bacteriologic index (IB) or persistence of solid bacilli occurred during the reactivation, indicating proliferative activity, suggestive of a relapse. The histopathological aspects of the granulomas were similar in both groups. Conclusion Bacterioscopy provided the only means to differentiate a reversal reaction from a relapse in patients with granulomatous reactivation. The type 1 leprosy reaction may be considered as a part effective immune reconstitution (reversal, upgrading reaction) or as a mere hypersensitivity reaction (downgrading reaction) in a relapse.

References

[1]  World Health Organization (2009) Global Leprosy Situation 2009. Wkly Epidemiol Rec 33: 333–40.
[2]  Ridley DS, Jopling WH (1966) Classification of leprosy according to immunity: a five-group system. Int J Lepr 34: 255–73.
[3]  Congresso de Madrid (1953) Classifica??o, Resolu??o Técnica, VI Congresso Internacional de Leprologia. Int J Lepr 21: 504–16.
[4]  Jopling WH (1978) Leprosy reactions (reactional states). Handbook of leprosy. 2.ed. London: Willian Heinemann Medical Books. pp. 66–74.
[5]  Souza Lima, Souza Campos (1947) Leprides tuberculóides reacionais. In: Lepra tuberculóide: estudo clínico histopatológico. S?o Paulo: Renascen?a. pp. 173–215.
[6]  Fujieda S, Sieling PA, Modlin RL, Saxon A (1998) CD1-restricted T-cells influence IgG subclass and IgE production. J Allergy Clin Immunol 101: 545–51. doi: 10.1016/S0091-6749(98)70362-8
[7]  Silva CL, Faccioli LH, Foss NT (1993) Supression of human monocyte cytokine release by phenolic glycolipid-I of Mycobacterium leprae. Int J Lepr 61: 107–8.
[8]  Ridley DS (1987) Reacciones. La biopsia de piel en la lepra. 2.ed. Basilea: Ciba-Geigy. pp. 53–8.
[9]  Ridley DS, Radia KB (1981) The histological course of reactions in borderline leprosy and their outcome. Int J Lepr 49: 383–92.
[10]  Lockwood DN, Lucas SB, Desikan KV, Ebenezer G, Suneetha S, et al. (2008) The diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol 61: 595–600. doi: 10.1136/jcp.2007.053389
[11]  Trindade MAB (1996) Evolu??o histológica de reativa??es da hanseníase durante ou após o tratamento. 63 p. http://pesquisa.bvsalud.org/regional/res?ources/lil-204390 accessed on 27/03/2010.
[12]  Ridley DS, Hilson GRF (1967) A logarithmic index of bacilli in biopsies. Int J Lep 35: 184–186.
[13]  Katoch K, Ramanathan U, Natrajan M, Bagga AK, Bhatia AS, et al. (1989) Relapses in paucibacillary patients after treatment with three short-term regimens containing rifampin. Int J Lepr Other Mycobact Dis 57: 458–64.
[14]  Naafs B, Wheate HW (1978) The time interval between the start of anti-leprosy treatment and the development of reactions in borderline patients. Lepr Rev 49: 153–7.
[15]  Opromolla DVA (1994) Recidiva ou rea??o reversa. Hansen Int 19: 10–6.
[16]  Barreto JA, Belone AFF, Fleury RN, Soares CT, Lauris JRP (2005) Manifestations of reactional tuberculoid pattern in borderline leprosy: comparative, histochemical and immunohistochemical study, in skin biopsies, between type 1 reactions occurred before and during multidrugtherapy. An Bras Dermatol 80: S268–74.
[17]  Opromolla DVA (1995) Alguns comentários acerca de um caso relatado por Wade e Rodriguez nos anos 30. Hansen Int 20: 29–37.
[18]  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 Etiopia. Int J Lepr 60: 173–84.
[19]  Desikan KV (1995) Relapse, reactivation or reinfection? Indian J Lepr. 67. : 3–11. [Symposium paper].
[20]  Jamet P, Baohong J, Marchoux Chemotherapy Study Group (1995) Relapse after long-term follow up of multibacillary patients treated by WHO multidrug regimen. Int J Lepr 63: 195–201.
[21]  Khanolkar-Young S, Rayment N, Brickell PM, Katz DR, Vinayakumar S, et al. (1995) Tumour necrosis factor-alpha (TNF-alpha) synthesis is associated with the skin and peripheral nerve pathology of leprosy reversal reactions. Clin Exp Immunol 99: 196–20. doi: 10.1111/j.1365-2249.1995.tb05532.x
[22]  Little D, Khanolkar-Young S, Coulthart A, Suneetha S, Lockwood DN (2001) Immunohistochemical analysis of cellular infiltrate and gamma interferon, interleukin-12, and inducible nitric oxide synthase expression in leprosy type 1 (reversal) reactions before and during prednisolone treatment. Infect Immun 69: 3413–7. doi: 10.1128/IAI.69.5.3413-3417.2001
[23]  Trindade MAB, Manini MIP, Masetti JH, Leite MA, Takahashi MD, et al. (2005) Leprosy and HIV co-infection in five patients. Lepr Rev 76: 162–6.
[24]  Trindade MAB, Valente NYS, Manini MIP, Takahashi MDF, Anjos CFD, et al. (2006) Two patients coinfected with Mycobacterium Leprae and Human Immunodeficiency Virus Type 1 and naive for antiretroviral therapy who exhibited Type 1 Leprosy Reactions mimicking the Immune Reconstitution Inflammatory Syndrome. Journal of Clinical Microbiology 44: 4616–18. doi: 10.1128/JCM.01425-06
[25]  Batista MD, Porro AM, Maeda SM, Gomes EE, Yoshioka MC, et al. (2008) Leprosy reversal reaction as immune reconstitution inflammatory syndrome in patients with AIDS. Clin Infect Dis 46: e56–60. doi: 10.1086/528864
[26]  Deps PD, Lockwood DNJ (2008) Leprosy occurring as immune reconstitution syndrome. Trans R Soc Trop Med Hyg 30: 966–8. doi: 10.1016/j.trstmh.2008.06.003
[27]  Sarno EN, Illarramendi X, Nery JA, Sales AM, Gutierrez-Galhardo MC, et al. (2008) HIV-M. leprae interaction: can HAART modify the course of leprosy? Public Health Rep 123: 206–12.
[28]  Kar HK, Sharma P, Bhardwaj M (2009) Borderline tuberculoid leprosy with upgrading Type 1 reaction in a HIV seropositive patient, after antiretroviral therapy: an immune reconstitution inflammatory syndrome. Lepr Rev 80: 85–8.
[29]  Couppié P, Abel S, Voinchet H, Roussel M, Hélénon R, et al. (2004) Immune reconstitution inflammatory syndrome associated with HIV and leprosy. Arch Dermatol 140: 997–1000. doi: 10.1001/archderm.140.8.997
[30]  Job CK (1995) Histopathological features of relapsed leprosy. Indian J Lepr 67: 69–80. [Symposium paper].
[31]  Opromolla DVA (2005) Some considerations on the origin of type 1 reactions in leprosy. Int J Lepr 73: 33–4. [Correspondence].

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