Risk factors for type-1 reactions in borderline leprosy patients

Type-1 or reversal reactions are the major cause of nerve damage and disability in leprosy. We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male,...

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Published in:The Lancet (British edition) 1991-09, Vol.338 (8768), p.654-657
Main Authors: Roche, P.W., Theuvenet, W.J., Britton, W.J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antibodies
Antibodies, Bacterial - analysis
Antibodies, Monoclonal - analysis
Antigens
Antigens, Bacterial
Bacteria
Bacterial diseases
Biological and medical sciences
Biomarkers - blood
Chemotherapy
Child
Drug Hypersensitivity - etiology
Drug Hypersensitivity - immunology
Drug therapy
Drugs
Female
Glycolipids - immunology
Human bacterial diseases
Humans
Immune response
Immunity, Cellular
Immunoglobulin G
Immunoglobulin M
Immunoglobulins
Infectious diseases
Inflammation
Intradermal Tests
Lepromin test
Leprosy
Leprosy, Borderline - drug therapy
Leprosy, Borderline - immunology
Leprosy, Tuberculoid - drug therapy
Lipopolysaccharides - immunology
Male
Medical research
Medical sciences
Middle Aged
Mycobacterium leprae - immunology
Neuritis - chemically induced
Neuritis - immunology
Patients
Peripheral Nervous System Diseases - chemically induced
Peripheral Nervous System Diseases - immunology
Phenolic compounds
Phenols
Proteins
Risk analysis
Risk Factors
Skin
Smear
Tropical bacterial diseases
Tropical medicine
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creator Roche, P.W.
Theuvenet, W.J.
Britton, W.J.
description Type-1 or reversal reactions are the major cause of nerve damage and disability in leprosy. We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male, 39 female; age range 7-73 years) had a type-1 reaction during the first 2 years of multi-drug therapy. Before therapy, 41 (98%) of the 42 patients were seropositive for antibodies to one of three mycobacterial antigens. Seropositivity for IgM anti-phenolic-glycolipid-1 (PGL-1) antibodies, but not IgG anti-lipoarabinomannan or anti-Mycobacterium leprae 35 kDa protein antibodies, was significantly associated with subsequent manifestation of a type-1 reaction (p
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We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male, 39 female; age range 7-73 years) had a type-1 reaction during the first 2 years of multi-drug therapy. Before therapy, 41 (98%) of the 42 patients were seropositive for antibodies to one of three mycobacterial antigens. Seropositivity for IgM anti-phenolic-glycolipid-1 (PGL-1) antibodies, but not IgG anti-lipoarabinomannan or anti-Mycobacterium leprae 35 kDa protein antibodies, was significantly associated with subsequent manifestation of a type-1 reaction (p&lt;0·001). The concentration of IgM anti-PGL-1 antibodies in serum was significantly higher in patients in whom a type-1 reaction developed. The risk attributable to anti-PGL-1 seropositivity was independent of leprosy class, skin smear positivity, and the presence of other anti-M leprae antibodies (adjusted odds ratio=8·7, p&lt;0·001). In the 87 patients who had a lepromin test, anti-PGL-1 seropositivity and lepromin reactivity were significant independent risk factors for subsequent reaction. 78% of patients with positive lepromin reactivity and IgM anti-PGL-1 antibodies had type-1 reactions. Patients with these risk factors should be carefully monitored during antimicrobial therapy to permit early initiation of anti-inflammatory treatment thus minimising permanent nerve damage and resultant disability.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/0140-6736(91)91232-J</identifier><identifier>PMID: 1679473</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Antibodies ; Antibodies, Bacterial - analysis ; Antibodies, Monoclonal - analysis ; Antigens ; Antigens, Bacterial ; Bacteria ; Bacterial diseases ; Biological and medical sciences ; Biomarkers - blood ; Chemotherapy ; Child ; Drug Hypersensitivity - etiology ; Drug Hypersensitivity - immunology ; Drug therapy ; Drugs ; Female ; Glycolipids - immunology ; Human bacterial diseases ; Humans ; Immune response ; Immunity, Cellular ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Infectious diseases ; Inflammation ; Intradermal Tests ; Lepromin test ; Leprosy ; Leprosy, Borderline - drug therapy ; Leprosy, Borderline - immunology ; Leprosy, Tuberculoid - drug therapy ; Lipopolysaccharides - immunology ; Male ; Medical research ; Medical sciences ; Middle Aged ; Mycobacterium leprae - immunology ; Neuritis - chemically induced ; Neuritis - immunology ; Patients ; Peripheral Nervous System Diseases - chemically induced ; Peripheral Nervous System Diseases - immunology ; Phenolic compounds ; Phenols ; Proteins ; Risk analysis ; Risk Factors ; Skin ; Smear ; Tropical bacterial diseases ; Tropical medicine</subject><ispartof>The Lancet (British edition), 1991-09, Vol.338 (8768), p.654-657</ispartof><rights>1991</rights><rights>1992 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Sep 14, 1991</rights><rights>Copyright Elsevier Limited Sep 14, 1991</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-c41859b414b775befea0d49897fa35752cb1e94246657d60d28635e880f0db93</citedby><cites>FETCH-LOGICAL-c441t-c41859b414b775befea0d49897fa35752cb1e94246657d60d28635e880f0db93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=4981088$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1679473$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roche, P.W.</creatorcontrib><creatorcontrib>Theuvenet, W.J.</creatorcontrib><creatorcontrib>Britton, W.J.</creatorcontrib><title>Risk factors for type-1 reactions in borderline leprosy patients</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Type-1 or reversal reactions are the major cause of nerve damage and disability in leprosy. We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male, 39 female; age range 7-73 years) had a type-1 reaction during the first 2 years of multi-drug therapy. Before therapy, 41 (98%) of the 42 patients were seropositive for antibodies to one of three mycobacterial antigens. Seropositivity for IgM anti-phenolic-glycolipid-1 (PGL-1) antibodies, but not IgG anti-lipoarabinomannan or anti-Mycobacterium leprae 35 kDa protein antibodies, was significantly associated with subsequent manifestation of a type-1 reaction (p&lt;0·001). The concentration of IgM anti-PGL-1 antibodies in serum was significantly higher in patients in whom a type-1 reaction developed. The risk attributable to anti-PGL-1 seropositivity was independent of leprosy class, skin smear positivity, and the presence of other anti-M leprae antibodies (adjusted odds ratio=8·7, p&lt;0·001). In the 87 patients who had a lepromin test, anti-PGL-1 seropositivity and lepromin reactivity were significant independent risk factors for subsequent reaction. 78% of patients with positive lepromin reactivity and IgM anti-PGL-1 antibodies had type-1 reactions. Patients with these risk factors should be carefully monitored during antimicrobial therapy to permit early initiation of anti-inflammatory treatment thus minimising permanent nerve damage and resultant disability.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibodies</subject><subject>Antibodies, Bacterial - analysis</subject><subject>Antibodies, Monoclonal - analysis</subject><subject>Antigens</subject><subject>Antigens, Bacterial</subject><subject>Bacteria</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Chemotherapy</subject><subject>Child</subject><subject>Drug Hypersensitivity - etiology</subject><subject>Drug Hypersensitivity - immunology</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Female</subject><subject>Glycolipids - immunology</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Immune response</subject><subject>Immunity, Cellular</subject><subject>Immunoglobulin G</subject><subject>Immunoglobulin M</subject><subject>Immunoglobulins</subject><subject>Infectious diseases</subject><subject>Inflammation</subject><subject>Intradermal Tests</subject><subject>Lepromin test</subject><subject>Leprosy</subject><subject>Leprosy, Borderline - drug therapy</subject><subject>Leprosy, Borderline - immunology</subject><subject>Leprosy, Tuberculoid - drug therapy</subject><subject>Lipopolysaccharides - immunology</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mycobacterium leprae - immunology</subject><subject>Neuritis - chemically induced</subject><subject>Neuritis - immunology</subject><subject>Patients</subject><subject>Peripheral Nervous System Diseases - chemically induced</subject><subject>Peripheral Nervous System Diseases - immunology</subject><subject>Phenolic compounds</subject><subject>Phenols</subject><subject>Proteins</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Skin</subject><subject>Smear</subject><subject>Tropical bacterial diseases</subject><subject>Tropical medicine</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LxDAQhoMoun78A4WiHvRQnWnz0VxEET8RBPHgLaTpFKJruyZdYf-9WXfRk14SyDwzb-ZhbBfhBAHlKSCHXKpSHmk81liURX6_wkbIFc8FVy-rbPSDbLDNGF8BgEsQ62wdpdJclSN2_uTjW9ZaN_QhZm0fsmE2oRyzQOnN913MfJfVfWgojH1H2ZgmoY-zbGIHT90Qt9laa8eRdpb3Fnu-vnq-vM0fHm_uLi8ecsc5DunESuiaI6-VEjW1ZKHhutKqtaVQonA1kuYFl1KoRkJTVLIUVFXQQlPrcosdLMam9I8pxcG89tPQpURTFKAFSFnMqf2_KExZugSEBPEF5NIiMVBrJsG_2zAzCGZu1sy1mbk2o9F8mzX3qW1vOXtav1Pz27RQmeqHy7qNzo7bYDvn4w-WdkWoqoSdLTBKsj49BRNdEumo8YHcYJre__-PL257khg</recordid><startdate>19910914</startdate><enddate>19910914</enddate><creator>Roche, P.W.</creator><creator>Theuvenet, W.J.</creator><creator>Britton, W.J.</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>ASE</scope><scope>C1K</scope><scope>FPQ</scope><scope>H94</scope><scope>K6X</scope><scope>K9.</scope><scope>KB~</scope><scope>M7N</scope><scope>NAPCQ</scope></search><sort><creationdate>19910914</creationdate><title>Risk factors for type-1 reactions in borderline leprosy patients</title><author>Roche, P.W. ; 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We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male, 39 female; age range 7-73 years) had a type-1 reaction during the first 2 years of multi-drug therapy. Before therapy, 41 (98%) of the 42 patients were seropositive for antibodies to one of three mycobacterial antigens. Seropositivity for IgM anti-phenolic-glycolipid-1 (PGL-1) antibodies, but not IgG anti-lipoarabinomannan or anti-Mycobacterium leprae 35 kDa protein antibodies, was significantly associated with subsequent manifestation of a type-1 reaction (p&lt;0·001). The concentration of IgM anti-PGL-1 antibodies in serum was significantly higher in patients in whom a type-1 reaction developed. The risk attributable to anti-PGL-1 seropositivity was independent of leprosy class, skin smear positivity, and the presence of other anti-M leprae antibodies (adjusted odds ratio=8·7, p&lt;0·001). In the 87 patients who had a lepromin test, anti-PGL-1 seropositivity and lepromin reactivity were significant independent risk factors for subsequent reaction. 78% of patients with positive lepromin reactivity and IgM anti-PGL-1 antibodies had type-1 reactions. Patients with these risk factors should be carefully monitored during antimicrobial therapy to permit early initiation of anti-inflammatory treatment thus minimising permanent nerve damage and resultant disability.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>1679473</pmid><doi>10.1016/0140-6736(91)91232-J</doi><tpages>4</tpages></addata></record>
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identifier ISSN: 0140-6736
ispartof The Lancet (British edition), 1991-09, Vol.338 (8768), p.654-657
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subjects Adolescent
Adult
Aged
Antibodies
Antibodies, Bacterial - analysis
Antibodies, Monoclonal - analysis
Antigens
Antigens, Bacterial
Bacteria
Bacterial diseases
Biological and medical sciences
Biomarkers - blood
Chemotherapy
Child
Drug Hypersensitivity - etiology
Drug Hypersensitivity - immunology
Drug therapy
Drugs
Female
Glycolipids - immunology
Human bacterial diseases
Humans
Immune response
Immunity, Cellular
Immunoglobulin G
Immunoglobulin M
Immunoglobulins
Infectious diseases
Inflammation
Intradermal Tests
Lepromin test
Leprosy
Leprosy, Borderline - drug therapy
Leprosy, Borderline - immunology
Leprosy, Tuberculoid - drug therapy
Lipopolysaccharides - immunology
Male
Medical research
Medical sciences
Middle Aged
Mycobacterium leprae - immunology
Neuritis - chemically induced
Neuritis - immunology
Patients
Peripheral Nervous System Diseases - chemically induced
Peripheral Nervous System Diseases - immunology
Phenolic compounds
Phenols
Proteins
Risk analysis
Risk Factors
Skin
Smear
Tropical bacterial diseases
Tropical medicine
title Risk factors for type-1 reactions in borderline leprosy patients
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