Leprosy is a disease caused by听Mycobacterium leprae.听The prevalence of new leprosy patients in Indonesia has decreased over time.听However, leprosy patients usually experience an inflammation episode called leprosy reaction.听There are two types of leprosy reactions, type 1 reaction, and type 2 reaction (Erythema nodosum leprosum).听It is based on the type of immunity that plays a role.听If it is not handled correctly, this reaction will lead to disability.
Type I leprosy reaction is caused by an increase in cellular immune response in the form of a slow type hypersensitivity reaction to听Mycobacterium leprae听antigens听in the nerves and skin.听This reaction is a result of the change in the balance of听cell-mediated immunity听(CMI) and bacilli.听When a type 1 leprosy reaction occurs, there are two possible outcomes of this reaction:听upgrading / reversal听if there is an increase in the CMI response to the听Mycobacterium leprae听antigen听that it leads to a tuberculoid or听downgrading听clinical form听if there is a decrease in the CMI response to the antigen that leads to the clinical form of lepromatous.
Subpolar type of leprosy patients has unstable immunity, so they often experience repetitive type I reactions especially听borderline听borderline leprosy听(BB) type听because the number of bacilli and CMI levels are relatively balanced so it is very easy to experience changes in immune response.听The prevalence of leprosy type 1 reactions reaches 8-33% of all leprosy patients.听In multibacillary leprosy patients (MB), especially the BB type, the incidence reaches 70.9%.听Type 1 leprosy reaction is experienced by many men and people aged 14 years and over.
Type 1 leprosy reaction will show inflammation symptom of the skin or nerves. There is redness, swelling, pain, and heat on the skin. In some instances, fever may be experienced by the patient. There are also pain and disruption in the nerves, and it may cause disability, such as paralysis and deformity.
A retrospective study conducted by the Leprosy Division of Dermatology and Venereology Outpatient Clinic RSUD Dr.听Soetomo from January 2014 to December 2017 found that type 1 reactions occurred in 68 of 516 new leprosy patients (13.2%) where听60.3% were male, and 41.2% were aged between 15-34 years.听Patients with type 1 reactions had some symptoms, thick red spots (80.9%) and without systemic symptoms (42.6%) and without peripheral nerve symptoms (70.6%).听This reaction generally occurs during the first six months of multidrug treatment听(MDT) administration.听Patients who have been diagnosed with type 1 leprosy reaction were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and sometimes combined with corticosteroids.
References showed that 6-67% of leprosy patients would experience type 1 leprosy reaction. Therefore, this reaction is a natural journey of leprosy, so the prevalence is not much different worldwide.听The most type 1 reaction was found in MB type (97%) especially BB type (72.1%).听The high proportion of new MB leprosy patients is caused by this type of symptom which is more visible than the papillary bacilli (PB) type or can be caused by late and irregular administration of MDT.听The most common symptom that occurs most often in type 1 reactions are thickened long red blotches.听Thickening long red spots is a sign of increased CMI which shows localized inflammation to the skin.听Moreover, type 1 reactions may give symptoms of new spots, nodules,听or a combination of the three.听On the other hand, systemic or constitutional symptoms such as fever, malaise, and joint pain are rarely seen in patients with type 1 reactions because the increasing CMI makes the symptoms limited to nerves and skin.听Patients with type 2 reactions often accompanied by systemic symptoms such as fever due to an increase in humoral immune response.听Regarding the symptoms of peripheral nerves in type 1 reactions, there is only pain and disruption of nerve function due to increased CMI and sometimes even appear without symptoms.
Type 1 reactions frequently occur during the MDT treatment period due to excessive rise in CMI to eat fragments of germs that have died due to MDT administration. With a typical symptom of thick red spots long. If a type 1 reaction occurs, OAINS is given to mild degrees of corticosteroids to prevent further inflammation in the nerves that cause disability.
Author: Prof. Dr. dr. Cita Rosita Sigit Prakoeswa, SpKK (K), FINS-DV, FAADV
Details of the research available at:
Article: Restrospective Study: Type 1 Leprosy Reaction
Ridha Ramadina Widiatma, Cita Rosita Sigit Prakoeswa
Department of Dermatology and Venereology, Faculty of Medicine, 51动漫 / Dr. Soetomo General Hospital, Surabaya, Indonesia
