title: Tumor necrosis factor: status in reactions in leprosy before and after treatment.
abstract: BACKGROUND
  Tumor necrosis factor-alpha (TNF) is an important mediator of immunologic responses to chronic infections.
  
  
  METHODS
  Sera from 25 patients with acute reactions (6 with type 1 upgrading, 8 with type 1 downgrading, and 11 with type 2 reaction) were assayed for TNF before treatment and after clinical remission of the acute episode. The results were compared with serum TNF levels in healthy controls and fresh pauci- and multibacillary leprosy patients.
  
  
  RESULTS
  TNF levels in acute reactions were higher than in the control groups (significant only in upgrading reaction). In type 1 reaction, serum TNF concentrations fell to approximately the levels of the control patients following treatment and clinical remission. In type 2 reaction, however, levels of TNF were seen to rise further (became statistically significant) as a result of therapy induced clinical remission.
  
  
  CONCLUSIONS
  The rise in TNF-alpha level in reactions in leprosy is significant and indicates its active role in immunopathogenesis. The corresponding decline in TNF-alpha levels seen following regression of type 1 (lepra) reactions was not observed in the case of type 2 (ENL) reaction. This probably reflects the enhancement of cellular immunity in such cases and/or an attempt by the immunologic process to overcome specific inhibitors.
authors.affiliation: Department of Dermatology and Venereology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: S N
authors.initials: SN
authors.lastname: Bhattacharya
authors.forename: D
authors.initials: D
authors.lastname: Chattopadhaya
authors.forename: K
authors.initials: K
authors.lastname: Saha
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002738:Chloroquine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D002991:Clofazimine / Q000008:administration & dosage / Q000627:therapeutic use; D004893:Erythema Nodosum / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000097:blood* / Q000188:drug therapy; D007917:Leprostatic Agents / Q000627:therapeutic use; D015439:Leprosy, Borderline / Q000097:blood* / Q000188:drug therapy*; D015440:Leprosy, Lepromatous / Q000097:blood* / Q000188:drug therapy*; D015441:Leprosy, Tuberculoid / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013607:Tablets; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007917:Leprostatic Agents; D013607:Tablets; D014409:Tumor Necrosis Factor-alpha; C023676:chloroquine diphosphate; D002738:Chloroquine; D011239:Prednisolone; D002991:Clofazimine