High dose prednisolone treatment of leprosy patients undergoing reactions is associated with a rapid decrease in urinary nitric oxide metabolites and clinical improvement.
Evidence is accumulating that nitric oxide (NO) produced by macrophages has a role in the pathogenesis of reactions in leprosy. We followed the urinary levels of the metabolites of NO [nitrite (NO2-) and nitrate (NO3-)] and the clinical response to prednisolone treatment in leprosy patients (n = 9) admitted to ALERT leprosy hospital Addis Ababa, Ethiopia, because of reversal reaction (RR) or erythema nodosum leprosum (ENL). In untreated reactional leprosy patients, the levels of urinary NO metabolites (1645 +/- 454 microM, n = 9, ENL = 4, RR = 5) decreased significantly 2 weeks after high dose prednisolone treatment (1075 +/- 414 microM, P < 0.05), and remained stable 4 (895 +/- 385 microM, P < 0.02) and 6 weeks following treatment initiation (1048 +/- 452 microM, P < 0.02). This decrease was also present when the reactional patients were subdivided according to the type of reaction (ENL, RR) and coincided with a clinical improvement. In patients showing a poor clinical response to steroids, no or minor effects on the urinary NO metabolite levels were observed. We conclude that there is a correlation between the decrease in urinary NO metabolites and a favourable clinical response after high dose prednisolone treatment of reactional leprosy patients.
Schön
T
T
Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, Sweden. t.schon@telia.com
Leekassa
R
R
Gebre
N
N
Sundqvist
T
T
Bizuneh
E
E
Britton
S
S
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004893:Erythema Nodosum / Q000188:drug therapy / Q000652:urine; D005260:Female; D006801:Humans; D007918:Leprosy / Q000188:drug therapy* / Q000652:urine; D015439:Leprosy, Borderline / Q000188:drug therapy / Q000652:urine; D015440:Leprosy, Lepromatous / Q000188:drug therapy / Q000652:urine; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism / Q000652:urine*; D011239:Prednisolone / Q000008:administration & dosage*; D011379:Prognosis; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D015415:Biomarkers; D009569:Nitric Oxide; D011239:Prednisolone