title: Mycobacterium leprae DNA associated with type 1 reactions in single lesion paucibacillary leprosy treated with single dose rifampin, ofloxacin, and minocycline.
abstract: Leprosy affects skin and peripheral nerves, and acute inflammatory type 1 reactions (reversal reaction) can cause neurologic impairment and disabilities. Single skin lesion paucibacillary leprosy volunteers (N = 135) recruited in three Brazilian endemic regions, treated with single-dose rifampin, ofloxacin, and minocycline (ROM), were monitored for 3 years. Poor outcome was defined as type 1 reactions with or without neuritis. IgM anti-phenolic glycolipid I, histopathology, Mitsuda test, and Mycobacterium leprae DNA polymerase chain reaction (ML-PCR) were performed at baseline. chi(2) test, Kaplan-Meir curves, and Cox proportional hazards were applied. The majority of volunteers were adults with a mean age of 30.5 +/- 15.4 years; 44.4% were ML-PCR positive. During follow-up, 14.8% of the patients had a poor clinical outcome, classified as a type 1 reaction. Older age (> or = 40 years), ML-PCR positivity, and lesion size > 5 cm were associated with increased risk. In multivariate analysis, age (> or = 40 years) and ML-PCR positivity remained baseline predictors of type 1 reaction among monolesion leprosy patients.
authors.affiliation: Tropical Pathology and Public Health Institute, Federal University of Goias, Goiania, Goias, Brazil. almaroclo@dm.com.br
authors.forename: Ana Lucia O M
authors.initials: AL
authors.lastname: Sousa
authors.forename: Mariane M A
authors.initials: MM
authors.lastname: Stefani
authors.forename: Gisner A S
authors.initials: GA
authors.lastname: Pereira
authors.forename: Mauricio B
authors.initials: MB
authors.lastname: Costa
authors.forename: Paula F
authors.initials: PF
authors.lastname: Rebello
authors.forename: Maria Katia
authors.initials: MK
authors.lastname: Gomes
authors.forename: Kazue
authors.initials: K
authors.lastname: Narahashi
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Gillis
authors.forename: James L
authors.initials: JL
authors.lastname: Krahenbuhl
authors.forename: Celina M T
authors.initials: CM
authors.lastname: Martelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000302:isolation & purification*; D004893:Erythema Nodosum / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007918:Leprosy / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use*; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D015242:Ofloxacin / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D012293:Rifampin / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D004269:DNA, Bacterial; D015242:Ofloxacin; D008911:Minocycline; D012293:Rifampin