Leprosy reactions: coinfections as a possible risk factor.
OBJECTIVE
This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes.


METHODS
A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections.


RESULTS
Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%).


CONCLUSIONS
Coinfections may be involved in the development and maintenance of leprosy reactions.
Division of Dermatology, Departamento de Clínica Médica, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto/SP, Brazil. anacfm@usp.br
Ana Carolina F
AC
Motta
Karla Juliana
KJ
Pereira
Daniela Chaves
DC
Tarquínio
Mariana Bellini
MB
Vieira
Karina
K
Miyake
Norma Tiraboschi
NT
Foss
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007918:Leprosy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D055815:Young Adult