ENLIST 1: An International Multi-centre Cross-sectional Study of the Clinical Features of Erythema Nodosum Leprosum.
Erythema nodosum leprosum (ENL) is a severe multisystem immune mediated complication of borderline lepromatous leprosy and lepromatous leprosy. ENL is associated with skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. The treatment of ENL requires immunosuppression, which is often required for prolonged periods of time and may lead to serious adverse effects. ENL and its treatment is associated with increased mortality and economic hardship. Improved, evidence-based treatments for ENL are needed; however, defining the severity of ENL and outcome measures for treatment studies is difficult because of the multiple organ systems involved. A cross-sectional study was performed, by the members of the Erythema Nodosum Leprosum International STudy (ENLIST) Group, of patients with ENL attending seven leprosy referral centres in Brazil, Ethiopia, India, Nepal, the Philippines and the United Kingdom. We systematically documented the clinical features and type of ENL, its severity and the drugs used to treat it. Patients with chronic ENL were more likely to be assessed as having severe ENL. Pain, the most frequent symptom, assessed using a semi-quantitative scale was significantly worse in individuals with "severe" ENL. Our findings will determine the items to be included in a severity scale of ENL which we are developing and validating. The study also provides data on the clinical features of ENL, which can be incorporated into a definition of ENL and used for outcome measures in treatment studies.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Stephen L
SL
Walker
Leonard Wood Memorial Center for TB and Leprosy Research, Cebu, Philippines.
Marivic
M
Balagon
The Leprosy Mission Hospital, Purulia, India.
Joydeepa
J
Darlong
ALERT Center, Addis Ababa, Ethiopia.
Shimelis N
SN
Doni
Anandaban Hospital, Kathmandu, Nepal.
Deanna A
DA
Hagge
Bombay Leprosy Project, Mumbai, India.
Vikas
V
Halwai
The Leprosy Mission Trust India, New Delhi, India.
Annamma
A
John
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; ALERT Center, Addis Ababa, Ethiopia.
Saba M
SM
Lambert
Leonard Wood Memorial Center for TB and Leprosy Research, Cebu, Philippines.
Armi
A
Maghanoy
FIOCRUZ, Rio de Janeiro, Brazil.
Jose A C
JA
Nery
Anandaban Hospital, Kathmandu, Nepal.
Kapil D
KD
Neupane
University of Southampton, Southampton, United Kingdom.
Peter G
PG
Nicholls
Bombay Leprosy Project, Mumbai, India.
Vivek V
VV
Pai
Anandaban Hospital, Kathmandu, Nepal.
Pawan
P
Parajuli
FIOCRUZ, Rio de Janeiro, Brazil.
Anna M
AM
Sales
FIOCRUZ, Rio de Janeiro, Brazil.
Euzenir
E
Sarno
Anandaban Hospital, Kathmandu, Nepal.
Mahesh
M
Shah
ALERT Center, Addis Ababa, Ethiopia.
Digafe
D
Tsegaye
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Diana N J
DN
Lockwood
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D004893:Erythema Nodosum / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D007391:International Cooperation; D007917:Leprostatic Agents / Q000627:therapeutic use; D015440:Leprosy, Lepromatous / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D012720:Severity of Illness Index; D055815:Young Adult
D007917:Leprostatic Agents