Pitta Izabela Jardim Rodrigues, Hacker Mariana Andrea, Vital Robson Teixeira, Andrade Ligia Rocha, Spitz Clarissa Neves, Sales Anna Maria, Antunes Sergio Luiz Gomes, Sarno Euzenir Nunes, Jardim Marcia Rodrigues
Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Front Med (Lausanne). 2022 Mar 25;9:865485. doi: 10.3389/fmed.2022.865485. eCollection 2022.
Leprosy reactions are complications that can occur before, during, or after multidrug therapy (MDT) and are considered a major cause of nerve damage. Neuritis is an inflammatory process that causes nerve function impairment associated with pain and tenderness along the nerve. Neuritis can be found in both type 1 and type 2 reactions and may also be the sole manifestation of a leprosy reaction. The objective of this study is to describe the incidence of leprosy reactions and its association with neuropathic pain in pure neural leprosy (PNL) patients.
We selected 52 patients diagnosed with PNL and 67 patients with other clinical forms of leprosy. During the MDT the patients visited the clinic monthly to take their supervised dose. The patients were instructed to return immediately if any new neurological deficit or skin lesions occurred during or after the MDT.
Of the PNL patients, 23.1% had a leprosy reaction during or after the MDT, while this was 59.7% for patients with the other clinical forms of leprosy. There was an association between having PNL and not having any reaction during and after the MDT, as well as having PNL and having neuritis after the MDT.There was also an association between having previous neuritis and having neuropathic pain in the other clinical forms of leprosy group, although this association was not present in the PNL group.
Our data suggest that PNL is a different form of the disease, which is immunologically more stable. In addition, PNL patients have more neuritis than the classical leprosy skin reactions. In PNL there was no association between acute neuritis and neuropathic pain, suggesting that these patients may have had silent neuritis. Understanding and identifying neuritis is essential to reduce disability and the impact on public health.
麻风反应是多药联合治疗（MDT）之前、期间或之后可能出现的并发症，被认为是神经损伤的主要原因。神经炎是一种炎症过程，会导致神经功能受损，并伴有沿神经的疼痛和压痛。1型和2型反应中均可出现神经炎，它也可能是麻风反应的唯一表现形式。本研究的目的是描述麻风反应的发生率及其与纯神经型麻风（PNL）患者神经性疼痛的关联。
我们选取了52例诊断为PNL的患者和67例其他临床类型的麻风患者。在MDT治疗期间，患者每月到诊所接受监督服药。患者被告知，如果在MDT治疗期间或之后出现任何新的神经功能缺损或皮肤损害，应立即复诊。
在PNL患者中，23.1%在MDT治疗期间或之后出现了麻风反应，而其他临床类型的麻风患者这一比例为59.7%。患有PNL与在MDT治疗期间及之后未出现任何反应之间存在关联，同时患有PNL与在MDT治疗后出现神经炎之间也存在关联。在其他临床类型的麻风患者组中，既往有神经炎与患有神经性疼痛之间也存在关联，尽管在PNL组中不存在这种关联。
我们的数据表明，PNL是一种不同的疾病形式，其免疫状态更为稳定。此外，PNL患者比经典的麻风皮肤反应患者有更多的神经炎。在PNL中，急性神经炎与神经性疼痛之间没有关联，这表明这些患者可能存在隐匿性神经炎。了解和识别神经炎对于减少残疾以及对公共卫生的影响至关重要。
