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REACTIONS &
NEURITIS
REACTIONS:
The appearance of systemic or localized
signs of acute inflammation on patients with
leprosy or who have had leprosy.
Reactions can occur before diagnosis,
during treatment, and even after cure.
2 TYPES OF REACTIONS:
Type 1: Reversal Reaction
An effect of increased immune system
response to bacilli or fragments of bacilli.
This leads to an acute, localized, cell
mediated inflammatory response.
Affects both PB and MB patients.
2 TYPES OF REACTIONS:
Type 2: Erythema Nodosum Leprosum
Only affects MB patients.
Results when large numbers of
Mycobacterium leprae are killed and
decompose.
The proteins from
dead bacilli cause an
allergic reaction.
MEDICAL MANAGEMENT:
When signs of reaction and/or neuritis
are found, ACT IMMEDIATELY!
Management
Give only analgesics.
Do Nerve Function
Assessment (NFA)
every two (2) weeks.
Advise bed rest.
Continue MDT.
Nerve tenderness
Swollen lesion(s) in
the face.
Management
Give the prescribed
WHO Prednisone
treatment.
Continue MDT
Do NFA every two (2)
weeks.
Refer patients with
persistent, recurrent &
non-responding
reactions.
High fever.
Reddish nodules
Painful neuritis.
Joint pain.
Skin ulceration
Orchitis, iritis,
ostitis, nephritis,
swollen hands, feet
& face.
Management
Give the prescribed
WHO Prednisone
treatment.
Continue MDT
Do NFA every two (2)
weeks.
Refer patients with
persistent, recurrent &
non-responding
reactions.
Prednisone should be
taken in the morning after
a full meal.
Lack of cooperation;
Hypertension;
Mature cataract;
Glaucoma;
Pregnancy;
Ulceration;
If Prednisone is contraindicated or
insufficient to control recurrence, give:
Clofazimine:
300mg / day during the 1st month.
200mg / day during the 2nd month.
100mg / day during the 3rd month.
Distinguishing Features
Between Reaction and Relapse:
Feature
Onset
Reaction
Relapse
Sudden
(weeks or months)
Distinguishing Features
Between Reaction and Relapse:
Feature
Reaction
Relapse
Generally occurs
long after
chemotherapy is
discontinued, after
an interval of at
least 6 months, but
usually after 2
years.
Distinguishing Features
Between Reaction and Relapse:
Feature
Old
Lesions
Reaction
Some or all the
existing lesions
become
erythematous,
shiny or swollen.
Relapse
The margins of
some may become
erythematous.
Distinguishing Features
Between Reaction and Relapse:
Feature
New
Lesions
Reaction
Previously
undetected lesions
may become
visible.
Relapse
Few, but always in
different sites than
previous lesions.
Distinguishing Features
Between Reaction and Relapse:
Ulceration
Feature
Reaction
Sometimes.
Relapse
Unusual.
Distinguishing Features
Between Reaction and Relapse:
Feature
Scaling
Reaction
Lesions
desquamate as
they subside.
Relapse
Absent.
Distinguishing Features
Between Reaction and Relapse:
Nerve
Involvement
Feature
Reaction
Common: many
nerves may
rapidly become
painful and tender;
disturbances
develop rapidly.
Relapse
A single nerve
becomes involved;
disturbances
develop slowly.
Distinguishing Features
Between Reaction and Relapse:
General
Condition
Feature
Reaction
Relapse
Distinguishing Features
Between Reaction and Relapse:
Response to
Prednisone
Feature
Reaction
Excellent.
Relapse
Lesions do not
subside with
Prednisone.
Distinguishing Features
Between Reaction and Relapse:
Drug
Compliance
Feature
Reaction
May have been
good.
Relapse
Poor.