REACTIONS IN LEPROSY - AN EPIDEMIOLOGIC-STUDY OF 386 PATIENTS IN WESTNEPAL

This paper presents epidemiological data on reversal reaction (RR) and erythema nodosum leprosum reaction (ENL) from a retrospective study o f 386 leprosy patients newly registered at Green Pastures Hospital, Po khara, West Nepal. The average follow-up time was 21 months. The preva lence of RR at first examination was 28% (23-32), and the prevalence o f ENL reaction was 5.7% (2.3-9.2). The overall incidence rates among t he 335 patients that were available for follow-up were 8.7 (6.5-12)/10 0 person years at risk (PYAR) for RR and 3.2 (1.5-6.7)/100 PYAR for EN L. Relapse of RR was common (1.4/patient). In all, 52% of RR were comp licated by new nerve function impairment, against 59% of ENL reactions . The finding of other investigators that most RRs occur during the fi rst year of treatment was confirmed by this study. The most significan t risk factor for RR was extent of clinical disease measured by a coun t of body areas with clinical signs of leprosy. The risk of developing a RR for patients with 'extensive disease' (3 or more out of 9 body a reas involved) was 10 times that of patients with limited disease (Rat e Ratio 10 (1.3-76), p = 0.026). The study indicated that the followin g categories of patients in Nepal are at high or increased risk of dev eloping a RR: 1, borderline patients during their first year of MDT; a nd 2, patients with more extensive clinical disease as described above .