TUBERCULOSIS IN LEPROSY PATIENTS DETECTED BETWEEN 1902 AND 1991 IN FRENCH-POLYNESIA

From 1902 onward notification and follow up of leprosy patients has be en systematic in French Polynesia. Since 1960, a tuberculosis control program and a register has also been implemented. From 1902 to 1959, 6 73 cases of leprosy were detected [346 multibacillary (MB), 138 paucib acillary (PB), and 179 unclassified due to the loss of medical files b y the time of classification which was done during the 1980s]. Of thes e 673 cases, 89 (13.2%) died from tuberculosis, giving a mean annual d eath rate of tuberculosis in leprosy patients of 232 per 100,000. Mort ality from tuberculosis in leprosy patients detected between 1901 and 1930 was 20.7%, and decreased to 8.04% in patients detected from 1931 to 1959. In total, it was estimated that 26.4% of the leprosy cases ha d developed tuberculosis. From 1960 to 1991, 350 new cases of leprosy were detected (I 41 MB, 209 PB). Of them, 12 (3.4%) developed tubercul osis (7 before detection of leprosy, 5 after detection of leprosy). Th e dramatic decrease of the proportion of leprosy patients who develope d tuberculosis between the periods 1902-1959 (26.4%) and 1960-1991 (3. 4%) might be related to the important decline of the tuberculosis situ ation since 1960. From 1902 to 1959, mortality from tuberculosis occur red significantly more frequently in MB patients (13%) than in PB pati ents [4%, relative risk (RR) = 3.21, p = 0.003]. From 1960 to 199 1, t he incidence of tuberculosis seemed more frequent in MB patients (RR = 2.96, p = 0.07) whatever the sequence of detection of the two disease s. Our study suggests that lepromatous patients could share factors of susceptibility to mycobacterial diseases with patients developing tub erculosis.