| Autor: |
Fairley JK; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia., Ferreira JA; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., de Oliveira ALG; Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil., de Filippis T; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., de Faria Grossi MA; Secretaria de Estado da Saúde de Minas Gerais, Belo Horizonte, Brazil., Chaves LP; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Caldeira LN; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Dos Santos PS; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Costa RR; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Diniz MC; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Duarte CS; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil., Bomjardim Pôrto LA; Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil., Suchdev PS; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia., Negrão-Corrêa DA; Departamento de Parasitologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil., do Carmo Magalhães F; Departamento de Parasitologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil., Peixoto Moreira JM; Departamento de Parasitologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil., de Melo Freire Júnior A; Laboratório São Marcos, Belo Horizonte, Brazil., Cerqueira MC; Laboratório São Marcos, Belo Horizonte, Brazil., Kitron U; Department of Environmental Sciences, Emory University, Atlanta, Georgia., Lyon S; Faculdade Saúde e Ecologia Humana (FASEH), Vespasiano, Brazil. |
| Abstrakt: |
Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni , Strongyloides , and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy. |
