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Mycobacterium leprae DNA Associated with Type 1 Reactions in Single Lesion Paucibacillary Leprosy Treated with Single Dose Rifampin, Ofloxacin, and Minocycline

Leprosy affects skin and peripheral nerves, and acute inflammatory type 1 reactions (reversal reaction) can cause neurologic impairment and disabilities. Single skin lesion paucibacillary leprosy volunteers (N = 135) recruited in three Brazilian endemic regions, treated with single-dose rifampin, ofloxacin, and minocycline (ROM), were monitored for 3 years. Poor outcome was defined as type 1 reactions with or without neuritis. IgM anti-phenolic glycolipid I, histopathology, Mitsuda test, and Mycobacterium leprae DNA polymerase chain reaction (ML-PCR) were performed at baseline. ² test, Kaplan-Meir curves, and Cox proportional hazards were applied. The majority of volunteers were adults with a mean age of 30.5 ± 15.4 years; 44.4% were ML-PCR positive. During follow-up, 14.8% of the patients had a poor clinical outcome, classified as a type 1 reaction. Older age (40 years), ML-PCR positivity, and lesion size > 5cm were associated with increased risk. In multivariate analysis, age (40 years) and ML-PCR positivity remained baseline predictors of type 1 reaction among monolesion leprosy patients.

Received February 28, 2007. Accepted for publication August 23, 2007.

Acknowledgments: The authors thank the staff of the collaborative institutions for their support during clinical follow-up.

Financial support: This work was supported by United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (Grant 981007) and Brazilian Research Council CNPq Grants 307963/2004-7 to CMTM and 450010/0007 to MMAS. This Multicentric SSL-PB project was conducted by the following Brazilian Institutions: Tropical Pathology and Public Health Institute, Federal University of Goiás (IPTSP/Goiás State—host institution), Fundação Alfredo da Matta (FUAM/Amazonas State), Federal University of Rio de Janeiro and Fiocruz (Rio de Janeiro State), and Leprosy Control Program (Rondônia State) in partnership with the National Hansen’s Disease Program, Louisiana (NHDP/USA).

^* Address correspondence to Mariane M. A. Stefani, Tropical Pathology and Public Health Institute, Universidade Federal de Goias Rua 235 esq. c/1ª Avenida, S/N, Setor Universitario, Goiania, Goias CEP 74605-050, Brazil. E-mail: mstefani{at}iptsp.ufg.br

Authors’ addresses: Ana Lucia O. M. Sousa, Universidade Federal de Goias Rua 235 esq. c/1ª Avenida, S/N. Setor Universitario. Goiania, Goias, Brazil CEP 74605-050, Telephone: 55-62-3202-0500, Fax: 55-62-3202-500, E-mail: almaroclo{at}dm.com.br. Mariane M. A. Stefani, Universidade Federal de Goias Rua 235 esq. c/1ª Avenida, S/N. Setor Universitario. Goiania, Goias, Brazil CEP 74605-050, Telephone: 55-62-3209-6111, Fax: 55-62-3251-1938, E-mail: mstefani{at}iptsp.ufg.br. Gisner A. S. Pereira, Universidade Federal de Goias Rua 235 esq. c/1ª Avenida, S/N. Setor Universitario. Goiania, Goias, Brazil CEP 74605-050, Telephone: 55-62-3209-6111, Fax: 55-62-3251-1938, E-mail: gisner{at}terra.com.br. Mauricio B. Costa, Faculdade de Medicina-Universidade Federal de Goiás. Rua 235 esq. c/1ª Avenida, S/N. Setor Universitario. Goiania, Goias, Brazil CEP 74605-050, Telephone: 55-62-3202-0500, Fax: 55-62-3202-0500, E-mail: mbarcelos{at}cultura.com.br. Paula F. Rebello, Av. Djalma Batista S/N–Conj. Jardim Haydéa III, casa 10 Chapada–Manaus/AM, Brazil CEP 69.050-630, E-mail: epi{at}fuam.am.gov.br. Maria Katia Gomes, Universidade Federal do Rio de Janeiro Hospital Universitário/ Serviço de Dermatologia, Quinto andar Av Brigadeiro Trompovsky, S/N Ilha do Fundão Rio de Janeiro/RJ, Brazil, Telephone: 55-21-2562-2580, Fax: 55-21-2287-9696, E-mail: mkgomes{at}gmail.com. Kazue Narahashi, Secretariat of Health, Porto Velho, Rondônia State, Brazil Caixa Postal 1846, Agência Central, Porto Velho/RO/Brazil CEP 78 900-970, Telephone: 55-69-3223-2665, E-mail: knarahashi{at}uol.com.br. Thomas P. Gillis, Laboratory Research Branch, National Hansen’s Disease Programs, Baton Rouge, LA 70803, Telephone: 225-578-9836, E-mail: tgillis{at}lsu.edu. James L. Krahenbuhl, Laboratory Research Branch, National Hansen’s Disease Programs, Baton Rouge, LA 70803, Telephone: 225-756-3776. Celina M. T. Martelli, Universidade Federal de Goias, Rua 235 esq. c/1ª Avenida, S/N. Setor Universitario, Goiania, Goias, Brazil CEP 74605-050, Telephone: 55-62-3202-0500, Fax: 55-62-3202-0500, E-mail: celina{at}iptsp.ufg.br.