A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction.
BACKGROUND: Erythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunos...
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ftdoajarticles:oai:doaj.org/article:96f10e9927a64c5c916c6b58ef346e43 2023-05-15T15:11:55+02:00 A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. Carlijn G N Voorend Erik B Post 2013-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0002440 https://doaj.org/article/96f10e9927a64c5c916c6b58ef346e43 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC3789767?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0002440 https://doaj.org/article/96f10e9927a64c5c916c6b58ef346e43 PLoS Neglected Tropical Diseases, Vol 7, Iss 10, p e2440 (2013) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2013 ftdoajarticles https://doi.org/10.1371/journal.pntd.0002440 2022-12-31T10:46:05Z BACKGROUND: Erythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunosuppressive drugs. Global occurrence is unknown. METHODOLOGY/PRINCIPAL FINDINGS: Systematic review of evidence on ENL incidence resulted in 65 papers, predominantly from India (24) and Brazil (9), and inclusive of four reviews. Average incidences are based on cumulative incidence and size of study populations (n>100). In field-based studies 653/54,737 (1.2%) of all leprosy cases, 194/4,279 (4.5%) of MB cases, and 86/560 (15.4%) of LL cases develop ENL. Some studies found a range of 1-8 per 100 person-years-at-risk (PYAR) amongst MB cases. Hospital samples indicate that 2,393/17,513 (13.7%) of MB cases develop ENL. Regional differences could not be confirmed. Multiple ENL episodes occurred in 39 to 77% of ENL patients, with an average of 2.6. Some studies find a peak in ENL incidence in the first year of treatment, others during the second and third year after starting MDT. The main risk factor for ENL is a high bacteriological index. CONCLUSIONS/SIGNIFICANCE: Few studies reported on ENL as a primary outcome, and definitions of ENL differed between studies. Although, in this review averages are presented, accurate data on global and regional ENL incidence is lacking. Large prospective studies or accurate surveillance data would be required to clarify this. Health staff needs to be aware of late reactions, as new ENL may develop as late as five years after MDT completion, and recurrences up to 8 years afterwards. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 7 10 e2440 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Carlijn G N Voorend Erik B Post A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Erythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunosuppressive drugs. Global occurrence is unknown. METHODOLOGY/PRINCIPAL FINDINGS: Systematic review of evidence on ENL incidence resulted in 65 papers, predominantly from India (24) and Brazil (9), and inclusive of four reviews. Average incidences are based on cumulative incidence and size of study populations (n>100). In field-based studies 653/54,737 (1.2%) of all leprosy cases, 194/4,279 (4.5%) of MB cases, and 86/560 (15.4%) of LL cases develop ENL. Some studies found a range of 1-8 per 100 person-years-at-risk (PYAR) amongst MB cases. Hospital samples indicate that 2,393/17,513 (13.7%) of MB cases develop ENL. Regional differences could not be confirmed. Multiple ENL episodes occurred in 39 to 77% of ENL patients, with an average of 2.6. Some studies find a peak in ENL incidence in the first year of treatment, others during the second and third year after starting MDT. The main risk factor for ENL is a high bacteriological index. CONCLUSIONS/SIGNIFICANCE: Few studies reported on ENL as a primary outcome, and definitions of ENL differed between studies. Although, in this review averages are presented, accurate data on global and regional ENL incidence is lacking. Large prospective studies or accurate surveillance data would be required to clarify this. Health staff needs to be aware of late reactions, as new ENL may develop as late as five years after MDT completion, and recurrences up to 8 years afterwards. |
format |
Article in Journal/Newspaper |
author |
Carlijn G N Voorend Erik B Post |
author_facet |
Carlijn G N Voorend Erik B Post |
author_sort |
Carlijn G N Voorend |
title |
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
title_short |
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
title_full |
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
title_fullStr |
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
title_full_unstemmed |
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
title_sort |
systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2013 |
url |
https://doi.org/10.1371/journal.pntd.0002440 https://doaj.org/article/96f10e9927a64c5c916c6b58ef346e43 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 7, Iss 10, p e2440 (2013) |
op_relation |
http://europepmc.org/articles/PMC3789767?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0002440 https://doaj.org/article/96f10e9927a64c5c916c6b58ef346e43 |
op_doi |
https://doi.org/10.1371/journal.pntd.0002440 |
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PLoS Neglected Tropical Diseases |
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7 |
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10 |
container_start_page |
e2440 |
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