Sunday, February 15, 2015

Study group discussion: Lepra type 1 and type 2 reaction

Can somebody explain lepra reaction in leprosy?

When the bacteria is killed, it's toxins are released & these toxins exaggerate the lesions.. More painful more red etc..

Lepra reaction 1 and 2?

I know that Lepra reaction 1 is type 4 HR and Lepra reaction 2 is type 3 HR.

Yes, 1 is 4, 2 is 3. The sum should be 5, that was my mnemonic

Oh okay ! Thanks for clearing this!!

This is a good way of remembering! 4+1=5 & 2+3=5!

Mnemonic you have to sum up so that total comes out to be 5
So in Lepra 1 + 4 HR = 5
And Lepra 2 + 3 HR =5

It's similar to the Jarisch Herxheimer reaction in syphilis right?!

Yes, the antigens cause the reaction.

Sometimes it happens when the patient begins treatment and loses faith in the doctor because of the reaction!

Woah! Loses faith in doctor!

Yes, so you have to explain the patient well. Maybe inform about the possibility before hand.

Is ENL the same? Or the severe form of lepra reaction?
Type 2 is ENL.
What's the difference between type 2 and 1?

The 2 is a type 3 hypersensitivity. Meaning deposition of antigen-antibody complexes.

Type 4 reaction is a delayed hypersensitivity due to t- lymphocytes. Which is seen lepra reaction type 1.

Type 1 is mediated by Th1 cells and type 2 is mediated by Th2 cells

In lepra reaction type 1 - there is widespread new lesions all over the body, cause those  Ag-ab reactions get deposited everywhere.

In type 2, the existing lesions become more pronounced, more red.

There are other differences based on extent of nerve damage and blah blah..Which I don't remember!

Treatment?

Aspirin!

Treatment is aspirin, steroids and even an anti leprosy drug, I guess.

Chloroquine.

Thalidomide used to be ...Not used now, right? Thalidomide is completely discarded due to  phocomelia.

Oh no.. It is still used. But strictly avoided in pregnancy.

In which case?

Used in behcet disease, Multiple myeloma.

Thalidomide is used only for type 2 reaction, not type 1.

And which anti leprosy drug was it? Clofamizine?

Yes.

*the discussion went on types of hypersensitivity reactions, which will be continued in the next post!*

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