LAUSR

Dear Editor, The clinical manifestations of leprosy are varied and depend on genetic predisposition, environmental and immunological factors and the disease is punctuated by reactional episodes that result in significant morbidity, deformity and disability. AMR surveillance has reported resistance from endemic countries like India, Brazil, Indonesia, Nepal and Columbia. Our aim was to undertake a prospective case control study to study the prevalence of drug resistance in reactions and the effect of modified second line treatment Anti leprosy treatment (ALT). We studied patients of age > 18 years attending the leprosy clinic with a sample size of 42 cases and 40 controls. The diagnosis of T1R and T2R and upgrading and downgrading reaction was based on established clinical and histopathological findings. The diagnosis of static reaction was made when there was clinical evidence of reaction in the absence of histological change in disease spectrum and is beleived to be an ineffective attempt at upgrading. T2R was subclassified as acute, recurrent, chronic and late T2R. Detailed examination, investigations for known trigger factors and resistance testing were done. The treatment of cases and controls was based on standard guidelines. Of the total 42 cases and 40 control, resistance was seen in 14/42 (33.3%) in cases as compared with 3/40 (7.5%) of controls (p = 0.008; Table 1). In reactional group, the most common type of leprosy was LL Hansen (n = 25, 59.5.%) followed by BT Hansen (n = 13, 31%), BL Hansen (n = 3, 7.1%) and TT Hansen (n = 1, 2.5%). In the control group, BT Hansen (n = 27, 67.5%) was followed by LL Hansen (n = 9, 22.5), BL Hansen (n = 2, 5%) and one patient (2.5%) of BB Hansen and TT Hansen. T2R (n = 27, 64.3%) was more common than T1R (n = 15, 35.7%). In the T1R group, downgrading reaction was more commonly seen (n = 12, 80%) followed by upgrading reaction (n = 2, 13.3%) and static reaction (n = 1, 6.7%). LLsp Hansen was the most common spectrum to undergo T2R and chronic T2R (n = 14, 51.9%) was the most common subtype seen. In the Late reaction Received: 9 December 2021 | Accepted: 25 October 2022