Some immunological aspects in the reaccional states of Hansen disease

The crucial clinical problem in leprosy is represented by episodes of intense inflammation that produce nerve damage. When Mycobacterium leprae has been eliminated by means of antibiotics, the death of the bacteria is not a complete solution to the damage caused in nerves. Two of the more frequent immunopathological phenomena in Hansen's disease are Type I, reactions, known as Reversal Reactions (RR), and Type II reactions, of which the most frequent and well known are those called Erythema Nodosum Leprosum (ENL). Type II reactions have been defined as an immunologic complication in multibacillary patients. Both types of reactions are accompanied mainly by the increase of pro-inflammatory cytokines TNF-alpha, IL-1, IL-2, IL-4, IL-6, IL-8, INF-gamma, IL-10, IL-12, among others. In a retrospective analysis of a population of 150 patients of the Central Service of Dermatology, Institute of Biomedicine, where these patients were subjected to Multidrug Therapy (MDT) and MDT + inmunotherapy (IMT), both groups presented type II reactions, but the group that additionally received inmunotherapy also presented type I reactions. In the group of patients that presented ENL, it appeared to be associated with the large amount of bacilli in their lesions.