Stress can trigger leprosy reactions

Leprosy Mailing List – March 27^th, 2011

Ref:    Stress can trigger leprosy reactions (?)
From: Barreto J. A., Bauru, SP, Brazil

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Dear Salvatore,

Thank you very much for the report of Dr. Barminus (LML, March 18th, 2011).  His observations are very interesting.  I would like to offer some comments.

Relapses of Erythema Nodosum Leprosum (ENL) reactions which occur a few days after a patient's discharge (from the hospital) is a common situation, as well as after traveling to endemic areas, as pointed out by me. The patients of Dr. Barminus who had episodes of ENL within a few days after being discharge from the hospital, and the fact that the reactions subsided after one patient moved into the house of the chief nursing, while the other one was employed by the hospital, can be explained by the absence of re-exposure to environmental bacilli or to other antigens of infectious origin.

For five years now none of these 2 patients showed any sign of recurrent ENL.  This is consistent with the hypothesis that stress (environmental, physical, emotional), which could be due to the re-exposure of a high load of the same bacilli or to other hazardous parasites, like worms, viruses, bacteria, or brought about by poverty, like desnutrition, commonly present in areas with poor social conditions, can trigger the immune system and could initiate inflammatory (leprosy) reactions.  So, I agree with Dr Barminus and we must look beyond hospital (medical) care to help our patients.

Nevertheless, more studies must be done to prove these associations.

Best regards,

Jaison A. Barreto

Instituto Lauro de Souza Lima

Bauru, SP, Brazil