Leprosy Mailing List – January 29, 2018
Ref.: (LML) Mortality in leprosy
From: Shimelis Nigusse Doni, Addis Abeba, Ethiopia
Arry Pongtiku (LML, January 26, 2018) asked how to address mortality in leprosy and described examples which distinguished between the direct cause of death ((the final disease, injury, or complication directly causing death) and underlying cause of death (the disease or injury that initiated the chain of morbid events that led directly and inevitably to the death).
There is one study which may be of interest: Stephen L. Walker, Eglantine Lebas, Shimelis N. Doni, Diana N. J. Lockwood and Saba M. Lambert. The Mortality Associated with Erythema Nodosum Leprosum in Ethiopia: A Retrospective Hospital-Based Study. PLoS Negl Trop Dis. 2014 Mar; 8(3): e2690 doi: 10.1371/journal.pntd.0002690 PMCID: PMC3953021
Erythema nodosum leprosum (ENL) is a debilitating multisystem disorder which complicates leprosy. It is characterised by fever, malaise and painful erythematous cutaneous nodules. ENL is often recurrent or chronic in nature and frequently severe. Patients often require prolonged treatment with high doses of oral corticosteroids. There are no data on the mortality associated with treated ENL.
The notes of patients who were admitted, discharged, transferred to another facility or died with a diagnosis of leprosy or a leprosy-related complication for a five-year period were reviewed.
414 individuals were identified from the ward database. 312 (75.4%) patient records were located and reviewed. Ninety-nine individuals had ENL and 145 had a Type 1 reaction. The median age of individuals with ENL was 25 years. Eight patients with erythema nodosum leprosum died compared with two diagnosed with Type 1 reaction. This difference is statistically significant (p = 0.0168, Fisher's Exact Test). There is a significant mortality and morbidity associated with ENL in this Ethiopian cohort. The adverse outcomes seen are largely attributable to the chronic administration of oral corticosteroids used to control the inflammatory and debilitating symptoms of the condition.
Shimelis Nigusse Doni (M.D)
Head Leprosy and Dermatology Departement
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/Contact