Management of “Intractable” recurrent erythema nodosum leprosum (ENL) reaction

Leprosy Mailing List –  March 13^th, 2011

Ref: Management of “Intractable” recurrent erythema nodosum leprosum (ENL) reaction.
From:  Ganapati R., Bombay , India  

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Dear Dr Noto

I refer to Dr Jaison A. Barreto’s observation (LML February 26th, 2011) that after treating the household contacts for lepromatous leprosy the index case responded to “intractable recurrent“ ENL.  I cannot understand the basis of this assumption.  It is well established that in leprosy, the host parasite relationship in relation to immunity decides the out came of the disease.  The occurrence of events like reactions in a mild, moderate or “intractable” form is also related to immune mechanisms of the host as well as the adverse effect of antigens derived from M. leprae.

There should be a strong scientific reason to conclude that the bacilliferous household contacts will influence the reaction adversely and the treatment of the contacts will help in any way. 

Can any of the readers throw some light on this hypothesis?

With regards,

R Ganapati

Director Emeritus

Bombay Leprosy Project Vidnyan Bhavan, 11, V.N.Purav Marg

Sion-Chunabharri

Bombay - 400 022 India