Name: TAYNAH ALVES ROCHA REPSOLD

Publication date: 24/02/2022
Advisor:

Name	Role
PATRÍCIA DUARTE DEPS	Advisor *

Examining board:

Name	Role
MOISES PALACI	Internal Examiner *
PATRÍCIA DUARTE DEPS	Advisor *

Summary: Introduction: Hansen’s disease (leprosy) is an infectious disease endemic in Brazil and caused by two species of mycobacteria. Covid-19, caused by the SARS-CoV-2 virus, has caused a pandemic, with Brazil being the country with the 3rd highest number of reported cases and 2nd highest total number of reported deaths. To date (January 2022), the consequences of Mycobacterium leprae complex and SARS-CoV-2 co-infection have not been fully characterised. It is known that the chronic course of Hansen’s disease can be interrupted by Hansen’s disease reactions, involving a sudden increase in production of pro-inflammatory cytokines, superficially similar to the ‘cytokine storm’ that can occur in patients who have severe Covid-19. It has been suggested that SARS-CoV-2 infection might be a risk factor for triggering a Hansen’s disease reactions. Objective: To describe the clinical and epidemiological characteristics of a series of cases of Hansen’s disease and Covid-19 coinfection. Methods: A cross-sectional study in a cohort of Hansen’s disease patients being treated at referral centres located in 5 cities Brazilian cities – Belém (PA), Brasília (DF), Vitória (ES), Palmas (PA) and Petrolina (PE) - from March 1, 2020 to December 20, 2020 WHERE Covid-19 was confirmed by RT-PCR. None of the patients had received any Covid-19 vaccines. Data were collected by medical staff from medical records supplemented by telephone interviews with patients conducted from March 1st to April 23rd, 2021. Results: Of the 1,377 patients undergoing treatment for Hansen’s disease, 70 (5.1%) reported having had Covid-19, of whom 41 had PCR confirmation and provided data. Of the 41 co-infected patients, 19 (46.3%) were men and 22 (53.7%) were women, with a mean age of 46 years. One patient had Hansen’s disease of indeterminate form, 2 (4.9%) tuberculoid, 8 (21.9%) lepromatous, and 29 (70.7%) the borderline form. Twenty-six (63.4%) were using standard multidrug therapy (MDT) for Hansen’s disease, 7 (17.1%) were using alternative regimens and 8 (19.5%) had discontinued treatment. Thirteen patients (31.7%) had Hansen’s disease reactions diagnosed prior to Covid-19, 9 with type 1 reaction and 4 with type 2 reaction (erythema nodosum leprosum). Reactions were being treated using thalidomide in two patients and oral prednisone in 17 (41.5%). Comorbidities that are known risk factors for severe Covid-19 affected 31 patients (75.6%), including hypertension, diabetes, coronary artery disease, kidney disease, and (in one patient) acquired immunodeficiency syndrome. Twelve patients (29.3%) required hospitalization and 6 (14.6%) died from Covid-19 (age 39-60 years), of whom 3 had comorbidities, all were receiving MDT. One patient who died was on an alternative MDT regimen and receiving systemic corticosteroids. Anosmia and ageusia appeared to be more common symptoms in co-infected patients than in patients with Covid-19 alone. Conclusion: There did not appear to be an increase in frequency of Hansen’s disease reactions in coinfected patients, but mortality from Covid-19 in the study group was high. It is not possible to infer from our data whether persons affected by Hansen’s disease have a higher risk of Covid-19 mortality than the general population. This question can only be answered by conducting a study with a comparison group matched on age, comorbidities and other confounders.

Access to document