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6th Edition of World Congress on Infectious Diseases

June 24-26, 2024 | Paris, France

June 24 -26, 2024 | Paris, France
Infection 2022

Rohit Kothari

Speaker at Infection Conferences - Rohit Kothari
Command Hospital Air Force Bengaluru, India
Title : Clinical and Cytokine Profile in Type-2 Reaction in Leprosy in Response to Thalidomide: A Randomized Controlled Trial


Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae (M. Lepra). Reactions may interrupt its usual chronic course. Type-2 leprosy reaction or erythema nodosum leprosum (ENL) is an acute event which is type-III hypersensitivity response and manifests clinically as tender evanescent skin-colored or erythematous nodules and systemic features. Various cytokines like TNF-alpha and IFN-gamma may be increased in ENL along with CD-64 which may be overexpressed due to massive influx of neutrophils during this reaction. Thalidomide is considered the drug of choice for type-2 lepra reaction. We tried to extrapolate these facts in the treatment of Leprosy reactions in the form of reduction of these molecules following Thalidomide use and therefore predicting response and prognosis.

Objective: To find a correlation between TNF-alpha, IFN-gamma and CD-64 expression on circulating neutrophils following Thalidomide treatment and predicting response and prognosis in cases of Type-2 lepra reaction.
Methodology: This randomized controlled trial consisted of fifty confirmed cases of type-2 leprosy reaction and fifty age, sex and area of residence matched healthy controls. It was conducted in a tertiary care hospital in Bengaluru, India. The diagnosis of leprosy was made by the presence of cardinal features in the form of pale or red skin patch with definite loss of sensation, thickened or enlarged peripheral nerves with sensory and/or motor deficit, and positive slit skin smear for M. Lepra bacillus. Type-2 reaction was diagnosed in case the leprosy patient developed tender evanescent skin-colored or red nodules with systemic symptoms and neutrophil leukocytosis. Blood samples and skin biopsy were taken at baseline and on 14th day after Thalidomide therapy in the treated patients and subjected to histopathology, immunohistochemistry, immunofluorescence, Reverse Transcriptase-Polymerase Chain reaction (RT-PCR Quantitative) and flow cytometry. All patients with ENL responded well to Thalidomide and the lesions resolved within 1-2 weeks.

Results: TNF-alpha and IFN-gamma are increased in almost all cases of type-2 reaction. CD-64 expression is also upregulated in type-2 reaction and downregulated in patients who received Thalidomide and showed favorable clinical response. There was significant correlation of increased CD-64 expression with the severity of reaction.


Dr. Rohit studied MBBS and MD Dermatology at Armed Forces Medical College, India and graduated as MD in 2021. He then joined the department of Dermatology, Command Hospital Air Force Bengaluru as Senior Resident. He has won several national and state level quizzes during his residency. He has been the quiz master of various national level quizzes as well and has published more 16 research articles in PubMed indexed journals including high impact one’s. He has presented at various national level forums and has many upcoming national and international level presentations as well.