Estimation of Serum Vitamin D Levels and Helminthic Coinfection in Patients with Type 2 Lepra Reactions and Its Correlation with Severity of Type 2 Reactions: A Cross-Sectional Study.

Abstract

Background: Manifestations of leprosy are largely driven by host immune response, with the lepra reactions complicating the indolent course of the disease. Research indicates that the biological processes linked to vitamin deficiencies and helminth infections increase susceptibility to other infections.

Aims and objectives: To estimate serum vitamin D levels and helminthic coinfections in patients with type 2 lepra reactions and their correlation with the severity of type 2 lepra reactions.

Patients and methods: A prospective cross-sectional study involving 75 leprosy patients of all ages with type 2 reactions, was conducted at a tertiary health care center for 18 months. Serum vitamin D was estimated and stool wet-mount examination was performed to look for the presence of helminth ova. The severity of type 2 reaction was measured by a modified ENLIST erythema nodosum leprosum (ENL) severity scale.

Results: Out of 75 patients, 76% ( n = 57) were males and the most affected age group was 31-40 years. In total, 70.6% ( n = 53) of patients had lepromatous leprosy, while the rest had borderline lepromatous leprosy. ENLIST score showed severe ENL in 47 (62.7%) patients. Ova of helminths were found in 17.3% ( n = 13) patients, two of which were Ascaris lumbricoides and the rest were Ankylostoma duodenale . Vitamin D deficiency was seen in 23 (30.7%) patients, insufficient levels were found in 33 (44%) patients, and the association with ENLIST score was found to be statistically significant ( P < 0.05).

Limitations: The limitations include a small sample size and a cross-sectional study design. Estimation of serum vitamin D levels in age and sex-matched controls could have eliminated the confounders. Additionally, as patients were not followed up, it remains unclear whether vitamin supplementation and deworming reduced the frequency or severity of reaction episodes.

Conclusion: The above correlation implies that the immune consequences of vitamin D deficiency and helminthic coinfection may increase the risk of active leprosy and the severity of lepra reactions.