Leprosy Reactions and Nerve Damage in Children and Adolescents: A Pediatric Evidence Synthesis with Verified Cohort Findings
DOI:
https://doi.org/10.46799/jhs.v7i9.2878Keywords:
Leprosy, Childhood Leprosy, Pediatric Leprosy, Leprosy Reactions, NeuritisAbstract
Leprosy in childhood is an indicator of ongoing transmission and may be complicated by inflammatory reactions, neuritis, and disability. Antimicrobial treatment is essential; however, completion of therapy alone does not guarantee the preservation of nerve function. Pediatric evidence remains dispersed across small observational cohorts, with inconsistencies in denominators and outcome definitions. This study prepared a pediatric evidence synthesis using publicly accessible full-text cohort reports that provided verifiable numerators and denominators for reactions, neuritis, nerve damage, or disability outcomes. The synthesis was structured according to PRISMA 2020 guidelines. Studies were eligible if they included children younger than 15 years with leprosy and reported clinically defined outcomes during diagnosis, multidrug therapy, or follow-up. Two Brazilian prospective cohorts from referral units were verified through full-text review. In a 2019 cohort, 18 of 34 children (52.9%) experienced a leprosy reaction and/or isolated neuritis; among these, 14 of 18 (77.8%) had type 1 reactions, 14 of 18 (77.8%) experienced two or more episodes, and 6 of 18 (33.3%) developed complications. In a 2024 two-year cohort, 38 of 77 children (49.3%) experienced reactions; among these 38 children, 16 (42.1%) showed progression with worsening nerve damage. At diagnosis, 29 of 38 children (76.3%) had nerve damage, 20 (52.6%) had physical disability, and 11 (28.9%) had grade 2 disability. The verified cohorts indicate a substantial burden of leprosy reactions and nerve impairment among children treated in referral settings. Reactions occurred both during and after multidrug therapy, highlighting the importance of continued neurological surveillance beyond the completion of antimicrobial treatment.
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