Risk Factors of Acute and Chronic Erythema Nodosum Leprosum in Dr. Soetomo General Academic Hospital Surabaya

Abstract

Background: Leprosy is a chronic granulomatous infection and is one of the neglected diseases caused by Mycobacterium leprae. ENL is a complex syndrome, that caused inflammation of the skin, nerves, and other organs due to an inflammatory immune response to Mycobacterium leprae antigens. Acute ENL was defined as the first episode of ENL with a duration of less than 24 weeks. Chronic ENL was defined as ENL that persisted for more than 24 weeks. These types of ENL can have different risk factors and require different therapeutic interventions. Purpose: The onset of ENL is acute, but may progress to a chronic or recurrent phase and require long-term therapy. Early detection of leprosy is very important, because the infection is curable and prompt treatment can reduce nerve damage and associated stigma. Chronic ENL patients require prolonged high doses of corticosteroids to control inflammation in ENL and cause severe complications and side effects associated with morbidity and mortality. Methods: This retrospective study was conducted using a non-probability sampling technique consecutively using a casecontrol formula in leprosy patients with ENL in the Leprosy Division of the Outpatient Dermatology and Venereology Unit RSUD Dr. Soetomo Surabaya for the period 2015 – 2020, using secondary data in the form of medical record data. Result: The results of this study obtained leprosy patients with ENL as many as 234 patients, 56 patients with acute ENL and 89 patients with chronic ENL. 45 patients with acute ENL and 45 patients with chronic ENL were obtained from the case-control minimal sample size formula. Conclusion: The results of the bivariate analysis test showed that there was a relationship between risk factors for coinfection and steroid therapy with the type of ENL. The presence of coinfection and steroid therapy showed that patients tend to be chronic ENL, conversely, in the absence of coinfection and without steroid therapy, patients tend to be acute ENL. The multivariate logistic regression analysis test showed a significant association between risk factors for ENL onset before MDT and the presence of coinfection with chronic ENL, whereas ENL onset after MDT and absence of coinfection were associated with acute ENL.