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Gautam S, Sharma D, Singh S, Arora M, Goel A, Bisht D. Analysis of socioeconomic condition and bacillary index with respect to the development of Hansen's disease. Int J Mycobacteriol 2023; 12:254-260. [PMID: 37721229 DOI: 10.4103/ijmy.ijmy_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae or Mycobacterium lepromatosis and mainly affects the skin and peripheral nerves. Although treatable, its early intervention can significantly reduce the occurrence of disability. India accounts for more than half of new cases globally. This study was undertaken to better understand the clinical traits of newly diagnosed cases in a tertiary facility of Western Uttar Pradesh, and a few from Madhya Pradesh and Uttarakhand. Methods The observational prospective study was carried out on all the newly diagnosed leprosy cases who visited the Outpatient Department of ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, during October 2019-December 2022. After obtaining answers to a prestructured questionnaire with their consent, participants were enrolled in the study and underwent clinical examination and a slit-skin smear test. Results A total of 56 cases were investigated, and among them, 20 (35.7%) and 36 (64.3%) women and men, respectively, had positive contact with persons affected by leprosy either within family, friends, or neighbors. It is observed that due to the delayed detection of leprosy cases, paucibacillary (PB) patients converted into multibacillary (MB) patients, and the number of MB cases is much higher compared to PB cases. Conclusion Leprosy instances continue to spread frequently from sick to healthy people indicating continued transmission of leprosy in society. Multidrug therapy in the management of leprosy cases is effective; however, early diagnosis of PB cases is still a challenge and needs to be addressed on priority.
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Affiliation(s)
- Sakshi Gautam
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Devesh Sharma
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Sakshi Singh
- Clinical Division, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Mamta Arora
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Anjana Goel
- Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India
| | - Deepa Bisht
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
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Hazarika N, Gupta PK, Dhanta A, Singh A, Mohanty A, Gupta P. Renaissance of Hansen's Disease in Post-Elimination Era in North India: A Retrospective Clinico-Bacteriological Study. Cureus 2021; 13:e17514. [PMID: 34603886 PMCID: PMC8476198 DOI: 10.7759/cureus.17514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Hansen's disease is a chronic infectious disease caused by Mycobacterium leprae. India declared the elimination of leprosy in December 2005, but a slow resurgence of the disease still continues in several parts of India. The diagnosis of leprosy is primarily clinical but slit-skin smear microscopy aids in an accurate diagnosis. There are very few studies on clinico-bacteriological patterns of leprosy at this post-elimination phase. Aim This study aimed to analyze the clinical and bacteriological findings of newly diagnosed cases of Hansen's disease in the post-elimination era. Materials and methods This is a descriptive, hospital-based, retrospective study of newly diagnosed cases of Hansen's disease, enrolled in the Hansen's disease clinic attached to the dermatology outpatient department (OPD) of a tertiary care hospital in North India. A retrospective chart review of newly diagnosed cases of leprosy for a period of one year was done. Information about demographics, clinical characteristics, spectrum of disease, and slit skin smear data of patients were collected. Statistical analysis was performed using SPSS Version 16.0 (Chicago, IL, SPSS Inc.). Result A total of 116 patients were included of which 68.1% (79) were males. The age of patients ranged from 7 to 72 years and children (<15 years) constituted 6% (7/116) of all cases. The most common clinical spectrum was borderline lepromatous leprosy 37.9% (44/116) followed by lepromatous leprosy 32.8% (38/116). Out of 116 cases, 39.6% of cases showed slit-skin smear positivity. Conclusion The study brings forth evidence on the slow re-emergence of leprosy in India. In this study, multibacillary cases outnumber the paucibacillary cases; also, childhood cases were encountered indicating active community spread of the disease in the "post-elimination era." There is an urgent need to step up the surveillance for Hansen's disease to curb the further spread of the bacilli in the community.
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Affiliation(s)
- Neirita Hazarika
- Dermatology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Puneet K Gupta
- Microbiology, All India Institute of Medical Sciences, Bilaspur, IND
| | - Aditi Dhanta
- Dermatology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Arpana Singh
- Clinical Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Aroop Mohanty
- Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Pratima Gupta
- Microbiology, All India Institute of Medical Sciences, Rishikesh, IND
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Sardana K, Kulhari A, Mathachan SR, Khurana A, Bansal P, Ahuja A, Lavania M, Ahuja M. Late leprosy reaction presenting as erythema multiforme-like erythema nodosum leprosum with underlying rifampicin resistance and its potential implications. Int J Mycobacteriol 2021; 9:226-228. [PMID: 32474551 DOI: 10.4103/ijmy.ijmy_26_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erythema multiforme (EM)-like erythema nodosum leprosum (ENL) is a rare atypical presentation, and its late appearance after the completion of multidrug therapy (MDT) is unusual. We describe the case of a lepromatous leprosy patient who after the completion of MDT presented to us with late EM-like ENL and was found to be resistant to rifampicin. We discuss the implications of this finding and the potential role of resistant bacilli in causing reactions with atypical presentations.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology and STDs, Dr. RML Hospital and PGIMER, New Delhi, India
| | - Anita Kulhari
- Department of Dermatology and STDs, Dr. RML Hospital and ABVIMS, New Delhi, India
| | - Sinu Rose Mathachan
- Department of Dermatology and STDs, Dr. RML Hospital and ABVIMS, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology and STDs, Dr. RML Hospital and ABVIMS, New Delhi, India
| | - Prekshi Bansal
- Department of Dermatology and STDs, Dr. RML Hospital and ABVIMS, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Dr. RML Hospital and ABVIMS, New Delhi, India
| | - Mallika Lavania
- Research Scientist, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Madhvi Ahuja
- Research Scientist, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
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Ansari AS, Saxena K, Singh KK, Choudhary A, Singh A, Tripathi AK, Sharma V. Clinicobacteriological evaluation of leprosy patients with 1-5 skin lesions. Int J Mycobacteriol 2021; 9:209-211. [PMID: 32474546 DOI: 10.4103/ijmy.ijmy_7_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mycobacterium leprae is a noncultivable mycobacteria, and diagnosis of the disease is based on its clinical and histopathological characteristics and finding the bacteria in skin scrapings and in biopsies taken from the patients. The aim of this study was to shed light on the clinical classification (based on the number of skin lesions) used extensively in the field where patients classified as paucibacillary (PB) were positive on skin smears and histopathology leading to treatment failure and drug resistance. Methods In this study, we enrolled untreated 62 leprosy patients with 1-5 skin lesions and did a detailed bacterio-histopathological analysis by slit-skin smears (SSSs) and histopathology. Results Of 62 patients analyzed, 15 patients came out to be multibacillary (MB) and 47 were PB by SSS and histopathology. Conclusion The findings of the present study showed that the WHO classification of leprosy based on the number of lesions seems to be inappropriate as it considers a number of MB lesions as PB only, thus misleading the treatment strategies. Hence, it is essential that a comprehensive clinicobacteriological assessment of leprosy cases should be done to ensure the appropriate bacillary status and guiding the appropriate treatment strategy.
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Affiliation(s)
- Amir Shahid Ansari
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Kshitij Saxena
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Kaushal Kumar Singh
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Anshul Choudhary
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Anukriti Singh
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Aditya Kumar Tripathi
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
| | - Vichitra Sharma
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow Era University, Lucknow, Uttar Pradesh, India
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Tiyo BT, Vendramini ECL, de Souza VH, Colli CM, Alves HV, Sell AM, Zucoloto SBP, Visentainer JEL. Association of MBL2 Exon 1 Polymorphisms With Multibacillary Leprosy. Front Immunol 2020; 11:1927. [PMID: 33013845 PMCID: PMC7494844 DOI: 10.3389/fimmu.2020.01927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
Mannose-binding lectin (MBL) is a serum protein of innate immunity, with a central role in the activation of the complement system through the lectin pathway. This protein is encoded by MBL2 gene, and single-nucleotide polymorphisms located at exon 1, such as rs5030737 C>T (D variant), rs1800450 G>A (B variant), and rs1800451 G>A (C variant), may change the MBL structure and the serum concentration. MBL2 polymorphisms have been associated with several infectious diseases, including leprosy. Host immune response has a major impact on the clinical manifestation of leprosy since only a few individuals infected with Mycobacterium leprae will develop the disease. Therefore, the aim of this study was to evaluate the influence of MBL2 exon 1 polymorphisms (rs5030737, rs1800450, and rs1800451) on the MBL levels and leprosy immunopathogenesis. This case–control study included 350 leprosy patients from Southern Brazil, with 279 classified as multibacillary (MB) and 71 as paucibacillary (PB). The control group consisted of 350 non-consanguineous individuals, who were not diagnosed with leprosy or other infectious and autoimmune diseases. Genotyping was performed by PCR–sequence specific primers, and the MBL serum concentrations were evaluated by ELISA. MBL2 exon 1 polymorphisms were analyzed individually and grouped as genotypes, considering “A” as the wild allele and “O” as the presence of at least one polymorphism (D, B, or C variants). Differences were not observed in the distribution of genotypic and allelic frequencies between leprosy per se patients and controls. However, in a haplotypic analysis, the TGG haplotype presented a risk for development of leprosy per se in women when compared to the wild haplotype (CGG) (OR = 2.69). Comparing patients with MB and PB, in a multivariate analysis, the B variant was associated with the susceptibility of developing the MB form of leprosy (OR = 2.55). Besides that, the CAG haplotype showed an increased susceptibility to develop MB leprosy in women compared to men. It was observed that the A/O genotype in women was associated with a susceptibility to leprosy development per se (OR = 1.66) and progression to MB leprosy (OR = 3.13). In addition, the MBL serum concentrations were in accordance with the genotyping analysis. In summary, our data suggest that MBL2 exon 1 polymorphisms are associated with an increased risk to leprosy development and progression.
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Affiliation(s)
- Bruna Tiaki Tiyo
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | | | - Victor Hugo de Souza
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Cristiane Maria Colli
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Hugo Vicentin Alves
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Ana Maria Sell
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
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Noormohammadpour P, Kamyab‐Hesari K, Razavi Z, Dolatyabi N, Taghizadeh Fazli J, Daneshpazhooh M, Nouri Z. An unusual case of multibacillary lepros y mimicking prurigo nodularis. Clin Case Rep 2020; 8:1234-1237. [PMID: 32695365 PMCID: PMC7364099 DOI: 10.1002/ccr3.2897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/01/2020] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Leprosy is a chronic infectious disease with a wide range of clinical manifestations. The early diagnosis of leprosy is a worldwide challenge. We present a case of leprosy with unusual severe pruritus and generalized excoriated papules and nodules.
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Affiliation(s)
| | - Kambiz Kamyab‐Hesari
- Department of DermatopathologyRazi HospitalTehran University of Medical sciencesTehranIran
| | - Zahra Razavi
- Department of DermatologyRazi HospitalTehran University of Medical sciencesTehranIran
| | - Nooshin Dolatyabi
- Department of DermatologyRazi HospitalTehran University of Medical sciencesTehranIran
| | - Jafar Taghizadeh Fazli
- Department of DermatopathologyRazi HospitalTehran University of Medical sciencesTehranIran
| | - Maryam Daneshpazhooh
- Department of DermatologyRazi HospitalTehran University of Medical sciencesTehranIran
| | - Zeinab Nouri
- Department of DermatologyRazi HospitalTehran University of Medical sciencesTehranIran
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7
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Pepineli AC, Alves HV, Tiyo BT, Macedo LC, Visentainer L, de Lima Neto QA, Zacarias JMV, Sell AM, Visentainer JEL. Vitamin D Receptor Gene Polymorphisms Are Associated With Leprosy in Southern Brazil. Front Immunol 2019; 10:2157. [PMID: 31636627 PMCID: PMC6787522 DOI: 10.3389/fimmu.2019.02157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022] Open
Abstract
Vitamin D, together with its nuclear receptor (VDR), plays an important role in modulating the immune response, decreasing the inflammatory process. Some polymorphisms of the VDR gene, such as BsmI (G>A rs1544410), ApaI (G>T rs7975232), and TaqI (T>C rs731236) could affect its stability and mRNA transcription activity, while FokI T>C (rs2228570) gives a truncated protein with three fewer amino acids and more efficiency in binding vitamin D. This study evaluated these four polymorphisms in the immunopathogenesis of leprosy in 404 patients and 432 control individuals without chronic or infectious disease in southern Brazil. When analyzing differences in the allele and genotype frequency of polymorphisms between patients (leprosy per se, multibacillary, and paucibacillary clinical forms) and controls, we found no statistically significant association. Regarding haplotype analysis, the bAt haplotype was associated with protection from leprosy per se (P = 0.004, OR = 0.34, CI = 0.16–0.71) and from the multibacillary clinical form (P = 0.005, OR = 0.30, CI = 0.13–0.70). In individuals aged 40 or more years, this haplotype has also showed protection against leprosy per se and multibacillary (OR = 0.26, CI = 0.09–0.76; OR = 0.26, CI = 0.07–0.78, respectively), while the BAt haplotype was a risk factor for leprosy per se in the same age group (OR = 1.34, CI = 1.04–1.73). In conclusion, despite having found no associations between the VDR gene polymorphisms with the development of leprosy, the haplotypes formed by the BsmI, ApaI, and TaqI polymorphisms were associated with leprosy per se and the multibacillary clinical form.
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Affiliation(s)
- Afonso Carrasco Pepineli
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Hugo Vicentin Alves
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Bruna Tiaki Tiyo
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Luciana Conci Macedo
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | - Lorena Visentainer
- Department of Medicine, Faculty of Medical Sciences, Campinas State University (UNICAMP), São Paulo, Brazil
| | - Quirino Alves de Lima Neto
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
| | | | - Ana Maria Sell
- Laboratory of Immunogenetics, Department of Basic Health Sciences, Maringá State University (UEM), Maringá, Brazil
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Abstract
HIV-associated tuberculosis can present as extremes, ranging from acute life-threatening disseminated disease to occult asymptomatic infection. Both ends of this spectrum have distinct pathological correlates and require specific diagnostic and treatment approaches. Novel therapeutics, targeting both pathogen and host, are needed to augment pathogen clearance. In latent tuberculosis infection, enhancement of immune activation could be desirable. Antiretroviral therapy augments the beneficial effects of antitubercular therapy. However, in the context of high bacillary burden, antiretroviral therapy can also result in pathology (tuberculosis immune reconstitution inflammatory syndrome). In the immune reconstituting patient, modulation of immune activation controls tissue destruction. Interventions should also be appropriate and sustainable within the programmatic setting.
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Affiliation(s)
- Neesha Rockwood
- Department of Medicine, Imperial College London, London, UK, and Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert John Wilkinson
- Department of Medicine, Imperial College London, London, UK, and Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, and Francis Crick Institute Mill Hill Laboratory, London, UK
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Pooja VK, Vanishree M, Ravikumar S, Koneru A, Hunasgi S, Surekha R. Evaluation of the orofacial lesions in treated leprosy patients. J Oral Maxillofac Pathol 2015; 18:386-9. [PMID: 25948993 PMCID: PMC4409183 DOI: 10.4103/0973-029x.151322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/03/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. AIM To evaluate the incidence of orofacial lesions in treated leprosy patients. MATERIALS AND METHODS Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated. RESULTS On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%). CONCLUSION Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae.
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Affiliation(s)
- V K Pooja
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
| | - M Vanishree
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
| | - Shamala Ravikumar
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
| | - Anila Koneru
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
| | - Santhosh Hunasgi
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
| | - R Surekha
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
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Kumar A, Girdhar A, Girdhar B. Twelve months fixed duration WHO multidrug therapy for multibacillary leprosy: incidence of relapses in Agra field based cohort study. Indian J Med Res 2013; 138:536-40. [PMID: 24434261 PMCID: PMC3868067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND & OBJECTIVES The reported low relapse rates after 24 months multidrug therapy (MDT) for multibacillary leprosy (MB) led to the recommendation of reducing duration of therapy to 12 months. However, only a few reports exist on long term follow up data after 12 months fixed duration therapy (FDT). The present study was done to assess the incidence of relapse in MB leprosy patients after 12 months treatment. METHODS The leprosy patients detected in field surveys during 2001-2006 in Agra district, Uttar Pradesh, India, were put on WHO-MDT and followed up for treatment completion, relapse, reactions and development of disability. The assessment was done clinically by following up the patients until January 2011. Data collected were analyzed for risk and survival analysis. RESULTS The incidence of relapse was found to be 1.97/100 person years of follow up. The incidence of relapse by age (34 yr vs >34 yr), sex (male vs female), delay in detection (<36 months vs >36 months) and smear status (smear +ve vs -ve) was not found to be significantly different but patients with no nerve involvement were observed to have significantly higher relapses than those with three or more nerve involvement (P<0.05). Similarly, borderline-borderline and BB with reaction (BB/BBR) patients were observed to have significantly high relapses than among those with borderline tuberculoid or BT with reaction (BT/BTR) or borderline lipromatous/lepromatous/neuritic (BL/LL/N) type of leprosy (P<0.01). INTERPRETATION & CONCLUSION From the observations in the study, it can be suggested that relapses occur in 12 months FDT and almost as much as reported in 24 months FDT for MB leprosy. Although, early relapses may be due to insufficient treatment, late relapses may be due to persistent dormant mycobacteria. However, a study relating to immunological response of treatment and change in immunological profile relating to the occurrence of relapses and its clinical correlates may suggest better information on causes of relapses.
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Affiliation(s)
- Anil Kumar
- Epidemiology & Clinical Divisions, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Anita Girdhar
- Epidemiology & Clinical Divisions, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - B.K. Girdhar
- Epidemiology & Clinical Divisions, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
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11
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Abstract
Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.
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Affiliation(s)
- Munisamy Malathi
- From the Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Devinder Mohan Thappa
- From the Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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12
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Dogra S, Narang T, Kumar B. Leprosy--evolution of the path to eradication. Indian J Med Res 2013; 137:15-35. [PMID: 23481049 PMCID: PMC3657879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 11/09/2022] Open
Abstract
Leprosy is among the world's oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system. All these provisions in the integrated health care approach will go a long way in further reducing the stigma. Efforts need to be made to reduce deformity through early detection, self care, physiotherapy and reconstructive surgery and developing sound surveillance systems. With all the remarkable achievements in the fight against leprosy, the stage is now set for the final assault. It is hoped that with the efforts of all the stake holders and strong political will, the disease will be eradicated in the near future.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Bhushan Kumar
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Abstract
OBJECTIVE To document leprosy trends in Zambia over the past two decades to ascertain the importance of leprosy as a health problem in Zambia. METHODS Retrospective study covering the period 1991-2009 of routine national leprosy surveillance data, published national programme review reports and desk reviews of in-country TB reports. RESULTS Data reports were available for all the years under study apart from years 2001, 2002 and 2006. The Leprosy case notification rates (CNR) declined from 2.73/10 000 population in 1991 to 0.43/10 000 population in 2009. The general leprosy burden showed a downward trend for both adults and children. Leprosy case burden dropped from approximately 18 000 cases in 1980 to only about 1000 cases in 1996, and by the year 2000, the prevalence rates had fallen to 0.67/10 000 population. There were more multibacillary cases of leprosy than pauci-bacillary cases. Several major gaps in data recording, entry and surveillance were identified. Data on disaggregation by gender, HIV status or geographical origin were not available. CONCLUSION Whilst Zambia has achieved WHO targets for leprosy control, leprosy prevalence data from Zambia may not reflect real situation because of poor data recording and surveillance. Greater investment into infrastructure and training are required for more accurate surveillance of leprosy in Zambia.
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Affiliation(s)
- Nathan Kapata
- Ministry of Health, Lusaka, Zambia National TB and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia University of Zambia and University College London Medical School Research and Training Programme, University Teaching Hospital, Lusaka, Zambia Center for Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands Department of Infection, Division of Infection and Immunity, University College London, London, UK
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