A Retrospective Study about Relapse among MDT Treated Leprosy Patient
Keywords:
MDT, relapse, BI, leprosy
Abstract
Background: New skin or nerve lesions may develop despite the fixed duration of multi drug therapy (MDT), in multibacillary (MB) and paucibacillary (PB) leprosy. The lesions could be due to reaction, relapse or reinfection. The index study was conducted to know the percentage of relapse in leprosy at a tertiary care hospital in Southern Rajasthan, India.
Material and Methods: The study was conducted on 29 (4 PB and 25 MB) cases, who had completed WHO guided fixed duration MDT regimens and were under regular surveillance for more than one year. Besides the relapse criteria laid by Beck-Bleumink, we performed slit skin smear (BI) and skin biopsy. Study spanned from January 2005 to December 2006.
Observations: Two MB cases (8%) evidenced features of clinical as well as bacteriological relapse, but none of the PB cases relapsed. The overall relapse rate was 6.9%. Relapsed patients reported after 1 and 5 years of release from treatment (RFT) and their newer clinical and bacteriological status was also lepromatous leprosy (LL) with BI 4+.
Conclusions: MDT is quite effective for treatment of leprosy, however, possibility of relapse is still there. Relapse rate showed wide variation in different studies.
References
1. Jopling WH, McDougall AC. In: Hand book of leprosy. 5th edn. CBS Publishers & Distributors. 1996; 1-161.
2. Pfaltzgraff RE, Ramu G. Clinical leprosy. In: Hastings RC, Opromolla DV, editors. Leprosy. 2nd ed. Edinburgh: Churchill Livingstone. 1994. p. 237-87.
3. The Leprosy Unit, WHO. Risk of relapse in leprosy. Indian J Lepr.1995;67:13-26.
4. Reddy PK, Mohinuddin SK. Pattern of relapses in paucibacillary leprosy patients treated with MDT (WHO 1982). Indian J Lepr. 1988;60:581-588.
5. Desikan KV. Relapse, reactivation or re-infection. Indian J Lepr. 1995;67:3-11.
6. Maganjeet, Rakesh B. Relapse, re-infection or inadequate MDT? Ind J Dermatol Veneroel Leprol. 1996;62:45-46.
7. Becx-Bleumink M. Relapses among leprosy patients treated with multidrug therapy: Experience in the leprosy control programme of the All Africa Leprosy and Rehabilitation and Training Centre (ALERT) in Ethiopia; Practical difficulties with diagnosing relapses, operational procedures and criteria for diagnosing relapses. Int J Lepr. 1992;60:421-35.
8. Pandian TD, Sithambaram M, Bharathi R, Ramu G. A study of relapse in non-lepromatous and intermediate groups of leprosy. Indian J Lepr. 1985;57:149-58.
9. Pavithran K. Relapse of PB leprosy after short course Multidrug therapy. Indian J Lepr. 1988;60:225-229.
10. Brakel WV, Kist P, Noble S et al. Relapses after multidrug therapy for leprosy: a preliminary report of 22 cases in West Nepal. Lepr Rev. 1989;60:45-50.
11. Grugni A, Nitin JN, Manjunath SK et al. Relapses in paucibacillary leprosy after MDT - A clinical study. Int J of Lepr. 1990;58:19-24.
12. Ekambaram V, Rao MK. Relapse rate in paucibacillary leprosy patients after Multidrug therapy in North Arcot district. Indian J Lepr. 1991;63:34-42.
13. Boerrigter G, Ponnighaus JM, Fine PE, Wilson RJ. Four-year follow up results of a WHO-recommended multiple-drug regimen in paucibacillary leprosy patients in Malawi. Int J Lepr. 1991;59:255-61.
14. Haldar A, Mahapatra BS, Mundle M et al. A study of relapse after MDT in a district in West Bengal, India. Indian J Lepr. 2003;75:1-8.
15. Revankar CR, Karjivkar VG, Gurav VJ et al. Clinical assessment of paucibacillary leprosy under Multidrug therapy - 3 years follow-up study. Indian J Lepr. 1989;6: 344-349.
16. Pattyn SR. Incubation period of relapses after treatment of paucibacillary leprosy. Lepr Rev. 1984;55:115- 120.
17. Kaur S, Sharma VK, Basak P et al. Paucibacillary multidrug therapy in leprosy 7½ years experience. Indian J Lepr. 1992;64:153-161.
18. Rakesh B, Malhotra SK. Relapse after PB MDT. Ind J Dermatol Venereol Leprol. 1992;58:41-42.
19. Thomas A, Hari L, Nagarajan M et al. Relapses during long-term follow up with drug susceptible M. leprae among multibacillary leprosy patients treated with multidrug therapy regimens; case reports. Int J Lepr. 1995;63:391-394.
20. Lockwood DNJ. To investigate the profiles of leprosy relapses after treatment with WHO recommended multidrug therapy in China. Int J Lepr. 1999;67:379- 387.
21. Samad AK. An analysis of relapsed leprosy cases. Ind J Dermatol Venereol Leprol. 2000;66:126-128.
22. Kaimal S, Thappa DM. Relapse in leprosy: a review. Ind J Dermatol Venereol Leprol. 2009;75:126-138.
23. Biswas S, Mondal KK. Multidrug therapy in leprosy can prevent relapse - A retrospective study. Indian J Lepr. 2002;74:313-317.
24. Ganapati R, Bulchand HO, Pai VV et al. Relapsing multibacillary leprosy - a new dimension to transmission in urban areas. Int J Lepr. 2001;69:114-115.
25. Umarane SB. Relapse rates amongst the multidrug therapy treated leprosy patients. Indian J Lepr. 2001;73:362-363.
26. Kar HK, Sabhnani S, Khosla M et al. Appearance of new lesions after fixed duration MDT in PB and MB leprosy: Is it reactivation? Reaction? Recognition (immunological)? Relapse? or reinfection? Indian J Lepr. 2005;77(4):337-338.
27. Shen J, Liu M, Zhang J, Su W, Ding G. Relapse in MB leprosy patients treated with 24 months of MDT in south west China: A short report. Lepr Rev. 2006;77:219-24.
28. Ali MK, Thorat DM, Subramanian M, Parthasarathy G, Selvaraj U, Prabhakar V. A study on trend of relapse in leprosy and factors influencing relapse. Indian J Lepr. 2005;77:105-15.
29. Mathur JN. Short course treatment of leprosy: present status, ICMR bulletin, ICMR offset press, New Delhi. 2002;32:1-15.
30. Gebre S, Saunderson P, Byass P. Relapses after fixed duration multiple drug therapy: The AMFES cohort. Lepr Rev. 2000;71:325-31.
31. Jamet P. Ji B, Blanc L, member of Marchoux Study Group. Relapse after long term follow-up of multidrug patients treated by WHO multidrug therapy regimen. Int J Lepr. 1995;63:195-201.
32. Ramu G. Clinical features and diagnosis of relapses in leprosy. Indian J Lepr. 1995; 67:45-59.
33. Katoch VM. Microbiological aspects of relapse in leprosy. Indian J Lepr. 1995;67: 85-98.
34. Ebenezer GJ, Daniel S, Norman G, Daniel E, Job CK. Are viable Mycobacterium leprae present in lepromatous patients after completion of 12 months’ and 24 months’ multi-drug therapy? Indian J Lepr. 2004;76:199-206.
35. Job CK. Histopathological features of relapsed leprosy. Indian J Lepr. 1995; 67:69-80.
36. Sengupta U. Immunological aspects of relapse in leprosy. Indian J Lepr. 1995;67: 81-3.
37. Kiran KU, Krishnamoorty KV, Maher V, Rao PN. Relapse of leprosy presenting as nodular lymph node swelling. Ind J Dermatol Venereol Leprol. 2009;75:177- 9.
38. Reddy PK, Cherian A. Relapse in leprosy after multidrug therapy and its differential diagnosis with reversal reaction. Indian J Lepr. 1991;63:61-69.
39. Shetty VP, Suchitra K, Uplekar MW et al. Higher incidence of viable M. leprae within nerves as compared to skin among multibacillary leprosy patients released from multidrug therapy. Lepr Rev. 1997;68:131-138.
40. Jacobson RR. Treatment of relapsed leprosy. Indian J Lepr. 1995;67:99-102.
2. Pfaltzgraff RE, Ramu G. Clinical leprosy. In: Hastings RC, Opromolla DV, editors. Leprosy. 2nd ed. Edinburgh: Churchill Livingstone. 1994. p. 237-87.
3. The Leprosy Unit, WHO. Risk of relapse in leprosy. Indian J Lepr.1995;67:13-26.
4. Reddy PK, Mohinuddin SK. Pattern of relapses in paucibacillary leprosy patients treated with MDT (WHO 1982). Indian J Lepr. 1988;60:581-588.
5. Desikan KV. Relapse, reactivation or re-infection. Indian J Lepr. 1995;67:3-11.
6. Maganjeet, Rakesh B. Relapse, re-infection or inadequate MDT? Ind J Dermatol Veneroel Leprol. 1996;62:45-46.
7. Becx-Bleumink M. Relapses among leprosy patients treated with multidrug therapy: Experience in the leprosy control programme of the All Africa Leprosy and Rehabilitation and Training Centre (ALERT) in Ethiopia; Practical difficulties with diagnosing relapses, operational procedures and criteria for diagnosing relapses. Int J Lepr. 1992;60:421-35.
8. Pandian TD, Sithambaram M, Bharathi R, Ramu G. A study of relapse in non-lepromatous and intermediate groups of leprosy. Indian J Lepr. 1985;57:149-58.
9. Pavithran K. Relapse of PB leprosy after short course Multidrug therapy. Indian J Lepr. 1988;60:225-229.
10. Brakel WV, Kist P, Noble S et al. Relapses after multidrug therapy for leprosy: a preliminary report of 22 cases in West Nepal. Lepr Rev. 1989;60:45-50.
11. Grugni A, Nitin JN, Manjunath SK et al. Relapses in paucibacillary leprosy after MDT - A clinical study. Int J of Lepr. 1990;58:19-24.
12. Ekambaram V, Rao MK. Relapse rate in paucibacillary leprosy patients after Multidrug therapy in North Arcot district. Indian J Lepr. 1991;63:34-42.
13. Boerrigter G, Ponnighaus JM, Fine PE, Wilson RJ. Four-year follow up results of a WHO-recommended multiple-drug regimen in paucibacillary leprosy patients in Malawi. Int J Lepr. 1991;59:255-61.
14. Haldar A, Mahapatra BS, Mundle M et al. A study of relapse after MDT in a district in West Bengal, India. Indian J Lepr. 2003;75:1-8.
15. Revankar CR, Karjivkar VG, Gurav VJ et al. Clinical assessment of paucibacillary leprosy under Multidrug therapy - 3 years follow-up study. Indian J Lepr. 1989;6: 344-349.
16. Pattyn SR. Incubation period of relapses after treatment of paucibacillary leprosy. Lepr Rev. 1984;55:115- 120.
17. Kaur S, Sharma VK, Basak P et al. Paucibacillary multidrug therapy in leprosy 7½ years experience. Indian J Lepr. 1992;64:153-161.
18. Rakesh B, Malhotra SK. Relapse after PB MDT. Ind J Dermatol Venereol Leprol. 1992;58:41-42.
19. Thomas A, Hari L, Nagarajan M et al. Relapses during long-term follow up with drug susceptible M. leprae among multibacillary leprosy patients treated with multidrug therapy regimens; case reports. Int J Lepr. 1995;63:391-394.
20. Lockwood DNJ. To investigate the profiles of leprosy relapses after treatment with WHO recommended multidrug therapy in China. Int J Lepr. 1999;67:379- 387.
21. Samad AK. An analysis of relapsed leprosy cases. Ind J Dermatol Venereol Leprol. 2000;66:126-128.
22. Kaimal S, Thappa DM. Relapse in leprosy: a review. Ind J Dermatol Venereol Leprol. 2009;75:126-138.
23. Biswas S, Mondal KK. Multidrug therapy in leprosy can prevent relapse - A retrospective study. Indian J Lepr. 2002;74:313-317.
24. Ganapati R, Bulchand HO, Pai VV et al. Relapsing multibacillary leprosy - a new dimension to transmission in urban areas. Int J Lepr. 2001;69:114-115.
25. Umarane SB. Relapse rates amongst the multidrug therapy treated leprosy patients. Indian J Lepr. 2001;73:362-363.
26. Kar HK, Sabhnani S, Khosla M et al. Appearance of new lesions after fixed duration MDT in PB and MB leprosy: Is it reactivation? Reaction? Recognition (immunological)? Relapse? or reinfection? Indian J Lepr. 2005;77(4):337-338.
27. Shen J, Liu M, Zhang J, Su W, Ding G. Relapse in MB leprosy patients treated with 24 months of MDT in south west China: A short report. Lepr Rev. 2006;77:219-24.
28. Ali MK, Thorat DM, Subramanian M, Parthasarathy G, Selvaraj U, Prabhakar V. A study on trend of relapse in leprosy and factors influencing relapse. Indian J Lepr. 2005;77:105-15.
29. Mathur JN. Short course treatment of leprosy: present status, ICMR bulletin, ICMR offset press, New Delhi. 2002;32:1-15.
30. Gebre S, Saunderson P, Byass P. Relapses after fixed duration multiple drug therapy: The AMFES cohort. Lepr Rev. 2000;71:325-31.
31. Jamet P. Ji B, Blanc L, member of Marchoux Study Group. Relapse after long term follow-up of multidrug patients treated by WHO multidrug therapy regimen. Int J Lepr. 1995;63:195-201.
32. Ramu G. Clinical features and diagnosis of relapses in leprosy. Indian J Lepr. 1995; 67:45-59.
33. Katoch VM. Microbiological aspects of relapse in leprosy. Indian J Lepr. 1995;67: 85-98.
34. Ebenezer GJ, Daniel S, Norman G, Daniel E, Job CK. Are viable Mycobacterium leprae present in lepromatous patients after completion of 12 months’ and 24 months’ multi-drug therapy? Indian J Lepr. 2004;76:199-206.
35. Job CK. Histopathological features of relapsed leprosy. Indian J Lepr. 1995; 67:69-80.
36. Sengupta U. Immunological aspects of relapse in leprosy. Indian J Lepr. 1995;67: 81-3.
37. Kiran KU, Krishnamoorty KV, Maher V, Rao PN. Relapse of leprosy presenting as nodular lymph node swelling. Ind J Dermatol Venereol Leprol. 2009;75:177- 9.
38. Reddy PK, Cherian A. Relapse in leprosy after multidrug therapy and its differential diagnosis with reversal reaction. Indian J Lepr. 1991;63:61-69.
39. Shetty VP, Suchitra K, Uplekar MW et al. Higher incidence of viable M. leprae within nerves as compared to skin among multibacillary leprosy patients released from multidrug therapy. Lepr Rev. 1997;68:131-138.
40. Jacobson RR. Treatment of relapsed leprosy. Indian J Lepr. 1995;67:99-102.
Published
2019-08-27
How to Cite
C M Kuldeep, A K Khare, Tantia J, Mittal A, L K Gupta, Garg A, Mehta S. (2019). A Retrospective Study about Relapse among MDT Treated Leprosy Patient. The Indian Practitioner, 68(3), 24-28. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/658
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Original Article
