Chronic recalcitrant erythema nodosum leprosum: therapeutic dilemma and role of mycobacterium indicus pranii vaccine

Gupta, Sunil; Kumari, Sushantika

doi:10.1016/j.abd.2020.08.032

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…Fortunately, recent development of the Mycobacterial indicus pranii (MIP) vaccine derived from the non-pathogenic MIP has shown to improve treatment outcomes in patients affected with multidrug-resistant leprosy. MIP vaccine is an inactivated, non-tuberculous mycobacterial vaccine used for multibacillary leprosy patients as an adjunct immunotherapeutic agent by reducing the bacterial load and by reducing the duration of multidrug therapy in such patients by modulating the immune response towards the Th1 subtype [ 55 , 56 ]. In a study using guinea pig models, it was found that when the MIP vaccine was given as a booster in conjunction with the BCG vaccine, pro-inflammatory cytokines such as IL-12, IFN-γ, IL-2, IL-17, and TNF-α were increased in the infected lungs of these guinea pigs, relative to guinea pigs that were inoculated with only the BCG vaccine [ 57 ].…”

Section: Mycobacterium Lepraementioning

confidence: 99%

Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections

et al. 2022

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The genus mycobacterium includes several species that are known to cause infections in humans. The microorganisms are classified into tuberculous and non-tuberculous based on their morphological characteristics, defined by the dynamic relationship between the host defenses and the infectious agent. Non-tuberculous mycobacteria (NTM) include all the species of mycobacterium other than the ones that cause tuberculosis (TB). The group of NTM contains almost 200 different species and they are found in soil, water, animals—both domestic and wild—milk and food products, and from plumbed water resources such as sewers and showerhead sprays. A systematic review of Medline between 1946 and 2014 showed an 81% decline in TB incidence rates with a simultaneous 94% increase in infections caused by NTM. Prevalence of infections due to NTM has increased relative to infections caused by TB owing to the stringent prevention and control programs in Western countries such as the USA and Canada. While the spread of typical mycobacterial infections such as TB and leprosy involves human contact, NTM seem to spread easily from the environment without the risk of acquiring from a human contact except in the case of M. abscessus in patients with cystic fibrosis, where human transmission as well as transmission through fomites and aerosols has been recorded. NTM are opportunistic in their infectious processes, making immunocompromised individuals such as those with other systemic infections such as HIV, immunodeficiencies, pulmonary disease, or usage of medications such as long-term corticosteroids/TNF-α inhibitors more susceptible. This review provides insight on pathogenesis, treatment, and BCG vaccine efficacy against M. leprae and some important NTM infections.

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Section: Mycobacterium Lepraementioning

confidence: 99%

Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections

et al. 2022

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“…Several alternative therapies have been proposed for ENL, such as vaccination with Mycobacterium indicus pranii (10), apremilast (an oral phosphodiesterase IV inhibitor), cyclosporine, and tenidap (an anti-inflammatory drug) (7), as well as anti-TNF-α therapy (1,2,6,11,12). We here present four patients with severe, recalcitrant, and chronic ENL who did not respond to multiple therapeutic regimens and were treated with anti-TNF-α therapy.…”

Section: Introductionmentioning

confidence: 99%

Case Report: A Case Series of Immunobiological Therapy (Anti-TNF-α) for Patients With Erythema Nodosum Leprosum

et al. 2022

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Patients with leprosy may experience a chronic and severe type II leprosy reaction (ENL) erythema nodosum leprosum that may not respond to thalidomide and systemic immunosuppressants or may even cause serious adverse events. We here present four patients in whom anti-TNF-α therapy was used with successful results and compare our findings with other published cases. Four patients with chronic and severe ENL who did not respond to, at least, thalidomide and steroids (high doses) were followed up at two reference centers in Brazil. A thorough laboratory investigation was performed to exclude tuberculosis and other diseases before the start of immunobiological medication. Three patients were started on etanercept, and one patient was started on adalimumab. Of all patients, three developed severe adverse events resulting from the use of classical immunosuppressants for ENL (cataracts, deep vein thrombosis, diabetes, and osteoporosis). In all cases, a reduction in the number of ENL and, at least half of the immunosuppressant dose between 6 months and 2 years, were observed. Long-term follow-up of one patient revealed a dramatic reduction in hospital admissions due to ENL, from 12 instances in 1 year (before biologic therapy) to none (after biologic therapy), along with an improvement in condyloma acuminatum. In addition, no direct adverse events were observed with biologics. Treatment with anti-TNF-α therapy may be used as an alternative in patients with chronic and severe ENL who do not respond to traditional treatment (e.g., thalidomide, steroids, and other immunosuppressants). This treatment can help reduce the frequency of ENL, the immunosuppressive burden, and the number of hospital admissions.

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2022

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Chronic recalcitrant erythema nodosum leprosum: therapeutic dilemma and role of mycobacterium indicus pranii vaccine

Cited by 5 publications

References 7 publications

Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections

Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections

Case Report: A Case Series of Immunobiological Therapy (Anti-TNF-α) for Patients With Erythema Nodosum Leprosum

Multiple drugs

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