Combined Multidrug andMycobacterium wVaccine Therapy in Patients with Multibacillary Leprosy

Abstract

Immunotherapy with Mycobacterium w vaccine was attempted in patients with borderline-borderline, borderline lepromatous (BL), or lepromatous leprosy (LL) to determine whether immunization can hasten recovery and reduce treatment time by invigorating cell-mediated immunity. Mycobacterium w, a nonpathogenic, rapidly growing, atypical mycobacterium, shares a number of common B and T cell determinants with Mycobacterium leprae and Mycobacterium tuberculosis. Patients receiving the vaccine had rapid clinical improvement and accelerated bacteriologic clearance. After treatment with vaccine for 2 years, 13 of 31 BL and LL patients were bacteriologically negative as were 5 of 25 controls. Vaccinated patients had one of two distinct histologic features, either an upgrading in the disease spectrum or complete clearance of granuloma. Some 80% of lepromin conversions were in BL and LL patients who received vaccine versus none and 14.3% of BL and LL controls, respectively. Thirteen of 17 vaccinated LL patients were released from treatment after 2 years in contrast to 2 of 15 controls.

The Continuing Challenges of Leprosy

“…In addition, patients vaccinated with Mycobacterium w demonstrated reduced bacillary indices over time compared to patients receiving only multidrug therapy for 12 months. An important finding in this study, corroborating findings from an earlier study (453), was that patients in the vaccine group experienced a higher percentage (30%) of type 1 reactions compared to the control group (10%). Fortunately, neuritis was not increased with vaccination in patients with or without reactions, a finding also reported in the earlier study (453).…”

“…An important finding in this study, corroborating findings from an earlier study (453), was that patients in the vaccine group experienced a higher percentage (30%) of type 1 reactions compared to the control group (10%). Fortunately, neuritis was not increased with vaccination in patients with or without reactions, a finding also reported in the earlier study (453). In contrast to the increased incidence of type 1 reactions following vaccination with Mycobacterium w, the incidence of type 2 reactions was similar in controls and vaccinated patients.…”

“…A number of reports using Mycobacterium w as immunotherapy suggest that when given as adjunct therapy to multidrug therapy, significant clinical improvement does result (88,206,453). For example, De Sarkar et al (88) observed significant improvement in both clinical and histopathological assessments of lesions in patients receiving Mycobacterium w plus multidrug therapy.…”

Addition of immunotherapy to chemotherapy in pediatric borderline leprosy: a clinical evaluation

“…11 Zaheer at al reported a statistically significant fall of 1-84±0.18 in LL per year who received MDT+ MIP as compare to fall 0.98±0.11 in patients on MDT alone. 12 Sharma et al reported that 63% of cases of BL and LL on MDT+MIP became skin smear negative compared to 25% of MDT group in the same period. 6 Sarkar et al reported a fall in BI 2.05 per year in patients who received MDT+MIP as compared to BI fall of 1.05 per year in patients who received MDT alone.…”

Cytotoxicity of Mycobacterium indicus pranii on Mia-Pa-Ca2 cells

“…Previous studies show that ID injections of MIP in the deltoid region, together with standard multidrug treatment, increase the clearance of bacilli and reduce the recovery time of leprosy patients [15,35]. In addition, several side effects of the chemotherapeutic drugs could be reduced with combination therapy.…”