Leprosy Relapse: A Retrospective Study on Epidemiologic, Clinical, and Therapeutic Aspects at a Brazilian Referral Center

Nascimento, Ana Cláudia Mendes do; Santos, Diogo Fernandes dos; Antunes, Douglas Eulálio; Gonçalves, Maria Aparecida; Santana, Marcela Araujo de Oliveira; Dornelas, Bruno de Carvalho; Goulart, Luiz Ricardo; Goulart, Isabela Maria Bernardes

doi:10.1016/j.ijid.2022.01.009

Cited by 14 publications

(30 citation statements)

References 22 publications

(42 reference statements)

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“…In leprosy management, identifying relapse, which involves the emergence of novel active disease manifestations after completion and documented cure with the standard treatment regimen, is crucial 17 . A specific study indicated that the median time to relapse among leprosy patients is approximately 12 years; however, our patient experienced a relapse after an extended period of 20 years 18 . Nerve dysfunction, developing months or years after MDT, may occur independently of overt reactions or relapse, leading to chronic progressive polyneuropathy or multiple mononeuropathies in the absence of active leprosy 19 .…”

Section: Discussionmentioning

confidence: 84%

Challenging in leprosy relapse with antiphospholipid syndrome diagnosis: A case report

Kolahi,

Ghadakchi,

Jabbaripour Sarmadian

et al. 2024

Clinical Case Reports

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Key Clinical MessageInfectious diseases like leprosy can cause antiphospholipid antibodies, leading to blood clots. Clinicians should consider this for patients with unusual thrombotic events and prior infectious disease history.AbstractThis case report details the diagnostic challenge of a 42‐year‐old man with a history of treated leprosy who presented with clinical features suggestive of antiphospholipid syndrome (APS). Vascular angiography revealed thrombosis, and serological tests were positive for APS antibodies. However, the patient subsequently developed symptoms, including thenar atrophy, paresthesia, and hypopigmented skin patches, which prompted further investigation. Electromyography detected sensorimotor polyneuropathy, while a nerve biopsy indicated a resurgence or chronic presence of leprosy. Despite initial APS management, the case evolved into a leprosy relapse confirmation after 20 years of remission, underscoring the diagnostic intricacies when concurrent autoimmune antibodies and infectious disease manifestations are present. This report emphasizes the importance of considering a broad differential diagnosis, including the potential for infectious disease relapse, in the presence of antiphospholipid antibodies. It illustrates the necessity of an interdisciplinary treatment approach in complex clinical scenarios.

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Section: Discussionmentioning

confidence: 84%

Challenging in leprosy relapse with antiphospholipid syndrome diagnosis: A case report

Kolahi,

Ghadakchi,

Jabbaripour Sarmadian

et al. 2024

Clinical Case Reports

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“…The characteristics of these 18 studies included in the meta-analysis are presented in Chart 1 14,15,31,32,33,34,36,37,39,40,42,45,46,47,48,49,50,51 . Of the total population suffering from leprosy analyzed in the meta-analysis (n=74,742), 867 (1.15%) were treated as relapse.…”

Section: Resultsmentioning

confidence: 99%

“…The main findings from the studies indicated that the relapse occurrence time after the initial PCT treatment is equal to or greater than 5 years after clinical cure, with higher prevalence of patients treated for MB 26,27,28,29 . Complementary findings from the cohort studies revealed that relapse cases were more prevalent among cases with positive bacilloscopy when compared to those with negative bacilloscopy in the initial treatment 13,14,15,30,31,32,33,34,35,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . The characteristics of these 18 studies included in the meta-analysis are presented in Chart 1 14,15,31,32,33,34,36,37,39,40,42,45,46,47,48,49,50,51 .…”

Section: Characteristics Of the Population And Clinical Aspects Accor...mentioning

confidence: 99%

“…Complementary findings from the cohort studies revealed that relapse cases were more prevalent among cases with positive bacilloscopy when compared to those with negative bacilloscopy in the initial treatment 13,14,15,30,31,32,33,34,35,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . The characteristics of these 18 studies included in the meta-analysis are presented in Chart 1 14,15,31,32,33,34,36,37,39,40,42,45,46,47,48,49,50,51 . Of the total population suffering from leprosy analyzed in the meta-analysis (n=74,742), 867 (1.15%) were treated as relapse.…”

Section: Characteristics Of the Population And Clinical Aspects Accor...mentioning

confidence: 99%

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Leprosy Relapse After Polychemotherapy: A Systematic Review and Meta-Analysis

Verônica da Silva,

Santos de Sousa,

Ferreira

et al. 2023

Preprint

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Objective: To synthesize the best scientific evidence related to estimating the prevalence of leprosy relapse cases after polychemotherapy treatment.Method:A systematic review was conducted following the JBI methodology for systematic reviews of prevalence studies, and the reporting stage adhered to PRISMA-P, with registration No.: CRD42020177141. The inclusion criteria were adopted following the PopCoCo mnemonic (Population, Condition, Context). Population: people of both genders and any age, diagnosed with leprosy relapse, and treated with paucibacillary or multibacillary therapeutic regimes. Condition: leprosy relapse after Polychemotherapy (PCT) estimated as a proportion of cases.Context: studies conducted within the scope of health services. Databases used: Medline, LILACS, Embase, CINAHL, Scopus, WoS, CARPHA; Mendeley reference manager. A random-effects meta-analysis model was applied, and heterogeneity was assessed using the Higgins test.Results: Out of 41 studies included in the review, involving a total of 93,461 patients with leprosy, 4.09% (n=3,830) were eligible for relapse after polychemotherapy. Of them, 69.71% (n=2,670) were treated both with multibacillary and with paucibacillary regimes (72.36%, n=1,932; and 27.64%, n=738, respectively), and with a bacilloscopy index ≥4. Relapse prevalence was observed in males and in people aged over 30 years old. The meta-analysis estimated the global prevalence of leprosy relapse at 11% (95%CI: 0.09-0.12), with higher prevalence rates in Brazil (31%) and India (13%).Conclusion: There is evidence of high global prevalence of leprosy relapse after PCT, with higher estimates in India and Brazil, countries burdened with higher prevalence of the disease.SYNTHESISAlthough leprosy us an ancient disease with a scientifically proven effective treatment, it remains a Public Health problem. This is not only due to the disease high prevalence but also to its potential to cause physical disabilities, leading to emotional and social impacts and, consequently, compromising quality of life. In addition to the new cases of the disease, another concern commonly reported in the literature is leprosy relapse after polychemotherapy, as it has repercussions on therapeutic effectiveness. The relapse causes are usually associated with therapeutic failure due to incomplete treatment, misclassification in the initial treatment, and multidrug resistance. This study provides insights to verify the disease current prevalence based on scientific evidence, which can contribute to expanding the prevention strategies.

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“…Since that time, leprosy treatment has evolved despite a lack of studies to clarify the relationship of the bacilli with the immune system and its presence in the bone marrow. The high number of leprosy relapses raises concern for a possible mechanism involving the persistence of bacilli multiplying in organs, such as bone marrow, after the standard treatment, especially in lepromatous leprosy ( 8 , 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

Fever of Unknown Origin, Wasting Syndrome and Bone Marrow Involvement: A Leprosy Case Report

et al. 2022

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Mycobacterium leprae, the etiologic agent of leprosy, is an acid-fast-staining and slow-growing bacilli that infect macrophages and Schwann cells individually or through forming globi. The clinical presentation of leprosy is broad and depends on the host immune response. We report a case of a 42-year-old Brazilian man presenting with fever of unknown origin (FUO), anemia, wasting syndrome, and neuropathy. The diagnosis of lepromatous leprosy was made after an extensive investigation revealed the presence of M. leprae in the bone marrow. Bone marrow involvement in leprosy is rare and some authors believe the presence of M. leprae in the bone marrow can act as a reservoir of the disease facilitating future relapses. It is important to investigate bone marrow involvement in leprosy, especially when the patient presents with cytopenias and positive epidemiologic history.

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Leprosy Relapse: A Retrospective Study on Epidemiologic, Clinical, and Therapeutic Aspects at a Brazilian Referral Center

Cited by 14 publications

References 22 publications

Challenging in leprosy relapse with antiphospholipid syndrome diagnosis: A case report

Challenging in leprosy relapse with antiphospholipid syndrome diagnosis: A case report

Leprosy Relapse After Polychemotherapy: A Systematic Review and Meta-Analysis

Fever of Unknown Origin, Wasting Syndrome and Bone Marrow Involvement: A Leprosy Case Report

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