Persistent plaques after release from treatment in slit‐skin smear negative leprosy patients: Wait and watch or adopt a proactive approach?

Narang, Tarun; Bishnoi, Anuradha; Thakur, Vishal; Chatterjee, Debajyoti; T, Muhammad Razmi; Kamat, Divya; Dogra, Sunil

doi:10.1111/dth.14226

Cited by 2 publications

(3 citation statements)

References 9 publications

(20 reference statements)

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“…We decided to initiate second-line therapy and the administration of rifampicin for 2 weeks is intended to provide a strong bactericidal effect, targeting persistent bacteria found in deeper locations. Administration of corticosteroid was not intended to suppress reversal reaction, but as a prevention of disability [7], [8].…”

Section: Discussionmentioning

confidence: 99%

Approach of Persisters Relapse in a Smear-negative Leprosy after Second MB-MDT Completion: An Arduous Case Report

Hartanto

Astindari

Kusumaputra

et al. 2022

Open Access Maced J Med Sci

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Introduction: Many infectious disease intervention programs, including leprosy, are cautious about the establishment of relapse and drug resistance. This case report reports on a male patient who has had two relapses and had undergone twice MB-MDT treatment as well. Case Report: A 31 year-old male, came with the main complaint of new hypopigmented patches appeared on the body since 4 months ago, which arose from his second MB-MDT treatment. He started his first MB-MDT treatment in 2019 and second MD-MDT in 2020. Slit skin smear yielded negative results and histopathological examination showed no signs of leprosy. Serological anti-PGL-1 antibody tests yielded very high IgM (3.163) and normal IgG (2) levels. PCR amplification examination showed positive, but DNA sequencing targeting rpoB, folP, and gyrA genes showed no mutations. He was diagnosed with persisters relapse in a borderline-lepromatous leprosy and was treated with rifampicin 600 mg/day for 2 weeks; combination of minocycline 100 mg/ day, clarithromycin 500 mg/ day, and clofazimine 50 mg/ day for 6 months; and methylprednisolone 32 mg/ day for the neuritis. No new lesions appeared during current treatment and he is also showing gradual improvement of foot drop in his left leg. Discussion: The fact of a very high IgM levels after 2 courses of MB-MDT indicated that there is still bacteria that continued to induce antibody formation, thus supporting the persisters bacilli hypothesis in this case. Positive results of PCR amplification conclude that there is still M. leprae bacilli in skin tissues, which may be hidden in deeper tissues. We have to make a more proactive approach considering this was his second times of relapse, and knowing the fact that MB-MDT was consumed religiously in the two previous treatment. Conclusion: In an arduous case like this, proactive step must be taken. Whenever possible, the use of whole genome sequencing is strongly advised. Keywords: leprosy, persisters bacilli, relapse, drug resistance

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Section: Discussionmentioning

confidence: 99%

Approach of Persisters Relapse in a Smear-negative Leprosy after Second MB-MDT Completion: An Arduous Case Report

Hartanto

Astindari

Kusumaputra

et al. 2022

Open Access Maced J Med Sci

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“…After 4 weeks of treatment with ofloxacin in a Phase III clinical trial, M. leprae bacteria viability was reduced by 99.99%. Some studies indicate that the use of ofloxacin can entirely replace 2 years of clofazimine and dapsone treatment and eliminate rifampicin‐resistant bacterial mutants 49 . Minocycline has a faster clearance of M. leprae than that of pefloxacin and ofloxacin.…”

Section: Management: What Is Newmentioning

confidence: 99%

“…49 Minocycline has a faster clearance of M. leprae than that of pefloxacin and ofloxacin. Clarithromycin has shown an additive effect when used with fluoroquinolones or rifampicin.…”

mentioning

confidence: 99%

Leprosy: what is new

2021

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Leprosy, also known as Hansen’s disease, is an age‐old chronic granulomatous infection characterized by prominent cutaneous and neurologic findings. Long known to be caused by Mycobacterium leprae, a new etiologic species was identified and linked in 2008, Mycobacterium lepromatosis. The BCG vaccine with highly variable efficacy may soon be replaced by the first leprosy‐specific subunit vaccine LepVax, which has recently moved forward in human trials. Recent evidence supporting theories of zoonotic transmission from armadillos and the less‐discussed Eurasian red squirrels has emerged. Knowledge on genetic polymorphisms that may increase leprosy susceptibility, such as the newly uncovered mitochondrial ribosomal protein S5 (MRPS5) polymorphism in the Chinese population, has provided a fresh perspective and direction. Further, we will delineate the latest information on leprosy, including the possible effects of leprosy coinfection with COVID‐19, HIV, and HTLV‐1, and the shift to newer leprosy therapies and treatment regimens.

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Persistent plaques after release from treatment in slit‐skin smear negative leprosy patients: Wait and watch or adopt a proactive approach?

Cited by 2 publications

References 9 publications

Approach of Persisters Relapse in a Smear-negative Leprosy after Second MB-MDT Completion: An Arduous Case Report

Approach of Persisters Relapse in a Smear-negative Leprosy after Second MB-MDT Completion: An Arduous Case Report

Leprosy: what is new

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