Relapses in multibacillary leprosy patients after Multidrug therapy

Poojabylaiah, Mitranna; Marne, Ramesh Bhat; Varikkodan, Rajina; Bala, Nandakishore; Sukumar, D; Martis, Jacintha

doi:10.47276/lr.79.3.320

Cited by 15 publications

(14 citation statements)

References 2 publications

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“…These studies have shown an IR ranging from 0.52/1000 py after a mean of 6.4 years follow-up/patient [12], 1.97/ 100 py in 162 patients followed for up to 8 years [11], to 7.5/1000 py after up to 7 years of follow-up [10]. Poojabylaiah et al [21] observed no relapses in 41 cases, but indicated the patients were not followed-up for a sufficient period of time after RFT. In another study, the enhancement of the twelve-dose MDT with monthly minocycline and ofloxacin did not reduce the rate of relapse.…”

Section: Discussionmentioning

confidence: 95%

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Low rate of relapse after twelve-dose multidrug therapy for hansen’s disease: A 20-year cohort study in a brazilian reference center

et al. 2021

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The World Health Organization has raised concerns about the increasing number of Hansen disease (HD) relapses worldwide, especially in Brazil, India, and Indonesia that report the highest number of recurrent cases. Relapses are an indicator of MDT effectiveness and can reflect Mycobacterium leprae persistence or re-infection. Relapse is also a potential marker for the development or progression of disability. In this research, we studied a large cohort of persons affected by HD treated with full fixed-dose multibacillary (MB) multidrug therapy (MDT) followed for up to 20 years and observed that relapses are a rare event. We estimated the incidence density of relapse in a cohort of patients classified to receive MB regime (bacillary index (BI) > 0), diagnosed between September 1997 and June 2017, and treated with twelve-dose MB-MDT at a HD reference center in Rio de Janeiro, Brazil. We obtained the data from the data management system of the clinic routine service. We linked the selected cases to the dataset of relapses of the national HD data to confirm possible relapse cases diagnosed elsewhere. We diagnosed ten cases of relapse in a cohort of 713 patients followed-up for a mean of 12.1 years. This resulted in an incidence rate of 1.16 relapse cases per 1000 person-year (95% CI = 0.5915–2.076). The accumulated risk was 0.025 in 20 years. The very low risk observed in this cohort of twelve-dose-treated MB patients reinforces the success of the current MDT scheme.

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Section: Discussionmentioning

confidence: 95%

“…Poojabylaiah et al . [ 21 ] observed no relapses in 41 cases, but indicated the patients were not followed-up for a sufficient period of time after RFT. In another study, the enhancement of the twelve-dose MDT with monthly minocycline and ofloxacin did not reduce the rate of relapse.…”

Section: Discussionmentioning

confidence: 99%

Low rate of relapse after twelve-dose multidrug therapy for hansen’s disease: A 20-year cohort study in a brazilian reference center

et al. 2021

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“…In our study the highest numbers of relapse cases belonged to age group 20-60 which may be due high number of leprosy cases belong to this age group, high exposure (as these age group people are the earning members of the family so more exposed to community for bread and butter rather than children and old age/ retired person) and long incubation period (about 5 years to 30 years [11][12][13]) of the disease may also contribute to the situation [14]. BCG vaccine has shown some protective effect among children less than four years [15-18] so this population is not generally affected and if a person is affected in childhood (<18 years of age) and take complete treatment, he or she is likely to relapse after a few years hence this may be a probable reason that 20-60 age group is most affected age group.…”

Section: Discussionmentioning

confidence: 99%

“…Relapse in leprosy indicates failure of treatment either complete or partial and it is affected by many factors [1,2]. Relapse rate in the country is an important indicator to assess of efficacy of therapeutic regimens incorporated to reduce the disease transmission in the community.…”

Section: Introductionmentioning

confidence: 99%

Profile of Person Affected by Leprosy with Clinical Relapse among in High Endemic State of India

Gitte¹,

Nigam²,

Chakraborty³

et al. 2018

Journal of Microbiology and Infectious Diseases

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Objective: Relapse is not an unusual phenomenon in leprosy, there are many predisposing factors which may lead to occurrence of relapse; some of these include the presence of persistent bacilli, drug monotherapy, inadequate or irregular therapy. Patients usually presents with presence of multiple skin lesions and/or thickened nerves, reason for early relapse is probably bacillary persistence due to inadequate treatment and for late relapse due to or re-infection. The objectives of this study are to assess various clinico-epidemiological factors associated with the occurrence of relapses in leprosy patients.Methods: A hospital record based retrospective follow-up study has been performed and 117 relapse cases of leprosy were included. Leprosy relapse cases presented in the study hospital were interviewed using a predesigned and pretested preformed. Each patient was subjected to clinical, bacteriological and disability assessments for diagnosis of relapse and followed until the completion of multi drug therapy.Results: During a study period, relapse was seen more in male as compared to female. The duration between cessation of treatment and re-appearance of new lesions varied from 1 to 33 years. Disability proportion was high among MB patients. Conclusion:Relapse in leprosy should be thoroughly examined and looked for drug resistance.

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“…A taxa de recidiva é um parâmetro fundamental para avaliação da eficácia do tratamento na doença de Hansen. 14,15,22,27 Após implementação da terapêutica múltipla, a OMS estima uma taxa de recidiva na doença de Hansen de cerca de 1%. 1,12 De acordo com alguns estudos pode atingir 20%.…”

Section: Discussionunclassified

Recidiva Na Doença De Hansen - Estudo Retrospectivo E Descritivo De 5 Anos

Pires

Oliveira

Cardoso

2016

SPDV

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Introdução: A recidiva na doença de Hansen refere-se ao aparecimento de novos sinais e sintomas em doentes com diagnóstico prévio e que completaram o esquema de tratamento proposto pela OMS.Objectivos: Determinar e caracterizar os casos de recidiva da doença de Hansen num período de 5 anos (2008-2012), na consulta de doença de Hansen do Hospital Curry Cabral.Material e Métodos: Realizou-se um estudo retrospectivo e descritivo, através da consulta dos processos clínicos, com identificação dos casos num total de 89 doentes observados na consulta no referido período. O tempo mínimo de seguimento foi de 6 meses. Em todos os casos, a suspeita clínica de recidiva foi confirmada por baciloscopias e exame histopatológico.Resultados: Foram identificados 4 casos de recidiva, o que correspondeu a 4,5% do total dos doentes observados, todos com diagnóstico prévio da forma clínica borderline lepromatosa, de acordo com a classificação de Ridley-Jopling. Foi instituída terapêutica para as formas multibacilares de acordo com esquema OMS em todos os casos. As recidivas ocorreram num período de seguimento entre 7 e 16 meses após interrupção do tratamento.Discussão: A frequência da recidiva da doença na população de doentes foi superior à observada na maioria dos estudos. Verificou-se incumprimento da terapêutica em todos os doentes, admitida como causa de recidiva, excluídos outros factores. Destacamos a importância do acompanhamento regular dos doentes em tratamento, permitindo assegurar a adesão à terapêutica e a sua eficácia.

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Relapses in multibacillary leprosy patients after Multidrug therapy

Cited by 15 publications

References 2 publications

Low rate of relapse after twelve-dose multidrug therapy for hansen’s disease: A 20-year cohort study in a brazilian reference center

Low rate of relapse after twelve-dose multidrug therapy for hansen’s disease: A 20-year cohort study in a brazilian reference center

Profile of Person Affected by Leprosy with Clinical Relapse among in High Endemic State of India

Recidiva Na Doença De Hansen - Estudo Retrospectivo E Descritivo De 5 Anos

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