The imperatives of leprosy treatment in the pre‐ and post‐global leprosy elimination era: Appraisal of changing the scenario to current status

Abstract

Leprosy was supposed to be eliminated by WHO at the global level by the end of the year 2000; however, it still remains a significant public health problem at a national level in six countries, where India alone accounts for 64% of prevalence and 78% of new case detection, worldwide. The global registered prevalence of leprosy at the beginning of 2006 was 219,826 cases. The number of new cases reported during 2005 was 296,499. The clinical diagnosis of leprosy continues to be based on patients having one or more of the three cardinal signs: hypopigmented or reddish anesthetic skin lesion(s); involvement of the peripheral nerves, as demonstrated by definite thickening with loss of sensation in the area of distribution; and a positive skin smear for acid-fast bacilli. Multidrug therapy (MDT) for leprosy has proved to be highly effective, with low relapse rates resulting in a dramatic decrease in the global prevalence rate to less than one case per 10 000 by the end of the year 2000. It was thought to be worthwhile to review the progress made in the treatment of this neglected tropical disease from the time diaminodiphenylsulfone (dapsone) monotherapy was introduced in its management, to the rapidly changing situation following the advent of WHO-recommended MDT and subsequently to short-course newer drug regimens with the prime objective to eliminate/eradicate leprosy from the world. Several permutations and combinations of drugs were utilized, the outline of which are succinctly depicted in the following account. Furthermore, a synopsis of the role of immunoprophylaxis therapy has briefly been reviewed to arrive at the possible current status. It is expected that this article is not only essential at this point in time but is also likely to make clear the intricacies surrounding its management.

A study of histological types of leprosy along with clinico-histopathological correlation in a Tertiary Centre from North Maharashtra region.

“…Similar findings were noted by other authors too [13,19,20] .Five cases of BL leprosy were classified as BT leprosy. Bhatia A S [19] et al and Sehgal V N [20] also noted similar findings.…”

Elimination of neglected tropical diseases in the South-East Asia Region of the World Health Organization

“…They include, for leprosy, multidrug therapy to treat and cure patients and reduce the reservoir of infection 17 ; for lymphatic filariasis, mass drug administration of diethylcarbamazine and albendazole to reduce microfilaraemia levels and transmission rates; for kala-azar, the use of a simple rapid dipstick diagnostic screening test known as rK39 followed by treatment with an effective drug and vector control by indoor residual spraying (only these interventions are required because, unique to this region, there is no animal reservoir and humans are the only source of infection of this disease) 18 ; and for yaws, the use of a single intra-muscular injection of long-acting benzathine penicillin to cases and their contacts to cure the disease and interrupt transmission. 16 All endemic countries require improved infrastructure and additional human resources to deliver these recommended intervention strategies.…”

Realities of leprosy control: updating scenarios

“…One of the most argued issues in the medical scope of the MDT mentions about the shortened duration of the treatment, feasible, over all, due to its detached bactericide action: only the first dose of rifampin would be capable to kill 99% or more than the viable organisms and would become the sick person in two days not infectious, inhibiting per some days the reproduction of the rare survivors 45 . These, however, as it was demonstrated in tissue preparations, have presented persistence in the host, even if passed a very superior time to the year of the treatment duration, for the multibacillary cases that decimate the majority of them.…”