Updates on management of leprosy in the context of COVID-19 pandemic: Recommendations by IADVL SIG Leprosy

Abstract

The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.

Viral co‐infections in leprosy: a scoping review

“…Smaller studies also provide some evidence of a lack of interaction: An Indian study reported a series of seven co‐infected patients treated with prednisone for leprosy reactions, where no one developed severe COVID‐19 82 . Similarly, a Turkish study reported nine cases of co‐infected multibacillary patients, all of which presenting with mild respiratory symptoms 83 …”

“…13 Smaller studies also provide some evidence of a lack of interaction: An Indian study reported a series of seven co-infected patients treated with prednisone for leprosy reactions, where no one developed severe COVID-19. 82 Similarly, a Turkish study reported nine cases of co-infected multibacillary patients, all of which presenting with mild respiratory symptoms. 83 A Brazilian surveillance COVID-19 study followed 378 leprosy individuals in the first months of the pandemic and identified four cases of co-infection, yielding a cumulative incidence of 1% as of June 30, 2020.…”

Leprosy and leprostigma: A review from the past through COVID-19

“…Such prioritization has prevented leprosy patients from easily accessing treatment, leaving them with severe physical disabilities (13). Moreover, due to the effectiveness of systemic corticosteroids in the treatment of COVID-19 complications, there has been a decreased availability of oral corticosteroids, which is used to treat those suffering from leprosy-associated reactions (14). Additionally, though related data is limited, COVID-19 and leprosy co-infection may increase the severity and frequency of leprosy-related complications (15).…”

“…Furthermore, leprosy patients may be more susceptible to COVID-19. Previous use of steroids and immunosuppressant therapy for leprosy-reaction management makes leprosy patients more susceptible to COVID-19 and vulnerable to its symptoms (14,16). Moreover, physical disabilities and deformities like dry skin, as well as poverty resulting from social difficulties, prevents leprosy patients from maintaining the personal hygiene necessary to prevent COVID-19 infection and thus increase their chance of contracting COVID-19 (17).…”

Leprosy reactions after SARS‐COV2 (COVID‐19) infection

“…We excluded patients who might have had other triggers (hormonal changes, medication, or stress). 4 Of the four patients, the two who had a lepromatous leprosy diagnosis were male and the other two who had tuberculoid leprosy and borderline leprosy were females (Table 1). The patients had experienced fever, malaise, paresthesias and cutaneous lesions such as erythematous-painful nodules (Figure 1).…”