Low risk of relapse and deformity among leprosy patients who completed multi-drug therapy regimen from 2005 to 2010: A cohort study from four districts in South India

Abstract

Introduction Relapse of leprosy among patients released from treatment (RFT) is an indicator of the success of anti-leprosy treatment. Due to inadequate follow-up, relapse in leprosy patients after RFT is not systematically documented in India. Relapsed leprosy patients pose a risk in the transmission of leprosy bacilli. We determined the incidence of relapse and deformity among the patients RFT from the leprosy control programme in four districts in South India. Methods We conducted two follow-up surveys in 2012 and 2014 among the leprosy patients RFT between 2005 and 2010. We assessed them for any symptoms or signs of relapse, persistence and deformity. We collected slit skin samples (SSS) for smear examination. We calculated overall incidence of relapse and deformity per 1000 person-years (PY) with 95% confidence intervals (CI) and cumulative risk of relapse. Results Overall, we identified 69 relapse events, 58 and 11, during the first and second follow-up surveys, respectively. The incidence of relapse was 5.42 per 1000 PY, which declined over the years after RFT. The cumulative risk of relapse was 2.24%. The rate of deformity among the relapsed patients was 30.9%. The overall incidence of deformity was 1.65 per 1000 person years. The duration of M. leprae detection in smears ranged between 2.38 and 7.67 years. Conclusions Low relapse and deformity rates in leprosy RFT patients are indicative of treatment effectiveness. However, a higher proportion of detection of deformity among relapsed cases is a cause for concern. Periodic follow-up of RFT patients for up to 3 years to detect relapses early and ensure appropriate treatment will minimize the development of deformity among relapsed patients.

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

“…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.…”

“…Eight (0.93%) of these studies were classified as MB relapse 14,15,32,34,42,46,47,51 and four (0.58%) by the PB classification 15,32,46,50,51 . In the 12 studies, the male gender was more prevalent 14,31,32,34,36,37,39,40,42,45,46,48 and the mean age was over 30 years old, with one study having a mean age below 15 years old 14,15,31,32,34,36,37,42,45,46 . A bacilloscopy index ≥4 BI was observed in the studies evaluated 14,31,32,33,34,36,37,40,42,45,46 .…”

“…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 .…”

“…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.…”

Systematic Review of Survival Analysis in Leprosy Studies—Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability

“…The main outcomes identified in the studies were leprosy, relapse, nerve function impairment, leprosy reactions and physical disabilities. The mean times and outcomes are key elements of discussion for the prevention and control of leprosy [4,39,40,43].…”