Relapse in leprosy

Abstract

Leprosy is unique in terms of the nature of the causative organism (Mycobacterium leprae), the chronicity of the disease, its prolonged treatment and the definitions of "cure" and "relapse." The principal mode of assessing the efficacy of therapeutic regimens in leprosy is the "relapse rate." There are wide variations in estimates of relapse rates after the World Health Organization (WHO) multidrug therapy in different regions. The important predisposing factors for relapse include the presence of "persister" bacilli, monotherapy, inadequate/irregular therapy, presence of multiple skin lesions/thickened nerves and lepromin negativity. The conventional methods of confirming activity or relapse in an infectious disease (demonstration and/or culture of the etiologic agent) have limited utility in leprosy because of the difficulty in demonstrating bacilli in paucibacillary (PB) cases and absence of a method of in vitro cultivation of M. leprae. Bacteriological parameters are useful in multibacillary (MB) leprosy, whereas in PB leprosy, the criteria for relapse depend primarily on clinical features. Although there are no widely available serologic tests for leprosy other than in a research setting, various immunological tests may be useful for monitoring patients on chemotherapy as well as for confirming suspected cases of relapse. The main differential diagnoses for relapse are reversal reactions, erythema nodosum leprosum and reactivation/resistance/reinfection. The most reliable criteria for making an accurate diagnosis of relapse include clinical, bacteriological and therapeutic criteria. Additional ones that may be used, depending on the setting, are histopathological and serologic criteria. Relapsed cases of leprosy should be identified and put back on chemotherapy as soon as possible to prevent further disability and transmission of infection. Factors that should be considered in choosing an appropriate regimen are the type of leprosy (PB or MB), previous treatment and drug resistance. Occasionally, clinicians may need to use their judgement to modify the standard WHO treatment regimens according to the scenario in each patient.

Correlation between Central Memory T Cell Expression and Proinflammatory Cytokine Production with Clinical Presentation of Multibacillary Leprosy Relapse

“…Several studies describe a variety of relapse rates [ 14 , 18 – 19 ], which may be justified by some of the following reasons: difficulties at the diagnosis, time of diagnosis (which should be made as early as possible), and differences in discrimination between RR and relapse. Within this context, none of the relapsed patients studied presented any signs or symptoms that could characterize reactional episodes at the moment of relapse diagnosis.…”

A 29-Year-Old Male with Borderline Lepromatous Leprosy

“…Subsequently borderline leprosy and lepromatous leprosy may develop depending upon the immunity of the individual. 8 Tuberculoid leprosy patient has strong T-cell and macrophage activation with release of type-1 cytokine (IL-2, IFN-Y and IL-12) which results in CMI response and localizes the infection. In lepromatous leprosy, release of type-2 cytokine (IL-4, IL-5, IL-10) causes strong antibody response and concomitantly inhibits T-cell and macrophage resulting in progression of the infection.…”

Patients with skin smear positive leprosy in Bangladesh are the main risk factor for leprosy development: 21-year follow-up in the household contact study (COCOA)

“…[ 5 ] Cure rates with modern MDT are very high and relapse rates are low. [ 2 , 6 ] Leprosy has significant social and psychological implications. [ 7 ] Stigma is an important cause of delayed diagnosis.…”