Relapse in leprosy

Leprosy Mailing List – October 19th, 2008

Ref.: Relapse in leprosy
From: Kar H. K., New Delhi, India


Dear Dr Noto,

I refer to Dr Moharani’s LML message dated Oct. 18th, 2008. Relapse is defined as the recurrence of the disease at any time after the completion of a full course of treatment (WHO, OPERATIONAL GUIDELINE\SEA/GLP/2006.2).

Relapse is indicated by the appearance of new skin lesions and in case of multibacillary (MB) relapse, by evidence on a skin smear of an increase in bacteriological index (BI) of two or more units. It is difficult to be certain that a relapse has occurred, as new lesions may appear in late Type 1 leprosy reaction (also called late reversal reaction or LRR) after the patient has been released from treatment (RFT). Usually, the relapse appears after a sufficient time period to allow the left out live bacilli to multiply, may be a period of three years approximately, to produce a clinical new lesion.

Down grading type 1 reaction is no more considered as a separate type of type 1 reaction since this is nothing but a downgradation of the disease process in the spectrum due to delay in starting MDT. However, when ever there is difficulty to differentiate between LRR and relapse a course of oral steroid for a period of 4 to 6 weeks help in confirmation of the LRR which shows remarkable improvement. MB relapse should be investigated by using skin smears and histopathology.

Dr (Prof.) H K Kar
MD, MNAMS,
President, Indian Association of Leprologists,
Consultant & HODDepartment of Dermatology, STD & Leprosy
PGIMER and associated Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001
India