Present fear is relapse of leprosy

Leprosy Mailing List – January 7^th, 2011

Ref.:   Present fear is relapse of leprosy

From: Warren G., Sydney, Australia

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Dear Dr Noto,

I would like to compliment Dr Porichhas on his  comments on fear of relapse (LML Dec. 31st 2010).

Yes persisters are, I feel, very much to blame and, have been shown to be able to cause relapse after the patients has had 5 years of effective drug therapy and apparent “cure” of obvious lesions.  In one official trial at the end of five years of supervised daily rifampicin (supervised so we could not blame non compliance!).  Far more than we normally give, normal M. leprae, fully sensitive  to rifampicin could be cultured from  selected nerves!

However I would be interested to know if anyone has seen a patient on MDT, who had not been given rifampicin alone previously,  who has developed rifampicin resistance.    One presented with rifampicin resistant relapse?  Most of us have no facilities to do these sensitivity  tests whether by mouse foot pads or CPR.  Congratulations of India getting some centres organised in this field.

We all know dapsone resistance is common but, with due respect to some earlier correspondence, I would be interested to know if any research laboratory has identified clofazimine resistance developing in a human patient on treatment, whether monotherapy or in multidrug therapy.  Yes I know resistance to clofazimine has been developed in a laboratory but that was in mouse foot pads and, as  was a said in the 1960s  “a mouse even if he is a mighty mouse is still a mouse” and  what can be done in the laboratory will not of necessity produce the same effects in a human.

Greetings to all for the New year,

Grace  Warren

Adviser in Leprosy and Reconstructive surgery for The Leprosy Mission in Asia ( 1975-1994).