Leprosy Mailing List – January 31, 2015
Ref.: (LML) How Efficacious is MDT
From: HK Kar, New Delhi, India
Dear Dr Helen,
I would like to react to the letter by Dr. Helen Roberts, LML January 29, 2015. We appreciate her concern. Instances of relapse are not uncommon with standard fixed duration WHO MDT even after full course of treatment.
So many factors come to our mind regarding possible causes of relapse in that particular case. Is the classification wrong? Is the fixed duration MDT regimen not adequate to kill all organisms, particularly when BI is 4+ or above. Is the culprit presence of persisters? Did the patient real take the full course of treatment at home even though taken full courses from Medical centre? Is it a case of reinfection since the source of infection is still persisting in the community either in human being or environment? And so many other possible factors.
Each case has to be examined separately and retreated adequately. Fortunately Multi Drug resistance is only been reported in leprosy in few case reports. But we have to be adequately prepared to face the future challenge with 2nd line regimen with existing available antileprosy drugs or newer regimens for the future.
Thanks once again for bringing this challenging topic to limelight.
Dr (Prof.) H K Kar
Professor in Dermatology
Director and Med. Superintendent
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << firstname.lastname@example.org
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