Leprosy Mailing List – July 19 , 2017
Ref.: (LML) Re-infection of lepromatous patients after release from MDT
From: H K Kar, New Delhi, India
To thank Joel Almeida (LML, 18-07-2017) for bringing back the relevant observation which is discussed by the leprologists off and on. We know that there are two types of lepromatous leprosy. We encounter in our clinical practice:
-Sub-polar lepromatous leprosy which are the downgraded ones from borderline/indeterminate types of leprosy because of the delay in diagnosis and appropriate treatment of these cases, which are the majority of all LL cases.
-And another small group of LL cases, those from the beginning, manifest as LL with bilateral symmetrical hypo-pigmented or erythematous ill defined small macular lesions without loss of sensation all over the body or as diffuse fine infiltrations especially on face and extensor aspects of the trunks and extremities without any apparent peripheral nerve involvements initially. These cases create diagnostic problem clinically unless we do Slit skin smear (SSS) examination for detection of AFB with or without skin histopathological examination.
These polar LL cases, though very small in number especially in India, are sources of reservoir of infection in the community. After adequate MDT the possibility of relapse/reinfection either from endogenous /exogenous sources respectively is a possibility because of inherent zero cell mediated immune (CMI) response against Mycobacterium leprae. These cases require immune therapy along with MDT for prevention of relapse or reinfection. These cases also create problem of showing slow or nonresponse to MDT (non-responders) in the form of delayed bacteriological clearance through SSS and dermal granuloma clearance (skin biopsy). We have found quicker clinical, bacteriological and histopathological responses when longer course of MDT (2 to 3 years) was added with 4 to 8 doses of Immunotherapy (Mw/MIP vaccine). We have seen lepromin conversion in more than 60% of these cases after immunotherapy (published reports).
Therefore through immunotherapy along with longer duration of MDT we can reduce chance of reinfection and relapse in these small group of LL patients at-least theoretically by 60%.
Thanks and Regards,
Dr H K Kar
Dr. Hemanta Kumar Kar
Medical Director - LA Skin
Head of the Department - Dermatology
Paras Hospital - Gurugram, Haryana
Max Smart Hospital - Saket, New Delhi
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