resent fear is relapse of leprosy

Leprosy Mailing List – December 31st, 2010

Ref.:   Present fear is relapse of leprosy

From: Porichha D., Bhubaneswar, Orissa, India

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Dear Dr Noto,

I refer to Dr Pannikar’s message dated LML Dec. 5^th, 2010.  Present fear is relapse of leprosy.  Relapse can be due to reactivation of “persisters“ which are sensitive to the multi-drug therapy (MDT) and respond well to the 12-dose (12 months) treatment of the presently used schedule.  Most of the relapses belong to this category.  We are much bothered for emergence of bacteria not responding to rifampicin, which is the major component of MDT.  Hence for any case of relapse suspected clinically, skin smear is tested to know whether the bacilli in the smear are sensitive to rifampicin (can be killed by the drug) or resistant. 

Earlier sensitivity testing was done in mouse foot pad; now through molecular biological technique or amplification of bacterial deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR).  The surveillance for drug resistance is being undertaken in 12 states in India as per WHO protocol.  Skin smear  samples from suspected cases  from the field sentinel surveillance sites are sent along with  past (when initially treated) and present (the relapsed) clinical detail to one of the 4 accredited laboratories in the country.

Yours sincerely,

D Porichha

Medical Coordinator, LEPRA Society, Bhubaneswar