Leprosy Mailing List – January 29, 2015
Ref.: (LML) How Efficacious is MDT
From: V.P. Shetty, Mumbai, India
Dear Dr. Pieter,
We would like to share with LML readers some of our findings in the field where we work i.e in District Raigad, state of Maharashtra, India. We notice that relapse following MDT is not uncommon as it is projected out to be. Following are only few examples. The serious question that we would like to ask is how efficacious is MDT.
No. 1:
In Oct. 2009, A 28 years old male was seen with complains of, tingling and numbness over extremities. On examination, there were crops of nodular lesions on the back (see fig.1). BI was 5+. We checked for drug sensitivity using molecular method, was sensitive to both DDS and RFP.
History: Detected with MB leprosy in 1994, taken MB-MDT x 24 months, RFT in Nov. 1996.
Fig 1
Crop of nodular lesion on the back.
No. 2:
In March 2013, a 62 year old male was seen with multiple plaques & nodules (see fig below) and multiple thick nerves, BI=5+, using molecular technique mutation in fol-p gene (DDS resistance) was detected.
History: 1971- Numerous HPPs -Rx DDS mono x 12 years (RFT in~ 1983)
1st Relapse- In 1998 - Reappearance of HPPs -Rx MB MDT x 12mnths (RFT 1999)
2011 - c/o multiple new NFI- No Rx~ Sept 2012 - c/o few nodular lesions
2nd Relapse- March 2013- Multiple plaques & nodules, multiple nerves thick, and BI=5+
Fig 2
No. 3 :
In April 2014, 70 year old male was seen with numerous nodular lesions all over body (see fig below). BI =6+, using molecular testing no mutation were seen
History: Detected with leprosy in 1972, was treated with DDS monotherapy for 12 years and released in 1984.
1st Relapse- Around 2007- reappearance of nodular lesion, treated with MBMDT for 24 months. RFT in 2010.
2nd Relapse- April 2014 - detected with multiple nodular infiltration. BI=6+.
Fig: 3
No. 4:
Contacts and relapse around 2 child cases
Fig: 4
Family Neighbours
Left hand side- Familial Contacts
Right hand side – Non Familial Contacts.
Dr. V. P. Shetty
Senior Scientist
The Foundation for Medical Research
84-A, R. G. Thadani Marg, Worli,
Mumbai - 400 018. INDIA
Tel: 91 22 24934989 / 24938601
Fax: 91 22 24932876
Email: fmr@fmrindia.org
Website: www.fmrindia.org
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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