Fw: Ref.: (LML) Drug Resistance in Mycobacterium Leprae in the Context of Zero Leprosy

 

Leprosy Mailing List – December 9,  2021

 

Ref.:  (LML) Drug Resistance in Mycobacterium Leprae in the Context of Zero Leprosy

 

From:  Ben Naafs, Munnekeburen, the Netherlands

 

 

Dear Pieter,

 

 

Utpal Sengupta made me aware of his publication in the Indian Dermatology Online Journal (http://www.idoj.in on Wednesday, November 24, 2021, IP: 247.98.17.194).

 

"WHO has drawn up a strategical road map from the year 2021 to 2030 focussing toward Zero leprosy target.[11] However, at the moment although the prevalence of leprosy has gone down to 0.22/10,000 worldwide[12] and to 0.66/10,000 in India,[13] a total number of 202,185 new cases including 14,981 child cases are appearing in the world.[14] India is still housing 114,451 (57%) of these new cases of the world. These data clearly indicate that despite the continuation of effective chemotherapeutic preventive measures by MDT for more than 4 decades, the transmission of the disease is continuing in the community. Leprosy being a chronic disease with a known long period of incubation (>20 years),[12] a total elimination program with Zero leprosy target by 2030 may be too optimistic.[15] "

 

"It is clear that secondary and primary resistance to rifampicin and ofloxacin are on the rise which has been established by screening relapse and newly diagnosed MB cases from the leprosy endemic countries.[31‑40] Further, the annual records also show a gradual rise of relapse cases (from 2844 of 2016 to 3897 of 2019) [14,67,68] under the elimination program. In addition, reports of isolation of rifampicin drug‑resistant strains from both type 1 and type ENL cases which are being reported from various research groups are of great concern as this has not been taken up yet in the M. leprae‑resistant strain surveillance mechanism under the program."

 

 

It is a very timely article since the WHO steps up its strategic plan "Towards zero leprosy by 2030". Again, a political and not scientific slogan. The recommendations in this concerned paper are essential to be considered.

 

"Therefore, it is recommended that the following strategy should be adopted immediately to check the transmission of anti-microbial resistance (AMR) strains of M. leprae in the endemic community are as follows:

-       (i) Establishment of a robust setup for early diagnosis of relapse and reactions in leprosy at the field level and their molecular screening for mutations for drug resistance to DDS, rifampicin, ofloxacin, and clarithromycin.

-       (ii) Screening of all new MB cases for the presence of molecular mutations for primary drug‑resistant strains to DDS, rifampicin, ofloxacin, and clarithromycin.

-       (iii) Once a drug resistance case to the above drugs is identified, the close contacts in the family should be screened for early detection of transmission of drug‑resistant M. leprae strains in the family.

-       (iv) After identification of either primary or secondary drug‑resistant cases, the patient should be treated adequately with an alternative regimen for the cure of leprosy."

 

 Ben Naafs

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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