Abstract
Introduction According to many studies, the relapse rate in leprosy has come down to negligible levels after the introduction of multi-drug therapy (MDT) by WHO. However, a small number of patients have been known to relapse after release from treatment, even when there has been good compliance. Methods and findings During 2009–2017 (8 years), 23 multibacillary relapse cases were diagnosed clinically at SIHR&LC, and investigated further to confirm relapse; 95.6% of cases were positive by slit skin smear, 78.3% on histopathology and 63.2% through growth in the mouse foot pad (MFP). Conclusion The positive slit skin smear and the presence of active Hansen’s disease with solid stained M. leprae on histopathology are suggestive of relapse. Positive mouse footpad inoculation indicated the presence of viable M. leprae. Relapse was confirmed in 12 patients, but negative mouse footpad results cannot exclude relapse. Where there are no facilities for such investigations, we must develop awareness about possible relapse in all treated patients, especially in field conditions, for early self-reporting, referral, and retreatment (with alternative drugs in cases of drug resistance) as needed.
Highlights
Leprosy is a chronic bacterial infection involving skin and peripheral nerves
At the Schieffelin Institute of Health – Research Leprosy Centre, Karigiri, a tertiary leprosy referral center in South India, between 2009–2017, 22 patients presented with new skin lesions and one patient with an increase in Bacillary Index (BI) > 2+ at one site and Morphological Index (MI) 2%
At clinical diagnosis of relapse, 14 patients (60.8%) were classified as lepromatous leprosy according to the Ridley Jopling classification, 8 patients (34.8%) as borderline lepromatous (BL), and 1 patient (4.2%) as borderline tuberculoid (BT)
Summary
Leprosy is a chronic bacterial infection involving skin and peripheral nerves. The efficacy of MDT is measured by the number of relapses seen after completion of MDT and is expressed as the relapse rate.[1]. Relapse is defined as the occurrence of new skin lesions after completion of a standard course of MDT, or by an increase of two or more logs in the Bacillary Index (BI) compared with the previous BI at any one skin smear site.[2] Since relapses usually occur years after completion of MDT, it is difficult to suspect and identify them under field conditions.[3] Clinically, it is often difficult to differentiate between relapse and late reversal reaction
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