Multidrug Therapy Research Articles

Long-acting growth hormones: innovations in treatment and guidance on patient selection in pediatric growth hormone deficiency.

Long-acting growth hormones (LAGHs) represent a significant advancement in the treatment of pediatric growth hormone deficiency (GHD), offering an alternative to daily recombinant human growth hormone (rhGH) therapy. Traditional rhGH treatments, while effective, require daily injections, often leading to poor adherence due to the frequency of dosing, injection pain, and difficulties with storage and travel. In contrast, LAGHs, such as somatrogon, somapacitan, and lonapegsomatropin, are designed for once-weekly administration, improving patient compliance and quality of life. LAGHs have demonstrated non-inferiority to daily rhGH in phase 3 clinical trials, showing similar efficacy in terms of growth velocity and safety profiles. Despite these advantages, there remain concerns regarding the altered pharmacodynamics of LAGHs, such as the lack of pulsatile secretion and the potential for antibody formation. While the overall safety of LAGHs has been confirmed, some side effects, like lipoatrophy at the injection site, may occur, especially with PEGylated formulations. Guidelines for prescribing LAGHs are still evolving.. They are not yet approved for other conditions traditionally treated with rhGH, such as Turner or Noonan syndrome. Pediatric endocrinologists must carefully consider which patient groups would benefit most from this therapy, particularly those at risk for poor adherence to daily injections, such as patients undergoing multi-drug therapy, patients with needle phobia or behavioral disorders, very young children, adolescents, patients with separated parents, families that travel frequently, or children involved in activities like scouting. LAGHs present an opportunity to enhance therapeutic outcomes and adherence, but careful patient selection remains critical to maximizing their potential benefits.

Statement of Retraction: Effectiveness of Ivermectin-Based Multidrug Therapy in Severely Hypoxic, Ambulatory COVID-19 Patients.

Statement of Retraction: Effectiveness of Ivermectin-Based Multidrug Therapy in Severely Hypoxic, Ambulatory COVID-19 Patients.

Unveiling the impact of traditional Chinese herbal medicines on cutaneous adverse drug reactions: A landmark 15-year nationwide study.

Traditional Chinese herbal medicines (TCMs) have become increasingly integrated into global healthcare systems, often used alongside conventional pharmaceuticals. While TCMs offer therapeutic benefits, their concomitant use with other medications raises concerns over cutaneous adverse drug reactions (CADRs). Despite the widespread use of TCMs, large-scale studies examining their safety in combination with antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) remain limited. This study aimed to analyze the frequency and severity of CADRs associated with TCMs, focusing on their interactions with antibiotics and NSAIDs in a comprehensive dataset spanning over 15 years in China. We retrospectively reviewed clinical data from over 1.8 million patient visits annually between 2007 and 2022. Both mild and severe CADRs (SCARs) associated with TCMs, antibiotics, and NSAIDs were evaluated. While used in combination with antibiotics or NSAIDs, TCMs did not significantly increase the incidence of SCARs, although TCMs, antibiotics, or NSAIDs accounted for a proportion of CADRs. In contrast, the combination of antibiotics with NSAIDs showed a higher frequency of SCARs compared to monotherapy. These results suggest that TCMs have a favorable safety profile in multi-drug regimens, but careful monitoring is essential, particularly in multi-drug therapies involving conventional medications. This groundbreaking study provides unprecedented insights into the role of TCMs in CADRs, highlighting their potential for safer integration into multi-drug regimens. Although TCMs did not exacerbate the risk of severe reactions when combined with antibiotics or NSAIDs, vigilance in drug safety protocols remains crucial. These findings support the cautious and well-regulated use of TCMs within broader healthcare frameworks, promoting their safe integration alongside conventional therapies.

Comparison of Mono Therapy with Tazobactam Versus Multi Drug Therapy for Treatment of Perforated Appendix in Children

Introduction: Appendicitis stands as the predominant surgical emergency among pediatric patients. Despite its high occurrence rate, there remains a lack of agreement concerning the diagnostic and treatment approaches for this condition. This study aims to assess and compare the surgical results of open appendectomy in children with perforated appendicitis, utilizing either a perioperative multiple antibiotic regimens or a single antibiotic regimen. Patients and Methods: The investigation was carried out on pediatric patients who underwent open appendectomy due to perforated appendicitis at the Pediatrics Surgery Department in Mayo Hospital between December 2023 and June 2024. A total of 74 children were enrolled in the research. One group, Group A, received monotherapy with piperacillin/tazobactam, while another group, Group B, received multiple drug therapy with Metronidazole and Meropenem. Results: The mean age of patients in group A was 9.76±2.488 years and in group B was 9.86±2.406 years. In group-A (Tazobactam monotherapy), intra-abdominal collection was noted in 4(10.8%) patients and 3(8.1%) patients in group-B (Multi-drug therapy) with a p-value of 0.691. The mean hospital stay in Tazobactam monotherapy group was 7.92±0.829 days and in Multi-drug therapy group as 7.16±0.727 days (p<0.05). Conclusion: In the current study population, the use of monotherapy antibiotic treatment for perforated appendix in children demonstrated comparable effectiveness to triple antibiotic therapy in mitigating infectious morbidities, suggesting that the choice between these two approaches may not significantly impact the clinical outcomes of patients in this particular cohort.

Breaking the resistance: integrative approaches with novel therapeutics against Klebsiella pneumoniae.

Klebsiella pneumoniae is a leading cause of anti-microbial resistance in healthcare-associated infections that have posed a severe threat to neonatal and wider community. The escalating crises of antibiotic resistance have compelled researchers to explore an innovative arsenal beginning from natural resources to chemical modifications in order to overcome the ever-increasing resistance issues. The present review highlights the drug discovery efforts with a special focus on cutting-edge strategies in the hunt for potential drug candidates against MDR/XDR Klebsiella pneumoniae. Nature's bounty constituting plant extracts, essential oils, fungal extracts, etc. holds promising anti-bacterial potential especially when combined with existing antibiotics. Further, enhancing these natural products with synthetic moieties has improved their effectiveness, creating a bridge between the natural and synthetic world. Conversely, the synthetically modified novel scaffolds have been also designed to meticulously target specific sites. Furthermore, we have also elaborated various emerging strategies for broad-spectrum infections caused by K. pneumoniae, which include anti-microbial peptides, nanotechnology, drug repurposing, bacteriophage, photodynamic, and multidrug therapies. This review further addresses the challenges confronted by the research community and the future way forward in the field of drug discovery against multi-resistant bacterial infections.

Analysis of drugs-based treatment methods for Alzheimer’s disease

Alzheimer’s disease (AD) treatment is one of the focuses of current medical research. Researchers have made progress in exploring the pathogenesis and treatment for AD, especially with disease-modifying therapies, cognitive enhancers, and medications for neuropsychiatric symptoms. However, there is still a research gap on how to effectively combine these drugs to improve the quality of life for AD patients. Therefore, this research aims to explore the effects of three drugs on AD, including lecanemab, brexpiprazole, and donepezil. This research systematically analyzed the efficacy of three drugs in different aspects of the disease: lecanemab as a disease-modifying therapy, brexpiprazole for relieving agitated symptoms, and donepezil for improving cognitive function. Through the analysis of their action mechanisms and clinical trial data, this research reveals the different roles of these drugs in AD treatment. The research results indicate that the combination of these three drugs can improve patients' symptoms from different aspects. Because of the various pathological mechanisms of AD, individualized multi-drug combination therapy may be an effective direction for future treatment.

Cardiac findings in a phase II double-blind randomized placebo-controlled trial of combination therapy (HAZDPac) to treat COVID-19 patients

ObjectiveHydroxychloroquine paired with Azithromycin, Vitamin C, Vitamin D, and Zinc (HAZDPac), was used as a multidrug therapy method to treat COVID-19 illness and superimposed secondary bacterial pneumonia. Concerns have been raised though about such combinations regarding cardiac QTc interval prolongation and risks of arrhythmias, which we set out to address in this study.DesignWe evaluated cardiac safety in a Phase II Double-Blind Randomized Placebo-Controlled Trial of Combination Therapy to Treat COVID-19 Infections study, conducted by ProgenaBiome. Acutely ill patients with COVID-19 had QTc intervals recorded in an outpatient setting utilizing a continuously worn EKG monitor for the duration of the 10 days treatment. QTc intervals were normally distributed. Two-sample t-tests were used to measure any significant differences in QTc intervals between treatment and placebo groups.ResultsBetween March 2020 and June 2021, 118 COVID-19 patients were recruited and signed informed consent, of which 83 were enrolled for a Double-Blind Randomized Placebo-Controlled Trial. Of the 83, 52 patients were randomly assigned to receive HAZDPac treatment, and 31 patients to receive placebo. Overall, and in stratified analysis by gender, maximum QTc values of patients in the treatment arm were normal and no differences were observed when compared to maximum QTc values from patients in the placebo arm (p ≥ 0.15). There were no adverse events related to HAZDPac treatment.ConclusionWe found that the outpatient treatment of COVID-19 patients with HAZDPac which includes Hydroxychloroquine and Azithromycin, was not associated with prolongation of QTc compared to placebo and QTc remained within normal range.Clinical TrialClinical Trial NCT04482686, clinicaltrials.gov, date of registration 07/21/2020

Relevance of reporting leprosy related disability at the completion of multi drug therapy: A 5-year retrospective analysis of disability in persons affected by leprosy at ALERT Hospital Ethiopia.

Leprosy is one of the neglected tropical diseases associated with significant morbidity in endemic regions. It causes disability affecting the daily activities and social participation of affected individuals. Understanding the prevalence and trend of leprosy-related disability throughout the world and the accuracy of disability data counted by WHO is crucial in guiding efforts to be made towards the targets set by WHO to be achieved by 2030. This study aims to show the significance of reporting leprosy-related disability at the end of MDT and critique how disability is counted in the context of WHO data. This is a mixed method study with a 5-year retrospective analysis of outcomes of newly diagnosed leprosy patients at ALERT Hospital in Ethiopia from 2016 to 2020. A comparative review and analysis of leprosy related G2D (Grade 2 Disability), globally, regionally, and in Ethiopia using WHO data was also done. In addition, semi-structured interview of health workers (HCWs) and professionals working in the field of leprosy at various organizations was conducted. The trend of G2D among newly diagnosed leprosy patients shows no decline globally for the past 20 years. It is increasing in Africa and stable in the Southeast Asian and American regions where majority of leprosy patients are found showing the gap in early case identification and prompt treatment of leprosy cases. The total number of newly diagnosed leprosy cases at ALERT hospital between January 2016 and December 2020 were 1032 and among those patients who had completed treatment the prevalence of G2D was 33% at diagnosis and 23% at completion. The interview has also shown gaps in the completeness and quality of disability data reported to WHO and how disability is counted. Leprosy related G2D among newly diagnosed patient is not declining worldwide and even increasing in endemic regions like Ethiopia. More training should be given to health professionals in assessing disability. WHO should make some changes in the way it counts disability as the current definitions are prone to interpretation bias and lacks uniformity among various programmes and health workers. Prospective studies are needed in assessing disability progression post MDT so as design interventions and strategies in preventing worsening of disability after patients are discharged from treatment centre.

Bedaquiline Monotherapy for Multibacillary Leprosy

BackgroundStandard multidrug therapy for leprosy may be associated with severe side effects, which add to the stigma and discrimination that affect persons with the disease. In addition, the threat posed by drug-resistant leprosy shows the need for alternative drug combinations and shorter, safer regimens of multidrug therapy.MethodsIn this open-label, proof-of-concept study conducted in Brazil, we assigned patients with previously untreated multibacillary leprosy to receive bedaquiline monotherapy for 8 weeks. After completing the 8-week course of bedaquiline, the patients started standard multidrug therapy (as defined by the World Health Organization) for leprosy and were followed for 112 weeks. The primary end point was the change from baseline in the odds of positive growth of Mycobacterium leprae in mouse footpads after 8 weeks of bedaquiline therapy. The secondary end point was safety. Exploratory end points included change in the clinical signs and symptoms of leprosy and in the molecular viability of M. leprae (measured by a quantitative reverse-transcriptase–polymerase-chain-reaction assay).ResultsA total of nine patients were included in the modified intention-to-treat analysis. The odds of positive M. leprae growth had decreased from 100% in all the patients at baseline to no growth after 4 weeks of bedaquiline monotherapy. After 7 weeks of treatment, all the patients showed improvement in the appearance of skin lesions as compared with baseline. Seven patients had at least one adverse event (all grade 1 or 2) during treatment.ConclusionsIn patients with multibacillary leprosy, bedaquiline monotherapy cleared M. leprae by 4 weeks of treatment and led to improvement in the appearance of skin lesions by 7 weeks. (Funded by Janssen Research and Development; ClinicalTrials.gov number, NCT03384641.)

Persistence of Bacteriological Index After 1 Year of Multidrug Therapy Intake in Hansen’s Patients: An Indication to Strengthen the Antimicrobial Surveillance

Persistence of Bacteriological Index After 1 Year of Multidrug Therapy Intake in Hansen’s Patients: An Indication to Strengthen the Antimicrobial Surveillance

A retrospective cohort study of monthly rifampicin, ofloxacin and minocycline in the management of leprosy at the Hospital for Tropical Diseases, London, United Kingdom.

The World Health Organization (WHO) recommends rifampicin, dapsone and clofazimine multi-drug therapy (MDT) for the treatment of leprosy. Severe adverse effects include dapsone hypersensitivity syndrome, skin pigmentation, haemolytic anaemia, and hepatitis. At the Hospital for Tropical Diseases (HTD), London, United Kingdom monthly rifampicin, ofloxacin and minocycline (mROM) is used as first line treatment for leprosy. To determine the clinical outcomes and experiences of individuals treated with mROM. A retrospective study of individuals with leprosy who were prescribed mROM at HTD was conducted. Demographic and clinical data were collected on outcomes including relapses, leprosy reactions, bacterial index (BI) and adverse effects. Individuals were interviewed using a semi-structured questionnaire to understand their experiences of mROM. 29 individuals were identified and 20 interviewed. 26 (89.7%) individuals completed monthly mROM. 9 (31%) had switched from WHO MDT to mROM (five of whom (55.6%) were interviewed). BI reduced significantly following mROM treatment (p = 0.04). 17 individuals (58.6%) experienced a leprosy reaction. One of the 29 (3.4%) relapsed. The relapse rate was 9.5/1000 person years. 49 reports of adverse effects were either mild or moderate. The most frequent adverse effect (14/49) reported was orange discolouration of urine. No adverse effect required hospitalisation or discontinuation of mROM. Most individuals reported that skin lesions improved by the time they had completed mROM. In this small study in a non-endemic setting mROM was safe, effective and acceptable. mROM therapy is associated with improvement in skin lesions, decline in bacterial index and acceptable adverse effects. Larger, prospective, randomised studies are needed to determine whether relapse rates with mROM are equivalent or better than WHO MDT and to provide robust data on the seemingly better adverse effect profile of mROM.

Severe Erythema Nodosum Leprosum in Lepromatous Leprosy Patient

A case of a 58-year-old woman with lepromatous leprosy and severe ENL reaction is reported. The patient has symptoms of pustules for 1 year and the nodules were getting worse in the last week, accompanied by fever, joint pain, nausea, and vomiting. Physical examination revealed madarosis, infiltrates of both ears, and multiple painful erythematous nodules on the extremities and trunk. Slit skin smear examination showed bacterial index +3 and morphological index of 15%. Histopathological examination revealed neutrophil infiltration and vasculitis in the upper dermis. The patient was diagnosed with lepromatous leprosy and severe ENL reaction. The patient received multidrug therapy and methylprednisolone (62.5 mg/day), which was gradually reduced. The ENL reaction is caused by the deposition of M. leprae antigens and antibodies in small blood vessels, resulting in vasculitis and the release of enzymes that damage tissues. ENL reactions are commonly found in multibacillary MH and occur before, during, and after treatment. This reaction is mediated by cytokines produced by T-helper-2 (Th2). ENL reactions can cause disability.

HIV-TB Coinfection: A Systemic Review and Meta-analysis Insights

HIV and Tuberculosis (TB) are the leading global causes of death among patients with infectious diseases. They contribute significantly to morbidity around the world because of their impact on shared immune defense mechanisms. Tuberculosis is an infection that exploits the vulnerability of compromised immune systems. Opportunistic infections are illnesses that are more frequent or severe in individuals with compromised immune systems. HIV weakens the immune system, making people more susceptible to tuberculosis. When someone is infected with both HIV and tuberculosis, this is known as HIV/TB coinfection. HIV and tuberculosis represent the primary infectious disease challenges in countries with limited resources. In affected individuals, the interaction between Mycobacterium tuberculosis and HIV exacerbates the effects of each other, hastening the decline of immune function and leading to premature mortality if left untreated. Individuals with HIV are more likely than those without HIV to develop active tuberculosis as a result of untreated latent tuberculosis. Antiretroviral therapy (ART) is the use of HIV medications to protect the immune system and prevent the progression of HIV to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent tuberculosis, combined treatment with HIV and TB medications reduces the likelihood of latent tuberculosis progressing to active tuberculosis. The purpose of this research is to understand better the pathogenesis and pathways of HIV/TB co-infection, as well as to investigate drug-drug interactions in multi-drug therapies.

A mechanistic approach to optimize combination antibiotic therapy.

Antimicrobial resistance is one of the most significant healthcare challenges of our times. Multidrug or combination therapies are sometimes required to treat severe infections; for example, the current protocols to treat pulmonary tuberculosis combine several antibiotics. However, combination therapy is usually based on lengthy empirical trials, and it is difficult to predict its efficacy. We propose a new tool to identify antibiotic synergy or antagonism and optimize combination therapies. Our model explicitly incorporates the mechanisms of individual drug action and estimates their combined effect using a mechanistic approach. By quantifying the impact on growth and death of a bacterial population, we can identify optimal combinations of multiple drugs. Our approach also allows for the investigation of the drugs' actions and the testing of theoretical hypotheses. We demonstrate the utility of this tool with in vitro Escherichia coli data using a combination of ampicillin and ciprofloxacin. In contrast to previous interpretations, our model finds a slight synergy between the antibiotics. Our mechanistic model allows investigating possible causes of the synergy.

Trend and Factors Associated with Medical-Surgical Complications in Patients Discharged from Leprosy Multidrug Therapy at the Specialized Regional Hospital in Macenta, Guinea, from 2012 to 2021.

This study analyzed the trend and factors associated with medical-surgical complications in patients discharged from leprosy multidrug therapy at the Centre Hospitalier Régional Spécialisé (CHRS), in Macenta, Republic of Guinea. This was a retro 2012 (n = 54) and 2013 (n = 35) and then a slight decrease between 2014 (n = 34) and 2017 (n = 26). From 2019 (n = 18) to 2021 (n = 1), a significant d spective study using routine secondary data from 2012 to 2021. The most represented age group ranged from 25 to 59 years (73.8%), with a male predominance of 72.6%. Farmers represented 60.7% of the patients, 74.5% of the patients had plantar wounds, and 48.8% resided in the N'zerekore region. A trend analysis showed an overall significant decrease in the number of patients with complications between ecline was found. In the patients with leprosy reactions, there was a reduction in numbers from 48 in 2012 to 2 in 2014, with a predominance in men. There were significant associations between region, plantar perforation disease (p = 0.013), and physical disability (p = 0.029) and between year and leprosy reaction after the cure (p < 0.001). In summary, there was a high proportion of patients with plantar ulcers, which predominantly affected farmers, and a significant proportion with leprosy reactions and physical disabilities. Community awareness around leprosy and capacity building of the providers in terms of appropriate management may contribute to improving patients' quality of life.

Leprosy.

Leprosy, a neglected tropical disease, causes significant morbidity in marginalized communities. Before the COVID-19 pandemic, annual new case detection plateaued for over a decade at ~200,000 new cases. The clinical phenotypes of leprosy strongly parallel host immunity to its causative agents Mycobacterium leprae and Mycobacterium lepromatosis. The resulting spectrum spans from paucibacillary leprosy, characterized by vigorous pro-inflammatory immunity with few bacteria, to multibacillary leprosy, harbouring large numbers of bacteria with high levels of seemingly non-protective, anti-M. leprae antibodies. Leprosy diagnosis remains clinical, leaving asymptomatic individuals with infection undetected. Antimicrobial treatment is effective with recommended multidrug therapy for 6 months for paucibacillary leprosy and 12 months for multibacillary leprosy. The incubation period ranges from 2 to 6 years, although longer periods have been described. Given this lengthy incubation period and dwindling clinical expertise, there is an urgent need to create innovative, low-complexity diagnostic tools for detection of M. leprae infection. Such advancements are vital for enabling swift therapeutic and preventive interventions, ultimately transforming patient outcomes. National health-care programmes should prioritize early case detection and consider post-exposure prophylaxis for individuals in close contact with affected persons. These measures will help interrupt transmission, prevent disease progression, and mitigate the risk of nerve damage and disabilities to achieve the WHO goal 'Towards Zero Leprosy' and reduce the burden of leprosy.

Efficacy of leprosy vaccines across the globe: A systematic review & meta-analysis of randomized controlled trials.

Background & objectives Although multi-drug therapy has decreased the burden of disease, leprosy is yet to be eliminated. Accelerating progress requires optimal use of existing tools, advanced diagnostic tests, newer drugs, and vaccines. The search for a vaccine with therapeutic and preventive potential is ongoing, but evidence on effectiveness and safety is lacking. This systematic review and meta-analysis will evaluate and compare the clinical efficacy, immunogenicity, and safety of leprosy vaccines in humans. Methods In June 2024, three databases were systematically searched with updated search keywords. Randomized controlled trials (RCTs) pertaining to leprosy vaccines for humans which evaluated either therapeutic or prophylactic vaccines in leprosy with a placebo or active comparator arm, with full-text access, were included in the study. There were no restrictions on language, country or date. For the risk of bias assessment in the studies included, the revised Cochrane risk-of-bias 2 tool for RCTs was used. A P value (two-sided) of <0.05 was considered as significant for all tests; however for heterogeneity, a one-sided P value of <0.1 was considered as statistically significant. The quality of generated evidence specific to the desired outcomes were assessed using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). The study protocol was registered in PROSPERO (ID: CRD42024561651). Results A total of 2163 studies were retrieved from different databases. After removing duplicates and full text screening, 12 articles were finally selected. Out of these studies, eight used leprosy vaccines on prophylactic basis, while four used leprosy vaccines on therapeutic basis. In therapeutic use of leprosy vaccine, Ramu's score was found to be significantly protective [-3.06 (95% confidence interval (CI): -3.96 to -2.16)] among the recipients of the therapeutic leprosy vaccine. Bacterial index was found to be insignificant [-0.26 (95% CI: -1.54 to 1.03)] among the recipients of therapeutic leprosy vaccine. In subgroup analysis among the eight prophylactic vaccine studies, pooled relative risk was found to be 0.61 (95% CI: 0.41 - 0.91). Interpretation & conclusions The findings of this meta-analysis suggest that both prophylactic and therapeutic leprosy vaccines were significantly better compared to the placebo. Leprosy vaccine in the form of Mw/Mycobacterium welchii/MIP along with combination of World Health Organization (WHO) multi-drug therapy (MDT) or Bacillus Calmette-Guerin (BCG) vaccine along with second line treatment with rifampicin were found to be protective among the recipients.

A stochastic population model for the impact of cancer cell dormancy on therapy success

Therapy evasion – and subsequent disease progression – is a major challenge in current oncology. An important role in this context seems to be played by various forms of cancer cell dormancy. For example, therapy-induced dormancy, over short timescales, can create serious obstacles to aggressive treatment approaches such as chemotherapy, and long-term dormancy may lead to relapses and metastases even many years after an initially successful treatment.In this paper, we focus on individual cancer cells switching into and out of a dormant state both spontaneously as well as in response to treatment. We introduce an idealized mathematical model, based on stochastic agent-based interactions, for the dynamics of cancer cell populations involving individual short-term dormancy, and allow for a range of (multi-drug) therapy protocols. Our analysis – based on simulations of the many-particle limit – shows that in our model, depending on the specific underlying dormancy mechanism, even a small initial population (of explicitly quantifiable size) of dormant cells can lead to therapy failure under classical single-drug treatments that would successfully eradicate the tumour in the absence of dormancy. We further investigate and quantify the effectiveness of several multi-drug regimes (manipulating dormant cancer cells in specific ways, including increasing or decreasing resuscitation rates or targeting dormant cells directly). Relying on quantitative results for concrete simulation parameters, we provide some general basic rules for the design of (multi-)drug treatment protocols depending on the types and processes of dormancy mechanisms present in the population.

The Neurological Impact of Leprosy: Manifestations and Treatment Approaches.

Leprosy primarily affects peripheral nerves, leading to significant neurological complications such as polyneuritis, mononeurosis, and autonomic dysfunction, which contribute to severe disabilities and impaired quality of life for patients. This scoping review aims to investigate the neurological manifestations and main treatments of leprosy patients. Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases. This review has been registered on OSF (n) PQBYH. Neurological complications of leprosy, such as neuropathy and paralysis, necessitate accurate diagnosis and treatment, as immunological reactions can exacerbate nerve damage. Various studies highlight the effectiveness of personalized therapies, such as corticosteroids, multi-drug therapy (MDT), and surgical interventions, in improving symptoms and neurological function in leprosy patients. Managing neurological complications of leprosy necessitates careful diagnosis and treatment, as many patients experience unresolved peripheral neuropathy despite multidrug therapy. Future research should focus on improving diagnostic tools, exploring the link between neuropathic pain and psychological issues, and developing effective vaccines and treatments to enhance patient outcomes.

Impact of histopathological and serological assessments on early diagnosis of leprosy relapse.

This study aimed to identify laboratory factors predicting leprosy relapse (LR) after multi-drug therapy (MDT). A case-control study included 80 patients treated with MDT at a national reference center over 12 years. The Relapse Group had 40 patients who relapsed after an average of 89.2 months post-MDT, while the Control Group had 40 patients who remained asymptomatic for an average of 113.1 months. Significant predictors of LR included neural/perineural lymphocytic infiltrate (OR = 4.67; p = 0.0076) and foamy granulomas (OR = 15.55; p = 0.0005), increasing odds by 4.7 and 15.6 times, respectively. The Relapse Group had a mean histological bacillary index (hBI) of 3.23+ compared to 1.8 in the Control Group (p = 0.004). An hBI ≥3+ had 72% sensitivity and 65% specificity for detecting LR (AUC = 0.72; p = 0.0002). Elevated anti-phenolic glycolipid I (anti-PGL-I) IgM antibody levels (ELISA index, EI ≥1) were also associated with LR (OR = 4.67; p = 0.0031). An EI ≥3.6 had 71% sensitivity and 62% specificity (AUC = 0.70; p = 0.0012). Multivariate analysis indicated that neural/perineural infiltrate, foamy granulomas, hBI ≥ 1+, and EI ≥ 1 significantly predicted LR, with up to 94.32% probability. Conclusively, these factors can identify individuals at high probability of LR after MDT.