rifampin and Leprosy--Borderline

Leprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely. The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO-supported preventive measures and strategies play a key role in endemic areas.

Topics: Adult; Aged; Child; Clofazimine; Cross-Sectional Studies; Dapsone; Disease Progression; Drug Administration Schedule; Female; Guideline Adherence; Humans; Immunity, Cellular; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Long-Term Care; Male; Neglected Diseases; Rifampin

Leprosy is a slowly progressive, chronic infectious disease caused by the bacillus Mycobacterium leprae. It is a very serious, multilating and stigmatizing disease in many parts of the world and early diagnosis and therapy is the most important strategy for its control. The skin and peripheral nerves are the most affected organs. It is highly infective, but has low pathogenicity and low virulence with a long incubation period. The geographical distribution of leprosy has varied greatly with time and it is now endemic only in tropical and subtropical regions such as India and Brazil. The diagnosis of leprosy is made from the clinical picture, but must be complimented by skin bacilloscopy and histopathology. Leprosy has a number of distinct clinical presentations. Indeterminate leprosy is frequently the initial form consisting of a few lesions that either evolves into the other forms or resolves spontaneously. Lepromatous leprosy is the more contagious form and affects mainly the skin. In addition, some peripheral nerves may be thickened and other symptoms maybe present. The tuberculid form affects the skin and nerves, although usually there are few lesions. There is also a form borderline between the lepromatous and tuberculoid forms. Current treatment of leprosy involves use of 3 drugs: rifampicin (rifampin); clofazimine; and dapsone. Multidrug therapy aims to effectively eliminate M. leprae in the shortest possible time to prevent resistance from occurring. The duration of therapy was recently reduced from 24 to 12 months. Other treatment options are under evaluation in both preclinical and clinical trials and a number show promise. The combination of rifampicin, ofloxacin and minocycline given as a single dose has been recommended for the treatment of paucibacillar leprosy. Only when physicians, other health workers, and the population in endemic countries become fully aware of, and able to recognize, the disease in its initial phase, will it be possible for therapy to be instituted at the very beginning with either the standard scheme or the newer ones. Intervention at such an early stage will avoid the onset of the more serious signs and symptoms, meaning that leprosy will eventually become a less important public health problem. Therefore, efforts must be made to alert populations at risk and all health workers of the importance of an early diagnosis and treatment in leprosy infection.

Topics: Adolescent; Adult; Age Factors; Biopsy; Child; Clinical Trials as Topic; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Male; Multicenter Studies as Topic; Peripheral Nerves; Rifampin; Skin; Time Factors; World Health Organization

Multidrug therapy (MDT), according to the recommendations of a WHO Study Group of 1982, was introduced in the leprosy control program of the All African Leprosy and Rehabilitation Training Center (ALERT), Ethiopia, in January 1983. Paucibacillary (PB) patients are treated with 6 months of MDT. Multibacillary (MB) patients are treated with at least 2 years of MDT and until skin-smear negativity. An analysis was made of the relapses which had been diagnosed among self-reporting patients in four rural districts and Addis Ababa. Among 3065 PB patients, 34 relapses (1.1%) were diagnosed during an average period of 6.1 years after stopping MDT (range 2 1/2 to 7 1/2 years). Among 2379 MB patients, 24 relapses (1.0%) were diagnosed during an average period of 4.7 years after stopping MDT (range 2 1/2 to 6 years). The estimated relapse rate per 1000 patient-years after release from MDT was 2.1 for PB patients and 2.4 for MB patients. From the analysis of the clinical, bacteriological, and histopathological findings, it was concluded that there was strong positive evidence for the diagnosis for 16 of the 34 relapses in the PB patients and for 0 of the 24 relapses in the MB patients. The main cause for overdiagnosis of MB relapses was that too much reliance had been put on skin-smear results, without a careful comparison of the results with those from before, during, and at completion of MDT; the diagnosis was based on the finding of positive smears in one set of smears only; insufficient attention was given to finding solid-staining bacilli; and findings in biopsies, if these were examined, did not confirm the diagnosis. The main cause of overdiagnosis of PB relapses was that too much reliance was put on histological findings, while these are often inconclusive for differentiating between a relapse and late reversal reaction. Recommendations are made on how to limit overdiagnosis of relapses. Operational procedures and criteria for making the diagnosis under conditions where facilities for back-up histological and mouse foot pad investigations are not available are proposed.

Topics: Clofazimine; Dapsone; Epidemiologic Methods; Ethiopia; Humans; Incidence; Leprostatic Agents; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Recurrence; Rifampin

Multidrug therapy (MDT), according to the recommendations of a WHO Study Group of 1982, was introduced in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT), Ethiopia, in January 1983. Of 6042 paucibacillary patients who were put on MDT during a period of 7 years, 5485 patients (90.8%) completed the course of MDT; 437 patients (7.2%) did not fulfill the requirement for clinic attendance and either discontinued MDT themselves or the treatment was discontinued by the service. The remaining 120 patients (2.0%) either died, were transferred, left the control area or continued MDT after 9 months. The urine spot test for the presence of dapsone showed a significantly higher proportion of positive results for patients on MDT than for patients on dapsone. The analysis of the compliance with the prescribed doses of MDT showed that of 963 patients, 81.9% received six doses of MDT and 18.1%, more than six doses; 82.6% of these 963 patients attended with 100% regularity, 12.7%, 3.6%, and 1.1% missed one, two, or three clinic appointments, respectively, while fulfilling the requirement for overall clinic attendance. Of the 429 patients who had not been treated with dapsone before MDT, the skin lesions were clinically active at the time of stopping MDT in 130 patients (30.3%). In all, except one of the 114 patients (0.9%) who attended for follow-up examinations, the skin lesions had become clinically inactive within 2 years after stopping MDT. The recommended duration of MDT is discussed based on findings in the ALERT leprosy control programs and observations by others.

Topics: Dapsone; Drug Therapy, Combination; Ethiopia; Humans; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Patient Compliance; Rifampin; Time Factors; World Health Organization

Daily, long-term treatment with minocycline 100 mg and rifampin 600 mg was initiated in 24 previously untreated borderline lepromatous (BL) and lepromatous (LL) patients for a total of 646 patient-months, averaging 26.9 months per patient. The same regimen was started in 12 BL and LL patients having a bacteriologic relapse for a total of 379 patient-months, averaging 32.5 months per patient, and in 12 patients judged to be at high risk for relapse for a total of 354 patient-months, averaging 29.5 months per patient. Daily, long-term treatment with clarithromycin 500 mg and rifampin 600 mg was initiated in 8 previously untreated BL and LL patients for a total of 174 patient-months, averaging 21.8 months per patient. The results in these 56 patients were compared to those obtained in 34 previously untreated BL and LL patients who were treated concurrently receiving daily, long-term dapsone 100 mg and rifampin 600 mg. No evidence of dangerous drug reactions or bone marrow, kidney or liver toxicity was seen in any of these five patient groups. Drug intolerance in 10 of the 90 patients studied necessitated discontinuing the chosen regimen, 4 from rifampin, 3 from dapsone, 2 from minocycline and 1 of undetermined attribution. The use of either minocycline or clarithromycin in conjunction with rifampin appears to pose no great risk when used long term.

Topics: Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leukopenia; Male; Minocycline; Recurrence; Rifampin

New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.

Topics: Adolescent; Adult; Aged; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Leukopenia; Male; Middle Aged; Ofloxacin; Rifampin

Between 1980 and 1994, 67 new or relapsing leprosy patients were treated by daily administered multidrug regimens. Tuberculoid patients (23 TT/BT) received either bitherapy [rifampin + dapsone or clofazimine (RMP + DDS or CLO)] or tritherapy [RMP + DDS and/or CLO and/or ethionamide (ETH)] until clinical cure. Lepromatous patients (44 BB/BL/LL) received tritherapy (RMP + DDS and/or CLO and/or ETH) at least until bacteriological negativity. Of the 23 tuberculoid patients only one patient (5%) was cured at 6 months and about 70% needed between 6 and 24 months of treatment to obtain clinical cure (mean 19.5 months). In the 44 lepromatous patients, the achievement of bacteriological negativity was significantly linked to the initial bacterial index (BI), and it occurred after 2 to 7 years (mean 66.5 months) of multidrug therapy (MDT). The average BI decrease per year was 1.1+ during the first year, 0.9+ the second year, and then < 0.5+ per year. Reactional states significantly (p < 0.01) influenced the BI course: reversal reactions (RR) accelerated while erythema nodosum leprosum (ENL) delayed the BI decrease. Three of the 23 (13%) tuberculoid and 19 of the 44 (43%) lepromatous patients (p < 0.02) exhibited a RR and 18 of 44 (41%) lepromatous patients had ENL during MDT. A late RR (LRR) was observed in 1 (5%) and 6 (17%) of our tuberculoid and lepromatous patients, respectively, and 3 (8%) of our lepromatous patients suffered post-MDT ENL. No confirmed relapse has been observed within a follow-up period of 6 months to 7 years and 3 months [59 person-years at risk (PYR)] for TT/BT patients and of 4 months to 5 years and 10 months (100 PYR) for BB/BL/LL patients. When compared to the recommended WHO/MDT, it appears that daily MDT does not increase the clinical or the bacteriological cure rates either at 6 months in paucibacillary tuberculoid patients or at 2d years in multibacillary lepromatous patients. Moreover, as does the WHO/MDT, our regimens show a high frequency of reactional states both during and after treatment. This fact constitutes the main new problem of the actual treatment of leprosy.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Clofazimine; Dapsone; Drug Resistance, Microbial; Drug Therapy, Combination; Erythema Nodosum; Ethionamide; Female; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Male; Middle Aged; Recurrence; Rifampin

Previous studies have shown that when multibacillary leprosy patients were treated with recombinant human interferon gamma (rhuIFN-gamma) for 6-10 months there was an accelerated reduction in the number of acid-fast bacilli in the skin at the site of injection as well as an accelerated bacillary reduction at distal sites. However, this favorable out-come of IFN-gamma treatment was associated with the development of erythema nodosum leprosum (ENL). The present study was undertaken to investigate whether rhuIFN-gamma-induced bacillary clearance could be disassociated from the induction of ENL. rhuIFN-gamma was administered together with thalidomide and conventional multidrug chemotherapy to newly diagnosed leprosy patients. During treatment with this combination of drugs, the mean reduction in bacterial load was the same as the reduction observed with chemotherapy alone. Moreover, the inclusion of thalidomide in the treatment regimen was associated with a low frequency of ENL episodes. A second group of leprosy patients, who had already completed 2 years of chemotherapy, were treated with rhuIFN-gamma only. In those patients who were skin bacilli negative, ENL did not occur during rhuIFN-gamma treatment. In contrast, in bacilli-positive patients the frequency of ENL during rhuIFN-gamma treatment was higher, as was the occurrence of local erythema and induration. However, rhuIFN-gamma treatment without concomitant chemotherapy did not result in a reduction in the bacterial load in the skin of bacilli-positive patients. These findings, taken together, indicate that rhuIFN-gamma does not, by itself, accelerate bacterial clearance, but requires concomitant chemotherapy to achieve the accelerated reduction in bacillary load. Thalidomide reduces the frequency of IFN-gamma-induced ENL, but also eliminates the IFN-gamma-induced bacillary clearance.

Topics: Clofazimine; Dapsone; Drug Therapy, Combination; Erythema Nodosum; Humans; Interferon-gamma; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Mycobacterium leprae; Recombinant Proteins; Rifampin; Skin; Thalidomide

In the course of a clinical trial designed to re-examine the bactericidal efficiency of 600-mg doses of rifampin (RMP) against Mycobacterium leprae, two doses of RMP, either 600 mg or 1200 mg, were administered 28 days apart to 29 previously untreated patients with lepromatous or borderline leprosy. Seven, 28, and 35 days after the start of the trial, skin biopsies were performed and immunologically normal mice were inoculated with 5 x 10(3) or 10(4) M. leprae in each hind foot pad. The patients assigned to the two regimens did not differ significantly in terms of sex, age, disease classification, bacterial index, or the concentration of M. leprae in the skin lesion biopsied for the inoculation of mice. The concentrations of organisms in the skin-biopsy specimens did not change significantly over the course of the trial among the patients, whether they were being treated by the first or the second regimen. The M. leprae recovered from specimens obtained from 21 of the patients, before beginning treatment, multiplied in a majority of the mice inoculated. The results of mouse inoculation confirmed the rapid bactericidal effects of RMP against M. leprae: a single dose of RMP rendered the organisms obtained from all but two of the patients incapable of multiplying in mice. No significant difference was demonstrated between the two regimens, nor was an additional effect of the second dose of RMP observed.

Topics: Adult; Animals; Biopsy; Female; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Mice; Middle Aged; Mycobacterium leprae; Rifampin; Skin

During the decade between the mid 1970s and the mid-1980s, 12 rifampin (RMP)-containing combined regimens were tested among lepromatous leprosy patients in the Institut Marchoux. The 384 patients who were seen at least once during the period beginning 12 months after completion of treatment were considered eligible for analysis of the relapse rate. By the end of May 1991, relapse, manifested by a significant increase of the bacterial index (BI) and the appearance of new lesions with a BI greater than that of preexisting lesions, had been observed in 68 (17.7%) of these patients. Relapse was confirmed by the presence of viable Mycobacterium leprae in skin biopsy specimens obtained from 54 of the first 61 cases; virtually all of the isolated strains remained susceptible to RMP. The relapses occurred late, about 5 +/- 2 years after stopping treatment; the shorter the duration of RMP administration, the earlier the appearance of the relapse. The variations of the relapse rate among regimens were considerable: total relapse rate ranged from 2.9% to 27.8%, and the relapse rate per 100 patient-years of observation ranged from 0.8 to 6.9. Among the 12 regimens, only the WHO/MDT yielded an acceptable relapse rate (defined as a rate lower than 1.0 per 100 patient-years). However, because the mean duration of follow up was shortest among the patients treated with WHO/MDT, the relative low relapse rate among these patients must be interpreted with great caution.

Topics: Drug Therapy, Combination; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Microbial Sensitivity Tests; Mycobacterium leprae; Recurrence; Rifampin; Skin

A controlled clinical trial of two multidrug regimens in multibacillary lepromatous and near-lepromatous patients with a bacterial index (BI) of 2.5 or more was conducted. Patients were randomly allocated to either a two-drug regimen of dapsone plus clofazimine for 60 months or a four-drug regimen of rifampin, isoniazid, dapsone, and clofazimine for the first 3 months and clofazimine plus dapsone for the next 57 months. There was no difference between the rifampin and nonrifampin regimens with respect to the clinical improvement or bacteriological status of the patients at 60 months. Reactive states and neuritis were observed to be equal in the two patient groups.

Topics: Adolescent; Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Randomized Controlled Trials as Topic; Rifampin

Topics: Abattoirs; Anti-Inflammatory Agents; Antitubercular Agents; Clofazimine; Dapsone; Diagnosis, Differential; Humans; Isoniazid; Latent Tuberculosis; Leprostatic Agents; Leprosy, Borderline; Leprosy, Multibacillary; Male; Middle Aged; Prednisolone; Rifampin; Thrombophlebitis

Rifampicin is a highly effective antibacterial drug and an important component of multidrug therapy used to treat leprosy. Side effects of rifampicin are rare with the once-a-month dosage regimen of anti-leprosy multidrug therapy. Here, we report a case of rifampicin-induced thrombocytopenia during anti-leprosy treatment. Although rare, this potential side effect merits attention.

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Rifampin; Thrombocytopenia

Topics: Clofazimine; Dapsone; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Mycobacterium leprae; Rifampin

Topics: Adult; Biopsy; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Multibacillary; Morocco; Neglected Diseases; Rifampin; Skin

Hansen Disease (leprosy) is an infectious disease that targets macrophages and Schwann cells, caused by the acid fast intracellular organism, Mycobacterium leprae. Clinically, it presents with a spectrum of findings that may include hypopigmented macules, erythematous plaques and nodules, and thickened or tender peripheral nerves. The most feared complication is mutilating damage to facial structures or digits resulting from loss of sensation in affected skin. In non-endemic areas, the diagnosis of leprosy is frequently delayed because it may mimic other more common skin conditions. We present a case of borderline/lepromatous leprosy in an otherwise healthy young Brazilian man that was initially diagnosed as tinea versicolor, but did not respond to appropriate treatment. This case highlights the importance of having a high index of suspicion for leprosy in patients from endemic areas who present with lesions that could be consistent with this disease.

Topics: Clofazimine; Contraindications; Dapsone; Delayed Diagnosis; Diagnostic Errors; Humans; Hypesthesia; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Minocycline; Mycobacterium leprae; Rifampin; Tinea Versicolor; Young Adult

Amidst the plethora of ocular complications of leprosy, involvement of the posterior segment or optic nerve is extremely rare. The mechanism of optic neuritis in leprosy is poorly understood. A 47 year-old man presented with a single lesion suggestive of mid-borderline (BB) leprosy over left periorbital region; the histology showed borderline lepromatous (BL) leprosy with a BI of 3+. After initial improvement with WHO MDT-MB and prednisolone (40 mg/d) he developed sudden and painless diminished vision in the left eye, about 3 weeks later. His visual acuity was 6/9 in the left and 6/6 in the right eye, and there was left optic disc edema, hyperemia and blurred disc margins. Treatment with prednisolone (60 mg/d) along with WHO MDT-MB continued. A month later he returned with painless diminished vision in the other eye as well. Visual acuity was 6/6 in the right and 6/12 in the left eye, and there was right optic disc edema and left optic disc atrophy. CT of the head and MRI of the brain were normal. Inflammatory edema of the orbital connective tissue or other surrounding structures, or direct infiltration of vasa nervosa with resultant vascular occlusion leading to optic nerve ischemia, seems the most plausible explanation of optic nerve involvement in this case.

Topics: Anti-Inflammatory Agents; Clofazimine; Dapsone; Drug Therapy, Combination; Humans; India; Leprostatic Agents; Leprosy, Borderline; Male; Middle Aged; Ophthalmoscopy; Optic Disk; Optic Nerve; Prednisolone; Rifampin; Visual Acuity; Visual Field Tests

Topics: Aged; Clofazimine; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Minocycline; Mycobacterium leprae; Prednisone; Rifampin; Treatment Outcome

Topics: Adult; Antigens, CD; Antigens, Differentiation, Myelomonocytic; B-Lymphocytes; CD3 Complex; Clofazimine; Dapsone; Drug Therapy, Combination; Emergencies; Face; Facial Dermatoses; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Prednisone; Receptors, Cell Surface; Rifampin; T-Lymphocytes; Treatment Outcome

Topics: Adult; Clofazimine; Dapsone; Diagnostic Errors; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Rifampin; Sarcoidosis; Skin Diseases, Bacterial

Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.

Topics: Adult; Cellulitis; Dapsone; Diagnosis, Differential; Facial Dermatoses; Female; Glucocorticoids; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Mycobacterium leprae; Prednisolone; Rifampin

Topics: Adrenal Cortex Hormones; Adult; Anti-HIV Agents; Dapsone; Diagnostic Errors; Female; HIV Infections; HIV-1; Humans; Immune Reconstitution Inflammatory Syndrome; Lamivudine; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Neuritis; Nevirapine; Rifampin; Senegal; Stavudine; Tinea Capitis

Leprosy is rare in Australia, particularly in the southern states. We report two cases of leprosy in southern Australia that presented to the dermatology outpatients' department within a 4-month period. The presentation of the first case was complex, making the correct diagnosis difficult. Both cases involved immigrants from South-East Asia, were classified as multi-bacillary leprosy as defined by the World Health Organization, and were commenced on the recommended multiple drug therapy. The ensuing clinical course was complicated, with both cases developing Type 1 leprosy reactions. The first case also developed the rare but serious dapsone-induced delayed hypersensitivity reaction.

Topics: Adult; Aged, 80 and over; Arm; Back; Clofazimine; Dapsone; Diagnosis, Differential; Drug Hypersensitivity; Drug Therapy, Combination; Face; Female; Forearm; Glucocorticoids; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Mycobacterium leprae; Rifampin; Treatment Outcome

Topics: Anti-Bacterial Agents; Clofazimine; Dapsone; Drug Therapy, Combination; Glucocorticoids; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Middle Aged; Ofloxacin; Prednisone; Rifampin

Leprosy is generally revealed by cutaneous lesions often associated to nerve impairment. Rarely, it may be revealed by polyarthritis. The diagnosis, often delayed in the cutaneous-nevritic form because of the low prevalence of the disease in metropolitan France, is very difficult in case of rheumatic presentation. We report the case of a 28 year-old woman from Mali, who was diagnosed with lepromatous borderline leprosy with reversal reaction occurring in the postpartum as she presented with polyarthritis and skin lesions.

Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Arthritis; Biopsy; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Rifampin; Skin; Treatment Outcome

Topics: Adult; Antigens, Bacterial; Dapsone; Facial Dermatoses; Fever; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Mycobacterium leprae; Peripheral Nervous System Diseases; Philippines; Prednisone; Rifampin; Uveitis

Leprosy in a preschool child appearing at the age of four years is reported due to its rarity, particularly at a time when we are hoping for its elimination. A 5-year-old female child presented with an erythematous rash over-her right buttock for last one year. Histopathological examination from the patch revealed it to be a case of indeterminate leprosy. The child responded favourably with antileprosy treatment.

Topics: Child, Preschool; Clofazimine; Dapsone; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Rifampin; Treatment Outcome

Musculoskeletal symptoms are not infrequent in leprosy and, when inaugural, may be difficult to differentiate from other conditions, most notably rheumatoid arthritis. We report the case of a 24 year-old man with a 5 year history of intermittent inflammatory arthritis and fever. Physical findings and radiographs were normal initially. Several years later, he had severe wasting of the hand muscles, stocking-glove sensory loss, burn scars on the hands, and plantar ulcers. Electrophysiological test results indicated sensory-motor neuropathy with predominant demyelination. Laboratory tests showed inflammation without immunological abnormalities. A prominent endoneurial inflammatory infiltrate composed of mononuclear cells was seen on a nerve biopsy specimen, suggesting leprosy. A family study then revealed that the patient's aunt had been diagnosed with leprosy. Dapsone, clofazimine, and rifampin were given. The joint manifestations and laboratory tests for inflammation improved. However, no changes were noted in the neurological symptoms.

Topics: Adult; Arthritis; Chronic Disease; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Electrophysiology; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Musculoskeletal System; Neurons; Radiography; Rifampin; Toes

A 38-year-old Indonesian man presented with a single anaesthetic plaque on his right forearm and no other sensory changes. His clinical presentation was consistent with tuberculoid leprosy, but histopathology of a skin biopsy from the lesion showed borderline lepromatous disease. The patient was treated with multidrug therapy for multibacillary disease. Seven months after initiation of treatment his solitary skin anaesthetic plaque became tumid, and he developed multiple small plaques on his arms, legs and face, without evident neuritis. He was clearly in a reversal reaction (type 1), which slowly resolved with treatment of prednisone.

Topics: Administration, Oral; Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Forearm; Glucocorticoids; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Prednisone; Recurrence; Rifampin; Skin; Treatment Outcome

We report a case of borderline tuberculoid leprosy complicated by a median nerve abscess, acute renal failure secondary to rifampicin-induced haemolysis and duodenal ulceration secondary to steroid use. Rifampicin induced hameolysis is a rare and probably under-reported complication of leprosy multi-drug therapy. It should be considered when patients complain of flu-like symptoms after taking their monthly rifampicin.

Topics: Abscess; Acute Kidney Injury; Adult; Female; Hemolysis; Humans; Leprostatic Agents; Leprosy, Borderline; Magnetic Resonance Imaging; Median Nerve; Peptic Ulcer; Rifampin

Topics: Adolescent; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Rifampin; Time Factors

Topics: Adolescent; Anti-Infective Agents; Drug Therapy, Combination; Extremities; Female; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Minocycline; Mycobacterium leprae; Ofloxacin; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pulse Therapy, Drug; Rifampin; Skin; Treatment Outcome

We describe a patient with widespread borderline tuberculoid leprosy and significant peripheral nerve involvement. Despite the presence of widespread lesions, Fite stains and polymerase chain reaction studies were initially negative. We discuss the diagnosis and treatment of leprosy including recent changes in treatment regimens and duration.

Topics: Aged; Clofazimine; Dapsone; DNA, Bacterial; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Mycobacterium leprae; Polymerase Chain Reaction; Rifampin

A 29 year-old Bengali male case is presented in this paper which was a borderline tuberculoid leprosy (BT) at detection. His father contracted a lepromatous leprosy of G = 2 deformity. He took anti-leprosy drugs including MDT/MB regimen irregularly and had maculae widely-spread with anesthesia 16 months after being released from treatment (RFT). The histopathology of the maculae unexpectedly showed that of an indeterminate group of leprosy. The recurrent skin lesions were susceptive to a four-week regimen of Rifampicin and Ofloxacin. This case can not be defined as a relapsed case, because slit skin smears were always negative. It would be called a recurrent case after MDT/MB regimen. Though the reason recurrent skin lesions occur is unknown, it is reasonable to assume that the recurrent lesions are caused by dormant persisters which are originally drug sensitive. The recurrent skin lesions can not be classified because the clinical features can not be matched to their histology. Such recurrent cases might occur among the defaulters of MDT in future.

Topics: Adult; Bangladesh; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Ofloxacin; Recurrence; Rifampin; Skin; Time Factors; Treatment Outcome; Treatment Refusal

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Dapsone; Drug Monitoring; Granuloma; Histiocytes; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Lymphocytes; Male; Minocycline; Ofloxacin; Recurrence; Rifampin

Topics: Aged; Biopsy, Needle; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Recurrence; Rifampin; Time Factors

Topics: Adult; Anti-Inflammatory Agents; Clofazimine; Dapsone; Diagnosis, Differential; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Motor Neuron Disease; Prednisolone; Rifampin

Topics: Anti-Infective Agents; Communicable Disease Control; Drug Therapy, Combination; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Ofloxacin; Rifampin; Skin; World Health Organization

Thirty nine cases of borderline tuberculoid leprosy having nerve abscesses (15 with sinuses) were treated with daily dose of rifampicin and isoniazid for six months along with standard multidrug therapy. The patients were followed up for three to five years. No recurrence of abscess or sinus was observed. Observations indicate that medical approach is required at times to supplement surgical intervention for management of these cases.

Topics: Abscess; Adult; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Nervous System Diseases; Rifampin; Treatment Outcome

This study reports the clinical profile and therapeutic response of seventy-two mono-lesions leprosy cases. These 72 cases were among 578 paucibacillary (PB) cases classified according to WHO (1982) and were followed-up on multidrug therapy (MDT). Of these 72 mono-lesion cases, 46 (64%) were tuberculoid (TT) cases, 24 (33%) were Indeterminate (Ind) cases and 2 (3%) were of borderline tuberculoid (BT) types. While 37.5% of these cases presented as macular patches, the remaining 62.5% had raised erythematous lesions. In majority of cases (94%), the lesions were present on the exposed parts like legs and feet, arms and hands, face, whereas only 6% presented on covered areas of trunk and buttocks. These cases were treated with dapsone 100 mg daily for 12 months and rifampicin 600 mg once a month for 6 months. After 6 months of MDT, lesions in 81% of the patients regressed clinically and by one year of therapy 96% of cases had regressed. Treatment was stopped in all cases by one year of therapy. There were no relapse or late reaction in the 5 years of post treatment follow-up. The response of mono-lesion PB cases was better than the multi-lesions PB cases at 6 months and during the post treatment follow-up period.

Topics: Adolescent; Adult; Arm; Dapsone; Drug Therapy, Combination; Facial Dermatoses; Follow-Up Studies; Humans; Leg Dermatoses; Leprosy, Borderline; Leprosy, Tuberculoid; Middle Aged; Recurrence; Remission Induction; Rifampin

Topics: Adult; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Rifampin; Yemen

A study was undertaken to evaluate the efficacy of multidrug therapy as per WHO recommendation in 50 fresh cases (46 males and 4 females) suffering from borderline tuberculoid leprosy. All were given multidrug therapy consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for 6 months. At the end of 6 months all were evaluated clinically and histopathological examinations of the lesions were studied. The lesions were still active in 60% of patients clinically; 32% cases receiving multidrug therapy had shown marked improvement. Histologically lymphocytic infiltration in skin still persisted in all the slides examined and nerve infiltration was still present in 68% of cases at the end of 6 months after receiving multidrug therapy. The study shows that treatment with multidrug regimen for 6 months may not be sufficient to treat borderline tuberculoid leprosy cases.

Topics: Adolescent; Adult; Dapsone; Drug Therapy, Combination; Female; Humans; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Middle Aged; Prospective Studies; Rifampin; Treatment Outcome

Between 1982 and 1985, a single 1500 mg dose of rifampin (RMP) was given to 136 multibacillary leprosy patients who had become clinically inactive and skin-smear negative after various durations of dapsone monotherapy, and then antileprosy chemotherapy was totally stopped. By the end of June 1992, 15 relapses were detected among these patients. The overall relapse rate was 11%; the relapse rate per 100 patient-years was 2.1%, which was the highest among those published to date; the cumulative risk of relapse at year 7 of follow up was 8.8%. All of these figures indicate that the relapse rate among this group was at least the same as in other studies where patients received dapsone monotherapy only. Therefore, the administration of a single large dose of RMP could neither prevent relapse nor reduce its rate among multibacillary patients who had already become clinically and skin-smear negative after dapsone monotherapy.

Topics: Adult; Aged; Confidence Intervals; Dapsone; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Recurrence; Rifampin; Risk Factors; Skin

To investigate whether drug treatment improves the electroneurological measures of affected peripheral nerve function in leprosy patients.. Clinical status of patients determined on the first visit by an investigator administered, pre-designed questionnaire, followed by measurement of motor conduction velocity (MCV) and distal latency (DL) of ulnar, median, common peroneal and posterior tibial nerves bilaterally in patients referred consecutively from the dermatology unit and leprosy clinic, Teaching Hospital, Galle. MCV and DL measurements were repeated after 6 to 12 months of treatment.. Department of Physiology, Faculty of Medicine, University of Ruhuna, Galle.. 24 diagnosed leprosy patients; tuberculoid, lepromatous and borderline in clinical type.. Based on clinical typing. Tuberculoid (paucibacillary) type rifampicin 600 mg monthly and dapsone 100 mg daily for six months. Lepromatous and borderline (multibacillary) type rifampicin 600 mg and clofazimine 300 mg monthly and dapsone 100 mg and clofazimine 50 mg daily for 24 months.. DL in all 4 nerves and MCV in 3 nerves tested were significantly different (p > 0.001) to those for the normal population and remained so after 6 to 12 months of treatment. The DL in the ulnar nerve showed significant improvement (p < 0.05) after treatment. When analysed in each patient individually, before and after treatment, the MCV showed an improvement in 48 to 72% of patients and the DL in 41 to 59%, but differences were not significant.. Electroneurological recovery (return to normal state) of the affected peripheral nerves of leprosy patients does not occur after 6 to 12 months of drug treatment. The significant (p < 0.05) improvement (becoming better) of ulnar nerve DL indicates that, if at all, electroneurologically detectable improvement of nerve function occurs in the early stages of nerve damage, and that it may take longer than one year after starting treatment.

Topics: Adolescent; Adult; Aged; Child; Clofazimine; Dapsone; Drug Therapy, Combination; Electrophysiology; Female; Humans; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Male; Middle Aged; Neural Conduction; Peripheral Nerves; Reaction Time; Rifampin

Topics: Clofazimine; Dapsone; Drug Therapy, Combination; Edema; Foot Diseases; Humans; Leprosy, Borderline; Male; Middle Aged; Rifampin; Toes

Sixty-five patients initially seropositive for IgM anti-phenolic glycolipid-I (PGL-I) antibodies were tested for antibody levels to PGL-I, lipoarabinomannan (LAM), and the 35-kDa protein of Mycobacterium leprae at regular intervals for up to 30 months following the commencement of multidrug therapy (MDT). There was a steady decline in IgM anti-PGL-I and anti-35-kDa antibody levels to a mean of 17% and 14%, respectively, of the starting level at 24 months. The development of type 1 and type 2 reactions or the presence of drug-resistant organisms in a small number of patients had no significant influence on the changes in antibody level. The rate of decline was similar in different disease categories, but a higher proportion of lepromatous patients remained seropositive at the end of 2 years of treatment than borderline tuberculoid patients. By contrast, the mean IgG anti-LAM antibody levels remained stable or increased. Again the occurrence of type 1 or type 2 reactions had no significant effect on antibody level over 2 years. Falls in the IgM anti-PGL-I antibody levels mirrored the falls in the bacterial index in individual patients and provide an additional parameter for monitoring the response to chemotherapy.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Antigens, Bacterial; Child; Dapsone; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Glycolipids; Humans; Immunoglobulin G; Immunoglobulin M; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Lipopolysaccharides; Male; Middle Aged; Mycobacterium leprae; Rifampin

Renal failure is a rare complication associated with the use of rifampin. Intravascular hemolysis leading to acute renal failure following rifampin therapy is extremely rare. Two patients with leprosy who developed hemolysis and acute renal failure following rifampin are reported.

Topics: Acute Kidney Injury; Adult; Anemia, Hemolytic; Hemolysis; Humans; Leprosy; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Rifampin

Type 1 Hansen's disease reaction (reversal reaction) is believed to result from a change in the immune response in patients with borderline Hansen's disease. The only effective therapy for significant type 1 reactions has been systemic corticosteroid therapy. Cyclosporine is an immunosuppressive drug which has been widely used in organ transplantation. We report a case of type 1 reaction complicating borderline lepromatous Hansen's disease. Cyclosporine therapy resulted in prompt and sustained resolution of the reaction. The possible mechanism of action of cyclosporine and the implications regarding the immunopathogenesis of type 1 reaction are discussed.

Topics: Adult; Clofazimine; Cyclosporine; Drug Therapy, Combination; Humans; Leprosy, Borderline; Male; Rifampin; Skin

Report on the results with a new therapy with a complex combination (rifampicin + co-trimoxazole + isoniazid) for the treatment of leprosy. High tolerance. Duration of treatment 2 months.

Topics: Adult; Aged; Drug Therapy, Combination; Erythema Nodosum; Female; Follow-Up Studies; Humans; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Recurrence; Rifampin; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We have examined the Mycobacterium leprae phenolic glycolipid-I (PG-I) antigen levels in the sera of 45 multibacillary leprosy patients commencing chemotherapy. The PG-I antigen levels correlated with the bacterial and morphological indices, but not with the serum IgM anti-PG-I antibody levels. Antigen levels were significantly higher in patients with diffuse skin infiltration, but did not vary significantly with other parameters reflecting the duration and extent of untreated disease. The PG-I antigen levels in 27 patients examined serially decreased consistently over the first year of multidrug therapy.

Topics: Antibodies, Bacterial; Antigens, Bacterial; Carbohydrate Sequence; Clofazimine; Dapsone; Drug Therapy, Combination; Glycolipids; Humans; Immunoglobulin M; Leprostatic Agents; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Molecular Sequence Data; Mycobacterium leprae; Rifampin; Skin; Time Factors

The World Health Organization (WHO) has recommended a fixed duration of multidrug therapy (MDT) for paucibacillary leprosy which is currently widely implemented in India. A clinico-pathological study was initiated in 1984 to assess the efficacy of this regimen. The clinical and histological responses of the patients to MDT were assessed at the end of 6 months, when their treatment was stopped, and at 2 1/2 years, when they were released from surveillance, and compared with the responses of a matched patient group to conventional dapsone (DDS) monotherapy during the same period. Of 28 patients who completed the MDT schedule, there was less than 60% improvement in 33% of them when treatment was stopped at the end of 6 months and in 20% of them at the end of 2 1/2 years. Of 26 patients receiving DDS monotherapy, 37% showed less than 60% improvement at the end of 6 months but only 8.8% had less than 60% improvement at 2 1/2 years. It is concluded that MDT for paucibacillary leprosy as recommended by WHO may not have a major advantage over DDS monotherapy, since about 20% of those patients on MDT continue to have evidence of active disease when discharged from surveillance.

Topics: Adolescent; Adult; Aged; Child; Dapsone; Drug Therapy, Combination; Female; Humans; Leprosy; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Middle Aged; Rifampin; Time Factors

A male born in 1930 was diagnosed as smear-positive borderline leprosy in 1971, and was treated with dapsone and/or sulfamethoxypyridazine from 1972 to 1980 with clinical improvement. However, new skin lesions with smears strongly positive appeared in August 1980, and he was diagnosed as having downgraded to lepromatous (LL) leprosy, but the bacilli recovered from the skin biopsy were fully susceptible to both dapsone and rifampin by mouse foot pad technique. Between 1981 and 1983, the patient was treated with 24 months of rifampin 600 mg and dapsone 100 mg daily, supplemented with prothionamide 500 mg daily during the initial 3 months, and his skin lesions gradually improved during treatment with the combined regimen. Afterward, the patient was kept under surveillance without treatment. From 1984 to 1986, his skin smears were negative, and no bacilli could be found from a skin biopsy taken in 1985. Then in 1987, 52 months after stopping treatment, new skin lesions appeared with a high concentration of Mycobacterium leprae (2 x 10(6)/mg tissue). The drug-susceptibility test again demonstrated that the organisms were fully susceptible to both dapsone and rifampin. Apparently the relapse was due to remultiplication of drug-susceptible persisters.

Topics: Adult; Dapsone; Drug Therapy, Combination; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Mycobacterium leprae; Prothionamide; Recurrence; Rifampin; Sulfamethoxypyridazine

Highly bacillated lepromatous patients (BL/LL) with an initial bacterial index (BI) of 4 to 6+ are being treated with a modified World Health Organization-recommended multiple-drug therapy (WHO/MDT) regimen consisting of rifampin 600 mg once a month, clofazimine 100 mg on alternate days, and dapsone 100 mg daily. The clinical and bacteriological profiles of the patients who had discontinued treatment at different durations have been compared with patients who took the same treatment until attainment of smear negativity. All six of the patients who had discontinued treatment at 12-18 months had worsened clinically and bacteriologically, and viable bacilli could be demonstrated in those tested for ATP. In four patients who had stopped treatment at 24-30 months, the BI continued to fall and there was no clinical or bacteriological worsening in 1 to 2 years of follow-up. The fall in the BI in five cases who had discontinued treatment at 36-44 months was comparable to those on continuous treatment, and there was no worsening. These observations indicate that with the conventional MDT regimen it is not advisable to stop treatment at 12 and 18 months. It appears that treatment should be continued for at least 2 years, and longer in the untreated highly bacillated cases. Prospective clinical trials with a sufficient number of cases and long-term follow-up need to be carried out to ascertain the optimum duration.

Topics: Adolescent; Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Middle Aged; Mycobacterium leprae; Rifampin; Time Factors

Laser microprobe mass analysis of single bacterial organisms allows the determination of their intrabacterial ratio of sodium-to-potassium ions and the registration of fragment ions originating from their organic bacterial cell matrices as mass fingerprint spectra. It has been established previously that the intrabacterial cation ratio provides information on the physiological state of an individual bacterial cell. In the present experiments it is also shown, with different cultivable mycobacterial species and strains (drug sensitive and resistant) exposed to various drugs, that data derived from the evaluation of the mass fingerprint spectra reflect changes in the degree of impairment. The analysis of Mycobacterium leprae derived from a limited number of skin biopsies of lepromatous/borderline lepromatous leprosy patients under World Health Organization-recommended multiple-drug therapy (WHO/MDT) showed impairment of the organisms with both of the methods of measurement in proportion to the duration of treatment except in one case. In one M. leprae population from a patient who had been treated for 19 months, the fingerprint evaluation gave the first evidence for an insufficient response to treatment. This was further confirmed by the unusual frequency distribution of the Na+,K+ ratios which revealed the existence of two subpopulations, one impaired and one unimpaired.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Mass Spectrometry; Mycobacterium; Mycobacterium leprae; Polymyxin B; Potassium; Rifampin; Sodium; Trimethoprim

In order to judge the value of therapeutic regimens in paucibacillary leprosy, knowledge of incubation time of relapses is essential, as this will define the length of time patients have to be followed up after treatment has been stopped. The prospective study of relapse includes paucibacillary cases of leprosy belonging to a non-lepromatous group consisting of tuberculoid, neuritic and indeterminate. Data are presented on the incubation time of 21 relapses after multidrug therapy in Baroda district; 76.19% of relapses occur during the first 2 years. This figure is most important in the analysis of results of drug trials in paucibacillary leprosy. This figure should also be relevant to regimens including drugs that are more bacteriocidal than dapsone, since the bacteriocidal activity has a bearing on the minimal necessary duration of treatment, but not on the incubation time of relapses. With the introduction of bactericidal drugs e.g. rifampicin in multidrug therapy, the incidence of relapse are very low, hence relapse rates fall down to a very low level after multidrug therapy. Our study shows a mean relapse rate of 0.19% after multidrug therapy. Factors associated with the occurrence of relapse are discussed.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; India; Infant; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Mycobacterium leprae; Prospective Studies; Recurrence; Rifampin; Time Factors

Topics: Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Humans; Leprosy, Borderline; Male; Rifampin; Time Factors

The feasibility and effects of a 3-year treatment using rifampicin (RFP), clofazimine (B663) and dapsone (DDS) in multibacillary leprosy patients in Yangzhou Prefecture and Dongtai County (1983-1986) are reported. Among 591 active multibacillary leprosy patients in the two areas, 569 (96.30%) were treated with this regimen. Of 303 cases available for analysis, 196 (64.7%) cases showed negative skin smears and clinical inactivity. The rest showed different degrees of improvement. The average reduction of BI was 0.78. The intensity and frequency of ENL and neuritis decreased markedly with treatment. The main side-effects were pigmentation and ichthyosiform changes of the skin, but these did not influence treatment.

Topics: Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Rifampin

A 25-year-old male patient was diagnosed as a case of borderline lepromatous (BL) type of leprosy in erythema nodosum leprosum type reaction. He was put on multidrug treatment. He took regular treatment. Approximately a year after the beginning of the treatment he developed multiple cold abscesses and later tuberculosis of the left hip joint. He was given antitubercular treatment with 4 drugs and the abscesses were treated surgically. He showed good response. This unusual case and the role of intermittent rifampicin is discussed.

Topics: Abscess; Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Ethambutol; Hip Joint; Humans; Isoniazid; Leprosy, Borderline; Leprosy, Lepromatous; Male; Rifampin; Tuberculosis, Osteoarticular

A regimen consisting of 600 mg of rifampin once a month, 100 mg of clofazimine on alternate days, and 100 mg of dapsone daily was used in 56 untreated, highly bacillated borderline lepromatous/lepromatous (BL/LL) patients with an average bacterial index (BI) of 4.45. Treatment was continued until skin-smear negativity. After 2 years of therapy, none of the patients had become smear negative and the average BI was 2.56. There was no growth on inoculation of skin-tissue biopsies in the normal mouse foot pad after 6 months of therapy. Bacillemia was still detectable in 11/50 patients, and significant ATP levels were detected in Mycobacterium leprae from skin-tissue biopsies in 16% of the cases. After 3 years of therapy, three patients had become smear negative. The average BI was 1.30. None of the patients had detectable bacillemia, and 5% of the cases showed detectable ATP levels in M. leprae from tissue biopsies. After 4 years of therapy, 41.7% of the patients had become smear negative. The average BI was 0.66, and no ATP was detected in any of the purified bacillary suspensions. The fall in BI was accelerated, and more patients on continued treatment became negative earlier compared to those having treatment for a limited duration, as reported by others.

Topics: Adenosine Triphosphate; Adolescent; Adult; Animals; Clofazimine; Dapsone; Drug Therapy, Combination; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Mice; Middle Aged; Mycobacterium leprae; Rifampin

In Paraguay, the National Leprosy/Tuberculosis Program is based on a combined chemotherapy with isoprodian and rifampicin. The aim of this descriptive study was to investigate the therapy durations used so far in the treatment of 475 leprosy patients and to analyze the criteria responsible for the wide-ranging differences in therapy durations. As initial criteria, the following parameters were identified to have a significant influence on the therapy duration: Patients never treated before or pretreated, clinical classification and initial bacteriological index (BI) value. During therapy, conditions like the attendance and BI decrease/year showed a significant correlation with the therapy duration. Even though the studied criteria did not allow to draw a definite conclusion with regard to an 'ideal' therapy duration, they proved to be reliable, as only 2 patients have relapsed so far.

Topics: Dapsone; Drug Combinations; Drug Therapy, Combination; Humans; Isoniazid; Isonicotinic Acids; Leprostatic Agents; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Mycobacterium leprae; Paraguay; Patient Compliance; Prothionamide; Rifampin; Time Factors

Twenty-five patients of bacilliferous leprosy (17 LL, 8 BL) were studied by the modified haemolysis method for occurrence of bacillaemia and its clearance after two multidrug therapy regimens. Acid-fast bacilli were found in 76% of all patients and in 88.2% LL and 50% BL patients. Bacillaemia occurred with significantly reduced frequency in patients with type II reaction. Acid-fast bacilli were demonstrable in peripheral blood after 1 month in one patient on MDT of an Indian Working Group and 3 lepromatous patients on WHO multidrug therapy. However, bacillaemia could not be demonstrated in any patients after 2 and 3 months of treatment with both regimens.

Topics: Adolescent; Adult; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Mycobacterium leprae; Rifampin; Sepsis; Skin

Topics: Biopsy; Cambodia; Child; Clofazimine; Diagnosis, Differential; Drug Therapy, Combination; Humans; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Rifampin

Thirty-three active multibacillary patients from nine counties of Weifang Prefecture, Shandong Province, and 47 active cases from Menla County, Yunnan Province, People's Republic of China, were treated with 24 and 27 months of multidrug therapy (MDT), respectively, in 1983. Clinical assessments, smears, and histopathologic examinations were carried out independently by study teams from the Institutes of Dermatology of these two provinces. Reexaminations at 12-14 months and at termination of therapy showed marked improvement, and there was continued improvement at 12-18 and 33 months on follow up. Conversion of the bacterial index to negativity was 0/33, 5/47 for the patients from Shandong and Yunnan provinces, respectively, at the end of MDT and 2/33 at 12 months' and 17/47 at 18 months' follow up, which increased to 21/33 and 26/44 at 33 months' follow up. Regression of specific infiltration was about 21%-100% after 24-27 months of MDT; further regression to 95%-100% occurred at 33 months' follow up.

Topics: Adult; China; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Retrospective Studies; Rifampin; Skin

This paper discussed the effect in a 5 year period (1983-88) of MDT on the Leprosy situation in North Arcot District where MDT was started in 1983. The cases at the start of MDT were 68351 and 29511 cases were detected in the year period and the total case load was 97862. Out of this total case load 84810 cases were deleted by RFC, deaths or PL*. The causes for deletions are discussed in detail. The remaining case load at the end of the 5 year period is 13052 or 13.35% of the cases at start. The M.D.T. has definitely played a part in the drastic reduction of the case load since the major number of cases have been deleted as RFC due to cure of the disease and so the future planning of leprosy work when the case load becomes very low is also discussed.

Topics: Clofazimine; Cohort Studies; Dapsone; Drug Therapy, Combination; Follow-Up Studies; Humans; India; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Recurrence; Rifampin

55 B.T. patients were treated with WHO Paucibacillary MDT (1982). The patients suffered from reversal reaction neither at the time of initiation of MDT nor prior to that. During the 6 months period of MDT, one patient developed reversal reaction of a skin patch, and another patient developed neuritis of a peripheral nerve trunk.

Topics: Dapsone; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Hypersensitivity, Delayed; Immunity, Cellular; Leprosy, Borderline; Male; Rifampin

Two cases of 'flu' syndrome on once monthly rifampicin are reported. The symptoms were reproduced in one patient with the next supervised dose. In the second patient they did not recur probably because she was receiving systemic steroids for left ulnar neuritis.

Topics: Adult; Dizziness; Drug Administration Schedule; Female; Fever; Humans; Leprosy, Borderline; Rifampin; Shivering; Syndrome