Paucibacillary multidrug therapy in leprosy. 7 1/2 years experience.

Three hundred and twenty-three paucibacillary (PB) leprosy patients were treated with WHO-recommended multidrug therapy (MDT) and followed up for over 7 1/2 years. The paucibacillary MDT regimen (PBR) was well accepted and tolerated. Complete clinical regression was attained in 61.2% patients after 6 doses of PBR. Persistence of clinical activity after 6 months of therapy was associated with occurrence of type I upgrading reaction, presence of six or more patches and more than two thickened major nerve trunks. Reversal reactions were encountered in 15.9% patients, one third of which were accompanied by severe neuritis. Delayed upgrading reaction occurred in six patients, two patients had relapse one and two years after stopping of PBR. The WHO recommended MDT regimen for paucibacillary cases needs careful evaluation and it may be necessary to extend the treatment beyond six months in certain situations.     

Clinico-histopathological study of multidrug therapy in indeterminate leprosy

A study was undertaken in 42 patients with indeterminate leprosy to evaluate the efficacy of multidrug therapy (MDT) in Indeterminate leprosy for 12 months. The main clinical finding was a single hypopigmented macule in 31 (73.8%) of the 42 cases. Histopathologically all cases showed lymphohistiocytic infiltration around skin appendages and dermal nerves. At the end of six months of MDT all the cases were evaluated clinically and 33 (85.5%) showed marked improvement or total inactivation while the lesions were still active clinically in 21.4% cases. Histopathological examination of lesions in 30 patients showed complete histological resolution in 9 cases only. At the end of one year of treatment it was found that 28 cases (66.3%) had become inactive and only 2 (4.7%) were found to be still active.     

Experience with multidrug therapy in paucibacillary leprosy

Eighty paucibacillary leprosy cases were randomly put on two different multidrug regimens for 6 months followed by dapsone monotherapy. Regimen I was according to WHO (1982) recommendations consisting of Dapsone and six once a month rifampicin. In regimen II in addition to above two constituents, clofazimine was added 100 mg on alternate days. Dapsone thereafter was continued in both the regimens upto one year. The efficacy, acceptability and side effects of multidrug regimens were observed for a period of one year. Histopathological assessment was done on completion of multidrug therapy in all cases. A comparative evaluation of effect of two multidrug regimens in paucibacillary leprosy patients is reported. Addition of clofazimine over WHO (1982) recommended regimen appears to have no added benefit. The duration of WHO (1982) recommended regimens was found to be inadequate in many cases.     

Bacillaemia in leprosy and effect of multidrug therapy

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.     

麻风联合化疗中发生麻风反应43例临床分析

目的:了解联合化疗(MDT)中发生麻风反应患者的临床特征及相关因素,为麻风防治工作提供依据.方法:收集2006-2020年在全国麻风病防治管理信息系统(LEPMIS)中登记并终审通过的山东省所有完成MDT且在此期间发生麻风反应的患者的相关信息,应用SPSS 23.0软件进行一般描述性统计分析和非参数Spearman秩相...     

Effectiveness of multidrug therapy in multibacillary leprosy: a long-term follow-up of 34 multibacillary leprosy patients treated with multidrug regimens till skin smear negativity

The World Health Organization (WHO) Field Trials of multidrug therapy (MDT) started at Schieffelin Leprosy Research and Training Centre (SLR & IC), Karigiri, India in December 1981. The patients were treated with two MDT regimens. The first (regimen A) consisted of 600mg rifampicin and 300mg of clofazimine given under supervision on 2 consecutive days monthly, 225mg injection of acedapsone bimonthly and dapsone 100mg daily. The second regimen (regimen B) was the conventional MDT (WHO/MDT), rifampicin 600mg and clofazimine 300mg supervised once a month, dapsone 100mg and clofazimine 50mg daily, unsupervised. Both the regimens were administered for a minimum period of 2 years or until skin smear negativity, whichever occurred later. Thirty-four newly detected previously untreated MB patients, 16 of whom received regimen A and 18 regimen B, were reassessed. Both regimens were well accepted and well tolerated by the patients. Clofazimine discolouration was the only adverse effect of MDT seen in these patients. After completion of treatment with MDT, the patients were followed up for a total duration of 466 person-years with a mean of 13.7 +/- 1.4 years per patient. No relapse was seen.     

Relapse of paucibacillary leprosy after short course multidrug therapy

Among 25 patients who had short-course multidrug therapy as recommended by the WHO for paucibacillary leprosy, 3 were observed to develop relapse of their disease 8 to 12 months after completion of treatment. These three cases of relapse are reported in detail. The duration of chemotherapy recommended by the WHO in paucibacillary cases appears to be too short.     

A study of relapse in paucibacillary leprosy in a multidrug therapy project, Baroda District, India

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.     

麻风患者166例统一联合化疗后2年随访

目的 探讨6个月麻风统一联合化疗方案对各型麻风患者的疗效。方法 对166例各型麻风患者采取世界卫生组织多菌型方案治疗6个月,观察临床和细菌学方面的疗效。结果 在166例患者中因各种原因退出31例,完成治疗并随访2年的患者135例。135例疗前查菌阴性者为45例（33.3%）,其余90例患者细菌指数从0.1 ~ 6.0不等,细菌指数疗前平均为2.91 ± 1.45,在停止治疗第2年末,45例细菌阴性患者显示总的皮损消退和改善率达到93.3%。神经体征改善率达80.0%。在90例查菌阳性患者中,皮肤损害消退和改善率达95.6%,神经改善率达77.8%。疗前细菌阳性的90例患者中有49例患者细菌阴转,占54.4%,平均细菌指数降低为0.66 ± 0.99。从开始治疗后的2.5年中,平均每年下降 0.9。在完成治疗停药随访满2年的135例患者中有25例发生麻风反应。其中Ⅰ型和Ⅱ型反应分别为13例和12例。在166例患者中,有1例多菌型患者在停止治疗后13个月复发。结论 统一联合化疗的近期疗效与常规MDT方案治疗2年的结果相似,其反应发生率差异以及远期复发率尚待观察。     

Three years assessment of multidrug therapy in multibacillary leprosy cases

Analysis of Bacteriological Index (BI) of 584 multibacillary leprosy patients who had completed multidrug therapy (MDT) as per the recommendations of World Health Organization (WHO) and Indian Association of Leprologists (IAL) showed smear conversion rates of 56% at 24 doses and 66% at 36 doses. Taking BI as a parameter of judgement, the results indicate distinct improvement over the performance achieved through dapsone monotherapy during earlier period. IAL regimen consisting of daily initial administration of rifampicin for 21 days did not show any distinct advantage over WHO regimen. Bacteriological decline was uniformally noticeable in all patients though in cases with high initial BI, smear conversion rate was much less. All the six patients with BI more than 5, and 59 patients (70%) with BI 1 to 4.9 and 87 patients (64%) with BI 3 to 3.9 have not been rendered negative even after three years of treatment. On the contrary seventeen patients whose skin smears were still positive after receiving 24 supervised doses became bacteriologically negative subsequently, and remained so though chemotherapy was stopped. Such studies on large number of patients for a longer period is essential to establish whether chemotherapy should necessarily be continued up to the point of negativity.     

Relapses after multidrug therapy for leprosy: a preliminary report of 22 cases in west Nepal

The WHO recommended multidrug therapy regimens for leprosy patients were implemented in Nepal from 1982. Therefore a considerable number of both paucibacillary (PB) and multibacillary (MB) patients have been on observation after release from MDT, for as long as 4-5 years. A retrospective study was done considering the patients who relapsed during this period and who were registered at the Out-patients Department of Green Pastures Hospital in Pokhara, Nepal. A total of 22 patients relapsed out of 927 who were released from MDT.     

A clinico-pathological study of multidrug regimen in paucibacillary leprosy

Preliminary results of a clinical trial in one hundred untreated paucibacillary leprosy cases with multidrug therapy (MDT) as per WHO recommendation are presented. Out of 100 fresh cases studied 18 had indeterminate, 35 tuberculoid and 47 cases had borderline tuberculoid leprosy. All were given MDT consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for six months. At the end of six months all the cases were evaluated clinically and histopathological examination of lesions were studied. The lesions were still active in 35% of patient clinically and 47% histologically. Complete histological resolution have come across only in 4 cases suffering from indeterminate leprosy. Altogether 65% cases receiving MDT have shown marked improvement to total inactivation. Histologically, lymphocytic infiltration still persisted in 90% of slides examined and nerve infiltration were still present in 64% of cases at the end of six months receiving MDT.     

Reduction in caseload after multidrug therapy in an urban leprosy control programme--a retrospective study in Bombay

A fall in the active registered case prevalence rate together with a fall in the active caseload per worker after the introduction of multidrug therapy (MDT) is becoming a managerial issue in leprosy control. A retrospective analysis was undertaken to assess the caseload per paramedical worker with reference to active cases for treatment (3341), cases for surveillance (2227) and cases for care after cure (165) at the end of December 1989. All these cases were under the care of 24 paramedical workers. The analysis showed that the caseload per worker was 239 (active cases 139, plus surveillance cases 93, plus care after cure cases 7), though active registered case prevalence rate declined from 1.82/1000 (before starting MDT) to 0.79/1000 by the end of December 1989. The case detection rate was 0.49/1000 by the end of 1989. So, although the active registered case prevalence rate declines, the worker will have enough to do because of the need for surveillance and the detection of relapses, early neuritis, early disabilities and care after cure. Simultaneously, new case detection and treatment must be continued. All these aspects need to be considered when programme managers are reviewing leprosy control strategy.