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Case Report: Multidrug-Resistant Mycobacterium leprae in a Case of Smear-Negative Relapse
Divya Kamat1, Tarun Narang1, Madhvi Ahuja2
1Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract:
The ongoing transmission of leprosy in India is worrisome, and emerging drug resistance may be one of the factors responsible for the continued transmission of leprosy in India. Emerging cases of multidrug-resistant Mycobacterium leprae pose a great threat to eradication of leprosy and must be addressed with utmost priority. We report a case of multidrug-resistant M. leprae in a case of relapse where slit skin smear (SSS) was negative and histopathology was inconclusive. Drug resistance studies in leprosy are undertaken only in smear-positive relapse cases, and detection of this type of multidrug resistance in a case with negative SSS and innocuous histopathology is rather unusual and highlights the importance of undertaking drug resistance tests even in smear-negative cases of leprosy relapse. Resistance to ofloxacin (OFL) is also a cause for concern as OFL is one of the reserve drugs recommended for treatment of rifampicin-resistant strains.
Insights
Multidrug-resistant leprosy strains are a major threat to eradication efforts in India. This case highlights the need for drug resistance testing even in smear-negative leprosy relapse cases.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Leprosy transmission persists in India, potentially driven by emerging drug resistance.
- Multidrug-resistant Mycobacterium leprae (M. leprae) strains pose a significant challenge to leprosy eradication programs.
- Standard diagnostic methods like slit skin smear (SSS) and histopathology can be inconclusive in certain leprosy relapse cases.
Observation:
- A case of leprosy relapse with multidrug-resistant M. leprae was identified.
- The patient presented with a negative SSS and inconclusive histopathology results.
- This presentation is unusual as drug resistance studies are typically performed on smear-positive relapse cases.
Findings:
- Multidrug resistance was confirmed in a leprosy relapse case despite negative SSS and inconclusive histopathology.
- Resistance to ofloxacin (OFL), a key reserve drug, was noted, raising further concern.
- The findings challenge the conventional approach to leprosy drug resistance testing.
Implications:
- Drug resistance testing for M. leprae should be considered even in smear-negative leprosy relapse cases.
- The emergence of resistance to reserve drugs like ofloxacin necessitates urgent attention.
- This case underscores the importance of adapting diagnostic strategies to combat evolving drug resistance in leprosy.
