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Delayed resolution versus treatment failure in paucibacillary leprosy patients under six months fixed duration
C K Job1, J Jayakumar, M Aschhoff
1Leprosy Department, St Thomas Hospital & Leprosy Centre, Chettupattu.
Abstract:
Thirty paucibacillary (PB) patients were given multidrug therapy (MDT) PB regimen for six months and were examined clinically and histopathologically before therapy, at six months and 12 months after therapy; and in four patients, at 18 to 23 months after MDT. Histopathological activity was present in 50% and 25% of patients after six months and 12 months respectively after MDT. At 18 to 23 months, the four patients continued to have active lesions both clinically and histopathologically. On the basis of this study it is found that fixed duration of MDT is effective in a large majority of patients especially those with indeterminate leprosy. However, there is "delayed resolution" in a significant number of patients which in a few instances may turn out to be "treatment failures". Therefore, a regular follow up of high risk patients for at least two years and if possible, five years, with freedom to intervene with additional anti-inflammatory or antileprosy therapy as desired, is recommended.
Insights
Fixed-duration multidrug therapy (MDT) is effective for most leprosy patients. However, some cases show delayed resolution or treatment failure, necessitating long-term follow-up for high-risk individuals.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Leprosy remains a global health concern, requiring effective treatment strategies.
- Multidrug therapy (MDT) is the standard treatment for leprosy, but optimal duration and follow-up are crucial.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of a six-month multidrug therapy (MDT) regimen for paucibacillary (PB) leprosy.
- To assess the rate of histopathological activity and clinical resolution post-treatment.
Main Methods:
- Thirty paucibacillary leprosy patients received a six-month MDT regimen.
- Clinical and histopathological examinations were conducted before, at six months, and 12 months post-therapy.
- Four patients were followed for 18-23 months post-MDT.
Main Results:
- Histopathological activity persisted in 50% at six months and 25% at 12 months post-MDT.
- Four patients showed persistent active lesions clinically and histopathologically at 18-23 months.
- The fixed-duration MDT was effective for most patients, particularly those with indeterminate leprosy.
Conclusions:
- Fixed-duration MDT is largely effective for PB leprosy, including indeterminate cases.
- A significant proportion of patients experience delayed resolution, with a few progressing to treatment failure.
- Regular, long-term follow-up (2-5 years) is recommended for high-risk patients to manage potential treatment failures.