Evaluation of multi-drug therapy for leprosy in the United States using daily rifampin.

OBJECTIVES: To evaluate the occurrence of relapse of multibacillary leprosy after multi-drug treatment including daily rifampin. METHODS: A retrospective review was performed utilizing data from the National Hansen's Disease Program (NHDP) on patients with leprosy treated and followed from 1988-1997 who received multi-drug therapy including daily rifampin. The occurrence of relapse in this cohort was measured, and demographic data and various clinical variables were also gathered. RESULTS: Ultimately, 158 cases fulfilled the eligibility criteria. 77% of cases were multibacillary patients and were treated with 2 or 3 drug protocols at rates of 36% and 35% before and after 1992, respectively. Only one case of relapse was found, and this patient underwent 2-drug therapy versus 3-drug therapy. CONCLUSION: These data are remarkable for the absence of relapse with daily rifampin, as contrasted with the published experience using the WHO protocol with monthly rifampin.

Can leprosy be eradicated with chemotherapy? An evaluation of the Malta Leprosy Eradication Project.

The Malta Leprosy Eradication Project (MLEP) was proposed in 1971 by Freerksen with the aim of eradicating leprosy in Malta. The project involved re-treatment of all known cases in Malta as of 1972 and all new cases thereafter with a regimen consisting of Isoprodian (a combination of dapsone, prothionamide and isoniazid) and rifampicin for varying intervals depending on the severity of their disease and their response to treatment. Overall the response to therapy was excellent with an extremely low relapse rate. During the 30 years of the project the incidence of leprosy steadily decreased continuing a decline that had started at least two decades earlier and Freerksen declared the disease eradicated from Malta in 2001. Although given the long incubation period of leprosy cases may still be occasionally detected in the future, the disease has been basically eradicated at this time and there are no patients currently receiving treatment. This work was done at the leprosy clinic, Boffa Hospital, Floriana, Malta.

Single lesion subpolar lepromatous leprosy and its possible mode of origin

Three case reports of patients with a single, nodular, subpolar lepromatous skin lesion, one on the left elbow, another on the posterior aspect of the left leg, and the third on the extensor ulnar aspect of the right forearm, are presented. The lesions, clinically and histopathologically, resemble lepromas which develop at the site of experimental inoculation of Mycobacterium leprae in armadillos. These are sites on the body which are likely to be traumatized. With the distinct possibility of the presence of viable M. leprae in the soil of Louisiana and Texas from wild armadillos with the natural disease, it is suggested that these three patients acquired the infection from the environment and had inoculation lepromas

Bone changes in leprosy: a correlation of clinical and radiographic features

Characteristic bone lesions in leprosy affect the small bones of the face, hands, and feet. They are due directly to leprous infection imposed upon denervated tissues. The manifestations of leprous bone infection vary from the presence of bacilli in the bone to actual destruction. Distal absorption involves fingers and toes with the loss of digits. Combined absorption of lenght and width of bone often affects the metatarsophalangeal joints. Tarsal absorption patterns are determined by abnormal weight-bearing forces and infection.