Field trial on efficacy of supervised monthly dose of 600mg rifampin, 400mg ofloxacin and 100mg minocycline for the treatment of leprosy; first results

In 1995, a field trial was implemented in Senegal in order to evaluate the efficacy of a regimen based on the monthly supervised intake of rifampin 600 mg, ofloxacin 400 mg and minocycline 100 mg to treat leprosy. During the first year of the trial, 220 patients with active leprosy (newly detected or relapsing after dapsone monotherapy) were recruited: 102 paucibacillary (PB) (60 males and 42 females) and 118 multibacillary (MB) (71 males and 47 females). All of them accepted the new treatment (none requested to be preferably put under standard WHO/MDT), no clinical sign which could be considered as a toxic effect of the drug was noted, and none of the patients refused to continue treatment because of any clinical trouble. The compliance was excellent: the 113 patients (PB and MB) detected during the first 6 months of the trial have taken six monthly doses in 6 months, as planned. The rate of clearance and the progressive decrease of cutaneous lesions was satisfactory. Although it is too soon to give comprehensive results, it should be noted that no treatment failure was observed in the 56 PB patients who have completed treatment and have been followed up for 6 months. The long-term efficacy of the new regimen is to be evaluated on the rate of relapse during the years following the cessation of treatment. If that relapse rate is acceptable (similar to that observed in patients after treatment with current standard WHO/ MDT), the new regimen could be a solution to treat, for instance, patients very irregular and/or living in remote or inaccessible areas since no selection of rifampin-resistant Mycobacterium leprae should be possible (a monthly dose of ofloxacin and minocycline being as effective as a dose of dapsone and clofazimine taken daily for 1 month). Nevertheless, until longer term results of this and other trials become available, there is no justification for any change in the treatment strategy, and all leprosy patients should be put under standard WHO/MDT.

PGL-1 antigen and antibody detection in leprosy patients: evolution under chemotherapy

Multibacillary (MB) and paucibacillary (PB) leprosy patients were tested for circulating phenolic glycolipid-I (PGL-I) antigen and antibodies before treatment. In the 27 MB patients tested, 27 (100%) were antigen positive with levels ranging from 50 to 5000 ng/ml, and 26 (96%) were antibody positive with titers ranging from 1000 to 64,000. Although the antigen and antibody levels were much higher in MB than in PB patients, we could not demonstrate a correlation between the number of acid-fast bacilli/mg of skin biopsy and these two parameters in 14 MB patients. After starting daily multidrug therapy, 10 MB patients were monitored monthly. As much as 88.75% +/- 10.8% of the PGL-I antigen was cleared from the bloodstream after 1 month while the anti-PGL-I antibody remained stable. This rapid decrease in the PGL-I antigen level strongly suggests the usefulness of this test for monitoring MB patients under chemotherapy

Implementation of chemoprophylaxis of leprosy in the southern marquesas with a single dose of 25 mg kg rifampin

Between 1967 and 1987 in the Southern Marquesas, a remote archipelago in French Polynesia, the detection rate of leprosy was 48.9 per 100,000 when it was 8.6 per 100,000 for French Polynesia as a whole. In 1988, a program of chemoprophylaxis of leprosy with a single dose of 25 mg/kg rifampin was implemented, and 2751 persons (98.7% of the population) were treated in the Southern Marquesas. In addition, 678 South Marquesans and 2466 members of their families living in the Northern Marquesas and in the Society Archipelago, received the same chemoprophylaxis. Among 2676 persons studied in the Southern Marquesas (97.4% of the treated population), 130 had elevated IgM anti-phenolic glycolipid-I antibodies by ELISA without any evidence of leprosy. The onset of a skin lesion of borderline leprosy in a boy 3 months after chemoprophylaxis raises the question of the nature of such a skin lesion and, indirectly, of the effectiveness of the chemoprophylaxis

Study of 39 documented relapses of multibacillary leprosy after treatment with rifampin

Among 39 strains of Mycobacterium leprae isolated from patients with multibacillary leprosy who relapsed after treatment with rifampin (RMP), 22 strains were resistant to RMP and 17 were susceptible. All of the RMP-resistant strains were recovered from patients who had been treated with more than 50 doses of RMP, usually given as monotherapy. RMP-susceptible strains were recovered from only six patients who had received more than 50 doses of RMP, and from 11 patients who had received no more than seven doses. The median time to relapse after the beginning of RMP therapy was 9 years (range 1-12 years) among the patients harboring RMP-resistant strains of M. leprae, and the median time to relapse after discontinuation of RMP treatment was 7 years (range 1-11 years) among the patients harboring RMP-susceptible strains. These data suggest that monotherapy with more than a few doses of RMP can be responsible for the emergence of RMP-resistant strains of M. leprae, thus emphasizing the need to employ RMP only in combination with other effective drugs in the chemotherapy of multibacillary leprosy

Epidemiología de la lepra en Guadalupe de 1970 a 1983 / The epidemiology of leprosy in Guadeloupe from 1970 to 1983

Se estudiaron la prevalencia y la evolución de la incidencia anual de lepra en Guadalupe entre 1970 y 1983. El análisis de los datos acopiados en el servicio de control de lepra indicó que en 1981 la prevalencia era de 380 por cada 100 000 habitantes, calculada según el número de enfermos incluidos en el archivo activo del registro departamental durante 12 años en el caso de enfermos paucibacilares y durante toda la vida en el caso de enfermos multibacilares. De 1970 a 1983 la incidencia anual disminuyó de 24,0 a 13,0 por 100 000 habitantes. La disminución fue más importante en las formas de lepra paucibacilar que en las de lepra multibacilar, y mucho más importante en menores que en mayores de 15 años. El análisis de la forma de detección reveló que 80% de los enfermos se encontraron mediante la búsqueda pasiva (enfermos sintomáticos que acudieron a consulta), 10% mediante la búsqueda entre la población escolar y 10% mediante la búsqueda entre los contactos domiciliarios de enfermos conocidos. A partir de 1980 se inoculó a ratones con Mycobacterium leprae provenientes de biopsias de enfermos multibacilares para efectuar cultivos y estudiar la sensibilidad del microorganismo a la dapsona y a la rifampicina. Las 16 cepas de M. leprae provenientes de pacientes que padecían recidivas de lepra multibacilar demonstraron ser resistentes a la dapsona, y 15 de estas pusieron de manifiesto una elevada resistencia. De las 19 cepas de M. leprae provenientes de casos nuevos que nunca habían recebido tratamiento, solo ocho eran sensibles a la dapsona. Todas las cepas de M. leprae, tanto de pacientes con recidivas como de casos nuevos, resultaron ser sensibles a la rifampicina. En términos generales, los diferentes parámetros considerados indican que desde el punto devista epidemiológico la lepra ha tenido una evolución favorable en Guadalupe. Por ende, se deben mantener la infraestructura y la organización actual del control de lepra, aunque la frecuencia de la resistencia a la dapsona impone una utilización estricta de la poliquimioterapia