Leprosy
Mailing List – October 19th, 2008
Ref.: Relapse in leprosy
From: Kar H. K.,
New Delhi
,
India
Dear Dr Noto,
I refer to Dr
Moharani’s LML message dated Oct. 18th, 2008. Relapse is defined as the
recurrence of the disease at any time after the completion of a full
course of treatment (WHO, OPERATIONAL GUIDELINE\SEA/GLP/2006.2).
Relapse is
indicated by the appearance of new skin lesions and in case of
multibacillary (MB) relapse, by evidence on a skin smear of an
increase in bacteriological index (BI) of two or more units. It is difficult to be certain
that a relapse has occurred, as new lesions may appear in late Type 1
leprosy reaction (also called late reversal reaction or LRR) after the
patient has been released from treatment (RFT). Usually, the relapse appears
after a sufficient time period to allow the left out live bacilli to
multiply, may be a period of three years approximately, to
produce a clinical new lesion.
Down grading
type 1 reaction is no more considered as a separate type of type 1
reaction since this is nothing but a downgradation of the disease
process in the spectrum due to delay in starting MDT. However, when ever there is
difficulty to differentiate between LRR and relapse a course of oral
steroid for a period of 4 to 6 weeks help in confirmation of the LRR
which shows remarkable improvement. MB
relapse should be investigated by using skin smears and
histopathology.
Dr (Prof.) H K Kar MD, MNAMS,
President, Indian
Association of Leprologists,
Consultant & HOD
Department of Dermatology, STD & Leprosy
PGIMER and associated Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001
India
