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Sharath S, Sinha S, Sardana K, Ahuja A. Sequential occurrence of upgrading and downgrading type 1 leprosy reactions: A case report. Trop Doct 2024; 54:185-188. [PMID: 38356319 DOI: 10.1177/00494755241229754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Savitha Sharath
- Senior Resident, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Surabhi Sinha
- Assistant Professor, Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College, New Delhi, India
| | - Kabir Sardana
- Director Professor and Head of the Department, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Director Professor and Head of the Department, Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Chhabra N, Kumar TS, Singh I, Ganguly S. Morphological Index as a Sensitive Marker of Drug Resistance in Leprosy: A Case Series. Indian J Dermatol 2024; 69:202. [PMID: 38841236 PMCID: PMC11149822 DOI: 10.4103/ijd.ijd_781_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Resistance to antileprosy drugs is one of the main contributors for the persistence of leprosy in the present era. In the absence of universal antimicrobial resistance (AMR) surveillance through the national program, the indications for resistance testing remain a important dilemma to clinicians. WHO recommendations mainly focus on clinical relapse, which could be picked up late with continued transmission and repeated leprosy reactions in the patient. We report here a series of eighteen leprosy cases who were tested for AMR in view of the positive morphological index after completion of multidrug therapy, chronic Erythema nodosum leprosum, and clinical relapse.
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Affiliation(s)
- Namrata Chhabra
- From the Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Tamil S. Kumar
- From the Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Itu Singh
- Stanley Browne Research Laboratory, The Leprosy Mission Community Hospital, New Delhi, Delhi, India
| | - Satyaki Ganguly
- From the Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Savitha B, Sardana K, Khurana A, Rani S, Sachdeva S, Ahuja A. Case Report: Chemoradiation with Paclitaxel and Carboplatin Unveiling Leprosy Type 1 Downgrading Reaction. Am J Trop Med Hyg 2022; 107:94-96. [DOI: 10.4269/ajtmh.22-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 11/07/2022] Open
Abstract
Type 1 lepra reaction (T1R) is a major complication seen in nonpolar forms of leprosy and leads to significant morbidity. The classification of T1R as up and downgrading, based on previously defined histopathological criteria (by Ridley), has therapeutic and prognostic implications. The trigger factors for these reactions are poorly described, especially in case of downgrading T1R and we describe a case of leprosy reaction that was possibly triggered by chemoradiation and elucidate the possible mechanism.
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Affiliation(s)
- B. Savitha
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Seema Rani
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Narang T, Kamat D, Thakur V, Lavania M, Singh I, Ahuja M, Dogra S. Equal rates of drug resistance in leprosy cases with relapse and recurrent /chronic type 2 reaction; Time to revise the guidelines for drug resistance testing in leprosy. Clin Exp Dermatol 2021; 47:297-302. [PMID: 34382256 DOI: 10.1111/ced.14884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leprosy relapse/recurrence is a serious concern especially in a leprosy endemic nation like India. It is believed that bacilli persisting even after multi-drug therapy could cause relapse; recently however drug resistance as a cause for recurrences and chronic erythema nodosum leprosum (ENL) has been speculated. Our objective was to study drug resistance patterns in cases of leprosy relapse and chronic/recurrent ENL's. METHODOLOGY This cross-sectional study conducted over a period of 1 year included patients diagnosed as leprosy relapse and those with chronic/recurrent (c/r) ENL. Skin biopsy specimens were subjected to conventional PCR for resistance testing for rifampicin, dapsone and ofloxacin, targeting rpoB, folP and gyrA gene of M.leprae respectively. RESULTS A total of 61 patients (25 smear negative) were included in the study. Of these, 37 were diagnosed as leprosy relapse and 24 had c/r ENL. Drug resistance to at least one drug was identified in 10 (16.4%) cases. Rates of drug resistance were 5.4% (2/37) for dapsone, 10.8% (4/37) for rifampicin and 2.7% (1/37) for ofloxacin amongst cases of relapse where as it was 12.5% (3/24) and 8.3% (2/24) for dapsone and rifampicin respectively amongst those with c/rENL.. Multi drug resistance was seen in 3.3% (2/61) patients. CONCLUSION Drug resistance rate amongst those with c/rENL was almost equaled that of relapse. Smear negative leprosy relapse cases also had resistance to bactericidal drugs. These findings call for modifications in criteria for testing under leprosy drug resistance surveillance and all cases of relapse and those with recalcitrant c/rENL should be tested.
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Affiliation(s)
- T Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - D Kamat
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - V Thakur
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - M Lavania
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, India
| | - I Singh
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - M Ahuja
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - S Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Muddebihal A, Sardana K, Mathachan SR, Khurana A, Singh I, Sharma R. Drug resistance to rifampicin in a case of steroid-dependent erythema nodosum leprosum and the therapeutic implications of resistance and reactions in leprosy. Int J Dermatol 2021; 60:e407-e409. [PMID: 33811328 DOI: 10.1111/ijd.15559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences & Dr RML Hospital, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences & Dr RML Hospital, New Delhi, India
| | - Sinu R Mathachan
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences & Dr RML Hospital, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences & Dr RML Hospital, New Delhi, India
| | - Itu Singh
- The Leprosy Mission Community Hospital, NAND Nagri, New Delhi, India
| | - Rahul Sharma
- The Leprosy Mission Community Hospital, NAND Nagri, New Delhi, India
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Kamat D, Narang T, Ahuja M, Lavania M, Dogra S. Case Report: Multidrug-Resistant Mycobacterium leprae in a Case of Smear-Negative Relapse. Am J Trop Med Hyg 2020; 102:724-727. [PMID: 32043454 DOI: 10.4269/ajtmh.19-0905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Divya Kamat
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhvi Ahuja
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - Mallika Lavania
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sardana K, Khurana A. Leprosy stigma & the relevance of emergent therapeutic options. Indian J Med Res 2020; 151:1-5. [PMID: 32134008 PMCID: PMC7055175 DOI: 10.4103/ijmr.ijmr_2625_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi 110 001, India
| | - Ananta Khurana
- Department of Dermatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi 110 001, India
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