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Franco-Paredes C, Garcia-Creighton E, Henao-Martínez A, Kallgren DL, Banjade R, Dyer JA, Nelson T, Zaesim A, Peluso MJ, Jain V, Lee DH, Minces LR, Wirshup M, Sierra Hoffman M, Katsolis J, Brust K, Giron J, Smiarowski L, Hoosepian-Mer PA, Stryjewska B. Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States. Ther Adv Infect Dis 2022; 9:20499361221135885. [PMID: 36387060 PMCID: PMC9647311 DOI: 10.1177/20499361221135885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/12/2022] [Indexed: 09/05/2023] Open
Abstract
The World Health Organization (WHO) recommends multidrug therapy (MDT) for the treatment of paucibacillary and multibacillary forms of leprosy, also known as Hansen's disease (HD). MDT combinations of dapsone, rifampin, and clofazimine have reduced the prevalence of the disease but are not without adverse effects impacting regimen adherence. Hence, an urgent need exists to consider alternative MDT regimens with an improved safety profile that promotes treatment adherence. Herein, we described a case series of 10 patients with HD (nine patients with multibacillary leprosy and one with pure neural leprosy) treated with monthly rifampin, moxifloxacin, and minocycline (RMM). The United States National Hansen's Disease Program (NHDP) diagnosed and treated patients across US institutions. All patients received a regimen of 12-24 months of RMM. We reviewed the clinical outcomes, adherence, rate of completion, and adverse events of patients treated with monthly RMM from January 2019 to August 2022. Nine patients had multibacillary leprosy, with some having type-2 reactions. One patient had pure neural leprosy with a reversal reaction. In this case series, we identified that all patients completed the RMM regimen without treatment interruptions. None of the patients experienced any skin hyperpigmentation or any significant side effects. All patients tolerated the monthly RMM regimen with rapid improvement of skin lesions and without logistic hurdles. Based on previous clinical evidence and the results of this case series, the NHDP and other programs should consider the RMM regimen as first-line therapy.
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Affiliation(s)
- Carlos Franco-Paredes
- Hospital Infantil de Mexico, Federico Gomez,
Mexico City 06720, Mexico
- Division of Infectious Diseases, University of
Colorado, Anschutz Medical Campus, Denver, CO, USA
| | | | - Andrés Henao-Martínez
- Division of Infectious Diseases, University of
Colorado, Anschutz Medical Campus, Denver, CO, USA
| | | | - Rashmi Banjade
- Department of Medicine, Division of Infectious
Diseases and Epidemiology, Penn State M.S. Hershey Medical Centre, Penn
State College of Medicine, Hershey, PA, USA
| | | | | | | | - Michael J. Peluso
- Division of HIV, Infectious Diseases &
Global Medicine, Zuckerberg San Francisco General Hospital, University of
California, San Francisco, San Francisco, CA, USA
| | - Vivek Jain
- Division of HIV, Infectious Diseases &
Global Medicine, Zuckerberg San Francisco General Hospital, University of
California, San Francisco, San Francisco, CA, USA
| | - Dong Heun Lee
- Department of Medicine, Division of Infectious
Diseases, University of California, San Francisco, San Francisco, CA,
USA
| | - Lucio R. Minces
- Infectious Disease, Carris Health
(CentraCare), Willmar, MN, USA
| | - Mary Wirshup
- Community Volunteers in Medicine, West
Chester, PA, USA
| | - Miguel Sierra Hoffman
- Infectious Disease Department and
Pulmonary
- Department, Texas A&M Victoria Campus, and
Family Medicine Residency Program, Victoria, TX, USA
| | - Jenn Katsolis
- St. Vincent’s Infectious Disease Specialists,
Jacksonville, FL, USA
| | - Karen Brust
- Division of Infectious Diseases, Department of
Internal Medicine, University of Iowa Carver College of Medicine, Iowa City,
IA, USA
| | - Jose Giron
- Sunshine Specialty Health Care and Florida
State University, College of Medicine, Tallahassee, FL, USA
| | - Lauren Smiarowski
- Sunshine Specialty Health Care and Florida
State University, College of Medicine, Tallahassee, FL, USA
| | | | - Barbara Stryjewska
- National Hansen’s Disease Program (NHDP), 9181
Interline Avenue, Baton Rouge, LA 70809, USA
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Julian K, Shah N, Banjade R, Bhatt D. Utility of Ct values in differentiating COVID-19 reinfection versus prolonged viral shedding in an immunocompromised patient. BMJ Case Rep 2021; 14:14/7/e243692. [PMID: 34315745 PMCID: PMC8317077 DOI: 10.1136/bcr-2021-243692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We describe the case of a 26-year-old man who presented to an outside hospital with concerns of blurred vision. He subsequently tested positive for COVID-19 and his lab work suggested acute leukaemia. The patient was admitted to our hospital and completed a course of remdesivir. He eventually tested negative for COVID-19 before initiating chemotherapy. Two days after starting chemotherapy, he developed a neutropenic fever and tested positive for COVID-19. Through this case, we aim to bring attention to patients who recurrently test positive with COVID-19 PCR testing, thereby causing a dilemma of differentiating between reinfections and prolonged shedding of the virus, as well as understand and use cycle threshold values to discern these aetiologies.
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Affiliation(s)
| | - Neal Shah
- Department of Internal Medicine, Division of Hematology/Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rashmi Banjade
- Department of Internal Medicine, Division of Infectious Disease, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dhirisha Bhatt
- Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Daley AS, Naro GR, Craig TJ, Hussein RH, Banjade R, Jacobs JB, Ross IR. POPS case: A 30-year-old Filipino woman with fevers, lymphadenopathy, painful scalp lesions, and a neck mass. Allergy Asthma Proc 2020; 41:305-308. [PMID: 32605702 DOI: 10.2500/aap.2020.41.200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We described a case of a 30-year-old Filipino woman who presented with fevers, night sweats, left hip pain, painful scalp lesions, and a neck mass. Symptoms began 6 months earlier, with nasal drainage, fever, cough, and occasional hemoptysis, which did not resolve with outpatient antibiotics. A further workup revealed lymphadenopathy and several lytic bone lesions. Her hospital course was later further complicated by the development of a tracheoesophageal fistula secondary to an esophageal mass and, then later, aseptic meningitis. Extensive diagnostic workup and immunologic tests were performed and finally led to the diagnosis. Here, we discussed the diagnostic workup and pathophysiology of the underlying condition. This case illustrated the importance of appropriate immunologic workup to make the diagnosis of a rare condition that proves to be clinically significant and presents challenges in management.
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Affiliation(s)
- Aparna S. Daley
- From the Division of Allergy and Immunology, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Timothy J. Craig
- From the Division of Allergy and Immunology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Rezhan H.A. Hussein
- Division of Infectious Diseases and Epidemiology. Penn State College of Medicine, Hershey Pennsylvania; and
| | - Rashmi Banjade
- Division of Infectious Diseases and Epidemiology. Penn State College of Medicine, Hershey Pennsylvania; and
| | - Jennifer B. Jacobs
- Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian R. Ross
- Division of Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Affiliation(s)
- Christine Ruh
- a Antibiotic Stewardship Pharmacist , Erie County Medical Center , Buffalo , NY , USA
| | - Rashmi Banjade
- b Infectious Diseases Fellow , University at Buffalo , Buffalo , New York , USA
| | - Subhadra Mandadi
- b Infectious Diseases Fellow , University at Buffalo , Buffalo , New York , USA
| | - Candace Marr
- b Infectious Diseases Fellow , University at Buffalo , Buffalo , New York , USA
| | - Zarchi Sumon
- b Infectious Diseases Fellow , University at Buffalo , Buffalo , New York , USA
| | - John K Crane
- c Division of Infectious Diseases , University at Buffalo , Buffalo , New York , USA
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