BACKGROUND: Several trials on relapse rates on duration of multibacillary regimens have varying results. OBJECTIVE: To compare the relapse rate among smear-positive Leprosy patients receiving 12 blister packs of multibacillary drug therapy and 24 blister packs of multibacillary drug therapy. METHOD: A review of records of smear positive Leprosy patients seen from 2002 to 2006 was done. Demographic, clinical and therapeutic data were collected. Bacteriologic index was determined from Leprosy Laboratory records. RESULT: A total of 391 patients were found to have complete records for review and analysis. Relapse rate was 11.9%(28) for patients who received 12 blister packs and 1.91%(3) for patients who received 24 blister packs and the difference was found to be statistically significant (p<0.01). Distribution of relapse was statistically significant according to age (p<0.01), bacteriologic index (p<0.01) and clinical spectrum (p<0.01). CONCLUSION: Relapse rates shown among smear positive leprosy patients receiving 12 blister packs vs. those receiving 24 blister packs was statistically higher which differs from previously published studies. Significant predictors were clinical spectrum, bacteriologic index of >3.5, and >4 and number of blister packs.
Leprostatic Agents ; Drug Therapy, Combination ; Leprosy ; Recurrence ; Chronic Disease

BACKGROUND: The novel COVID-19 (Coronavirus Disease 19) predisposes the general population to a high risk of infection. The 106 million population of the Philippines would be considered an at-risk group due to the high density of the populace in cities. As the situation in each country differs during this era of the COVID-19 pandemic, this paper aims to give practical recommendations for safe procedural dermatology practice in the Philippine setting after the lifting of the government-mandated quarantine. METHODS: An online survey was conducted among Philippine Dermatological Society members. The survey was sent electronically on March 22, 2020. RESULTS: A total of 466 or 42% of the PDS’s 1100 current members replied to the survey. The top 10 procedures performed among the respondents are: 1. Electrocautery (N=437, 94.38%), 2. Chemical peeling (N=422, 91.13%), 3. Laser & energy based device treatment (N= 341, 73.65%), 4. Botulinum toxin injection (N=323, 69.76%), 5. Excision (N=263, 56.80%), 6. Acne surgery (N=176, 38.01%), 7. Injectable Filler (N=171, 36.93%), 8. Cryotherapy (N=145, 31.32%), 9. Platelet rich plasma injection (N=111, 23.97%) and 10. Scar revision (N=85, 18.36%). The majority of the respondents have access to personal protective equipment (PPE) such as surgical masks (N=457, 98.7%), face shields (57.67%), goggles (46.00%), protective gown (42.76%) and bonnets (32.83%). Before the government quarantine, the majority (N=375, 81.17%) of respondents see patients on a firstcome, first-serve system. Only 18.83% (N=87) see patients only by appointment. Regarding teledermatology, most respondents answered that they would advise patients to do digital consultation with only a minority responding they would not consider doing teledermatology. CONCLUSIONS: In the Philippine setting, the best ways to prevent COVID infection inthe procedural dermatology setting include: 1. Education of staff and patients on proper exposure prevention and sanitation measures. 2. Ensuring the correct usage of PPE. 3. Ensuring physical distancing and reducing patient wait times by scheduling visits on an appointment basis. 4. Sufficient protocols must be made for sanitation before and after each patient visit. 5. Teledermatology in pre-procedure consults and post-procedure follow-ups would reduce the risk of COVID-19 transmission for both patient and physician.
Leprostatic Agents ; Drug Therapy, Combination ; Leprosy ; Recurrence ; Chronic Disease

Anti-Inflammatory Agents ; administration & dosage ; Arthritis ; diagnosis ; drug therapy ; etiology ; physiopathology ; Arthritis, Rheumatoid ; diagnosis ; Clofazimine ; administration & dosage ; Dapsone ; administration & dosage ; Delayed Diagnosis ; Diagnosis, Differential ; Humans ; Leprostatic Agents ; administration & dosage ; Leprosy ; complications ; diagnosis ; drug therapy ; physiopathology ; Male ; Middle Aged ; Prednisolone ; administration & dosage ; Rifampin ; administration & dosage ; Treatment Outcome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.
Biopsy ; Dapsone ; Diagnosis, Differential ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Leprosy ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Lymphoma, T-Cell, Peripheral ; Prurigo ; Pseudolymphoma ; Skin

Global Health ; Humans ; Leprosy ; drug therapy ; Mycobacterium leprae ; drug effects

Global efforts to control leprosy by intensive chemotherapy, including rifampin, have led to a significant decrease in the number of registered patients. But emergence of rifampin-resistant strains of pathogenic mycobacteria has threatened the usefulness of this drug in treating mycobacterial diseases. Mutations in the rpoB gene, encoding the betasubunit of RNA polymerase, were reported to result in resistance to rifampin in several mycobacterial species, including M leprae. To prevent the emergence and transmission of drug-resistant leprosy and to identify and treat existing cases, it is necessary to establish rapid methods for detection of drug resistance in M leprae. However, M. leprae has not been cultivated on artificial media; therefore, to identify drug susceptibility patterns, bacteria must be tested using Shepard's mouse footpad assay. This in vivo method requires at least 6 months and relatively large numbers of bacteria. Recently, there have been advances in the elucidation of molecular events responsible for drug resistance in mycobacteria Sequences of the rpoB, genes were analyzed for 43 isolates of Mycobacterium leprae from leprosy patients in Korea. Three isolates(6.98%) showed representative mutations in the rpoB, genes, suggesting the emergence of rifampin-resistant M. leprae.
Animals ; Bacteria ; DNA-Directed RNA Polymerases ; Drug Resistance ; Drug Therapy ; Humans ; Korea* ; Leprosy ; Mice ; Mycobacterium leprae ; Rifampin

Chemotherapy is a main component of treatments for leprosy. The World Health Organization (WHO) recommends multiple-drug therapy (MDT) consisting of dapsone, clofazimine and monthly rifampin as the first-line drugs against leprosy. Minocycline, clarithromycin and certain fluoroquinolones can be used as substitutes in dapsone or clofazimine. For management of reactions, type I reactions should be treated with corticosteroids while thalidomide is the drug of choice for type II reaction. This review summarizes pharmacologic effects of drugs being used in leprosy including mechanisms of action, side effects, drug interactions and drug resistance.
Adrenal Cortex Hormones ; Clarithromycin ; Clofazimine ; Dapsone ; Drug Interactions ; Drug Resistance ; Drug Therapy ; Fluoroquinolones ; Leprosy* ; Minocycline ; Rifampin ; Thalidomide ; World Health Organization

OBJECTIVETo analyze the trends of case detection and other indicators of leprosy in China during 1985-2002.

METHODSData reported by each province were collected by China National Leprosy Database in Nanjing P.R. China. All data about registered cases were put into computer for analysis.

RESULTSFrom 1985 to 2002, a total of 49,477 new leprosy cases had been detected. Among them, 69.5% were multibacillary cases and 25.4% had grade 2 disability. The child cases aged below 15 years accounted for 3.74% of total cases. Totally, 5824 cases and 303 cases relapsed after dapsone (DDS) mono-therapy and multidrug therapy (MDT), respectively. Case detection showed a marked reduction from 0.47/100,000 in 1985 to 0.18/100,000 in 1993 although there were several spurts due to operational factors. From 1994, case detection showed no significant decline. The grade 2 disability among new patients decreased from 31.4% in 1985 to 23.4% in 2002. The child case detection rate among new cases fluctuated between 2.70%-3.56% from 1999 to 2002. The incidence of relapse declined after the introduction of DDS mono-therapy. However, it increased after the introduction of MDT.

CONCLUSIONChina experiences in leprosy control show that it will take a long time with continuing present leprosy control activities to bring down the case detection and other indicators to a very low level even after reaching the elimination goal of leprosy.

Adolescent ; Adult ; Age Factors ; Child ; China ; epidemiology ; Communicable Disease Control ; trends ; Dapsone ; administration & dosage ; therapeutic use ; Disability Evaluation ; Drug Therapy, Combination ; Humans ; Incidence ; Leprostatic Agents ; administration & dosage ; therapeutic use ; Leprosy ; drug therapy ; epidemiology ; prevention & control ; Recurrence

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, which is an obligate intracelluar pathogen. It presents broad spectrum of clinical manifestations depending on the host's specific cell-mediated immune response to M. leprae. Especially, type I Th cells and macrophages are important in defense mechanism to M. leprae, and the immune response is regulated by cytokines secreted by immune cells. Recent investigations showed nitric oxide(NO) was the key molecule in the killing activity of macrophages, which was enhanced by IFN-gamma but suppressed by TGF-beta1 and IL-10. Since cytokine is secreted by activated immune cells with antigenic stimulation, decreased antigens by treatment modulates the expression of cytokines in leprosy. In this study, we observed the dynamics of cytokines expression using RT-PCR, such as TGF-beta1 and IL-10, which suppress the activity of macrophages, IFN-gamma, which activates macrophages, and iNOS, which represents the killing activity of macrophages, in the lesions taken from fifteen borderline lepromatous leprosy patients before and after multiple drug therapy for 4 weeks. The results are summarized as follows: 1. Before treatment, cytokines were expressed in order of IL-10, iNOS, TGF-beta1 and IFN-gamma(p>0.05). 2. After 4 weeks treatment, cytokines were expressed in order of iNOS, IL-10, TGF-beta1 and IFN-gamma(p<0.05). 3. Fifty-four percent of patients showed a non-polarized Th 0 pattern, 33% a polarized Th 1 pattern, and 20% Th-negative. Th 2 pattern was not observed. 4. The changes of cytokines expression after 4 weeks treatment were not significant, although mRNA of IL-10, TGF-beta1 and IFN-gamma were somewhat decreased. 5. There was negative correlation between TGF-beta1 and iNOS(gamma(2)=0.499, p<0.05, before treatment), positive correlation between TGF-beta1 and IFN-gamma(gamma(2)= 0.622, p<0.05, before treatment), and positive correlation between IFN-gamma and IL-10(gamma(2)= 0.935, p<0.05, before treatment; gamma(2)= 0.937, p<0.05, after treatment). In conclusion, these results suggest that TGF-beta1 and IL-10 may contribute to immune suppression in multibacterial leprosy patients, and that TGF-beta1 suppresses iNOS expression in macrophages. With 4 weeks treatment, the significant changes in cytokines expression were not observed. Interestingly, the majority of BL patients showed Th 0 pattern of cytokine, and none of Th 2 pattern.
Cytokines ; Drug Therapy ; Granulomatous Disease, Chronic ; Homicide ; Humans ; Interleukin-10* ; Leprosy* ; Leprosy, Multibacillary* ; Macrophages ; Mycobacterium leprae ; RNA, Messenger* ; Transforming Growth Factor beta1*

BACKGROUND: Distinct patterns of T cell cytokine production have been shown to influence the outcome of infection. There will be plethora of dynamic changes of T cells and their cytokine production after starting drug therapy in leprosy skin lesions. OBJECTIVE: To determine dynamics of cytokine expression, T cell and macrophage populations in the lesions taken serially in early part of World Health Organization-Multiple Drug Therapy in BL patients. METHODS: Cytokine mRNA expression of TNF-alpha, IFN-gamma, IL-4 and IL-10 in BL skin lesion was detected by RT-PCR analysis. To determine cellular phenotypes of infiltrated cells, immunohistochemical staining method was performed using antibodies to CD4, CD8, CD56, CD57, CD 68, gammadelta-TCR , and S-100 protein. RESULTS: TNF-alpha mRNA, initially showed no consistent change, increased 6 months after MDT. IFN-gamma and IL-10 mRNA showed decreasing tendency initially, but failed to show any consistent increase or decrease after 6 months. IL-4 mRNA was not detected in our patients. In reactional states, mRNA expression of TNF-alpha, IFN-gamma, IL-10 was increased in 2 patients but decreased in 1 patient compared to baseline. Ratio of TNF-alpha positive cells decreased during MDT compared to baseline(p<0.05), but ratio of cells expressing IFN-gamma showed no significant change after MDT. Only CD68 positive cells decreased after MDT(p<0.05). CONCLUSION: Variable treatment induced changes in cellular patterns and cytokine expression within BL lesion observed in this study suggest that complex mechanism of immune systems - including cytokine regulation and defect in macrophages - may exist and be involved in the pathogenesis of leprosy.
Antibodies ; Drug Therapy* ; Humans ; Immune System ; Interleukin-10 ; Interleukin-4 ; Leprosy* ; Leprosy, Multibacillary* ; Macrophages ; Phenotype* ; RNA, Messenger ; S100 Proteins ; Skin* ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; World Health ; World Health Organization