Long-term relapse risk of multibacillary leprosy after completion of 2 years of multiple drug therapy (WHO-MDT) in Cebu, Philippines. The American journal of tropical medicine and hygiene [Am J Trop Med Hyg] Journal article | | Title | Long-term relapse risk of multibacillary leprosy after completion of 2 years of multiple drug therapy (WHO-MDT) in Cebu, Philippines. | | Author(s) | Balagon MF, Cellona RV, Cruz E, Burgos JA, Abalos RM, Walsh GP, Saunderson PR, Walsh DS | | Institution | Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines. | | Source | Am J Trop Med Hyg 2009 Nov; 81(5):895-9. | | MeSH | Adolescent
Adult
Aged
Child
Drug Resistance, Bacterial
Drug Therapy, Combination
Humans
Leprostatic Agents
Leprosy
Middle Aged
Mycobacterium leprae
Philippines
Recurrence
Time Factors
Young Adult
| | Abstract | From 1987 to 1994, we enrolled 500 subjects completing 2-year WHO multiple drug therapy (MDT) for multibacillary leprosy in a prospective relapse study. Relapse was defined as new skin lesions and an increase in the bacterial index (BI) > or = 2+ (> or = 100x) at any single slit-skin smear site. At the study end in 2006, follow-up was 6,401 subject-years, a mean of 12.8 years/subject. We observed 23 relapses, 6-16 years after MDT (mean, 10.5 years; 95% confidence interval [CI], 9.2-11.8), peaking in Years 11-12 (> 1%/year). The cumulative risk was 6.6% (95% CI, 5.0-8.2%). In a subset of 181 subjects with pre-MDT average BI > or = 4+, 11 relapses occurred (cumulative risk, 10.1%). In mouse footpad assays, Mycobacterium leprae from relapsed subjects were rifampin and clofazimine sensitive. Taken together, the data suggest relapses are related to activation of dormant organisms (persisters) not killed by MDT rather than new infection. | | Language | eng | | Pub Type(s) | Journal Article
Research Support, Non-U.S. Gov't
| | PubMed ID | 19861628 |
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