Leprosy elimination

MDT: duration of treatment FAQ

Is it necessary to give MDT cover to patients who have to receive steroids (e.g. for late reversal reaction or other medical conditions) even after successful completion of the scheduled course of MDT?

The risk of possible endogenous reactivation is very small after completion of adequate chemotherapy. Immunosuppressive drugs, like corticosteroids, are known to accelerate the multiplication of organisms located in dormant foci and cause disseminated reactivation; for example, in TB. There is no evidence that this happens in leprosy. Whenever possible, 50 mg of clofazimine daily is started as a prophylactic measure if the duration of steroid therapy is expected to exceed 4 months, and should be continued until the course of steroids is complete. However, these patients should not be re-entered into the case registry.

It is said that almost all the bacilli seen in skin smears after MDT are dead bacilli. Is there any way to accelerate their removal?

There are some reports that immunotherapy using M. leprae or other mycobacterium-derived vaccines may be useful in accelerating the clearance of dead bacilli from the tissues. However, more research is needed before this approach can be recommended for use in routine leprosy control programmes.

Does the presence of dead bacilli in the skin and other tissues cause the patient any problems?

In most patients the presence of dead bacilli in the skin and other tissues does not cause any problem, and the dead organisms are gradually cleared by the phagocytic system of the body. However, in a very small proportion of patients, the antigens from dead bacilli can provoke immunological reactions, such as (late) reversal reaction, causing serious nerve damage and subsequent disabilities. Therefore, possibility of such events occurring should be informed to patients at the time of stopping treatment. Such reactions can be successfully treated with a standard course of prednisolone.