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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Long-term relapse risk of multibacillary leprosy after completion of 2 years of multiple drug therapy (WHO-MDT) in Cebu, Philippines
American Journal of Tropical Medicine and Hygiene, Volume 81, No. 5, Year 2009
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Description
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) ≥ 2+ (≥ 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 ≥ 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. Copyright © 2009 by The American Society of Tropical Medicine and Hygiene.
Authors & Co-Authors
Balagon, Maria Victoria F.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Cellona, Roland V.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Dela Cruz, Eduardo C.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Burgos, Jasmin A.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Abalos, Rodolfo M.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Walsh, Gerald P.
Unknown Affiliation
Saunderson, Paul R.
Philippines, Cebu
Leonard Wood Memorial Center for Leprosy Research, Philippines
Walsh, Douglas S.
Kenya, Nairobi
Us Army Medical Research Unit-kenya
Statistics
Citations: 40
Authors: 8
Affiliations: 2
Identifiers
Doi:
10.4269/ajtmh.2009.09-0189
ISSN:
00029637
Research Areas
Health System And Policy
Study Design
Cohort Study