Evaluation of a new fixed duration (12 weeks) multi-drug regimen of bactericidal drugs in multibacillary leprosy.

Leprosy still remains a public health problem mainly in Asia, Africa and South America. The WHO Expert Committee on Leprosy recommended, in 1997, the simplified treatment of leprosy for multibacillary (MB) cases, by reducing the duration of treatment from 24 to 12 months. From the operational point of view even this reduced duration is still long and monthly supervised drug administration may not always be practical in those areas where the accessibility is difficult and health infrastructure weak. The present study was carried out to compare the safety and efficacy of a new fixed duration regimen consisting of four bactericidal drugs with WHO/MDT (MB). METHODS: Thirty adult patients were randomly allocated to two groups. Group 1 (18 patients) received a new regimen of daily rifampicin 600 mg, sparfloxacin 200 mg, clarithromycin 500 mg and minocycline 100 mg for 12 weeks. Group 2 (12 patients) received WHO/MDT (MB) for 12 months. A detailed clinical evaluation and laboratory investigations, BI and MI were done at the baseline, every 4 weeks for 12 weeks, and thereafter every 8 weeks till 48 weeks. Skin biopsies were taken and chest X-rays were done at 0, 12 and 48 weeks. RESULTS: At 48 weeks, the net percentage clinical improvement in group 1 was 73.92% and in group 2 it was 66.66%. The net percentage reduction (NPR) in BI in group 1 was 19.17% and in group 2 it was 18.87% (p = 0.09). NPR in MI in both groups was 100% by 8 weeks, and somewhat faster in group 1. In group 1, 8 patients had mild gastrointestinal side-effect, and 16 had minocycline-induced hyperpigmentation. Three patients in group 1 developed type I reversal reactions. CONCLUSION: The regimen containing daily doses of rifampicin 600 mg, sparfloxacin 200 mg, minocycline 100 mg and clarithromycin 500 mg for 12 weeks was found to be an acceptable, effective and safe alternative regimen for MB leprosy with an additional operational advantage of shorter duration of treatment.

Post-kala-azar dermal leishmaniasis: a histopathological study.

BACKGROUND: Post-kala-azar dermal leishmaniasis follows an attack of visceral leishmaniasis and is caused by the same organism, i.e. Leishmania donovani. METHODS: In the present study, biopsy specimens from hypopigmented macules, nodules or plaques of 25 patients clinically diagnosed as PKDL were evaluated for epidermal and dermal changes and for the presence or absence of Leishmania donovani bodies (LDBs). RESULTS: The hypopigmented macules showed a patchy perivascular and periappendageal infiltrate with no demonstrable LDBs in any of the biopsies. In the nodular and plaque lesions, the infiltrate was diffuse, beneath an atrophic epidermis (74%) and follicular plugging (95.6%) was seen in most biopsies. The infiltrate consisted of lymphocytes, histiocytes and plasma cells in decreasing order of presence. LDBs could be demonstrated in only 10 (43.5%) biopsy specimens from nodular and plaque lesions and were never numerous. CONCLUSIONS: Histopathological features of PKDL are elucidated and discussed.

Mucosal and peri-orificial involvement in post-kala-azar dermal leishmaniasis.

BACKGROUND AND AIMS: Lesions of post-kala-azar dermal leishmaniasis (PKDL) usually affect the skin. Uncommonly, the involvement of oral and genital mucosae has been reported. METHODS: Twenty five patients clinically diagnosed as post-kala-azar dermal leishmaniasis were studied for periorificial and mucosal lesions. Clinical examination, skin smears and biopsy were done for the patients with periorificial or mucosal lesions. RESULTS: Out of 25 patients of PKDL, seven patients had lesions on the oral and/or genital mucosa. Three cases had oral lesions; two had only genital lesions and three patients had both sites involved. All the patients were having skin lesions elsewhere too either as nodules and/or plaque or macules. Conclusion: While examining a case of PKDL, mucosal involvement must also be examined carefully.

Therapeutic trial of sodium antimony gluconate alone and in combination with ketoconazole in post-kala-azar dermal leishmaniasis.

BACKGROUND: Drugs used in PKDL include parenteral sodium antimony gluconate (SAG), amphotericin-B, pentamidine, and ketoconazole (KTZ). SAG is the most effective one. Given alone, SAG has to be given for a long duration, leading to poor patient compliance and treatment failure. This study was carried out to compare the effectiveness of SAG alone and a combination of SAG and KTZ for sixty days. METHODS: Ten patients of PKDL were included in the study. Five patients (Group A) were given SAG intravenously, in the dose of 20 mg/kg per day and five (Group B) were given SAG (intravenously 20 mg/kg per day) and KTZ (200 mg twice daily orally). Both treatment regimens were given for sixty days. RESULTS: In Group A, the nodules and/or plaques showed approximate 80-85% clinical improvement, and macules showed 25-30% improvement. In group B (SAG + KTZ), there was 90-95% clinical improvement in the nodules and/or plaques and 25-30% in macules. CONCLUSION: This study suggests the therapeutic superiority of the combination treatment regimen in a shorter duration but is not conclusive as the number of patients was low. Further trials are recommended.

Group B streptococcal bacteremia in an adult: a case report from India.

The incidence of group B streptococcal bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However, group B still remains an unusual pathogen in adults in developing countries. We report a case of group B streptococcal bacteremia in a non-pregnant adult, the only case reported in our hospital. The organism was only isolated from the blood and responded to specific therapy.

Sporotrichosis in an unusual location--dermatologically and geographically.

We report the unusual fixed cutaneous variety of sporotrichosis in a patient hailing from Uttarkashi (Uttar Pradesh) in the north-western part of India.

Leprosy in resettlement colonies of Delhi.

Population influx into urban areas like Delhi has encouraged mushrooming of numerous slums where about 30% population of the city is living. A survey was conducted in four resettlement colonies of Delhi. Of the 6,876 persons examined, 43 (6.25 per 1000) subjects were found to have clinical and histologic evidence of leprosy. Fifteen (35%) patients of neuritic leprosy, eight (19%) with tuberculoid leprosy, 12 (38%) of borderline tuberculoid, three (4%) each with borderline and borderline lepromatous and one (2%) each of lepromatous and indeterminate leprosy were diagnosed. The study revealed that 21% of the patients were less than 20 years of age.

Sexually transmitted diseases in children.

Fifty eight (16%) of the 362 patients, who reported to Dermatology and STD Department with symptoms pertaining to their genitourinary system were below 14 years of age. Fifty four (93.1%) of these children belonged to families of lower socio-economic strata. All the children were slum dwellers and none of them had studied beyond the third class. Syphilis was seen in 27.6%, gonorrhea in 24.1%, chancroid in 22.4%, candidiasis in 10.3%, condylomata acuminata in 6.9% and herpes genitalis in 6.9% of these children. The probable reasons for the increased prevalence of sexually transmitted diseases in children as ascertained by this study were sexual promiscuity and probably sexual assault.

Hepatic ultrasonography in patients with lepromatous leprosy.

Hepatic Sonography was done in 36 patients with lepromatous Leprosy and 3 patients with borderline lepromatous leprosy with the view to assess abnormalities of size, changes in the echotexture and to observe the presence of any nodules and calcification in the liver. Routine liver function tests were also done in these patients. No definite abnormal sonographic findings were seen in the liver in a large majority of these patients. One patient, however, showed nodular changes in the liver.