ABSTRACT
Erythema nodosum leprosum (ENL) is an immune complex mediated type III hypersensitivity reaction seen in patients of borderline lepromatous and lepromatous leprosy. It can be caused by a wide array of triggers and can be seen before, during, or after completion of anti-leprosy therapy. There are multiple well-known triggers for type 2 reactions like the initiation of multidrug therapy, Mantoux testing, vaccination, mental and physical stress, and physiological states like pregnancy. Herein, we report a case of exacerbation of ENL in a middle-aged woman, probably due to COVID-19 vaccine while she was well-controlled on immunosuppressive therapy. The episode was treated with non-steroid anti-inflammatory drugs and oral steroids and the symptoms resolved within 2 weeks. Although causality was highly possible between the occurrence of ENL and COVID-19 vaccine, physicians should be aware that it can be easily managed with proper care and medicines and this should not be a basis for deferring the vaccine. Copyright © Hind Kusht Nivaran Sangh, New Delhi.
ABSTRACT
This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.
ABSTRACT
Vaccine makers are racing to develop COVID-19 vaccines and have advanced ten candidates into clinical trials. However, vaccine development is typically a lengthy process. A number of immune response modifiers have also been explored for their efficacy in the management of COVID-19. In this short communication, we explore the possibility of using Mycobacterium indicus pranii (MIP) for the management of severely ill COVID-19 patients and its plausible role in the mitigation of severe disease in mildly infected patients. The MIP vaccine has a proven role in the prevention of leprosy to house-hold contacts of lepromatous leprosy, category-II tuberculosis patients, and patients with severe septicemia and low CD4 counts. It has also been used as an immune response modifier in patients with bladder carcinoma. Notably, this vaccine may be more efficacious than the BCG vaccine. The possible benefits and risks of using such an agent are described in this article. The use of such an approach could be beneficial in resource-poor countries and countries where diseases like tuberculosis and leprosy are endemic. © 2020 Iranian Society of Dermatology.