부산대학교 도서관

Introduction: Relapse of leprosy among patients released from treatment (RFT) is an indicator of the success of anti-leprosy treatment. Due to inadequate follow-up, relapse in leprosy patients after RFT is not systematically documented in India. Relapsed leprosy patients pose a risk in the transmission of leprosy bacilli. We determined the incidence of relapse and deformity among the patients RFT from the leprosy control programme in four districts in South India. Methods: We conducted two follow-up surveys in 2012 and 2014 among the leprosy patients RFT between 2005 and 2010. We assessed them for any symptoms or signs of relapse, persistence and deformity. We collected slit skin samples (SSS) for smear examination. We calculated overall incidence of relapse and deformity per 1000 person-years (PY) with 95% confidence intervals (CI) and cumulative risk of relapse. Results: Overall, we identified 69 relapse events, 58 and 11, during the first and second follow-up surveys, respectively. The incidence of relapse was 5.42 per 1000 PY, which declined over the years after RFT. The cumulative risk of relapse was 2.24%. The rate of deformity among the relapsed patients was 30.9%. The overall incidence of deformity was 1.65 per 1000 person years. The duration of M. leprae detection in smears ranged between 2.38 and 7.67 years. Conclusions: Low relapse and deformity rates in leprosy RFT patients are indicative of treatment effectiveness. However, a higher proportion of detection of deformity among relapsed cases is a cause for concern. Periodic follow-up of RFT patients for up to 3 years to detect relapses early and ensure appropriate treatment will minimize the development of deformity among relapsed patients. Author summary: India achieved leprosy elimination (<1 case/10000 population) in 2005. However, it remains a country with a high burden of leprosy (120,334 cases in 2017–18), with an annual detection of more than 10000 new cases, including children, indicating widespread active transmission. In addition to the untreated leprosy cases, even patients who relapse after release from leprosy treatment play a significant role in disease transmission. Early detection and management of leprosy relapse cases will minimize the disease transmission and might prevent leprosy-associated deformity. Leprosy management services are primarily provided by the government healthcare system in India and supported by several major non-governmental charitable organizations. The burden of leprosy relapse in India cannot be measured since there is no provision to follow-up the patients who complete multi-drug treatment (MDT) in the national leprosy program. We report the incidence of leprosy relapse among the patients who completed leprosy treatment from the national leprosy control program in four districts in South India. The report also highlights the effectiveness of MDT in program settings, the lower risk of developing deformity after treatment completion, and the need to incorporate an appropriately designed follow-up strategy. [ABSTRACT FROM AUTHOR]