AMID suspicions that leprosy patients could be turning resistant to drugs, just like several strains of the tuberculosis bacteria are to even the most aggressive medication, samples of nine leprosy patients in Mumbai, who have had a relapse, have been sent to a national laboratory in Delhi for tests to confirm whether resistance to drugs is the cause for the recurrence of the disease. Leprosy, a bacterial infection, is known to silently advance in the human host with early symptoms showing numb skin patches and shiny skin that progress into nodules on the entire body.
Samples of nine patients from Mumbai have been sent to The Leprosy Mission, to check if patients suffer from any resistance. In two cases, the results are still awaited. In the remaining cases, lab tests have found no resistance. Medical records of those two patients show they suffered a relapse despite undergoing full treatment. A 38-year-old man, native of Jaunpur in Uttar Pradesh, underwent leprosy treatment in 2011 after he experienced numbness in his hands and legs followed by visible nodules on his body. In 2014, he tested negative for leprosy bacteria after undergoing multidrug therapy treatment for three years. In April this year, he developed new lesions. “His skin biopsy is suggestive of active leprosy,” said Dr VV Pai, from Bombay Leprosy Project, adding that cause of the relapse is not known.
In another case, a 39-year-old woman from Kolkata, who had undergone leprosy treatment in 1998 in West Bengal, has suffered a relapse. She was referred from Thane’s Municipal Hospital to Bombay Leprosy Project for recurrent and painful lesions that she developed 17 years after being treated of leprosy. While multi-drug therapy (MDT) has been initiated for her, her samples have also been sent to check if she is resistant to any drug under the MDT. Resistance to leprosy drugs such as dapsone and ofloxacin has already been found in patients across India. What is worrying doctors is possible resistance to the stronger drug rifampicin, which is a monthly dose for leprosy patients and used in first line treatment. Resistance to rifampicin is already rampant amongst tuberculosis patients in the country.
In 2016, Foundation for Medical Research along with Bombay Leprosy Project conducted lab tests on 90 leprosy patients in Mumbai and Panvel to check for drug resistance as a part of Indian Council of Medical Research (ICMR) study on drug resistance. The study found 4 per cent resistance to dapsone and 2 per cent resistance to ofloxacin. “But we did not find any patient resistant to rifampicin,” said senior scientist Dr Vanaja Shetty, adding, “Rifampicin resistance has been reported in north India. But we suspect cases may start coming up in this region too.”
A treated leprosy patient may relapse due to fresh bacterial infection, persistence of old bacteria in body or due to drug resistance. The fresh load of nine cases sent from Mumbai to Delhi for tests are all relapse cases. In 1980s and 90s, 35 per cent patients treated for leprosy showed resistance to dapsone in India. Experts believe if rifampicin resistance becomes common, patients may face similar issues that TB patients witness-lack of newer drug options to treat the infectious disease.
In Maharashtra, under the National Leprosy Eradication Programme, a door-to-door survey of leprosy patients was conducted in September to screen 5.46 crore people in 22 districts. “In 2016, a similar drive had screened 3.5 crore people and diagnosed 4,322 patients suffering from leprosy,” said state leprosy in-charge Dr Sanjeev Kamble. He added that Maharashtra has still not recorded rifampicin resistance actively amongst patients.
Under the national programme, the government has ambitiously aimed to eradicate the disease by next year. The current first line of treatment includes rifampicin, dapsone and clofazamine. If patients do not respond to first line, they are pushed for second line of treatment, which includes ofloxacin and minocycline.