TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Child
KW - Drug Resistance, Bacterial
KW - Drug Therapy, Combination
KW - Humans
KW - Leprostatic Agents
KW - leprosy
KW - Middle Aged
KW - Mycobacterium leprae
KW - Philippines
KW - Recurrence
KW - Time Factors
KW - Young Adult
AU - Balagon M
AU - Cellona RV
AU - Dela Cruz E
AU - Burgos J
AU - Abalos R
AU - Walsh GP
AU - Saunderson P
AU - Walsh DS
AB - <p>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) > or = 2+ (> or = 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 > or = 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.</p>
BT - The American journal of tropical medicine and hygiene
C1 - http://www.ncbi.nlm.nih.gov/pubmed/19861628?dopt=Abstract
DA - 2009 Nov
DO - 10.4269/ajtmh.2009.09-0189
IS - 5
J2 - Am. J. Trop. Med. Hyg.
LA - eng
N2 - <p>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) > or = 2+ (> or = 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 > or = 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.</p>
PY - 2009
SP - 895
EP - 9
T2 - The American journal of tropical medicine and hygiene
TI - Long-term relapse risk of multibacillary leprosy after completion of 2 years of multiple drug therapy (WHO-MDT) in Cebu, Philippines.
UR - http://www.ajtmh.org/content/81/5/895.full.pdf+html
VL - 81
SN - 1476-1645
ER -