New cases of leprosy indicate that M. leprae transmission is continuing. In the first half of 2015 we sequentially diagnosed new leprosy patients attending Cebu Skin Clinic, a referral and leprosy treatment centre in Cebu City, Philippines. The great majority of patients were characterised as multibacillary (145 of 147; 98.6%), most of whom had bacterial indices 3+ (86; 58.5%) or more than 20 skin lesions (94; 63.9%). Importantly, 65.3% estimated that slightly over a year had elapsed between their initial symptoms and diagnosis, while 26.5% reported a lapse of greater than 3 years. Many patients (73.8%) and their household contacts (79.2%) reported that their lives had already been adversely affected. This indicates that improvements to expedite diagnosis are required, and rapid diagnostic tests (RDT) appear suited for this. Questionnaires were conducted among various groups to ascertain the acceptability and perception of RDT. All groups responded favourably, with 95.9% patients, 93.2% contacts and 81.4% of the general population responding that RDT would be beneficial for leprosy. The vast majority of patients (88.6%) indicated that they would ‘definitely’ submit to testing, followed by 69.4% of contacts and 72.2% of the general population. The majority of patients thought their household members should also be tested, while a subset indicated that RDT use should be extended to their respective communities. We propose that, due to their ease of use, point of care applicability and acceptability within target populations, RDT could be used as an entry point to inform the diagnostic process for leprosy.
Duration of leprosy treatment remains long and difficult to complete in resource poor areas. Studies suggest that shortening duration of therapy for MB patients to 6 months may be possible.
New MB patients in 2005 in two NGO projects in Bangladesh were treated with 6 months WHO MB MDT and the rate of relapse and fall in BI on slit skin smear during follow up to date were compared with a control group treated for 12 months the previous year.
1612 patients were enrolled in the trial, and the average duration of follow up was over 7 years after diagnosis. During 11,425 PYAR of follow-up, no relapses were detected, by bacteriological or clinical criteria, in the 918 patients in the 6 months MB MDT group, nor in the 694 patients in the control group. Rate of decline of BI in those who were smear positive was not significantly different between groups.
The data does not suggest that shortening duration of treatment from 12 months to 6 months MDT for MB leprosy patients leads to increased rates of relapse.