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Volume - 91, Issue - 3

Page 231
Pages 232 - 243
  • The adverse drug effects of dapsone therapy in leprosy: a systematic review

    • Robin Hilder
    • Diana Lockwood
    Volume 91, Issue 3

    | Published on September 2020


    To establish the rate of adverse drug reactions (ADR) when dapsone is given in leprosy multi-drug therapy (MDT). This paper reviews the reporting of ADRs by systematic review of the databases Ovid Medline, Ovid Embase and Global Health according to pre-specified eligibility criteria.


    The search identified 5859 relevant citations. These publications were divided into two data sets and reviewed for their documentation of ADRs. One hundred and fourteen publications reported ADR as the primary outcome and 98 papers reported the efficacy of treatment. Of the 114 papers included, 79 were case reports, 23 retrospective studies, 7 prospective studies and 7 literature reviews. Dapsone Hypersensitivity Syndrome (DHS) was reported most frequently as an adverse effect, then anaemia (haemolytic and not otherwise specified), cutaneous eruptions, gastrointestinal disturbance and hepatitis. Eleven studies report a mean rate of DHS as 1.22% and an average fatality rate in 8 studies of 11.24%. Of the 98 papers reporting treatment efficacy, 33 papers reported ADRs to medications other than dapsone and 36 publications had no documentation of adverse effects.


    Most publications report ADRs in case reports, many from India. DHS was the most commonly reported ADR, followed by individual features of the syndrome. Many studies lack patient information with many not reporting ADRs. Our findings show that improved prospective monitoring of adverse events associated with dapsone is needed. We propose that all patients should be tested with a full blood count before starting MDT and repeated after 4–8 weeks with mandatory follow-up. This would facilitate detecting ADRs including DHS and dapsone-associated anaemias.

Original Papers
Pages 244 - 254
  • Hansen’s Disease: differences in clinical presentation among Latin American and South East Asian born patients identified in Los Angeles County, California (1995–2016)

    • Curtis Croker
    • Jeffrey Phommasith
    • Robert Jerskey
    • Amy Marutani
    • Maria T. Ochoa
    Volume 91, Issue 3

    | Published on September 2020


    Hansen’s Disease (HD, or Leprosy) is a mycobacterial infection associated with severe nerve damage and physical disfigurement, primarily affecting economically disadvantaged persons. Increased morbidity occurs when patients experience an immunological reaction to this infection prior to, during, or after HD treatment. Our objective was to identify HD patients at risk for such reactions.


    We performed a multivariate retrospective case--control analysis of HD patient risk for reaction (types 1 and 2) among patients reported in Los Angeles County (LAC) (1995–2016). Risk factors included age, gender, report year, birth place, and bacillary classification (paucibacillary vs. multibacillary).


    Most of the 78 LAC HD patients identified for this study were male (78.2%, 61), born in Latin America (48.7%, 38) or South East Asia (SE Asia) (41.0%, 32), classified as multibacillary (88.5%, 69), with a median age of 43.5 years (range 18–82 years). Sixty-two HD patients (79.5%) experienced a reaction type: 34 experienced type 1 (43.6%), 34 experienced type 2 (43.6%), 6 experienced multiple types (7.7%). SE Asian born patients were more likely to experience a type 1 reaction (59.4%, aOR = 3.0, CI: 1.2–7.7), whereas Latin American born patients were more likely to experience a type 2 reaction (68.4%, aOR = 11.1, CI: 3.5–35.1).


    The risk of reaction types among LAC HD patients appears to be correlated with the patient’s birth place, where their exposure likely occurred. Explanations for these differences include different mycobacterial variants circulating geographically, different immune responses of racial-ethnic groups to HD, and genetic associations.

    Author Summary:

    Hansen’s Disease is rare in Los Angeles County and primarily occurs among persons who acquired the infection outside of the US. The findings of this 22-year study of 78 Hansen’s patients suggest that the clinical progression of this disease differs by the global region of exposure. Latin American born patients with Hansen’s disease had eleven times the odds of developing a type 2 reaction, which is associated with severe long-term disability, than patients born in SE Asia. Possible explanations for this result include: (1) variations of the mycobacterial strain across the globe or, (2) variations in immunological responses of racial/ethnic groups to this mycobacterium. Both explanations may be the result of this agent being introduced into the Americans much more recently than in Asia. Clinicians should consider a patient’s race/ethnicity background when developing a Hansen’s Disease treatment plan.

Original Papers
Pages 255 - 261
  • Changing proportions of paucibacillary leprosy cases in global leprosy case notification

    • C. R. Butlin
    • D. N. J. Lockwood
    Volume 91, Issue 3

    | Published on September 2020


    Classification of new cases of leprosy into Paucibacillary (PB) or Multibacillary (MB) groups is important as it determines the duration of the treatment regimen, and predicts both complications of leprosy and risk of infection to contacts. Criteria have changed over the past 4 decades. We studied the published global leprosy statistics to reveal any major temporal changes in the proportion of PB cases.


    Global data published by WHO over the past 40 years demonstrate a continuous decrease in the proportion of newly reported leprosy cases who are classified as paucibacillary (PB) from nearly 80% to around 40%. Independent validation of consistent and accurate classification is lacking.


    The decrease in PB proportion may be an artefactual, rather than an epidemiological, phenomenon. Whilst it is impossible to be certain, we suspect that a combination of changes in criteria and “overclassifying” to the MB group by field staff is the cause.

Original Papers
Pages 262 - 273
  • Peek Acuity vs Snellen Chart for visual impairment screening in leprosy: a cross-sectional study

    • Yunia Irawati
    • Anna Puspitasari Bani
    • Krystle Gabriella
    • Anis Fitriana
    • Carennia Paramita
    • Made Susiyanti
    • Tri Rahayu
    • Gitalisa Andayani
    • Yeni Dwi Lestari
    Volume 91, Issue 3

    | Published on September 2020


    Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which has a high incidence of ocular involvement. Due to the need for good vision for leprosy patients, visual acuity becomes an essential early screening examination. The Snellen Chart has been commonly employed as the standard for measuring visual acuity. Nevertheless, it is immobile and time-consuming. A smartphone-based application, Portable Eye Examination Kit (Peek Acuity), is already known to be accessible, reliable and easy to use for measuring visual acuity. This study examines the reliability of Peek Acuity in performing visual acuity screening for leprosy patients.


    A population-based cross-sectional study was carried out at a leprosy settlement village near Sitanala Hospital, Tangerang and Alverno Hospital, Singkawang. Participants’ uncorrected visual acuity was measured using both the Snellen Chart and Peek Acuity. The scores were converted into logMAR.


    This study involved 347 subjects which included 692 eyes (2 eyes were anophthalmic). The mean difference between the Snellen chart and Peek Acuity was 0.11 logMAR (95% CI, 0.096 to 0.13). Linear regression analysis showed no statistically significant difference between the Snellen Chart and Peek Acuity measurements (P =0.98). Cohen’s Kappa and concordance rate of visual acuity measured with Peek Acuity and Snellen Chart were 0.65 and 0.83.


    Peek Acuity is an accurate and repeatable visual acuity screening tool as effective as the Snellen Chart, which also can be used for leprosy patients to overcome barriers in accessing eye health services, especially in rural areas.

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