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Leprosy remains a significant public health concern despite major strides in treatment and control efforts. The Global Leprosy Strategy 2021–2030 and the National Strategic Plan for Leprosy 2023–2027 majorly focus on facilitating action to reach the goal of zero leprosy. Exploration of new treatment regimens is emphasized as one of the verticals of the multipronged approach for reaching the aforementioned goals. This becomes particularly pertinent in the wake of growing evidence for resistance to the drugs currently being used in the management of leprosy. Repurposed molecules present a very good approach in this direction. The present review aims to explore the potential of bedaquiline, a drug used for multidrug‐resistant tuberculosis, as a potential addition to the therapeutic armamentarium of leprosy. Through this narrative review, the authors attempt to look into the available proof of concept, clinical evidence, potential risks, and possible ways forward with bedaquiline in leprosy. [ABSTRACT FROM AUTHOR]

Background: Leprosy is known to be a great mimicker. Its dermatoscopic evaluation may be of value in establishing diag- nosis. Objective: To study the dermatoscopic findings encountered across the leprosy spectrum. Methods: This was a multi-centre cross-sectional study of leprosy patients, where after a thorough cutaneous and neurologi- cal evaluation, representative skin lesions from the study patients were photographed in standard settings, and the most repre- sentative skin lesions were chosen for dermatoscopic evaluation. Data was entered in a structured proforma and a descriptive analysis of dermatoscopic patterns was carried out. Results: A total of 53 cases of ages between 14 and 80 years, ranging from tuberculoid to the lepromatous spectrum of dis- ease, with active skin lesions in the form of patches and plaques were included. The spectrum of leprosy as per Ridley-Jopling classification at diagnosis was indeterminate in 1 (1.9%), tuberculoid in 1 (1.9%), borderline tuberculoid in 25 (21.5%), bor- derline lepromatous in 9 (17%), lepromatous in 14 (26.4%) and histoid in 3 (5.7%). Dermatoscopic features included distort- ed pigment network in 48 (90.6%), focal white areas in 40 (75.5%), reduced eccrine and follicular openings in 43 (81.1%), widened skin lines in 28 (52.8%), circle hairs in 15 (28.3%) and white shiny streaks in 17 (32.1%). Conclusion: Dermatoscopy is a practical, non-invasive device to assess skin lesions of leprosy and provide cues to its diag- nosis, spectral classification and differentiating it from other granulomatous disorders. However, dermatoscopy alone cannot reliably differentiate between the various types of leprosy and future large-scale studies are required. Limitations of the study: The numbers for each subtype were variable and few in some spectrum of leprosy patients. A dermatoscopic-histologic correlation was not done. [ABSTRACT FROM AUTHOR]

Background This study aimed to assess the effectiveness of nurse-led interventions in managing leprosy due to a shortage of dermatologists and other healthcare professionals. Methods A total of 100 leprosy patients were divided into experimental (n=50) and control groups (n=50). The intervention included face-to-face counseling by a trained nurse, motivational videos and exercise demonstrations. The control group received standard care. The primary outcome of interest was treatment adherence (Adherence to Refills and Medications Scale); other assessed outcomes included changes in perceived stigma (Stigma Assessment and Reduction of Impact scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder seven-item) and quality of life (WHO QOL–BREF Scale) from baseline to week 8. Results The intervention group had better treatment adherence (p<0.001). At baseline, moderately severe and severe depression prevalence was 18% and 28%, respectively, and anxiety was 25%, with no intergroup differences. Anxiety significantly decreased in the intervention group (p<0.001), but depression remained similar (p=0.291). Perceived stigma improved notably, especially in disclosure of concern (p<0.001), internal stigma (p<0.001) and anticipated stigma (p<0.001). Quality of life scores improved in the intervention group vs controls. Conclusion Nurse-led interventions effectively enhanced quality of life and treatment adherence and reduced anxiety, depression and perceived stigma among leprosy patients. The study recommends strengthening the capacity of nurses for active involvement in leprosy care. [ABSTRACT FROM AUTHOR]

The article discusses the utility of cutaneous thermography in assessing nerve function impairment in leprosy. Leprosy, caused by Mycobacterium leprae and Mycobacterium lepromatosis, remains a global health concern with a significant number of new cases reported annually. The study conducted on five leprosy patients found that cutaneous temperature changes correlated with areas of sensory loss, indicating the potential of thermography as a screening tool for early neural involvement in leprosy. Further research is needed to validate these findings and explore the application of thermography in detecting leprosy and assessing nerve function impairment in field settings. [Extracted from the article]

Just as we prioritize personalized medicine for various other medical conditions, we should also include a neglected disease like leprosy, ensuring that patients receive the best care possible and improving their quality of life. Our case highlights the importance of instituting an alternate therapeutic regimen in a scenario where there is a lack of clinical response to multidrug therapy, even in the absence of documented drug resistance of the currently available molecular diagnostics. The search for the perfect regimen tailored for each individual leprosy patient should continue. Alternate anti-leprosy therapy is highly useful in cases with confirmed drug resistance or clinically non-responsive cases; however, their misuse should also be strictly avoided to prevent the development of resistance to them. [ABSTRACT FROM AUTHOR]

This article discusses a case of lepromatous leprosy presenting as a lichenoid rash. Leprosy is a slowly progressing infectious disease primarily affecting the skin and nerves. The diagnosis is typically based on WHO cardinal signs, but atypical skin manifestations can complicate the disease's course and delay diagnosis. The patient in this case presented with erythematous, lichenoid infiltrated papules and plaques, as well as ulnar nerve involvement and facial infiltration. The use of systemic corticosteroids likely led to unusual skin manifestations and complications. The article emphasizes the importance of considering leprosy as a possible diagnosis for unusual clinical presentations, especially in endemic regions. [Extracted from the article]

Fixed duration multidrug therapy (FDT–12 months) is recommended by the WHO for multibacillary (MB) Hansen's disease (HD). However, highly bacillated patients tend to experience problems such as painful neuritis, worsening nerve function, delayed regression of lesions, and relapses. There is also concern about the increasing rate of relapse and antimicrobial resistance. Persistent or slowly regressing skin lesions and disabilities can occur even after completion of treatment. The decline in expertise to diagnose and treat Hansen's disease and poor treatment adherence are additional challenges. It is suggested that prolonging antimicrobial therapy, adding immunotherapy, increasing the dosage of rifampicin, adding more potent bactericidal drugs, and improving diagnostic services and treatment adherence may help manage highly bacillated patients. [Extracted from the article]

This article discusses a case of a 34-year-old woman with lepromatous leprosy and uncontrolled type 2 diabetes who developed rhino-orbito-cerebral mucormycosis, a fungal infection. The patient had been treated with steroids for necrotic erythema nodosum leprosum, a complication of leprosy, and subsequently developed mucormycosis. The article highlights the increased susceptibility to mucormycosis in patients with chronic leprosy reactions and diabetes who undergo prolonged corticosteroid therapy. It also emphasizes the need for novel immunomodulatory agents to manage these cases and mitigate the risk of complications. [Extracted from the article]

Background Erythema nodosum leprosum (ENL) is an immunologically mediated phenomenon complicating the course of leprosy. Reverse Koebner phenomenon is the term used to describe the sparing of previously injured or diseased skin by new skin lesions of the disease. Methods A middle-aged woman with a known case of lepromatous leprosy for the past year presented with an eruption of reddish painful nodules over her body. The lesions were found to characteristically spare the sites of previous scars. Results This sparing phenomenon of previous scar sites has been termed reverse Koebner phenomenon, a site of the body that offers greater resistance than the rest of the body to the onset of the disease, seen in various diseases, but it has never been described in ENL. Conclusion This sparing of scar sites in ENL can be attributed to reverse Koebner phenomenon. [ABSTRACT FROM AUTHOR]

Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease. [ABSTRACT FROM AUTHOR]

Introduction: Presently the leprosy program has no defined surveillance protocols for patients who complete the fixed duration multidrug therapy and are released from treatment (RFT). Hence, the information about the post‑RFT events in these patients is sparse and qualitative and quantitative data regarding their health care requirements is missing. During the DermLep survey carried out by the Indian Association of Dermatologists,Venereologists and Leprologists (IADVL), a number of patients presented to dermatologists during the post RFT period for a variety of symptoms. This paper analyses the events in these patients during the post RFT period. Results: Out of a total of 3701 leprosy patients who presented to 201 dermatologists across India during the DermLep survey, 708 (26.2%) were in the post RFT period (488 males; 220 females). Of these, 21% were PB and 79% MB patients as per their treatment records. Majority were in the age group of 31‑59 years (55.5%); however, a significant proportion of them (20.7%) were elderly (>60 years). Majority of the patients (45.5%) presented within the first year of RFT with variable symptoms; 28% were between 1‑5 years, 5.5% between 5‑10 years; and 11.0% presented more than 10 years after RFT. Most common presenting complaint being persistent skin lesions as perceived by patients in 21.2%, followed by neuritis in 14.5%; trophic ulcers in 13.8%; deformities in 67 (11.8%); lepra reactions in 66 (11.6%); and recurrence of original symptoms in 6.7%. Conclusion: The DermLep Survey highlights the importance of ‘post RFT’ patients as an important subset of leprosy patients who visit dermatologists for various health related issues. The most common complaints in this subset were active/persistent skin lesions, lepra reactions and neuritis. In these patients, who are a sub‑group of ‘persons affected with leprosy’ the disease related issues can persist for many years post RFT. Hence, it is important to provide services in the programme to monitor and manage these complications for the prevention of impairments, disability and the related social issues. [ABSTRACT FROM AUTHOR]

Herein, we report a leprosy patient with trigeminal nerve involvement presenting as facial pain and paraesthesias which was initially diagnosed as trigeminal tumour and considered for gamma-knife surgery. Leprosy is a chronic infectious disease caused by I Mycobacterium leprae i which affects the skin and nerves. Intra-cranial involvement of trigeminal nerve in a patient with borderline tuberculoid leprosy in type 1 lepra reaction. [Extracted from the article]

Background: Contacts of leprosy patients have an increased risk of infection with Mycobacterium leprae. Contact tracing and chemo- or immunoprophylaxis are important means of preventing leprosy transmission. Aims: We aimed to evaluate the efficacy of immunoprophylaxis with Mycobacterium indicus pranii vaccine in reducing anti-phenolic glycolipid-1 titers in household contacts of leprosy patients. Methods: This prospective single-center study was conducted in a tertiary care center in North India from January 2015 to December 2016. Contacts of leprosy patients (both paucibacillary and multibacillary) were screened for anti-phenolic glycolipid-1 antibodies with enzyme-linked immunosorbent assay. Those found positive were given immunoprophylaxis with a single dose of Mycobacterium indicus pranii vaccine, and anti-phenolic glycolipid-1 titers were evaluated at six and 12 months. All contacts were clinically followed for three years. Results: Of the 135 contacts of 98 leprosy patients that were screened, 128 were recruited. Seventeen of these contacts were positive for anti-phenolic glycolipid-1 antibodies and were given Mycobacterium indicus pranii vaccine. Two contacts were lost to follow-up. After immunoprophylaxis, anti-phenolic glycolipid-1 titers were negative in all patients at all intervals, and no contact developed any clinical signs or symptoms of leprosy during the three-year follow-up. Limitations: The small number of contacts studied, the short follow-up period and the absence of a control group were limitations of this study. Dicussion: We could not find any papers on natural decline of PGL 1 titres in contacts, although in leprosy patients, these titres may even increase after completion of treatment. However the titres do correlate with bacterial load (reference: Int J Lepr Other Mycobact Dis. 1998 Sep;66(3):356-64) so if the tires decrease or become negative it may be considered as an indirect evidence of bacillary clearance. Hence we may suggest the protective efficacy. Furthermore, as the editor mentioned, considering the small number of positive patients, a control group was not possible in the present pilot study, but such studies may be carried out in the future. Conclusion: Immunoprophylaxis with Mycobacterium indicus pranii vaccine is effective and safe in preventing disease in contacts of leprosy patients. However, these findings need to be replicated in larger studies. [ABSTRACT FROM AUTHOR]

The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows. [ABSTRACT FROM AUTHOR]

A subset of leprosy patients has clinical and histopathological activity in the form of persistent plaques and granulomas after completion of multidrug therapy (MDT) which can have significant impact on their quality of life. In the absence of clear guidelines regarding management of such patients, majority of the times they are treated either as late reversal reaction with corticosteroids or no active treatment is offered. We observed 11 patients of leprosy with persistent plaques after completing the 6/12‐months MDT who were treated favorably with minocycline 100 mg once daily for 16 weeks. Complete clinical resolution was observed in 9/11 patients while two patients had partial improvement. Histopathological improvement in the form of disappearance of granulomas corroborated with the clinical improvement. All the patients tolerated the treatment well and hyperpigmentation was the only adverse effect noted. Minocycline may be considered as a useful and well tolerated therapeutic option for this subset of leprosy patients due to its immune modulatory and anti‐inflammatory effects. [ABSTRACT FROM AUTHOR]

Response to "Three drugs are unnecessary for treating paucibacillary leprosy - A critique of the WHO guidelines" We read with interest the viewpoint by Lockwood and colleagues on the recent World Health Organization (WHO) guidelines recommending three drugs for treating paucibacillary (PB) leprosy. [[6]] So, it can be safely presumed that the occurrence of higher relapse rate in PB leprosy in comparison to MB leprosy is either due to misclassification or inadequate therapy. Uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): Results of an open label, randomized and controlled clinical trial, among multibacillary patients. [Extracted from the article]

Tuberculosis and leprosy remain endemic in developing countries of the world, but concomitant infection with tuberculosis and leprosy in the same individual are rarely seen in the modern era. This is a report of co‐infection by tuberculosis in a known case of leprosy, diagnosed on cytology and confirmed by performing conventional polymerase chain reaction using cell scrapings obtained from the stained cytology smears. [ABSTRACT FROM AUTHOR]

Background: Erythema nodosum leprosum is an immune-mediated complication of leprosy which causes significant morbidity. Biomarkers in the pathogenesis of erythema nodosum leprosum are not yet fully determined.Aim: To determine macrophage migration inhibitory factor levels in the sera of leprosy patients with erythema nodosum leprosum and to correlate the same with clinical parameters.Methods: This cross-sectional study included 37 consecutive leprosy patients with active erythema nodosum leprosum and 31 age- and sex-matched controls. Detailed clinical history and examination findings were recorded including the severity and frequency of erythema nodosum leprosum. Slit skin smears and histopathologic examination were done in all patients at baseline. Serum macrophage migration inhibitory factor levels were determined using an enzyme-linked immunosorbent assay.Results: Most of our patients were males (78.4%) and suffering from lepromatous leprosy (27, 73%) with a mean initial bacillary index of 3.38 ± 1.36. Recurrent and chronic patterns of erythema nodosum leprosum were seen in 15 (40.5%) and 6 (16.3%) patients, respectively. Most (86.5%) of our patients presented with moderate to severe erythema nodosum leprosum. The mean serum macrophage migration inhibitory factor level was 21.86 ± 18.7 ng/ml among patients while it was 11.78 ± 8.4 ng/ml in the control group (P < 0.01). There were no statistically significant correlations of macrophage migration inhibitory factor levels with erythema nodosum leprosum frequency or severity.Limitation: Serum macrophage migration inhibitory factor levels in leprosy patients with no erythema nodosum leprosum and in patients with other inflammatory and autoimmune conditions were not assessed. Hence, this study falls short of providing the predictive value and specificity of higher macrophage migration inhibitory factor concentrations in serum as a biomarker of erythema nodosum leprosum.Conclusion: Macrophage migration inhibitory factor levels are elevated in erythema nodosum leprosum patients as compared to controls. A larger sample size and macrophage migration inhibitory factor gene polymorphism analysis will be needed to elucidate the role of this pro-inflammatory cytokine in erythema nodosum leprosum. [ABSTRACT FROM AUTHOR]

Dear Editor, We read with interest the recent correspondence entitled "Childhood leprosy: a Pandora's box."1 The author reported a case of tuberculoid leprosy in a 5-year-old child. The protective efficacy of this vaccine is reported to be 26% in experimental studies and as high as 61% in observational studies.5 Failure to administer the BCG vaccine likely predisposed this child to develop leprosy. Diagnosis of childhood leprosy provides a valuable opportunity for the detection of index cases in the family. [Extracted from the article]

Mycobacterium w (Mw) vaccine is a heat-killed suspension derived from a nonpathogenic, cultivable, atypical mycobacterium named Mycobacterium indicus pranii. Mw immunotherapy has been reported to be efficacious as an adjunct to multidrug therapy multibacillary regimen in leprosy patients with high bacillary index. Cutaneous reactions are predominant adverse effects associated with the administration of vaccines. Cutaneous adverse effects ascribed to Mw vaccine are generally limited to the site of injection. We herein describe two cases of lepromatous leprosy who developed an unusual generalized cutaneous reaction following Mw immunotherapy. A high index of suspicion is needed to identify such manifestations in leprosy cases to avoid misdiagnosis of a relapse or a reaction and for appropriate treatment. [ABSTRACT FROM AUTHOR]

Leprosy is among the world's oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system. All these provisions in the integrated health care approach will go a long way in further reducing the stigma. Efforts need to be made to reduce deformity through early detection, self care, physiotherapy and reconstructive surgery and developing sound surveillance systems. With all the remarkable achievements in the fight against leprosy, the stage is now set for the final assault. It is hoped that with the efforts of all the stake holders and strong political will, the disease will be eradicated in the near future. [ABSTRACT FROM AUTHOR]

We read with great interest the recommendations made by Abdelmaksoud and Gupta1 for managing leprosy patients in the era of coronavirus disease 2019 (COVID-19). However, long-term effects of this very brief "storm" on the long course of leprosy/lepra reactions in the COVID-19 survivors are difficult to predict. We do agree that leprosy patients who are the lucky survivors of COVID-19 infection should be seen regularly (as presently the case is) but those with reactions would require more frequent monitoring or follow-up. [Extracted from the article]

Leprosy pseudoimbricata: an unusual presentation of steroid-modified borderline lepromatous leprosy The borderline leprosy is an immunologically unstable entity lying between the two polar ends of disease.[1] We report an unsual case of borderline lepromatous (BL) leprosy presenting with concentric erythematous rings mimicking tinea pseudoimbricata. We propose the term "leprosy pseudoimbricata" for such patients of steroid modified leprosy presenting as concentric rings. [Extracted from the article]

Leprosy is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Both organisms cannot be cultured in vitro. M. lepromatosis was found to be associated mainly with diffuse lepromatous leprosy and with Lucio's phenomena initially. Later, M. lepromatosis was observed in borderline leprosy cases (BL), lepromatous leprosy cases (LL) and leprosy reactional cases (T1R and ENL). Although many cases are being reported with similar clinical features like Lucio phenomenon in India but M. lepromatosis was not isolated from these cases. The aim of this study was to screen MB patients and patients with type 2 reaction for the presence of M. lepromatosis. We recruited a total of 75 multibacillary leprosy cases (45 MB cases without reaction and 30 type 2 reaction (ENL) cases) from TLM hospitals Purulia (West Bengal), Barabanki (Uttar Pradesh), Shahdara (Delhi) and PGIMER (Chandigarh), India. Punch biopsies of 5 mm were collected in 70% ethanol from all the study subjects. DNA was extracted followed by Hemi-nested PCR targeting 16S rRNA gene specific for M. lepromatosis. Further, PCR products were processed for Sanger sequencing for an absolute confirmation of M. lepromatosis. Whole genome sequencing was done to confirm the presence of M. lepromatosis. We observed presence of M. lepromatosis in 4 necrotic ENL patients by heminested PCR. There was 100% 16S rRNA sequence similarity with M. lepromatosis FJ924 in one case, 98.96% in two cases and in one case it was 90.9% similarity by nucleotide BLAST (BLASTn) by using the NCBI website. On the basis of Sanger sequencing, we noted presence of M. lepromatosis in 3 necrotic ENL patients as one sample only gave 90.9% similarity by BLASTn. On the basis of de novo assembly and genome obtained, only one sample S4 with a 2.9 mb genome size was qualified for downstream analysis. Sixteen M. lepromatosis- specific proteins were identified in this case and the closest species was M. lepromatosis strain FJ924 based on whole genome level phylogeny. These results provide valuable insights into the prevalence of M. lepromatosis in ENL patients in different regions of India and contribute to our understanding of the genetic characteristics of this pathogen in the context of leprosy. • For the first time M. lepromatosis was isolated from leprosy (ENL) cases in India. • Leprosy patients resembling Lucio phenomenon should be considered for investigating the presence of M. lepromatosis. • M. lepromatosis strain FJ924 was recorded as the closest species based on whole genome level phylogeny. • Availability of the M. lepromatosis genome sequence in India will enable us to search for its presence in India. [ABSTRACT FROM AUTHOR]