       Document 0096
 DOCN  M95B0096
 TI    Clinical features and diagnosis of relapses in leprosy.
 DT    9511
 AU    Ramu G
 SO    Indian J Lepr. 1995 Jan-Mar;67(1):45-59. Unique Identifier : AIDSLINE
       MED/95348589
 AB    1. The definition of relapse as occurrence of new signs and symptoms of
       the disease during the period of surveillance or thereafter in a patient
       who successfully completes an adequate course of multidrug therapy
       accommodates the current policy of releasing patients even when there
       are clinical and bacteriological signs of activity after fixed duration
       treatment. 2. The predisposing cause of relapse in the persistence of
       live M. leprae in various tissues in MB leprosy and in the nerve in PB
       leprosy. 3. The precipitating causes of relapse include (a) inadequate
       therapy due to miscategorization of MB cases as PB when there are
       solitary or few MB lesions since skin smear examinations for AFB are not
       routinely done in PB cases. (b) Previously sulphone treated LL cases
       inactive for more than two years are not included for MDT. Relapses
       commonly seen in NLEP units are in such cases. (c) Multiple skin and
       nerve lesions in PB leprosy. (d) Pregnancy and lactation. (e) Mental
       depression which downgrades immunity. (f) HIV infection. 4. There may be
       a change in type on relapsing, PB cases relapsing as MB and MB cases
       relapsing as PB. 5. Criteria for diagnosis of relapse are: increase in
       the extent of lesions, infiltration and erythema, fresh skin and nerve
       lesions, positive skin smears for AFB in previously negative cases; and
       in bacteriologically positive cases during surveillance, an increase in
       BI by two logs at any site over the previous BI in two successive
       examinations. 6. Relapses are but too often diagnosed as reversal
       reactions inspite of the absence of symptoms and signs of acute
       inflammation to the detriment of patients; a course of steroid therapy
       which is administered to these patients on the diagnosis of reversal
       reaction does not halt the progress of the disease especially in the
       nerve, resulting in disability.
 DE    Causality  Diagnosis, Differential  Human
       Leprosy/*DIAGNOSIS/*EPIDEMIOLOGY/MICROBIOLOGY  Recurrence  JOURNAL
       ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

