Content area
Full Text
Histopathological Activity in Paucibacillary Leprosy Patients after ROM Therapy1
Almost two decades after the introduction of multidrug therapy (MDT) the treatment of leprosy and an intensive drive on the part of the World Health Organization (WHO) and the national leprosy programs to eliminate leprosy as a public health problem, there have been several reports of patients being detected at an early stage, presenting with just a single skin lesion (4,11). In 1995 WHO passed a recommendation that patients with five skin lesions or less and/or only one nerve trunk involvement should be considered as paucibacillary (PB) leprosy patients (15). These patients were to be treated with fixed-duration MDT composed of dapsone 100 mg daily and rifampin 600 mg once a month for 6 months. During this time various clinical trials to check the efficacy of other antimicrobial drugs against leprosy had been undertaken (1,5). These trials have confirmed that minocycline is highly effective both clinically and microbiologically in mouse foot pad models inoculated with Mycobacterium leprae (2,3,6). It is known that a single dose of rifampin (600 mg) exerts a strong bactericidal effect on M. leprae (7,10) and together with ofloxacin (400 mg) and minocycline (100 mg) would form an effective drug combination (ROM) to treat any early PB leprosy lesion in which the bacterial population is expected to be well below I million (11). To our knowledge no histological studies have been conducted to find out the effectiveness of ROM to clear inflammatory granulomatous response in early skin lesions in leprosy patients.
MATERIALS AND METHODS
Serial skin biopsies from 13 PB leprosy patients who had been clinically diagnosed and classified according to the RidleyJopling classification as borderline tuberculoid (BT) patients attending the outpatient department of The Leprosy Mission Hospital, Naini, Utter Pradesh, India, were sent to us for histopathological examination. Each patient had a comprehensive clinical examination and the morphology and the site of skin lesions were recorded. Skin-smear examination for acid-fast bacilli (AFB) was done from routine and selective sites.
A single dose of rifampin 600 mg, ofloxacin 400 mg, and minocycline 100 mg (ROM) was given. Before giving these drugs an elliptical piece of skin was biopsied from an active patch using local anesthesia. The skin biopsies were fixed in...