GD01 (P31): Clinical and chemokine profile in patients with leprosy during multidrug therapy and their healthy contacts: a randomized control trial

Orals

Rohit Kothari

Command Hospital Air Force, Bengaluru, India

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Reactions may interrupt its usual chronic course. Type 1 and type 2 lepra reactions are acute events and signify type IV and type III hypersensitivity responses, respectively. Various chemokines (e.g. CCL3, CCL5, CCL11 and CCL24) may be increased during the course of leprosy or during reactions, and may serve as markers of early diagnosis, response to therapy and prognosis. The aim was to find correlation of CCL3, CCL5, CCL11 and CCL24 levels in patients with leprosy on multidrug therapy (MDT) and their family contacts after ruling out active disease during leprosy treatment and during periods of lepra reactions. This randomized control trial was conducted with 50 patients with clinicohistopathologically diagnosed leprosy in a tertiary care hospital in Bengaluru, India. Fifty of their family contacts were adequately examined and investigated to rule out active disease. The two study groups comprised of patients with leprosy, and age-, sex- and area of residence-matched healthy contacts who were given single-dose rifampicin prophylaxis. Blood samples were taken at baseline, 6 months and after 1 year in both the groups (on completion of MDT in the leprosy group) and also during periods of reaction in the leprosy group. Our study found that, at baseline, CCL5, CCL11 and CCL24 were statistically significantly higher in the leprosy group compared with healthy contacts. CCL3 was also found to be higher at baseline in the leprosy group; however, the difference was not statistically significant. At 6 months and 1 year, the levels of CCL5, CCL11 and CCL24 reduced, and the difference was statistically significant in patients with leprosy, whereas it remained almost static in all healthy contacts. Twenty patients with leprosy developed a lepra reaction over the course of 1 year, and during the reaction the increase in CCL11 and CCL24 was statistically significant compared with baseline, whereas CCL3 and CCL5 did not rise significantly. One healthy contact developed signs of leprosy in the form of a hypopigmented numb patch, and CCL11 and CCL24 were found to be statistically significantly higher compared with baseline values. CCL5, CCL11 and CCL24 are sensitive diagnostic markers of leprosy, response to MDT and prognosis, and are not increased in healthy contacts. CCL11 and CCL24 are sensitive markers of lepra reactions and may serve as an early diagnostic modality for identifying reactions and leprosy in healthy contacts. To the best of our knowledge, this is the first study to evaluate these biomarkers in patients with leprosy and their healthy contacts with a follow-up of up to 1 year, with one developing the disease, which was confirmed based on these biomarkers.