Burdened with the highest number of leprosy cases in the world, India’s fight against the crippling disease is becoming a tad tougher with a first-of-its kind global study (2009-2015) warning that antimicrobial resistance (AMR) cases are emerging in the sector. AMR against prevalent drugs means prolonged and expensive treatment and greater risk of disability to the person afflicted with leprosy.
Researchers from across the countries on behalf of the WHO had studied the multi-bacillary leprosy cases at sentinel sites of 19 countries including India where five laboratories across the country were selected for the same.
As per the ‘Antimicrobial resistance in leprosy: results of the first prospective open survey conducted by a WHO surveillance network for the period 2009-15', among the 1,932 (1,143 relapse and 789 new) cases studied, 3.8 per cent showed gene mutations showing resistance to Rifampicin, 4.5 per cent for Dapsone and 1.1 per cent for Ofloxacin.
Certain cases showed resistance to more than one drug. Globally, 20 cases showed Rifampicin and Dapsone resistance, four showed Ofloxacin and Dapsone resistance. Interestingly there were no cases of resistance to Rifampicin and Ofloxacin together. India and Brazil topped the list with more than 10 rifampicin-resistant cases each, said the study published in the journal 'Clinical Microbiology and Infection'.
In India, among the 382 cases studied, 4.7 per cent showed resistance to Rifampicin, 6.4 per cent and 4.4 per cent respectively showed Dapsone and Ofloxacin resistant. Primary drug resistant cases were seen mostly in Northern parts, often in difficult and hard-to-reach areas with tribal and similar population groups. High resistance has been observed in both new and relapse cases in Agra and New Delhi.
“Relapse cases may be under-diagnosed as we rely on self-reporting and there is decreasing leprosy expertise. Now, with the emergence of AMR, it also stresses the need for immediate notice, routine investigation and establishment of proper treatment guidelines by the government,” said Dr UD Gupta, one of the authors of the paper.
“No resistance was observed from other sentinel sites in India. Community-based surveillance is required to get better data. Challenges identified include identification of relapses and their referral, inadequate tissue material available for testing, technically demanding procedures and difficulty in collecting skin smears from child cases,” said Dr Gupta.
Dr VV Pai, Director of the Bombay leprosy Project working towards the welfare of leprosy patients, echoed similar views saying that AMR cases have started trickling, hence there is a need for initiating surveillance in new and relapse cases to curb the disease.
Vinita Shankar, Director of the Sasakawa India leprosy Foundation, noted that India continues to account for 60 per cent of new cases reported globally each year, mainly because of prevalent stigma. “We need to reduce the associated stigma, because it not only limits the medical reach of the leprosy eradication programme but also violates human rights.” Shankar also stressed on empowerment of leprosy affected people to bring them into the mainstream.