Two cases of leprosy who had drug resistance related mutations to diaphenylsulfone, rifampicin and new quinolone

Abstract

Two relapsed cases of leprosy having drug resistance related mutations to diaphenylsulfone, rifampicin and new quinolone (NQ) are presented. Case 1 was prescribed ofloxacin in the past with unknown purpose and that was supposed to have led to NQ-resistance. Case 2 had high bacterial load for more than 10 years having no effective chemotherapy. Then eventually, multi-drug-resistance must have developed. These 2 cases were treated with CAM, MINO, CLF and completely cured without newly developed disability since our first examination. There is no guide line of chemotherapy for the cases of resistance to these 3 drugs. Then therapeutic regimen should be discussed more. During the clinical course of case 1, we observed good correlation between the decrease of PGL-I titer and reversal reaction. Past histories of these 2 cases explain that the benefit of advanced medicine was not available in some sanatorium, even when the WHO’s MDT had been adopted worldwide. Under the leprosy segregation law, the treatment of leprosy itself had been confined in sanatoria for a long time. Both cases have completed treatment in outpatient care without taking long-term absence from their occupations. Originally, leprosy should have been treated in the community-based medical institutions.