Leprosy with comorbidities: A call for strengthening vigilance

We read the article “A case of lepromatous leprosy in a background of chronic hepatitis B infection” by Jayashankar et al. (2024)[1] with great interest. The case study was well written and highlighted the important issues; in addition to this, we would like to contribute some important insights related to this article. Globally, more than 2,00,000 new leprosy cases are registered every year; among that, more than 50 percent of new leprosy cases are from India.[2] Due to long incubation period, the slow appearance of symptoms, and the stigma attached to this disease make complete elimination of this neglected disease more difficult. Leprosy remains endemic in several states and union territories in India. The presence of leprosy in a person alone causes a significant burden and can lead to physical, psychological, and social disabilities. Various individual and community-related factors delay health-seeking behavior and early detection. In recent years, due to epidemiological transition, non-communicable diseases are also global health challenges, accounting for about three-fifths of morbidity and mortality. These diseases can coexist in the same patient and interact with leprosy.

The presence of leprosy with other infectious diseases like tuberculosis, human immunodeficiency virus, diabetes, hypertension, hepatitis, and COVID-19 can lead to (i) a weakened immune system, (ii) affect the clinical manifestations, (iii) drug toxicity due to more drugs, (iv) increased chances for complications (drug adverse reactions, type 1, type 2 reactions, and neuritis), (v) confusion and challenges in diagnosis, treatment and higher risk for relapse cases.[3] Additionally, the overall health of the patient may be compromised, making it harder to achieve successful treatment outcomes and increasing the chances for morbidity and mortality.

The National Strategic Plan for Leprosy 2023–2027 and the National Guidelines for Antimicrobial Resistance Surveillance in leprosy majorly focus on the importance of robust surveillance and early detection of drug resistance.[4] One of the key concerns highlighted in the guidelines is the risk of severe adverse drug reactions (ADRs) associated with certain drug combinations used in leprosy treatment. Rifampicin and Dapsone, two commonly prescribed drugs, can lead to serious side effects if not administered with caution. Similarly, steroid therapy, which is prescribed for leprosy reactions and neuritis, should be prescribed with caution in patients with diabetes, hypertension, liver disorders, and other comorbidities. Appropriate referrals to higher centers should be made in case of complications.

Primary health workers play a crucial role in preventing these reactions by closely monitoring for signs and symptoms of ADRs.[5] They must be more vigilant while treating a person affected with leprosy, and the evaluation should be performed in a systematic manner with a uniform algorithm, while detecting new cases with comorbidities. An integrated approach is needed while managing leprosy co-infections, and it requires comprehensive screening for other diseases, simultaneous treatment of both conditions, careful monitoring for drug interactions, and close patient monitoring.[6] An appropriate laboratory diagnosis should be performed during the multidrug therapy (MDT) initiation to assess any associated comorbidities, which can include sputum examination for acid-fast bacilli (AFB) and hemoglobin and routine urine and stool examinations. Through these combined efforts, we can move closer to eradicating leprosy and improving public health on a global scale.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.