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Biomedical subjects

P Vijayakumaran

Publications and source records attributed to P Vijayakumaran.

At least 19 recordsLinked to original sources
PubMed2006

Repeated sputum microscopy is not essential for monitoring tuberculosis treatment response.

SETTING: This study was conducted in two districts in India where DOTS has been implemented. There are 39 microscopy centres in Anantpur district and 34 in Nellore district (one per 100,000 population), each with a trained microscopist. Periodic follow-up sputum microscopy is performed for all tuberculosis (TB) patients on treatment, with two sputum specimens examined on each follow-up. Results are recorded in a laboratory register. OBJECTIVE: To determine whether examining two sputum specimens for follow-up is useful for assessing treatment outcome. DESIGN: A retrospective study using data from laboratory registers of all microscopy centres for 2002 in Anantpur and 2003 (January-June) in Nellore. RESULTS: Of 5086 follow-up examinations done in Anantpur and 1028 in Nellore, 8% were acid-fast bacilli positive. One additional positive result was obtained on examination of a second sputum specimen. This result did not significantly add to the assessment of treatment outcome. CONCLUSION: The yield of a second on-the-spot sputum specimen is negligible, provided that the first smear is from an overnight specimen. From the data available, it is evident that repeated follow-up smears are not essential for documenting treatment outcome.

Antitubercular Agents↗
PubMed2000

Chemoprophylaxis against leprosy: expectations and methodology of a trial.

Because of the great efficacy of multidrug therapy (MDT), it had been hoped that the widespread use of MDT would bring about a rapid decrease of the incidence of leprosy. To the present, a decrease of incidence has not been observed, possibly because of the long incubation period of the disease, and because general implementation of MDT is still recent. Other reasons, such as environmental sources of infection or the role of healthy carriers in transmitting Mycobacterium leprae, cannot be excluded. Therefore, one must seek alternative or supplementary strategies, such as chemoprophylaxis. Household contacts of leprosy patients are at greater risk of developing leprosy than is the general population. Therefore, a randomized, controlled trial of chemoprophylaxis, using a single 10 mg/kg dose of rifampicin, or a placebo, is planned in nine projects in India, among the household contacts of newly detected leprosy patients. Based upon assumptions of a protective efficacy of the chemoprophylaxis of 50%, an annual incidence of 2 per 1000 contacts, a desired power of the study of 90%, and a level of significance of 95%, 15,000 household contacts will be allocated randomly by household to each arm of the study, and followed for 5 years. Considered as household contacts will be all persons living in the same household as an index case and sharing the same kitchen. Pregnant women and infants will be excluded. To be certain that transmission of the organisms from the index case cannot occur once the prophylaxis is administered, rifampicin will be administered 2 months after diagnosis of the index case. Diagnosis of leprosy will be clinical, and confirmed independently. Although household contacts usually constitute only a small proportion of the new patients detected in a control programme, their high-risk status makes them particularly appropriate for a study of the potential effect of chemoprophylaxis. Following the trial, one could evaluate the usefulness and feasibility of using the same strategy in other population-groups, based on the number of persons necessary to treat to prevent one case.

Drug Therapy, Combination↗
PubMed1999

Pace of leprosy elimination and support teams in Bihar state, India.

Despite the extensive implementation of multiple drug therapy (MDT) in most leprosy-endemic countries world-wide since 1982, bringing about a remarkable reduction in prevalence, there are still regions at the sub-national level where the implementation of MDT remains difficult. The state of Bihar (population 86.3 million) in India is a good example of such a region. Previously rated as one of the most highly endemic states, it still contributes about 21% of the total caseload in India and about 12% of the global caseload. For various reasons, case-finding and drug treatment have lagged behind the progress made in most other states in the country and in 1996, the Damien Foundation India Trust (DFIT) volunteered technical support to increase the pace of elimination. Sixteen out of the 39 districts in the state were allocated, with a population of 41.8 million. Support teams, including a Medical Advisor and a Non-Medical Supervisor, both with over 10 years experience of leprosy work and control programmes, were provided to assist and work alongside government staff in case detection, treatment delivery, case-holding and discharge in their respective areas of operation. New case detection by intensive survey increased by 394% and total new case detection by 226% during the year 1996-1997, with similar trends in the following year. Striking improvements were also observed in MDT coverage, treatment regularity, monitoring and discharge of patients and in the training of local staff. This collaboration between a non-government agency (DFIT) and the staff of the National Leprosy Eradication Programme in 16 out of 39 districts in the State of Bihar has clearly been extremely successful. Similar approaches in the remaining districts of Bihar, and in other parts of India, where the infrastructure is available but inadequate, may contribute significantly to achieving the elimination goal at national and sub-national levels.

Drug Therapy, Combination↗
PubMed1998

Study of the problem of hidden cases of leprosy among "inaccessible" section of urban population in Madras City.

A questionnaire survey was conducted amongst 1300 general practitioners (GPs) of Madras city to assess the magnitude of leprosy problem amongst the upper middle class and upper class populations who are getting treatment from these GPs. A total of 2944 leprosy patients were being treated by 200 GPs. One third of these patients belonged to the upper middle/upper class section of the population living in the city of Madras.

Humans↗
PubMed1998

Does MDT arrest transmission of leprosy to household contacts?

The multidrug therapy program with the World Health Organization (WHO)-recommended treatment (WHO/MDT) regimens has given the hope of early case detection and rendering a leprosy patient, especially a multibacillary (MB) patient, noninfectious within a short period of time. Hence, the duration of exposure for household contacts to infection is expected to be remarkably less when compared to exposure to MB leprosy patients on dapsone monotherapy. A total of 1661 household contacts of skin-smear-positive leprosy patients were recorded from 1984 to 1994. Follow up of these individuals [8403 person-years at risk (PYR)] revealed that the incidence of leprosy was 7.7 per 1000 PYR, which was 8 times more than that of the general population. The risk was more if there was a coprevalent case in the family. The incidence of leprosy declines from the third year of surveillance onward, and declines more so in children. Although disease transmission should have been arrested as soon as the index case was started on MDT, the incidence of leprosy among the household contacts was still high when compared to that of the total population. Effective intervention needs to be introduced to reduce the risk of contacts developing leprosy.

Drug Therapy, Combination↗
PubMed1997

Leucocytopenia after rifampicin and ofloxacin therapy in leprosy.

New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.

Adolescent↗
PubMed1997

Ulnar nerve abscess in a multibacillary patient during post-multidrug therapy surveillance.

An old borderline-lepromatous leprosy patient, treated initially with DDS monotherapy followed by MDT, 11 years later during surveillance presented with 3-month-old asymptomatic cystic swelling, arising from the right ulnar nerve without exhibiting any evidence to document relapse of the disease. It responded promptly to corticosteroid therapy. This unusual clinical presentations of ulnar nerve abscess has not been reported elsewhere.

Abscess↗
PubMed1996

Origin of new leprosy cases during general surveys in relation to previous survey findings.

As part of the leprosy control activities in the area of Gudiyatham Thaluk, general surveys are done once every three to five years. The percentage of examination is about 90%. An analysis of all new cases registered for treatment between 1990-94 was done to study whether these cases had been examined in the previous general survey. Of the new cases detected and registered, 566 cases (32.6%) were not examined during the previous survey. The significance of these findings in relationship to cost-effectiveness of general surveys, case-detection methodology and possible continuing of transmission of leprosy are discussed.

Adult↗
PubMed1996

Fixed-duration therapy (FDT) in multibacillary leprosy; efficacy and complications.

The World Health Organization (WHO) recommended a multidrug therapy (MDT) regimen for multibacillary (MB) leprosy patients in 1982 which was to be administered for a minimum period of 2 years or until a skin smear was negative for acid-fast bacilli, whichever was later. This regimen contains rifampin, dapsone and clofazimine. A single dose of rifampin was shown to effect a high degree of bacterial killing (99.9%). The combined therapy administered for 2 years may be adequate to bring about "total" bacterial killing and to prevent the emergence of drug resistance and persisters. In this study, 360 smear-positive and previously untreated MB leprosy patients were treated with WHO/MDT for 2 years; 22.8% of these MB patients developed lepra reaction during therapy and 10.7% during surveillance. The bacterial index continued to decline even after termination of fixed-duration therapy. None of these patients relapsed during 886 person-years of surveillance.

Drug Therapy, Combination↗
PubMed1996

Effectiveness of MDT in multibacillary leprosy.

The study on the use of World Health Organization multidrug therapy (WHO/MDT) under field conditions was initiated in December 1981, and included 1067 multibacillary (MB) patients treated with two MDT regimens. The first was a THELEP-recommended regimen which consisted of 600 mg of rifampin (RFP) and 600 mg of clofazimine (CLO) given under supervision on two consecutive days monthly and 225 mg of diacetyl diaminodiphenylsulfone (DADDS) bimonthly plus dapsone (DDS) 100 mg daily unsupervised. The second regimen was the conventional MDT: patients received RFP 600 mg and CLO 300 mg supervised once a month, daily 100 mg of DDS and 50 mg of CLO unsupervised. A zero relapse rate was obtained after more than 10 years (a total of 8244 person-years) of follow up. Both regimens were well tolerated with few complications and a high acceptability, even among women. The fall in the bacterial index (BI) was 0.5 - 1.0+ in positive patients. CLO discoloration began to decrease after 3 months and disappeared within 1 year after it was discontinued. Seventy-two patients (67%) developed reactions during the treatment period; a further 12 patients developed post-treatment reactions during the surveillance period. This study vindicates MDT treatment for MB patients as recommended by WHO under field conditions.

Drug Therapy, Combination↗
PubMed1996

Absence of relapse within 4 years among 34 multibacillary patients with high BIs treated for 2 years with MDT.

Thirty-four multibacillary patients with a bacterial index (BI) of 3+ or more were treated with 2 years of WHO multidrug therapy (WHO/MDT). Treatment was then stopped and the patients followed for a minimum of 4 years. The rate of fall in the BI in this group without further treatment was similar to the rate of fall in the BI in an earlier group of similar patients treated with MDT until skin-smear negativity. No relapses have been seen.

Drug Therapy, Combination↗
PubMed1995

Incidence of late lepra reaction among multibacillary leprosy patients after MDT.

Multidrug therapy (MDT) recommended by the World Health Organization (WHO) had been administered in 1982 to a cohort of multibacillary (MB) leprosy patients. Treatment was administered for a minimum period of 2 years or until skin-smear negativity for acid-fast bacilli was achieved (whichever was later). Among 980 MB leprosy patients who completed treatment, 11 patients (1.1%) experienced lepra reactions during surveillance. Probable predictive factors are discussed. The incidence of lepra reaction seemed to be three times more common in borderline (BL) leprosy than in lepromatous (LL) leprosy. The majority of these events occurred during the first 3 years of surveillance. All of these episodes were treated with steroids without antileprosy chemotherapy. None of these patients was confirmed as experiencing a relapse during the subsequent period of surveillance.

Colony Count, Microbial↗
PubMedDate not supplied

"Instant" new leprosy case-detection: an experience in Bihar State in India.

The National Leprosy Eradication Programme (NLEP) is based on survey, education and treatment, including coverage of all the registered cases with multi-drug therapy (MDT). The Government of India introduced MDT in all leprosy endemic districts through a vertical set-up, and through mobile leprosy treatment units in low endemic districts. Anti-leprosy work has not been uniform in all the states and needed push-start in some, such as Bihar. There have been spurts of leprosy elimination activities and the entire populations of the regions have not been covered because of various administrative reasons and logistic problems. In Singhbhum district of Bihar, a successful attempt was made to cover the maximum population by campaign approach. The strategy was to involve all the field workers of the leprosy programme in the district, supported by a small group of experienced personnel. The campaign, lasting for 39 working days, resulted in detecting leprosy cases equivalent to 64% of cases detected during the previous one full year. The entire operation helped the local staff to gain experience that would be useful for the future of the NLEP, and also provide an insight into working practices. Similar campaign approach can be used in situations where case-detection activities are feeble and the implementation of MDT is slow. If such campaigns are repeated at appropriate intervals, it will be a great support to achieving the goal of leprosy elimination.

Community Health Workers↗
PubMedDate not supplied

Trends in new case-detection leprosy in Bihar, India.

Multi-drug therapy (MDT) has been successfully implemented in all leprosy endemic countries. Prevalence of leprosy has declined remarkably after the introduction of MDT. Detection of new cases did not show expected decline in many endemic and low endemic situations. Bihar in India started implementing MDT in 1993. The Damien Foundation India Trust (DFIT) supported the leprosy control programme in Bihar by providing a district technical support team (DTST) for each district assigned to DFIT. Effective coverage was achieved in 1996-98. Data for the period 1996-2004 from 10 districts are presented in this paper. The total population in these districts was 29.4 million. Deformity among newly detected leprosy patients declined to 1% indicating effective early case-detection. Intensive new case-detection activities were in vogue contributing to high new case-detection rate (NCDR). The NCDR remained high during the 9-year period reported here and did not show any declining trend.

Drug Therapy, Combination↗
PubMedDate not supplied

Incidence of "chance" smear positivity among MB leprosy patients after MDT.

Multidrug therapy (MDT) was introduced in 1982. Nine hundred eighty multibacillary (MB) leprosy patients had successfully completed the MDT administered for a minimum of two years or till skin smear negativity, whichever was later, as recommended by the World Health Organisation (WHO). During surveillance, 2.24% of them revealed presence of acid-fast bacilli (AFB) in the skin smear. They did not have any clinical evidence suggestive of relapse. Subsequent followup (without antileprosy chemotherapy) for periods ranging from one to eight years was uneventful. We have called this as "chance smear positivity" where a few bacilli, yet to be cleared by the immune system, were picked up by routine skin smear examination.

Cohort Studies↗