Infections and reactions in leprosy: a diagnostic dilemma
Keywords:Dapsone syndrome, Dengue, Leprosy, Lepra reaction
Leprosy (Hansen’s disease) is a chronic infectious disease caused by Mycobacterium leprae. It continues to be a public health problem in India, which contributes about 60% to the world leprosy burden. Leprosy patients when on treatment can develop either lepra reactions or reactions due to antileprosy drugs, also they can develop other infections endemic in their areas during the course of their disease. We are presenting such two cases where in one case patient on treatment with multibacillary multidrug therapy (MBMDT) developed fever, lympadenopathy and other systemic features during the course of therapy and was mistakenly diagnosed as type 2 lepra reaction but turned out to be a case of dapsone hypersensitivity. Similarly another case developed fever and other systemic features after 6 weeks of MBMDT, thinking it to dapsone syndrome his MBMDT pack was stopped but later it turned out to be a case of dengue.
Central leprosy division. NLEP-Progress report for the year 2010-2011 ending on 31 March 2011, Directorate general of Health services, Nirman Bhawan, New Delhi. Available at: www.nlep.nic.in. Accessed on 3 October 2017.
Swarnakumari G, Rao TVN, Ngeswaramma S, Vani T, Ch R, Neenavathu RN. A study of clinical profile in leprosy in post leprosy elimination era. . IOSR-JDMS. 2015;14(11):4-12
Leprosy in India. 2017. Available at: https://en.wikipedia.org/wiki/Leprosy_ in_India. Accessed on 19 November 2017.
Leprosy. 2017. Available at: http://www.webmd. com/a-to-z-guides/leprosy-10651. Accessed on 27 October 2017.
Jopling WH, McDougall AC. Handbook of leprosy. 5th ed. New Delhi: Satish Kumar Jain for CBS publishers and distributors; 2004: 1-72.
Dengue: Guidelines for diagnosis, treatment, prevention and control in sub-Saharan Africa and 13 countries in South America. Geneva: WHO, 2009 & 2012.
Dengue and severe dengue Fact sheet N°117. WHO, 2015.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504–7.
Carabali M, Hernandez LM, Arauz MJ, Villar LA, Ridde V. Why are people with dengue dying? A scoping review of determinants for dengue mortality. BMC Infect Dis. 2015;15:301.
Martina BE, Koraka P, Osterhaus AD. Dengue virus pathogenesis: an integrated view. Clin Microbiol. Rev. 2009;22(4):564–81.
Rodenhuis-Zybert IA, Wilschut J, Smit JM. Dengue virus life cycle: viral and host factors modulating infectivity. Cell Mol Life Sci. 2010;67(16):2773–86.
Satio S, Ikezawa Z, Miyamoto H. A case of the 'dapsone syndrome'. Clin Exp Dermatol. 1994;19:152-6.
Grossman SJ, Jollow DJ. Role of dapsone hydroxylamine in dapsone induced hemolytic anaemia. J Phamacol Exp Ther. 1998;224:118-25.
Prussik R, Shear NH. Dapsone hypersensitivity syndrome. J Am Acad Dermatol. 1996;35:346-9.