Efficacy of BCG as Immunomodulator in Multibacillary Leprosy

Yazhini, R (2020) Efficacy of BCG as Immunomodulator in Multibacillary Leprosy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae. It principally affects skin and peripheral nerves. Multidrug therapy (MDT) has been very successful in the management of leprosy. However, even after 12 months of MDT, patients in lepromatous spectrum continue to harbour both dead bacilli and viable persisters leading to complications like recurrent reactions and late relapses. This is due to partial or complete lack of cell-mediated immunity in these patients. To alter this anergy, immunotherapeutic agents (vaccines) are being evaluated as an adjunct to MDT. AIM OF THE STUDY: To study the immunomodulatory efficacy of BCG administered along with MB-MDT in multibacillary (BB, BL, LL) leprosy patients. METHODOLOGY: A sample size of 30 between the age group 15-70 years were recruited for this study. Detailed case history, thorough clinical examination and slit skin smear were done. Blood investigations like Complete blood count, Renal function test, Liver function test, VCTC, VDRL and skin biopsy were taken. The patients were randomly allocated into two groups. One group received MB-MDT WITH BCG vaccine at 3 months interval ( 4 doses ) – 0.1mg in 0.1ml injected intradermally and the other group received MB-MDT alone (without BCG) - which served as control. The following parameters were assessed periodically. ◈ Clinical assessment was done every 3 months and measured using Ramu’s clinical scoring system. ◈ Slit skin smear examination (SSS) was done initially, then at 6 months and 12 months of staring treatment from the same site. Bacteriological Index was calculated (BI). ◈ Histopathological examination was done initially. ◈ Reaction pattern was observed. RESULTS: The mean age of the sample was 42.2 years. Males outnumbered females with the ratio of 2.3:1 in the study. The clinical scores, BI, histological and reaction pattern in both the groups were compared. Reduction in the clinical score was more marked in the Study group than in the Control group both at 6 and 12 months (P value < 0.05). The mean reduction of BI in the study group at 12 months was 2.60, whereas in control group it was 1.93 which was statistically significant (P value=0.01). The reduction of granuloma fraction in the study group was 35.09μm and in the control group, it was 29.20μm, which is again statistically significant. Type 1 reactions were seen more frequently in the Study group than the control group (33% in the study group vs 20% in the control group). Type 2 reactions occurred more frequently in the Control group than the study group patients (33% in the control group vs 13% in the study group). Neuritis was observed in 28% of patients in the study group and 50% of patients in the control group. No patients in the vaccine treated group developed any new deformity or deterioration of the pre-existing deformity, but 13% of patients in the control group developed grade 2 deformities during treatment. CONCLUSION: In our study, it is observed that addition of BCG with MDT resulted in faster clinical improvement, better bacteriological clearance and histopathological upgrading. Incidence of type 2 reaction and the incidence of new deformities were found to be decreased in the study group. Thus BCG can be considered an effective immuno-therapeutic tool in the management of multibacillary leprosy patients.

Item Type: Thesis (Masters)
Additional Information: 201730010
Uncontrolled Keywords: BCG, Multibacillary, bacteriological index, granuloma fraction, immunomodulatory.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 01:35
Last Modified: 05 Feb 2021 01:35
URI: http://repository-tnmgrmu.ac.in/id/eprint/13861

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