Tuberculosis and other mycobacterial infections / International Journal of Infectious Diseases 101(S1) (2021) 452–463
1108
Randomized control trial to evaluate the
clinical and cytokine response profile to oral
thalidomide in leprosy patients with erythema
nodosum leprosum
B. Mitra
ACMS, Pediatrics, New Delhi, India
Background: Leprosy is a chronic granulomatous disease
caused by Mycobacterium leprae. Erythema nodosum leprosum
is an acute inflammatory type III hypersentivity response during
the chronic course of the disease process. This immune response
manifests clinically as painful erythematous nodules and systemic
symptoms similar to sepsis with neutrophilic leukocytosis. Capsule
thalidomide is the drug of choice for treating erythema nodosum
leprosum. A randomized control study into the immunological
markers involved in the pathogenesis of erythema nododsum
leprosum and its successful suppression by thalidomide should
provide newer insight into the pathogenesis of this disease pro-
cess, better diagnostic and therapeutic options and better markers
to predict prognosis. Based on the previous studies our aim was
to find a correlation with tumour necrosis factor-␣, Interferon-␥
and CD␥-64 expression on activated circulating neutrophils dur-
ing Type II lepra reaction and the successful response to capsule
thalidomide.
Methods and materials: The two study groups comprised on
patients diagnosed to have leprosy and the other group was healthy
controlled individuals with matched age, sex and area of resi-
dence. A patient was diagnosed to have type II lepra reaction if a
patient of leprosy developed acute onset painful red raised nodules
along with systemic signs of fever and neutrophilic leukocytosis.
Blood samples and skin biopsy was subjected to histopathology,
immunoflourescence assay, immunohistochemical staining, quan-
titative reverse transcriptase-polymerase chain reaction (RT-PCR)
and flow cytometry.
Results: Our study found out that interferon-␥ and tumour
necrosis factor-␣ are sensitive markers in diagnosing erythema
nodosum leprosum and CD-64 expression on activated circulat-
ing neutrophils is both a specific and sensitive marker in type II
lepra reaction. CD-64 expression also had a positive correlation
with thalidomide treatment and clinical response.
Conclusion: Several studies in literature had suggested the role
of interferon-␥, tumour necrosis factor-␣ and CD-64 expression on
activated circulating neutrophils as a highly specific and sensitive
marker for sepsis. Considering the success of thalidomide in sup-
pressing CD-64 expression on circulating neutrophils, which is a
marker or sepsis as well; this study can be extrapolated for the
study of role of thalidomide in treatment of sepsis. Interferon-␥
and tumour necrosis factor-␣ are sensitive markers in diagnosing
erythema nodosum leprosum.
https://doi.org/10.1016/j.ijid.2020.09.1196
457
1110
Tuberculosis: A nightmare story of people who
inject drugs treated on methadone
S. Tun 1,∗ , V. Balasingam 2 , D. Singh 2
1Myanmar Medical Association, Yangon, Myanmar
2Universiti Sains Malaysia, Centre for Drug
Research, Penang, Malaysia
Background: Tuberculosis (TB) is one of the global burdens
of diseases and one-third of the global population is infected. In
Myanmar, there were an estimated 93,000 people who inject drugs
according to 2017 IBBS survey and the HIV prevalence rate was
34.9%. WHO highlights that people with HIV had 16–27 times more
likely to develop TB and this study identifies characteristics associ-
ated with the TB burden among the people who inject drugs (PWID)
treated on methadone.
Methods and materials: This study was conducted in 5 cities
of Myanmar with stratified random sampling among 210 PWID
treated on methadone who fulfilled at least 6-month treatment.
Respondents answered semi-structured questionnaires answering
their TB screening history, TB treated history alongside with other
behavioural characteristics.
Results: Among the respondents, 63% (130/208) answered that
they had been screened for TB infections and one-fourth (27%,
n = 54/201) had a history of TB treatment in their lifetime. Those
who treated for TB had lower (WHO-QOL) quality of life score at
the time of assessment. Results showed associated factors between
tuberculosis treatment history and sexually transmitted infec-
tions (STI) in their lifetime, HIV respondents, respondents taking
anti-retroviral therapy (ART), HIV and HCV coinfection, who need
higher methadone dose and respondents taking longer duration
on methadone. Those who answered the difficult accessibility of
needle and syringes, those who had drug-related charges and
who employed as peer workers had a significant association with
TB treated history. Stepwise binary logistic regression showed
that those who had incarcerated due to drug-related charges
also had a significant association with increased TB treated his-
tory (OR = 2.79, p = 0.016) while STI history increased 2.6 times
(OR = 2.61, p = 0.013). Respondents answered the easy availability
of needle/ syringes had a preventive effect from being treated with
TB (OR = 0.35, p = 0.035).
Conclusion: TB treatment history was associated with those
who had incarcerated due to drug-related charges and history of
STI in their lifetime. Moreover, as the availability of the needle
and syringes is associated with the protective effect for being on
TB infection treatment, it is also beneficial for considering ways
and means of preventive measures of TB infections for people who
inject drugs.
https://doi.org/10.1016/j.ijid.2020.09.1198