A CASE of leprosy in a 21-year-old migrant from Nepal presenting to a Sydney hospital has highlighted the importance of early diagnosis and treatment of the notoriously slow-moving infectious disease.
The man had a 12-month history of an “asymptomatic polymorphic rash consisting of generalized macules, plaques, papules, and nodules” for which he had never previously sought medical attention. She also had nasal congestion, pedal edema and discomfort, as well as numbness in the fingers and shiny papules on her wrists, feet and ears.
After multiple biopsies, Wade-Fite staining, and polymerase chain reaction testing, the presence of the cause of leprosy, Mycobacterium leprae, was confirmed. Syphilis, human immunodeficiency virus, strongyloidiasis, tuberculosis, and sarcoidosis were excluded.
“The local public health unit was notified, with close contacts identified and evaluated for leprosy,” the authors wrote. “The patient was referred to the infectious disease department and started on a multibacillary leprosy regimen consisting of rifampicin 600 mg monthly, clofazimine 300 mg monthly and 50 mg daily, and dapsone 100 mg daily, for at least 12 months”.
Leprosy is a notifiable disease in Australia, with an average of 9.6 notifications per year over the past 5 years.
“The majority of locally acquired cases occur in Indigenous Australians residing in remote communities such as the Northern Territory and far north Queensland,” the case study authors wrote.
“However, leprosy can occur in people who have lived in or traveled to endemic areas such as the Indian subcontinent, Brazil or Indonesia.”
According to Dr Colin Martin of The Leprosy Mission Australia, part of the challenge of trying to eliminate leprosy is its long incubation period – an average of 5 years, but can vary between 2 and 20 years.
“There’s always an incubating case,” Dr. Martin said. “It can remain asymptomatic for a decade or more, and because it is so rarely seen, it is missed by GPs and even dermatologists. It is difficult to diagnose because it is indolent.
“Early treatment is vital,” he said. “If you can get in early enough with the triple therapy described in the case study, you can make it infectious within 48 hours.”
The case report was published on the MJA’s Wiley Online page and will be published on mja.com.au on 19 September 2022.
Prevention of RSV may be within reach
Immunizations that provide protection against respiratory syncytial virus (RSV) could be months away, according to a review published in The Lancet Infectious Diseases. The review, which includes researchers from the Telethon Kids Institute, UNSW Sydney and the University of Western Australia, has outlined how long-acting monoclonal antibody prophylaxis for babies is likely to be on the market within 12 to 24 months, closely followed by the approval of a maternal vaccine given during pregnancy to provide protection to newborns against the virus. Professor Peter Richmond, Head of the Vaccine Trials Group at the Wesfarmers Center for Vaccines and Infectious Diseases, based at the Telethon Kids Institute, Head of Paediatrics at the University of Western Australia and Paediatrician, Perth Children’s Hospital, say researchers were now completing the final stages. of development of numerous preventive antibody therapies and vaccines against RSV. “There are nine potential candidates in phase 3 clinical trials, including two antibody immunization treatments for prevention in infants and two maternal vaccines designed to be given to pregnant mothers,” Professor Richmond said. “We started our first phase 1 and 2 studies looking at RSV vaccines since 2000 and it’s been a long journey to get to this point. In 2016, we started seeing positive results for a phase 1 study 2 which looked at a monoclonal antibody treatment called niversimab. We have recently completed phase 3 studies of niversimab here in Perth, and positive results have been reported from the northern hemisphere before COVID-19, so it is expected to be licensed for use as the first RSV prevention treatment in the US/Europe in late 2022 or early 2023. [We have begun] a phase 3 study of the second potential antibody treatment, which is expected to provide long-lasting protection to infants at increased risk of hospitalization with RSV, including those born prematurely or those with congenital heart disease or chronic lung disease,” said the Professor Richmond.
Step towards long local diagnosis of COVID
Researchers at Murdoch University’s Australian National Phenomena Center (APNC) have developed a new diagnostic tool that can help diagnose debilitating long-term COVID symptoms, which can include severe headaches, extreme exhaustion, heart palpitations and brain fog. Eighteen months ago, researchers used nuclear magnetic resonance (NMR) technology to identify new molecular biomarkers that indicate whether someone has the disease, without the need to detect the disease itself. They then used this work to develop a low-cost clinical MRI, which general practitioners can use to detect blood markers to predict the long-term effects of the disease. The technology uses a specially designed set of radio pulses to extract signals from highly specific biomarker signals (of inflammatory glycoprotein markers and lipoprotein-bound fats) that provides a rapid diagnosis in about a minute. The findings were recently published in The Analyst. “We only discovered these signals about 18 months ago with a more expensive NMR instrument, but with some modifications to the pulse sequence, we can now get identical results on small machines that cost a tenth of the price,” said Professor Jeremy Nicholson, director. of the ANPC. “We think about this technology [low field NMR spectroscopy] It will likely have many other clinical applications in the future and may be of particular value in controlling some of the residual effects of long-term COVID in individual patients.”
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