Publication:

Addition of immunotherapy to chemotherapy in pediatric borderline leprosy: a clinical evaluation

Background Immunotherapy with BCG, BCG + M. leprae, ICRC, MIP has been observed to be effective in improving the treatment in adulthood leprosy. Clinical improvement with accelerated bacterial clearance and histological up grading using MIP vaccine as an immunotherapeutic with standard WHO-MDT has been reported in adult cases with high bacillary load. However, there is lack of information in borderline pediatric leprosy which is characterized by a state of shifting immunity and would therefore be ideally suited to such observations. This pilot study is originated from involvement of our Institute in a trial aimed for improving the therapy of pediatric borderline leprosy by using combined immunotherapy and chemotherapy. The study was aimed to assess the clinical improvement by adding immunotherapy (MIP vaccine) with chemotherapy (WHO -MDT) in pediatric borderline leprosy.

Methods A total of 98 new pediatric borderline leprosy cases were included, after formal written consent, detailed clinical examination. A non-randomized trial was conducted. In this study, patients attending the OPD were serially recruited in two treatment groups. In group-1 (Mw vaccine plus WHO- MDT) 50 pediatric cases and in Group-2 (MDT only), 48 pediatric borderline cases were recruited. The therapeutic regimens containing MIP vaccine was injected intra-dermally at the start of therapy and every six months in addition to chemotherapy (WHO- MDT) in group 1 pediatric patient and chemotherapy only (WHO- MDT) were given in group-2 pediatric cases and effect was observed on clinical parameters (size of lesions, erythema, infiltration, sensory improvement) and bacillary clearance.

Results Addition of immunotherapy resulted in faster clinical recovery from disease, faster bacillary clearance in pediatric borderline leprosy cases.

Conclusions This study shows the usefulness of adding immunotherapy (MIP vaccine) to chemotherapy (WHO- MDT) in pediatric borderline leprosy for faster clinical improvement.