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Is BCG Vaccine Safe To Take For Prevention Of Lepromatous Leprosy?
Question: Hi,
Our live in household helper of 10 years has just been diagnosed with multibacillary (sorry if this is misspelled) lepromatous leprosy that her doctors believe she contracted during one of her annual trips to her home in the Philippines. They have never heard of a case progressing as rapidly as her's has (1 week from first small rash with fever to red thickened skin all over her face, ears, arms, and legs and enlarged lymph nodes) so they thought NTM at first but her skin biopsy confirmed leprosy and she responded to MDT within 24 hours. She had her first dose of MDT 4 days ago and is currently in the hospital in the isolation ward. We live in an area where they haven't seen leprosy before and her doctors are unsure how to go forward with regard to our family. They plan to release our helper tomorrow.
We have four children. Three are away at school and our youngest is 10 and at home, and receives IVIG for an immune disorder. Her last IVIG was three months ago and she is scheduled for her treatment again in 6 weeks. We are also scheduled to go through an IVF FET in 1 month after losing a baby 9 months ago. I have a few questions:
1) Should we ask that our helper remain away from the household for 2 weeks or 4 weeks from/after her initial MDT dosage? Alternatively, is it fine for her to come home now?
2) Should we all take the single dose Rifampicin as a prophylaxis? I've also read that one or two doses of the entire MDT may be more effective but isn't used due to cost. As cost isn't a factor for us should we request the entire two full months of MDT as a prophylaxis?
3) We also understand that the BCG vaccine can have a cumulative preventative effect when used in combination with single dose Rifampicin. Three of our children received the BCG as infants and one did not. My husband received the BCG as a child but I did not. Should our child that didn't receive the BCG (this is not our child that receives IVIG) as a child get it now? Should I also get the BCG now?
4) Should our daughter that receives IVIG postpone her next treatment? I'm worried that the immunosuppression of the IVIG may make it more likely for her to develop leprosy. Her doctors have never seen a case of leprosy and wanted to know what our doctors here think but they are also unsure.
5) Are these drugs okay to take during IVF? I asked about leprosy at my IVF center and they didn't know as they'd never had anyone ask about leprosy. I didn't ask about Rifampicin or the other drugs used for MDT as I didn't know about the prophylaxis when I called. If I take only the Rifampicin will it be out of my system in a month?
6) I understand that the bacteria can mutate and become drug resistant quickly. If we take the single dose prophylaxis and it doesn't work is it likely that the bacteria will then be drug resistant to Rifampicin?
7) Was our helper contagious from the time she contracted the disease until today or only when she showed symptoms?
8) How long can the bacteria live outside the body? Should we have a professional medical disinfection team come in to disinfect our house before our helper comes home?
9) Finally, our helper is scheduled to go on her annual trip to the Philippines in one month. Should we ask her to wait a few months or is it fine for her to go? I don't know why I'm nervous because I know by that point she will not be contagious and while taking the medication she can't get it again. Maybe because I'm worried she will not take her medication?
I apologize for the lengthy and multiple questions and I appreciate any help you may be able to offer. Thank you.
Brief Answer:
Lepromatous leprosy
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have understood it.
Lepromatous leprosy patients have a high bacillary load due to low immunity against the bacillus. The bacillus keeps proliferating and infiltrates the entire skin. The patient may not notice that something is wrong with him/her because it is ever so gradual over the years. Few signs and symptoms may prompt a doctor to think in terms of leprosy like infiltrated Nodules/papules, Hypopigmented macules and glove and stocking anesthesia, hoarseness of voice, bleeding and crusting in the nose, loss of eyebrows(lateral 1/3rd) until the development of a reaction(fever, red, painful nodules throughout the body) when usually the diagnosis is made, most of the time.
Leprosy is not highly infectious and the risk of transmission to contacts is low. Although not highly infectious, it is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. There is a 5% chance that someone in contact with a leprosy patient will contract leprosy. In general, closeness of contact is related to the dose of infection, which in turn is related to the occurrence of disease. The disease is transmitted by contact between infected persons and healthy persons, particularly prolonged close contact.
1) Leprosy loses its infectiousness after treatment with appropriate antibiotics. A single dose of MDT kills 99.9% of bacteria. Sufferers are no longer infectious after about 2 weeks of treatment therefore isolation for 2 weeks is required.
2)Prophylaxis is not recommended.
3)BCG vaccination is only recommended for neonates born to cases.
4)Your daughter can take treatment as scheduled, provided your maid is isolated for 2 weeks for her to become non-infectious.
5)No need for prophylaxis though rifampicin is safe during pregnancy.
6)self-explanatory
7)Yes, she was contagious
8)Leprosy bacteria can survive for extended periods outside the body but this in insignificant since the most common route of transmission is through the respiratory route, droplet infection
9)Make sure that she takes her treatment and completes it (1 year) whether she travels to philippines or not.
regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. She did not have any of the symptoms you describe prior to last week so the team considers the progress highly atypical. I do have a question with regard to my question #6 where you have replied that it is self-explanatory. In what regard is it self-explanatory? Does the bacteria become drug resistant after the single dose prophylaxis or not? And, if so, then why would it be recommended and how is it treated? Could you please elaborate? Thank you.
Brief Answer:
Leprosy treatment
Detailed Answer:
Hi.
Lepromatous leprosy is so insidious and often comes to light only when the patient develops a reaction(type II, ENL reaction). I don't think it is atypical but rather no one would have suspected it earlier until now when she develops fever and rash, because the signs and symptoms are ever so subtle and also since it is rare in singapore therefore the doctors must have not seen many cases, therefore they label it as atypical. Nevertheless, the treatment remains the same (MDT)
Answer to question #6: You dont' need to take rifampicin as i mentioned in answer to question #2 and #5, therefore the question of resistance to rifampicin does'nt arise. Anyways, your question #6 was thoughtful. The answer is that single drug is never given for leprosy because the chances of resistance to a single drug are high rather than to a triple drug combination. MDT is a triple drug combination of rifampicin+dapsone+clofazimine, for exactly the same reason.
regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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