Leprosy recurrences in the Astrakhan region (1951–2020): a long-term analysis of incidence, risk factors, and treatment outcomes

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Abstract

Background. Despite significant progress in controlling leprosy incidence, the problem of relapses remains relevant, especially in endemic regions. Analysis of long-term dynamics of relapses and factors influencing their development is necessary to optimize treatment tactics and follow-up observation. Aims — to study the frequency, structure and risk factors for leprosy relapses based on a 70-year retrospective observation, to evaluate the evolution of therapeutic approaches and their impact on disease recurrence. Methods. A retrospective continuous cohort study was conducted. We analyzed 1165 medical records of patients with verified leprosy registered at the Astrakhan Leprosy Dispensary in 1951–2020. A total of 465 relapse cases (1959–2019) were studied. The association of relapses with the clinical form, type of therapy and duration of remission was assessed. Descriptive statistics, χ² test and multivariate logistic regression analysis were used. Results. The dynamics of relapses had three periods: a high frequency period in the era of dapsone monotherapy (1959–1976; 297 cases; 63.9%); a steady decline period with the introduction of combined therapy (1977–1990; 80 cases; 17.2%); a period of sporadic relapses (1991–2019; 88 cases; 18.9%) with near-complete elimination after 2008 (3 cases). It was found that 68.8% of relapses developed in patients with an initial multibacillary (MB) form of leprosy. Multivariate analysis identified independent risk factors: MB form (OR — 4.8; 95% CI: 3.2–7.1; p < 0.001), dapsone monotherapy (OR — 6.2; 95% CI: 4.1–9.3; p < 0.001), irregular/incomplete treatment (OR — 3.9; 95% CI: 2.5–6.1; p < 0.001), and high bacterial index (OR — 5.3; 95% CI: 3.4–8.2; p < 0.001). Conclusions. The problem of leprosy relapses in modern conditions has been solved due to the transition to standardized WHO multidrug therapy. The key risk factor is the MB form. The obtained data substantiate the need for differentiated follow-up observation of patients depending on the initial clinical form and received therapy.

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About the authors

Elena Yu. Yanchevskaya

Astrakhan State Medical University

Author for correspondence.
Email: apteca-111a@mail.ru
ORCID iD: 0000-0002-3741-4528
SPIN-code: 8004-3847

MD, PhD, Assistant Professor

Russian Federation, Astrakhan

Anatoly G. Serdyukov

Astrakhan State Medical University

Email: agma@astranet.ru
ORCID iD: 0000-0001-8304-0048
SPIN-code: 2474-7476

MD, PhD, Professor

Russian Federation, Astrakhan

Lyudmila P. Voronina

Astrakhan State Medical University

Email: voroninaluda74@mail.ru
ORCID iD: 0000-0002-2395-745X
SPIN-code: 4472-1574

MD, PhD, Professor

Russian Federation, Astrakhan

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2. Fig. 1. Flow chart of the research sample formation

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3. Fig. 2. Long-term dynamics of leprosy recurrences in the Astrakhan region, 1960–2020.

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