Leprosy case pops up in Sydney

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 in the notoriously slow-moving infectious disease.

The man had a 12-month history of asymptomatic “polymorphic eruption consisting of widespread macules, plaques, papules, and nodules” for which he had never before sought medical attention. He also had nasal stuffiness, pedal oedema and malaise, as well as finger numbness and shiny papules on his wrists, feet and ears.

Following multiple biopsies, Wade–Fite staining and polymerase chain reaction testing, the presence of leprosy’s cause – 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 assessed for leprosy,” wrote the authors. “The patient was referred to the infectious diseases department and commenced 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.

“Most locally acquired cases occur in Indigenous Australians who reside in remote communities such as in the Northern Territory and Far North Queensland,” wrote the case study authors.

“However, leprosy may present in people who have lived in or travelled to endemic areas such as the Indian subcontinent, Brazil or Indonesia.”

According to Dr Colin Martin, from 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 a case incubating out there,” said Dr Martin. “It can remain asymptomatic for a decade or more, and because it’s seen so rarely, it’s easily missed by GPs and even dermatologists. It’s difficult to diagnose because it’s 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 stop it being 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.

RSV prevention may be within reach

Immunisations providing protection against respiratory syncytial virus (RSV) could be just months away according to a Review published in The Lancet Infectious Diseases. The Review, including researchers from Telethon Kids Institute, UNSW Sydney and the University of Western Australia, has described how long-lasting monoclonal antibody prevention for babies is likely to be accessible on the market within 12–24 months, followed closely by the approval of a maternal vaccine given in pregnancy to provide newborns with protection against the virus. Professor Peter Richmond, Head of the Vaccine Trials Group at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at the Telethon Kids Institute, Head of Paediatrics at the University of Western Australia and Perth Children’s Hospital Paediatrician, said researchers were now completing the final stages of development for numerous preventive antibody therapies and RSV vaccines. “There are nine potential candidates in phase 3 clinical trials, including two antibody immunisation treatments for prevention in babies and two maternal vaccines designed to be given to pregnant mothers,” said Professor Richmond. “We started our first phase 1 and 2 studies looking at RSV vaccines all the way back in 2000 and it has been a long journey to get to this point. In 2016, we began to see positive results for a phase 2 study looking at a monoclonal antibody treatment called niversimab. We recently completed phase 3 studies on niversimab here in Perth, and there have been positive results reported from the northern hemisphere pre-COVID-19, so it is expected to be licensed for use as the very first RSV prevention treatment in the US/Europe by late 2022 or early 2023. [We have begun] a phase 3 study on the second potential antibody treatment, which hopes to provide long-lasting protection for babies at highest risk of being hospitalised with RSV, including those born prematurely, or those with congenital heart disease or chronic lung disease,” said Professor Richmond.

Step towards local long COVID diagnostics

Researchers from Murdoch University’s Australian National Phenome Centre (APNC) have developed a new diagnostic tool that may aid the diagnosis of debilitating symptoms of long COVID, which can include severe headaches, extreme exhaustion, heart palpitations and brain fog. Eighteen months ago, the researchers used nuclear magnetic resonance (NMR) technology to identify new molecular biomarkers that tell if someone has the disease, without the need to detect the disease itself. They then used this work to develop an inexpensive clinical NMR, which general practitioners may be able to use to detect blood markers to predict the long term effects of the condition. The technology uses a specially designed set of radio pulses to extract signals from highly specific biomarker signals (from inflammatory glycoprotein markers and fats bound to lipoproteins) which gives a rapid diagnosis in approximately a minute. The findings were recently published in The Analyst. “We only discovered these signals about 18 months ago using a more expensive NMR instrument, but with some pulse sequence modifications, we are now able to get identical results on small machines that costs one-tenth of the price,” Professor Jeremy Nicholson, Director of the ANPC said. “We think this technology [low field NMR spectroscopy] will probably have many other clinical applications in the future and may be of particular value in monitoring some of the residual effects of long COVID in individual patients.”

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