Leprosy-tuberculosis co-infection: A case series

Background Leprosy and tuberculosis (TB) share common characteristics, such as acid-fastness of causative bacteria, geographic endemicity, route of spread, large number of asymptomatic infections, and requirement of multiple drugs for long periods of time to prevent resistance and provide treatment. Being relatively common, co-infection with the two diseases should occur based on chance alone. However, coinfection is surprisingly rare, with less than 20 cases being reported in the last decade. Aim The purpose of this case series was to study the clinico-epidemiological profile of patients with leprosy and TB co-infection. Methods This prospective, descriptive, case series describes leprosy patients with a past or current diagnosis of TB who visited the leprosy clinic of a tertiary care hospital over 3 years. The demographic details of the patients, details about the type of leprosy, slit skin smear, lepra reaction, and use of corticosteroids were noted for all patients. The type of TB, chest X-ray findings, sputum positivity, Interferon gamma release assay (IGRA) test, and Mantoux test results were recorded. The gap between the two diagnoses, the first disease to be diagnosed, family history of either disease, and the presence of predisposing factors were noted. Results This case series describes a total of 20 patients with leprosy co-infected with TB. There were 11 (55%) males, and the mean age of patients was 32.7 years. Half of these patients had lepromatous leprosy, and a similar number had type 2 lepra reaction. Pulmonary TB was seen in 12 (60%) patients, and tubercular pleural effusion in two (10%) patients. Multidrug-resistant TB was seen in two patients, and only one patient had received the bacilli of Calmette-Guerin (BCG) vaccination. Of the two diseases, leprosy was diagnosed first in six (30%) patients, while it was TB in 12 (60%) patients, and two (10%) patients had a concomitant diagnosis. Limitations The small number of patients in this single-centre study from a tertiary care hospital may not be reflective of the general population. Conclusion Leprosy and TB co-infection may present several management issues involving diagnosis and treatment, including drug resistance to tubercular bacilli. Management guidelines for such coinfections are needed to facilitate treatment of such patients and prevent high mortality and morbidity associated with such coinfections. More studies are needed to correctly define the clinico-epidemiological parameters of patients with co-infection.