{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:55:03Z","timestamp":1782924903715,"version":"3.54.5"},"reference-count":32,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Persistent\/partially regressed, expanding\/spreading, or newly appearing lesions after completion of multidrug therapy remain some of the most challenging gray zones in the clinical management of leprosy. Distinguishing between slowly regressing granulomas, immunologically driven activity, relapse, drug resistance, and reinfection is complex, particularly in settings where advanced diagnostics are limited. This perspective synthesizes current evidence to propose a structured, algorithmic approach integrating slit-skin smears and histopathology along with where available, molecular viability assays. We highlight scenarios of persistent lesions, increased size of pre-existing lesions, appearance of new lesions, and posttreatment nerve function impairment, outlining key differentiators and suggesting practical management pathways. The article underscores the need for individualized approaches for patients with high bacillary loads, broader access to molecular diagnostics, and improved posttreatment surveillance. A unified framework for labeling such cases as \u201crecurrence\u201d should be avoided in field-level reporting as even if it maintains clinical nuance, it does not provide a clear picture of the underlying etiology. These strategies aim to reduce misclassification, improve outcomes, and minimize missed opportunities for early retreatment\/management.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0687","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:24:05Z","timestamp":1778595845000},"page":"13-18","source":"Crossref","is-referenced-by-count":0,"title":["From Conundrums to Consensus: Addressing Gaps in the Management of Leprosy"],"prefix":"10.4269","volume":"115","author":[{"given":"Sunil","family":"Dogra","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitaishi","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debajyoti","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhushan","family":"Kumar","sequence":"additional","affiliation":[{"name":"Shalby Multispeciality Hospital, Mohali, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Global Leprosy (Hansen Disease) Update, 2024: Beyond Zero Cases\u2014What Elimination of Leprosy Really Means.","year":"2025"},{"issue":"6","key":"b2","series-title":"Dermatol Ther","first-page":"e14226","article-title":"Persistent plaques after release from treatment in slit-skin smear-negative leprosy patients: Wait and watch or adopt a proactive approach?","volume":"33","author":"Narang","year":"2020"},{"issue":"6","key":"b3","series-title":"Am J Trop Med Hyg","first-page":"1260","article-title":"Assessment of clinical, histopathological, and bacteriological findings in treated leprosy patients with persistent skin lesions: A retrospective cohort study","volume":"109","author":"Patial","year":"2023"},{"key":"b4","article-title":"Guidelines for the Diagnosis, Treatment and Prevention of Leprosy.","year":"2017"},{"issue":"3","key":"b5","series-title":"Lepr Rev","first-page":"e2025068","article-title":"Relapse\u2014A diagnostic enigma: The role of 16S rRNA PCR in deciding whether or not to restart MDT","volume":"96","author":"Aswini","year":"2025"},{"issue":"3&4","key":"b6","series-title":"Indian J Med Res","first-page":"293","article-title":"Efficacy of leprosy vaccines across the globe: A systematic review and meta-analysis of randomized controlled trials","volume":"160","author":"Dasgupta","year":"2024"},{"issue":"1","key":"b7","series-title":"Indian J Dermatol Venereol Leprol","first-page":"64","article-title":"Fixed-duration multidrug therapy (12 months) in leprosy patients with high bacillary load\u2014Need to look beyond","volume":"90","author":"Narang","year":"2023"},{"issue":"2","key":"b8","series-title":"Curr Protoc","first-page":"e359","article-title":"A sensitive and quantitative assay to enumerate and measure Mycobacterium leprae viability in clinical and experimental specimens","volume":"2","author":"Collins","year":"2022"},{"issue":"1","key":"b9","series-title":"Nat Rev Dis Primers","first-page":"90","article-title":"Leprosy","volume":"10","author":"Grijsen","year":"2024"},{"issue":"2","key":"b10","series-title":"Indian J Dermatol Venereol Leprol","first-page":"126","article-title":"Relapse in leprosy","volume":"75","author":"Kaimal","year":"2009"},{"issue":"6","key":"b11","series-title":"PLoS Negl Trop Dis","first-page":"e0005598","article-title":"Whole-genome sequencing distinguishes between relapse and reinfection in recurrent leprosy cases","volume":"11","author":"Stefani","year":"2017"},{"issue":"1","key":"b12","series-title":"APMIS","first-page":"e13497","article-title":"Impact of histopathological and serological assessments on early diagnosis of leprosy relapse","volume":"133","author":"de Carvalho Dornelas","year":"2025"},{"issue":"2","key":"b13","series-title":"J Ultrasound","first-page":"265","article-title":"Role of shear-wave elastography in treatment follow-up of leprosy neuropathy","volume":"25","author":"Meghashyam","year":"2022"},{"issue":"1","key":"b14","series-title":"Dermatol Ther","first-page":"e12412","article-title":"Minocycline in leprosy patients with recent onset clinical nerve function impairment","volume":"30","author":"Narang","year":"2017"},{"issue":"3","key":"b15","series-title":"Am J Trop Med Hyg","first-page":"547","article-title":"Evidence for Mycobacterium leprae drug resistance in a large cohort of leprous neuropathy patients from India","volume":"102","author":"Mahajan","year":"2020"},{"issue":"1","key":"b16","series-title":"BMC Infect Dis","first-page":"460","article-title":"Underlying mechanisms of leprosy recurrence in the Western Amazon: A retrospective cohort 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