Leprosy Mailing List, January 11th, 2009
Ref.: New mycobacterium species? (see attachment)
From: de Koning P., Würzburg, Germany
Dear colleagues,
Recently there has been a press release in the German media describing “a new mycobacterium species causing diffuse lepromatous leprosy”. I refer to a link describing the findings recently published in the Am J Clin Pathol. 2008 Dec;130(6):856-64:
http://www.mdanderson.org/departments/newsroom/display.cfm?id=CF698F6E-FDCC-4589-84F2FAE5EE4278F8&method=displayFull&pn=00c8a30f-c468-11d4-80fb00508b603a14
The scientist claims finding a new species which may account for some of the clinical and geographic variability of leprosy and which may have implications for the research and diagnosis of leprosy. Is this really a new species, or simply one that has existed all along but can only now be found due to more sophisticated DNA and bio-molecular techniques? Although I am not familiar with the details, to me it appears that the patient who died was not diagnosed in time and therefore not given anti-leprosy drugs on time and may have died due to septicaemia secondary to extensive ulceration whilst undergoing Lucio’s phenomenon, which is indeed geographically limited to South America. (attached word document)
Dr. Pieter de Koning, MD, MPH
Medical Advisor
Deutsche Lepra- und Tuberkulosehilfe e.V (DAHW)
Mariannhillstraße 1c, 97074 Würzburg
Telefon: ++49 (0)931 7948-113, Fax: -160
E-mail: pieter.de-koning at dahw.de
Pages
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Wednesday, January 14, 2009
Orfloxacin as alternative drug in dapsone hypersensitive paucibacillary (PB) leprosy patients?
Leprosy Mailing List, January 11th, 2009
Ref.: Orfloxacin as alternative drug in dapsone hypersensitive paucibacillary (PB) leprosy patients?
From: Kamaladasa S. D., Nugegoda, Sri Lanka
Dear Dr Noto,
I would like to know the dosage and the duration of treatment with Orfloxacin for leprosy patients who are having sensitivity reaction to Dapsone?
If we start them on Orfloxacin 400 mg bd for 6 months plus monthly Rifampicin 600 mg would that be enough for PB therapy?
The drug literature form in the pack of course does not mention about Mycobacterium leprae as one of the sensitive organisms and also it says it should be taken 400 mg daily not exceeding 2 months duration.
Could you please let me know about the efficacy of this drug in treating leprosy, the dosage, the duration of the treatment and also reported complications of long term therapy?
I would greatly value your opinion.
Thanks
Dr S. D. Kamaladasa
Consultant Dermatologist
University of Sri Jayawardenapura
Nugegoda, Sri Lanka.
Ref.: Orfloxacin as alternative drug in dapsone hypersensitive paucibacillary (PB) leprosy patients?
From: Kamaladasa S. D., Nugegoda, Sri Lanka
Dear Dr Noto,
I would like to know the dosage and the duration of treatment with Orfloxacin for leprosy patients who are having sensitivity reaction to Dapsone?
If we start them on Orfloxacin 400 mg bd for 6 months plus monthly Rifampicin 600 mg would that be enough for PB therapy?
The drug literature form in the pack of course does not mention about Mycobacterium leprae as one of the sensitive organisms and also it says it should be taken 400 mg daily not exceeding 2 months duration.
Could you please let me know about the efficacy of this drug in treating leprosy, the dosage, the duration of the treatment and also reported complications of long term therapy?
I would greatly value your opinion.
Thanks
Dr S. D. Kamaladasa
Consultant Dermatologist
University of Sri Jayawardenapura
Nugegoda, Sri Lanka.
WER No.50, 83, 449-460; 12 December 2008
Leprosy Mailing List, January 10th, 2009
Ref.: WER No.50, 83, 449-460; 12 December 2008 (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached the WER No.50, 83, 449-460; 12 December 2008
With best wishes for the New Year,
V. Pannikar
Ref.: WER No.50, 83, 449-460; 12 December 2008 (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached the WER No.50, 83, 449-460; 12 December 2008
With best wishes for the New Year,
V. Pannikar
A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and 2 leprosy reactions
Leprosy Mailing List, January 10th, 2009
Ref.: A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and 2 leprosy reactions (see attachment)
From: Garbino J. A., Bauru, SP, Brazil
Dear Salvatore,
I am sending annexed one recent study about steroids regimens that can help our thinking about the trials on reactions.
Best regards,
José Garbino
Enclosed:
José Antonio Garbino, Marcos da Cunha Lopes Virmond, Somei Ura, Manoel Henrique Salgado, Bernard Naafs
A RANDOMIZED CLINICAL TRIAL OF ORAL STEROIDS FOR ULNAR NEUROPATHY IN TYPE 1 AND TYPE 2 LEPROSY REACTIONS
Arq Neuropsiquiatr 2008;66(4):861-867
Ref.: A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and 2 leprosy reactions (see attachment)
From: Garbino J. A., Bauru, SP, Brazil
Dear Salvatore,
I am sending annexed one recent study about steroids regimens that can help our thinking about the trials on reactions.
Best regards,
José Garbino
Enclosed:
José Antonio Garbino, Marcos da Cunha Lopes Virmond, Somei Ura, Manoel Henrique Salgado, Bernard Naafs
A RANDOMIZED CLINICAL TRIAL OF ORAL STEROIDS FOR ULNAR NEUROPATHY IN TYPE 1 AND TYPE 2 LEPROSY REACTIONS
Arq Neuropsiquiatr 2008;66(4):861-867
Are there clinical trials experimenting the efficacy of new anti-reactions drugs?
Leprosy Mailing List, January 10th, 2009
Ref.: Are there clinical trials experimenting the efficacy of new anti-reactions drugs?
From: Ogbeiwi O. J. I., Wakefield, United Kingdom
Dear Dr. Noto,
I wish to agree with Dr. Wim Theuvenet (LML Dec. 30th, 2008) about the need for new effective drugs for treatment of reactions in leprosy, judging from the frustrations and complications experienced from steroid therapy in leprosy hospitals around the world, particularly in Africa where I am more knowledgeable. I think we need a proper study and documentation of the magnitude of the post-steroid therapeutic failures and complications in a more evidenced based manner though.
I am aware of some leprosy reaction related studies going on in some locations. I lack the details of these studies however. But are there clinical trials experimenting the efficacy of new anti-reactions drugs and tools? If yes, can we be privileged to know what progress is being made in this very important area of leprosy management?
I wish all LML subscribers a very happy new year in 2009.
Dr. Osahon Jeremie I. Ogbeiwi,
Programme Management Consultant
Jeremie Programme Management Services (UK)
Ref.: Are there clinical trials experimenting the efficacy of new anti-reactions drugs?
From: Ogbeiwi O. J. I., Wakefield, United Kingdom
Dear Dr. Noto,
I wish to agree with Dr. Wim Theuvenet (LML Dec. 30th, 2008) about the need for new effective drugs for treatment of reactions in leprosy, judging from the frustrations and complications experienced from steroid therapy in leprosy hospitals around the world, particularly in Africa where I am more knowledgeable. I think we need a proper study and documentation of the magnitude of the post-steroid therapeutic failures and complications in a more evidenced based manner though.
I am aware of some leprosy reaction related studies going on in some locations. I lack the details of these studies however. But are there clinical trials experimenting the efficacy of new anti-reactions drugs and tools? If yes, can we be privileged to know what progress is being made in this very important area of leprosy management?
I wish all LML subscribers a very happy new year in 2009.
Dr. Osahon Jeremie I. Ogbeiwi,
Programme Management Consultant
Jeremie Programme Management Services (UK)
Management of reactions and nerve damage in leprosy
Leprosy Mailing List, January 8th, 2009
Ref.: Management of reactions and nerve damage in leprosy
From: Srinivasan H., Chennai, India
Dear Dr Noto,
I do not agree with Dr Theuvenet (LML Dec. 30th 2009) that "no one has ever found a regimen that is really effective in restoring nerve function up to a functional level."
In my experience innumerable patients have had their nerve function restored to a 'functional level', although not all had been restored to absolute normalcy. The problem is two fold: 1) many patients are under-treated, with too small a dose, for too short a period and without the benefit of surgical nerve decompression at the optimal time even when it is attempted; 2) many times the nerve status is not assessed carefully until it is too late, by which time the nerve has been destroyed (irrecoverably damaged). A reason for this state of affairs is the “tyranny” of the necessity of "field management” which heavily dilutes the quality of management of this potentially difficult clinical condition.
The above statement does not mean that we do not need alternative and more effective treatments, drugs and programmes, of course we do. By all means, let us be on the look out for them. But we should also at the same time try much harder to find out ways of improving the efficiency of our existing treatment programmes so that they become more effective.
My New Year Greetings to all in the LML group.
H. SrinivasanReconstructive Surgeon (Retired)25 first Seaward RoadValmiki NagarChennai 600 041India
Ref.: Management of reactions and nerve damage in leprosy
From: Srinivasan H., Chennai, India
Dear Dr Noto,
I do not agree with Dr Theuvenet (LML Dec. 30th 2009) that "no one has ever found a regimen that is really effective in restoring nerve function up to a functional level."
In my experience innumerable patients have had their nerve function restored to a 'functional level', although not all had been restored to absolute normalcy. The problem is two fold: 1) many patients are under-treated, with too small a dose, for too short a period and without the benefit of surgical nerve decompression at the optimal time even when it is attempted; 2) many times the nerve status is not assessed carefully until it is too late, by which time the nerve has been destroyed (irrecoverably damaged). A reason for this state of affairs is the “tyranny” of the necessity of "field management” which heavily dilutes the quality of management of this potentially difficult clinical condition.
The above statement does not mean that we do not need alternative and more effective treatments, drugs and programmes, of course we do. By all means, let us be on the look out for them. But we should also at the same time try much harder to find out ways of improving the efficiency of our existing treatment programmes so that they become more effective.
My New Year Greetings to all in the LML group.
H. SrinivasanReconstructive Surgeon (Retired)25 first Seaward RoadValmiki NagarChennai 600 041India
We need new treatment for reactions and neuritis in leprosy
Leprosy Mailing List, December 30th, 2008
Ref.: We need new treatment for reactions and neuritis in leprosy
From: Theuvenet W., Apeldoorn, The Netherlands
Dear Salvatore,
In the past 30 years corticosteroids have been the first drug of choice for treating neuritis in leprosy. In spite of this and with a wide variety of regimens that were used, no one has ever found a regimen that is really effective in restoring nerve function up to a functional level. Should we therefore not simply conclude that we urgently need other tools!
Warm regards,
Wim Theuvenet
Ref.: We need new treatment for reactions and neuritis in leprosy
From: Theuvenet W., Apeldoorn, The Netherlands
Dear Salvatore,
In the past 30 years corticosteroids have been the first drug of choice for treating neuritis in leprosy. In spite of this and with a wide variety of regimens that were used, no one has ever found a regimen that is really effective in restoring nerve function up to a functional level. Should we therefore not simply conclude that we urgently need other tools!
Warm regards,
Wim Theuvenet
Steroid therapy in leprosy should be individualised
Leprosy Mailing List, December 30th, 2008
Ref.: Steroid therapy in leprosy should be individualised.
From: Kar H. K., New Delhi, India
Dear Dr Joseph,
I completely agree with you (Chukwu J. LML Dec 24th, 2008).
Yours sincerely,Dr (Prof.) H K KarMD, MNAMSConsultant & HODDepartment of Dermatology, STD & LeprosyPGIMER, Dr Ram Manohar Lohia HospitalBaba Kharag Singh MargNew Delhi-110001
India
Ref.: Steroid therapy in leprosy should be individualised.
From: Kar H. K., New Delhi, India
Dear Dr Joseph,
I completely agree with you (Chukwu J. LML Dec 24th, 2008).
Yours sincerely,Dr (Prof.) H K KarMD, MNAMSConsultant & HODDepartment of Dermatology, STD & LeprosyPGIMER, Dr Ram Manohar Lohia HospitalBaba Kharag Singh MargNew Delhi-110001
India
Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
Leprosy Mailing List, December 30th, 2008
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Ganapati R., Mumbay, India
Dear Dr Noto
We are indebted to Dr V Pannikar for bringing to light the dangers of propagating wrong concepts about leprosy to the medical students. It is not the first time that this particular textbook has published such unscientific statements. When MDT was introduced by WHO and practiced effectively as a mass strategy for eliminating leprosy, Park was preaching archaic concepts of treatment and control. I pointed this out to the author with no response till the later editions came out incorporating the correct facts. By that time several batches of students had read the book and appeared for the examinations Even examiners are not updated on recent developments in leprosy!
The difficulty with textbooks is that such wrong messages reach a wide range of students and teachers and it is not easy to revert the damage quickly even if the author wants to do so. Probably an effective method is to issue a strong statement directly to the teaching faculty of all medical colleges throughout the regions where the text books are read. Perhaps an authentic body like WHO can do this.
I propose to circulate a note with Dr Pannikar’s letter among the faculties of dermatology and community medicine of the colleges situated in and around Bombay where we have some contact.
Dr R Ganapati
Director Emeritus
Bombay Leprosy Project
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Ganapati R., Mumbay, India
Dear Dr Noto
We are indebted to Dr V Pannikar for bringing to light the dangers of propagating wrong concepts about leprosy to the medical students. It is not the first time that this particular textbook has published such unscientific statements. When MDT was introduced by WHO and practiced effectively as a mass strategy for eliminating leprosy, Park was preaching archaic concepts of treatment and control. I pointed this out to the author with no response till the later editions came out incorporating the correct facts. By that time several batches of students had read the book and appeared for the examinations Even examiners are not updated on recent developments in leprosy!
The difficulty with textbooks is that such wrong messages reach a wide range of students and teachers and it is not easy to revert the damage quickly even if the author wants to do so. Probably an effective method is to issue a strong statement directly to the teaching faculty of all medical colleges throughout the regions where the text books are read. Perhaps an authentic body like WHO can do this.
I propose to circulate a note with Dr Pannikar’s letter among the faculties of dermatology and community medicine of the colleges situated in and around Bombay where we have some contact.
Dr R Ganapati
Director Emeritus
Bombay Leprosy Project
Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
Leprosy Mailing List, December 29th, 2008
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Vijayakumaran P, Chennai, India
Dear Mr Bhanot,
Leprosy is the only disease where large scale disease control measures have been very successful in reducing the burden though many aspects regarding the disease and M leprae are still remaining unclear. Expertise in leprosy (Medical and para-medical professionals) is becoming less as a result. Governments are relying on general health care system and Private Medical Practitioners for extending quality care to leprosy affected persons.
National disease control programmes have put in lots of effort to demystify fears and instil confidence not only among the public but also among the medical professionals. Many laws related to leprosy affected persons framed during pre-dapsone era are being repealed.
Professionals working in the field of leprosy in many parts of the world are still struggling to offer good quality services to leprosy affected persons. One would expect that a reputed medical text book as yours must aim at improving knowledge about the disease with right facts and help eliminate a problem. The amazing references in your text book are totally baseless. Hence this is disturbing and may even discourage medical professionals to join the task of eliminating the leprosy problem.
I strongly suggest that relevant (or rather irrelevant) parts of the text may be removed or modified.
Dr. P. Vijayakumaran,
Director (Prog), DFIT
Damien Foundation India Trust,
14, Venugopal Avenue, Spurtank Road, Chetpet,
Chennai 600 03, India
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Vijayakumaran P, Chennai, India
Dear Mr Bhanot,
Leprosy is the only disease where large scale disease control measures have been very successful in reducing the burden though many aspects regarding the disease and M leprae are still remaining unclear. Expertise in leprosy (Medical and para-medical professionals) is becoming less as a result. Governments are relying on general health care system and Private Medical Practitioners for extending quality care to leprosy affected persons.
National disease control programmes have put in lots of effort to demystify fears and instil confidence not only among the public but also among the medical professionals. Many laws related to leprosy affected persons framed during pre-dapsone era are being repealed.
Professionals working in the field of leprosy in many parts of the world are still struggling to offer good quality services to leprosy affected persons. One would expect that a reputed medical text book as yours must aim at improving knowledge about the disease with right facts and help eliminate a problem. The amazing references in your text book are totally baseless. Hence this is disturbing and may even discourage medical professionals to join the task of eliminating the leprosy problem.
I strongly suggest that relevant (or rather irrelevant) parts of the text may be removed or modified.
Dr. P. Vijayakumaran,
Director (Prog), DFIT
Damien Foundation India Trust,
14, Venugopal Avenue, Spurtank Road, Chetpet,
Chennai 600 03, India
Steroid therapy in leprosy should be individualised
Leprosy Mailing List, December 24th, 2008
Ref.: Steroid therapy in leprosy should be individualised.
From: Chukwu J., Enugu, Nigeria
Dear Noto,
I would like to congratulate you and all LML readers/contributors on the current vigorous debate on duration of steroid regimens for leprosy reactions. Our hope and indeed expectation is that this healthy exchange should not end in winners and losers but rather in a broad consensus and joint action to establish an evidence-based regimen.
It is reassuring to learn that a protocol is already in place for a multi-centre trial (Wim van Brakel LML Dec. 2, 2008). In view of the great diversity in relation to man and microbe as acknowledged by Dr. Ben Naafs (….’leprosy in one geographical area is not that in another’) as well as the need to complete enrolment quickly, I suggest that the trial co-ordinators consider including more countries.
As we embark on the study, it is important that some consensus is achieved on what to do with the current guidelines: should we recommend that cases of severe reaction be managed with individually-tailored steroid regimens in referral centres until study results are available?
Best wishes from Nigeria,
Joseph Chukwu
GLRA Nigeria
Ref.: Steroid therapy in leprosy should be individualised.
From: Chukwu J., Enugu, Nigeria
Dear Noto,
I would like to congratulate you and all LML readers/contributors on the current vigorous debate on duration of steroid regimens for leprosy reactions. Our hope and indeed expectation is that this healthy exchange should not end in winners and losers but rather in a broad consensus and joint action to establish an evidence-based regimen.
It is reassuring to learn that a protocol is already in place for a multi-centre trial (Wim van Brakel LML Dec. 2, 2008). In view of the great diversity in relation to man and microbe as acknowledged by Dr. Ben Naafs (….’leprosy in one geographical area is not that in another’) as well as the need to complete enrolment quickly, I suggest that the trial co-ordinators consider including more countries.
As we embark on the study, it is important that some consensus is achieved on what to do with the current guidelines: should we recommend that cases of severe reaction be managed with individually-tailored steroid regimens in referral centres until study results are available?
Best wishes from Nigeria,
Joseph Chukwu
GLRA Nigeria
Thursday, January 1, 2009
The current leprosy situation in Brazil
Leprosy Mailing List, December 20th, 2008
Ref.: The current leprosy situation in
From: de Pinho Andrade J. E., Rio de Janeiro, RJ, Brazil
Dear Salvatore,
Thanks for publishing our bulletin. Please find the latest publication of Brazilian Ministry of Health on the current Hansen’s disease situation in the country (both Portuguese andEnglish versions).
The 10 major leprosy clusters comprise more than 1,100 municipalities. It would be difficult to enlist the relevant towns, districts and states involved. I’m attaching a map of
I take this occasion to wish Season’s greetings to all LML readers.
José Eduardo de Pinho Andrade, MD, MPH
Associação NLR Brasil
Avenida Marechal Câmara, 350 Sala 1002 – Centro
CEP 20.020-080 –
Telefones celulares: (21) 8166-8419 e (73) 8807-2122
Telefone comercial: (21) 2544-8383
Fax comercial: (21) 2532-7989
E-mail: eduardo at hansen.org.br
Web: www.hansen.org.br
Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
Leprosy Mailing List, December 20th, 2008
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Verma S. B., Vadodara, Gujarat, India
Dear Salvatore,
I refer to Dr Pannikar’s message (LML Dec. 19th, 2008). I am bringing this issue up in our (International Society of Dermatology) Academic discussion group too as leprology comes under our jurisdiction. This is ridiculous and the Editors' attention should be drawn to this nonsensical writing. Unfortunately much of this kind of writing is done by non leprologists who have no idea of current concepts or priorities.
Best regards,
Shyam Verma
Revue de press. News Letter NLR Brazil. Clusters of new case detection of leprosy in Brazil
Leprosy Mailing List, December 19th, 2008
Ref.: Revue de press. News Letter NLR Brazil. Clusters of new case detection of leprosy in
From: de Pinho Andrade J. E., Rio de Janeiro, Brazil
Dear All,
Please find in attachment our news letter (in Portuguese).
Season’s greetings to all of you.
José Eduardo de Pinho Andrade, MD, MPH
Consultor técnico - Associação NLR Brasil (www.hansen.org.br)
Avenida Marechal Câmara, 350 sala 1002 – Centro
Rio de Janeiro - RJ - C.E.P. 20.020-080
Brazil
E-mail:
Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
Leprosy Mailing List, December 19th, 2008
Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Pannikar V.,
Dear Mr Bhanot,
I wish to bring to you’re an extremely disturbing reference made in this textbook which is widely respected and used by all young medical professionals for learning public health practices.
The offending text is on page 390 under the Chapter 8- Demography and Family Planning – subsection- Family Planning – item b.-foetal health, which states _ “the quality of population can be improved only by avoiding completely unwanted births, compulsory sterilization of all the adults who are suffering from certain diseases such as leprosy and psychosis.”
Similarly on page 277 under leprosy Control and item –Others it states that “preventing contact with infectious cases and fomites is an accepted methods for controlling the spread for any communicable disease, and leprosy is no exception.”
Such statements made at a time when programmes are trying to reduce stigma and discrimination against people suffering from leprosy and mental ill health. I consider this as a gross violation of basic human rights and against human dignity. The way the subject matte has been dealt with displays a total lack of understanding of leprosy and its control. Such statement in reputed textbooks of medicine would have disastrous consequences on management and control of communicable diseases in generally and leprosy control in particular in
In the same textbook on page 268– under Chapter 5 Epidemiology of communicable diseases, section V – Surface Infections., under the heading – Leprosy, item – social pathology which states that “Over the centuries, a legend has grown around leprosy that it is highly contagious and that it is incurable. Even today, in spite of scientific information available about leprosy, this legend is deeply rooted in the minds of most people at all levels of society, with the result that social ostracism is apparent everywhere.”
Under the same heading on page 277, under Health education, under item General Public it states “the public should be made aware that leprosy is not a hereditary disease; it’s a bacterial disease like tuberculosis; it is curable; not all leprosy patients are infectious; regular and adequate treatment is essential to obtain cure and prevent disabilities, and that the patient needs sympathy and social support.”
I urge you to take immediate steps to remove the disparaging references from your textbook as a responsible publisher.
Thanking you in advance for considering the request.
Yours sincerely,
Dr V. Pannikar
Team Leader.
Global Leprosy Programme
World Health Organization
Leprosy images in Online Dermatology atlases
Leprosy Mailing List, December 18th, 2008
Ref.: Leprosy images in Online Dermatology atlases (see attachment)
From: Al Aboud K.,
Dear Dr Noto,
Greetings from Makkah.
I have collected, in the attached table, links to leprosy images in some of the Online Dermatology atlases. I wish to share it with my colleagues through the LML., and hope that they will find it useful.
Yours sincerely,
Dr Khalid Al Aboud
Medical Director and Consultant Dermatologist
P.O.
Makkah
Tel.: 0096625566411 ext 6666
Fax: 0096625563523
E-mail: alaboudkhalid at yahoo.ca