Wednesday, February 4, 2009

Request to Participate in Infolep User Survey

Leprosy Mailing List, January 31st, 2009

Ref.: Request to Participate in Infolep User Survey
From: Erlings J., Amsterdam, The Netherlands

Dear Dr Noto,

I would like to ask all LML readers to participate in the Infolep user survey.The purpose of this user survey is to evaluate current Infolep resources and services and assess future information needs of the leprosy community. (See covering letter)

The attached survey exists of three parts:- Current situation- Your information needs- Personal details.Filling in this survey will take 10 to 15 minutes.

A prompt return (before 9th of February) of the survey will be appreciated.Please e-mail the completed survey to: infolep at

Thank you for taking the time to participate!

With kind regards,
Jiske Erlings
INFOLEP Leprosy Information Services
P.O.Box 9500

Tel.: + 31 20 5950530
Fax: + 31 20 6680823
Email: infolep at
Infolep catalogue:

Garbino et Al. “A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and 2 leprosy reactions”

Leprosy Mailing List, January 29th, 2009

Ref.: Garbino et Al. “A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and 2 leprosy reactions” (see LML Jan. 10th)
From: Kar H. K., New Delhi , India

Dear Dr Noto,

Thanks you FOR SENDING THE ARTICLE FROM DR GARBINO (LML Jan. 10th, 2009). It is a very good in depth study, will be helpful for the management of reaction.

With regards,Dr (Prof.) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
PGIMER, Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001

Park's Textbook of Preventive and Social Medicine-19th Edition, 2007

Leprosy Mailing List, January 24th, 2009

Ref.: Park's Textbook of Preventive and Social Medicine-19th Edition, 2007
From: Pannikar V., New Delhi , India
Dear Dr Noto,
Thank you for circulating the reply from Mr Bahnot-publisher of the text book.
V. Pannikar

Dear Dr Pannikar,
Greetings, I am forwarding here below a communication received from the author of the book Dr K. Park for your kind perusal.
<< " I wish to say that health education is the best tool available to change the public opinion about myths and beliefs associated with leprosy. It took decades to remove fear complex about TB and now, by and by, people are coming forward for treatment on their own. Same way, the national leprosy eradication programme is doing a commendable job to remove the psychological fear about leprosy and the MDT has shown a drastic fall in prevalence rate during last 15 years or so.

What I had written about social pathology was the picture till a few years back, however the matter has been amended as per current scenario in the forthcoming 20th edition of the book. Regarding the mater on page 277, I am not writing about isolation of the patient. The subject mater is written only to make the medicos aware about the preventive aspect of breaking the chain of transmission between the period of initiation of treatment and succession of infectivity in a infectious case of leprosy, which should be taken in the right perspective.
I convey my thanks for your initiative and communication in the mater." >>
I hope the above note of the author meets the requirement. I request you to kindly forward to me your postal address, so as to enable me to send a complimentary copy of the 20th edition of the book, when it will be released, may be by Feb end.With best regards,

B. M. Bhanot

Treatment of HD in transplant recipients

Leprosy Mailing List, January 23rd, 2009

Ref.: Treatment of HD in transplant recipients
From: Scollard, David M., Stryjewska B, Baton Rouge , LA , USA

Dear Salvatore,

In response to Dr. Ariyawansa, LML Jan 19 09:

We have experience with the treatment of HD in transplant recipients in the United States , in addition to those that have been reported in the literature, as well as with patients receiving immunosuppressive therapy for cancer.

There is no standard MDT protocol for such patients, but we recommend continuation of at least 2 drugs long after completing the standard MDT regimen. We have seen that HD treatment can be discontinued after a few more years of treatment and complete resolution of lesions, even while they are still immunosuppressed. To be cautious, however, we recommend that such patients should also be followed with annual checkups for several additional years.

Generally, we recommend that the management of Type 1or Type 2 reactions in such patients is similar to that in non-immunosuppressed patients. After the bacterial/ antigen load has been substantially reduced, the occurrence of ENL will decline. There is no simple protocol for this, either. Like Dr. Ariyawansa, we would be interested in others' experience with such patients.

David M. Scollard, M.D., Ph.D.
Barbara Stryjewska, M.D.
National Hansen's Disease Programs
1770 Physician Park Dr .
Baton Rouge , LA 70816
tel 225-756-3713
FAX 225-756-3819

Dr. Roland Kazen

Leprosy Mailing List, January 23rd, 2009

Ref.: Dr. Roland Kazen
From: Kar H. K., New Delhi , India

Dear Dr Noto,

We lost a great Reconstructive surgeon in the field of leprosy, Dr Kazen untimely. I got the opportunity to meet him at ALERT, Ethiopia . On behalf of the Indian Association of Leprologists (IAL), I express my heart felt condolences to his family. We pray for this great soul to rest in peace.

With Regards.Dr (Prof.) H K KarPresident, IALConsultant & HODDepartment of Dermatology, STD & Leprosypgimer, Dr Ram Manohar Lohia HospitalBaba Kharag Singh MargNew Delhi-110001

Human rights and leprosy

Leprosy Mailing List, January 22nd, 2009

Ref.: Human rights and leprosy
From: de Pinho Andrade J. E., Rio de Janeiro, Brazil

Dear Salvatore,

Please read this news. Can you forward it the LML!
The link is:-

Best regards,

José Eduardo de Pinho Andrade
NLR Brasil

Human rights and leprosy

Leprosy Mailing List, January 22nd, 2009

Ref.: Human rights and leprosy
From: Soutar D., London , UK

Dear Salvatore,
Following the exposure of recent wrong information in a Public health text book, I would like to urgently bring to the attention of readers the outrageous proposal made by the chairman of the Andhra Pradesh Human Rights Commission. B. Subashan Reddy, chairman of the Andhra Pradesh Human Commission (APHRC), has called for legislation to prosecute parents with diseases such as tuberculosis, HIV, leprosy and dyslexia should they, knowing that they have the disease, have hildren......

To read of such unacceptable nonsense coming from a respected human rights lawyer is most disturbing and I would urge all right minded persons to do whatever they can to ensure this person is taken to task in the most appropriate manner and forced to retract such ludicrous and abusive proposals.

Douglas Soutar
Mr Douglas Soutar
General Secretary
International Federation of Anti-Leprosy Associations
doug.soutar at
Tel: + 44 (0)20 7602 6925

Dr. Roland Kazen

Leprosy Mailing List, January 21st, 2009

Ref.: Dr. Roland Kazen
From: Srinivasan H., Chennai, India

I am extremely sorry to hear that Dr Roland Kazen is no more. He was a good friend of mine, an extremely sincere person truly interested in the welfare of leprosy patients and spread of knowledge of Reconstructive surgery in leprosy. While holding on to his own ideas, he had no difficulty in examining other viewpoints sincerely and accept them if found reasonable. My sincere condolences to his family.

H SrinivasanReconstructive surgeon (Retd.)25 First Seaward Road Chennai 600 041India

Might ILEP/Infolep undertake a review of leprosy references in key medical textbooks?

Leprosy Mailing List, January 20th, 2009

Ref.: Might ILEP/Infolep undertake a review of leprosy references in key medical textbooks?
From: Soutar D., London , UK

Dear Leprosy Mailing List readers,

With the regards to the outrageous material in Parks textbook of Preventive Medicine, 2007 edition, my suggestion would be that WHO and the Indian MoH write jointly to the publisher of this text book with a suggested “corrigendum” demanding their commitment to insert this in all future copies being distributed. It should be stressed to the publishers and in a letter to all medical colleges that this text book should no longer be promoted without the addition of such a corrigendum.

I am sure there are other materials which continue to promote wrong and even harmful information. Seeking to ensure that all medical reference text books in key leprosy endemic countries have a correct reference to, and information about, leprosy is an important task for the future and I might suggest that ILEP/Infolep could undertake to carry out a review of references in key medical reference texts from various countries. It would be useful to this end if people could bring to our attention other instances of erroneous and outdated reference material on leprosy.

With best wishes to all LML readers for 2009.
Doug Soutar
ILEP General Secretary

Fluoroquinolones are associated with tendinitis and tendon rupture

Leprosy Mailing List, January 19th, 2009

Ref.: Fluoroquinolones are associated with tendinitis and tendon rupture
From: Frankel Richard I., Honolulu, Hawaii, USA

Dear Dr. Noto,

More recent data indicate that fluoroquinolones as a group are also associated with tendinitis and tendon rupture. Those prescribing them should be aware of this and of the clinical presentation of these disorders. Some information is available at


Richard I. Frankel, M.D., M.P.H., F.A.C.P.
Emeritus Professor of Medicine
University of Hawai'i

Erythema nodosum leprosum reaction in a post kidney transplant patient

Leprosy Mailing List, January 19th, 2009

Ref.: Erythema nodosum leprosum reaction in a post kidney transplant patient
From: Ariyawansa D., Thalapathpitiya, Nugegoda , Sri Lanka

Dear Dr Noto,

I am treating a post kidney transplant (KT) patient with lepromatous leprosy (LL) with erythema nodosum leprosum (ENL) reaction. Herewith follows her clinical history.

A 29 year old female presented with tender erythematous nodules over arms & legs for 4 months; arthralgia and fever for 3 weeks.

She gave a past history of histologically confirmed LL leprosy with Bacillary Index (BI) of 4+ and Morphological Index (MI) of 10% in January 2005 treated according to WHO multi-drug therapy (Rifampicin, Clofazimine & Dapsone) for one year.

She has undergone renal transplantation in January 2008 and was subsequently given immunosuppressives (Cyclosporine, Prednisolone, Mycophenolate mofetil).

Slit skin smear done in September 2008 (with the current presenting symptoms) showed evidence of BI 4+ and MI 0% and histology confirmed evidence of lepromatous leprosy. We prescribed multi-drug therapy with the same regimen used in 2005 and Prednisolone 40 mg/day considering a diagnosis of LL leprosy with ENL reaction.

She developed severe symptomatic haemolysis dropping Haemoglobin from 11 to 7 g/dl. Therefore we discontinued Dapsone but continued the rest of medications. While tailing off Prednisolone gradually over 12-16 weeks she started developing ENL on 2 occasions at a dose of 25 -15 mg. Therefore during second occasion we increased the dose of clofazimine to a total dose of 150 mg on 16/01/2009.

My questions are:
1. Is there a prophylactic anti leprosy regimen to prevent leprosy recurrence for patients on immunosuppresives drugs who have had leprosy in the past?
2. What alterations of the regimen of treatment should we consider if this particular patient develops ENL again?
3. According to the literature search I did, I found only 10 case reports of post transplanted patients with leprosy. Do you have more information?

Kind regards,

Dr Dananja Ariyawansa
Sri Jayawardenepura General Hospital
Sri Lanka

Dr. Roland Kazen

Leprosy Mailing List, January 19th, 2009

Ref.: Dr. Roland Kazen
From: Virmond M., Bauru, SP, Brazil

Dear Colleagues,

I regret to inform that Dr. Roland Kazen has passed away last Januray 11th. Dr. Kazen was one of the leading surgeons in the field of rehabilitation in leprosy with outstanding services in many countries including Ethiopia where he developed very active teaching activities. We most regret his early departure.

Marcos Virmond
ILSL - Bauru
ILA - President

New mycobacterium species

Leprosy Mailing List, January 18th, 2009

Ref.: New mycobacterium species
From: Spencer J S., Fort Collins , Colorado , USA

Dear Dr. Noto,
Dr. Brennan forwarded your message (de Koning P, LML Jan 11th, 2009) about AJCP paper concerning the new mycobacterium that was recently described by Dr. Xiang Han from the University of Texas M. D. Anderson Cancer Center in Houston, Texas, with collaboration from Colorado State University. Enclosed is the PDF of our recently published paper on this discovery.

Initially, I was contacted by Dr. Geetha Nair, a clinician at a clinic in Phoenix , Arizona , about a patient who had died from what seemed to be disseminated mycobacterial infection. Although leprosy was suspected at first, the antigen serological recognition pattern was not typical of what we had previously seen, and DNA sequencing of several genes that we use for typing M. leprae did not match the sequence data, and included a difference of 2.1% in the 16S rRNA gene compared with that of M. leprae, with lower identity with all other mycobacterial 16S sequences in the database. After sequencing over 20 genes (both partial and complete gene sequences) at M. D. Anderson and at CSU, our conclusion was that what we had identified was very different from M. leprae. Attempts to grow this mycobacterium from biopsy specimens from this patient were unsuccessful.

The pathology fit the criteria for diffuse lepromatous leprosy with Lucio's phenonmenon, a rare and frequently lethal form of leprosy since it was first described in Mexico by Lucio and Alvarado in 1852, and which is most commonly reported in Mexico , the Caribbean and countries in South America . We are acquiring additional samples from archived biopsy material from individuals diagnosed with DLL from Mexico and South America to confirm the 16S sequence findings. We are also trying to sequence the entire genome of this rare mycobacterium, and hope to obtain a fresh isolate to try to grow in the nude mouse footpad.

I had presented a poster and an oral presentation about this new mycobacterium at the 17th ILC meeting in Hyderabad , India last February, which generated some interest. I hope this has answered some of your questions about this discovery. I would be pleased to be added onto your leprosy mailing list.

Best regards.
John S. Spencer, Ph.D.
Assistant Professor

16SRNA genes

Leprosy Mailing List, January 18th, 2009

Ref.: 16SRNA genes
From: Jadhav V., Pune, Maharashtra , India

Dear Dr. Noto,
I agree with the views expressed by Dr de Koning (LML Jan 11th, 2009). I feel that patients from different parts of world should be included in further study to know the 16SRNA genes in the bacteria found in these patients.
Dr Vitthal Jadhav
Past President
Indian Association of Leprologists

Ofloxacin in leprosy

Leprosy Mailing List, January 18th, 2009

Ref.: Ofloxacin in leprosy
From: Saunderson P., Greenville , SC , USA

Dear Salvatore,

In response to Dr Kamaladasa’s question (LML Jan. 11th, 2009) about ofloxacin, the recommended dose for the treatment of leprosy is clearly stated by the WHO Expert Committee on Leprosy (Seventh Report, 1998; page 13) as 400mg daily. Monthly rifampicin, plus daily ofloxacin (400mg) for 6 months will be more than adequate for PB cases.

The fluoroquinolones, including ofloxacin, are not recommended for children and adolescents, because of possible effects on growing joints (arthropathy is seen in studies using immature animals). The WHO report also states: “Side effects include nausea, diarrhoea and other gastrointestinal complaints, and a variety of central nervous system complaints including insomnia, headaches, dizziness, nervousness and hallucinations. Serious problems are rare and do not usually require discontinuing the drug.”

With best wishes,

Dr Paul Saunderson, MD, MRCP
Medical Director: American Leprosy Missions
Head Office: 1 ALM Way, Greenville , SC 29601 , USA
Home address: Østrem, 6013 Ålesund , Norway
Email: psaunderson at