Leprosy Mailing List, July 17th, 2009
Ref.: LML closes temporarily
From: Noto S., Genoa, Italy
Dear All,
The LML will temporarily close. It will be working again by the end of August 2009.
Thank you to all of you,
S. Noto
Pages
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Tuesday, July 28, 2009
Acworth Leprosy Museum, Mumbay, India
Leprosy Mailing List, July 17th, 2009
Ref.: Acworth Leprosy Museum, Mumbay, India (see attachments)
From: Mishra K. J., Mumbai, India
Dear Dr Noto,
I would like to send an article related with the initiation of the efforts to open a museum for leprosy history. I have been associated with Acworth Leprosy Hospital Research Society for one and half years and worked as a Research Assistant in regards to collection, documentation, filing and analysis of archival materials for leprosy subject for the period 1860-1953.
I request you to kindly publish it in the leprosy mailing list and pleased to inform you that "Leprosy Review" has covered this information in their "News and Item" column for this month's edition.
In addition to this, I am attaching the photograph of display of exhibit artefacts of Museum to Mr. Phatak by Dr. W.S. Bhatki, the Honourable Director of Acworth Leprosy Museum. Looking forward for your positive response.
Thanks and Regards,
Ms. Kavita J Mishra
Placement Officer
Alkesh Dinesh Mosy Institute for Financial and Management Studies
University of Mumbai
Tel.: 022-26524450/9819925109
Ref.: Acworth Leprosy Museum, Mumbay, India (see attachments)
From: Mishra K. J., Mumbai, India
Dear Dr Noto,
I would like to send an article related with the initiation of the efforts to open a museum for leprosy history. I have been associated with Acworth Leprosy Hospital Research Society for one and half years and worked as a Research Assistant in regards to collection, documentation, filing and analysis of archival materials for leprosy subject for the period 1860-1953.
I request you to kindly publish it in the leprosy mailing list and pleased to inform you that "Leprosy Review" has covered this information in their "News and Item" column for this month's edition.
In addition to this, I am attaching the photograph of display of exhibit artefacts of Museum to Mr. Phatak by Dr. W.S. Bhatki, the Honourable Director of Acworth Leprosy Museum. Looking forward for your positive response.
Thanks and Regards,
Ms. Kavita J Mishra
Placement Officer
Alkesh Dinesh Mosy Institute for Financial and Management Studies
University of Mumbai
Tel.: 022-26524450/9819925109
Report of the 10th meeting of the WHO Technical Advisory Group on Leprosy Control
Leprosy Mailing List, July 17th, 2009
Ref.: Report of the 10th meeting of the WHO Technical Advisory Group on Leprosy Control (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached the report of the 10th meeting of the WHO Technical Advisory Group on Leprosy Control held on 23 April 2009 at New Delhi, India. Kindly share this document with interested colleagues.
Regards,
V. Pannikar
Ref.: Report of the 10th meeting of the WHO Technical Advisory Group on Leprosy Control (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached the report of the 10th meeting of the WHO Technical Advisory Group on Leprosy Control held on 23 April 2009 at New Delhi, India. Kindly share this document with interested colleagues.
Regards,
V. Pannikar
WER article on drug resistance Page 264-267
Leprosy Mailing List, July 8th, 2009
Ref.: WER article on drug resistance Page 264-267
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached WER (Pages 264-267) on WHO’s drug resistance surveillance in Leprosy. I believe that it is of paramount importance to keep a close watch on the drug resistance situation, particularly for the emergence of rifampicin resistant M. leprae.
WHO is planning to publish such reports at least once a year from now onwards. I will be grateful if you can share this article with your colleagues.
Regards,
V. Pannikar
Ref.: WER article on drug resistance Page 264-267
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find attached WER (Pages 264-267) on WHO’s drug resistance surveillance in Leprosy. I believe that it is of paramount importance to keep a close watch on the drug resistance situation, particularly for the emergence of rifampicin resistant M. leprae.
WHO is planning to publish such reports at least once a year from now onwards. I will be grateful if you can share this article with your colleagues.
Regards,
V. Pannikar
4 new leprosy cases in one family of 5 house holds
Leprosy Mailing List, July 8th, 2009
Ref.: 4 new leprosy cases in one family of 5 house holds
From: Bhatki W. S., Mumbai, India
Dear Dr Noto,
Greetings from Mumbai, India. I have received three brief comments to my message (Bhatki W. S. LML July 3rd , 2009). They were from Prof. P K Das, Dr A Mondjo and from yourself. Thank you very much for these. I express my sincere thanks particularly to Prof. Das for taking interest in my recent experience on contact examination. You are requested to kindly communicate my response as follows through the LML.
The leprosy cases (i.e. 4 new cases in one family of 5 house holds) mentioned in the manuscript referred above have not been published any where. The cases, however, had been registered for MDT and included as new cases in the monthly report of the respective month submitted to the Asstt. Director of Health Services, Leprosy (Mumbai), the local Government authority for leprosy.
There was a time when leprosy was highly prevalent, we used to get families with multiple cases particularly in slums. However, now when the leprosy prevalence is drastically reduced to a level of elimination, the incidence of multiple cases in one family is very rare.
The intention of my communication on contact examination was mainly to sensitize and motivate all those who are working in the leprosy programme for undertaking proper contact examination if there are multiple child cases in the family. If this is added with simple smear examination, there are chances that the source case, if any, among adult house holds could be detected significantly early.
I do not think that there will be adequate number of families with multiple cases to take up any research project involving PGL-1 or other serological studies. I will be happy to meet Prof. Das in person when he will visit Mumbai and discuss with him the related issues. I will certainly communicate his regards to Dr Ganapathi.
Thanks and regards.
Dr W S Bhatki
Maharshtra Lokahita Seva Mandal,
Mumbai, India
Ref.: 4 new leprosy cases in one family of 5 house holds
From: Bhatki W. S., Mumbai, India
Dear Dr Noto,
Greetings from Mumbai, India. I have received three brief comments to my message (Bhatki W. S. LML July 3rd , 2009). They were from Prof. P K Das, Dr A Mondjo and from yourself. Thank you very much for these. I express my sincere thanks particularly to Prof. Das for taking interest in my recent experience on contact examination. You are requested to kindly communicate my response as follows through the LML.
The leprosy cases (i.e. 4 new cases in one family of 5 house holds) mentioned in the manuscript referred above have not been published any where. The cases, however, had been registered for MDT and included as new cases in the monthly report of the respective month submitted to the Asstt. Director of Health Services, Leprosy (Mumbai), the local Government authority for leprosy.
There was a time when leprosy was highly prevalent, we used to get families with multiple cases particularly in slums. However, now when the leprosy prevalence is drastically reduced to a level of elimination, the incidence of multiple cases in one family is very rare.
The intention of my communication on contact examination was mainly to sensitize and motivate all those who are working in the leprosy programme for undertaking proper contact examination if there are multiple child cases in the family. If this is added with simple smear examination, there are chances that the source case, if any, among adult house holds could be detected significantly early.
I do not think that there will be adequate number of families with multiple cases to take up any research project involving PGL-1 or other serological studies. I will be happy to meet Prof. Das in person when he will visit Mumbai and discuss with him the related issues. I will certainly communicate his regards to Dr Ganapathi.
Thanks and regards.
Dr W S Bhatki
Maharshtra Lokahita Seva Mandal,
Mumbai, India
Recommendation to examine household contacts of new leprosy cases
Leprosy Mailing List, July 7th, 2009
Ref.: Recommendation to examine household contacts of new leprosy cases. (see link below)
From: Soutar D, London, UK
Dear Dr Noto,
In reference to the note posted by Dr Bhakti (LML July 3rd, 2009) I should bring to the attention of readers that the Enhanced Global Strategy on Leprosy agreed on by WHO and its partners in Delhi in April 2009 specifically includes the recommendation to examine all household contacts of newly detected cases. (See below the link to the WHO release about the Enhanced Strategy).
This I believe represents a very positive step towards ensuring early detection, prevention of disability and ultimately curtailment of transmission.
Regards, Douglas Soutar
General Secretary
International Federation of Anti-Leprosy Associations
Tel: 44 (0) 207 602 69 25 – Fax: 44 (0) 207 371 16 21
Website: www.ilep.org.uk
E-mail: doug.soutar(at)ilep.org.uk
Ref.: Recommendation to examine household contacts of new leprosy cases. (see link below)
From: Soutar D, London, UK
Dear Dr Noto,
In reference to the note posted by Dr Bhakti (LML July 3rd, 2009) I should bring to the attention of readers that the Enhanced Global Strategy on Leprosy agreed on by WHO and its partners in Delhi in April 2009 specifically includes the recommendation to examine all household contacts of newly detected cases. (See below the link to the WHO release about the Enhanced Strategy).
This I believe represents a very positive step towards ensuring early detection, prevention of disability and ultimately curtailment of transmission.
Regards, Douglas Soutar
General Secretary
International Federation of Anti-Leprosy Associations
Tel: 44 (0) 207 602 69 25 – Fax: 44 (0) 207 371 16 21
Website: www.ilep.org.uk
E-mail: doug.soutar(at)ilep.org.uk
http://www.searo.who.int/EN/Section980/Section2572/Section2578_14961.htm
Leprosy eliminated? … A wake-up call from Liberia
Leprosy Mailing List, July 7th, 2009
Ref.: Leprosy eliminated? … A wake-up call from Liberia (see attachment)
From: Diefenhardt A., Koning P. de, Würzburg, Germany
Dear Salvatore,
We – Dr Pieter de Koning and me – would be very grateful, if you could kindly publish the following statement (see attachment) in the LML. We are just coming back from a visit from Liberia.
Thanks a lot.
Many greetings,
Dr Adolf Diefenhardt
Head of Medical Social Projects DAHW Würzburg
Ref.: Leprosy eliminated? … A wake-up call from Liberia (see attachment)
From: Diefenhardt A., Koning P. de, Würzburg, Germany
Dear Salvatore,
We – Dr Pieter de Koning and me – would be very grateful, if you could kindly publish the following statement (see attachment) in the LML. We are just coming back from a visit from Liberia.
Thanks a lot.
Many greetings,
Dr Adolf Diefenhardt
Head of Medical Social Projects DAHW Würzburg
Importance of contact examination in leprosy case detection
Leprosy Mailing List, July 3rd, 2009
Ref.: Importance of contact examination in leprosy case detection
From: Bhatki W. S., Mumbai, India
July 2, 2009
Dear Salvatore Noto,
Greetings from Mumbai.
We wish to share our experience on Contact Examination in leprosy case detection as narrated below with all those interested and request you to circulate the same through the LML.
Yours truly,
W S Bhatki
Sub: Importance of contact examination in leprosy case detection
During the current phase of Integration of leprosy services with General Health Services, all the methods of active case detection (i.e. surveys) have been suspended. There is emphasis on information education and communication (IEC) to promote voluntary case reporting. However, we have recently come across 4 new cases clustered in one family of 5 households in which early lepromatous leprosy (LL) case could be detected through contact examination.
We had recently undertaken a Selective Special Drive (SSD), a house to house leprosy awareness campaign, through trained Community Volunteers (CVs) in one of the slum pockets in our project area in Mumbai. A week following the SSD, a youth brought two of his younger siblings, i.e. 11 year old brother with patch on left knee and 9 year old sister with small patches 1 each on left forearm and right thigh for examination at nearby Leprosy Referral Centre (LRC). Both the children were diagnosed as paucibacillary (PB) leprosy. They were formally registered for multi-drug therapy (MDT). The youth was also examined but did not have any thing suggestive of leprosy. He was counselled on leprosy.
In the next week, the same youth visited the LRC accompanied by his father who had suspected patch on his right cheek. On examination, the father too, was found to be suffering from PB leprosy. According to the youth, he did not bring his mother for examination because she did not have any patch on the body. We however, got the mother examined at home by the paramedical worker and found that she had shiny, oily skin with mild infiltration on forehead and on ear lobes suggestive of early LL leprosy. Her skin smears examination done at the LRC showed bacterial index (BI) 3+ for acid fast bacilli.
From this experience, we want to suggest that even though the active case detection through surveys have been stopped, the contact examination needs to be continued especially when there are multiple child cases in one family. There is good awareness about skin patch as the early sign of leprosy but no so much about the early signs of infectious leprosy, i.e. lepromatous leprosy. While carrying out IEC programs, this aspect should be kept in mind and enough publicity should given.
W S Bhatki*, Leelamma Joseph*
Maharashtra Lokahita Seva Mandal, Santacruz (E),
Mumbai, India
* Dr W S Bhatki is working in the field of leprosy for over 3 decades. He was former Medical Superintendent of Acworth Leprosy Hospital, Mumbai. Presently, he is working as Executive Director of Maharashtra Lokahita Seva Mandal (MLSM), a NGO operating on National Leprosy Eradication Program (NLEP) in 3 Municipal Wards in Mumbai since 1975. He has contributed to Leprosy Review and International Journal on Leprosy by writing several articles on Leprosy Vaccine, clinical leprosy and epidemiological situation in Mumbai. He is also a secretary of Acworth Leprosy Hospital Research Society (e mail – acworthleprosyrre@yahoo.co.in ).
* Leelamma Joseph is working as Para Medical Worker at MLSM for over 25 years.
Ref.: Importance of contact examination in leprosy case detection
From: Bhatki W. S., Mumbai, India
July 2, 2009
Dear Salvatore Noto,
Greetings from Mumbai.
We wish to share our experience on Contact Examination in leprosy case detection as narrated below with all those interested and request you to circulate the same through the LML.
Yours truly,
W S Bhatki
Sub: Importance of contact examination in leprosy case detection
During the current phase of Integration of leprosy services with General Health Services, all the methods of active case detection (i.e. surveys) have been suspended. There is emphasis on information education and communication (IEC) to promote voluntary case reporting. However, we have recently come across 4 new cases clustered in one family of 5 households in which early lepromatous leprosy (LL) case could be detected through contact examination.
We had recently undertaken a Selective Special Drive (SSD), a house to house leprosy awareness campaign, through trained Community Volunteers (CVs) in one of the slum pockets in our project area in Mumbai. A week following the SSD, a youth brought two of his younger siblings, i.e. 11 year old brother with patch on left knee and 9 year old sister with small patches 1 each on left forearm and right thigh for examination at nearby Leprosy Referral Centre (LRC). Both the children were diagnosed as paucibacillary (PB) leprosy. They were formally registered for multi-drug therapy (MDT). The youth was also examined but did not have any thing suggestive of leprosy. He was counselled on leprosy.
In the next week, the same youth visited the LRC accompanied by his father who had suspected patch on his right cheek. On examination, the father too, was found to be suffering from PB leprosy. According to the youth, he did not bring his mother for examination because she did not have any patch on the body. We however, got the mother examined at home by the paramedical worker and found that she had shiny, oily skin with mild infiltration on forehead and on ear lobes suggestive of early LL leprosy. Her skin smears examination done at the LRC showed bacterial index (BI) 3+ for acid fast bacilli.
From this experience, we want to suggest that even though the active case detection through surveys have been stopped, the contact examination needs to be continued especially when there are multiple child cases in one family. There is good awareness about skin patch as the early sign of leprosy but no so much about the early signs of infectious leprosy, i.e. lepromatous leprosy. While carrying out IEC programs, this aspect should be kept in mind and enough publicity should given.
W S Bhatki*, Leelamma Joseph*
Maharashtra Lokahita Seva Mandal, Santacruz (E),
Mumbai, India
* Dr W S Bhatki is working in the field of leprosy for over 3 decades. He was former Medical Superintendent of Acworth Leprosy Hospital, Mumbai. Presently, he is working as Executive Director of Maharashtra Lokahita Seva Mandal (MLSM), a NGO operating on National Leprosy Eradication Program (NLEP) in 3 Municipal Wards in Mumbai since 1975. He has contributed to Leprosy Review and International Journal on Leprosy by writing several articles on Leprosy Vaccine, clinical leprosy and epidemiological situation in Mumbai. He is also a secretary of Acworth Leprosy Hospital Research Society (e mail – acworthleprosyrre@yahoo.co.in ).
* Leelamma Joseph is working as Para Medical Worker at MLSM for over 25 years.
Dapsone related complications: hypersensitivity and toxicity
Leprosy Mailing List, July 3rd, 2009
Ref.: Dapsone related complications: hypersensitivity and toxicity.
From: Dhakal K. P., Kathmandu, Nepal
Dear Ariyawansa,
Thank you very much for your message (LML June 22nd, 2009).
The case presented by you is almost definitely the case of dapsone related complication. You have not mentioned about pruritus and relevant skin presentations which are the commonest presentations of dapsone hypersensitivity which ranges from mild pruritus with some skin rashes to severe exfoliative dermatitis. I have successfully treated many cases of dapsone hypersensitivity with somewhat similar presentation like your case but with associated with skin manifestations and pruritus. In this case presented by you, it seems to be dapsone toxicity which is very different from hypersensitivity reaction. In the case presented by you, there is high chance of dapsone related complication but at the same time we can look for any other accompanying pathology.
Dr K P Dhakal
NLR
Kathmandu, Nepal
Ref.: Dapsone related complications: hypersensitivity and toxicity.
From: Dhakal K. P., Kathmandu, Nepal
Dear Ariyawansa,
Thank you very much for your message (LML June 22nd, 2009).
The case presented by you is almost definitely the case of dapsone related complication. You have not mentioned about pruritus and relevant skin presentations which are the commonest presentations of dapsone hypersensitivity which ranges from mild pruritus with some skin rashes to severe exfoliative dermatitis. I have successfully treated many cases of dapsone hypersensitivity with somewhat similar presentation like your case but with associated with skin manifestations and pruritus. In this case presented by you, it seems to be dapsone toxicity which is very different from hypersensitivity reaction. In the case presented by you, there is high chance of dapsone related complication but at the same time we can look for any other accompanying pathology.
Dr K P Dhakal
NLR
Kathmandu, Nepal
Clinical case: suspect dapsone hypersensitivity reaction.
Leprosy Mailing List,
June 23rd, 2009
Ref.: Clinical case: suspect dapsone hypersensitivity reaction.
From: Naafs B., Munnekeburen, The Netherlands
Dear Dr Ariyawansa,
Thank you for your message. The first thought indeed is a reaction to dapsone. In my opinion all data can be explained, but a concomitant secondary infection cannot be excluded.
With kind regards,
Dr Ben Naafs
June 23rd, 2009
Ref.: Clinical case: suspect dapsone hypersensitivity reaction.
From: Naafs B., Munnekeburen, The Netherlands
Dear Dr Ariyawansa,
Thank you for your message. The first thought indeed is a reaction to dapsone. In my opinion all data can be explained, but a concomitant secondary infection cannot be excluded.
With kind regards,
Dr Ben Naafs
Clinical case: suspect dapsone hypersensitivity reaction.
Leprosy Mailing List,
June 23rd, 2009
Ref.: Clinical case: suspect dapsone hypersensitivity reaction.
From: Smith C., Aberdeen, UK
Dear Dr Ariyawansa,
Thank you for sharing your case (LML June 22nd, 2009) with us. I think serious consideration needs to be given to the possibility of dapsone hypersensitivity reaction - typically the onset is within 6 weeks of starting dapsone and the presentation is consistent with your description.
Cairns Smith
Suggested references:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1524788
June 23rd, 2009
Ref.: Clinical case: suspect dapsone hypersensitivity reaction.
From: Smith C., Aberdeen, UK
Dear Dr Ariyawansa,
Thank you for sharing your case (LML June 22nd, 2009) with us. I think serious consideration needs to be given to the possibility of dapsone hypersensitivity reaction - typically the onset is within 6 weeks of starting dapsone and the presentation is consistent with your description.
Cairns Smith
Suggested references:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1524788
http://www.ncbi.nlm.nih.gov/pubmed/16361748?dopt=AbstractPlus
Clinical case
Leprosy Mailing List,
June 22nd, 2009
Ref.: Clinical case
From: Ariyawansa D., Thalapathpitiya, Nugegoda, Sri Lanka
Dear Dr Noto,
I would like to present a case to LML members for their opinion.
18 year old female was treated for a single patch, histologically proven tuberculoid leprosy, with paucibacillary treatment according to WHO guidelines (Rifampicin-monthly, Dapsone-daily).
Pre Treatment Full blood count, Liver funtions and G6PD levels were normal. Presented with high remittent fever (101-103 F) and jaundice 3weeks after commencement of anti-leprosy treatment with evidence of deep jaundice and hepato-splenomegaly on examination.
Investigations
*WBC/DC(10x 3 / UL) Total 5.3---8.3--8.6---13.5---16.8---19.07---27
(with Neutrophil leucocytosis and mild eosinophilia)
Haemoglobin (g/dl)- 8.37--8.9---7.7--8.1----8.6.
Platelet count-with in normal range
Retic count-5%---10%
ESR (mm/1st hour) 20--40--32
Blood Picture-suggests intra vascular Hemolysis with a left shift (?underling infective origin)
S. Bilirubin(mg/dl) Total 8.1 10.6 16.6 19.2
Direct 6.9 8.6 14.2 15.8
Indirect 1.2 1.8 2.4 3.4
Serum Alkaline Phosphatase (U/L)-395 587 761
SGOT- 472 370 551 266
SGPT- 419 401 545 442
Hepatitis Screening ( A,B,C)- Negative
Urine for Hemosiderin-Negative
CRP- 12 mg/dl
Mycoplasma AB-Negative
S. Creatinine 31 Mmol/L
Urine full report-Few granular casts Monospot test-Negative Widal Test-Negative
APTT and Thrombin Test-with in normal range USS abdomen-Hepato-splenomegaly with thickened wall of Gall bladder, no evidence of Gall bladder calculi or liver abscesses.
Management Discontinued anti Leprosy treatment Broad Spectrum antibiotics Monitor vital parameters
Still being managed as a inward patient
My question is:- Can we explain this picture with Anti Leprosy drugs alone or is it a double pathology?
Thanking you,
Dr Dananja Ariyawansa
Sri Jayawardenepura General Hospital
Thalapathpitiya Nugegoda Sri Lanka
June 22nd, 2009
Ref.: Clinical case
From: Ariyawansa D., Thalapathpitiya, Nugegoda, Sri Lanka
Dear Dr Noto,
I would like to present a case to LML members for their opinion.
18 year old female was treated for a single patch, histologically proven tuberculoid leprosy, with paucibacillary treatment according to WHO guidelines (Rifampicin-monthly, Dapsone-daily).
Pre Treatment Full blood count, Liver funtions and G6PD levels were normal. Presented with high remittent fever (101-103 F) and jaundice 3weeks after commencement of anti-leprosy treatment with evidence of deep jaundice and hepato-splenomegaly on examination.
Investigations
*WBC/DC(10x 3 / UL) Total 5.3---8.3--8.6---13.5---16.8---19.07---27
(with Neutrophil leucocytosis and mild eosinophilia)
Haemoglobin (g/dl)- 8.37--8.9---7.7--8.1----8.6.
Platelet count-with in normal range
Retic count-5%---10%
ESR (mm/1st hour) 20--40--32
Blood Picture-suggests intra vascular Hemolysis with a left shift (?underling infective origin)
S. Bilirubin(mg/dl) Total 8.1 10.6 16.6 19.2
Direct 6.9 8.6 14.2 15.8
Indirect 1.2 1.8 2.4 3.4
Serum Alkaline Phosphatase (U/L)-395 587 761
SGOT- 472 370 551 266
SGPT- 419 401 545 442
Hepatitis Screening ( A,B,C)- Negative
Urine for Hemosiderin-Negative
CRP- 12 mg/dl
Mycoplasma AB-Negative
S. Creatinine 31 Mmol/L
Urine full report-Few granular casts Monospot test-Negative Widal Test-Negative
APTT and Thrombin Test-with in normal range USS abdomen-Hepato-splenomegaly with thickened wall of Gall bladder, no evidence of Gall bladder calculi or liver abscesses.
Management Discontinued anti Leprosy treatment Broad Spectrum antibiotics Monitor vital parameters
Still being managed as a inward patient
My question is:- Can we explain this picture with Anti Leprosy drugs alone or is it a double pathology?
Thanking you,
Dr Dananja Ariyawansa
Sri Jayawardenepura General Hospital
Thalapathpitiya Nugegoda Sri Lanka
Leprosy versus Hansen’s disease. The conscientious motivations behind the name change have largely failed.
Leprosy Mailing List,
June 20th, 2009
Ref.: Leprosy versus Hansen’s disease. The conscientious motivations behind the name change have largely failed.
From: Poorman E., Boston, MA, USA
Dear Dr. Noto,
I thank Drs. Booth and Manimozhi for their inquiries into my article. I refer them to the explanation offered there as to why I use the word "leper." Simply put, I NEVER call a person a leper (though occasionally this is done by patients themselves amongst trusted friends), and I use the term leper colonies as I find the notion of "Hansen's colony" anachronistic and revisionist. There would never have been colonies for a disease as little contagious as Hansen's were it not known as leprosy, and to use that term in connection with isolation is to misunderstand the whole of the disease's history. If this is not clear from the entirety of my article, and not simply the abstract, I apologize.
"Currently, leprosy is more or less equated with Hansen’s disease. But the former is as much a social condition as a bacterial disease, while the latter is a highly medicalized affliction in which the bacteria is considered far more important than the experience of the disease.¬ To state it more simply, to call oneself a “Hansen’s patient” (hanseniano, in Portuguese) is to talk about the presence of an invading bacterium, while to call oneself a “leper” (leproso, in Portuguese) is to subjugate the biological definition to the social experience of the disease.
Historiography and the process of translation and interpretation have caused several historical diseases to be known as “leprosy.” Therefore, it is not that leprosy was consistently believed to be repulsive, but that repulsive diseases were consistently given the name of “leprosy.” Renaming leprosy “Hansen’s disease” is as much a reflection of the shifting view of disease, in which the causal agent is paramount, as an attempt to conquer the disease’s stigma. The conscientious motivations behind the name change have largely failed because there is little clarity on this concept, both among academics and the general public....
In a leper colony outside of Rio de Janeiro, Curupaiti, where I worked for seven months during 2007, residents occasionally counsel those who are recently diagnosed with Hansen’s disease. “You have Hansen’s disease,” I heard one resident say to a young man, who had come to have his bandages changed. “But take care of yourself, or you’ll get leprosy.” The interaction became an oft-repeated joke among employees of the hospital, who considered the explanation to be more evidence of the residents’ deep-seated ignorance about their own disease. I did too. But in the time that I have had since to reflect on this peculiar community, I believe that this resident demonstrated more astuteness about his disease than I had. He had lived his life with leprosy. He had been officially sanctioned a leper by the Brazilian government. He had been forced to give up his family outside the colony, and—because “healthy” children were removed from their “sick” parents—all hopes of creating one within. By contrast, the younger man had Hansen’s disease, which could be treated with antibiotics and controlled through diligent hygiene. Though he may have suffered discrimination, he could come and go to the colony as he pleased. As long as he did not develop the visible disabilities associated with Hansen’s disease, he could conceal it from the world."
All the best,
Elisabeth Poorman
June 20th, 2009
Ref.: Leprosy versus Hansen’s disease. The conscientious motivations behind the name change have largely failed.
From: Poorman E., Boston, MA, USA
Dear Dr. Noto,
I thank Drs. Booth and Manimozhi for their inquiries into my article. I refer them to the explanation offered there as to why I use the word "leper." Simply put, I NEVER call a person a leper (though occasionally this is done by patients themselves amongst trusted friends), and I use the term leper colonies as I find the notion of "Hansen's colony" anachronistic and revisionist. There would never have been colonies for a disease as little contagious as Hansen's were it not known as leprosy, and to use that term in connection with isolation is to misunderstand the whole of the disease's history. If this is not clear from the entirety of my article, and not simply the abstract, I apologize.
"Currently, leprosy is more or less equated with Hansen’s disease. But the former is as much a social condition as a bacterial disease, while the latter is a highly medicalized affliction in which the bacteria is considered far more important than the experience of the disease.¬ To state it more simply, to call oneself a “Hansen’s patient” (hanseniano, in Portuguese) is to talk about the presence of an invading bacterium, while to call oneself a “leper” (leproso, in Portuguese) is to subjugate the biological definition to the social experience of the disease.
Historiography and the process of translation and interpretation have caused several historical diseases to be known as “leprosy.” Therefore, it is not that leprosy was consistently believed to be repulsive, but that repulsive diseases were consistently given the name of “leprosy.” Renaming leprosy “Hansen’s disease” is as much a reflection of the shifting view of disease, in which the causal agent is paramount, as an attempt to conquer the disease’s stigma. The conscientious motivations behind the name change have largely failed because there is little clarity on this concept, both among academics and the general public....
In a leper colony outside of Rio de Janeiro, Curupaiti, where I worked for seven months during 2007, residents occasionally counsel those who are recently diagnosed with Hansen’s disease. “You have Hansen’s disease,” I heard one resident say to a young man, who had come to have his bandages changed. “But take care of yourself, or you’ll get leprosy.” The interaction became an oft-repeated joke among employees of the hospital, who considered the explanation to be more evidence of the residents’ deep-seated ignorance about their own disease. I did too. But in the time that I have had since to reflect on this peculiar community, I believe that this resident demonstrated more astuteness about his disease than I had. He had lived his life with leprosy. He had been officially sanctioned a leper by the Brazilian government. He had been forced to give up his family outside the colony, and—because “healthy” children were removed from their “sick” parents—all hopes of creating one within. By contrast, the younger man had Hansen’s disease, which could be treated with antibiotics and controlled through diligent hygiene. Though he may have suffered discrimination, he could come and go to the colony as he pleased. As long as he did not develop the visible disabilities associated with Hansen’s disease, he could conceal it from the world."
All the best,
Elisabeth Poorman
Labelling persons affected, and the places they live, by their disease.
Leprosy Mailing List,
June 20th, 2009
Ref.: Labelling persons affected, and the places they live, by their disease.
From: Soutar D., London, UK
Dear Salvatore,
With regard to the article posted recently entitled “The Legacy of Brazil’s Leper Colonies” by Elizabeth Poorman (LML May 30th, 2009). This article presents some very interesting elements of the political history of leprosy in Brazil. Her perspectives regarding the perception of “cure” by people who continue to suffer the sequelae of the disease are also important to be reiterated. However, the paper loses its credibility through its frequent and wholly unnecessary use of the term “leper”.
The discrimination and stigma imposed on people affected by leprosy will never end until people cease from labelling persons affected, and the places they live, by their disease.
To continue to use such labels is both disrespectful and affront to the dignity of those affected. As long ago as 1948 the International Leprosy Congress in Havana passed the resolution: “That the use of the term “leper” in designation of the patient with leprosy be abandoned…”
And of course this has been stressed most recently in the Global Appeal of Mr. Sasakawa in London 2009 when he called on media and religious leaders to stop using the term “leper”. Leprosy causes nerve damage and impairments but ultimately it is society that creates ‘disability’ in terms of the continuing stigma and discrimination experienced by those affected.
Our behaviour, our attitudes and the language we use are measures of whether we are part of the problem or part of the solution.
Regards,
Douglas Soutar
General Secretary
International Federation of Anti-Leprosy Associations
Tel: 44 (0) 207 602 69 25 – Fax: 44 (0) 207 371 16 21
Website: www.ilep.org.uk
E-mail: doug.soutar(at)ilep.org.uk
June 20th, 2009
Ref.: Labelling persons affected, and the places they live, by their disease.
From: Soutar D., London, UK
Dear Salvatore,
With regard to the article posted recently entitled “The Legacy of Brazil’s Leper Colonies” by Elizabeth Poorman (LML May 30th, 2009). This article presents some very interesting elements of the political history of leprosy in Brazil. Her perspectives regarding the perception of “cure” by people who continue to suffer the sequelae of the disease are also important to be reiterated. However, the paper loses its credibility through its frequent and wholly unnecessary use of the term “leper”.
The discrimination and stigma imposed on people affected by leprosy will never end until people cease from labelling persons affected, and the places they live, by their disease.
To continue to use such labels is both disrespectful and affront to the dignity of those affected. As long ago as 1948 the International Leprosy Congress in Havana passed the resolution: “That the use of the term “leper” in designation of the patient with leprosy be abandoned…”
And of course this has been stressed most recently in the Global Appeal of Mr. Sasakawa in London 2009 when he called on media and religious leaders to stop using the term “leper”. Leprosy causes nerve damage and impairments but ultimately it is society that creates ‘disability’ in terms of the continuing stigma and discrimination experienced by those affected.
Our behaviour, our attitudes and the language we use are measures of whether we are part of the problem or part of the solution.
Regards,
Douglas Soutar
General Secretary
International Federation of Anti-Leprosy Associations
Tel: 44 (0) 207 602 69 25 – Fax: 44 (0) 207 371 16 21
Website: www.ilep.org.uk
E-mail: doug.soutar(at)ilep.org.uk
Leprosy Patients and their Anxiety: An Anthropological Study in Union Territory of Chandigarh
Leprosy Mailing List,
June 17th, 2009
Ref.: “Leprosy Patients and their Anxiety: An Anthropological Study in Union Territory of Chandigarh”
From: Singh S., Chandigarh, Panjab, India
Respected Sir,
Sir, as you know I am doing my doctoral research on leprosy patients. I am writing one paper on “Leprosy Patients and their Anxiety: An Anthropological Study in Union Territory of Chandigarh”.
Sir, for this I need some favour from you. This is my first paper writing. If possible please give me some feedback on this topic. Sir your guidance will help me a lot.
Hope to hear soon from you.
Sukhbir Singh Capacity Building Officer
Global Fund Project on HIV/AIDS
School of Public Health
PGIMER,Chandigarh
email-buntysen2k(at)gmail.com
Mobile-09888889395
June 17th, 2009
Ref.: “Leprosy Patients and their Anxiety: An Anthropological Study in Union Territory of Chandigarh”
From: Singh S., Chandigarh, Panjab, India
Respected Sir,
Sir, as you know I am doing my doctoral research on leprosy patients. I am writing one paper on “Leprosy Patients and their Anxiety: An Anthropological Study in Union Territory of Chandigarh”.
Sir, for this I need some favour from you. This is my first paper writing. If possible please give me some feedback on this topic. Sir your guidance will help me a lot.
Hope to hear soon from you.
Sukhbir Singh Capacity Building Officer
Global Fund Project on HIV/AIDS
School of Public Health
PGIMER,Chandigarh
email-buntysen2k(at)gmail.com
Mobile-09888889395
Questions on leprosy research
Leprosy Mailing List,
June 17th, 2009
Ref.: Questions on leprosy research
From: Higgins S., Peterborough, England, UK
Dear Dr Noto,
I'm very interested to find out the progress we are making in research into leprosy and would be grateful if any of the members of the LML could enlighten me by answering the questions below:
What are the main current areas of research into leprosy?
What are the most recent findings in relation to leprosy and genetic predisposition, and environmental factors?
Is there any evidence for transmission of leprosy between a mother and her unborn/newborn child?
What evidence is there of leprosy occurring in young children under 3 years of age, and if it is low, is this because we lack the diagnostic tests or because this age group is relatively unaffected?
Are there any statistics to show rate of infection between family members, e.g. is it greater between spouses, siblings or parent-to-child?
Thanks and best wishes,
Siân Siân Higgins
Head of Programmes Coordination,
TLMEW Direct line: 01733 404874
June 17th, 2009
Ref.: Questions on leprosy research
From: Higgins S., Peterborough, England, UK
Dear Dr Noto,
I'm very interested to find out the progress we are making in research into leprosy and would be grateful if any of the members of the LML could enlighten me by answering the questions below:
What are the main current areas of research into leprosy?
What are the most recent findings in relation to leprosy and genetic predisposition, and environmental factors?
Is there any evidence for transmission of leprosy between a mother and her unborn/newborn child?
What evidence is there of leprosy occurring in young children under 3 years of age, and if it is low, is this because we lack the diagnostic tests or because this age group is relatively unaffected?
Are there any statistics to show rate of infection between family members, e.g. is it greater between spouses, siblings or parent-to-child?
Thanks and best wishes,
Siân Siân Higgins
Head of Programmes Coordination,
TLMEW Direct line: 01733 404874
The word "leper" (“L”)
Leprosy Mailing List,
June 17th, 2009
Ref.: The word "leper" (“L”)
From: Manimozhi N., Bangalore, Karnataka, India
Dear Dr. Noto,
This is with reference to LML May 30th 2009 regarding “The legacy of Brazil's leper colonies” attachment paper by Elisabeth Poorman.
If I could recollect there had been a lot of discussion with the Author, on technical, operation, ethical, logical and emotional parameters and stopped. Now it appears again. I really do not want to go to continue discussions on technical aspects but on very sensitive emotional issue the “L” word. In the paper I found words synonymous with leprosy like Hansen’s and the most disliked, discouraged, word “L“.
Many of us keep fighting against use of this words and it seems to be an ever ending battle. Should we give up! If no then what should we do. I do not intend to ridicule the Author, maybe there is a very valid reason. We need to have a fair dialogue with the Author and I would go on to request, plead and what not! Madam please stop using this word “L”.
I can only beg, plead, and request..... please join the movement and try to protect the “Rights of all Persons affected due to leprosy”.
I am sure she did not commit with intentions but out of ignorance – sometimes there is no excuse for ignorance. I am trying to face this situation with a positive attitude and hope, will see a difference a Change!
With best wishes and kindest regards,
Dr. N. Manimozhi
Medical Coordination – AIFO/India
June 17th, 2009
Ref.: The word "leper" (“L”)
From: Manimozhi N., Bangalore, Karnataka, India
Dear Dr. Noto,
This is with reference to LML May 30th 2009 regarding “The legacy of Brazil's leper colonies” attachment paper by Elisabeth Poorman.
If I could recollect there had been a lot of discussion with the Author, on technical, operation, ethical, logical and emotional parameters and stopped. Now it appears again. I really do not want to go to continue discussions on technical aspects but on very sensitive emotional issue the “L” word. In the paper I found words synonymous with leprosy like Hansen’s and the most disliked, discouraged, word “L“.
Many of us keep fighting against use of this words and it seems to be an ever ending battle. Should we give up! If no then what should we do. I do not intend to ridicule the Author, maybe there is a very valid reason. We need to have a fair dialogue with the Author and I would go on to request, plead and what not! Madam please stop using this word “L”.
I can only beg, plead, and request..... please join the movement and try to protect the “Rights of all Persons affected due to leprosy”.
I am sure she did not commit with intentions but out of ignorance – sometimes there is no excuse for ignorance. I am trying to face this situation with a positive attitude and hope, will see a difference a Change!
With best wishes and kindest regards,
Dr. N. Manimozhi
Medical Coordination – AIFO/India
The legacy of Brazil’s leper colonies
Leprosy Mailing List,
June 17th, 2009
Ref.: The legacy of Brazil’s leper colonies
From: Both P., Apeldoorn, The Netherlands
Dear Dr Noto,
You may recall that I responded earlier to an e-mail exchange following mail published in LML written by Ms Elisabeth Poorman, which was about the use of words, in that case ''elimination of leprosy''.
I read the first pages of the above mentioned article (LML May 30th, 2009) written by Ms Elisabeth Poorman about the legacy of Brazil's ''leper'' colonies and I wonder why the term ''leper'' appears. If this is just a reference to a word/name of a colony used in the past and in the context of un-masking ill-intentions of that time?
In that case I can understand the use of the term, but in the text of the article the term ''leper'' continues to be used, even in the context of research done in 2005 - 2007. I just don't understand! Although my interest in ''leprosy'' was raised in the 60th, when I read a book in which the life of patients was described in a colony/leprosarium in Brazil in those 60th, I lost my concentration to read the article to the ''bitter'' end.
Can Ms Poorman assure me I should continue to read and find the change in terminology somewhere as a clue to the un-masking of ill intentions of former leprosy workers?
The book I read about leprosy in Brazil gave me a very high esteem of the persons involved in care! I am not sure whether you would want to publish this at LML.
If you wish you could forward my question to Ms Elisabeth to her e-mail address which I do not have.
Yours sincerely,
Piet Both
TLM Country Development Director
June 17th, 2009
Ref.: The legacy of Brazil’s leper colonies
From: Both P., Apeldoorn, The Netherlands
Dear Dr Noto,
You may recall that I responded earlier to an e-mail exchange following mail published in LML written by Ms Elisabeth Poorman, which was about the use of words, in that case ''elimination of leprosy''.
I read the first pages of the above mentioned article (LML May 30th, 2009) written by Ms Elisabeth Poorman about the legacy of Brazil's ''leper'' colonies and I wonder why the term ''leper'' appears. If this is just a reference to a word/name of a colony used in the past and in the context of un-masking ill-intentions of that time?
In that case I can understand the use of the term, but in the text of the article the term ''leper'' continues to be used, even in the context of research done in 2005 - 2007. I just don't understand! Although my interest in ''leprosy'' was raised in the 60th, when I read a book in which the life of patients was described in a colony/leprosarium in Brazil in those 60th, I lost my concentration to read the article to the ''bitter'' end.
Can Ms Poorman assure me I should continue to read and find the change in terminology somewhere as a clue to the un-masking of ill intentions of former leprosy workers?
The book I read about leprosy in Brazil gave me a very high esteem of the persons involved in care! I am not sure whether you would want to publish this at LML.
If you wish you could forward my question to Ms Elisabeth to her e-mail address which I do not have.
Yours sincerely,
Piet Both
TLM Country Development Director
The scratch due to the finger nail and the rub due to the finger tip
Leprosy Mailing List,
June 3rd, 2009
Ref.: The scratch due to the finger nail and the rub due to the finger tip
From: Ryan T., Oxford, UK
Dear Salvatore,
This is a response to Ben Naafs (LML June 2nd, 2009). He is of course right that scratch marks are not a feature of several conditions that itch, I might add chronic urticaria other than dermographism.
Itching is however a subjective symptom and those who have tried to measure it have had to use scratch, or at least the movement which brings the fingers to the exact site of the irritation, as the only reliable measure of it.
There is a difference between the scratch due to the finger nail and the rub due to the finger tip. No one has explained why these two responses are needed.
Terence Ryan
June 3rd, 2009
Ref.: The scratch due to the finger nail and the rub due to the finger tip
From: Ryan T., Oxford, UK
Dear Salvatore,
This is a response to Ben Naafs (LML June 2nd, 2009). He is of course right that scratch marks are not a feature of several conditions that itch, I might add chronic urticaria other than dermographism.
Itching is however a subjective symptom and those who have tried to measure it have had to use scratch, or at least the movement which brings the fingers to the exact site of the irritation, as the only reliable measure of it.
There is a difference between the scratch due to the finger nail and the rub due to the finger tip. No one has explained why these two responses are needed.
Terence Ryan
WHO Press Release on the Global Programme Managers’ Meeting on Leprosy Control Strategy
Leprosy Mailing List,
June 2nd, 2009
Ref.: WHO Press Release on the Global Programme Managers’ Meeting on Leprosy Control Strategy (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
I am sending you the WHO Press Release on the recently concluded “Global Programme Managers’ Meeting on Leprosy Control Strategy” held in New Delhi, India on 20-22 April 2009.
Thank you for sharing with the discussion list.
Regards,
V. Pannikar
June 2nd, 2009
Ref.: WHO Press Release on the Global Programme Managers’ Meeting on Leprosy Control Strategy (see attachment)
From: Pannikar V., New Delhi, India
Dear Dr Noto,
I am sending you the WHO Press Release on the recently concluded “Global Programme Managers’ Meeting on Leprosy Control Strategy” held in New Delhi, India on 20-22 April 2009.
Thank you for sharing with the discussion list.
Regards,
V. Pannikar
Paraesthesia
Leprosy Mailing List,
June 2nd, 2009
Ref.: Paraesthesia
From: Naafs B., Munnekeburen, The Netherlands
Dear Salvatore,
I love the answer of Dr Anthony Bryceson (LML May 12th, 2009). I too have seen leprosy patients complaining of itch. Both lepromatous patients and patients with active skin lesions. I do not recall to have seen scratch marks which I could relate to leprosy.
But also in, for instance, lichen planus and urticaria scratch marks are usually absent and these lesions surely itch. It is indeed a sign of paraesthesia.
Ben
June 2nd, 2009
Ref.: Paraesthesia
From: Naafs B., Munnekeburen, The Netherlands
Dear Salvatore,
I love the answer of Dr Anthony Bryceson (LML May 12th, 2009). I too have seen leprosy patients complaining of itch. Both lepromatous patients and patients with active skin lesions. I do not recall to have seen scratch marks which I could relate to leprosy.
But also in, for instance, lichen planus and urticaria scratch marks are usually absent and these lesions surely itch. It is indeed a sign of paraesthesia.
Ben
The legacy of Brazil’s leper colonies
Leprosy Mailing List,
May 30th, 2009
Ref.: The legacy of Brazil’s leper colonies (see attachment)
From: Moreira de Sousa A. C., Rio de Janeiro, Brazil
Dear Dr Noto,
Please find in attachment the paper “The legacy of Brazil’s leper colonies” by Elisabeth Poorman.
Best regards,
Artur Custodio Moreira de Sousa
Coordenador Nacional do MORHAN
TELEHANSEN 08000262001
Celular (21) 82263124
May 30th, 2009
Ref.: The legacy of Brazil’s leper colonies (see attachment)
From: Moreira de Sousa A. C., Rio de Janeiro, Brazil
Dear Dr Noto,
Please find in attachment the paper “The legacy of Brazil’s leper colonies” by Elisabeth Poorman.
Best regards,
Artur Custodio Moreira de Sousa
Coordenador Nacional do MORHAN
TELEHANSEN 08000262001
Celular (21) 82263124
Paresthesia in leprosy
Leprosy Mailing List,
May 30th, 2009
Ref.: Paresthesia in leprosy
From: Dhakal K. P., Biratnagar, Nepal
Dear All,
It is interesting topic which is being discussed about itching in leprosy.
As it is obvious itching is not the sign of leprosy, rather usually field workers use the itching sign for differentiating other skin conditions from leprosy. As it has already been explained by many members of the LML, accompanying itchy skin disorders may give the impression of itchy leprosy to some clinicians.
During my 18 years of involvement in the field of leprosy I have noticed that some patients interpret feeling of paresthesia as itching. So the clinicians must be very cautious to label some feelings or interpretations of patients as itching in leprosy.
Dr K P Dhakal
Dermatologist-Leprologist
Netherlands Leprosy Relief Nepal
May 30th, 2009
Ref.: Paresthesia in leprosy
From: Dhakal K. P., Biratnagar, Nepal
Dear All,
It is interesting topic which is being discussed about itching in leprosy.
As it is obvious itching is not the sign of leprosy, rather usually field workers use the itching sign for differentiating other skin conditions from leprosy. As it has already been explained by many members of the LML, accompanying itchy skin disorders may give the impression of itchy leprosy to some clinicians.
During my 18 years of involvement in the field of leprosy I have noticed that some patients interpret feeling of paresthesia as itching. So the clinicians must be very cautious to label some feelings or interpretations of patients as itching in leprosy.
Dr K P Dhakal
Dermatologist-Leprologist
Netherlands Leprosy Relief Nepal
Itching in leprosy ?
Leprosy Mailing List,
May 30th, 2009
Ref.: Itching in leprosy ?
From: Vijayakumaran P., Chennai, India
Dear Dr. Noto,
This is really an interesting discussion. "Fever plus nothing = typhoid until excluded. Itching plus nothing might = lepromatous leprosy until excluded." (Bryceson A. LML May 22nd , 2009).
This seems to be a nice argument.
Many of us must have seen persons with extensive scabies infestation or fungal dermatosis without scratch marks. Tolerance level varies widely among people. Some cannot tolerate mild itching. Others are comfortable even with severe itchy conditions. There was a study undertaken in south India several years ago (not published) when the prevalence of leprosy was high. It intended to correlate clinical suspicion of infiltration for early diagnosis of early lepromatous leprosy. The study was conducted in an area served by a Non-Governmental-Organisation implementing the National Leprosy Eradication Programme with 20 leprosy field workers, four supervisors and a Medical Officer.
Majority of the staff were engaged in leprosy work for more than 10 years. They did a survey in few selected villages looking for infiltration in the face. Several persons were listed as having suspected infiltration by these experienced workers. Slit-skin smear examination revealed that none of them was positive for AFB and hence not leprosy. What the "experienced" eyes see can also be deceiving. Manifestation of leprosy is a slow process more so in lepromatous leprosy.
General teaching is that multiplication of leprosy bacilli is very slow. I understand that rapid infiltration is a sign of lepra reaction. If itching were a sign of infiltration then it should have been a presenting symptom for all types of leprosy skin lesions. 1. Presenting complaint from the affected person is joint pain in many instances where it is actually neuritis. 2. Bleeding from nose may be a presenting symptom of lepromatous leprosy 3. Tingling sensation is interpreted as pain by many which can happen in neuritis. It does not mean that one should suspect leprosy in a person when presenting symptom is joint pain etc.
A common observation is that eyes do not see what the mind does not know. Even if mind does know, the presentation can be masked by many other skin conditions. Several such instances have been reported in previous communications. I like to sound caution that this concept of itching may mislead health workers or medical personnel in his/her diagnostic capabilities.
The equation formulated by Dr. Anthony Bryceson can be a good research question.
Vijayakumaran P
May 30th, 2009
Ref.: Itching in leprosy ?
From: Vijayakumaran P., Chennai, India
Dear Dr. Noto,
This is really an interesting discussion. "Fever plus nothing = typhoid until excluded. Itching plus nothing might = lepromatous leprosy until excluded." (Bryceson A. LML May 22nd , 2009).
This seems to be a nice argument.
Many of us must have seen persons with extensive scabies infestation or fungal dermatosis without scratch marks. Tolerance level varies widely among people. Some cannot tolerate mild itching. Others are comfortable even with severe itchy conditions. There was a study undertaken in south India several years ago (not published) when the prevalence of leprosy was high. It intended to correlate clinical suspicion of infiltration for early diagnosis of early lepromatous leprosy. The study was conducted in an area served by a Non-Governmental-Organisation implementing the National Leprosy Eradication Programme with 20 leprosy field workers, four supervisors and a Medical Officer.
Majority of the staff were engaged in leprosy work for more than 10 years. They did a survey in few selected villages looking for infiltration in the face. Several persons were listed as having suspected infiltration by these experienced workers. Slit-skin smear examination revealed that none of them was positive for AFB and hence not leprosy. What the "experienced" eyes see can also be deceiving. Manifestation of leprosy is a slow process more so in lepromatous leprosy.
General teaching is that multiplication of leprosy bacilli is very slow. I understand that rapid infiltration is a sign of lepra reaction. If itching were a sign of infiltration then it should have been a presenting symptom for all types of leprosy skin lesions. 1. Presenting complaint from the affected person is joint pain in many instances where it is actually neuritis. 2. Bleeding from nose may be a presenting symptom of lepromatous leprosy 3. Tingling sensation is interpreted as pain by many which can happen in neuritis. It does not mean that one should suspect leprosy in a person when presenting symptom is joint pain etc.
A common observation is that eyes do not see what the mind does not know. Even if mind does know, the presentation can be masked by many other skin conditions. Several such instances have been reported in previous communications. I like to sound caution that this concept of itching may mislead health workers or medical personnel in his/her diagnostic capabilities.
The equation formulated by Dr. Anthony Bryceson can be a good research question.
Vijayakumaran P
The educational value of our leprosy mailing list (LML)
Leprosy Mailing List,
May 28th, 2009
Ref.: The educational value of our leprosy mailing list (LML)
From: Al Aboud K., Mecca, Saudi Arabia
Dear Salvatore,
Greetings, As you know the interactive internet mailing lists, as LML, are important resources for medical professionals. Please visit this link:- http://www.skinandaging.com/content/interactive-internet-dermatology-mailing-lists-an-important-educational-tool
I would like to share with our LML colleagues this manuscript (Interactive Internet Dermatology mailing Lists: An Important Educational Tool) and I look forward for comments.
With my best wishes and regards.
Sincerely,
Dr Khalid Al Aboud
Medical Director and Consultant Dermatologist
King Faisal Hospital ,
P.O Box 5592
Makkah Saudi Arabia
Tel.: 0096625566411 ext 6666 Fax: 0096625563523
E-mail: alaboudkhalid(at)yahoo.ca
May 28th, 2009
Ref.: The educational value of our leprosy mailing list (LML)
From: Al Aboud K., Mecca, Saudi Arabia
Dear Salvatore,
Greetings, As you know the interactive internet mailing lists, as LML, are important resources for medical professionals. Please visit this link:- http://www.skinandaging.com/content/interactive-internet-dermatology-mailing-lists-an-important-educational-tool
I would like to share with our LML colleagues this manuscript (Interactive Internet Dermatology mailing Lists: An Important Educational Tool) and I look forward for comments.
With my best wishes and regards.
Sincerely,
Dr Khalid Al Aboud
Medical Director and Consultant Dermatologist
King Faisal Hospital ,
P.O Box 5592
Makkah Saudi Arabia
Tel.: 0096625566411 ext 6666 Fax: 0096625563523
E-mail: alaboudkhalid(at)yahoo.ca
WER n. 20, 15 May 2009. Leprosy in Yemen: trends in case detection, 1982-2008
Leprosy Mailing List,
May 28th, 2009
Ref.: WER n. 20, 15 May 2009. Leprosy in Yemen: trends in case detection, 1982-2008
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find in attachment the Weekly Epidemiological Record n. 20, 15 may 2009. It is intended for your kind information and for the members of the leprosy mailing list. Thank you very much in advance for circulating it.
I would like to encourage Countries to carefully analyze their leprosy data and look at disease trends.
Regards,
V. Pannikar
May 28th, 2009
Ref.: WER n. 20, 15 May 2009. Leprosy in Yemen: trends in case detection, 1982-2008
From: Pannikar V., New Delhi, India
Dear Dr Noto,
Please find in attachment the Weekly Epidemiological Record n. 20, 15 may 2009. It is intended for your kind information and for the members of the leprosy mailing list. Thank you very much in advance for circulating it.
I would like to encourage Countries to carefully analyze their leprosy data and look at disease trends.
Regards,
V. Pannikar
Early LL might present as itching
Leprosy Mailing List,
May 22nd, 2009
Ref.: Early LL might present as itching
From: Bryceson A., London, UK
Dear Salvatore,
This is a very interesting discussion in response to Dr Pai's letter (LML April 25th, 2009), but is in danger of losing its focus.
The question is not whether patients with leprosy may itch; they may for the same reasons as patients without leprosy.
The question is whether itching may be a symptom of early lepromatous leprosy. This is the stage when the skin is becoming rapidly infiltrated with bacilli that are mulltiplying in dermal histiocytes and Schwann cells of peripheral nerve fibres. It was my first leprosy teacher Dr Richard Buker, who had great experience in Burma, Thailand and Laos, who told me that early LL might present as itching. I have seen this 3 or 4 times, and particularly recall an Ethiopian girl whose only symptom was that of itching; no skin lesions were visible; slit skin smears were full of AFB. It was because of these experiences that Roy Pfaltzgraff and I stated in our little text book "Leprosy" "Rarely, a short period of generalised itching may herald the onset of diffuse rapidly progressive lepromatous leprosy".
Stanley Browne, a stickler for accuracy and good English, very kindly sent me his review copy of the 1st edition. He had found about 10 errors on each page; but he allowed the sentence on itching.
So itching is a known symptom, and it has crept into a text book. But Dr Vijayakumaran and others are right; itching has many causes, and these need to be looked for, but not at the expense of missing leprosy.
Others have mentioned itching in association with reactions; itching is common after cutaneous inflammation from any cause. I have sometimes wondered why a hot wet climate may cause itching, with or without prickly heat; might the itching be due to stretching of dermal structures?
The argument has been raised that itching in leprosy is not genuine itching, but paresthesia. But then itching is a form of paresthesia. So we might not all interpret our symptoms in quite the same way. Ho do I know that what I see as yellow is the same as what you see yellow? So I don't think this argument is important. But I like Terence Ryan's comment (LML May 1st, 2009) that true itching leads to scratching and scratch marks. Perhaps we should look more closely at these patients in future. Fever plus nothing = typhoid until excluded.
Itching plus nothing might = lepromatous leprosy until excluded.
Anthony
May 22nd, 2009
Ref.: Early LL might present as itching
From: Bryceson A., London, UK
Dear Salvatore,
This is a very interesting discussion in response to Dr Pai's letter (LML April 25th, 2009), but is in danger of losing its focus.
The question is not whether patients with leprosy may itch; they may for the same reasons as patients without leprosy.
The question is whether itching may be a symptom of early lepromatous leprosy. This is the stage when the skin is becoming rapidly infiltrated with bacilli that are mulltiplying in dermal histiocytes and Schwann cells of peripheral nerve fibres. It was my first leprosy teacher Dr Richard Buker, who had great experience in Burma, Thailand and Laos, who told me that early LL might present as itching. I have seen this 3 or 4 times, and particularly recall an Ethiopian girl whose only symptom was that of itching; no skin lesions were visible; slit skin smears were full of AFB. It was because of these experiences that Roy Pfaltzgraff and I stated in our little text book "Leprosy" "Rarely, a short period of generalised itching may herald the onset of diffuse rapidly progressive lepromatous leprosy".
Stanley Browne, a stickler for accuracy and good English, very kindly sent me his review copy of the 1st edition. He had found about 10 errors on each page; but he allowed the sentence on itching.
So itching is a known symptom, and it has crept into a text book. But Dr Vijayakumaran and others are right; itching has many causes, and these need to be looked for, but not at the expense of missing leprosy.
Others have mentioned itching in association with reactions; itching is common after cutaneous inflammation from any cause. I have sometimes wondered why a hot wet climate may cause itching, with or without prickly heat; might the itching be due to stretching of dermal structures?
The argument has been raised that itching in leprosy is not genuine itching, but paresthesia. But then itching is a form of paresthesia. So we might not all interpret our symptoms in quite the same way. Ho do I know that what I see as yellow is the same as what you see yellow? So I don't think this argument is important. But I like Terence Ryan's comment (LML May 1st, 2009) that true itching leads to scratching and scratch marks. Perhaps we should look more closely at these patients in future. Fever plus nothing = typhoid until excluded.
Itching plus nothing might = lepromatous leprosy until excluded.
Anthony
Pruritus as a possible premonitory symptom of leprosy
Leprosy Mailing List,
May 22nd, 2009
Ref.: Pruritus as a possible premonitory symptom of leprosy
From: Pai V. V., Ganapati R., Mumbai, India
Dear Dr Noto,
With the exception of a few responders who have pointed out pruritus as a possible premonitory symptom of leprosy, others have explained in detail about associated skin diseases.
We agree with remarks from these experts as regards other skin conditions. However, the object of pointing out our experience with patients complaining of a subjective feeling of itching as the presenting symptom in leprosy patients is restricted to those un-associated with other conditions causing pruritus. We appreciate that some observers have noticed this symptom prior to the occurrence of lesions due to reactions and relapses.
Moreover, we would like to have some light to be thrown on the patho-physiology of this phenomenon rarely encountered exclusively in leprosy.
Regards,
Dr VV Pai
Director
Bombay Leprosy Project
and Dr R Ganapati
Director Emeritus, BLP
May 22nd, 2009
Ref.: Pruritus as a possible premonitory symptom of leprosy
From: Pai V. V., Ganapati R., Mumbai, India
Dear Dr Noto,
With the exception of a few responders who have pointed out pruritus as a possible premonitory symptom of leprosy, others have explained in detail about associated skin diseases.
We agree with remarks from these experts as regards other skin conditions. However, the object of pointing out our experience with patients complaining of a subjective feeling of itching as the presenting symptom in leprosy patients is restricted to those un-associated with other conditions causing pruritus. We appreciate that some observers have noticed this symptom prior to the occurrence of lesions due to reactions and relapses.
Moreover, we would like to have some light to be thrown on the patho-physiology of this phenomenon rarely encountered exclusively in leprosy.
Regards,
Dr VV Pai
Director
Bombay Leprosy Project
and Dr R Ganapati
Director Emeritus, BLP
Desquamation is different from ichthyotic changes
Leprosy Mailing List,
May 22nd, 2009
Ref.: Desquamation is different from ichthyotic changes
From: Manimozhi N., Bangalore, India
Respected and dear Dr. Jerajani,
I refer to your LML message dated April 30th, 2009. Thank you very much for adding on information through our discussions and exchanging views and enriching ourselves. While I completely agree with you regarding the mild side effects of clofazimine causing itching sensation (also causes burning sensation eyes due to its effect on tear secretion).
However while lepra reactions (Type1/Reversal reaction) are subsiding the scaly dry skin surface is generally referred to as desquamation quite different from ichthyotic changes which have a different patho-physiological reason altogether with reference to leprosy. This was what we were taught and we continued to teach. I request you to kindly clarify my confusion.
With best wishes and kindest regards,
Dr. N. Manimozhi
Medical Coordination-AIFO Bangalore
May 22nd, 2009
Ref.: Desquamation is different from ichthyotic changes
From: Manimozhi N., Bangalore, India
Respected and dear Dr. Jerajani,
I refer to your LML message dated April 30th, 2009. Thank you very much for adding on information through our discussions and exchanging views and enriching ourselves. While I completely agree with you regarding the mild side effects of clofazimine causing itching sensation (also causes burning sensation eyes due to its effect on tear secretion).
However while lepra reactions (Type1/Reversal reaction) are subsiding the scaly dry skin surface is generally referred to as desquamation quite different from ichthyotic changes which have a different patho-physiological reason altogether with reference to leprosy. This was what we were taught and we continued to teach. I request you to kindly clarify my confusion.
With best wishes and kindest regards,
Dr. N. Manimozhi
Medical Coordination-AIFO Bangalore
ALERT announcement for 3 international courses
Leprosy Mailing List,
May 21st, 2009
Ref.: ALERT announcement for 3 international courses (see attachments 1 2 3)
From: Brandsma W., Addis Ababa, Ethiopia
Dear Dr Noto, Please find attached announcements (one, two, three) for three international courses that could be very beneficial for health professionals working in the disability/leprosy field. I would appreciate it if you could make these courses known through the LML.
Sincerely yours,
Wim Wim Brandsma, RPT, PhD
ALERT P.O.Box 165
Addis Ababa
Ethiopia
+251-11-3211371
New email: jwbrandsma(at)gmail.com
May 21st, 2009
Ref.: ALERT announcement for 3 international courses (see attachments 1 2 3)
From: Brandsma W., Addis Ababa, Ethiopia
Dear Dr Noto, Please find attached announcements (one, two, three) for three international courses that could be very beneficial for health professionals working in the disability/leprosy field. I would appreciate it if you could make these courses known through the LML.
Sincerely yours,
Wim Wim Brandsma, RPT, PhD
ALERT P.O.Box 165
Addis Ababa
Ethiopia
+251-11-3211371
New email: jwbrandsma(at)gmail.com
Leprosy in ICD 10
Leprosy Mailing List,
May 20th, 2009
Ref.: Leprosy in ICD 10
From: Frankel R. I., Honolulu, Hawaii, USA
Dear Dr Noto,
I agree with Dr Al Aboud (LML May 18th, 2009) that it would be better to have separate codes for Type 1 (reversal) and Type 2 (erythema nodosum leprosum) leprosy reactions. Since no codes are provided in Section A30 of Chapter I, one can use the following from Chapter III.
D89.8 Other specified disorders involving the immune mechanism, not elsewhere classified
D89.9 Disorder involving the immune mechanism, unspecified In addition, health care providers may have occasion to use Z codes in Chapter XXI when screening individuals suspected of having leprosy, contacts of leprosy, or populations thought to be at increased risk. Codes can include
Z00.8 Other general examinations Health examination in population surveys or
Z02.9 Examination for administrative purposes, unspecified for those who are asymptomatic and
Z03.8 Observation for other suspected diseases and conditions
for those who are screened because of a skin (or other) lesion but felt not to have leprosy or at least not to require any treatment for leprosy or its complications. Thank you.
Richard I. Frankel, M.D., M.P.H., F.A.C.P.
Emeritus Professor of Medicine
University of Hawai'i
May 20th, 2009
Ref.: Leprosy in ICD 10
From: Frankel R. I., Honolulu, Hawaii, USA
Dear Dr Noto,
I agree with Dr Al Aboud (LML May 18th, 2009) that it would be better to have separate codes for Type 1 (reversal) and Type 2 (erythema nodosum leprosum) leprosy reactions. Since no codes are provided in Section A30 of Chapter I, one can use the following from Chapter III.
D89.8 Other specified disorders involving the immune mechanism, not elsewhere classified
D89.9 Disorder involving the immune mechanism, unspecified In addition, health care providers may have occasion to use Z codes in Chapter XXI when screening individuals suspected of having leprosy, contacts of leprosy, or populations thought to be at increased risk. Codes can include
Z00.8 Other general examinations Health examination in population surveys or
Z02.9 Examination for administrative purposes, unspecified for those who are asymptomatic and
Z03.8 Observation for other suspected diseases and conditions
for those who are screened because of a skin (or other) lesion but felt not to have leprosy or at least not to require any treatment for leprosy or its complications. Thank you.
Richard I. Frankel, M.D., M.P.H., F.A.C.P.
Emeritus Professor of Medicine
University of Hawai'i
On the use of telephone for tracing absentee/defaulter in leprosy
Leprosy Mailing List,
May 18th, 2009
Ref.: On the use of telephone for tracing absentee/defaulter in leprosy
From: Kruijff A. (de), Pemba, Cabo Delgado, Mozambique
Dear Dr. Edward, Thank you for your message dated LML April 25th, 2009. Here in Mozambique we have been working on a possibly related issue that may or may not be of interest to you.
In the north of Mozambique we have fair cellphone coverage and nearly all healthcare workers have a cellphone. We have set up a automatic cellphone patient notification system whereby new diagnosed cases and completion of treatment notifications can be done via normal SMS message.
A server receives these messages, does a basic integrity test, and if it passes puts the patient in the provincial/national leprosy register. It then sends a message to the sender to confirm reception and to pass on the unique patient number. It can also be used to automatically send reminders from time to time to nurses/supervisors following up patients, and if patients have cellphones you could work it that they are reminded as well.
It uses simple hardware for instance an old laptop and oldish cellphone connected to the laptop. Software is free - Ubuntu, MySql and Gammu. The project here is still in development and is unfortunately standing still at present due to time constraints. We have not done any studies to evaluate effectiveness.
Kind regards,
Arie de Kruijff
TLM-Mozambique
May 18th, 2009
Ref.: On the use of telephone for tracing absentee/defaulter in leprosy
From: Kruijff A. (de), Pemba, Cabo Delgado, Mozambique
Dear Dr. Edward, Thank you for your message dated LML April 25th, 2009. Here in Mozambique we have been working on a possibly related issue that may or may not be of interest to you.
In the north of Mozambique we have fair cellphone coverage and nearly all healthcare workers have a cellphone. We have set up a automatic cellphone patient notification system whereby new diagnosed cases and completion of treatment notifications can be done via normal SMS message.
A server receives these messages, does a basic integrity test, and if it passes puts the patient in the provincial/national leprosy register. It then sends a message to the sender to confirm reception and to pass on the unique patient number. It can also be used to automatically send reminders from time to time to nurses/supervisors following up patients, and if patients have cellphones you could work it that they are reminded as well.
It uses simple hardware for instance an old laptop and oldish cellphone connected to the laptop. Software is free - Ubuntu, MySql and Gammu. The project here is still in development and is unfortunately standing still at present due to time constraints. We have not done any studies to evaluate effectiveness.
Kind regards,
Arie de Kruijff
TLM-Mozambique
On the use of telephone for tracing absentee/defaulter in leprosy
Leprosy Mailing List,
May 18th, 2009
Ref.: On the use of telephone for tracing absentee/defaulter in leprosy (see attachment)
From: Ganapati R., Mumbai, India
Dear Dr Noto,
In response to Dr Edward Eremugo Luka’s query (LML April 25th 2009), I invite the attention of all readers of leprosy mailing list the attached report (not published). We in Bombay Leprosy Project (BLP) have been pioneers in using mobile phones for tracing defaulters ever since this technology came into vogue in 1998.
With regards,
Dr R Ganapati
Director Emeritus
Bombay Leprosy Project
May 18th, 2009
Ref.: On the use of telephone for tracing absentee/defaulter in leprosy (see attachment)
From: Ganapati R., Mumbai, India
Dear Dr Noto,
In response to Dr Edward Eremugo Luka’s query (LML April 25th 2009), I invite the attention of all readers of leprosy mailing list the attached report (not published). We in Bombay Leprosy Project (BLP) have been pioneers in using mobile phones for tracing defaulters ever since this technology came into vogue in 1998.
With regards,
Dr R Ganapati
Director Emeritus
Bombay Leprosy Project
Leprosy in ICD 10
Leprosy Mailing List,
May 18th, 2009 Ref.:
May 18th, 2009 Ref.:
Leprosy in ICD 10
From: Al Aboud K., Mecca, Saudi Arabia
Dear Salvatore, Greetings, As you know many hospital in the world including mine are adapting a computer net work for patients' files. They are using mostly, ICD 10. Please visit this link:-
However, you and other LML members may agree that there might be a need for some changes in ICD 10 regarding leprosy. Namely, there is no subheading under the sequelae of leprosy in B92. There is no clear subheadings for leprosy reactions. However A.30.8 is given for other forms of leprosy, and A.30.9 is given for leprosy unspecified. Most importantly, the resistance to antibiotics are not given in Chapter 1 together with leprosy but kept in Chapter 22 together with U00-U99 Codes for special purposes. Bacterial agent resistant to antibioticsU80-U89. U88 is given for agent resistant to multiple antibiotics. I look forward to the comments of LML members. With my best wishes and regards.
Sincerely, Dr Khalid Al Aboud
Medical Director and Consultant Dermatologist
King Faisal Hospital ,
P.O Box 5592 Makkah
Saudi Arabia
Tel.: 0096625566411 ext 6666 Fax: 0096625563523
E-mail: alaboudkhalid(at)yahoo.ca