BI and MI results in BB, BL and LL leprosy

Leprosy Mailing List – October 4^th, 2011

Ref.:    BI and MI results in BB, BL and LL leprosy

From:  L Duncan, Peebles, Scotland, UK

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Thanks Salvatore,

I would like commenting on Dr Verduga and Barreto’s letters dated respectively LML 27^th Sept. and 2^nd Oct. 2011.  About Dr Verduga’s clinical cases (see attachment) I would agree that the last 2 slides (cases 4 and 5) should have been with a bacteriological index of 5+ and with a positive morphological index (MI) as well.  The mid borderline (BB) ones are often more difficult to get as positives but again should have been positive with a positive MI.

Dr Barreto’s letter commenting on the methodology for taking the smears is well made ... as was the second point about the strength of alcohol-acid to decolourise ...

I am sure that you will find in many countries the over-simplification of methodology to diagnose and treat leprosy, together with inadequacy of follow up - so many people with leprosy are told 'Here is your treatment, 'MDT Cure' and you do not need to come back to see us for check-up'' has added to the present apparent resurgence of leprosy in many countries.

The failure to teach about the risk of pregnancy for the woman with leprosy and the need to check her during and after delivery, and to follow up for at least a year after delivery also has to be addressed.

I recently saw one such woman who did all that she was told, was not supervised after delivery and was bedridden with severe reaction and neuritis for a year after delivery.  By the grace of God she was seen unofficially / accidentally (!) by someone who recognised the problem and gave her appropriate treatment and advice for the babe.

Lysbeth Duncan