Leprosy Mailing List – August 20, 2013
Ref.: (LML) Nerve impairment, sensory testing and M.leprae immune status
From: D Porichha, Orissa, India
Dear Pieter,
This is regarding the different method of testing sensation of leprosy patients. Dr Das is adding an interesting dimension to the issue under direction. It is interesting because tissue damage is proportional to immune response than anything else.
My responses need for some clarity are as follows:
1. In leprosy in some areas there are dual procedures. For example in classification we have MB, PB for field and RJ system for institution/research/ may be better quality. For MB classification smear positivity and more than 5 patches. These are just to name the two. Hence whatever new improvement we are thinking I feel we should think to have such dual approach. For nerve function assessment ball pen is good enough, but say, for RCS (reconstructive surgery) evaluation SWM may be more suitable. For field use in leprosy either has equal validity in their own contexts.
2. Coming to the status of immune reaction or its effect, an infected person may belong to any one of the following categories:
• Presence M.leprae / AFB within the cell or tissue but no tissue repose- as phagocytosis has already taken place which is viewed often as innate immunity.
• Perineural or neural infiltration of lymphocytes- indeterminate leprosy, probably a pre-sensitized state.
• Polar lepromatous leprosy (P) - granulomatous but only innate immune reaction-no sensitization?
• Tuberculoid leprosy (P)- strong delayed hypersensitivity- strongly sensitized.
• Both types of reaction with no or under treatment.
• Both types of reactions completed MDT but tissue containing antigens.
3. Each of the groups is likely to give different results. Even if an ideal testing method is identified it will be difficult to correlate with the immune response nerve . My contention may be wrong.
Dr. D Porichha
Consultant, LEPRA India, Bhubaneswar
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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