Leprosy Mailing List – March 6, 2013
Ref.: (LML) Serological tests for leprosy
From: Dr. Jaison Barreto, Bauru, Brazil
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Dear Editor,
Dear Pieter
We all (leprologists) know that diagnosis of leprosy is essentially based on clinical and epidemiological background. It is easy, usually, for a skilled professional, to make the differential diagnosis between typical cases of Borderline or Lepromatous leprosy and other diseases.
The main problems are to diagnose Indeterminate leprosy in children, Tuberculoid leprosy in patients with mental disturbances, and to distinguish Primary neural leprosy from other neuropathies. What could a serological test help us? Only maybe to prevent the misclassification of MB cases as PB ones.
For example, WHO Classification states that, for borderline patients with type 1 reaction which started before treatment, MDT MB must be given, once they have more than 5 lesions. However, if the reaction occurs after the treatment, and less than 6 clinical lesions were seen before treatment, MDT PB must be done, despite dozen of lesions be present. The same disease, two regimens.
According to WHO Classification, a patient with 1 leproma must be treated with MDT PB, because there is "only 1 visible lesion". Should we treat this patient with thalidomide only, if he develops ENL? What should be the MDT regimen for a patient with bacilloscopy = 4+ inside nerve branches, and negative in index points or lesions?
I think serological tests could be useful in these cases, once the levels of immune-globulins are proportional to the amount of antigens in most diseases caused by intracellular parasites.
Regards,
Dr. Jaison A. Barreto, MD, PhD
Chief of the Leprosy Section
Instituto Lauro de Souza Lima
Bauru - SP - Brazil
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Contact: Dr Pieter Schreuder << editorlml@gmail.com >>.
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