Leprosy Mailing List – October 21, 2013
Ref.: (LML) MB patients without clear treatment status and chronic ENL
From: Maneesha Godbole, Andhra Pradesh, India
Dear Dr. Schreuder,
I would like to refer to the letter of Prof. José Augusto da Costa Nery of 17 October 2013.
If it is possible to obtain information about their treatment status from the state that they have migrated in from, it would be excellent. This is possible if the records are maintained and there exists a good communication system. I have no idea how it would be in your country. In India, it would be possible if the patient migrates in from within the same state, but difficult if from another state. If the patient gives the history of having completed treatment recently, then of course it would take time for the BI to come down.
However, if the history is very unreliable, it would be safer to restart and complete a full course of MDT, not only for the patient's benefit, but also in the interest of the community, to prevent transmission.
The Type II reaction can be managed with Thalidomide and steroids as required. Starting the patient on high dose of clofazimine would reduce the frequency and severity of the episodes. It can be given in the dose of 100 mg 3 times a day for 3 months, then 100 mg 2 times a day for 3 months, followed by 100 mg once a day for 3 months and then reduce to 50 mg daily.
With best wishes,
Dr.Maneesha Godbole
India
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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