Leprosy Mailing List – December 9, 2013
Ref.: (LML) Higher risk of relapses in BL/LL with BI 4 or more after MDT-U and MDT 12 doses
From: Jingquan Wang, Zhejiang, China
Dear Dr. Schreuder,
I would like to present a BL patient with initial BI 3. He received 40 months of MDT and was released from treatment without any active symptoms and without disabilities. During the subsequent follow-up of ten years, he showed no signs of activity and his annual skin smears remained negative. However, in the 11th year of follow-up he presented himself first with numbness feet, then left foot drop and later on an one sided facial paralysis. Examination showed no active skin lesions or neuralgia and the skin smears were still negative. The patient was diagnosed as silent neuritis and treated for six months with prednisone and Vit B1. His foot drop and facial paralysis recovered, numbness feet are still present.
China adopted the new one year course of MDT for MB patients and now, United MDT is being discussed. I think that one should be very carefully and that strong evidence should be collected before introducing such a new policy. Patients released from treatment should be follow-up regularly, especially regarding MB patients this should be imperative as care for patients with disabilities
I am working in a leprosarium in southern China. In recent years, I have the impression that more reaction cases after release from MDT, especially 2 – 3 years after stopping MDT, have been admitted. I think that is because of the reduced duration of MDT and irregular follow-up. I have the same feeling as Dr. Jaison Barreto as expressed in his LML letter of December 5: “Higher risk of relapses in BL/LL with BI 4 or more after MDT-U and MDT 12 doses”. I cannot imagine the terrible vision that many MB patients are declared cured or discharged with only 6 months of unified MDT regimen. I would like to suggest that MB patients could be treated with an one year course of MDT, but that regular follow-up and care when needed should be emphasized. Any decision related to leprosy control policy should be made also from the perspective of the patient.
Best regards,
Jingquan Wang
Chief physician,
Institute of Dermatology of Zhejiang Province,
China,313200
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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