Wednesday, April 29, 2015

(LML) The Missing Millions: A Threat to the Elimination of Leprosy

Leprosy Mailing List – April 29,  2015

Ref.:    (LML) The Missing Millions: A Threat to the Elimination of Leprosy

From: Grace Warren, Sidney, Australia


Dear Pieter,

Interested to read the letter from Dr Shen Jianping regarding the  presence of Leprosy today and the stated fall in incidence (LML April 28, 2015). Yes the article Bt Dr Smith was excellent and does raise problems that still need to be solved.

I agree that we would like better means of testing to diagnose if a patient has leprosy and also  I would be interested to be able to test  a patient who was treated years ago  to find out if he still has any viable  bacteria and if he is likely to relapse.

The diagnosis of leprosy is not always easy. In fact, when working in Hong Kong I soon discovered that many of the early LL type patients had NO obvious skin lesions and certainly no abnormalities of sensation and so would not be diagnosed as leprosy according to the WHO “diagnostic criteria”.  Careful observation often revealed a thickening of the skin but no definite edges so not enough to be called a definite patch,  and easily missed. When we did a slit skin smear we got the diagnosis.  I well remember one teenaged boy who was put in a psychiatric institution because he complained of anaesthesia of  some fingers of the right hand. He was brought to see me for a large lymph node in the neck which  on biopsy proved to be leprosy but I found the nerves on the hand were all large. He was typical of so many primary persistent neuritic leprosy patients  that I have so often see all round the world, and  they are often told, even by WHO consultants, No it is not leprosy because no anaesthetic skin patch!

Over the last 50 plus years I have worked with leprosy patients in over 27 countries and similar problem exist in most. The medical students are literally not taught enough about the disease and its symptomology.  As a Medical Student here in Australia, in the 1940/50s, we were taught very little, and as I always tell the students “what you do not look for you will never see”  and “what you do not know you will never diagnose”.  In the last twenty years I have been seeing patients here in Australia - yes they are here too - some white skinned and born here, some aboriginals - but a number have come from overseas and not previously diagnosed. Though some come with a diagnosis and are on treatment, but have so little to show that  the local General Practitioner  does not consider  it a problem and do not try and follow up.  One recent arrival from overseas presented with  a partly paralysed hand which was accepted for reconstructive surgery - but fortunately the surgeon took a nerve biopsy and was horrified at the diagnosis of leprosy!!!  So he was referred back to us.

Even back in the 1960s I remember working in countries where  leprosy was endemic with thousands of patients,  but when visiting as a consultant,  I was often asked to give a lecture on Leprosy and that was often the first leprosy lecture given in that Medical College. In one college the lecture was the result of having diagnosed a leprosy patient in their outpatients !

Yes, it has been said that Leprosy has been Eliminated, but some leprologists in endemic countries acknowledge that there are thousands of mild early cases, especially child contacts, who have the disease but because it does not fulfil the Who definition they are not included in the Statistics. Treatment is easily available and relatively cheap but unless the medical practitioners look for it they are not going to diagnose it.

A major need is to inform the Medical Practitioners that it is still present and often in forms that are easily hidden. Working in Taiwan in 1970s, I well remember a number of patients with LL disease and positive skin smears  who responded well to treatment but stated that No one knew that they had the disease !!! I found that in Chinese LL patients there was often no evidence of sensory abnormalities, let alone anaesthesia for up to twenty years of the disease!!! My query is how can we get the current practitioners to  look for a disease that is so clever  at remaining hidden!! Can the researchers find some test that will detect  the disease early? How can we awaken awareness - teach students, and keep checking the children, and child contacts of those who have had it. I agree it is unlikely that it will ever be completely eliminated, but Hopefully the numbers affected can  be much further reduced.

With best wishes to those involved in the research and teaching about the disease and especially the work being done through LML.

Grace Warren

Now in Australia. Former adviser in leprosy and reconstructive surgery for The Leprosy Mission in Asia ( 1975-1993).


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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(LML) The Missing Millions: A Threat to the Elimination of Leprosy

 

Leprosy Mailing List – April 29,  2015

Ref.:    (LML) The Missing Millions: A Threat to the Elimination of Leprosy

From: Pranab Kumar Das,   Birmingham, UK


Dear Pieter,


Please refer to the email by Smith et al. attached article appeared in Plos NTD (LML April 25, 2015) and the very interesting reply to it  by Dr Shen Jianping (LML April 28, 2015).

I must say that I do appreciate and rather agree with the points mentioned by Dr Jianping. At this juncture, my reserved comment on the article by Smith et al is that the article has been written as kind of a special note from a ‘think tank team' with self-motivated jargons from specialised experts. But when reading through it, the message comes through to me like note from a team of preachers.


It is high time that we should accept the fact that (I quote) “the battle front against leprosy will shrink and will not spread globally though the disease like tuberculosis will not be eradicated per se".


It should also be emphasised that the treatment of leprosy with MDT or any other needs to be personalised rather than through routine WHO protocol one for all for one, basis.


More in future.


Professor Pranab Kumar Das


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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(LML) The Missing Millions: A Threat to the Elimination of Leprosy

Leprosy Mailing List – April 29,  2015

Ref.:    (LML) The Missing Millions: A Threat to the Elimination of Leprosy

From:  Charles Mang’ombe, Mazabuka, Zambia


Dear Pieter,

 

I totally agree with Shen Jianping on sustaining the current Leprosy activities whilst waiting for new tools for Leprosy work (LML April 28, 2015).

 

However, to continue community awareness without dealing with capacity building on how to manage leprosy in our current Health Staff may not go well. In a number of countries, the hastiness in proclaiming Leprosy elimination by Governments without sustained LECs has led to very poor/reduced index of suspicion for leprosy as in most Health Training Schools Leprosy has fallen off the Syllabus.

 

Capacity building in Health Workers as well as sustained LECs would do us good.

 

Charles Mang'ombe, Zambia.

 


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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Tuesday, April 28, 2015

(LML) Parenteral treatment of leprosy reactions

Leprosy Mailing List – April 28, 2015

Ref.: (LML) Parenteral treatment of leprosy reactions  

From:  Herman Harun, Jakarta, Indonesia


Dear Pieter,

May I have the opinion of the LML readers on the parenteral treatment of leprosy reactions with a bolus of 125 mg prednisolone?

After 1 – 3 boluses depending on the initial reaction, the standard treatment with 40 mg prednisolone orally is to be continued.

My questions are:

1.     Will it shorten the duration of the pain?

2.     Will it reduce the pain?

3.     Can it shorten the duration of standard oral treatment?

4.   Can it help preventing neurological damage?

Awaiting your response and thanking you in advance,

 

Yours sincerely,

Dr Muherman Harun

The Bellezza Permata Hijau

Albergo Tower

31st floor. Apt. 09-10

Jl. Letjen Soepeno

South Jakarta 12210

Tel: (021) 30485501

Mobile: 08990635289 / 0818153808

email: muhermanharun@gmail.com

 


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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(LML) The Missing Millions: A Threat to the Elimination of Leprosy

Leprosy Mailing List – April 28, 2015

Ref.:   (LML) The Missing Millions: A Threat to the Elimination of Leprosy

From:  Shen Jianping, Nanjing, PR China


 

Dear Pieter,

 

 

I have read the article "The missing millions: A Threat to the Elimination of Leprosy" (LML April 25, 2015).  I basically agree to the viewpoints of Prof Smith and his coauthors. But I have some points of view that are different from Dr Smith and I put forward my points of view here:

 

  1. The peak of the number of new cases detected over the period of 2001-2005 might be mostly contributed by India. There were continuous 3 years of LEC all over the country. There were many over-diagnosed leprosy patients; some diagnosed leprosy patients even did not exist.
  2. Prevalence of leprosy will linger for a long time at the very low level, but after development of social economy in all countries in the world, the declined situation of leprosy control will never reverse. The overall trend of leprosy prevalence will decline, although there may be some fluctuations in the number of new cases in some countries.
  3. We have called for new tools for early diagnosis and improving community awareness of leprosy for many years, however it progresses too low and we may have no time to wait for that day to see new tools in leprosy control. What we only can do now is to sustain available routine activities of leprosy control and strengthen early case detection and treat patients with MDT. I believe that after 10 -20 years from now, the burden of leprosy in the world will further decrease with available techniques and methods of leprosy control.
  4. Before 2012, the annual number of new cases was more 1200, but in 2013, the number detected new cases first decreased to below1000 in the record of leprosy detection in China. Last year in 2014, this number further decreased to below 900. I think in a big country with population of 1.4 billion, the situation of only a several hundred of new cases of leprosy must lead a changing strategy of leprosy. The battlefront against leprosy will shrink and will not spread to all over country, but deploys in some pocket areas. Improving community awareness is only necessary in a village with a leprosy problem but not at county or district level.

 

 

With best regards

 

Dr Shen Jianping

National Center for Leprosy Control

Nanjing, PR China

 


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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Saturday, April 25, 2015

(LML) The Missing Millions: A Threat to the Elimination of Leprosy


Leprosy Mailing List – April 25, 2015
Ref.: (LML) The Missing Millions: A Threat to the Elimination of Leprosy
From:  Cairns Smith, Aberdeen, UK



Dear Pieter,

We would like to draw the attention of the LML readership to a view point that is published this week in the Journal of Neglected Tropical Disease (PLOS – open access) – see attached file (The Missing Millions: A Threat to the Elimination of Leprosy by William Cairns Smith, Wim van Brakel, Tom Gillis, Paul Saunderson, Jan Hendrik Richardus).  The paper is based on analysis of the consequences of the substantial fall in new case detection in leprosy that occurred immediately the year 2000.   We hope this analysis will stimulate debate about the current global leprosy situation.
With best wishes,
Cairns Smith
The University of Aberdeen is a charity registered in Scotland, No SC013683.
Tha Oilthigh Obar Dheathain na charthannas clàraichte ann an Alba, Àir. SC013683.


LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com



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(LML) Lepr Rev (2015) 86, page 124 LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research

Leprosy Mailing List – April 25, 2015

Ref.:    (LML) Lepr Rev (2015) 86, page 124 LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research

From:  Pranab Kumar Das, Birmingham, UK


 

Dear Pieter,

 

I find the contribution by Paul Saunderson (LML April 12, 2015) editor LR by mailing the page 124 Letters to the Editor referred in Leprosy Rev March 2015 vo. 86 No 1 is very thoughtful and useful for me personally because of two reasons:

1) I can read them by just clicking and

2) the subject matter is of great interest to the public  at large, who are engaged in leprosy from academic , scientific and clinical points of view. 

Last but not the least , as I did not have the access to Lep. Rev. I am thankful to Paul  for his present contribution. Leprosy Review on-line: https://www.lepra.org.uk/leprosy-review

One could also ask to be notified in case of a new issue.

Finally, I have had a quick glance at the "to and fro exchange of letters”. It is quite clear to me that no one is giving an important consideration to establish a ground rule on the basis of personalised medicine to monitor the patients individually for the completion of the treatment before declaring the patients as "Released from treatment" [i.e. RFT]. As well  as a measure of control of transmission and  monitoring the contacts or exposed individuals according to the same criteria, before even considering the use of chemoprophylaxis at large.

Nevertheless, thanks to Paul. It will be good to have the access of this journal on line,  so that I could read it regularly.

Sincerely,

Pran (albeit Pranab Kumar Das)

 


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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Sunday, April 12, 2015

(LML) Lepr Rev (2015) 86, page 124 LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research

Leprosy Mailing List – April 12,  2015

Ref.:   (LML) Lepr Rev (2015) 86, page 124 LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research

From:  Paul Saunderson, Editor LR, Middleborough, UK


 

Dear Pieter,

 

As mentioned in the LML communication of March 27, 2015, may we refer to Leprosy Review   March, 2015.  Volume 86, Number 1, “Letters to the Editor”:
page 124 Reply to the role of contact tracing and prevention strategies in the interruption of leprosy transmission D.N.J. Lockwood, P. Krishnamurthy, V. Pannikar and G. Penna”  and page 126  Contact management is an essential component of leprosy control W.C.S. Smith and A. Aerts

 

 

Best wishes,

 

 

Paul Saunderson

 

 

Leprosy Review   March, 2015.  Volume 86, Number 1.

The contents can be viewed in full, free-of-charge, at: https://www.lepra.org.uk/Pages/FAQs/Category/volume-86

CONTENTS

Editorial

1 Leprosy and Buruli ulcer: similarities suggest combining control and prevention of disability strategies in countries endemic for both diseases D.S. Walsh, B.C. De Jong, W.M. Meyers and F. Portaels

Original Papers

6 What stops people completing multi-drug therapy? Ranked perspectives of people with leprosy, their head of family and neighbours - across four Indian states M.S. Raju, A.S. John and P. Kuipers

21 The patient perspective of the diagnostic process for leprosy in Brazil. An exploratory study K. Teasdale, G. De Wildt, P.K. Das, M.D.C.L. Virmond, N.G. De Almeida Galan, R.B.R. Prado, M. Henry and H. Amar

37 Lay and peer counsellors to reduce leprosy-related stigma – lessons learnt in Cirebon, Indonesia M. Lusli, R.M.H. Peters, M.B.M. Zweekhorst, W.H. Van Brakel, F.S.S.E. Seda, J.F.G. Bunders and Irwanto

54 Comparing the perception of community members towards leprosy and tuberculosis stigmatisation S. Sermrittirong, W.H. van Brakel, N. Kraipui, S. Traithip and J.F.G Bunders-Aelen

62 Dehabilitation in the era of elimination and rehabilitation: a study of 100 leprosy patients from a tertiary care hospital in India D. Seshadri, B.K. Khaitan, N. Khanna and R. Sagar

75 Survey on child leprosy patients and problems resulted from the disease in China Y. Liangbin, S. Jianping, Z. Min and Z. Guocheng

80 Profile of oxidative stress in response to treatment for Type 1 leprosy reaction N. Chhabra, S.N. Bhattacharya, A. Singal, R.S. Ahmed and P. Verma

Short Paper

89 Mozambique Country Profile A. De Kruijff

Case Reports

96 Bullous erythema nodosum leprosum manifesting in the post partum period with unusual features R. Verma, B. Vasudevan, V. Pragasam, N. Moorchung, D. Mitra and M. Gopal

102 Chromoblastomycosis in a resident of a leprosarium D. Dashatwar, S. Kar, N. Gangane, V. Pol, B. Madke, S. Kulkarni and N. Singh

108 The deportation of two Ethiopian migrant workers with leprosy S.M. Lambert and S.L. Walker

112 Lymph node abscess and cardiac involvement in a patient with nodular lepromatous leprosy (LL) with erythema nodosum leprosum (ENL): A rare occurrence T. Goyal, A. Varshney, S.K. Bakshi and V. Sharma

117 Cost effective cosmetic prosthesis for lost digits G. Manivannan, G. Karthikeyan, P. Das and G. Babu

Letters to the Editor

124 Reply to the role of contact tracing and prevention strategies in the interruption of leprosy transmission D.N.J. Lockwood, P. Krishnamurthy, V. Pannikar and G. Penna

126 Contact management is an essential component of leprosy control W.C.S. Smith and A. Aerts

128 Chemoprophylaxis: sufficient evidence for starting implementation pilots J.H. Richardus

130 Obituary – Dr. Robert C. Hastings (1938–2014)

131 Obituary – Dr. Margaret Elizabeth Brand (1919–2014)

134 News and Notes


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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Wednesday, April 1, 2015

(LML) Lepr Rev (2015) 86, LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research

Leprosy Mailing List – April 1, 2015

Ref.:   (LML)   Lepr Rev (2015) 86, LETTER TO THE EDITOR: Reply to Role of Contact tracing and prevention Strategies in the interruption of leprosy transmission - Chemoprophylaxis: a call for more research 

From:  Jaison Barreto, ILSL Bauru, São Paulo, Brazil


 

Dear Pieter,

 

The discussion about the role of chemoprophylaxis for leprosy contacts is very interesting, but I think that it is not the most important thing. If this intervention could be effective or not, it does not matter! I think that what is really important is how to identify individuals with early leprosy, mainly among household contacts, and break the chain of transmission.

 

In the field, it is not uncommon to find household contacts, mainly young ones, with suggestive symptoms of leprosy, like whitish or dry areas on the skin, or paresthesias, but without loss of tactile sensibility. Nevertheless, diagnosis of leprosy in children requires expertise to proceed  to the examination of protective sensibility, i.e., thermal and pain, as tactile sensibility is often present in lesions of early leprosy or in BL cases. Palpation of nerve trunks is a very useful tool, but many professionals do not know how to perform.

 

When leprosy is almost asymptomatic, as in young patients with LL/BL leprosy, too often the first visible sign of the disease is a reaction. Or, at least, this is the cause of the seeking for help. The history is not uncommon that household contacts, previously without symptoms, developed typical signs/symptoms of leprosy (patches or neuritis) after the intake of some antibiotics, like rifampin, quinolones, macrolides, etc., or after BCG vaccination.

 

So, the question, indeed, is only one: if you had, mainly in the field, where there is often no laboratory assay, or when the biopsy and bacilloscopy usually does not help (as in primary neural leprosy or indeterminate leprosy), a chance to identify leprosy patients (sick) among household contacts with no symptoms (infected), would you like to wait for several years, or would you prefer to confirm the diagnosis earlier?

 

To be leprosy or not to be leprosy, that is the question!

 

Regards,

 

Jaison

 


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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