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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