Leprosy Mailing List – June 1, 2015
Ref.: (LML) Alternative MDT drugs and treatment duration
From: Teem-Wing Yip, Alice Springs, Australia
Dear Sir,
With all due respect to my friend and mentor Grace Warren, I would like to make some clarification about my patient whom she asked about on my behalf recently.
The man is otherwise quite healthy, no known family history of leprosy, had about 8 years of an anaesthetic patch on the knee which no one could diagnose, and presented with about a 6 month history of nodules around his body.
BL leprosy was diagnosed by biopsy of one of his nodules. It was confirmed by my slit skin smears that were 5+ on both ears, and PCR positive in both ears and both nostrils.
I put him on MDT. He had daily rifampicin for the first two months. Then he had a monthly dose of rifampicin and clofazamine. He has been on daily clarithromycin. He is G6PD deficient, so I never gave him dapsone. Instead, I put him on daily minocycline, but he did not tolerate it because of dizziness. I therefore changed him to daily clarithromycin (because it was relatively easy to obtain). He has not experienced any other side effects except for his skin becoming very bronzed from the clofazamine, and he hates it intensely, however he has been compliant.
Other than his anaesthetic patch, I have never detected any motor or sensory deficiencies, and his nerves have never been palpable. His nodules have settled down dramatically within months of starting treatment.
After 12 months of treatment, he was 4+ on skin smear, and still PCR positive in both nostrils too.
Now, after 24 months of treatment, he is still 4+ and still PCR positive in both nostrils, though the PCR has become less positive each year.
The guidelines say that I can stop treatment now, but considering he has gone from 5+ to 4+ in a year then stayed at 4+ for a year, I am not convinced that I should stop his treatment. However, he extremely keen to cease treatment after 2 long years, so I want to be very sure before I have to tell him he needs to extend the treatment duraion.
I look forward to responses now that I have provided this extra information.
Yours sincerely,
Dr. Teem-Wing Yip
Alice Springs, Northern Territory, Australia
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
 | This email has been checked for viruses by Avast antivirus software. |
No comments:
Post a Comment