Wednesday, September 30, 2015

(LML) The utility of the Pressure Specified Sensory Device TM (PSSD) in Hansen's Disease

Leprosy Mailing List – September  30,  2015

Ref.: (LML)  The utility of the Pressure Specified Sensory Device TM (PSSD) in Hansen's Disease

From:  Eric Lee Wan, Ecuador and USA


Dear Pieter,

I am speaking on behalf of our group in the United States. At this time, we would like to share with everyone on LML our recent investigation into the utility of the Pressure Specified Sensory Device TM (PSSD) in Hansen's (see attachment).

The PSSD is a non-invasive and quantitative technique to measure sensory impairment. The PSSD can aid the early detection of leprous neuropathy and has advantages over monofilament and ballpoint-pen testing, as described in our investigation; we have used the PSSD in practice in Ecuador for a decade now.

It is not impossible, nor improbable, for us to imagine how the PSSD can contribute to Dr. Almeida's "cadre of skilled, mobile leprosy workers," who he describes in the most recent LML (September 25, 2015) as those who will be in charge of regular screening of nerves in order to detect early nerve damage and provide interventions promptly.

The PSSD has previously been mentioned in the LML twice: Once on September 5, 2015 in "Infoleps Choice of new (e) publication on leprosy," and more importantly, by Dr. James Wilton on September 10, 2013, when he summarized his experience in Ecuador successfully detecting early Hansen's with the PSSD. He makes reference to another article describing the utility of the PSSD in detecting leprous neuropathy; this article is also attached, along with ours.

We would be happy to answer any questions.

The 2 articles can be cited as:

Baltodano PA, Wan EL, Noboa J, Rosson GD, Dellon AL. Selecting a Test for Leprous Neuropathy Screening. J Reconstr Microsurg. 2015 Oct;31(8):607-13.

Seiler DK, Wilton J, Dellon AL. Detection of neuropathy due to Mycobacterium leprae using non-invasive neurosensory testing of susceptible peripheral nerves. Ann Plast Surg 2005 Dec;55(6):633-7.

With warm regards,


Eric Lee Wan, BS

USA: +1 (240) 899 1181
Ecuador: +593 098-877-5430
Colombia: +57 (313) 780-6653

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Avast logo

This email has been checked for viruses by Avast antivirus software.

Friday, September 25, 2015

(LML) Protecting Indians from leprosy

Leprosy Mailing List – September 25,  2015

Ref.:  (LML)   Protecting Indians from leprosy

From:  Joel Almeida, London and Mumbai



Dear Pieter,



Anti-microbial treatment and anti-inflammatory treatment are like the warp and woof of the safety net which protects Indians against the deformities of leprosy. There are some holes in the safety net.


The suppression of active case finding since 2005 has led to several thousand Indians each year suffering visible deformity before the diagnosis of leprosy. 


Further, as many as 50% of newly treated MB patients in India (33,000 patients per year) may be estimated to develop serious but avoidable nerve damage, despite MDT.   Over 300,000 Indians are likely newly to develop visible deformity during the next 10 years, despite MDT.


Both these holes in the safety net can be repaired.


1) Active case detection can be aided by skin camps and similar detection drives, where all people with skin complaints are served.  This allows leprosy cases to be detected in less stigmatising ways.


2) Nerve damage occurs mostly during the first 2 years after the start of MDT.  This damage most often follows “silent” neuritis, of which even the patient is unaware.

Nerve damage can be better prevented by monthly monitoring of nerves by skilled leprosy workers, with prompt anti-inflammatory treatment where required.  This skilled monthly monitoring is required among at least MB patients during the first 2 years after the start of MDT.


India could re-introduce a cadre of skilled, mobile leprosy workers who travel to meet MB patients near where they live.  These skilled workers would cover the population served by several health centres (in cities, this amounts to a population of millions).  They would monitor the nerves of MB patients during the first 2 years after the start of MDT, and keep records of nerve function.  This would enable prompt anti-inflammatory treatment for neuritis, even silent neuritis.


I recently met Dr. Raghuram Rajan, governor of the Reserve Bank of India (RBI).  When asked, he asserted that spending on effective health interventions is investment, not expenditure.  Such investment is essential for continued economic growth in India.  This puts the ball in our court.  If we put a convincing case for intensified interventions against leprosy, adequate investment is likely.


The incidence rate of leprosy in India could eventually decline if extreme poverty is alleviated.  Such a decline was observed in Norway without effective anti-leprosy drugs and in Shandong province, China, with only dapsone.  Alleviation of extreme poverty is not a certainty, despite the impressive growth rate of the Indian economy.


The Table: Newly detected leprosy cases in India by deformity and type



Newly detected cases /10,000 population / yr


% with visible deformity among newly detected cases


Newly detected cases with visible deformities / million population / yr


Newly detected MB cases / 10,000 population / yr

































































source: NLEP (National Programme) progress reports


The table shows that, in India, the incidence rate of newly detected MB (multibacillary) cases is apparently not declining.  This indicates the trend in the underlying incidence rate of leprosy.  The ANCDR (annual new case detection rate of all types of leprosy) is less reliable because of self-healing cases.  The incidence rate of newly detected cases with visible deformity is apparently increasing; driven partly by delays in diagnosis and partly by the underlying incidence rate of leprosy.


New tools and approaches could help interrupt the transmission of leprosy.  That is not certain, since M. leprae can survive for at least 5 months in the shade in India; and resume multiplication when re-introduced into a host.  Extra-human reservoirs such as amoebae could permit indefinite survival and replication of M.leprae. Besides, MB patients usually are infectious for a long period before they show any signs of leprosy. 


We can try new tools and approaches, but our hopes need to be tested: the more rapidly the better.  Even as we hope for game-changing outcomes, we need to be prepared for disappointment.


There is no substitute for plucking the low-hanging fruit in leprosy control:


1) Active case detection


2) MDT


3) Monthly monitoring of nerves among MB patients during the first 2 years after the start of MDT, with prompt anti-inflammatory treatment when required.


Elimination of leprosy services has exacted a heavy price from the people of India, in terms of avoidable deformity.  This can be remedied.


We can save over 300,000 Indians from visible deformity over the next 10 years, using the tools already available.  Let’s make it happen.






Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Avast logo

This email has been checked for viruses by Avast antivirus software.

Tuesday, September 22, 2015

(LML) Brochure, literature about leprosy in Burmese

Leprosy Mailing List – September 22,  2015

Ref.:    (LML) Brochure, literature about leprosy in Burmese

From:  Robert Jersky, San Diego, USA



Greetings from San Diego, Pieter.


I would be interested to know if anyone reading the LML might assist me in obtaining any informative brochure, literature about leprosy in Burmese designed for a patient/family member affected by leprosy whose primary language is Burmese.  Ideally, would be helpful to also have the English translation of that same material, but not necessary.


With friendly regards to all readers,


Robert Jerskey, LOTR, consultant for prevention of disability and multiple morbidities.

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<

Avast logo

This email has been checked for viruses by Avast antivirus software.

Saturday, September 5, 2015

(LML) leprosy service in India

Leprosy Mailing List – September 5,  2015

Ref.:    (LML) leprosy service in India

From:  S. Maria Xavier Turtius, Tamil Nadu, India


Dear Peter, 



Greetings from Madurai Health and Leprosy Relief Centre, India. 


Celebrating Silver Jubilee year (1991-2015):

Madurai Health and Leprosy Relief Centre celebrates its silver Jubilee this August 2015. On 9th August 1991, our founder cum executive secretary Shri. S.  Maria Xavier Turtius and our Former President Shri. Maria Singarayor and the board member formed this society and registered it.  From that day onwards our organization has been functioning with an attitude of compassion and benevolence for the benefit of the brothers and sisters who suffer with leprosy.

In the past 25 years our organization has met so many ups and downs. In this quarter century we have done the following:

·         Thousands of leprosy patients have been detected and treated.

·         Many thousands of school students and the public have benefited through our awareness programmes

·         A thousands of medical camps have been conducted in villages.

·         We have given economical assistance to deformed lepers.

·         Through our rehabilitation self-employment activities, 60 families have benefited.

At this memorable time we gratefully remember our donors, supporters, volunteers and well-wishers and appreciate their generosity, munificence and goodwill. We trust in the Almighty who has been with us in all our endeavours.  





MaduraiHealthAndLeprosyReliefCentre (MAHELERECEN).

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<



Avast logo

This email has been checked for viruses by Avast antivirus software.

(LML) Infoleps Choice of new (e) publications on leprosy - 20150904

Leprosy Mailing List – September 5,  2015

Ref.:  (LML)  Infoleps Choice of new (e) publications on leprosy - 20150904

From:  Jiske Erlings, Amsterdam, the Netherlands

Dear Pieter,


Greetings from Infolep!

As you might know the Infolep team is currently developing a second portal for information resources on cross-cutting topics in Neglected Tropical Diseases. Until the launch of the portal our rapidly growing collection on Neglected Tropical Diseases can be found here:

Our WASH and NTD collection can be found here:

“This summer we had some technical problems with the Infolep portal. My sincere apologies for any inconvenience this may have caused you. I am happy to report though that all seems to be working again. Please do let me know if you experience any problems with the website.”

Below you will find a selection of recent publications on leprosy. Feel free to contact me to receive the full text versions if a link to the full text is not included.

With kind regards,


Jiske Erlings

INFOLEP Information specialist

Follow Infolep on Facebook or Twitter

To subscribe/unsubscribe to this service, please send an email to:


Highlighted Publications

Global leprosy update, 2014: need for early case detection. Wkly Epidemiol Rec. 2015 Sep 4;90(36):461-476. English, French.

Policy and technical topics: Selected neglected tropical diseases targeted for elimination: kala-azar, leprosy, yaws, filariasis and schistosomiasis.
World Health Organization, Regional Office for South East Asia. 2015 (issue date: 23 Jul). Free full text:

Water, Sanitation and Hygiene for Accelerating and Sustaining Progress on Neglected Tropical Diseases : a Global Strategy 2015-2020 / World Health Organization, 2015, 38 p. WHO Report No.: WHO/FWC/WSH/15.12. Free full text:

10 facts on tackling neglected tropical diseases with water, sanitation and hygiene

 Ten Steps: A guide for health promotion and empowerment of people affected by Neglected Tropical Diseases / Lehman LF, Geyer MJ, Bolton L. The American Leprosy Missions, 2015.

Free full text:


New Journal Articles

Aerts, A. Leprosy : still a public threat. In: MMS Bulletin 133, 2015 Free full text:

Allen, LM. Leprosy in Morocco: Discrimination Still Affects Victim-Learning a Lesson from the Original" Social Disease" : A Student Perspective. in: ABNF Journal, 2015

Bakare AT, Yusuf AJ,Habib ZG, Obembe A. Anxiety and Depression: A Study of People with Leprosy In Sokoto, North-Western Nigeria in: Journal of Psychiatry, 2015 (online)  Background: This study was prompted by the heightened reports of anxiety and depression Free full text:

Baltodano PA, Wan EL, Noboa J, Rosson GD, Dellon AL. Selecting a Test for Leprous Neuropathy Screening. in: J Reconstr Microsurg. 2015 Jul 28. Abstract:

Batista E Sá VW, Gomes MK, Rangel ML, Sanchez TA, Moreira FA, Hoefle S, Souto IB, Cunha AJ, Fontana AP, Vargas CD. Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy. in: PLoS Negl Trop Dis. 2015 Jul  23;9(7): e0003944. Free full text:

Braga AF, Moretto DF, Gigliotti P, Peruchi M, Vilani-Moreno FR, Campanelli AP, Latini AC, Iyer A, Maske AP, Sawant PA, Joseph S, Mahajan US, Kudale AM. Socio-cultural features and help-seeking preferences for leprosy and turbeculosis: a cultural epidemiological study in a tribal district of Maharashtra, India. in: Infect Dis Poverty. 2015 Jul 28;4:33. Free full text:

Bowers B, Kuipers P, Dorsett, P. A 10-Year Literature Review of the Impact of Community Based Rehabilitation. in: Disability, CBR and Inclusive Development (DCID) 2015 (Vol. 26, nr. 2), p. 104 -119. free full text:

Campos DC, Dutra AP, Suares VL, Carvalho PA, Camargo LM. New strategies for active finding of leprosy cases in the Amazonian region. in: Rev Soc Bras Med Trop.2015 Aug;48(4):488-490. Free full text:

Das PK, Souza VN. Activation and cytokine profile of monocyte derived dendritic cells in leprosy: in vitro stimulation by sonicated Mycobacterium leprae induces
decreased level of IL-12p70 in lepromatous leprosy. in: Mem Inst Oswaldo Cruz. 2015 Jul 24. Free full text:

De A, Reja AH, Biswas S, Bhattacharya B, Chatterjee G, Basu K, Sarda A, Chowdhury N. Unique TTC Repeat Base Pair Loss Mutation In Cases of Pure Neural Leprosy: A Survival Strategy of Mycobacterium Leprae? in: Indian J Dermatol. 2015 Jul-Aug;60(4):351-5. Free full text:

Dionello CF, Rosa Utiyama SR, Radominski SC, Stahlke E, Stinghen ST, de Messias-Reason IJ. Evaluation of rheumatoid factor and anti-citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from Southern Brazil. in: Int J Rheum Dis. 2015 Aug 6. Abstract:

Freitas AA, Oliveira RM, Hungria EM, Cardoso LP, Sousa AL, Costa MB, Reed SG, Duthie MS, Stefani MM. Alterations to antigen-specific immune responses before and after multidrug therapy of leprosy. in: Diagn Microbiol Infect Dis. 2015 Jul 2. pii: S0732-8893(15)00225-4. Abstract:

Fu X, Liu H, Zhang F. Borderline Lepromatous Leprosy with Type 1 (Reversal) Reactions in a Chinese Man. in: Am J Trop Med Hyg. 2015 Aug 5;93(2):207-9.
Free full text:

Goulart IM, Araujo S, Filho AB, de Paiva PH, Goulart LR. Asymptomatic leprosy infection among blood donors may predict disease development and suggests a potential mode of transmission. in:  J Clin Microbiol. 2015 Jul 22. Abstract:

Goyal S, Shah N, Shah FR, Shah NR, Shah CK. Clinicopathological Correlation with Histomorphological Spectrum and Bacillary Index of Skin Biopsy in Leprosy. in: (Biennial) Journal GAPM (Gujarat Journal of Pathologistes and Microbiologists) 2015 Free full text:

Han XY, Zhang J, Li L. The Leprosy Agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico: A Clarification. in: J Clin Microbiol. 2015 Jul 29. Abstract:

Han XY, Quintanilla M. A case of diffuse lepromatous leprosy due to Mycobacterium lepromatosis in Quintana Roo, Mexico. in: J Clin Microbiol. 2015 Aug 6.                                                                                                         

Hotez PJ. Blue Marble Health Redux: Neglected Tropical Diseases and Human Development in the Group of 20 (G20) Nations and Nigeria. PLoS Negl Trop Dis. 2015 Jul 28;9(7): e0003672. Free full text:


Hui M, Uppin MS, Challa S, Meena AK, Kaul S. Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India. in: Annals of Indian Academy of 2015, Volume : 18 , issue 3, p. 292-297 Free full text:

Kavya Shree KL, Raghu MT, Aravind Karinagannanavar, Manjunatha S. A Study of Proportion of Disability and its Determinants among Leprosy Patients. in: Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 62, August 03; Page: 10742-10746. Free full text: 

Kerr LR, Kendall C, Sousa CA, Frota CC, Graham J, Rodrigues L, Fernandes RL, Barreto ML. Human-armadillo interaction in Ceará, Brazil: potential for transmission of M.leprae. in: Acta Trop. 2015 Jul 29. Abstract:

Kumar A, Girdhar A, Girdhar BK. A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India.nIn: Indian Journal of Dermatology, Venereology, and Leprology, 2015 vol. 81(4) p. 356-362 Free full text: 

Leon K, Salinas JL, McDonald RW, Sheth AN, Fairley JK. Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic.                                                                                                                                    
in: Am J Trop Med Hyg. 2015 Aug 24.

Liguori R, Terlizzi R, Giannoccaro MP, Amati A, Foschini MP, Parodi A, Valentino ML. An inflammatory myopathy unmasks a case of leprosy in an Italian patient. in: J Neurol. 2015 Aug 2. [Epub ahead of print] PubMed PMID: 26233690. Abstract:

Machado PR, Machado LM, Shibuya M, Rego J, Johnson WD, Glesby MJ. Viral Co-infection and Leprosy Outcomes: A Cohort Study. in: PLoS Negl Trop Dis. 2015 Aug 12;9(8):e0003865. Free full text:

Mahajan A, Banerjee A. Perceived stigma among attendees of psychiatric and nonpsychiatric outpatients department in an industrial township: A comparative study. in: Ind Psychiatry J. 2015 Jan-Jun;24(1):70-5. Free full text:

Marahatta S, Ghimire A, Jha N, Pokhrel, SM. Social stigma in leprosy. in: Journal of Chitwan Medical College 2015; 5(12): 6-10 Free full text:

Mandal NK, Saha, G. A Qualitative Assessment of Current Perception of Different Social Groups about Leprosy in High & Low Prevalent Districts of West Bengal. in: Journal of Comprehensive Health, 2015 Vol 3 (2). Free full text:

Mistry AS, Rathod SP, Agarwal P. An institution-based observational study to identify sensitive histopathological parameters in leprosy. In: International Journal of Medical Science and Public Health, 2015 Vol. 4(12). Free full text:

Mohammed N, Maharaj N, Mohammed A, et al. Leprosy-knowledge, attitudes and practices among clinic attenders. in: West Indian Medical Journal Supplement, 2015, p. 1-75 Abstract:

Mowla MR, Ara, S,Tripura S. Leprosy profiles in post-elimination stage: a tertiary care hospital experience in: Int J of Dermatol. 2015 Jul 30. [Epub ahead of print] Abstract:

Nili S, A Rahimi, A Rasouli, M Karimi, J al. Using leprosy elimination campaign on leprosy case finding: Case series study in Kurdistan, Iran. in: Chronic Diseases Journal, 2015 Abstract:

Nwankwo, IU. Effects of traditional religious belief system of the Igbo group on the effectiveness of leprosy control programmes in Anambra and Ebonyi states of southeast Nigeria. in: Journal of Religion and Human Relations, 2015 p. 81 -94 Free full text:

Patrao NA, Bhat RM, Dandekeri S, Kambil SM. Diffuse cutaneous leishmaniasis in coexistence with leprosy. in: Int J Dermatol. 2015 Aug 12. doi: 10.1111/ijd.12954. [Epub ahead of print]. Abstract:

Pérez–Hernández MG,Velasco-Rodríguez R, et al.  Directed Imagination: A Procedure for Improving Self-concept in Persons with Leprosy. in: Nurs Care, 2015 Free full text:

Pinheiro MGC, Medeiros IBG, Monteiro AI, Simpson CA The nurse and the theme of leprosy in the school context: case studies. in: Revista de Pesquisa, 2015 Jul-Sept.

Free full text:


Rendini T, Levis W. Quantiferon-Gold TB Cannot Detect Latent TB in Patients with Leprosy. in: Clin Infect Dis. 2015 Jul 24.   Abstract:

Rodrigues FF, Calou CG, Leandro TA, Antezana FJ, Pinheiro AK, Silva VM, Alves MD. Knowledge and practice of the nurse about leprosy: actions of control and elimination. in: Rev Bras Enferm. 2015 Mar-Apr;68(2):297-304. English, Portuguese.PubMed PMID: 26222174. Free full text:

Uche, NI. Assessment of Level of Public Knowledge about Leprosy and its Effects on Leprosy Control Programmes in Anambra and Ebonyi States of Southeast Nigeria. In: Asian Journal of Social Sciences and Management, 2015 Vol. 2 (3) Free full text:

Vagner, WBE Sá, Gomes MK, Rangel MLS, Sanchez TA, et al. Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy. in: PLoS Neglected Tropical Diseases 2015 Free full text:

Valdivia PPO, Jiménez AYP, Díaz DS [et al..]. La Lepra y sus discapacidades / Leprosy and disabilities. in: MediCiego, 2015 Vol.21 No.2 Free full text:

H Wang, W Liu, Y Jin, M Yu [et al.]. Detection of antibodies to both M. leprae PGL-I and MMP-II to recognize leprosy patients at an early stage of disease progression. in: Diagnostic Microbiology and Infectious Disease [revised form: July 15, 2015] Abstract:

Westphal DC, Pennini SN, Souza PP, Maquiné GÁ, Schettini AP, Santos M.
Follicular mucinosis: an important differential diagnosis of leprosy in an endemic area. in: An Bras Dermatol. 2015 Jun;90(3 Suppl 1):147-149.   Free full text:

Witas HW, Donoghue HD, Kubiak D, Lewandowska M, GÅ‚adykowska-Rzeczycka JJ. Molecular studies on ancient M. tuberculosis and M. leprae: methods of pathogen and host DNA analysis. in: Eur J Clin Microbiol Infect Dis. 2015 Jul 26. [Epub ahead of print]. Free full text:

Zhang Y, Sun YH, Wang C, Liu D, Chen M, Fu X, Zhou G, Liu H, Zhang F. Failure to detect Mycobacterium lepromatosis as a cause of leprosy in 85 Chinese patients. in: Indian J Dermatol Venereol Leprol. 2015 Aug 11. Free full text:

Journals  & Newsletters

Disability, CBR & Inclusive Development:

Indian Journal of Dermatology, Venereology and Leprology:

Leprosy Review:

Revista de Leprología:

WHO Goodwill Ambassador’s Newsletter for the elimination of leprosy:

Jiske Erlings

Medewerker InfoLep / Information Officer

Infolep Leprosy Information Services


Postbus / P.O. Box 95005

1090 HA Amsterdam

The Netherlands


+31 20 5950530






LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<

Avast logo

This email has been checked for viruses by Avast antivirus software.