Friday, December 11, 2015

(LML) International Leprosy / Hansen's Disease History Symposium, Tokyo, 28-30 January, 2016

Leprosy Mailing List – December  11,  2015

Ref.:    (LML) International Leprosy / Hansen's Disease History Symposium, Tokyo, 28-30 January, 2016

From:  Nao Hoshino, Tokyo, Japan

Dear Dr Schreuder,



Warm greetings from Sasakawa Memorial Health Foundation.


Sasakawa Memorial Health Foundation is organising the International Leprosy / Hansen's Disease symposium – Leprosy / Hansen’s Disease History as a Heritage of Humanity – to accelerate the preservation of the history on a global scale, from 28th to 30th January 2016 in Tokyo, Japan. The symposium is to network across borders with people from different backgrounds and interests, and to discuss feasible steps. SMHF would like to welcome any who are interested in leprosy, history of the disease, and history of medicine to join us at the symposium.


1/27 pre-symposium sessions at the National Hansen's Disease Museum, Tokyo

1/28 symposium at the Sasakawa Peace Foundation Building, Tokyo

          special talk by a film director, Hayao Miyazaki

          session "Country Overview"

1/29 symposium at the Nippon Foundation Building, Tokyo

          session "Major Players in History Preservation: people, national agencies, 

          NGOs/NPOs: Inclusiveness and Sustainability"

          session "Legacies, Creativity, Artifacts: art, literature, creative products"

          session "History Preservation: Future Scenarios"

1/30 symposium at the Nippon Foundation Building, Tokyo

          session "History Preservation: Future Scenarios" (cotd.)


For further details, please contact us at <>

Yours sincerely,


Nao Hoshino

Sasakawa Memorial Health Foundation

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

LML blog link:

Contact: Dr Pieter Schreuder <<


This email has been sent from a virus-free computer protected by Avast.

Thursday, December 10, 2015

(LML) Updating templates with LML e-mail addresses

Leprosy Mailing List – December 10,  2015

Ref.:    (LML) Updating templates with LML e-mail addresses

From:  Pieter Schreuder, Maastricht, the Netherlands


Dear LML readers,



This weekend I am planning to update the templates with the LML e-mail addresses. If you want to change your e-mail address, please inform me as soon as possible (please include your address – city and country where you are living)?


May I also refer to our LML blog link:

You can always look up previous letters, or if you think you missed some, you can simple check our blog.


On behalf of the editorial board of LML our Season’s Greetings.



Pieter AM Schreuder


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

LML blog link:

Contact: Dr Pieter Schreuder <<

This email has been sent from a virus-free computer protected by Avast.

(LML) Ways forward

Leprosy Mailing List – December 10,  2015

Ref.:    (LML) Ways forward

From:  Joel Almeida, Mumbai and London


Dear Pieter,



A.           Monitoring for nerve damage


1.                   Delayed detection 

Detecting nerve damage too late is like detecting cardiac fibrillation too late.  If a defibrillator is used several hours after the fibrillation, it will be useless.  The patient will be dead forever.  The same applies to a nerve which is neglected for months (or even weeks).


According to the literature, as many as 90% of patients regain nerve function with anti-inflammatory treatment: if, and only if, nerve damage is detected promptly.  Infrequent or absent monitoring of nerves is responsible for the damage which is sometimes wrongly attributed to the limitations of anti-inflammatory treatment.  If defibrillators were tested on corpses, we might conclude (wrongly) that they, too, are no better than placebo.


The solution:

Skilled leprosy workers to monitor the nerves of MB patients every month, and keep records.  The more prompt the start of anti-inflammatory treatment, the greater the chance of reversing nerve function impairment.


2.                   Silent neuropathy

According to the literature, about 85% of nerve function impairment (NFI) in South Asian patients is silent: without signs of inflammation.  Further, about 65% of patients developing NFI do so within the first year after starting MDT.  Another 30% do so within the second year after starting MDT.


The solution:

Monthly monitoring of the nerves of MB patients should  begin with the start of MDT and continue for at least 2 years.  Leprosy workers should be taught that 85% of nerve function impairment is silent: without “reaction” or signs of inflammation.


3.                   Poverty and distance

The poorer leprosy patients in India cannot afford to take public transport to the nearest government health post.  They suffer silent neuropathy, and consequent disfigurement, in silence.  This steadily increases the burden of leprosy (the prevalence and weight of disabling sequelae).


The solution:

Skilled leprosy workers should be mobile, so that they can travel to near the homes of MB patients.  They could also cover the population of more than one health centre, in India.


These skilled leprosy workers would not only examine nerve function and keep records, but also be a valuable resource for educating the public about skin conditions.  They would boost attendance at skin camps (for early, non-stigmatising case-finding of leprosy).


The Indian government, ILEP in India and the people of India all deserve congratulations. This is because they are pressing for skilled leprosy workers to be appointed.  ILEP can make a real difference in the lives of poor people through these workers.



B.           Skin smears


A significant subset of MB patients requires prolonged MDT.  Otherwise they are likely to suffer from proliferating M. leprae after MDT, and type 2 reactions, while constituting sources of infection for others.


A significant subset of the most infectious MB patients shows few or no signs of infection.  Positive skin smears might be the only objective sign of disease. Without skin smears, they infect many others before they are finally detected.


The solution: Skin smears should be reintroduced for diagnosis and classification of leprosy.  This helps not only the patient but also the population at risk.

The staining technique for skin smear slides needs to use methods appropriate for M. leprae.  M. Tb staining methods can be misleading when applied to M. leprae!



C.           Mathematical models, definitions and assumptions


Mathematical models are only as good as the assumptions and definitions they adopt. 


For example, a model may ignore the increasing proportion and number of newly detected Indian cases diagnosed with visible deformity.  This increasing proportion indicates delay in diagnosis, with accompanying self-healing.  Models which overlook this are liable to make misleadingly optimistic projections, and even mistake the direction of the trend in incidence rate. 


Further, a model may fail to use the WHO’s clear 2013 definition of elimination: zero incidence. 


The solution:  Mathematical models should be disregarded if they disregard the proportion with visible deformity at diagnosis, and rely entirely on the crude new case detection rate.  It seems prudent too to insist on mainstream scientific definitions.  These are objective and rational rather than arbitrary. 



D.           Promises or demonstration


In the 1980s rifampicin caused a great stir in the TB world.  However, it was to be confined to affluent countries, since it might be carelessly used in poorer countries.  Then Dr. Karel Styblo went to Tanzania and demonstrated that rifampicin-containing regimens could be used to cure patients in poorer countries too. He did not promise, he merely demonstrated: by setting up a system in the field.  That was the precursor of the DOTS strategy now used around the world.


It may be that we can reduce the incidence rate to zero by earlier detection of infectious cases, prompt MDT, or even mass chemoprophylaxis and various other measures.  However, it would be more responsible to demonstrate than to claim. We need to set up a system in the field, and demonstrate exactly how zero incidence can be achieved.


Repeated mass chemoprophylaxis was tried and found wanting in the Federated States of Micronesia.  However, that should not stop us from attempting to reduce the incidence rate to zero on those same islands. A small island allows us to rapidly demonstrate or refute our claims.  We need to do one or the other, quickly.  Otherwise promises of zero incidence can be like pie in the sky: causing people to become careless and complacent about low-hanging fruit (such as the monitoring of nerves and prompt anti-inflammatory treatment where required). 


The solution:

Our fervent hopes need to be put to the test in a whole-hearted, “no effort spared” demonstration project.  We need to go “all out” to achieve zero incidence on a small island: the quicker the better.  If we succeed, the key elements can be scaled up and adopted elsewhere.  Otherwise we need to know where the gaps are.  Instead of making untested promises, we need to remember Dr. Styblo’s approach. Demonstrate, demonstrate, demonstrate.





Joel Almeida  

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

LML blog link:

Contact: Dr Pieter Schreuder <<


This email has been sent from a virus-free computer protected by Avast.

Wednesday, December 9, 2015

(LML) Enablement courses Community Based Rehabilitation in 2016

Leprosy Mailing List – December 9,  2015

Ref.:   (LML) Enablement courses Community Based Rehabilitation in 2016

From:  Huib Cornielje, Alphen aan de Rijn, the Netherlands


Dear Pieter



Would it be possible to circulate the following text on the news list? 


With thanks and kind regards


Enablement is well-known for its quality courses in Community Based Rehabilitation. In 2016, courses are offered with contemporary insights on e.g. the disability inclusive development approach. Besides the use of relevant theoretical models, innovative tools for monitoring and evaluation and participatory approaches based on actual case studies will be introduced. Dependent on the course content, we will select resources from a range of recent developments:

•  Roads to Inclusion: a toolkit that is designed by Light for the World Austria and Enablement to describe different aspects of inclusion and helps to monitor changes towards disability-inclusive societies.

•  A CBR impact evaluation toolkit: a joint product of the University College of London, the University of Cape Town, the Royal Tropical Institute in Amsterdam, and Enablement. The toolkit consists of a set of tools to measure impact at the community level.

•  Flashcards: a set of laminated cards that will help fieldworkers to identify disability, thereby suggesting basic interventions and options for referral.

•  Advocacy for Disability Rights Course: a joint course developed by Enablement for the Liliane Foundation, which focuses on advocacy for disability rights violations at a community level.

We are delighted by these developments and are keen to make as many organisations and individuals benefit from them. We therefore have a special end-of-the-year offer. Subscribe in the month of December and you will receive a €200 discount on the course fee. For information send an email to: 


Huib Cornielje


A van Leeuwenhoekweg 38 unit A16 

2408AN Alphen aan den Rijn

The Netherlands

tel: 0031-172-499940

Mobile: 0031 – 6 28485083


internet: and

Skype: enablement


If the rich live more simply the poor simply can live (Dom Helder Camara)



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

LML blog link:

Contact: Dr Pieter Schreuder <<


This email has been sent from a virus-free computer protected by Avast.

(LML) INFOLEP's monthly Choice list - November 2015

Leprosy Mailing List – December 9,  2015

Ref.:   (LML) INFOLEP’s monthly Choice list - November 2015

From:  Jiske Erlings, Amsterdam, the Netherlands

Dear Pieter, 

Greetings from Infolep!

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.
You might also be interested in our collection of publications on cross-cutting issues in Neglected Tropical Diseases. An overview of this rapidly growing collection
can be found here:

Our WASH collection can be found here:

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:

New Journal Articles

de Aarão TLS, de Sousa JR, Botelho BS, Fuzii HT, Quaresma JAS. Correlation between nerve growth factor and tissue expression of IL-17 in leprosy. in: Microbial Pathogenesis 2016;90( January): p. 64-68. Abstract:

Agidew A, Getachew Y, Enquselassie F, Hiruye A, Derbew M, Mammo D, et al. Magnitude of Disability and  Associated Factors among Patients in Boru Meda Hospital, South Wollo Zone, Amhara Region, Ethiopia. in: Ethiop. Med. J. 2015; Suppl. 2: p. 38-43. Abstract: 

Andrade PJ, Messias Sdos S, Ferreira PC, Sales AM, Machado Ade M, Nery JA. Histoid leprosy: a rare exuberant case. in: An Bras Dermatol. 2015 Oct;90(5): 756-757. Free full text:

Barreto JG, Bisanzio D, Frade MA, Moraes TM, Gobbo AR, de Souza Guimarães L, da Silva MB, Vazquez-Prokopec GM, Spencer JS, Kitron U, Salgado CG. Spatial epidemiology and serologic cohorts increase the early detection of leprosy. in: BMC Infect Dis. 2015 Nov 16;15(1): p. 527. Free full text:

Barman KD, Madan A, Garg VK, Goel K, Khurana N. Unusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp: A Case Report. in: Indian J Lepr. 2015 Jan-Mar;87(1): 23-26. Abstract:

Caetano GT, Moreira L, Foreman CS, Sampaio LH. Serology can help in the early diagnosis of leprosy in monitoring household contacts. in: Tempus, actas de saúde colet 2015 (9) 2 Jun: p. 181-185.  free full text:

Ganesan V, Mandal J. Primary oral tuberculosis in a patient with lepromatous leprosy : Diagnostic dilemma. in: International Journal of Mycobacteriology, 2015 (Nov.19). Free full text: 

Ghosh SK, Ghosh A, Agarwal M. Erythema necroticans exhibiting transepidermal migration of lepra bacilli as a probable source of infection to other family members. in: Int J Dermatol. 2015 Oct 31. [Epub ahead of print]. Abstract: 

Kim JS, Kwon SH, Shin JY. Leproma Presenting as a Nasal Cavity Mass. in: J Craniofac Surg. 2015 Nov; 26(8): e694-695. Abstract:

Lima LN, Frota CC, Mota RM, Almeida RL, Pontes MA, Gonçalves Hde S, Rodrigues LC, Kendall C, Kerr L. Widespread nasal carriage of Mycobacterium leprae among a healthy population in a hyperendemic region of northeastern Brazil. in: Mem Inst Oswaldo Cruz. 2015 Nov;110(7): p. 898-905. Free full trext:

Herath S, Navinan MR, Liyanage I, Rathnayaka N , Yudhishdran J, Fernando J , Sirimanne G, Kulatunga  Lucio's phenomenon, an uncommon occurrence among leprosy patients in Sri Lanka. in: BMC Res Notes. 2015 Nov 13;8(1):672. Free full text:

Lima AS, Pinto KC, Bona MP, Mattos SM, Hoffmann MP, Mulinari-Brenner FA, Ottoboni VC. Leprosy in a University Hospital in Southern Brazil. in: An Bras Dermatol. 2015 Oct;90(5):654-659. Free full text:

Macedo CS, Anderson DM, Pascarelli BM, Spraggins JM, Sarno EN, Schey KL, et al. MALDI imaging reveals lipid changes in the skin of leprosy patients before and after multidrug therapy (MDT). in: Journal of mass spectrometry 2015; 50(12) (Dec.): p. 1374 - 1385. Abstract:

Matsuoka M. Global surveillance system to monitor the development of drug resistance in Mycobacterium leprae.  in: Research and reports in tropical medicine (Dovepress) 2015;(30 Nov.): p. 75-83.Free full text:

Mizoguti Dde F, Hungria EM, Freitas AA, Oliveira RM, Cardoso LP, Costa MB, Sousa AL, Duthie MS, Stefani MM. Multibacillary leprosy patients with high and persistent serum antibodies to leprosy IDRI diagnostic-1/LID-1: higher susceptibility to develop type 2 reactions. in: Mem Inst Oswaldo Cruz. 2015 Nov;110(7): p. 914-920. Free full text:

Mohanty PS, Naaz F, Katara D, Misba L, Kumar D, Dwivedi DK, Tiwari AK, Chauhan DS, Bansal AK, Tripathy SP, Katoch K. Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination. in: Indian J Dermatol Venereol Leprol. 2015 Nov 3. Abstract:

Monteiro LD, Martins-Melo FR, Brito AL, Alencar CH, Heukelbach J. Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012. in:  Rev Saude Publica. 2015; 49. Free full text:

Naik JD, Kamble SV, Jain SR, Mathurkar MP, Dolare JR, Patil V. A retrospective study of disability profile of live leprosy patients in a district of Maharashtra. in: Int J Med Sci Public Health 2015; Vol. 5; Issue 06 (Online First): 5p. Free full text:

Narasimha Rao P, Dogra S, Suneetha S. Global leprosy program : Does it need uniform-multi-drug therapy now? in: Indian Dermatol Online J 2015; 6 (6): p. 425 - 427. Free full text:

Naser Moghadasi A. First Visual Evidence of Leprosy in the Continental Shelf of Iran. in: Iran J Public Health. 2015 Aug;44(8):1162-1163. Free full text:

Pandey P, Suresh MS, Dey VK. De Novo Histoid Leprosy. in: Indian J Dermatol. 2015 Sep-Oct;60(5): p. 525. Abstract:

Parashar N, Satish Kumar CR. Quality of life and self-esteem in the adolescent children of patients who are suffering with leprosy. in: Ind. J. of Health and Wellbeing (IAHRW) 2015;6(9): 910 - 913. Abstract:

Patni V, Baliga S, Sawal S. Saliva as a Diagnostic Tool for Measurement of Total Antioxidant Capacity in Children with Leprosy and Born to Leprosy Parent. in: Indian J Lepr. 2015 Jan-Mar; 87(1): p.17-21. Abstract:

Pinho JD, Rivas PM, Mendes MB, Soares RE, Costa GC, Nascimento FR, Paiva MF, Aquino DM, Figueireido IA, Santos AM, Pereira SR. Presence of Mycobacterium leprae DNA and PGL-1 antigen in household contacts of leprosy patients from a hyperendemic area in Brazil. in: Genet Mol Res. 2015 Nov 19;14(4):14479-14487. Abstract:

Pinheiro MGC, Bezerra e Silva SY, Moura IBL, de Souza Silva F, Ramos Isoldi DM, Simpson CA. [Contribution of educational actions for knowledge of high school students about Leprosy] = Contribuição de prátiquas educativas para conhecimento
de escolares de ensino médio sobre Hanseníase. in: Journal of Nursing JNUOL = Revista de Enfermagem UFPE On Line; 2015: p. 9804 - 9810. (art. in Eng./Port.). Free full text:

Porichha D.  Does Leprosy Need a Stronger Surveillance System Now? : A point of view article. in:  Indian J Lepr, 2015 (87):  p. 33–37. Free full text:

Reis FJ, Correia H, Nagen R, Gomes MK. The Use of Ozone in High Frequency Device to Treat Hand Ulcers in Leprosy: a Case Study. in: Trop Med Health. 2015 Sep;43(3):195-9. Epub 2015 Jun 4. Free full text:

Rodriguez G, Henríquez R, Gallo S, Panqueva C. Histoid leprosy with giant lesions of fingers and toes. in: Biomedica. 2015 Jun;35(2): 165-170. Free full text:

Saha G, Mandal NK, Dutta RN. Current Perceptions and Practices (KAP) about Leprosy among Leprosy Patients : A Comparative Study between High Prevalent & Low Prevalent Districts of West Bengal. in: Indian J Lepr. 2015 Jan-Mar; 87 (1): 1-16. Abstract:

Sarker UK, Uddin MJ, Chowdhury R, Roy N, Bhattacharjee M, Roy J. Clinical Profile of Peripheral Neuropathy in Leprosy. in: Mymensingh Med J. 2015 Oct;24 (4) :671-678. Abstract:

Sathyavardhana Rao D. Incidence of ocular manifestations in type of leprosy : A clinical study. in: Journal of evidence-based medicine and healthcare 2015;2 (45) November: 8183-8189. Free full text:

Sendrasoa FA, Ranaivo IM, Raharolahy O, Andrianarison M, Ramarozatovo LS, Rapelanoro Rabenja F. Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection. in: Case Rep Dermatol Med. 2015;2015: 898410. [Epub 2015 Oct 4]. Free full text:

Shah JA, Berrington WR, Vary JC, Wells RD, Peterson GJ, Kunwar CB, et al. Genetic Variation in TOLLIP is Associated with Leprosy Susceptibility and Cutaneous IL-1 Receptor Antagonist Expression. in: Journal of ifectious diseases (Oxford Journals) 2015; (first published online November 26.). Abstract:

Sharma I, Kaur M, Mishra AK, Sood N, Ramesh V, Kubba A, et al. Histopathological Diagnosis of Leprosy Type 1 Reaction with Emphasis on Interobserver Variation. in: Indian Journal of Leprosy 2015; 87: 101 - 107. Free full text:

Sharma R, Singh P, Loughry WJ, Lockhart JM, Inman WB, Duthie MS, Pena MT, Marcos LA, Scollard DM, Cole ST, Truman RW. Zoonotic Leprosy in the Southeastern United States. in: Emerg Infect Dis. 2015 Dec;21(12): p. 2127 -2134. Free full text:

Soomro FR, Shaikh MA, Shaikh IA, Bhatti NS, Pathan GM. New cases and types of leprosy in Interior Sindh : An analysis of 3 years (2012-2014). in: J Pakistan Association of Dermatologists 2015;25(3): 186 - 190. Free full text:

Soto A, Muñoz PT. Leprosy Diagnosis : An Update on the Use of Molecular Tools Lucrecia. in: Molecular biology 2015;4 (139):5 p. Free full text:

Suchonwanit P, Triamchaisri S, Wittayakornrerk S, Rattanakaemakorn P. Leprosy Reaction in Thai Population: A 20-Year Retrospective Study. in: Dermatol Res Pract. 2015;2015:253154. [Epub 2015 Oct 5]. Free full text:

Trindade MAB, da Silva LLC, Braz LMA, Amato VS, Naafs B, Sotto MN. Post-kala-azar dermal leishmaniasis and leprosy : case report and literature review. in: BMC Infectious Diseases, 2015;15(1): p. 543. Free full text:

Tufariello JM, Kerantzas CA, Vilchèze C, Calder RB, Nordberg EK, Fischer JA, Hartman TE, Yang E, Driscoll T, Cole LE, Sebra R, Maqbool SB, Wattam AR, JacobsWR Jr. The Complete Genome Sequence of the Emerging Pathogen Mycobacterium haemophilum Explains Its Unique Culture Requirements. in: MBio. 2015 Nov 17;6(6). pii: e01313-15. Free full text:

Wang N, Liu H, Zhang F. A Lepromatous Leprosy Patient with Permanent Disability. in: Am J Trop Med Hyg. 2015 Nov 4;93(5): 896-898. Free full text:


Journals  & Newsletters

Community Eye Health:

Disability, CBR & Inclusive Development:

Leprosy Review: 2015-1

Revista de Leprología:

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


Other Information Sources

You might also be interested in The Leprosy Mailing List (LML), a free moderated email list that allows all persons interested in this theme to share ideas, information, experiences, questions.



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 <<

This email has been sent from a virus-free computer protected by Avast.

Tuesday, December 8, 2015

(LML) Leprosy and mainstream scientific definitions

Leprosy Mailing List – December 8,  2015

Ref.:   (LML)  Leprosy and mainstream scientific definitions

From:  Pranab Kumar  Das, Birmingham, UK

Dear Pieter, 


Please refer to the communication by Joel Almeida about the trend in incidence rate of leprosy in India in LML on December 5 2015. In that communication he showed one table in explaining the standardised number of new cases in India. I wonder whether he has published this in one of his articles where expanded explanation can be found. I shall appreciate to get hold of that publication, so that I can try to understand the point with more clarity.

Thank you for your help.



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

LML blog link:

Contact: Dr Pieter Schreuder <<

This email has been sent from a virus-free computer protected by Avast.