Leprosy Mailing List – February 15, 2016
Ref.: (LML) What is the actual situation of leprosy and its elimination
From: Jaison Barreto, Bauru, São Paulo, Brazil
Dear Pieter
It is very good and simple this chart which was posted by Dr Dudhalkar LML, February 12, 2016).
I would like only to add some points:
1. Sensitive cutaneous branches, as Auricular Major and Superficial Fibularis nerves (photos attached) are also common in Lepromatous Leprosy, and sometimes the clue to diagnosis of early cases.
2. Borderline Tuberculoid Leprosy patients often have a weak lepromin response (less than f5mm), and usually evolves a downgrading (progressive or reactional) to Borderline Lepromatous Leprosy. So, these patients must be treated with MDT MB. It does not matter the number of patches. But we can define this group because they usually complain, when asked, of paresthesia in hands and feet, typical of disseminated disease.
3. There are five criteria which we must take in mind before the final classification of a patient:
a) clinical aspects of the lesion (patch, macule, nodules, diffuse infiltration, shape, borders), and number of nerves;
b) histopathology;
c) bacilloscopy;
d) immunology (lepromin/serology);
and as important as the other criteria,
e) evolution of the disease.
In case of doubt, it is better to treat a patients as having MB leprosy.
It is often seen, in practice, that most patients, initially classified as having True TT Leprosy, or adults with Indeterminate (early Leprosy), even by histophatology and/or bacilloscopy, are, indeed, BT, and this mistake will be noticed only after the finish of PB MDT, usually 2 or 3 month after discharge, when they develop type 1 reaction.
According to Ridley and Jopling Classification, True TT does not suffer reaction, and natural history is the evolution to a self-limited disease.
BT patients, however, with reaction after the beginning of MDT, or discharge, are still called (unfortunately) as "PB with reaction". This is catastrophic, once they are treated only with steroids for several years, become deformed by relapsing neuritis, and also developing arterial hypertension, osteoporosis, diabetes, etc. (effects steroids). Finally, the physician, usually 7 to 10 years later, say to these patients that their disease relapsed, and now the treatment must restarted for more 1 year (now correctly).
I think to myself: How can we make this patient to believe that Leprosy is curable?
"Primum non nocere!", or, in case of Leprosy, do not misclassify.
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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