Leprosy Mailing List – March 27, 2016
Ref.: (LML) Over-optimism and the antidote
From: Joel Almeida, Mumbai and London
Dear Pieter,
Every new prediction in leprosy can make us over-optimistic.
In 1991 we predicted the elimination of leprosy by MDT. Instead, we merely eliminated leprosy services. Meanwhile, the incidence rate of new cases with visible deformity increased by 40% in India, between 2008/9 and 2014/15. The price is being paid by Indians who still needlessly suffer devastating permanent damage to their nerves, limbs and eyes.
What is the antidote to over-optimistic predictions? A healthy "what if" analysis.
What if our predictions and hopes are mistaken? That approach can help us establish a safety net to protect trusting people from visible deformity. We can do this by appointing the skilled, mobile leprosy workers who can monitor nerve function regularly. Then we can ensure anti-inflammatory treatment in time to prevent visible deformity.
Cuba has tried chemoprophylaxis of contacts and BCG, without denting the incidence rate of leprosy. Micronesia has tried repeated mass chemoprophylaxis, but merely delayed the occurrence of new cases. The incidence rate returned to its former level. A randomised controlled trial of chemoprophylaxis among contacts showed a higher incidence rate of leprosy in the treated group 2 to 4 years later, although the numbers were too small for this difference to attain statistical significance.
What if our hopes and predictions about chemoprophylaxis are over-optimistic? What if chemoprophylaxis merely postpones the signs of leprosy? What if the main sources of leprosy infection are, in fact, re-infected polar lepromatous patients after release from MDT? Of course we hope for the best. However, we need to be prepared for the worst: a mere postponement of new cases instead of a dramatic reduction in the incidence rate.
If the worst happens, then the skilled, mobile leprosy workers will be a safety net that protects people from visible deformity. When it comes to the limbs and eyes of ordinary people, we need "safety first." Then we can try whatever we want.
It would seem ethically sound to include post-chemoprophylaxis surveillance, prompt MDT, nerve monitoring and prompt anti-inflammatory treatment in projects of chemoprophylaxis. Otherwise chemoprophylaxis might lead to the same kind of over-optimism, complacency and avoidable visible deformity as we have seen in the past.
Given our history of relying on over-optimistic predictions, we would do well to appoint skilled, mobile leprosy workers for nerve function monitoring. We would also do well to identify polar lepromatous patients at diagnosis, and to protect them from re-infection.
Regards,
Joel Almeida
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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Tuesday, March 29, 2016
Re: (LML) Over-optimism and the antidote
Sunday, March 27, 2016
(LML) Over-optimism and the antidote
Leprosy Mailing List – March 27, 2016
Ref.: (LML) Over-optimism and the antidote
From: Joel Almeida, Mumbai and London
Dear Pieter,
Every new prediction in leprosy can make us over-optimistic.
In 1991 we predicted the elimination of leprosy by MDT. Instead, we merely eliminated leprosy services. Meanwhile, the incidence rate of new cases with visible deformity increased by 40% in India, between 2008/9 and 2014/15. The price is being paid by Indians who still needlessly suffer devastating permanent damage to their nerves, limbs and eyes.
What is the antidote to over-optimistic predictions? A healthy "what if" analysis.
What if our predictions and hopes are mistaken? That approach can help us establish a safety net to protect trusting people from visible deformity. We can do this by appointing the skilled, mobile leprosy workers who can monitor nerve function regularly. Then we can ensure anti-inflammatory treatment in time to prevent visible deformity.
Cuba has tried chemoprophylaxis of contacts and BCG, without denting the incidence rate of leprosy. Micronesia has tried repeated mass chemoprophylaxis, but merely delayed the occurrence of new cases. The incidence rate returned to its former level. A randomised controlled trial of chemoprophylaxis among contacts showed a higher incidence rate of leprosy in the treated group 2 to 4 years later, although the numbers were too small for this difference to attain statistical significance.
What if our hopes and predictions about chemoprophylaxis are over-optimistic? What if chemoprophylaxis merely postpones the signs of leprosy? What if the main sources of leprosy infection are, in fact, re-infected polar lepromatous patients after release from MDT? Of course we hope for the best. However, we need to be prepared for the worst: a mere postponement of new cases instead of a dramatic reduction in the incidence rate.
If the worst happens, then the skilled, mobile leprosy workers will be a safety net that protects people from visible deformity. When it comes to the limbs and eyes of ordinary people, we need "safety first." Then we can try whatever we want.
It would seem ethically sound to include post-chemoprophylaxis surveillance, prompt MDT, nerve monitoring and prompt anti-inflammatory treatment in projects of chemoprophylaxis. Otherwise chemoprophylaxis might lead to the same kind of over-optimism, complacency and avoidable visible deformity as we have seen in the past.
Given our history of relying on over-optimistic predictions, we would do well to appoint skilled, mobile leprosy workers for nerve function monitoring. We would also do well to identify polar lepromatous patients at diagnosis, and to protect them from re-infection.
Regards,
Joel Almeida
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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Sunday, March 13, 2016
(LML) Basic Dermatology Course for Medical Doctors
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Thursday, March 10, 2016
Re: (LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 8, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Tahir Dahiru, India
Dear Schreuder,
As per the question by Geeske Zip (LML, March 6, 2016), in clinical Leprosy you classify base on skin lesions and major nerve trunk involvement. If an individual patient has 5 skin lesions or less with only one major nerve trunk involvement or none you classify as PB. If an individual has more than five skin lesions you classify as MB or if he has more than one nerve involvement even if he has less than 6 skin lesions you classify as MB as per the WHO guideline.
Dr Tahir Dahiru
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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(LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 10, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Indropo Agusni, Surabaya, Indonesia
Dear Pieter,
I am of the same opinion as Dr. Jaison Barreto (LML, March 9, 2016)). During reversal reaction many leprosy cases develop some new small skin lesions (" flare up”) at sites that previously looked like normal skin. It indicates that actually some of leprosy bacilli or antigen are already present in the tissue, without any previous sign or symptom. Soon after the start of MDT or type 1 reaction, the immune system detects the invaders, immune cells are recruited and inflammation occurs, manifested as “flare up" of skin lesions.
Leprosy bacilli seems to be “tolerated " by human body or having a "mask" in their face, so the immune system does not recognized the enemy. They live happily and multiply in human body without any opponent. That is why leprosy should be treated early and not to wait until the presence of skin lesions.
Best regards,
Indropo Agusni
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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(LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 10, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Marco Andrey Cipriani Frade, Ribeirão Preto, Brazil
Dear Pieter,
Dr Jaison (LML, March 9, 2016) touched exactly an uncomfortable point about leprosy classification and he has my complete agreement.
According the simple scheme, considering just the number of lesions and neglecting the nerve impairment, we are losing the chance to do an early diagnosis and the correct treatment of leprosy and really cure these patients before disabilities and incapacity.
Nowadays, the number of patients with borderline profile and with small number of skin lesions, many almost imperceptible, but with restrict neural branches impairment with islet of sensitivity alteration(s) (tactile, pain and/or hot), and/or sympathetic alteration. Sympathetic alteration defined as restricted areas (islet) with no vasomotor reflex to endogenous or exogenous histamine stimulus and/or sweat dysfunction defined by (the absence of) natural beads of sweat or using lugol test. None of these details and detailed peripheral nerve clinical exam are described in routine protocols.
With MDT leprosy became a simple disease to treat, but its diagnosis continues or became more complex. Sure, we should think strongly about it and propose a more elaborated continuous educational program in leprosy clinic mainly in these early neural signs preventing the advance and the consequent notoriety of stigmas that both committed leprosy patients.
Best regards
Marco Andrey C. Frade
President of Brazilian Society of Leprology
Prof. Dr. Marco Andrey Cipriani Frade
Professor Associado (Livre Docente)
Coordenador Residência Médica de Dermatologia HCFMRP-USP
Coordenador Centro de Referência em Dermatologia Sanitária - HansenÃase - HCFMRP-USP
[(http://lattes.cnpq.br/9103136155056414)]
Divisão de Dermatologia - Departamento de ClÃnica Médica
Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo
Av. Bandeirantes, 3900 - Monte Alegre - Ribeirão Preto -SP - Brasil
CEP: 14.049.900 - Tel: 55-16-36022441 (Sala) - 36022447 (Sec.) - FAX: 55-16-36021522
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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Wednesday, March 9, 2016
(LML) 19th International Leprosy Congress Beijing 2016
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(LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 9, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Jaison Barreto, Bauru, Brazil
Dear Pieter,
About pseudo-classifications, it is important to remind some points:
1. If a patient has only one visible leproma, even if infiltration is not easily seen, it is not a PB leprosy.
2. If a patient has only one visible honeycomb like plaque, with ill-defined borders, this patient has mid borderline leprosy, and this is not PB leprosy.
3. If a patient has only one plaque, even with well-defined borders, but several nerve trunks affected, i.e., disseminated disease, this patient has borderline tuberculoid leprosy, and this is not PB leprosy.
PB or MB are NOT forms of leprosy, but schemes of treatment.
Patients with several visible lesions have disseminated disease, but the opposite is not true, unfortunately.
Subclinical involvement of skin or nerves, or other organs like testis, kidneys or liver, is seen, in many instances, only after the beginning of MDT. We call this manifestations as reactions.
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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Tuesday, March 8, 2016
(LML) INFOLEP's monthly Choice list - February 2016
Leprosy Mailing List – March 8, 2016
Ref.: (LML) INFOLEP’s monthly Choice list - February 2016
From: Jiske Erlings, Amsterdam, the Netherlands
Dear Pieter,
Greetings from Infolep!
Below you will find a selection of recent publications on leprosy and related subjects. Feel free to contact me to receive the full text versions if a link to the full text is not included.
On International Women’s Day you might want to check out our Leprosy & Gender collection: http://www.leprosy-information.org/category/subject/gender.
Keep sending us your publications on leprosy or material on leprosy in your language to include in the portal.
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: infolep@leprastichting.nl
Some NTD publications
de Vlas SJ, Stolk WA, le Rutte EA, Hontelez JA, Bakker R, Blok DJ, Cai R, Houweling TA, Kulik MC, Lenk EJ, Luyendijk M, Matthijsse SM, Redekop WK, Wagenaar I, Jacobson J, Nagelkerke NJ, Richardus JH. Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained? in: PLoS Negl Trop Dis. 2016 Feb 18;10(2):e0004386. Full text: http://www.leprosy-information.org/resource/concerted-efforts-control-or-eliminate-neglected-tropical-diseases-how-much-health-will-be
Hotez PJ, Pecoul B, Rijal S, Boehme C, Aksoy S, et al. (2016) Eliminating the Neglected Tropical Diseases: Translational Science and New Technologies. in: PLoS Negl Trop Dis 10(3): e0003895. Full text online: http://www.leprosy-information.org/resource/eliminating-neglected-tropical-diseases-translational-science-and-new-technologies
Neglected Tropical Disease NGDO Network: Reflections on accomplishments in the prevention, treatment and management of consequences of NTDs - Special NNN2016 issue of Int. Health (2016) 8 Full text online: http://inthealth.oxfordjournals.org/content/8/suppl_1.toc
Combating NTDs: Lessons from India. PLOST NTDs Collection: http://collections.plos.org/india?#_=_
New Leprosy publications
Andrade PR, Jardim MR, da Silva AC, Manhaes PS, Antunes SL, Vital R, Prata RB, Petito RB, Pinheiro RO, Sarno EN. Inflammatory Cytokines Are Involved in Focal Demyelination in Leprosy Neuritis. in: J Neuropathol Exp Neurol. 2016 Feb 17. Full text online: http://www.leprosy-information.org/resource/inflammatory-cytokines-are-involved-focal-demyelination-leprosy-neuritis
de Sousa JR, de Sousa RP, de Souza Aarão TL, Dias LB Jr, Carneiro FR, Fuzii HT, Quaresma JA. In situ expression of M2 macrophage subpopulation in leprosy skin lesions. in: Acta Trop. 2016 Jan 28. Abstract: http://leprosy-information.org/resource/situ-expression-m2-macrophage-subpopulation-leprosy-skin-lesions
De Matos HJ, Blok DJ, De Vlas SJ, Richardus JH. Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study. in: PLoS Negl Trop Dis. 2016 10(3): e0004507. Full text online: http://www.leprosy-information.org/resource/leprosy-new-case-detection-trends-and-future-effect-preventive-interventions-par-state
Dimri D, Gupta A, Singh AK. Leprosy Continues to Occur in Hilly Areas of North India. in: Dermatol Res Pract. 2016;2016:7153876. Full text online: http://www.leprosy-information.org/resource/leprosy-continues-occur-hilly-areas-north-india
Fava VM, Manry J, Cobat A, Orlova M, Van Thuc N, Ba NN, Thai VH, Abel L, Alcaïs A, Schurr E; Canadian Lrrk2 in Inflammation Team (CLINT). A Missense LRRK2 Variant Is a Risk Factor for Excessive Inflammatory Responses in Leprosy. in: PLoS Negl Trop Dis. 2016 Feb 4;10(2):e0004412. Full text online: http://www.leprosy-information.org/resource/missense-lrrk2-variant-risk-factor-excessive-inflammatory-responses-leprosy
Ganesan V, Mandal J. Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma. in: Int J Mycobacteriol. 2016 Mar;5(1):102-5. Abstract: http://www.leprosy-information.org/resource/primary-oral-tuberculosis-patient-lepromatous-leprosy-diagnostic-dilemma
Júnior IA, Gresta LT, Noviello ML, Cartelle CT, Lyon S, Arantes RM. Leprosy classification methods: a comparative study in a referral center in Brazil.
in: Int J Infect Dis. 2016 Feb 26. ull text online: http://www.leprosy-information.org/resource/leprosy-classification-methods-comparative-study-referral-center-brazil
Lambert SM, Nigusse SD, Alembo DT, Walker SL, Nicholls PG, Idriss MH, Yamuah LK, Lockwood DN. Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia. in: PLoS Negl Trop Dis. 2016 Feb 6;10(2): e0004149. Full text online: http://www.leprosy-information.org/resource/comparison-efficacy-and-safety-ciclosporin-prednisolone-treatment-erythema-nodosum-leprosum
Mayboroda OA, van Hooij A, Derks R, van den Eeden SJ, Dijkman K, Khadge S, Thapa P, Kunwar CB, Hagge DA, Geluk A. Exploratory Urinary Metabolomics of Type 1 Leprosy Reactions. in: Int J Infect Dis. 2016 Feb 25. Full text online: http://www.leprosy-information.org/resource/exploratory-urinary-metabolomics-type-1-leprosy-reactions
Mendonça JA, Provenza JR, Castro de Mattos A, Ota FS, Appenzeller S. Hansen's disease: Descriptions of novel ultrasonographic findings. in: Joint Bone Spine. 2016 Jan 27. Abstract: http://www.leprosy-information.org/resource/hansens-disease-descriptions-novel-ultrasonographic-findings
Neela VS, Devalraju KP, Pydi SS, Sunder SR, Adiraju KR, Singh SS, Mpjs A, Valluri VL. Mycobacterial r32-kDa Ag specific T cell responses correlate with successful treatment and heightened antimicrobial response in human leprosy patients. in: Int Immunol. 2016 Feb 26. pii: dxw009. Abstract: http://www.leprosy-information.org/resource/mycobacterial-r32-kda-ag-specific-t-cell-responses-correlate-successful-treatment-and
Oliveira JM, Rêgo JL, de Lima Santana N, Braz M, Jamieson SE, Vieira TS, Magalhães TL, Machado PR, Blackwell JM, Castellucci LC. The -308bp TNF gene polymorphism influences tumor necrosis factor expression in leprosy patients in Bahia State, Brazil. in: Infect Genet Evol. 2016 Jan 29. Abstract: http://leprosy-information.org/resource/308bp-tnf-gene-polymorphism-influences-tumor-necrosis-factor-expression-leprosy-patients
Pradeep Nair S, Vidyadharan S. A study of the prevalence of smear-positive leprosy cases in a tertiary care center in the post-elimination phase of leprosy. in: Int J Dermatol. 2016 Feb 12. Abstract: http://www.leprosy-information.org/resource/study-prevalence-smear-positive-leprosy-cases-tertiary-care-center-post-elimination-phase
Ramos JM, Romero D, Belinchón I. Epidemiology of Leprosy in Spain: The Role of the International Migration. Plos Negl Trop Dis 10(3): e0004321. in: Full text online: http://www.leprosy-information.org/resource/epidemiology-leprosy-spain-role-international-migration
Roset Bahmanyar E, Smith WC, Brennan P, Cummings R, Duthie M, Richardus JH, Saunderson P, Shwe T, Rosen S, Geluk A. Leprosy Diagnostic Test Development As a Prerequisite Towards Elimination: Requirements from the User's Perspective.
in: PLoS Negl Trop Dis. 2016 Feb 11;10(2):e0004331. Full text online: http://www.leprosy-information.org/resource/leprosy-diagnostic-test-development-prerequisite-towards-elimination-requirements-users
Sen D, Satija L, Chatterji S, Majumder A, Gupta A, Kumar A. Ultrasonography and magnetic resonance imaging of ulnar nerve abscess in leprosy. in: Med J Armed Forces India. 2016 Jan;72(1):78-81. Abstract: http://www.leprosy-information.org/resource/ultrasonography-and-magnetic-resonance-imaging-ulnar-nerve-abscess-leprosy
Sharma I, Singh A, Mishra AK, Singh LC, Ramesh V, Saxena S. Is CXCL10/CXCR3 axis overexpression a better indicator of leprosy type 1 reaction than inducible nitric oxide synthase? in: Indian J Med Res. 2015 Dec;142(6):681-9. Full text online: http://leprosy-information.org/resource/cxcl10cxcr3-axis-overexpression-better-indicator-leprosy-type-1-reaction-inducible-nitric
Thomas M. A new era of diagnostic modalities for type 1 leprosy reactions: Promise for the future. in: Indian J Med Res. 2015 Dec;142(6):644-6. Full text online: http://leprosy-information.org/resource/new-era-diagnostic-modalities-type-1-leprosy-reactions-promise-future
Vieira AP, Trindade MÂ, Pagliari C, Avancini J, Sakai-Valente NY, Duarte AJ, Benard G. Development of Type 2, But Not Type 1, Leprosy Reactions is Associated with a Severe Reduction of Circulating and In situ Regulatory T-Cells. Am J Trop Med Hyg. 2016 Feb 22. Abstract: http://www.leprosy-information.org/resource/development-type-2-not-type-1-leprosy-reactions-associated-severe-reduction-circulating-and
Journals & Newsletters
Community Eye Health: http://www.cehjournal.org/wp-content/uploads/Working-with-communities-to-improve-their-eye-health.pdf
Disability, CBR & Inclusive Development: http://dcidj.org/
Leprosy Review: http://www.lepra.org.uk/Pages/FAQs/Category/volume-85
Plos Neglegted Tropical Diseases: http://journals.plos.org/plosntds/
Revista de Leprología: http://www.leprosy-information.org/resource/revista-de-leprologia
WHO Goodwill Ambassador’s Newsletter for the elimination of leprosy: http://www.leprosy-information.org/resource/who-goodwill-ambassador-s-newsletter-elimination-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 and questions. http://leprosymailinglist.blogspot.nl/
The new International Leprosy Association – History of Leprosy http://leprosyhistory.org/ website.
Jiske Erlings
Medewerker InfoLep / Information Officer
Infolep Leprosy Information Services
Postbus / P.O. Box 95005 1090 HA Amsterdam The Netherlands
|
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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(LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 8, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Tahir Dahiru, India
Dear Schreuder,
As per the question by Geeske Zip (LML, March 6, 2016), in clinical Leprosy you classify base on skin lesions and major nerve trunk involvement. If an individual patient has 5 skin lesions or less with only one major nerve trunk involvement or none you classify as PB. If an individual has more than five skin lesions you classify as MB or if he has more than one nerve involvement even if he has less than 6 skin lesions you classify as MB as per the WHO guideline.
Dr Tahir Dahiru
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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Monday, March 7, 2016
(LML) 19th International Leprosy Congress Beijing 2016
Leprosy Mailing List – March 7, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Hemanta Kumar Kar, New delhi, India
Dear Pieter,
Referring to the LML letter by Geeske Zijp of March 6, 2026:
Nerve involvement was kept as a factor to classify leprosy into PB and MB leprosy (WHO, Leprosy Elimination Group (2000). Presently in India, the number of nerves involved is taken into consideration along with skin lesion count while categorizing the patients into PB and MB as per the criteria laid down under NLEP of Govt, of India, which are similar to ILEP.
PB cases are those who are having one to five skin lesions including single nerve lesion if present or having only one nerve lesion even without having any skin lesion.
MB are cases those who are having six and above skin lesions with or without nerve lesions or more than one nerve lesions irrespective of number of skin lesions or skin smear positive at any site.
IAL Textbook of LEPROSY, 2nd edition, 2016, edited by Bhushan Kumar and Dr Hemanta Kumar Kar.
Regards,
Dr Kar
Dr. Hemanta Kumar Kar
Professor in Dermatology,North Delhi Municipal Corporation Medical College Delhi -110007
Former Director, Dean and Med. Superintendent
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital, New Delhi-110001
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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