Leprosy Mailing List – December 8, 2016
Ref.: (LML) I was dreaming
From: Arry Pongtiky, Irian Jaya, Indonesia
Dear Pieter,
May I refer to: “I was dreaming” by Ben Naafs (LML, November 18 , 2016) about Nerve damage. May be this dream can be translated into pictures and also linked to the issue of Nerve Decompression (LML, November 26 and 28, 2016)
My impression is that this topic is difficult to digest especially for field workers. I would like to share with the readers as I understood it!
Reaction type 1 causes inflammation; it will be easy to get nerve compression because of swelling. Prednisolone functions as anti-inflammation (anti-swelling and avoiding highly cellular response). Existence of mycobacterium leprae in nerves and skin as foreign bodies must be eliminated by immune system/cellular response, it is like a plane attacks and fires the targets. Reaction type 1 will be easier to have disability. Nerve compression can be overcome with steroid and surgery?
Reaction type 2: If too many bacilli (mycobacterium leprae) or after few months treatment, the bacilli in the form of fragmented or decay bacilli come into blood circulation, go far away cause inflammation, because immune system detects as foreign bodies. Antigen and antibody response happened. It will cause inflammation in vascular (vasculitis/pain and red nodules), eyes (iridocyclitis), arthritis (joint), lymphadenitis (lymph vessel), orchitis (testis). The reaction impacts more severe /ill for patient because of systemic response. Steroid and lamprene as well as talidomide , physiotherapy may help/work well for this type. Maybe less impact for surgery. If I did not know about triggers. My experience giving extra antibiotic (amoxicylin for 5 days) may help together with steroid. Looking for trigger factors is a must. Many chronic cases usually are feeling down must be addressed.
Note: giving steroid must be started high dose and do tapering off
Lucio Phenomenon....This was a rare case, severe reaction suspect of Lucio phenomenon. According to Ben Naafs, the Lucio phenomenon is just a blocking of the venules in the skin due to number of bacilli which leads to infarction. I did not have much experience about Lucio phenomenon, as I understood more reported in South America. Our case survived by giving MDT, good nutrition and counseling. At the time we avoided to use steroid because patient was too ill, we were worried about super infection/ sepsis. The trigger factor was pregnancy and the baby was died after delivery.
Thank you very much,
Arry Pongtiku
Papua,Indonesia
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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