Leprosy Mailing List – July 25, 2017
Ref.: (LML) New publications on cross-cutting issues and NTDs, July 2017
From: Ilse Egers, Amsterdam, the Netherlands
Dear Pieter,
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – July 21, 2017
Ref.: (LML) The ENLIST ENL Severity Scale
From: Steve Walker, London, UK
Dear Pieter,
On behalf of the Erythema Nodosum International STudy (ENLIST) Group I would be grateful if you could circulate the link to our recently published validation study of the 10-item ENLIST ENL Severity Scale (EESS) which is accompanied by a User Guide.
The paper can be found at: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005716
The final version of the EESS and User Guide can be found in the Supporting Information section.
We hope that colleagues will find the scale useful in both the clinical assessment of patients with ENL and in research studies. We would welcome comments or queries about the work of the ENLIST Group (enlist@LSHTM.ac.uk).
We are extremely grateful to the Austrian Leprosy Relief Association / AHWÖ Aussätzigen-Hilfswerk Österreich (http://www.aussaetzigen-hilfswerk.at/) and Leprosy Research Initiative (https://www.leprosyresearch.org/) for the generous support of this work.
Best wishes
Steve
Stephen L. Walker PhD, MRCP(UK), DTM&H | |
Associate Professor | |
London School of Hygiene & Tropical Medicine | |
Keppel St | London WC1E 7HT | United Kingdom |
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – July 19 , 2017
Ref.: (LML) Re-infection of lepromatous patients after release from MDT
From: H K Kar, New Delhi, India
Dear Pieter,
To thank Joel Almeida (LML, 18-07-2017) for bringing back the relevant observation which is discussed by the leprologists off and on. We know that there are two types of lepromatous leprosy. We encounter in our clinical practice:
-Sub-polar lepromatous leprosy which are the downgraded ones from borderline/indeterminate types of leprosy because of the delay in diagnosis and appropriate treatment of these cases, which are the majority of all LL cases.
-And another small group of LL cases, those from the beginning, manifest as LL with bilateral symmetrical hypo-pigmented or erythematous ill defined small macular lesions without loss of sensation all over the body or as diffuse fine infiltrations especially on face and extensor aspects of the trunks and extremities without any apparent peripheral nerve involvements initially. These cases create diagnostic problem clinically unless we do Slit skin smear (SSS) examination for detection of AFB with or without skin histopathological examination.
These polar LL cases, though very small in number especially in India, are sources of reservoir of infection in the community. After adequate MDT the possibility of relapse/reinfection either from endogenous /exogenous sources respectively is a possibility because of inherent zero cell mediated immune (CMI) response against Mycobacterium leprae. These cases require immune therapy along with MDT for prevention of relapse or reinfection. These cases also create problem of showing slow or nonresponse to MDT (non-responders) in the form of delayed bacteriological clearance through SSS and dermal granuloma clearance (skin biopsy). We have found quicker clinical, bacteriological and histopathological responses when longer course of MDT (2 to 3 years) was added with 4 to 8 doses of Immunotherapy (Mw/MIP vaccine). We have seen lepromin conversion in more than 60% of these cases after immunotherapy (published reports).
Therefore through immunotherapy along with longer duration of MDT we can reduce chance of reinfection and relapse in these small group of LL patients at-least theoretically by 60%.
Thanks and Regards,
Dr H K Kar
Dr. Hemanta Kumar Kar
Medical Director - LA Skin
Head of the Department - Dermatology
Paras Hospital - Gurugram, Haryana
Max Smart Hospital - Saket, New Delhi
Email: hkkar_2000@yahoo.com
Ph: +919599114121
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – July 17, 2017
Ref.: (LML) Re-infection of lepromatous patients after release from MDT
From: Joel Almeida, Mumbay and London
Dear Pieter,
Whole genome sequence analysis of M. leprae obtained from initial and relapse skin lesions demonstrated that reinfection with a different M. leprae strain can occur in lepromatous leprosy (LL) patients who remain in an endemic area after the conclusion of MDT (Stefani et al, 2017 in press, cited by Penna et al 2017, https://doi.org/10.1371/journal.pntd.0005725).
Exogenous re-infection was first postulated in the 1980's to explain supposed "relapses" among smear-negative BL and LL patients in an endemic area of India (Almeida et al, 1983, Int. J. Lepr 51(3):382-4, and 1984, Int. J. Lepr. 52(1): 16-19). The recent genome analysis lends support to that view.
So-called "relapse rates" among polar lepromatous patients in leprosy-endemic areas after MDT might be partly or wholly due to exogenous re-infection. For the interruption of transmission and the prevention of disfigurement, it seems important to identify polar lepromatous patients at diagnosis. They can then be protected against re-infection, by continued treatment, until they demonstrably develop specific immunity against M. leprae.
This is important for more than just the individual patient. It is crucial for leprosy control. One polar lepromatous patient is equivalent, in microbiological and epidemiological terms, to 10,000 or more TT or BT patients. Neglect of such microbiological and epidemiological realities renders our leprosy control efforts ineffective. It is a wholly avoidable error.
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
Leprosy Mailing List – July 5, 2017
From: Jiske Erlings, Amsterdam, the Netherlands
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
