Leprosy Mailing List – November 2 , 2017
Ref.: (LML) MDTU and the risk of emergence of resistant strains
From: Roberta Romero, San Juan, Metro Manila, Philippines
Dear Dr. Schreuder,
I agree with the observations that some patients may have a recurrence of the disease after they are released from treatment (LML, Ocober 24, 2017). These have always prompted us on how we manage patients with Hansen's Disease. We spend time educating them with emphasis on what the disease is all about, medicines we use to treat (their side effects especially), what the to watch out for in terms of signs and symptoms once released from treatment, and to bring their household contacts for initial examination (also to watch out for signs and symptoms of HD when these appear in their contacts in the future). We really, really take a lot of time on every single patient, we establish rapport, we get their confidence and assurance that we are there for them, and make sure they understand what the whole thing is all about because they need to be proactive in their cure. There is no shortcut for this initial and subsequent interactions.
We still don't know what percentage of bacilli are dormant and therefore unaffected by chemotherapy; we do not know what causes these to reactivate in the future. Sometimes our initial clinical evaluation is an under assessment of the burden of the disease and may miss out in affording a possible cure. So these patients must know they need to come back to us if and when there is a resurgence of their symptoms. Again, they can only do this if they trust us or the system that takes care of them.
I have no idea on drug resistance in leprosy, I have not been able to experience failure of re-treatment.
Lately, I have heard of two deaths from severe type 2 reactions of lepromatous patients confined in two medical centers in Quezon City. Apparently both were not recognized and managed as such. Which reminds me of our historical experience in seeing patients die from these same problems when we were helping out in Tala sometime in the 80's and have not seen this phenomenon since then.
There is still work for us to do in leprosy.
Dr Roberta Romero FPDS
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << email@example.com