(LML) Mortality in leprosy

Leprosy Mailing List – January 30,  2018

Ref.:    (LML) Mortality in leprosy

From:   Clovis Lombardi, São Paulo, Brazil

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Dear Pieter,

 

You will find below the link to an article of my authorship (abstract of my doctorate thesis) published in Revista de Saúde Pública São Paulo (Brazil) in 1984, about mortality in leprosy in the state of São Paulo.

 

Although it refers to the pre-MDT era, I believe it could eventually be useful to the discussion.

 

Link (with abstract in English):

 

http://www.scielo.br/scielo.php?pid=S0034-89101984000200003&script=sci_arttext

 

 

Best regards,

 

Clovis Lombardi

Retired professor Epidemiology Department

Public Health School - USP - São Paulo

 

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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

 

(LML) Mortality in leprosy

Leprosy Mailing List – January 29,  2018

Ref.:    (LML) Mortality in leprosy

From:   Shimelis Nigusse Doni, Addis Abeba, Ethiopia

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Dear Pieter,

 

 

Arry Pongtiku (LML, January 26, 2018) asked how to address mortality in leprosy and described examples which distinguished between the direct cause of death ((the final disease, injury, or complication directly causing death) and underlying cause of death (the disease or injury that initiated the chain of morbid events that led directly and inevitably to the death).

 

There is one study which may be of interest: Stephen L. Walker,  Eglantine Lebas,  Shimelis N. Doni, Diana N. J. Lockwood and Saba M. Lambert. The Mortality Associated with Erythema Nodosum Leprosum in Ethiopia: A Retrospective Hospital-Based Study. PLoS Negl Trop Dis. 2014 Mar; 8(3): e2690 doi:  10.1371/journal.pntd.0002690  PMCID: PMC3953021

 

Abstract

BACKGROUND:

Erythema nodosum leprosum (ENL) is a debilitating multisystem disorder which complicates leprosy. It is characterised by fever, malaise and painful erythematous cutaneous nodules. ENL is often recurrent or chronic in nature and frequently severe. Patients often require prolonged treatment with high doses of oral corticosteroids. There are no data on the mortality associated with treated ENL.

METHODOLOGY:

The notes of patients who were admitted, discharged, transferred to another facility or died with a diagnosis of leprosy or a leprosy-related complication for a five-year period were reviewed.

RESULT/DISCUSSION:

414 individuals were identified from the ward database. 312 (75.4%) patient records were located and reviewed. Ninety-nine individuals had ENL and 145 had a Type 1 reaction. The median age of individuals with ENL was 25 years. Eight patients with erythema nodosum leprosum died compared with two diagnosed with Type 1 reaction. This difference is statistically significant (p = 0.0168, Fisher's Exact Test). There is a significant mortality and morbidity associated with ENL in this Ethiopian cohort. The adverse outcomes seen are largely attributable to the chronic administration of oral corticosteroids used to control the inflammatory and debilitating symptoms of the condition.

 

Shimelis Nigusse Doni (M.D)
Consultant Dermatovenereologist
Head Leprosy and Dermatology Departement
Tel: +251911642060
PO.Box  183294
ALERT
Ethiopia

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact

(LML) Chemoprophylaxis in Leprosy

Leprosy Mailing List – January 27,  2018

Ref.:    (LML) Chemoprophylaxis in Leprosy

From: Wim van Brakel, Amsterdam, the Netherlands

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Dear Pieter,

I would like to react to the remark by Dr. Romero (LML, January 24, 2018) regarding the risk of developing Rifampicin resistance in case of chemoprophylaxis in leprosy.

High-level TB experts involved in work on MDR TB have assured us that single-dose rifampicin chemoprophylaxis does not pose a risk for inducing rifampicin-resistant TB. It is of course important that proper precautions and screening procedures are in place, as detailed in the attached paper. 

With kind regards,

Wim

 

Wim van Brakel, MD MSc PhD

Head Technical Department

Netherlands Leprosy Relief (NLR)

Wibautstraat 137k

1097DN Amsterdam

Netherlands

Tel. +31 20 5950529

URL: www.leprosyrelief.org

  

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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

 

(LML) Request for advice on HIV and Leprosy

Leprosy Mailing List – January 27,  2018

Ref.:   (LML)  Request for advice on HIV and Leprosy

From:  H K Kar, New Delhi, India

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Dear Pieter,

I agree with Ben (LML, January 24, 2018).

 

Nodular infiltrative lessons over the face indicates d/d nodular LL, Cutaneous lymphoma, PKDL, and sarcoidosis. In HIV positive patients in the absence of AFB positivity, Cut. Lymphoma should be considered. Therefore, in this case skin biopsy for histopathological examination is must along with repeat SSS exam. for AFB.

 

In polar LL as Ben gave his opinion, peripheral sensory loss is not very much marked. Rather in HIV positive patient itching is a common symptom for various skin pathology including eosinophilic folliculitis, scabies and fungal infections.

 

Regards,

 

Dr H K Kar

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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

 

(LML) Mortality in leprosy

 

Leprosy Mailing List – January 26,  2018

Ref.:    (LML) Mortality in leprosy

From:  Arry Pongtiku, Papua, Indonesia

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Dear Pieter,

Good morning, I would like to express my appreciation and thanks toJoel Almeida for his letters to make us aware of facts about leprosy and current situation. 

1.Leprosy is still neglected. We focus to talk about new cases (transmission), new child cases, disability and stigma.  Very little is said about leprosy mortality and economic loss due to leprosy. Leprosy can also kill people. When talking about leprosy, one must think comprehensively, like for example reactions and the cycle of unproductivity and poverty

2.In the field and hospital we found leprosy patients who died because of chronic ENL and cachexia, Dapsone allergy and mismanagement. Leprosy patients suffer from long illness, stigma, stress and denial made them feel hopeless and fragile, and more likely to die.  Steroid dependency and self treatment with steroid make them easy to get other infections. Some people died diagnosed as heart attack but having an history of leprosy and the use of steroids and self treatment with steroids. Others suddenly stopped taking steroids: steroid crisis followed by death. Death registration data: Leprosy and HIV---died due to HIV; Leprosy and TB---died to TB;  DDS allergy diagnosis --died from severe hepatitis or renal failure; chronic reaction and malaria---died due to malaria. Mortality related to leprosy is still underreported or not reported.

3. I just received a copy of an excellent book " IAL Text book of Leprosy, 2nd Edition,2016. Indian association of leprologists. Page:585 mentioned "Reliable mortality figure because of leprosy are not available".

 

How do we address mortality in leprosy?

 

Thank you very much,

Salam,

 

Arry Pongtiku

Papua-Indonesia

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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

 

(LML) Chemoprophylaxis in Leprosy

 

Leprosy Mailing List – January 25,  2018

Ref.:    (LML) Chemoprophylaxis in Leprosy

From: Roberta Romero, Makati, Philippines

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Dear Pieter

 

In the Philippines we never adopted this prophylaxis proposal simply because of so many factors that we can not control. I. e., we can not ensure that the household and the community are free of the leprosy bacteria so that exposure post prophylaxis is safeguarded; we have so much more TB and we have reason to worry about use of Rifampicin without good supportive data; Rifampicin resistance is a possibility; etc.

 

It is important to educate the remaining household members on early signs of leprosy and to be able to provide them easy and reliable access to medical workers knowledgeable about it.  We can not let our guard down.  The fight is not over.

 

Dr Roberta Romero,,FPLS, FPDS

Executive Director

Tropical Disease Foundation,Inc

Makati, Philippines 

 

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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

(LML) Request for advice on HIV and Leprosy

Leprosy Mailing List – January 24,  2018

Ref.:   (LML)  Request for advice on HIV and Leprosy

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear Pieter,

To answer the request for advice from Tahir Dahiru, LML 22-01-2018, the following. Leprosy lesions can itch. HIV infection can lead to this aspect.

However, the smears should be positive. If they are not positive it could be that the bacilli were stained in a TB lab. The staining for TB is too strong for M. leprae. This the smear result is negative. In MB leprosy who have not gone through a stage of Tuberculoid or Borderline there may be no loss of sensation.  The enlargement of nerves points in the direction of leprosy. But when no sensory changes it is doubtful. To make a definite diagnosis you need 2 of the cardinal signs.

As a DD I would think of lymphoma, or diffuse Leishmaniasis. But the large nerves make me doubt.

 

With regards

 

Ben

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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

 

(LML) Request for advice on HIV and Leprosy

Leprosy Mailing List – January 23,  2018

Ref.:   (LML)  Request for advice on  HIV and Leprosy

From:  Marco Andrey Cipriani Frade, Ribeirão Preto, Brazil

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Dear Pieter,

 

 

In the LML letter of 22-1-2018 Dr. Tahir asked for advice on HIV and Leprosy.

I would like to help you with some of my experiences at the Clinical Hospital of Faculty of Medicine of the Ribeirão Preto and in the field in many states of Brazil.

 

Some patients with leprosy refer to the sensation of itchiness, but it means most of the time pinching / tingling and it is difficult to distinguish by patients. One way to solve it is to ask them if the sensation is similar or not when they were bitten by mosquitoes (must be different). This sensation of paraesthesia in leprosy is very difficult for the patients to talk/express it properly. We have to spend long time to discuss with them about it. It is a challenge!!! Another consideration is about the difficult to identify areas with alteration of sensation in BL (in the case) or LL patients because almost all skin is compromised and you can not distinguish / islands from sensitive change.

 

Paradoxically is the negative result in Slit Skin Smear, probably by technical mistake in one of several steps of this method. In HIV-positive we always should consider shortage of material during collection! I suggest to remake it in many places.   

In HIV patients the leprosy did not have a different evolution in leprosy according literature and experience, except if the patient has one important immunosuppression and repair it so quickly as happen after HAART. In the figures, there are quite some numb/infiltrated red areas which can still indicate cellular response and possibility to evolve with reversal reaction. 

 

Well, hope to help you and to clarify some aspects about clinics in leprosy.

 

Best wishes

 

Marco Andrey 

 

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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

(LML) Request for advice

Leprosy Mailing List – January 22,  2018

Ref.:   (LML)  Request for advice

From:  Tahir Dahiru, Jos, Nigeria

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Dear Pieter Schreuder,

 

Happy new year. I send to you the attached photos of a HIV seropositive individual who presented in a rural Hospital in Northern Nigeria with multiple infiltrated skin lesions on his face and ear lobes. He also has Madarosis. There were also fairly defined hypopigmented skin lesions in his forearms. some areas of the lesion are itchy while others were not. Slit Skin Smear was negative .There was no sensory loss on any of the skin lesions on the forearms but there were multiple bilateral peripheral nerve enlargement involving both ulnar nerves, radial cutaneous nerves, common peroneal nerves  and posterior tibial nerves.  Based on clinical history and sign we made a clinical diagnosis of MB Leprosy and we gave MDT MB.

 

The question is can Leprosy lesions itch?  The patient noticed the first lesion according to him which appeared very small  on his face one and a half years ago. If this information is correct, can the HIV infection be responsible for the rapid progression to this advanced MB disease? 

 

Dr Tahir D.

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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

 

(LML) Chemoprophylaxis in Leprosy

 

Leprosy Mailing List – January 20,  2018

Ref.:    (LML) Chemoprophylaxis in Leprosy

From:  Joel Almeida, Mumbai and London

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Dear Pieter,

 

Thanks for the informative manuscript on Leprosy (Joel Almeida, LML January 13, 2018). One thing we must correct from past information of increased transmission chance towards LL spectrum. For the information of everyone, I've seen cases of children developing clinical Leprosy ahead of the parents whom could be the possible source of infection.

 

Please be vigilant about pre-clinical transmission of Leprosy. Any advice on how to device a study protocol will be very much appreciated.

 

Lisa

Dr. Luisa A. Venida

Fellow, Philippine Dermatological Society  & Consultant, Jose Reyes Memorial 

Medical Center, Manila, Philippines 

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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

(LML) Help for leprosy museum

Leprosy Mailing List – January 19 ,  2017

Ref.: (LML) Help for leprosy museum  

From:  Sheetal Amte-Karajgi, Maharashtra, India

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Dear Pieter,

 

We are trying to make a small museum to educate people about leprosy at Anandwan, the headquarters of Maharogi Sewa Samiti, Warora. 

 

Many visitors such as institutional guests, school children, medical and paramedical workers visit us to know about leprosy. Roughly about 10,000 people visit our hospital in a year for the same. 

 

Currently we do not have any audio-visual content to share with them. However, we soon plan to create one so that we can reach more effectively.

 

We would like to know whether audio-visual content for such kind of project can be shared with someone so that we need not reinvent the wheel.

 

Apart from leprosy work we have cradle to coffin services for differently abled. We run for example also a school for the deaf.

Warm regards,

 

 

Dr. Sheetal Amte- Karajgi 

Chief Executive Officer (Maharogi Sewa Samiti, Warora) 
Young Global Leader 2016 (World Economic Forum)
Fellow (World Innovation Organisation)
Fellow (INK)
Academy Member (Global Teacher Prize, UK)

Address:  At & Post : Anandwan, Tahsil: Warora, 

                District: Chandrapur, Maharashtra, India, 
                Pin: 442 914 
Mobile: +919822465834 
Website: http://anandwan.in/

Films: http://bit.ly/2fWhI80

        http://bit.ly/2fyExfi

            https://youtu.be/r4L-lkjPPpg

Twitter: https://twitter.com/AmteSheetal

LinkedIn: http://bit.ly/2eHMT5k

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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