Leprosy Mailing List – January 23, 2018
Ref.: (LML) Request for advice on HIV and Leprosy
From: Marco Andrey Cipriani Frade, Ribeirão Preto, Brazil
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.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/Contact: Dr Pieter Schreuder << firstname.lastname@example.org