Leprosy Mailing List – June 13, 2018
Ref.: (LML) Single-dose rifampicin chemoprophylaxis
From: Carlos Gustavo Wambier, Ponto Grosso, Brazil
I completely agree with Jaison (LML, June 12, 2018). The pivotal point is to teach leprosy to all physicians in all countries. It is NOT uncommon to see a diabetic patient labeled with diabetic neuropathy for years who is actually a LL patient.
Last Lúcio's phenomenon patient I saw, a great the pathologist did a ZN and wrote in the report it was not leprosy in the sections, maybe PAN. I had to call her to tell her that her stain was not working. She ran the positive control and confirmed my suspicion. She had to do ZN again for over 100 cases done with that batch of stain. Imagine trying to convince all labs to do FF instead of ZN.
My impression is that only on the reference centers such as Ribeirão Preto School of Medicine and Lauro de Souza Lima things are done properly.
Imagine what is done in England, or in the USA where I would have to teach physicians how to approach a leprosy patient without prejudice.
I was in Harvard for a month, and I was mesmerized by the amount of leprosy patients who would not have a diagnosis if I wasn't there. The pathology session where Dr Meem was showing a "atypical mycobacteriosis" where the dermatology resident did not even test sensibility. Imagine palpating nerves!!! My guess is that if he knew it was a typical BL case he would wear 2 gloves and a N95 mask and where an insulation gown.
Maybe most philosophic publications in Leprosy are done by people who should go to Brazil or India and see leprosy patients everyday for a decade and try to work hard to try to eliminate leprosy.
I am perplexed by the amount of publications done in Netherlands or England with substrate from other countries. You are definitely invited to move to Brazil or India to try to have the real idea of what is really going on.
Leprosy will NEVER be eliminated, my dear friends.
Medical students don't learn how to do a diagnosis or to check a household contact. You cannot learn medicine in theory, reading books or articles. You need to see at least 100 patients with your own hands to have a glimpse of how complex it is.
IMAGINE THE TECHNICIANS, nurses...
This mental masturbation about what is cost-effective or what could potentially cause ABX residency is great but should not impact real efforts to eliminate leprosy.
Carlos Gustavo Wambier, MD, PhD
Professor of Dermatology
Department of Medicine
State University of Ponta Grossa
LML - S Deepak, B Naafs, S Noto and P Schreuder
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