Leprosy Mailing List – August 7, 2018
Ref.: (LML) Manifest against the implementation of U-MDT
From: VP Shetty, Mumbai, India
Dr Ajit P (LML, July 26, 2018) has put some hypothetical questions to LML readers - if you or your family member gets leprosy then??? I would like to respond to some of the questions.
The questions raised by him are important regardless of who the effected person is.
First and foremost, leprosy is not a simple disease of the skin and our treatment approach cannot be casual and over simplistic. If I were a doctor treating leprosy patient I would like to equip my self fully before I take on the responsibility.
My responsibilities as a doctor include
1) having a confirmed diagnosis; I must do whatever I need to do (Slit skin smear, Biopsy if situation demands and Nerve function assessments);
2) talk and listen to the patient carefully. Council the patient and keep the patient fully informed and not to take them for granted;
3) examine and carefully record all the clinical presentations;
4) look for and be warned of all risk factors for Lepra reaction, drug reaction, nerve function impairments and co-morbidity if any;
5) choose a drug regime which is time tested;
6) closely monitor the treatment response as well as signs of reaction if any. Timely action in managing the reaction or any other problems go a long way;
7) I would do slit skin smear test on all the patients at baseline and mark the smear positive cases as a high-risk group;
8) Only in smear positive cases I would repeat it at 3 or 6 monthly intervals. This will help monitor the treatment response;
9) I would go for a good deep incision skin biopsy (not a punch biopsy it is a waste of time and effort) in cases with doubtful skin lesions and in Pure Neural cases biopsy of an involved sensory nerve and do a Fite faraco stain to ascertain diagnosis before initiating treatment;
10) As I have said before I would use a time tested regime for treatment. Half hazard use of antibiotic can do more harm than any good;
11) We have seen relapses in cases who were smear negative at baseline who had received three drug combination. WHO-MDT regimen is not free of relapse but it is the best available.
Lastly, we need to make a positive move towards identifying a better treatment regime that would take care of persisters (dormant) bacilli in leprosy.
Dr VP Shetty
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << email@example.com