(LML) Manifest against the implementation of U-MDT

Leprosy Mailing List – August 12,  2018

Ref.:    (LML) Manifest against the implementation of U-MDT

From: VP Shetty, Mumbai, India

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 Dear Pieter,

This is in response to Jose Kawuma's request (LML, August 9, 2018) for further justification on my passing comment that 'punch biopsy is a waste of time and effort in cases with doubtful skin lesions'.

 

Pathological Diagnosis of leprosy is based on three major characteristics features:

1) Granulomatous infiltration;

2) presence of acid fast bacilli and

3) involvement of dermal nerve i.e. infiltration with in and around dermal nerves. 

The last one is most important in case of doubtful lesions.

 

Presence of any two of the above confirms the diagnosis of leprosy.

 

Technically punch biopsy may be an easy option but when it comes to pathological diagnosis particularly in case of doubtful lesions it is important to obtain a deep incision biopsy from the centre of the lesion for 2 reasons:

1) it ensures inclusion of dermal nerves that will help in clinching the diagnosis and

2) to avoid crush artefacts which are fairly common in punch biopsy and which makes it difficult for identification of cell types.

 

In my opinion if done correctly this is an important tool in the diagnosis of leprosy, differential diagnosis and relapse.

 

Best regards,

 

VP Shetty   

 

Note editor: Over the past year we have been blocked by gmail several times. For this reason, we are working on a Google Group formation. The advantage of Google Groups is that there are no limitations to the total number of subscribers and to the numbers of messages sent out daily. Anybody could opt out if they do not agree by leaving the Google Group.

 

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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