Leprosy Mailing List – August 16, 2018
Ref.: (LML) Single-dose rifampicin chemoprophylaxis
From: Michael Waters, Radlett, UK
Dear Pieter,
Referring to the discussion between Anuj Tiwari, Wim van Brakel and Joel Almeida (LML, July 2018) regarding the article by Anuj Tiwari, Steaven Dandel, Rita Djupuri, Liesbeth Mieras and Jan Hendrik Richardus. Population-wide administration of single dose rifampicin for leprosy prevention in isolated communities: a three-year follow-up feasibility study in Indonesia. BMC Infectious Diseases 2018.18:324
https://doi.org/10.1186/s12879-018-3233-3
It should surely not be surprising that, in the first two years of follow-up in this trial, more new cases of leprosy were detected in the SDR group than in the non-SDR group.
Around 1960, in the days of dapsone monotherapy, when all newly-diagnosed cases of leprosy in Malaya were automatically admitted to a leprosarium, and when as a newcomer, I was being taught clinical classification by Dr D S Ridley's superb reports on the skin biopsies that I had been invited to send him, I well remember examining a new female patient. This lady gave the history that, around six weeks after a straight-forward delivery, and when she was feeling fully recovered from her pregnancy and delivery, she had developed a small number of skin lesions. Clinically and histolo-gically these were tuberculoid leprosy. We assumed, in our old-fashioned way, that during her pregnancy, due to the associated mild depression in immunological function, there had been a slight spread of leprosy bacilli which hitherto had not caused any clinical signs or symptoms. Around six weeks after giving birth, when her immunological function had returned to normal, these new bacilli or their products were 'recognised', with the result that tuberculoid lesions appeared.
Might not a single dose of rifampicin, given to someone incubating or suppressing a limited subclinical infection with M.leprae, have a similar effect? Were all the new patients, who developed clinical lesions in the first year after receiving the single dose of chemoprophylaxis, accurately classified, and are their data available?
Kind regards,
Michael Waters
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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