Monday, February 11, 2019

(LML) A New Atlas of Leprosy (Revised and Updated)

Leprosy Mailing List – February 11,  2019
Ref.:    (LML) A New Atlas of Leprosy (Revised and Updated)
From:  Aya Tobiki, Tokyo, Japan

Dear Pieter,

We would be grateful if you could post this to introduce A New Atlas of Leprosy (Revised and Updated).

Arry Pongtiku mentioned in his post on January 18 that it would be useful to have an illustrative book of leprosy (atlas) for nurses/leprosy field workers.

Sasakawa Memorial Health Foundation has recently published a revised and updated edition of "A New Atlas of Leprosy" with photographs and descriptions to aid in the diagnosis and treatment of leprosy. The original "Atlas of Leprosy" was published in 1981 and was followed by "A New Atlas of Leprosy" in 2002.

"A New Atlas of Leprosy (Revised and Updated)" brings the contents in line with the WHO Guidelines for the diagnosis, treatment and prevention of leprosy, published in 2018, and with the WHO's Global Leprosy Strategy 2016 – 2020 "Accelerating towards a leprosy-free world" and its Operational Manual. Specifically, the text takes into account the following: WHO guidelines on what constitutes multi- and pauci-bacillary leprosy; WHO recommendations for treating leprosy with
multidrug therapy (MDT); disability grading of leprosy; and WHO guidelines on chemoprophylaxis.

If you are interested to receive copies of the Atlas (currently available in English and Hindi versions), please contact Sasakawa Memorial Health Foundation for more details.

Aya Tobiki
Sasakawa Memorial Health Foundation
Aya Tobiki
          Chief Programme Officer, International Programme Division
Sasakawa Memorial Health Foundation 
Nippon Zaidan Bldg. 5F, 1-2-2 Akasaka Minato-ku, Tokyo, 107-0052, Japan
Tel. 81-3-6229-5379(Dir.)   URL

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) Lancet Editorial Feb 2

Leprosy Mailing List – February 9,  2019
Ref.:  (LML)  Lancet Editorial Feb 2
From:  Diana Lockwood, London, UK

Dear Pieter,
The Lancet have continued their helpful coverage of our New Face programme.
On Feb 2 there was an editorial on abandoning the stigma of leprosy.
I attach the editorial and hope it can be posted on LML.
Professor Diana Lockwood
Professor of Tropical Medicine
Department of Clinical Research
London School of Hygiene & Tropical Medicine
London WC1E 7HT

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) Interrupting transmission: the critical improvement

Leprosy Mailing List – February 8,  2019
Ref.:   (LML)  Interrupting transmission: the critical improvement
From:  Joel Almeida, London and Mumbai

Dear Pieter,
We know that untreated persons with the polar LL (LLp) type of Hansen's Disease generally have the highest bacterial loads. Histopathology typically shows globi. One such patient, if left without anti-microbial protection, can nurture, harbour and excrete more viable M. leprae than hundreds of thousands of patients with the BT type of HD.
Further, genes contribute to the observed polarisation of immune response in HD (1). Monozygotic twins with disseminated types of HD were reported to show a 70% concordance of HD type while dizygotic twins showed only a 20% concordance (2). In other words, LLp status seems linked to genetic status. These patients probably start off as LLp (sometimes recognised as "de novo MB") and then remain susceptible to reinfection after MDT. 
Since M. leprae remain viable in the environment for at least 5 months in the shade (3), the spread of M. leprae despite MDT is probably maintained as follows:
A. an unprotected LLp patient (before or after MDT)  
B. the environment, with viability retained for 5 months
C. another unprotected LLp patient, within 5 months. 
D. Repeat the cycle of transmission.
In households with several persons having the LLp genetic profile, transmission can skip the environmental step. 
This cycle of transmission probably explains why chemotherapy or chemoprophylaxis of limited duration show a disappointing impact, with children being infected and even disfigured. Further, re-treatment of LLp patients, if delayed until after clinical signs of relapse/reinfection, still allows the spread of M. leprae during the new sub-clinical phase.
The challenge, therefore, is two-fold:
a) Detect and identify LLp patients more promptly
b) Protect them against M. leprae for longer than the standard duration of MDT.
Such prolonged anti-microbial protection was used in Shandong Province in China. Implementation was so efficient that the outcome was steady and sustained interruption of transmission, even before the introduction of MDT (3). Interestingly, India's GDP per capita lagged behind China's by only 5 years. But India then discouraged skin smears and started withdrawing anti-microbial protection prematurely from LLp patients. Unsurprisingly, HD control in India lags China by more than 5 years. In some Indian hot spots, the observed incidence rate of HD has even been increasing. 
Recognising LLp patients more promptly is a challenge, because the clinical signs are very subtle. Sometimes, no more than a slight induration of the skin. The challenge is even greater when skin smears are unavailable.
Prolonged protection of LLp patients is easy and cheap to do. We need merely prolong MDT for an LLp patient. Without this, it becomes very difficult to reduce transmission. If we protect LLp patients against re-infection, we can better protect the eyes, limbs, minds, livelihoods and relationships of not only LLp patients but also everyone else who is susceptible to M. leprae.
I spent several years examining and biopsying every single relapsed patient in a population of nearly half million people in India, followed by histopathology and mouse foot pad tests. Every single known case of HD and household contact was accounted for. That intense front-line experience tends to open one's eyes and mind to clues about what's really happening clinically, microbiologically, immunologically and epidemiologically. All of us continue to learn and ask searching questions as steadily more pieces of the HD jigsaw are uncovered by great colleagues in the basic and applied sciences.
How did our lax approach to treatment arise?
We have not routinely been stratifying outcomes of MDT by the type of HD (LLp / other). So, we condone a relapse/reinfection rate of under 'n' % per year. Unfortunately, the LLp genes are probably so infrequent that every LLp patient could show relapse/reinfection and still the relapse/reinfection rate would remain below n%. But a single LLp patient can harbour and excrete more M. leprae than hundreds of thousands of patients with the BT type of HD. Consequently, M. leprae can continue to spread with full force, even while we condone "low" relapse/reinfection rates.
It's an easy mistake to make, and we were inexpert enough to make it. We're all human, so there's no shame in making mistakes. The important thing is to understand what is happening and take corrective action. 
Once we start providing prolonged anti-microbial protection (MDT) to persons with LLp, we can have more hope of a sustained reduction in transmission of M.leprae just as happened in Shandong Province. Half-hearted chemical isolation does not work, as shown by the continuing transmission of M. leprae in so many MDT programmes. It has to be highly efficient and effective chemical isolation to interrupt transmission at the source. That source is mainly unprotected LLp patients, through no fault of their own.
Let's join together and make this critical improvement. We are capable of saving more limbs, eyes, minds, livelihoods and relationships among susceptible people in endemic areas. Let's do it. Let's ensure prolonged anti-microbial protection for LLp patients.
O principal desafio no controle de HD é a proteção de pacientes com LL polar contra a re-infecção do M. leprae ambiental. Caso contrário, forçamos os pacientes com LLp a permanecer como as principais fontes de infecção para os outros e para o meio ambiente. Então a transmissão continua apesar da PQT e da quimioprofilaxia.
Le principal défi en matière de contrôle de la HD est la protection des patients LL polaires contre une réinfection à partir de M. leprae dans l'environnement. Sinon, nous obligerons les patients LLp à rester la principale source d'infection pour les autres, et la transmission se poursuit malgré la PCT et la chimioprophylaxie.
Joel Almeida
1. Gaschignard J, Grant AV, Thuc NV, Orlova M, Cobat A, Huong NT, et al. (2016) Pauci- and Multibacillary Leprosy: Two Distinct, Genetically Neglected Diseases. PLoS Negl Trop Dis 10(5): e0004345.
2. Chakravarrti MR, Vogel F. A twin study on leprosy Georg Thieme Publishers, Stuttgart, Germany; 1973.
3. Desikan KV, Sreevatsa. (1996) Extended studies on the viability of Mycobacterium leprae outside the human body. Lepr Rev 66(4):287-95 
4. Li Huan-Ying, Pan Yu-Lin, and Wang Yang. (1985) Leprosy Control in Shandong Province, China, 1955-1983; Some Epidemiological Features. Int J Lepr 53(1): 79-85.

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

Sunday, February 3, 2019

(LML) Early detection is the critical part

Leprosy Mailing List – February 3,  2019
Ref.:  (LML) Early detection is the critical part 
From:  Ben Naafs, Munnekeburen, the Netherlands

Dear Pieter,

I like to react to the letter from Wolfgang Hippke (LML, January 8, 2019): "Compared to any transmittable disease, Leprosy is in a bad situation:
1. We do not have a vaccine against Leprosy.
2. We only have estimations about the time of incubation.
3. We don't have any idea, from when, after infection, a person become infective for others. 
4. We don't know, who is infective.
5. We do not treat infect
ed, non-clinical patients, those without any clinical sign."
  1. Yes, we do not have a universal vaccine against leprosy. But we have still BCG, M.vaccae and The Indian vaccine from Talwar. These vaccines give protection in areas where there are environmental (myco)bacteria who boost the effect of the vaccine over the years. But be aware that 80% of the people get never leprosy because there are other factors than immunity that prevent them from developing the disease.
  2. I agree for the ones who develop leprosy; we do not know. But we have to search for methods to detect them. We have to develop tests which are not testing immunological response to M. leprae itself but to factors which show that the cells have been or can be programmed to sustain the growth of M. leprae.
  3. It is even worse I am afraid that there are carriers with infective M.leprae in their nose who are infective for sensitive individuals.
  4. True, but we have PCR here, but a positive PCR does not always mean that they are infective even not when alive.
  5. We indeed do not treat them. But 80% does not need treatment. But till today we do not know who the 20% who can develop leprosy are.
But I think a greater problem is that now that we have start to understand how M. leprae survives in the environment, we have to start to stop contact of susceptible people with this environment by for instance piped water and no contact with infected soil and animals.
Being aware of 4 and 5 certainly may be of help. But how to detect them.

With regards,

Ben Naafs

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) Infolep monthly update with a selection of leprosy publications - February 2019

Leprosy Mailing List – February 3,  2019
Ref.:    (LML) Infolep monthly update with a selection of leprosy publications - February 2019
From:  Jiske Erlings, Amsterdam, the Netherlands

Dear colleagues,
Infolep provides scientists, professionals and others working in the field of leprosy with up to date knowledge and information to support their daily work.
Every month we send you an overview of (scientific) publications on leprosy and related subjects recently added to Infolep website.

To search the full collection, please visit
Feel free to contact me to receive the full text versions if a link to the full text is not included or for assistance with your literature research. You are also invited to send us your publications on leprosy for inclusion in the portal.

With warm regards,

Jiske Erlings,
Infolep Information officer
Highlighted publication
Zero Discrimination: Ending the Stigma of Leprosy
ILEP. 2019.
Download PDF

Global Appeal 2019 to End Stigma and Discrimination Against People Affected by Leprosy.
Download PDF

Picturing health: a new face for leprosy.
Kumar A, Lambert S, Lockwood DNJ. Lancet. 2019 Jan 25.
Download PDF

Infolep WorldLeprosyDay2019 overview of publications on leprosy related stigma, discrimination and mental health:

WASH and health working together A 'how-to' guide for Neglected Tropical Disease programmes.
World Health Organization, Neglected Tropical Disease NGO Network (NNN). 2019
PDF and interactive toolkit
New publications
Abandoning the stigma of leprosy.
Lancet. 2019. Feb 2.
Download PDF

Clinicopathological correlation of leprosy and response to treatment in Eastern Saudi Arabia.
Alakloby OM, Alabdulkareem AS, M. Aljabre SH, et al. J Dermatol Dermatol Surg. 2019; 22(1):30-34.
Download PDF

Differential immunoglobulin and complement levels in leprosy prior to development of reversal reaction and erythema nodosum leprosum.
Amorim FM, Nobre ML, Nascimento LS, et al. PLoS Negl Trop Dis. 2019; 13(1):e0007089.
Download PDF

A five year study of profile of leprosy patients attending a tertiary care hospital in Manipur.
Bachaspatimayum R, Hafi BN, Thokchom NS, et al. Indian J Lepr. 2018; 90:189-195.
Download PDF

Mycobacterium leprae Recombinant Antigen Induces High Expression of Multifunction T Lymphocytes and Is Promising as a Specific Vaccine for Leprosy.
Bezerra-Santos M, do Vale-Simon M, Barreto AS, et al. Front Immunol. 2018 Dec 12;9:2920.
Download PDF

Catalina Devandas Aguilar: empowering people with disabilities.
Bull World Health Organ. 2019 Jan 1;97(1):8-9.
Download PDF

'Antimicrobial resistance in leprosy: results of the first prospective open survey conducted by a WHO surveillance network for the period 2009-2015' - Author's reply.
Cambau E, Saunderson P, Gillini. Clin Microbiol Infect. 2019 Jan 22.
Read abstract

Cataract surgery in leprosy: Quest for perfection.
Chowdhury S, Sneha, Priti, et al. Acta scientific medical sciences. 2019; 3(2):120-123.
Download PDF

Fingerstick test quantifying humoral and cellular biomarkers indicative for M. leprae infection.
Corstjens PLAM, van Hooij A, Tjon Kon Fat EM, et al. Clin Biochem. 2019 Jan 26.
Read abstract

T'sarat/leprosy: paths taken by relatives of former patients treated in the asylum environment.
Costa Pinheiro MG, Albino Simpson C, Nunes de Miranda FA, et al. 2019; 11(1):47-52.
Download PDF

Assessing the impact of the twin track socio-economic intervention on reducing leprosy-related stigma in Cirebon district, Indonesia.
Dadun D, Peters RMH, Van Brakel WH, et al. Int J Environ Res Public Health. 2019; 16(3).
Download PDF

Inclusive medical rehabilitation for persons with disability due to leprosy, lymphatic filariasis, and diabetes mellitus: Mapping the gap in three leprosy endemic districts in Indonesia.
Denny HM, Darmawan Y, Ginandjar P, et al. bioRxivorg. 2019:1-14.
Download PDF

Disability due to leprosy: a socio-demographic study in Leprosy Hospital, Chamba, Himachal Pradesh.
Dixit P, Dhiman AK. Int J Community Med Public Health. 2019; 6(2):590-593.
Download PDF

Notch signaling induces lymphoproliferation, T helper cell activation and Th1/Th2 differentiation in leprosy.
Dua B, Upadhyay R, Natarajan M, et al. Immunol. Lett. 2019.
Read abstract

Analysis of the rs2476601 polymorphism of PTPN22 in Mexican mestizo patients with leprosy.
Escamilla-Tilch M, Pérez-Suárez TG, Torres-Carrillo NM, et al.  Biomed Rep. 2019 Feb;10(2):127-132.
Download PDF

Accuracy of enzyme-linked immunosorbent assays (ELISAs) in detecting antibodies against in leprosy patients: A systematic review and meta-analysis.
Espinosa OA, Benevides Ferreira SM, Longhi Palacio FG, et al. Can J Infect Dis Med Microbiol. 2018; 2018:11.
Download PDF

Pleiotropic effects for Parkin and LRRK2 in leprosy type-1 reactions and Parkinson's disease.
Fava VM, Xu YZ, Lettre G, et al. bioRxivorg. 2019.
Download PDF

Evaluation of the physical limitations, psychosocial aspects and quality of life of people affected by leprosy.
Ferreira Silva PM, Esteves Pereira L, Lima Ribeiro L, et al. Revista de pesquisa, cuidado é fundamental online. 2019; 11(1):211-215.
Download PDF

Leprosy and rhinoscleroma: A rare case of concurrence: A case study.
Ghazizadeh M, Yazdani N. Arch Clin Infect Dis. 2019:e63233.
Download PDF

Lucio phenomenon mimicking antiphospholipid syndrome: the occurrence of antiphospholipid antibodies in a leprosy patient.
Guevara BEK, Saleem S, Chen WT, et al. J Cutan Pathol. 2019 Jan 21.
Read abstract

Endoplasmic reticulum stress markers and their possible implications in leprosy's pathogenesis.
Hirai KE, de Sousa JR, Silva LM, et al. Dis. Markers. 2018.
Download PDF

Unusual association of leprosy with Lucio phenomenon with secondary antiphospholipid antibody syndrome and ischemic stroke.
Kumar S, Kalita J, Rao RN, Misra UK. Neurol India. 2019 Jan-Feb;67(Supplement):S150-S151.
Read abstract

Leprosy: A great ımıtator.
Kundakçi N, Cengizhan E. Clin. Dermatol. 2019.
Read abstract

A study on trends and patterns of leprosy in Guyana during a ten year period, 2007-2016.
Kurup R, Haynes U, Mentore G. Indian J Lepr. 2018; 90:207-216.
Download PDF

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil.
Leturiondo AL, Noronha AB, do Nascimento MOO, et al. 2019; 19(1):22.
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Chronic aspects of leprosy—neglected but important.
Lockwood DNJ. Trans. R. Soc. Trop. Med. Hyg. 2019.
Read abstract

Insights on Mycobacterium leprae efflux pumps and their implications in drug resistance and virulence.
Machado D, Lecorche E, Mougari F, et al. Front Microbiol. 2018 Dec 13;9:3072.
Read abstract

Photo distributed leprosy- An atypical case of borderline lepromatous leprosy.
Nagar R, Patil S. Indian J Lepr. 2018; 90:241-244.
Download PDF

A review of the ophthalmic manifestations of leprosy.
Ogborogu EU, Omoti AE, Edema OT, et al. Annals of medical and surgical practice. 2018; 3(2):60-70.
Download PDF

[Clinical and epidemiological profile of patients with hanseniasis in a reference unit in the state of Pará].
do Quaresma MSM, da Souza LSC, da Silva FBM, et al. Acervo Saúde. 2018; (18):e269.
Download PDF

A 5 year study of leprosy patients in a tertiary care centre.
Rashmi M, Kishan N, Varun J, et al. Indian journal of clinical and experimental dermatology. 2018; 4(3):232-236.
Read abstract

Neglected tropical diseases in children: An assessment of gaps in research prioritization.
Rees CA, Hotez PJ, Monuteaux MC, Niescierenko M, Bourgeois FT. PLoS Negl Trop Dis. 2019 Jan 29;13(1):e0007111.
Download PDF

Clinical profile of leprosy cases registered in a hospital in Paraguay, 2013 to 2015.
Rios-González CM. Indian J Lepr. 2018; 90:249-251.
Download PDF

[Hansen's disease: a rare presentation with the involvement of 20 nails – case report].
Rodrigues MM, Cordeiro RN, da Santos MÁR, et al. Braz. J. Hea. 2019; 2(2):718-726.
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British red squirrels remain the only known wild rodent host for leprosy bacilli.
Schilling A-K, Avanzi C, Ulrich RG, et al. Front Vet Sci. 2019.
Read abstract

Mycobacterium lepromatosis lepromatous leprosy in US citizen who traveled to disease-endemic areas.
Sharma G, Sharma VD. Emerg Infect Dis. 2019 Feb;25(2):389-390.
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Heteroexpression of Mycobacterium leprae hypothetical protein ML0190 provides protection against DNA-alkylating agent methyl methanesulfonate.
Sharma M, Akula D, Mohan M, et al. Biochem. Biophys. Res. Commun. 2019.
Read abstract

Evaluation of the physical limitations, psychosocial aspects and quality of life of people affected by leprosy.
Silva PMF, Pereira LE, Ribeiro LL, et al. Revista de pesquisa, cuidado é fundamental online. 2019; 11(1):211-215.
Download PDF

Involvement of TNF-producing CD8 effector memory T cells with immunopathogenesis of erythema nodosum leprosum in leprosy patients.
Silva PHL, Santos LN, Mendes MA, et al. Am. J. Trop. Med. Hyg. 2019.
Read abstract

Community knowledge, attitude, and perceived stigma of leprosy amongst community members living in Dhanusha and Parsa districts of Southern Central Nepal.
Singh R, Singh B, Mahato S. PLoS Negl Trop Dis. 2019 Jan 11;13(1):e0007075.
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Poor treatment compliance leads to a higher mutation for rifampicin resistance in multibacillary leprosy patients.
Siskawati Y, Effendi EH, Legiawati L, et al. Med J Indones. 2018; 27(4):237-243.
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Validation of an instrument for the evaluation of adolescents' knowledge about Hansen's disease.
Soares JEF, da Soares NLS, de Freitas BHBM, et al. Acta Paul Enferm. 2018; 31(5):480-488.
Download PDF

Leprosy survey among rural communities and wild armadillos from Amazonas state, Northern Brazil.
Stefani MMA, Rosa PS, Costa MB, et al. PLoS ONE. 2019; 14(1):e0209491.
Download PDF

Leprosy- control through Superfoods.
Thapar P. Acta scientific microbiology. 2019; 3(2):43-45.
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Survival of Mycobacterium leprae and association with Acanthamoeba from environmental samples in the inhabitant areas of active leprosy cases: A cross sectional study from endemic pockets of Purulia, West Bengal.
Turankar RP, Lavania M, Darlong J, et al. Infect. Genet. Evol. 2019.
Read abstract

Transcription factors STAT-4, STAT-6 and CREB regulate Th1/Th2 response in leprosy patients: effect of M. leprae antigens.
Upadhyay R, Dua B, Sharma B, et al. BMC Infect. Dis. 2019; 19(1):52.
Download PDF

Life after leprosy treatment discharge: Physical and social limitations.
Vieira CSCA, Lobato ML, Figueira MCS, et al. Indian J Lepr. 2018; 90:177-188.
Download PDF

Journals & Newsletters
Disability, CBR & Inclusive Development:

Hansenologia Internationalis:

Indian Journal of Leprosy:

Leprosy Review:
Leprosy Review Repository (1928-2001) :

Plos Neglected Tropical Diseases:

Revista de Leprología:

WHO Goodwill Ambassador's Newsletter for the elimination of leprosy:

Websites & Services

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<