Leprosy Mailing List – April 12, 2021
Ref.: (LML) Prevention of ENL
From: Joel Almeida, London and Mumbai
Dear Pieter and colleagues,
ENL episodes can have a huge impact on highly bacillated persons who have completed 12 monthly doses of MDT. These are the words of the persons themselves, displayed in a presentation during the LRI spring meeting on 8 April 2021.
"Sometimes I want to take poison and finish my life." - man from India, with ENL
"I was frustrated of visiting several hospitals and consuming many kinds of medicines. Yet, these gave no improvement in my health." - woman from India, with ENL
"I am discouraged because I cannot be recovered from the treatment." - man from Indonesia, with ENL.
ENL is known to be excruciatingly painful and drives many socially excluded people deeper into extreme poverty and extreme isolation. The risk of painful ENL neuritis is known to be 600% higher among highly bacillated patients given only 12 monthly doses of MDT compared to those given 24 monthly doses.(1)
We can give special attention to persons with types of HD that are disseminated widely and bilaterally across their body, especially if they have ever had indurated skin or nodules. Many of these persons have a high BI, discoverable by bacilloscopy of nasal smears or skin smears. Enlightened colleagues in India, Brazil and other endemic countries increasingly ensure prolonged anti-microbial protection for highly bacillated patients. In so doing, not only do they greatly reduce the risk of ENL, but also they strike an important blow against reinfection and transmission. They set a good example for the world.
Quality medical care is an important element in Article 25 of the Universal Declaration of Human Rights. These people too frequently are excluded from home, family, relationships, community, education, training, employment opportunities and social participation. Exclusion from quality medical care need not be added to their adversity.
Prevention is better than treatment, for a highly painful and distressing condition such as ENL. Prevention of ENL can be achieved to a large extent by simply continuing MDT in persons with highly bacillated HD, for more than 12 months and ideally until smear negativity. Such prevention is highly worthwhile, ethical and humane. We could all follow the good example of our more enlightened colleagues at the frontline and continue MDT beyond 12 months for persons who have ever been highly bacillated.
Joel Almeida
References
1. Balagon MVF, Gelber RH, Abalos RM, Cellona RV. Reactions following completion of 1 and 2 year multidrug therapy (MDT) Am J Trop Med Hyg 2010 Sep;83(3):637-44. doi: 10.4269/ajtmh.2010.09-0586 reviewed in LML 7 Jan 2021
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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