Photos from Ecuador

Leprosy Mailing List – October 12th, 2011 

Ref.:    Photos from Ecuador

From:  R Ganapati, Mumbai, India

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Dear Dr Noto,

Dr Verduga's beautiful clinical photographs (LML Sept. 27^th, 2011) have indeed simulated veteran leprologists to give their comments arising from years of meticulous clinical observations.  Though in India we encounter all the manifestations reported from Ecuador and much more (thank you also to Dr Salafia for sharing his cases), the clan of students keen to learn leprology is unfortunately vanishing fast in the background of prevalence rate of leprosy rising after the government decided to integrate leprosy services of the disease with the general health system.

In this context the response from clinicians through the LML forms a veritable primer in the subject covering, clinico-bacteriological aspects, skin smear investigations  treatment of leprosy and complications in a nutshell.

I have prepared a file of the LMLs including the photographs to facilitate me to teach the beginners wanting to have elementary knowledge of leprosy.  But where are they?  "Made-easy" classification of leprosy, elimination of skin smear examination, over-simplification of treatment for mass usage, dogmatic teaching by a few teachers with little experience etc. are factors which have conspired to halt the progress of scientific approach to leprosy.  Even some diseases which are much rarer than leprosy have not been dealt with in this cruel manner by the medical profession and health planners!   

My compliments to you for being a pioneer in using internet medium to spread knowledge around the world.

With regards,

Dr R Ganapati,

Director Emeritus, Bombay Leprosy Project

rganapati(at)gmail.com

Case number 10: Borderline lepromatous (BL), lepromatous (LL) or histoid leprosy?

Leprosy Mailing List – October 12th, 2011

Ref.:    Case number 10: Borderline lepromatous (BL), lepromatous (LL) or histoid leprosy?

From:  Tahir D., Plateau State, Nigeria. 

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Dear Dr Noto,

Thanks a lot for the interesting articles circulated in the LML.  Thank you also to Drs Verduga and Salafia for sharing with us their cases.  About the case number 10 presented by Dr Salafia (attachment) I share the same opinion with Dr Khalid Al Aboud.  It looks more of a case of histoid type of leprosy which was seen in the past in BL or LL leprosy cases resistant to dapsone monotherapy.

Yours sincerely,

Dr Tahir D.

Nigeria

Case number 10: Borderline lepromatous, lepromatous or histoid leprosy?

Leprosy Mailing List – October 12th, 2011

Ref.:    Case number 10: Borderline lepromatous, lepromatous or histoid leprosy?
From:  H K Kar, New Delhi, India

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Dear Dr. Noto,

I agree with the comments of Dr Khalid on case 10 (attachment).  These are classical histoid nodules present over the apparently normal looking skin on the pinnae of the ear.  It is not possible have final conclusions from one picture but, history, slit-skin smear examination to look into bacteriological index (BI) and morphological index (MI) as well as histopathology will clinch the diagnosis of histoid leprosy.

Regards,

Dr (Prof.) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001

Case number 10: Borderline lepromatous, lepromatous or histoid leprosy?

Leprosy Mailing List – October 10th, 2011

Ref.:    Case number 10: Borderline lepromatous, lepromatous or histoid leprosy?

From:  K Al Aboud, Makkah, Saudi Arabia

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Dear Dr. Noto,

I am referring to Dr Antonio Salafia’s recent message “Leprosy in Mumbai, clinical cases” (see attachment).  Thank you very much to for sharing with us his cases.  Particularly I refer to the case number 10 and, I wonder if Dr Salfia has the histopathology?  It looks like the histoid type of leprosy.

With my thanks and regards,

Sincerely,

Dr Khalid Al Aboud
Consultant Dermatologist

King Faisal Hospital,

P.O. Box 5440

Makkah 21955, Saudi Arabia

Tel 0096625566411 ext 1110
Fax 0096625563523

E-mail alaboudkhalid(at)yahoo.ca
amoa65(at)hotmail.com

Choosing the decolourizer and its strength to stain Mycobacterium leprae

Leprosy Mailing List – October 10th, 2011

Ref.: Choosing the decolourizer and its strength to stain Mycobacterium leprae. Does it actually matter?

Lepr Rev. 1998 Jun;69 (2):128-33 (see attachments Page 1  2  3  4  5  6)

From:  R de Soldenhoff, Edinburgh, Scotland, UK

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Dear Dr Noto,
 

It may be of interest to LML readers to review the attached article of an operational research study carried out in Indonesia.  The original in Leprosy Review was published prior to all their articles being in electronic form, so my apologies for the mediocre quality scan of the article.
 The reason for the study was the premise that "tuberculosis diagnosing centres with an established system of quality control, can also be responsible for leprosy microscopy. This is easier if the staining technique for both organisms is identical."
 I would be very pleased if another laboratory could repeat the study, in order to confirm these findings.  In addition, a comparison between the "hot method" (usually used in field laboratories for tuberculosis) and the "cold method" and between methylene blue and malachite green (occasionally used as an alternative decolouriser), would also be of interest.
 With kind regards,
Dr. Richard de Soldenhoff

42 Drummond Place

Edinburgh, EH3 6NR

Scotland, UK

Home telephone: 44.131.556.7979

UK mobile: 44.777.0751578

Email: rdesoldenhoff(at)hotmail.com

Is 0.6% fucsin reagent significantly less effective?

Leprosy Mailing List – October 10th, 2011

Ref.:    Is 0.6% fucsin reagent significantly less effective?

From:  L Gilead, Jerusalem, Israel

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Dear Dr. Noto,

Thank you very much to Dr Barreto for his comments (LML Oct. 2^nd, 2011) concerning aspects of skin smears examination for leprosy and Ziehl-Neelsen (ZN) staining for acid-fast bacilli (AFB's).  Following that message we re-evaluated our lab reagents and found out that the concentration of the Ziehl's fucsin reagent we are using (commercially acquired from MERK is 0.6%.

I would appreciate it if any one of the LML members could let us know if this is significantly less effective and we need to prepare our own reagent in the lab with a 1% concentration, or whether any one has a different commercial supplier that can deliver a 1% reagent?

Thank you very much and a Happy New Hebrew year from Jerusalem.

Leon

Dr. Leon Gilead

Head of The Israeli Hansen's Disease Center

24Strauss St., Jerusalem, Israel

Department of Dermatogoy

Hadasssah University Hospital

Mobile: 972-50-7874309

Leprosy in Mumbai, India, clinical pictures

Leprosy Mailing List – October 6^th, 2011

Ref.:   Leprosy in Mumbai, India, clinical pictures

From: A Salafia, Mumbai, India

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Dear Salvatore,

Kindly, find in attachment a Power Point file with clinical pictures of some leprosy patients of mine.  Thank you very much for circulating them on the LML.

Yours sincerely,

Antonio