Does any one still use Lepromin for skin testing?

Leprosy Mailing List –  March 8^th, 2011

Ref:    Does any one still use Lepromin for skin testing?  

From: Gilead L., Jerusalem, Israel

---

Dear Dr Noto,

I would like to ask the participants of the leprosy mailing list (LML) regarding their use of the Lepromin reagent.  Does any one still use Lepromin for skin testing?  Where can a new batch of Lepromin be obtained nowadays, if at all, and what kind of other skin/blood/lab testing do LML participants use in addition to clinical and skin smear testing in their usual clinical work?

Thank you very much in advance for your collaboration.

Your sincerely,

Leon Gilead, MD PhD

The Israeli Hansen's Disease Center

ENL necroticans versus chicken pox versus small pox?

Leprosy Mailing List –  March 8^th, 2011

Ref:    ENL necroticans versus chicken pox versus small pox?

From: da Costa Nery J A, Rio de Janeiro, Brazil

---

Dear Salvatore,

Thank you very much to Dr Salafia for sharing his case with us.  I fully agree with Dr Paul (LML March 6^th, 2011), smallpox seems so unlikely to observe the epidemiology of this disease which is very rare.  But the case is very interesting; Iwork in Brazil for many years and never seen a case of reactions with thisassociation.

I have followed some patients with prolonged use of oral corticosteroids whodeveloped histoplasmosis.

Much obliged,

José

Dr, PHD, José Augusto da Costa Nery

Fiocruz

ENL, with eczema herpeticum [?]

Leprosy Mailing List –  March 6^th, 2011

Ref:    ENL, with eczema herpeticum [?]

From: Barreto J. A., Bauru, SP, Brazil

---

Dear colleagues,

My opinion is that the case presented by Dr Salafia is an ENL with an eczema herpeticum which developed after immunosupression due to corticosteroids (once small pox has been eradicated).  Other possibility is recurrence of ENL, which could be due the fact of fluorinated corticosteroids have a half life of 2-3 days.  In case of doubt, a biopsy of papules can make diagnosis, because intranuclear inclusions, in cases of HSV* diseases, are typically seen inside keratinocytes on active lesions.  

Jaison

*Herpes simplex virus

Causes of pustules that may resemble chicken pox or small pox

Leprosy Mailing List –  March 6^th, 2011

Ref:   Causes of pustules that may resemble chicken pox or small pox

From: Periche J. F., Santo Domingo , Dominican Republic

---

Dear Salvatore,

In response to Dr Salafia’s Leprosy Mailing List -  March 2nd, 2011 (Ref: ENL necroticans versus chicken pox versus small pox?) I would like listing causes of pustules that I can think of that may resemble chicken pox or small pox:-

Folliculitis by malassezia
Candidiasis
Tinea
Gonococcemia
Scabies
Staphylococcal infection
Staphyloccal scalded skin syndrome
Impetigo
Pustular psoriasis
Gram-negative folliculitis
Pustular syphilide
Dermatitis herpetiformis
Swimmer's itch- cercarial dermatitis and Schistosome cercarial dermatitis
Miliaria
Drug-induced
Subcorneal pustular dermatitis

hope this may help you

Dr. Juan Periche Fernandez
Medico-Dermatologo
Director Programa de control de la lepra de Rep. Dom.Santo Domingo DN Rep Dominicana
Movil (809)815-1060

ENL necroticans versus chicken pox versus small pox?

Leprosy Mailing List –  March 6^th, 2011

Ref:    ENL necroticans versus chicken pox versus small pox?

From: Fine PEM, London , UK

---

Dear Salvatore,

Just to say  (I refer to Dr Salafia’s message dated 02/03/2011) that smallpox must be extremely extremely unlikely....

Aside from the question of the origin of the virus (variola virus is thought to exist now only in two BSL* category four facilities, one in Atlanta USA and one in Russia ), given that there has been no smallpox vaccination for 30 years it would spread rapidly in a human population.  There are, however, other orthopox viruses, such as cowpox... which do affect humans from time to time and are in general of low transmissibility from human to human.

Paul Fine

Paul EM Fine  VMD, PhD
Professor of Communicable Disease Epidemiology
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1 7HT, UK

Tel:     (44)-[0]207-927-2219
Fax:    (44)-[0]207-636-8739

*

BSL stands for Biosafety level, or biosecurity level - on a scale from 1=low to 4=high.

There are strict rules and recommendations about cabinets and airflow and gloves and who is allowed into a lab and whether you need to change into a spacesuit etc. Smallpox virus is now held (must now be held only) under the highest possible security level.

Unresponsive Type 2 (ENL) reaction

Leprosy Mailing List – March 2nd, 2011

Ref: Unresponsive Type 2 (ENL) reaction
From: Frankel R., Hawaii, USA
____

Dear Salvatore,

I apologize for my tardy response as I have been away from home. I hope my comment has not been submitted by others and not yet seen by me.

With regard to the patient referenced by Dr. Antonio Salafia, LML 23-02-2011, I have seen many patients who reportedly do not respond to corticosteroids where the problem is not failure to respond but drug interaction resulting in a reduced amount of corticosteroid in the blood stream.

Most common in patients with leprosy is enzyme induction by rifampin (rifampicin), markedly reducing the amount of circulating corticosteroid. Is Dr. Salafia's patient receiving daily rifampin? If so, choices include changing the rifampin to monthly rather than daily, temporarily replacing rifampin with another antimicrobial agent, or increasing the amount of corticosteroid to levels far beyond what one would normally use. In my experience, this is almost always efficacious.

Kind regards,

Richard I. Frankel, M.D., M.P.H., F.A.C.P.

Emeritus Professor of Medicine

University of Hawai'i

NL necroticans versus chicken pox versus small pox?

Leprosy Mailing List – March 2nd, 2011

Ref: ENL necroticans versus chicken pox versus small pox?
From: Salafia A., Mumbai, India
____

Dear Salvatore,

I thank your for the prompt action following my request. I must thank Jaison Barreto for the time taking in answering and Ben Naafs. The latter, who I cordially greet, gives some light and I too was thinking of methotrexate.

For the records: in severe neuritis I advice IV of 8-16 mg of betha or dexametasone to be given slowly; this therapy usually brings remission for about a week.

In this your girl aged 12 but, her body weight is about 20 kg, I gave IV infusion of 4 mg of bethametasone; her pain stopped; but within two days she was restless and started crying bitterly. She is an advasi girl from a village, and her pain was severe. Within a day she developed small blisters which kept on increasing in number but not in size. On a first impression I thought of ENL necroticans (very common in India and I had written a paper on it a few years ago). But after a day there was not necrosis no pus formation and the blisters kept on increasing in number. At this point I changed my diagnosis and -while not ruling out the ENL- I started thinking in terms of chicken pox or something similar. The patient was shifted to Kasturba hospital which is a government institution specializing in infective disease; a temporary diagnosis of chicken pox was made and IV injections (very costly) of vaccine against varicella was started.

I am waiting for the latest news and diagnosis. Yet something does not seem right, the blisters, the extensive spread, practically the whole body is covered with small blisters which were not purulent till yesterday; could it be a case of small pox? But then the governmet of India has solemnly affirmed that small pox is totally eradicated from India. Yet, if my memory serves me right, a couple of months ago there was a report of small pox in some remote village.

Thanks for the patience.

Antonio