Leprosy Mailing List Blog

Tuesday, May 5, 2026

Fw: (LML) Did capsule P have a dramatic impact?

Leprosy Mailing List – May 5, 2026

Ref.: (LML) Did capsule P have a dramatic impact?

From: Joel Almeida, Mumbai, India

____________________________________________________________________________

Dear Pieter and colleagues,

A randomised controlled trial revealed a relatively large drop in incident single lesion cases of HD. This was after using a certain capsule (P) once among contacts of index cases. The incidence rate fell from 14/10k person-years during years 1 and 2 of follow-up, to only 4.3/10k p-yrs during years 3 and 4. This was a 69% reduction in incidence rate between the initial and later years. During that time the incidence rate of PB HD with 2 to 5 lesions also declined, but by 60%. The incidence rate of MB HD also declined, but by 40%. These too were relatively large and rapid declines.

Could capsule P be the definitive solution to HD? First consider the comparator arm.

The comparator arm used a different capsule (X) once, and failed to show such a dramatic drop in incidence rate between the initial and later years. Instead, there was a numerical increase in incidence rate, of 12% in single lesion HD, 70% increase in PB with 2 to 5 lesions, and 60% increase in MB HD, between the initial 2 years and years 3 and 4.

Interestingly, the risk of incident HD was numerically higher in contacts of PB index cases vs contacts of MB index cases, but only in the capsule P arm. In the capsule X arm, the usual pattern of risk was observed: numerically higher risk in contacts of MB index cases vs contacts of PB index cases.

Before considering capsule P for the family members of your patients, know that the trial did not report the incidence rate of visible deformity at diagnosis. Therefore neither P nor X could be considered safe on the basis of the trial outcomes.

What were the capsules?
P was placebo. X was rifampicin. (Moet et al 2004 Lepr Rev, Moet et al 2008 Br Med J, Feenstra et al 2012 Lepr Rev).

Why did the P arm alone show a numerically higher risk of HD in contacts of PB index cases vs MB index cases? Most likely because of undiagnosed inapparent LL cases among the contacts of PB index cases, occurring disproportionately in the P arm.

Why was placebo so dramatically effective in years 3 and 4? Nine incident MB cases were diagnosed in the P arm by year 2, and were removed from the infectious pool by starting them on full MDT. By contrast, only four incident MB cases in the X arm were similarly removed by year 2. The 9 incident MB cases diagnosed in the P arm by year 2 are likely to have included one or more previously inapparent LL cases that were initially (and understandably) classed as healthy contacts of PB index cases.

Placebo is unlikely to have had a dramatic effect between the initial two years and the latter two years. The excess cases in the placebo arm during years 1 and 2 are likely to have been due to undiagnosed LL cases occurring disproportionately in the placebo arm, shedding astronomical numbers of viable bacilli (10^7 per day or even per nose blow, Davey and Rees 1974 Lepr Rev). Based on the whole set of observations, diagnosis of inapparent LL followed by prompt full MDT treatment appears highly effective. The overwhelming importance of undiagnosed LL cases together with the reported numerical excess risk of HD in the PB index clusters of the placebo arm, somewhat undermine the reliability of conclusions from this trial.

Inapparent LL cases seem overwhelmingly important in maintaining transmission.

With all sincerity,

Joel Almeida

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Friday, April 24, 2026

Fw: Ref.: (LML) Animals and human participants

Leprosy Mailing List – April 24, 2026

Ref.: (LML) Animals and human participants

From: Joel Almeida, Mumbai, India

____________________________________________________________________________

Dear Pieter and colleagues,

Armadillos offer a useful model of H. Disease. Many aspects including nerve damage, immunobiology, deformity, immunomodulation, anti-microbial potency etc can be studied there.

Human participants in endemic countries are not always rich, influential or highly schooled. They do not have easy ways of telling whether and when experiments with potential serious harm or even fatality are being done on them. Even the experimenters might not be omniscient about the underlying biology.

Would it be a bad idea to first examine the underlying biology of an intervention in vitro or tissue culture or animal models, before experimenting on people?

With all sincerity,

Joel Almeida

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Fw: Ref.: (LML) Animals and human participants

Leprosy Mailing List – April 24, 2026

Ref.: (LML) Animals and human participants

From: Joel Almeida, Mumbai, India

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Thursday, April 23, 2026

Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy. March, 2026.

Leprosy Mailing List – April 23, 2026

Ref.: (LML) Infolep monthly overview of new publications on leprosy. March, 2026.

From: Elizabeth Talatu Williams, Amsterdam, the Netherlands

____________________________________________________________________________

Dear colleagues,

We are pleased to share with you the March 2026 edition of the Infolep Newsletter, bringing together a collection of new publications, case reports, and global developments shaping the leprosy field.

This month’s featured articles highlight advances in digital innovation, clinical reasoning, and patient-centred care. Key contributions include an independent assessment of the WHO Skin NTDs mobile application for leprosy detection, new insights into neuropathy and demyelinating patterns, and a scoping review exploring healing processes in chronic diseases. Additional studies examine mental health outcomes following treatment, stigma in endemic settings, and the development of interactive dashboards to strengthen disease monitoring and control.

The case reports featured in this issue reflect the ongoing diagnostic and clinical challenges in leprosy, including atypical presentations, delayed diagnoses, and complex reactions. Together, they underscore the importance of early detection, clinical awareness, and sustained treatment adherence.

We also highlight an important global development, with Chile becoming the first country in the Americas to be verified by WHO for the elimination of leprosy. In addition, we draw your attention to upcoming global events, including the Seventy-eighth World Health Assembly in Geneva and the World Health Summit Regional Meeting in Nairobi, which will bring together stakeholders to advance global health priorities.

We hope this March edition provides valuable insights, supports your work, and reinforces our shared commitment to improving leprosy care and reducing stigma worldwide.

Please feel free to contact us if you would like access to full-text articles not available through Infolep, or if you would like support with literature searches.

Warm regards,
Elizabeth Talatu Williams

www.leprosy-information.org
info@infolep.org

Featured Research Spotlight

Independent assessment of the WHO Skin Neglected Tropical Diseases application for leprosy detection
Deps P, Amorim BBC, Repsold T, et al. Revista Panamericana de Salud Pública. Pan American Health Organization. 2026.

Understanding healing: A comparative analysis in chronic diseases with leprosy—A scoping review
Darlong J, Kim J, Goswami S, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (3): 1-14.

Mental Health Burden and Associated Factors Among Patients With Leprosy After Treatment Completion in South West Delhi
Wadhwani S, Rasheed N, Rasania SK. Cureus. Springer Science and Business Media LLC. 2026; 18 (4): 1-13

User-Centered Design and Evaluation of an Interactive Dashboard to Support Leprosy Monitoring and Control in Brazil
Silva AB, Vilar de Andrade HG, Dourado RA, et al. Revista Eletrônica de Iniciação Científica em Computação. Sociedade Brasileira de Computacao - SB. 2026.

Stigma associated with leprosy among patients, contacts, and the general population in an endemic region of Brazil.
Cruz P, Miot H, Talhari C, et al. Anais brasileiros de dermatologia. 2026; 101 (2): 1-11.

Other New Publications

Feel free to contact us to receive full-text versions if these cannot be found through the Infolep portal.

Leprosy neuropathy and demyelinating impairment: How should we interpret this neurophysiological pattern?
dos Santos DF, Carvalho IR, Borges IS, et al. PLOS One. Public Library of Science (PLoS). 2026; 21 (4): 1-13.

Demyelinating Leprosy Neuropathy: An Unusual and Misleading Electrophysiological Pattern.
Foucard C, Jachiet M, Viala K, et al. Muscle & nerve. 2026; 73 (5): 898-905.

NEGLECTED BODIES AND STIGMATIZED TERRITORIES: THE BIOPOLITICS OF LEPROSY IN THE BRAZILIAN SEMIARID THROUGH THE LENS OF SOCIAL VULNERABILITY
Paulo Roberto Ramos, Natália Gomes de Carvalho, Kayla Caianne Gonçalves Alves, et al. Journal of Education, Science and Health – JESH. 2026; 6 (2): 1-18.

Impact of COVID-19 on adverse drug reactions in leprosy patients in Sri Lanka
Kahawita IP, Karawita UG, Nissanka NAKAI, et al. Academia Drug Development and Pharmacotherapy. Academia.edu Journals. 2026; 2 (1): 1-9

Evaluation of Transcranial Magnetic Stimulation for Detecting Subclinical Neuroplastic Changes in Newly Diagnosed Leprosy Patients without Peripheral Neuritis
Singh A, Mani S, Krishna A. Physical rehabilitation and recreational health technologies. Kharkiv State Academy of Physical Culture. 2026; 11 (1): 52-60.

The Impact of Incomplete Notification Forms on Leprosy Surveillance
Goncalves LESC, Milanski AS, Truppel TVS, et al. The 6th International Congress on Health Innovation&mdash;INOVATEC 2025. MDPI. 2026; 137 (1): 84.

The Use of a Multi-Drug Therapy (MDT) Monitoring Calendar as a Medium to Support Medication Adherence in Leprosy Patients
Marianti Agustina Gudipun, Yoany Maria Vianney Bita Aty , Maria Selestina Sekunda, et al. Viva Medika: Jurnal Kesehatan, Kebidanan dan Keperawatan. Lembaga Penelitian dan Pengabdian Kepada Masyarakat Universitas Harapan Bangsa. 2026; 19 (1): 9-18.

The Great Imitator: A Case Series of Leprosy Mimicking Other Diseases
Maitri Patel, Ritu Singh, Roshni Vahora, et al. GAIMS J Med Sci. 2026; 6 (1): 1-4.

Quality of life in Indian people affected by leprosy? A systematic review from the country with the highest burden of leprosy cases
Govindharaj P, Agrawal S, Ramasamy S, et al. Transactions of The Royal Society of Tropical Medicine and Hygiene. Oxford University Press (OUP). 2026.

Unveiling leprosy through machines: a review of artificial intelligence in a neglected tropical disease
Goswami A, Verma S, Marak A. Portuguese Journal of Dermatology and Venereology. Publicidad Permanyer, SLU. 2026; 84 (1): 1-8.

Lewis Y (Ley) orchestrates leukocyte trafficking and inflammatory remodeling in leprosy patients from the Brazilian Amazon
Almeida S, da Cruz EDRM, de Loiola RDSP, et al. Immunologic Research. Springer Science and Business Media LLC. 2026; 74 (1): 1-14.

Cognitive and Neuropsychiatric Sequelae After SARS-CoV-2 Infection: A Narrative Review and Exploratory Cross-Sectional Study of Neurofilament Light Chain and GFAP
Guzmán Priego CG, Villalpando JMG, Baeza Flores GDC, et al. Brain Sciences. MDPI AG. 2026; 16 (3): 1-19.

Diagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience
Sarkar S, Miraclin T A, Jayachandran R, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (4): 1-12.

HOW SUITABLE ARE NDO-LID AND PGL-I IN RAPID DIAGNOSTIC TESTS FOR SCREENING OF LEPROSY? A REVIEW OF DIAGNOSTIC STUDIES
Husodho GVP, Kumalasari ADA, Faiza AH. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal). Institute of Research and Community Services Diponegoro University (LPPM UNDIP). 2026; 15 (2): 129-136.

The oral health status of Filipinos affected by leprosy in a Philippine tertiary care center
Chung AT, Marquez MLU, Baghban GS, et al. Leprosy Review. Lepra. 2026; 97 (1): 1-11.

Descriptions of the natural history of erythema nodosum leprosum to inform clinical classification - A semi-systematic review.
De Barros B, Lambert S, Dias V, et al. PLoS neglected tropical diseases. 2026; 20 (3): 1-15.

Case Reports

Delayed diagnosis and poor treatment compliance remain key challenges in leprosy control: a case of lepromatous leprosy with type 2 reaction
Thilakarathna M, Uthayarajan N, Siriwardena C, et al. BMC Infectious Diseases. Springer Science and Business Media LLC. 2026.

Bilateral Lower Limb Sensory Motor Neuropathy as the Initial Manifestation of Borderline Tuberculoid Leprosy: A Diagnostic Challenge
Kumar BN, Singh M. Annals of African Medicine. Ovid Technologies (Wolters Kluwer Health). 2026.

Macrocheilia Revealing Lepromatous Leprosy: A Case Report
Sidi FM, Zemmez Y, Frikh R, et al. Scholars Journal of Medical Case Reports. SASPR Edu International Pvt. Ltd. 2026; 14 (04): 652-652.

Type 2 Lepra Reaction Presenting as Pyrexia of Unknown Origin: A Case Report
Rajbarath, Purn Pragya, S. S. Singh, et al. International Journal of Medical and Pharmaceutical Research. 2026; 7 (1): 2584-2585.

Atypical leprosy revisited: adding to the expanding spectrum—a case series
Shinde G, Dhurat R, Hassan A, et al. Leprosy Review. Lepra. 2026; 97 (1): 1-8.

Indeterminate leprosy: case report and literature review
Luh Putu Venny Cempaka Sari, Gusti Ayu Agung Dwi Karmila, Herman Saputra, et al. Indonesia Journal of Biomedical Science. 2026; 20 (1): 12-17.

Type 2 Lepra Reaction Following Antituberculosis Treatment Initiation in an Elderly Male With Coexisting Hansen's Disease: A Case Report
Villanueva CAG, Ortiz YRH, Mojica WP, et al. Respirology Case Reports. Wiley. 2026; 14 (3): 1-4.

A Rare Case of Leprosy in Sweden Mimicking Drug Eruption
Alvergren G, Hammarström H, Polyza S, et al. Acta Dermato-Venereologica. MJS Publishing, Medical Journals Sweden AB. 2026.

Tuesday, April 14, 2026

Fw: Ref.: (LML) WHO SEARO on WHD2026 launched the Banyan Framework

Leprosy Mailing List – April 14, 2026

Ref.: (LML) WHO SEARO on WHD2026 launched the Banyan Framework

From: Francesca Gajete, Manilla, Philippines

____________________________________________________________________________

Dear Dr Pieter,

Sharing this vital information I received from WHO SEARO which is worth emulating.

On #WHD2026, a Banyan Framework for WHO South-East Asia was launched.

“It is not just a strategy - it is how we will make science work for people. Over the next three years, it will guide our work across the Region. It focuses on four priorities:

Primary health care

Disease elimination

Health security

NCDs and mental health

But more importantly, it changes how we deliver—through four accelerators.

First, integrated health system delivery—shifting from programme silos to connected systems across surveillance, laboratories, service delivery, supply chains, and emergency response.

Second, focused priorities and tailored country support—directing efforts where they matter most, guided by subnational data.

Third, scaling access to medical countermeasures and strengthening ecosystems for innovation, digital health, and AI—moving from pilots to reliable, system-wide solutions.

And fourth—and most important—regional partnership platforms,’ said Dr Catharina Boehme, Officer-in-Charge, WHO South-East Asia. #cttoWHOSEARO

#WorldHealthDay #StandWithScience #HealthForAll #OneHealth

Best regards,

Dr Cess

Dr Francesca Cando Gajete MHA FPLS

Philippines

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Leprosy Mailing List Blog

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Tuesday, May 5, 2026

Fw: (LML) Did capsule P have a dramatic impact?

Friday, April 24, 2026

Fw: Ref.: (LML) Animals and human participants

Fw: Ref.: (LML) Animals and human participants

Thursday, April 23, 2026

Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy. March, 2026.

Tuesday, April 14, 2026

Fw: Ref.: (LML) WHO SEARO on WHD2026 launched the Banyan Framework

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