Be aware of the word 'cured' in LL cases

Leprosy Mailing List, August 30th, 2009

Ref.: Be aware of the word 'cured' in LL cases.
From: Ganapati R., Mumbai, India
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Dear Dr Derek,

I refer to your LML message dated August 27th, 2009. Thank you for this. Your illustrious father Dr Stanley Browne who made his contributions mainly in the dapsone mono-therapy era had warned long ago about the relapses due to the “lurking bacilli”.

He continued to make observations during the early MDT period, but unfortunately did not live long enough to observe the outcome of the persistence of lurking organisms leading to relapse many years after completion of effective treatment with far more powerful bactericidal drugs.

We are encountering relapses 10 to 15 years after withdrawal of treatment in spite of satisfactory completion of universally prescribed schedules of treatment. This phenomenon reiterates the foresight of the “Mr Leprosy” who rightly advised to use the word ”cure” in LL cases with caution. Unfortunately the word is freely used particularly by some who want to underestimate relapses for public health reasons.

Relapse should be viewed from the clinical angle, as this is of concern to the affected individual. If the patient is BI and MI* positive at the time of relapse, he may be source of transmission of leprosy.

With regards,

Dr R Ganapati


*BI= bacteriological index
MI= morphological index