Leprosy eliminated?

Leprosy Mailing List, September 12^th, 2009

Ref.: Leprosy eliminated?

From: Schreuder Pieter AM, The Netherlands

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Dear Salvatore,

I refer to Drs de Koning’s and Vijayakumaran’s comments (LML Sept. 11^th and Aug. 27, 2009 respectively).

Even when there is a functioning primary health care and referral system still some patients are only diagnosed very late. Multibacillary (MB) Hansen’s disease (HD), especially close to the lepromatous end of the spectrum, may mimic (many) other diseases, and the patient can not be diagnosed without a biopsy or a slit-skin smear examination. Clinicians (including dermatologists) working in a HD endemic area do not always include HD in their differential diagnosis, especially when the clinical presentation is unusual. HD should be considered in all patients with skin lesions not responding to treatment, especially when they have neurological deficits, and live or have lived in an HD endemic area. Due to the increase in global travel and immigration, doctors in low endemic areas need to consider HD as a possible diagnosis.

Nery JA, Schreuder PA, de Mattos PC, de Mendança LV, Tardi RT, de Mello S, Azulay RD, Lehman LF, Naafs B. Hansen’s disease in a

general hospital: uncommon presentations and delay in diagnosis. J Eur Acad Dermatol Venereol, 2009; 23: 150-156.

Kind regards,

Pieter AM Schreuder