Pure neuritic leprosy

Leprosy Mailing List – January 18^th, 2011

Ref.:   Pure neuritic leprosy

From: Warren G., Sydney, Australia

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Dear Dr Kar,

Thank you very much for your statement about primary/pure neuritis leprosy (LML Jan. 11^th, 2011.  I often wondered as to how much there was.  When you say 6% is that of the total number WHO lists or of all  leprosy affected  persons.

Working in Burma in the 1970/80s I diagnosed and treated many patients we saw with primary persistent neuritic leprosy, who developed  paralysis but NEVER had a skin lesion.  Many we could operate upon and correct the deformity.

In the 1990s I saw a large  number in Thailand / Cambodia.  A number of these has previously been seen by WHO consultants who stated that because there was no skin lesion they did not have leprosy in spite of large firm poorly functioning nerves at typical sites.  Because of this statement they had not been given multi-drug therapy (MDT) and since the WHO statement many had gone on to develop further deformity.  In one patient with many large nerves but no skin lesions we were able to biopsy a nerve and the biopsy indicated that the patient was definitely Borderline, tending to Lepromatous so he certainly needed full MDT and one wonders how many  others he may have infected by coughing and sneezing.

In endemic areas, when these primary neuritic patients present with affected typical nerves it would be worth treating them with standard full MDT, even if it is not possible to do a biopsy to prove it is leprosy.

One of the problems I encounter is that the general doctors do not always examine all the affected nerves; some do not even know how to examine for leprosy, and which ones are commonly affected, in Leprosy.   I have met several patients in whom the diagnosis was only made because a helpful surgeon, while decreasing the disability, took a biopsy of the nerve!  Surely these facts should encourage better education in medical schools.  I have been asked to lecture in Medical colleges where my lecture was the first time there had ever been a lecture on leprosy as such!

Can I ask if that 6% get included in the WHO figures of affected patients as they do not fulfil the WHO definition as there may never be any skin lesions.  Yes there may be anaesthesia and deformity but technically no skin lesion in the primary persistent neuritis cases.  I know that there are lots of these  primary persistent  neuritis  leprosy patients in S.E.  Asia and hopefully they are not going to be the nidus of a sudden increase in numbers of patients in the next 20 years.

Yours sincerely,

Grace  Warren

Previously Adviser in Leprosy and Reconstructive Surgery for The Leprosy Mission in Asia ( 1975-1995)