(LML) PB and MB are not two forms of leprosy

Leprosy Mailing List – August 13,  2014 

Ref.:    (LML) PB and MB are not two forms of leprosy

From:  S. Noto, Verdellino, Bergamo, Italy

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Dear Pieter,

Thank you to all colleagues that have given their contribution to this important topic that is about “Staining smears for leprosy”.   Dr Barreto in his message [LML - July 25, 2014] correctly widened the terms of the problem.  He interprets sentiments widely shareable. I would like to comment that Paucibacillary (PB) Multibacillary (MB) are not two forms of leprosy but, two treatment regimens. Their use as classification system generates problems.

Diagnosis
The diagnosis of leprosy is based on the 3 cardinal signs of the disease.  One of these is: “positive slit-skin smear examination”.  The other two are "skin patches with loss of sensation" and "enlarged peripheral nerves".

Classification
Once diagnosis is done we classify and, the Ridley and Jopling (R-J) classification is a milestone in modern leprosy.  Here I recall a few years ago comment of Dr Scollard: “we can see TV or movies with many colours and therefore we do not force ourselves to see only in black and white  -- in leprosy it would be like watching in black and white if we lose the R-J system.  I add that before the work of Drs Ridley and Jopling it was the chaos in clinical leprosy.  This classification was intended mainly for research purpose but, it helps all involved in leprosy and particularly in clinical leprosy.

Treatment
Paucibacillary (PB) Multibacillary (MB) are not two forms of leprosy but, two treatment regimens.  They were thought and introduced as such, as the two regimens or protocols of the multi-drug therapy (MDT).  They are the other mile-stone of modern leprosy therapy after the introduction of dapsone.  Patients with very few bacilli (pauci) can be treated with two anti-leprosy drugs for six months; these are tuberculoid and smear negative borderline tuberculoid leprosy cases.  Patients with many bacilli (multi) can be treated with three drugs and for a longer period; these are smear positive borderline tuberculoid, mid and borderline lepromatous and lepromatous leprosy cases.

Remarks opened to discussion
Early diagnosis and timely treatment are the goal of high quality leprosy work.  Diagnosis is based on the three cardinal signs of leprosy.  Treatment is dependent upon classification of the disease and classification is based on the work of Ridley and Jopling.  PB and MB are the used treatment regimens.  The ideal duration of the MB regimen is not clear yet but, it needs to be adequate to the patient’s bacterial load.

Attachment
In attachment are a Power Point (note editor: failed to get this file downloaded) and PDF file - - - “The leprosy spectrum and the bacteriological index”.
There are reported two slides with graphs representing the R-J classification.  They are adapted, only five forms of the disease are represented.  The second slide shows the relationship between bacillary index and cell mediated immunity.

Your sincerely,

Salvatore

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

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

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

 

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