Leprosy Mailing List – November 13, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Jaison Barreto, Bauru, Brazil
Dear Pieter,
I agree with the words of Dr Talhari concerning the fear of reducing the time for the treatment with MDT for most patients. However, as published by Dr Penna many years ago (leprosy: the knowledge shall not be neglected), and also by my professor Dr Opromolla, the 12 doses scheme was implemented without solid scientific bases.
It is important to remark that the bacteria take two weeks in order to multiply. The time interval for relapses, clinically and histo-pathologically documented in ILSL, after discharge from short schemes, is 7 to 10 years. For patients treated with 24 doses, the mean time is 13 years.
We cannot put at the same group patients without resistance to M leprae, with many lepromas, together with Borderline patients, whose are able to make a cellular response to the Bacillus. Katoch 2010 published a paper, where he observed for 10 years patients with high BI (4 or more), whose were treated with 12 doses of MDT plus ofloxacin and minociclin. 93% were cured.
It is well known, since 1980's, that patients in the lepromatous range have not the same prognosis after discharge of MDT. Negative bacilloscopy after 5 years in lepromatous leprosy patients does not mean cure. The mean time interval of restrict colonization of M leprae of Schwann cell is 10 years in these patients!!!! This is the reason why we see patients relapsing after many years, sometimes 15 or 20 years after treated with monotherapy, rifampin plus dapsone, or even MDT. We must take care when evaluating the results of regimens with short follow up. Five to ten years is like a vacation for M leprae, not a lifetime.
Regards,
Jaison Barreto
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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