(LML) New WHO guidelines on chemotherapy for PB leprosy

Leprosy Mailing List – December 25,  2018

Ref.:   (LML)  New WHO guidelines on chemotherapy for PB leprosy

From:  Jaison Barreto,  Bauru, São Paolo, Brazil

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Dear Pieter, 

I have worked in the most endemic leprosy state in the last 3 years. We decentralize the attention to the leprosy patients in the municipality of Palmas. As many as 80% of the children have been diagnosed with borderline leprosy. Also, 20% of the relapsed cases were indeed borderline patients treated previously as having "PB leprosy".

In Brazil, as many as 27% of patients with less than six lesions should be treated as MB leprosy according to the bacilloscopy of the biopsy. This occurs because 85% of the slides from smears or biopsies in Brazil are not correctly stained or they have errors (collection, dyes, destaining, dewaxing procedures). Most histopathologists does not know Faraco Fite staining.

Our Ministry of Health is trying to recover the knowledge about laboratory technics lost since 1997. Today, in the world, a patient having diffuse leprosy or an initial borderline leprosy (80% of the cases of patients with leprosy in adults, according to Ridley) are being treated with PB scheme. They are called "PB with reaction". They are treated for only 6 months, and suffer from neuritis for at least 6 years, having corticosteroid disfiguring, until the "relapse" is finally assumed. This is a crime, in my opinion.

Is it rational to undertreat 40% of leprosy patients? Also, according to Chaterjee, lepromin highly positive Indeterminate or true tuberculoid (TT) leprosy are rare, i.e., with good prognosis, self limited. I have found less that 10 cases in my 20 years of experience in the national reference centre or in the field. Most I or TT cases were found in young children, and during active surveys.

The side effects of clofazimine occurs more commonly in patients taking for more than 1 year. This is the reason I fully agree with the new recommendation of WHO.

Regards,

Jaison

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

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