(LML) Classification of patients and interruption of transmission

Leprosy Mailing List – April 25,  2019

Ref.:  (LML) Classification of patients and interruption of transmission

From:  Rajeev B Dudhalkar, Maharashtra, India

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Dear Pieter,

Classification of patients and interruption of transmission by Joel Almeida, April 14, 2019. I think we are not addressing very basic issues of new case detection and strategy to detect infectious leprosy cases.

1. Only patch with sensory loss is promoted, so we are mostly detecting non infectious cases.
2. Leprosy symptoms for infectious cases (Change in skin texture, namely Smooth Oily Shiny thickened skin and nodule – LL cases, patches without sensory loss – BB & BL cases) are neither looked for nor health workers are trained to look for.

This is very much evident from the prevailing flowcharts for leprosy diagnosis as well as grouping for MDT. Does not give the scope for the application of the most crucial cardinal/ diagnostic sign 'Presence of AFB in skin smear examination', for the detection of infectious cases.

3. When leprosy symptoms are trouble free, we expect suspects to report voluntary.
4. Detection of cases with few patches requires through physical examination, where as mere observation and looking exposed parts especially face suspecting symptoms for infectious case is much easy, provided health workers are trained / oriented to look for. 

Now we don't see the plateau in a graph of new case detection trend in terms of absolute number for almost past 10 years. When source of infection remains unchecked due to undetected infectious cases left in the community. which are difficult to diagnose at the peripheral health unit. The problem is non availability of skin smears examination facility in an integrated public health system for the diagnosis of infectious cases, 

I am once again sharing a flow chart for the application of three diagnostic signs, so that under or over diagnosis can be avoided while examining leprosy suspects in the field condition.

This is my determination for leprosy free world compelling me to respond.

With best regards,

Rajeev B. Dudhalkar

Mob. No. 9324381408

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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