Leprosy Mailing List – May 16, 2019
Ref.: (LML) Chronic aspects of leprosy
From: Diana Lockwood, London, UK
I have recently published a review on the chronic aspects of leprosy that I would like to share with readers of LML. Trans R Soc Trop Med Hyg 2019; 00: 1–5. Chronic aspects of leprosy—neglected but important
"The chronic aspects of leprosy are discussed here. They are a consequence of the peripheral nerve damage that affects many patients during their lifetime with leprosy. The peripheral nerve damage leaves people unable to feel and with weakness in their hands and feet. They are at risk of damaging their hands and feet, causing the disabilities and deformities that characterise late leprosy.
More than 200 000 new leprosy patients are diagnosed globally each year. Better data are needed from cohort studies to estimate the number of patients developing nerve damage and modelling studies are needed to estimate the number of patients who develop disabilities. For some of them, this will be a lifelong disability.
Nerve damage is caused by inflammation in leprosy-affected nerves. Patients with nerve damage of<6-mo duration need treatment with steroids. About 66% of multibacillary patients will develop nerve damage. Plastic graded monofilaments can be used to detect nerve damage in leprosy and diabetic clinics. Assessing nerve damage and treating patients with steroids in leprosy programmes needs to be strengthened.
The World Health Organization has a successful programme for supplying antibiotics for treating leprosy infection to national leprosy programmes. They should take responsibility for providing steroids to national programmes since this is a core part of the treatment for >66% of multibacillary patients. Patients need to be asked about neuropathic pain symptoms and treated if necessary.
Treated leprosy patients are at risk of developing ulcers in their feet. Treatment and prevention need to be improved through health education, providing protective footwear and patient empowerment."
Given the important role steroids have in preventing nerve damage it is important that this aspect of drug provision is considered by WHO. It can be argued that they should take a lead role in providing or at least securing steroid treatment for patients with reactions.
I also think there is important work to be done in modelling the numbers of leprosy patients with disability and I hope that a modeller will take up this challenge
Professor Diana Lockwood
Professor of Tropical Medicine
Department of Clinical Research
London School of Hygiene & Tropical Medicine
London WC1E 7HT
Tel 0207 -927 -2457
Visit my blog firstname.lastname@example.org
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