FW: (LML) MB-patient from Guinea

 

Leprosy Mailing List – September 19,  2019

Ref.:    (LML) MB-patient from Guinea

From:  Arry Pongtiku, Papua, Indonesia

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Dear Pieter,

 

I would like to thank Dr. Strahm for sharing this difficult post RFT case. As I saw the pictures, it seems clear to me, that he is suffered from chronic ENL. He has complications like wounds and arthritis, may be the patient cannot walk. The case appeared being in poor nutrition. 

 

My experience for recurrent ENL is that we can give high dose clofazimine 3x100 for 2 months, tapering  2x100 for  2 months and 1x100 for 2 months.  Clofazimine also works as anti inflammation. Be careful not to give prednisolone when there are open wounds. Extra nutrition such as milk with high protein (pediasure milk) and green beans. Physiotherapy to help for his legs mobile. Wound care use water /NaCl solution and vegetable oil. Personal hygiene is important as well. 

 

Check all possibilities of a reaction trigger. Often low haemoglobin: one can give Fe, vitamin and anthelmintics such as albendazole or pyrantel. For sources of infection one can give antibiotics. Check for malaria. To test also for example for HIV, for sexual transmitted disease and phimosis. Maybe it is a saying: we must check from the hair until the toes!

 

Counselling may be needed for feeling stress/hopeless and give motivation.

 

I usually asked leprosy field worker to learn from and accompany and support such patients to gain more confidence. Not infrequently these patients can be successfully cured.

 

Thank you.

Salam.

 

Arry Pongtiku. 

Former leprosy adviser, Papua, Indonesia.

 

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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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