Leprosy Mailing List – August 24, 2021
Ref.: (LML) Smear positivity after one year course of MB MDT
From: P. Narasimha Rao, Hyderabad, India
Dear Pieter,
Dr Rao wanted to know the management of a case of LL who completed a one-year course of MB MDT but continues to be smear positive. Wanted to know specifically whether to continue the treatment till smear negative or stop.
It all depends on whether we are looking at patients as a part of the larger 'leprosy programme' perspective or as an individual. Each individual leprosy patient deserves the best possible treatment. What WHO / NLEP programme recommends is a minimum duration of treatment to bring down the prevalence of leprosy. At the same time, NELP also supports extension of treatment beyond 1 year if the treating clinician, who is a competent leprosy specialist, considers it necessary. In other words, it is perfectly fine if it is extended beyond one year, if the signs and symptoms of the disease are still active in this patient.
While skin smears are not being practiced in NLEP / globally as part of the leprosy programme, it is heartening that Dr Rao is able to get these services for this patient. Please note that before the skin smears were abandoned/ discouraged in the year 1998, during the first 15 years of introduction of MDT for leprosy,-post 1983, the recommendation for smear positive patients was to treat them till smear negativity or up to 2 years.
Unfortunately, there are no directives / guidelines on how long one may treat beyond one year such smear positive patients. One way would be to treat them till all clinical activity abates, as the smears may continue to be positive for many years (>5 years) in a patient with a high initial bacillary index. In my opinion, the morphological index (MI) of skin smear, while good in theory, is difficult to practice as a basis for deciding the duration of treatment.
Treating leprosy patients beyond one year with MDT or rarely till smear negativity is alright. It is not unethical at all and was done previously. And many clinicians, dermatologists and country programme managers (e.g.; Japan, UK, US) still practice it in various forms. However, it has to be done with the consent and concurrence of the patient. And at the discretion and full understanding of the treatment leprologist. Only motive should be to help and benefit the patient IMHO.
Regards
P. Narasimha Rao, MD, D.D, PhD
President, Indian Association of Leprologists (IAL)
Past President, National IADVL- 2019
Coordinator, SIG-NTD, IADVL 2021-23
Professor of Dermatology,
Bhaskar medical college,
Hyderabad, India
.
Mobile-+91-9849044898
Email: dermarao@gmail.com
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
No comments:
Post a Comment