Fw: Ref.: (LML) Understanding Silent Neuropathy

 

 

Leprosy Mailing List –  February 25,  2025

 

Ref.:  (LML) Understanding Silent Neuropathy

From: Ben Naafs, Munnekeburen, the Netherlands

 

 

Dear Pieter,

I have some question marks and comments on Joel Almeida's contribution to LML on February 19th.

I will follow his alinea.

"Silent" neuropathy is indeed responsible for far most of the nerve damage in leprosy. Already Shetty and Antia showed that even contacts could have nerve damage, without inflammation. Also in "RFT" patients the damage may go on when visible bacilli are absent.

Indeed PGL-I can directly cause damage, but that stops when the bacilli have disappeared another  M.leprae  membrane component lipoarabinomannan may cause damage for a longer time as long as it is present. How long I could not find. Even patients who have had adequate antibacterial treatment may still harbor lipoarabinomannan in their tissue.

Indeed, many of the M. leprae-exposed persons even when they do not develop leprosy may show electrophysiological signs of demyelination. It may not be self-healing because 80% will never develop leprosy but just contact with an M. leprae antigenic determinant either from leprosy patients as you mention but also from the environment. There does not need to be inflammation detected.

All people may carry M. leprae in the nose after contact, they may shed it but the inoculum does need to be large enough to have any impact on the new host. I am not sure that they are provoked to be extra infective (virulent) when the carrier gets antibiotics. And 80% will never develop leprosy. And as far as I remember ref 5 talks about the risk of resistance.

I wonder whether in leprosy dormant bacilli do not stay dormant after contact with antibacterial treatment and that they need to be not dormant to be affected and expose their intracellular antigenemic determinants or the suggested extra virulence.

I agree that the 20% who can develop leprosy should not receive PREP but the full dose of treatment.

Ben

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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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