Leprosy Mailing List – August 18, 2026
Ref.: (LML) Long-lasting adverse impact of chemoprophylaxis & what actually works
From: Ben Naafs, Munnekeburen, the Netherlands
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Isabela Goulart “Long-lasting adverse impact of chemoprophylaxis & what actually works”. LML, August 17, 2026.
Dear Pieter,
I enjoyed reading Isabel’s contribution.
She points to the nerve damage occurring after contact with M. leprae. Both contacts that don’t develop leprosy and the ones who develop leprosy may already have nerve damage as already suggested by Shetty and Antia in 1975. It was shown later that could be done by lipoarabinomannan and PGL-1 too and not unlikely by other antigens or epitopes as well.
Her group showed that asymptomatic contact may have nerve damage when looked for. However, infection can be shown with anti-PGL-1 in the majority of patients. But infection may not lead to leprosy as disease in 80% the contacts. They found it also in a few of the PGL-1 seronegative contacts neural impairment in these contacts other antigens may be involved like lipoarabinomannan.
That qPCR is negative or positive depends how fast an individual clears the DNA, in days, weeks or months. And a seronegative contact may not have reacted on the PGL-1.
An important remark was: “important for the present discussion is the discrepancy between objective neurophysiological abnormalities and what could be detected by conventional clinical examination”.
I agree that nerve palpation is not very sensitive. However, a leprologist has this always with him/her and it is cheap.
Indeed, this is of importance for chemoprophylaxis trials. The essential question is:”
Before asking whether a single dose of rifampicin prevents Hansen’s disease in a contact. I agree with Isabel that individual who participates is truly disease-free.
She makes an important distinction:” Our findings do not, by themselves, demonstrate that SDR causes neurological damage”. And “some individuals operationally classified as asymptomatic household contacts already have measurable neural abnormalities and/or molecular evidence of M. leprae infection before any preventive intervention is considered”
It does not support Joël’s claim that chemoprophylaxis accelerates progression to multibacillary disease, reactions or disability.
She like many LML readers support Claudio’s call “for a more rigorous definition of who is truly eligible for chemoprophylaxis and for substantially more comprehensive long-term safety assessment.”
With regards,
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 << edit...@gmail.com
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