Leprosy Mailing List – September 9, 2026
Ref.: (LML) Long-lasting adverse impact of chemoprophylaxis & what actually works
From: Sandra Maria Barbosa Durães, Curitiba, Brazil
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Dear Pieter and colleagues,
Laila makes an excellent point, highlighting the genuine need to base public health policies on scientific evidence. I would add that this applies not only at the national level but also to individual cases; for instance, using unvalidated regimens is highly problematic unless done as part of a research project. In Brazil, some specialists insist on prescribing daily rifampicin—contrary to guidelines—and extending treatment beyond the standard 12 doses when lesions do not fully resolve, a practice that conflicts with current evidence.
As rightly noted, a positive PCR result does not necessarily indicate the presence of viable bacilli, and viability does not automatically imply transmission potential. There have been reports in Brazil of patients with positive PCR results but no clinical symptoms receiving treatment.
Similarly, classifying electroneuromyographic abnormalities—even those accompanied by ultrasound changes—as infection in patient contacts, when there are no clinical manifestations, strikes me as imprecise. I am unaware of electroneuromyography studies involving asymptomatic individuals with no history of leprosy exposure; it is possible that elderly individuals might exhibit abnormalities in these tests—even after age-adjustment—that hold no clinical significance.
Failure to diagnose the disease early is highly detrimental given its potential to cause disability; however, treating individuals who do not have the disease is equally harmful, as the damage caused by stigma and the adverse effects of medication are significant. Furthermore, in the absence of skin lesions, stricter criteria must be applied to establish a definitive diagnosis so as not to overlook other conditions.
Modifications to recommended treatment regimens—whether involving new drugs or changes to the duration of therapy—require controlled studies with long-term follow-up; only in this way can their efficacy be verified.
Best regards,
Sandra Maria Barbosa Durães
Associated Professor Clinical Medicine Department - MMc
Fluminense Federal University - UFF
+5521997370722
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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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