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Relapse after 8 month of MDTInbox x | 
Dear Pieter this is a case that was sent to me yesterday by Dr. J. Cabral, from Cuiabá, state of Mato Grosso, Brazil. This patient was treated with 8 month of MDT, 8 years before, and stoped (abandoned). Now, returns with positive bacilloscopy, and VDRL assay 1/64, with lesions that mimic syphilis, i.e., on palms and soles, with no patches. For a physician who does not know what is leprosy, it could be easily misdiagnosed. And I can wonder what is the reality of MDT-U, when a MB patient is treated with 6 month of MDT, and so it is given discharge by cure. How many 8 years (or more) follow up studies are described in literature? Even for MDT 12 doses versus 24 doses, the time interval of studies in Brazil was not so long, i.e, the follow up was only 6 years. And it was said that 12 doses would be enough. This deduction, which was (based on not scientifically based Medicine) encouraged by Ji Baohong in nineties, is causing several "relapses" in Brazil, today. For borderline patients with less than 4+ (BB/BT), personally I agree that 12 doses is enough, but this is not true for BL/LL. Unfortunately, leprosy diagnosis and/or treatment scheme are determined for politically purposes. According to WHO, no patches = no leprosy; if the patient has one visible lesion, even if this lesion is a leproma, it must be classified as PB. If the patient has several neural lesions, and bacilloscopy of slit skin smear is negative, the patient is also classified as having PB leprosy. In our last Brazilian Symposium of Leprology, this situation was declared to be dangerous. More an more we have seen drug resistance, and sometimes multidrugs resistance. Our Brazilian Health Ministry is trying to determine what is the extension of the problem, and clarify what is true relapse, or what could be due to reinfection and even multidrug resistance. In our Institute, mean time between MDT 12 doses and clinically and histopathologically relapse, in BL/LL patients, was 9 years. For those treated with 24 doses, this time interval was 13 years. Best regards Jaison Dr. Jaison A. Barreto, MD, PhD Chief of the Leprosy Section Instituto Lauro de Souza Lima Bauru - SP - Brazil 3 Attachments
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| Herman-Joseph Kawuma |
| Jaison Antonio Barreto |
| Salvatore Noto |
| a.rambuka |
| Bernard Naafs |
| Gwen Robbins Schug |
| hk kar |
| Justice, Judith |
| Linda Lehman |
| mariae.alonso |
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> < Why this ad? Babbel - Learn Languages Online - A fast, fun and effective way to learn. Choose from 12 languages. Click here to try it out for free! 17408 |
Relapse after 8 month of MDTInbox x | 
Dear Pieter this is a case that was sent to me yesterday by Dr. J. Cabral, from Cuiabá, state of Mato Grosso, Brazil. This patient was treated with 8 month of MDT, 8 years before, and stoped (abandoned). Now, returns with positive bacilloscopy, and VDRL assay 1/64, with lesions that mimic syphilis, i.e., on palms and soles, with no patches. For a physician who does not know what is leprosy, it could be easily misdiagnosed. And I can wonder what is the reality of MDT-U, when a MB patient is treated with 6 month of MDT, and so it is given discharge by cure. How many 8 years (or more) follow up studies are described in literature? Even for MDT 12 doses versus 24 doses, the time interval of studies in Brazil was not so long, i.e, the follow up was only 6 years. And it was said that 12 doses would be enough. This deduction, which was (based on not scientifically based Medicine) encouraged by Ji Baohong in nineties, is causing several "relapses" in Brazil, today. For borderline patients with less than 4+ (BB/BT), personally I agree that 12 doses is enough, but this is not true for BL/LL. Unfortunately, leprosy diagnosis and/or treatment scheme are determined for politically purposes. According to WHO, no patches = no leprosy; if the patient has one visible lesion, even if this lesion is a leproma, it must be classified as PB. If the patient has several neural lesions, and bacilloscopy of slit skin smear is negative, the patient is also classified as having PB leprosy. In our last Brazilian Symposium of Leprology, this situation was declared to be dangerous. More an more we have seen drug resistance, and sometimes multidrugs resistance. Our Brazilian Health Ministry is trying to determine what is the extension of the problem, and clarify what is true relapse, or what could be due to reinfection and even multidrug resistance. In our Institute, mean time between MDT 12 doses and clinically and histopathologically relapse, in BL/LL patients, was 9 years. For those treated with 24 doses, this time interval was 13 years. Best regards Jaison Dr. Jaison A. Barreto, MD, PhD Chief of the Leprosy Section Instituto Lauro de Souza Lima Bauru - SP - Brazil 3 Attachments
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| Herman-Joseph Kawuma |
| Jaison Antonio Barreto |
| Salvatore Noto |
| a.rambuka |
| Bernard Naafs |
| Gwen Robbins Schug |
| hk kar |
| Justice, Judith |
| Linda Lehman |
| mariae.alonso |
More
1 of 1
> < Why this ad? Babbel - Learn Languages Online - A fast, fun and effective way to learn. Choose from 12 languages. Click here to try it out for free! 17408 |
Relapse after 8 month of MDTInbox x | 
Dear Pieter this is a case that was sent to me yesterday by Dr. J. Cabral, from Cuiabá, state of Mato Grosso, Brazil. This patient was treated with 8 month of MDT, 8 years before, and stoped (abandoned). Now, returns with positive bacilloscopy, and VDRL assay 1/64, with lesions that mimic syphilis, i.e., on palms and soles, with no patches. For a physician who does not know what is leprosy, it could be easily misdiagnosed. And I can wonder what is the reality of MDT-U, when a MB patient is treated with 6 month of MDT, and so it is given discharge by cure. How many 8 years (or more) follow up studies are described in literature? Even for MDT 12 doses versus 24 doses, the time interval of studies in Brazil was not so long, i.e, the follow up was only 6 years. And it was said that 12 doses would be enough. This deduction, which was (based on not scientifically based Medicine) encouraged by Ji Baohong in nineties, is causing several "relapses" in Brazil, today. For borderline patients with less than 4+ (BB/BT), personally I agree that 12 doses is enough, but this is not true for BL/LL. Unfortunately, leprosy diagnosis and/or treatment scheme are determined for politically purposes. According to WHO, no patches = no leprosy; if the patient has one visible lesion, even if this lesion is a leproma, it must be classified as PB. If the patient has several neural lesions, and bacilloscopy of slit skin smear is negative, the patient is also classified as having PB leprosy. In our last Brazilian Symposium of Leprology, this situation was declared to be dangerous. More an more we have seen drug resistance, and sometimes multidrugs resistance. Our Brazilian Health Ministry is trying to determine what is the extension of the problem, and clarify what is true relapse, or what could be due to reinfection and even multidrug resistance. In our Institute, mean time between MDT 12 doses and clinically and histopathologically relapse, in BL/LL patients, was 9 years. For those treated with 24 doses, this time interval was 13 years. Best regards Jaison Dr. Jaison A. Barreto, MD, PhD Chief of the Leprosy Section Instituto Lauro de Souza Lima Bauru - SP - Brazil 3 Attachments
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Leprosy Mailing List – December 5, 2013
Ref.: (LML) Higher risk of relapses in BL/LL with BI 4 or more after MDT-U and MDT 12 doses
From: Jaison Barreto, ILSL Bauru, Brazil
Dear Pieter
This is a case that was sent to me two weeks ago by Dr. J. Cabral, from Cuiabá, state of Mato Grosso, Brazil. The patient was treated with 8 months of MDT, 8 years before, and stopped (abandoned). Now, returns with a positive bacilloscopy, and VDRL of 1/64, with lesions that mimic syphilis, i.e., on palms and soles, with no patches. For a physician who does not know leprosy, it could be easily misdiagnosed.
And I may wonder what may happen with MDT-U, when a MB patient is treated only with 6 month of MDT, and so than is declared cured and discharged. How many 8 years (or more) follow up studies are described in literature?
Even comparing MDT 12 doses versus 24 doses, the time interval of studies in Brazil was not so long, i.e, the follow up was only 6 years. And it was concluded that 12 doses would be enough. This conclusion, which was (not evidence based Medicine) encouraged by Ji Baohong in the nineties, is the cause of several "relapses" in Brazil, today. For borderline patients with less than 4+ (BB/BT? BB/BL?), personally I agree that 12 doses is enough, but this is not true for BL/LL. At our Institute, the mean time between MDT 12 doses and clinically and histopathologically relapse, in BL/LL patients, was 9 years. For those treated with 24 doses, this time interval was 13 years
Unfortunately, leprosy diagnosis and/or treatment schemes are determined politically. According to WHO, no patches = no leprosy. If the patient has one visible lesion, even if this lesion may be a leproma, it has to be be classified as PB. If the patient has several neural lesions, and bacilloscopy of the slit skin smear is negative, the patient is also classified as having PB leprosy. In our last Brazilian Leprosy Symposium , this situation was declared to be dangerous. More and more we see drug resistance, and sometimes even multidrug resistance. Our Brazilian Health Ministry is trying to determine what is the extension of the problem, and clarify what is true relapse, or what could be due to reinfection and multidrug resistance.
Best regards,
Jaison Barreto
ILSL Bauru
São Paulo, Brazil
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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