mleide@hucff.ufrj.br mlfpenna@gmail.com annasales10@gmail.com freisvianna@gmail.com cassioghidella@gmail.com angelatrindade@uol.com.br dejacn@uol.com.br wagnergalvao@gmail.com lucia_ito@hotmail.com clovislombardi@yahoo.com mmarzliak@gmail.com imbgoulart@gmail.com sergiooxwide@hotmail.com pdeps@uol.com.br xavier.surmont@gmail.com tom.gillis48@gmail.com geeske.zijp@gmail.com 552064522@qq.com rbttnt@gmail.com chenshm@public.jn.sd.cn shenjp@ncstdlc.org yumeiwen@gmail.com wjingquan@126.com ncardona@ces.edu.co mputulb@yahoo.fr angelikapiefer@gmail.com mariae.alonso@infomed.sld.cu jeycerey@hotmail.com jperiche@hvtudr.org jkongawi@leprosy.org jfaimee2009@yahoo.fr sabunip@tlmcongo.org ludwingg71@hotmail.com sabalambert@hotmail.com eshekebe@gmail.com shim_8000@yahoo.com wubitu@tlmethiopia.org dayanghirangn@wpro.who.int pohti.ritva@gmail.com maheant@yahoo.fr jacques.millan@orange.fr my.grauwin@neuf.fr annedebrettes976@gmail.com jean.gaschignard@inserm.fr annickmondjo@gmail.com birgit.loedige@gmx.de evelyne.leandro@gmail.com schliemann@derma-jena.de wolf@hippke.net schaefer@tropenklinik.de Birgit.markfelder@DAHW.DE ialo@gmx.com evdgrinten@leprosy.org ortunonimer@gmail.com stefan.strahm@gmx.net karthikot@hotmail.com sheetalamte@gmail.com indiranath@bprcleprasociety.org pktyagi1954@yahoo.co.in vikasamte@gmail.com doctorsaluja@gmail.com jayeshsachde@yahoo.in karthikot@hotmail.com hanumanth@leprahealthinaction.in jose@aifoindia.org natarajanmanimozhi@gmail.com sundarraopss@rocketmail.com marytom@live.com somabpc@rediffmail.com d_porichha@yahoo.com sundogra@hotmail.com narangtarun@yahoo.co.in sknoordeen1933@gmail.com vijaylepworker@gmail.com manickamp@gmail.com prahar82@gmail.com palpandi@gmail.com srinih@vsnl.com vaseemanjum8@gmail.com drashishbchakraborty@gmail.com prabhaa.vrudhula@gmail.com sunil.anand@tlmindia.org hkkar_2000@yahoo.com therapist_pankaj2002@yahoo.co.in drpkgopal@gmail.com akhila.r96@gmail.com sunil.deepak@gmail.com maneeshag65@gmail.com geetakiran.a@gmail.com vijay@fontilles.org dermarao@gmail.com pls29653@gmail.com drmanjunathr27@gmail.com vishwasnaik1987@gmail.com srniad@gmail.com training@karigiri.org sathishpaul77@gmail.com dr.rekha56@gmail.com jerry.joshua@tlmindia.org dr.ritudash@gmail.com doctorsaurabhjain@gmail.com rajeevdudhalkar@gmail.com drtsnkumar@yahoo.co.in mahelerecen@gmail.com alertprakash@gmail.com alertashutoshp@gmail.com clcp@vsnl.com
Saturday, October 14, 2017
Friday, October 13, 2017
(3) (LML) Leprosy and related issues
Leprosy Mailing List – October 13, 2017
Ref.: (LML) Leprosy and related issues
From: Pieter Schreuder, Maastricht., the Netherlands
Dear Colleagues,
By attached file you will find the article: "Leprosy - we've much left to learn, but are looking to squirrels, cows and cats for insights." J Feline Med Surg. 2017 Sep;19(9):977-978 A vetenarian view of M. leprae complex.
Our attention was drawn to this article by Kevin Dillon of the Scottish branch of LMI. The abstract was not available and he asked Jiske Erlings from InfoLep if she could look into.
If any of you has read an article which could be of interest to our LML readers, please contact us and we will distribute through LML. At the same thime comments on the article would be very much appreciated.
Yours,
Pieter AM Schreuder
Editor LML
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
(LML) Leprosy and related issues
Leprosy Mailing List – October 13, 2017
Ref.: (LML) Leprosy and related issues
From: Pieter Schreuder, Maastricht., the Netherlands
Dear Colleagues,
By attached file you will find the article: "Leprosy - we've much left to learn, but are looking to squirrels, cows and cats for insights." J Feline Med Surg. 2017 Sep;19(9):977-978 A vetenarian view of M. leprae complex.
Our attention was drawn to this article by Kevin Dillon of the Scottish branch of LMI. The abstract was not available and he asked Jiske Erlings from InfoLep if she could look into it.
If any of you has read an article which could be of interest to our LML readers, please contact us and we will distribute through LML. At the same time comments on any article would be very much appreciated.
Yours,
Pieter AM Schreuder
Editor LML
p/s Note editor: We have again problems with OUTLOOK, which blocks the sending out of our messages. What the problem is is not clear yet.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Monday, October 9, 2017
(LML) Steroid dependency in Leprosy
Leprosy Mailing List – October 8, 2017
Ref.: (LML) Steroid dependency in Leprosy
From: José Augusto, Rio de Janeiro, Brazil
Dear Pieter,
Thank Dr. Grace Warren (LML, 2-10-2017) to bring this important topic to our attention again. The longstanding use of steroids in leprosy (and the resulting dependency) is very worrying and must be well studied and evaluated. In Brazil we have had many problems with the indiscriminate use of this therapy leading to serious side effects and facilitating the appearance of opportunistic diseases of infectious origin. The protocols recommended are in the great majority of the times not followed by the doctors.
I think there must be time and dosage of corticosteroids adjusted for differential use when we have cases with cutaneous involvement and when we have neurological compromise.
Therapeutic behavior with Clofazimine unfortunately still needs to be further studied in endemic countries. However, it should not be forgotten that it also has side effects when used in high doses for an extended time.
Thank you.
Yours,
Jose Augusto
Dr. José Augusto da Costa Nery
Laboratório de Hanseníase/ ASA
Instituto Oswaldo Cruz - Fiocruz
Av. Brasil 4365, Manguinhos, Rio de Janeiro - RJ CEP 21040-360 - Tels.(21)2562-1588
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Tuesday, October 3, 2017
(LML) More about the use of B663 and lessons we should never forget
Leprosy Mailing List – October 3, 2017
Ref.: (LML) More about the use of B663 and lessons we should never forget
From: Grace Warren, Sidney, Australia
Dear Pieter,
As I said in my previous letter (LML, October 2, 2017) I frequently ordered B663 (Lamprene) as the initial drug (as monodrug ) while I checked for parasites, malaria and worms especially, and anemia, and other medical problems that may need to be treated adequately and often are not. In areas like SE Asia these med problems are so common the patients did not worry about reporting them. We need to check for them all - at initiation of therapy and whenever we are reviewing progress. It is often these intercurrent diseases that push the patient into reaction as his metabolic processes cannot cope with everything at once and so the Leprosy gets left of the urgent list as it does not kill.
One of the big factors is that as far as I know no person has ever been found to develop B663 resistance. Yes the labs have managed to produce B663 resistant organisms in research animals but never has it been found in patient. We cannot say the same for any other anti-leprosy drug (as far as I know). DDS resistance is so common that in some areas one must assume that new patients probably have DDS resistance. DDS also encourages anemia - and then there is G6PD problems which I found pretty common in the Chinese population (when looked for). But how often is it looked for nowadays?
B663 also has good anti-inflammatory action and is effective against some other bacterial infections that may be resistant to regular antibiotics. People talk of it causing irritation to some internal organs but if given with food (some say oil) or given soon after a meal - it seems to cause no real problems. I have often found it cures other infections that have been said to be resistant to antibiotics.
No I have not given it specially to cure the infection but some of the leprosy patients who had chronic infections did not respond to the usual antibiotics but after being put onto B663 the other infection also vanished.
I am not sure about provision of B663 – bought over the counter it is expensive – but does WHO merely provide free anti-leprosy drugs for a definite time period? I do not know what the arrangement now is - I merely did some of the original trials in the 1960s and would still use it if I had the opportunity. In fact I would go so far as to say that if I only had one anti-leprosy drug available I would make it B663.
In correspondence with Leprosy specialists in India I have been informed that there are many, perhaps in the hundreds of thousands of children with leprosy that has not been diagnosed. Leprosy is taught so little in medical colleges these days because of the advertisement that leprosy is no longer a public health problem in most countries of the world. I wonder how often immigrants are admitted to a new country after their medical examination, without any mention of leprosy or provision for its care or follow up. Even if they had leprosy, the Medical Officer in charge did not recognize the present signs of the disease.
Only a few years ago I was asked to consult an immigrant to a country where leprosy is not common and he acknowledged that he had had leprosy and had had some treatment, had abnormal sensory perception of the knees when he immigrated but was not listed as leprosy. After 5 years in the new country he developed nodules on which one of my student did slit skin smears and they were highly positive. And yes we found some large hard nerves, and sensory abnormalities in his legs. We put him on B663 and it settled easily and no further problem. I would certainly keep him on treatment till he is completely skin smear negative. There is no way one can check if there are any live bacilli in the nerves or other tissues. Yes the regular use of the MDT duration of dosage is reasonable but once a patient has shown reactions like this, one does wonder if he is ever really “Cured”.
One fascinating patient was diagnosed as neuritis on the long finger when she was 5 years old. The treatment was to paint with iodine every day, which was done for a short while but no record of how long or if it made any changes. No follow up. The patient acknowledges that when at school, the right hand behaved differently to the left. There was less hair growth and virtually no sweating and it was later realized she had abnormal sensation, strength and grip. Also absence of pain when trauma to the right hand (not to the left). But the hand seemed to function well. No one worried; said she was imagining things. When aged about 40 she met Stanley Brown who was intrigued and pointed out that some nerves on the back of the right had were large and hard and so was the ulna at the elbow, no evidence of skin lesions, or other typical signs. Ordinary skin biopsy negative but years later( about aged 60) shown to have a high Lymphocyte response showing she had caught leprosy somewhere and was now resistant. That of course was not known when Dr. Brown’s diagnosis was made so she did take a course of DSS (virtually the only drug used at that time) which seemed to produce no changes. At the time of the blood tests, it was discovered that as a small child she had had a nurse caring for her who about ten years later was diagnosed a markedly nodular lepromatous leprosy.
What a fascinating history. Inspires one to try and diagnose early and if in doubt treat with B663. Note that patient did not get any B663. She was obviously one of the 95% of those infected who self-cure.
In 1975 (or there about) I lectured in most of the Medical Colleges in Pakistan and in most of them I was told it was the first time they had had a lecture on leprosy in that College. In one City I gave a lecture on Leprosy to local medical society members and afterwards the head of the association thanked me and said “I wonder how many children I have missed”. What an acknowledgement for the head of their association in front of the members.
I guess it is unlikely to ever get the colleges to take teaching leprosy seriously nowadays. Even when I was at med school it was considered very special when we, in 1952, had one lecture on leprosy demonstrating a patient. We cannot go back and correct all that but somehow we can improve the possibilities of getting a higher proportion of patients diagnosed. “What you do not look for you never diagnose. What you do not know about you never recognize”.
Congratulation on the LML work for many years. Keep it up.
Grace Warren,
Former TLMI Consultant on Leprosy and Reconstructive Surgery for Asia
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Monday, October 2, 2017
(LML) Steroid Dependency and Chronic Reactions in Leprosy
Leprosy Mailing List – October 2, 2017
Ref.: (LML) Steroid Dependency in Leprosy
From: Grace Warren, Sidney, Australia
Dear Pieter,
Thank you for that lovely note. I was so pleased to hear of another B663 nut.
As you I found high dose B663 (Clofazimine) as an excellent treatment for the cortisone dependent ENL patients in Thailand and in many countries where the patient had been given steroids for reaction and when it was stopped by the hospital the patient went and bought it themselves. Not illegal, easy to buy and not to expensive!
It really hit me in Thailand when a 14 year old boy came in with reaction. He had been on steroids with DDS for several years. We weaned him over 6 months in hospital; then he went home. He returned in the holiday period when the Leprosy Doctor was not available and he was very ill with some form of pneumonia. The doctor on duty did not know of his past history and the mother did not mention leprosy and he did not look like a leprosy problem so the doctor on duty did not get his old records - as the boy was already in extremesis - and in fact collapsed completely and virtually died lying in casualty waiting to be seen! I saw so many who had taken steroids self-ordered for long periods of time.
I developed the process of starting any new patient who seem likely to develop reaction, on high B663 200mgms daily for the first two weeks. Then slowly reducing, and am sure I averted many severe cases of reaction. After about 3 months we would have the B663 to a normal level and add in other drugs to make it MDT. I am sure I averted many reactions and had a happy ending to others. Yes some did object to the skin colour, but would soon realise the advantages when they watched to progress or other wise of others or heard their stories.
Yes I am still in touch with others who treat and have letters from those in endemic areas who from time to time ask questions, though my main priority for the last twenty year has been neuropathic feet in diabetics as well as leprosy. However, I have by now officially ceased to be a registered medical practitioner.
I love reading some of your LML queries and as you know I do send replies to some of them. With many thanks and best wishes that you may continue to see many patients helped through the work you are doing for us all.
Do Hope the National Leprosy Conference in India goes well.
Yours,
Grace Warren
Former TLMI Consultant – Leprosy and Reconstructive Surgery - for Asia
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Sunday, October 1, 2017
(LML) National Leprosy Conference, New Delhi, 5 - 7 December 2017
Leprosy Mailing List – October 1, 2017
Ref.: (LML) National Leprosy Conference, New Delhi, 5 – 7 December 2017
From: Organizing Committee, New Delhi, India
Dear All,
Greetings from Delhi.
You may be aware that a National Leprosy Conference is being organized by the stakeholders implementing and supporting National Leprosy Eradication Program (NLEP) and persons affected by leprosy in India from 5th to 7th December, 2017 at Hotel Holiday Inn, Aerocity, New Delhi. It is my pleasure to invite you all to this conference.
The Theme of the conference is “Accelerating towards leprosy free India Through Innovative Approaches”.
The purpose of the conference is to bring all the stakeholders together, listen to each other, learn from each other and recommend measures to further improve the National Leprosy Eradication Program. All layers of implementers, persons affected by leprosy, national and international experts and support organizations will be expected to speak on the occasion. Discussions will be held to come out with relevant recommendations.
For further details, you can see the attached document, for registration, you can visit conference website i.e. www.leprosyconference.com or download the registration form and send the hard copy with Cheque/DD to the address given below. The attached document contains information on initiatives made under NLEP, objectives of the conference, registration fee and other details.
You are requested to register as early as possible, participate in the conference and contribute in deliberations and discussions. Academic committee is entrusted to select papers/articles for presentation during the conference. Details can be seen in the website.
For further information or any communication, please write at leprosyconference@gmail.com or contact Mr. Kumar Gaurav, The Deputy ILEP India Coordinator at phone no. +91-124-4045248.
Looking forward to your active participation and successful conference.
Thanks with regards,
Dr. Anil Kumar
Chairperson Organizing Committee
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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