Prevention of peripheral nerve damage in leprosy

Sir,Peripheral nerve damage is the most important problem in leprosy, leading to the disabilities weare so familiar with. Apart from treatment with corticosteroids during the active phase of neuritis,very little can be done once peripheral nerves are damaged. The only hopeful development atpresent is a microsurgical technique of nerve decompression pioneered by Dr W J Theuvenet atAnandaban Leprosy Hospital in Nepal.I would like to draw attention to the potential possibility of a medical approach. Recently anarticle appeared in the New England Journal of Medicine describing the positive results of an ACTH(4-9) analogue, Org 2766, in the prevention of cisplatin induced neuropathy in patients treated forovarian cancer. Although the exact mechanism is not known, evidence suggests that the presence ofmelanocortins (such as Org 2766) in nerve tissue may trigger off or facilitate neural repair.Melanocortins have already proved beneficial in rats with crush injuries, cut injuries, diabeticneuropathy, acrylamide neuropathy and cisplatin neuropathy. Org 2766 showed no adversereactions in humans in the trial described and the authors consider it as promising in the treatmentof other forms of neuropathy as well.At present there is no experience with Org 2766 at all in neuropathy caused by leprosy. In viewof the potential of this drug, I recommend that full attention is given to it by researchers in the fieldof leprosy. Every possibility to prevent or treat nerve damage in leprosy is of paramountimportanc

Prevention of peripheral nerve damage in leprosy

Sir,Peripheral nerve damage is the most important problem in leprosy, leading to the disabilities weare so familiar with. Apart from treatment with corticosteroids during the active phase of neuritis,very little can be done once peripheral nerves are damaged. The only hopeful development atpresent is a microsurgical technique of nerve decompression pioneered by Dr W J Theuvenet atAnandaban Leprosy Hospital in Nepal.I would like to draw attention to the potential possibility of a medical approach. Recently anarticle appeared in the New England Journal of Medicine describing the positive results of an ACTH(4-9) analogue, Org 2766, in the prevention of cisplatin induced neuropathy in patients treated forovarian cancer. Although the exact mechanism is not known, evidence suggests that the presence ofmelanocortins (such as Org 2766) in nerve tissue may trigger off or facilitate neural repair.Melanocortins have already proved beneficial in rats with crush injuries, cut injuries, diabeticneuropathy, acrylamide neuropathy and cisplatin neuropathy. Org 2766 showed no adversereactions in humans in the trial described and the authors consider it as promising in the treatmentof other forms of neuropathy as well.At present there is no experience with Org 2766 at all in neuropathy caused by leprosy. In viewof the potential of this drug, I recommend that full attention is given to it by researchers in the fieldof leprosy. Every possibility to prevent or treat nerve damage in leprosy is of paramountimportanc

Report of workshop on prevention of disability

Place of prevention of impairment and disability (POID) in leprosy control. Prevention of impairment and disability is integral to leprosy. From the perspective of the patient, impairments and disabilities constitute the essence of the disease. Thus, POID should be integral to any leprosy control program, be it vertical, integrated or otherwise organized. It is understood that early detection and the provision of multidrug therapy (MDT) are the primary means of POID. Yet nerve impairment and the resulting disability remain a vital issue in many cases, and need to be addressed at every level. This means that POID activities should be defined, implemented, and recorded effectively. Evaluation should occur using appropriate parameters, adequate teaching material provided, and sufficient resources supplied. [...

Report of workshop on prevention of disability

Place of prevention of impairment and disability (POID) in leprosy control. Prevention of impairment and disability is integral to leprosy. From the perspective of the patient, impairments and disabilities constitute the essence of the disease. Thus, POID should be integral to any leprosy control program, be it vertical, integrated or otherwise organized. It is understood that early detection and the provision of multidrug therapy (MDT) are the primary means of POID. Yet nerve impairment and the resulting disability remain a vital issue in many cases, and need to be addressed at every level. This means that POID activities should be defined, implemented, and recorded effectively. Evaluation should occur using appropriate parameters, adequate teaching material provided, and sufficient resources supplied. [...

Q fever in the Netherlands:A sero-epidemiological survey among human population groups from 1968 to 1983

A sero-epidemiological survey, using an indirect immunofluorescence test for IgG against Coxiella burnetii (phase II), was carried out in the Netherlands. Serum samples taken in 1968, 1975, 1979 and 1983 were tested. Occupational groups with a supposedly high risk of infection (veterinarians, residents of dairy farms and taxidermists) showed a significantly higher percentage of seropositives than defined controls. The percentage of seropositive amateur wool spinners was significantly higher than that of the controls from the same region. Since 1968 there has been no increase in the percentage of infected persons, indicating that, contrary to earlier assumptions, Q fever has been endemic in The Netherlands for a long time already. The increase in numbers of notified cases of overt Q fever is considered to be the result of the recent introduction of a sensitive indirect immunofluorescence test for IgM antibodies against C. burnetii. Antibody percentages in all age classes between 1 and 64 years were much alike, suggesting that most infections occur in early childhood. This is in accordance with the finding that 35% of our patients are younger than 3 years. The possibility of infection related to childbirth and lactation is discussed.</p

Effect of prophylactic corticosteroids on the incidence of reactions in newly diagnosed multibacillary leprosy patients [5]

To the editor: Leprosy reactions, including reversal re-actions and episodes of neuritis, are known to occur in leprosy patients most frequently in the first few months after starting multidrug therapy (MDT), especially in cases with multibacillary (MB) disease. Such reactions can lead to impairment of nerve function, and subsequent deformity and disability. That this can occur in leprosy patients who present without any nerve function impairment (NFI) at diagnosis is a discouraging phenomenon for both the patient and the doctor or health worker.It is an axiom of modern leprosy controlthat early case detection and treatment with MDT can prevent much NFI by halting the multiplication of the leprosy bacillus, and that this is the single most important activity in the prevention of NFI. [...]<br/

Effect of prophylactic corticosteroids on the incidence of reactions in newly diagnosed multibacillary leprosy patients [5]

To the editor: Leprosy reactions, including reversal re-actions and episodes of neuritis, are known to occur in leprosy patients most frequently in the first few months after starting multidrug therapy (MDT), especially in cases with multibacillary (MB) disease. Such reactions can lead to impairment of nerve function, and subsequent deformity and disability. That this can occur in leprosy patients who present without any nerve function impairment (NFI) at diagnosis is a discouraging phenomenon for both the patient and the doctor or health worker.It is an axiom of modern leprosy controlthat early case detection and treatment with MDT can prevent much NFI by halting the multiplication of the leprosy bacillus, and that this is the single most important activity in the prevention of NFI. [...]<br/

Close contacts with leprosy in newly diagnosed leprosy patients in a high and low endemic area:Comparison between Bangladesh and Thailand

Background: As part of a larger study of the role of close contacts in the transmission of M. leprae, we explored whether the proportion of newly detected cases with a family history of leprosy differs with different incidence rates of leprosy in a population. Methods: Retrospective analysis was performed of contacts of all new leprosy patients diagnosed during a 10-yr period in well-established leprosy control programs in Thailand and Bangladesh. By our definition, a contact group consisted of the new case and of past and present cases who were relatives and in-laws of the new case. For a new case, the nearest index case was defined on the basis of time of onset of symptoms for the cases in the contact group, in combination with the level of closeness of contact between these cases and the new case. Three contact levels were distinguished. In Bangladesh these levels were defined as 'kitchen contact'; 'house contact'; and 'non-house contact'. In Thailand comparable levels were defined as 'house contact'; 'compound contact'; and 'neighbor contact'. Results: In Bangladesh 1333, and in Thailand 129 new patients were included. The average new case detection rate over 10 yrs was 50 per 100,000 general population per year in Bangladesh, and 1.5 per 100,000 in Thailand. In the high endemic area 25% of newly detected cases were known to belong to a contact group and were not the index case of this group, whereas in the low endemic area 62% of newly detected cases had these characteristics. The distribution of the nearest index cases over the three contact levels was comparable in both areas. Just over half of the nearest index cases were found within the immediate family unit ('kitchen' in Bangladesh; 'house' in Thailand). Conclusion: The results indicate that in a low endemic area a higher proportion of newly detected leprosy cases have a family history of leprosy compared to a high endemic area. Different contact levels and their relative risks to contract leprosy need to be established more precisely. In high endemic situations the circle of contacts that should be surveyed may need to be wider than currently practiced.</p

Close contacts with leprosy in newly diagnosed leprosy patients in a high and low endemic area:Comparison between Bangladesh and Thailand

Background: As part of a larger study of the role of close contacts in the transmission of M. leprae, we explored whether the proportion of newly detected cases with a family history of leprosy differs with different incidence rates of leprosy in a population. Methods: Retrospective analysis was performed of contacts of all new leprosy patients diagnosed during a 10-yr period in well-established leprosy control programs in Thailand and Bangladesh. By our definition, a contact group consisted of the new case and of past and present cases who were relatives and in-laws of the new case. For a new case, the nearest index case was defined on the basis of time of onset of symptoms for the cases in the contact group, in combination with the level of closeness of contact between these cases and the new case. Three contact levels were distinguished. In Bangladesh these levels were defined as 'kitchen contact'; 'house contact'; and 'non-house contact'. In Thailand comparable levels were defined as 'house contact'; 'compound contact'; and 'neighbor contact'. Results: In Bangladesh 1333, and in Thailand 129 new patients were included. The average new case detection rate over 10 yrs was 50 per 100,000 general population per year in Bangladesh, and 1.5 per 100,000 in Thailand. In the high endemic area 25% of newly detected cases were known to belong to a contact group and were not the index case of this group, whereas in the low endemic area 62% of newly detected cases had these characteristics. The distribution of the nearest index cases over the three contact levels was comparable in both areas. Just over half of the nearest index cases were found within the immediate family unit ('kitchen' in Bangladesh; 'house' in Thailand). Conclusion: The results indicate that in a low endemic area a higher proportion of newly detected leprosy cases have a family history of leprosy compared to a high endemic area. Different contact levels and their relative risks to contract leprosy need to be established more precisely. In high endemic situations the circle of contacts that should be surveyed may need to be wider than currently practiced.</p