Leprosy mailing
list – February 11th, 2005
Ccn:
all.
Ref.: BI and MI.
From: G Warren,
Sidney
,
Australia
.
Dear
Salvatore,
I must add to the BI and MI debate. There are many patients in
South East Asia
who have a very diffuse lepromatous type of leprosy and there are no
obvious skin lesions. But routine skin smears will often
find a bacillary Index of +4 or +5 with a MI of 10-15 %.
Technicians with whom I work regularly churn through dozens daily and I
find their results very reliable.
Unfortunately these are the very patients that are not eligible under
WHO to be stated as leprosy patients for they do not have obvious
skin lesions. We know of those who have been rejected by WHO
consultants and the patients have returned in 2-3 years with
obvious LL lesions and smears of +6. When they have got to that state
one knows that all the treatment in the world will not prevent them
from developing permanent neural damage.
By
the elimination of skin smears as a criterion for diagnosis one is
asking for the continued spread of leprosy from these highly
infectious patients who still do not show obvious skin lesions.
Please WHO bring back positive smears as one of the criteria for
diagnosis.
Yours sincerely,
Grace Warren
Previously Superintendent
Hong Kong Leprosarium and still NGO Leprosy consultant in S E
Asia.
