Leprosy
Mailing List, August 30th, 2009
Ref.:
Be aware of the word 'cured' in LL cases.
From:
Ganapati R.,
Mumbai
,
India
Dear
Dr Derek,
I refer to your LML message dated August 27th, 2009.
Thank you for this. Your
illustrious father Dr Stanley Browne who made his contributions mainly
in the dapsone mono-therapy era had warned long ago about the relapses
due to the “lurking bacilli”.
He continued to make observations during the early MDT period, but
unfortunately did not live long enough to observe the outcome of the
persistence of lurking organisms leading to relapse many years after
completion of effective treatment with far more powerful bactericidal
drugs.
We are encountering relapses 10 to 15 years after withdrawal of
treatment in spite of satisfactory completion of universally
prescribed schedules of treatment.
This phenomenon reiterates the foresight of the “Mr
Leprosy” who rightly advised to use the word ”cure” in LL cases
with caution. Unfortunately
the word is freely used particularly by some who want to underestimate
relapses for public health reasons.
Relapse
should be viewed from the clinical angle, as this is of concern to the
affected individual. If
the patient is BI and MI* positive at the time of relapse, he may be
source of transmission of leprosy.
With regards,
Dr R Ganapati
*
BI=
bacteriological index
MI=
morphological index
