Thursday, October 19, 2017

(LML) Steroid Dependency

Leprosy Mailing List – October 19,  2017

Ref.:    (LML) Steroid Dependency

From:  Barbara M. Stryjewska and John F. Prestigiacomo, Baton Rouge, USA


Dear Pieter,


Thank you, Dr. Grace Warren and Dr Jose Augusto for bringing up the important topic of steroid dependency in the treatment of Leprosy reactions.  

We would like to share with LML readers the approach that is taken by the National Hansen's Disease Programs in the United States when steroids are needed for treatment of Type I or Type II reactions. 

In order to treat our reaction patients we use a combination of Prednisone and Methotrexate. 

For the past several years, we have been adding weekly methotrexate (10mg to 20mg) to the patient's treatment regimen as a steroid sparing drug. Also given is daily folic acid (1mg) to prevent and / or suppress methotrexate side effects. 

With many of our patients being diabetic, it is preferable to use the lowest dose of steroid necessary to control their reaction. 

Our approach helps us use much lower doses of steroids, prevent steroid dependent complications like glaucoma and prevent steroid withdrawal since our doses in the long term are relatively lower. 

Another observation we would like to share is that discontinuation of steroids must be low and slow. We use prednisone and taper the dose by 1 mg every 4 weeks when the patient's steroid dose reaches 5mg per day. 

In regards to ENL, the most severe outbreaks that we see are usually due to steroid dose reduction that is done too quickly or when steroids have been abruptly discontinued.





Barbara M. Stryjewska, M. D.

Chief, Clinical Branch

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA  70816

Ph #: (225) 756-3712

Fax#: (225) 756-3706

NHDP Web Site:

Online Course:  "Awareness of Hansen's Disease in the US"


John F. Prestigiacomo, MD, MBA

Medical Officer

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #:  (225) 756-3709

Ph #:  (800) 642-2477

Fax #: (225) 756-3706


NHDP Web Site:

Online Course:  "Awareness of Hansen's Disease in the US"


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Wednesday, October 18, 2017

(LML) InfoNTD monthly mail with the latest publications on cross-cutting issues and NTDs – October 2017

Leprosy Mailing List – October 18,  2017


From: Ilse Egers, Amsterdam, the Netherlands

Dear Pieter,

This newsletter provides you with a selection of news items and recent publications on cross-cutting issues in NTDs. Our starting point is to add articles covering a wide variety of issues. Unfortunately, this is not always possible due to a limited diversity in and shortage of articles on cross-cutting issues and NTDs.

Feel free to contact us
(  with any questions or to receive the full text versions if a link to the full text is not included. Our document delivery service is free!

Kind regards,
Ilse Egers
InfoNTD Information officer




WHO has added snakebite to the NTD list: these things need to happen next.
Author : Benjamin Waldmann
Benjamin Waldmann leads the snakebite campaign for Health Action International, including secretariat support for the Global Snakebite Initiative. Snakebite envenoming kills more than 125,000 people each year and leaves more than 400,000 victims with severe disability.
Read more






New publications



Support needs of people living with Mycobacterium ulcerans (Buruli ulcer) disease in a Ghana rural community: a grounded theory study.
Hemingway A, Ersser SJ, Effah S. Int. J. Dermatol. 2017.
Abstract Mycobacterium Ulcerans (also known as Buruli ulcer) disease is a rare tropical skin disease which causes contracture and severe scarring and thus affect the functional activities of people who suffer from it as well as their quality of life. An assessment of the effects of BU on patients' quality of life helps health professionals to meet the needs of such patients. Therefore the aim of this paper is to assess the quality of life of people living with the consequences of Buruli ulcer (BU).
Read more

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda.
Sanya RE, Tumwesige E, Elliott AM, et al. PLoS Negl Trop Dis. 2017; 11(10):e0005982.
Abstract Praziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. In this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials.
Download PDF

Schistosomiasis in international refugees and migrant populations.
Adeel AA. Curr Trop Med Rep. 2017.
Abstract Importation of schistosomiasis by migrant populations is increasingly being recognized as a global health issue in non-endemic countries, with consequences for the infected individuals and for public health. The purpose of this review is to assess the extent of the problem and the possible ways to mitigate its impacts.
Read more

Crossing the Billion. Preventive chemotherapy for neglected tropical diseases. (report)
World Health Organization. 2017.
Abstract Crossing the billion tells the story of a simple intervention that takes a massive effort to deliver. Preventive chemotherapy – one of the interventions deployed by the World Health Organization (WHO) to combat at least five diseases – involves administering six medicines in seven different combinations, making it possible to treat more than one disease at a time. This publication celebrates the 10 years since the strategy of combining preventive chemotherapy and integrating strategies to treat those diseases amenable to the intervention began.
Download PDF

Constructions of stigma. (book chapter)
O'Reilly M, Lester JN. Examining mental health through social constructionism. 2017:137–167.
Abstract This chapter focuses on the concept of stigma as related to mental distress, as stigma has been of central concern to the field of mental health. The language and discourses of mental distress are intrinsically linked to stigma, prejudice, and discrimination, and our discussion focuses on the importance of stigma when presenting arguments about mental distress and language. In this chapter, we consider the central theorists in terms of their contribution to the study of stigma and mental distress.
Read more

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.
Ortu G, Williams O. Infect Dis Poverty. 2017; 6(1):147.
Abstract Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered.
Download PDF

Estimating the prevalence and intensity of Schistosoma mansoni infection among rural communities in Western Tanzania: The influence of sampling strategy and statistical approach.
Bakuza JS, Denwood MJ, Nkwengulila G, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005937.
Abstract Schistosoma mansoni is a parasite of major public health importance in developing countries, where it causes a neglected tropical disease known as intestinal schistosomiasis. However, the distribution of the parasite within many endemic regions is currently unknown, which hinders effective control. The purpose of this study was to characterize the prevalence and intensity of infection of S. mansoni in a remote area of western Tanzania.
Download PDF

Household costs of hospitalized dengue illness in semi-rural Thailand.
Tozan Y, Ratanawong P, Sewe MO, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005961.
Abstract Dengue-related illness is a leading cause of hospitalization and death in Thailand and other Southeast Asian countries, imposing a major economic burden on households, health systems, and governments. This study aims to assess the economic impact of hospitalized dengue cases on households in Chachoengsao province in eastern Thailand.
Download PDF

Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?
Leite de Sousa-Gomes M, Romero GAS, Werneck GL. PLoS Negl Trop Dis. 2017; 11(9):e0005772.
Abstract The urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.
Download PDF

Nationwide cross-sectional survey of schistosomiasis and soil-transmitted helminthiasis in Sudan: study protocol.
Cha S, Hong S-T, Lee Y-H, Lee KH, et al. BMC Public Health. 2017; 17(1):703.
Abstract Schistosomiasis and soil-transmitted helminthiasis (STHs) are target neglected tropical diseases (NTDs) of preventive chemotherapy, but the control and elimination of these diseases have been impeded due to resource constraints. We present a detailed methodological description of the integrated mapping of schistosomiasis and STHs on the basis of our experiences, hoping that this protocol can be applied to future surveys in similar settings.
Download PDF

Global health policy and neglected tropical diseases: Then, now, and in the years to come.
Fürst T, Salari P, Llamas LM, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005759.
Download PDF

Supporting local health decision making with spatial video: Dengue, Chikungunya and Zika risks in a data poor, informal community in Nicaragua.
Curtis A, Quinn M, Obenauer J, et al. Appl Geogr. 2017; 87:197-206.
Abstract One option that has previously been utilized to assess cholera risk is spatial video. Here it is used to map potential mosquito breeding sites in an endemic Dengue and Chikungunya, and emerging Zika impacted community. We show how this method can provide mapping support in the hands of non-specialist public health workers who, working in collaboration with out-of-area geographic information systems (GIS) teams, can identify where to target limited intervention resources.
Read more






Project Zero
October 24, Webcast
The Carter Center
Experience two new, 360° virtual-reality videos from HuffPost's "Project Zero," which documents neglected tropical diseases, including the Carter Center's work on river blindness and lymphatic filariasis in Nigeria. A panel will discuss the challenges of eliminating the diseases worldwide and their experiences creating stories with this cutting-edge technology.
Read more

Call for papers

Neglected Tropical Diseases and Human Rights
June 2018
Potential paper topics will focus specifically on NTDs and the right to health. Topics might include:

  • Specific case studies where rights-based approaches were used, including, for example, NTD program efforts to ensure community participation, or gender-based NTD efforts
  • Strengthening health systems to improve their capacity to respond to the human rights entitlements of people living with NTDs
  • Human rights based accountability mechanisms related to NTDs
  • Human rights informed advocacy efforts to expand NTD programs
  • Examination of NTD-related stigma and discrimination
  • Conducting NTD programs in conflict regions
  • Addressing disability associated with NTD morbidity

Papers will demonstrate strong methodological approaches, high writing quality, and robust rights-based analysis.

Submission Details

Questions about this special section can be directed to Joseph Amon at, David Addiss at, Alvaro Bermejo at or Carmel Williams, Executive Editor, Health and Human Rights Journal at

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Monday, October 16, 2017

(LML) Basic Dermatology Training at BIKASH Nepal, Pokhara, 18 – 23 March 2018

Leprosy Mailing List – October 16,  2017

Ref.:   (LML) Basic Dermatology Training at BIKASH Nepal, Pokhara, 18 – 23 March 2018

From:  Gopal Gurung, Pokhara, Nepal

Dear Dr. Pieter Schreuder,


Warm Greetings from Nepal !


Kindly circulate our attached training announcement through your mailing list as in the past years. 


Thanking you for your support,


Gopal Gurung

Training Consultant


Pokhara 15


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<



Saturday, October 14, 2017

(LML) New publications on leprosy and related issues, October 2017

Leprosy Mailing List – October 14,  2017

Ref.:   (LML) New publications on leprosy and related issues, October 2017

From:  Jiske Erlings, Amsterdam, the Netherlands

Dear Pieter,


Greetings from Infolep!

Did you know that the Infolep ( portal gives you access to over 27,100 publications on leprosy? The purpose of this monthly newsletter is to inform you about 
recent publications on leprosy and related subjects.

Feel free to contact me to receive the full text versions if a link to the full text is not provided. Assistance with your literature research is also possible.
Do you have leprosy research or training material you would like to share? Please send me an e-mail.

We are working on the
toolkit pages with tools (with translations and related publications) to measure participation, stigma and quality of life. Please take a look & let me know if this is useful: Toolkit pages

With kind regards,
Jiske Erlings,
Infolep Information officer




Highlighted publications



Global leprosy update, 2016: accelerating reduction of disease burden. /
Situation de la lèpre dans le monde, 2016: accélération de la réduction de la charge de morbidité.
Wkly Epidemiol Rec. 2016 Sep 1;92(35):501-20. English, French.

Care Over Neglect: Neglected Tropical Diseases in South-East Asia Region
World Health Organization. Regional Office for South-East Asia, 2017

From neglecting to defeating NTDs
World Health Organization. Regional Office for South-East Asia, 2017

Health research: solutions through knowledge (Incl 1 chapter on leprosy)
World Health Organization. Regional Office for South-East Asia, Aug 2017

Enfermedades olvidadas -
New website about NTDs by Fontilles




New publications



Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon.
de Almeida ZM, Ramos Jr AN, Raposo MT, et al. Rev. Inst. Med. Trop. Sao Paulo. 2017; 59:e50.
Download PDF

Study of Histomorphological Spectrum of Lesions in Leprosy- One Year Study in S N Medical College, Bagalkote.
Anusha KS, Prabhu MH, Dombale VD. Int. J. Life. Sci. Scienti. Res. 2017; 3(5):1377-1381.
Download PDF

Impact of TNF -308 G>A (rs1800629) Gene Polymorphism in Modulation of Leprosy Risk: A Reappraise Meta-analysis of 14 Case-Control Studies.
Areeshi MY, Mandal RK, Dar SA, et al. Biosci Rep. 2017 Sep 21. pii: BSR20170806.
Read abstract

Clinical and Histopathological Correlation in Hansen's Disease.
Arunagirinathan M, Muniswamy V, Jeevirathinam S. APALM. 2017; 4(4):A454-A459.
Download PDF

Simultaneous analysis of multiple T helper subsets in leprosy reveals distinct patterns of Th1, Th2, Th17 and Tregs markers expression in clinical forms and reactional events.
de Azevedo MCS, Marques H, Binelli LS, et al. Med. Microbiol. Immunol. 2017.
Read abstract

Specific antigen serologic tests in leprosy: implications for epidemiological surveillance of leprosy cases and household contacts.
Carvalho APM, da Coelho ACO, Correa-Oliveira R, et al. Mem Inst Oswaldo Cruz. 2017; 112(9):609-616.
Download PDF

Necrotizing Vasculitis Due to a Severe Type II Leprosy Reaction.
Diallo M, Diack ND, Diatta BA, et al. IJAMS. 2017; 2(9):1-3.
Download PDF

Experience and feelings of women with leprosy.
Dias ACNS, Almeida RAAS, Coutinho NPS. J Nurs UFPE on line. 2017; 11(Suppl. 9):3551-7.
Download PDF 

La lèpre de l'enfant à Thiès/Sénégal: signal d'une recrudescence? / [Leprosy in children in the region of Thiès, Senegal: study determining whether or not it is a signal of recrudescence].
Dioussé P, Dione H, Bammo M, et al. Pan Afr Med J. 2017 Jul 5;27:174.
Download PDF

Dancing with the Stars: Phenolic Glycolipids Partners with Macrophages.
Dunlap MD, Khader SA. Cell Host Microbe. 2017; 22(3):249-251.
Read abstract

Leprosy associated with atypical cutaneous leishmaniasis in Nicaragua and Honduras.
Fuentes LR, Muñoz PT, Bornay-Llinares FJ, et al. Am. J. Trop. Med. Hyg. 2017.
Read abstract

Incidence of leprosy in patients aged 15 or younger cared in the municipality of Imperatriz, Maranhão, between 2004 and 2010.
de Gordon ASA, Gomes JMS, de Costa ACPJ, et al. Arquivos de ciências da saúde da UNIPAR. 2017; 21(1):19-24.
Read abstract

Wade's histoid leprosy in a 14-year-old teenage boy.
Figueira RBFDC, Oliveira KF, Souza LB, et al. Rev Soc Bras Med Trop. 2017 Jul-Aug;50(4):562-564.
Download PDF

Opening a can of worms: Leprosy reactions and complicit soil-transmitted helminths.
Hagge DA, Parajuli P, Kunwar CB, et al. EBioMedicine. 2017.
Download PDF

Suspected resistance of MDT-MB in Multibacillary Leprosy of Hansen's disease: Two case reports.
Irawan Y, Menaldi SL, Sjamsoe-Daili ES, et al. J Gen Pro DVI. 2016; 1(3):23-27.
Download PDF

Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report.
Jitendra SSV, Bachaspatimayum R, Devi AS, Rita S. J Clin Diagn Res. 2017 Aug;11(8):FD01-FD02.
Download PDF

The effect of leprotic infection on the risk of death in medieval rural Denmark.
Kelmelis SK, Price MH, Wood J. Am. J. Phys. Anthropol. 2017.
Read abstract

Iqbal N. Bi-PSSM: Position specific scoring matrix based intelligent computational model for identification of mycobacterial membrane proteins.
Khan M, Hayat M, Khan SA, et al. J Theor Biol. 2017 Sep 18;435:116-124.
Read abstract

[Nursing perspective on the care of people with leprosy in Ivory Coast]. Regard infirmier sur les soins aux personnes atteintes de la lèpre en Côte d'Ivoire. 
Lecocq D. Rev Infirm. 2017; 66(233):31-34.
Read abstract

Genome-wide Analysis of Protein-Coding Variants in Leprosy.
Liu H, Wang Z, Li Y, et al. J. Invest. Dermatol. 2017.
Read abstract

A Zebrafish Model of Mycobacterium leprae Granulomatous Infection.
Madigan CA, Cameron J, Ramakrishnan L. J. Infect. Dis. 2017; 216(6):776-779.
Download PDF

Usefulness of nuclear whole-body bone scanning for diagnosis of leprosy.
Marquez H, McDevitt J, Öz OK, et al. Proc (Bayl Univ Med Cent). 2017; 30(4):465-466.
Download PDF

Cross-cultural adaptation of the EMIC Stigma Scale for people with leprosy in Brazil.
Morgado FFDR, Silveira EMKXD, Sales AM, et al. Rev Saude Publica. 2017 Sep 4;51:80.
Download PDF

Bullous erythema nodosum as initial manifestation of leprosy.
Moura CAGG, Sampaio R, Góes P. Braz J Med Hum Health. 2017;5(3).
Download PDF

[Relationship between the International Classification of Functioning, Disability and Health (ICF) and the limitation of activities and restriction of participation for individuals with leprosy]
de Moura EGS, Araújo APM, da Silva MCR, et al. Cad Saúde Colet. 2017.
Download PDF

Leprosy in families: Clinicoepidemiological profile from a tertiary care centre.
Nair SP. Indian Dermatol Online J. 2017; 8(5):328-330.
Download PDF

Th17 Response of Borderline-Lepromatous Leprosy Inhibits Rash Manifestation of Dapsone Hypersensitivity Syndrome: Case Report.
de Nardo Vanzela T, Bernardes Filho F, Wambier CG, et al. Am J Dermatopathol. 2017 Sep 11.
Read abstract

New Insight into the Pathogenesis of Erythema Nodosum Leprosum: The Role of Activated Memory T-Cells. Negera E, Bobosha K, Walker SL, et al. Front Immunol. 2017 Sep 15;8:1149.
Download PDF

A case of leprosy, erythema nodosum leprosum, and hemophagocytic syndrome: A continuum of
manifestations of same agent-host interactions.

Panda PK, Prajapati R, Kumar A, et al. Intractable Rare Dis Res. 2017 Aug;6(3):230-233.
Download PDF

Profile of leprosy in children under 15 years of age monitored in a Brazilian referral center (2004-2012).
Pinto ACVD, Wachholz PA, Silva GVD, et al. An Bras Dermatol. 2017 Jul-Aug;92(4):580-582.
Download PDF

Lepromatous Leprosy and associated proprioceptive loss.
Sajid I. JDMS. 2016; 15(12):38-41.
Download PDF

Etanercept in erythema nodosum leprosum.
Santos JRS, Vendramini DL, Nery JADC, et al. An Bras Dermatol. 2017 Jul-Aug;92(4):575-577.
Download PDF

Spatial distribution of leprosy in Brazil: a literature review.
Silva CLM, Fonseca SC, Kawa H, Palmer DOQ. Rev Soc Bras Med Trop. 2017 Jul-Aug;50(4):439-449.
Download PDF

Partners in Crime: Phenolic Glycolipids and Macrophages.
Singh AK, Bishai WR. Trends Mol Med. 2017 Sep 29. pii: S1471-4914(17)30162-4.
Read abstract

Differential Expression of MicroRNAs in Leprosy Skin Lesions.
Soares CT, Trombone APF, Fachin LRV, et al. Front Immunol. 2017; 8:1035.
Download PDF

Type I Lepra Reaction as the Presenting Sign of Histoid Leprosy.
Sun J, Tu P, Yi S, et al. Ann Dermatol. 2017; 29(5):646-648.
Download PDF

Dapsone-induced severe cutaneous adverse drug reactions are strongly linked with HLA-B*13: 01
allele in the Thai population.

Tempark T, Satapornpong P, Rerknimitr P, et al. Pharmacogenet Genomics. 2017 Sep 6.
Read abstract

Evaluation of polymerase chain reaction in nerve biopsy specimens of patients with Hansen's disease.
Tiwari V, Malhotra K, Khan K, et al. J. Neurol. Sci. 2017; 380:187-190.
Read abstract

Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study.
Tiwari A, Mieras L, Dhakal K, Arif M, Dandel S, Richardus JH; LPEP Study Group. BMC Health Serv Res. 2017 Sep 29;17(1):684.
Download PDF

Trends in leprosy case detection in Rwanda, 1995-2011: analysis of 17 years of laboratory data.
Uwimana I, Bizimungu N, Ingabire F, et al. Afr J Lab Med. 2017 Feb 28; 6(1):426.
Download PDF

Early detection of neuropathy in leprosy: a comparison of five tests for field settings.
Wagenaar I, Post E, Brandsma W, et al. Infect Dis Poverty. 2017; 6(1):115.
Download PDF

Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.
Wagenaar I, Post E, Brandsma W, et al. PLoS Negl Trop Dis. 2017 Oct 4;11(10):e0005952.
Download PDF

The mtDNA replication-related genes TFAM and POLG are associated with leprosy in Han Chinese from Southwest China.
Wang D, Li GD, Fan Y, et al. J Dermatol Sci. 2017 Sep 14.
Download PDF

A pleiotropic effect of the APOE gene: association of APOE polymorphisms with multibacillary leprosy in Han Chinese from Southwest China.
Wang D, Zhang DF, Li GD, et al. Br J Dermatol. 2017 Oct 4.
Read abstract

ICRC Bacillus a Vaccine Candidate Strain (C-44) Is Coated with Human IgG.
Yadav AR, Mohanty KK, Sengupta U. Open Journal of Immunology, 2017; 7, 45-50.
Download PDF

Tuberculoid leprosy masquerading as systemic lupus erythematosus: an interesting observation.
Zawar V, Kumavat S, Pawar M, Desai D. Acta Dermatovenerol Alp Pannonica Adriat. 2017 Sep;26(3):81-83.
Read abstract




Journals & Newsletters



Community Eye Health Journal:

Disability, CBR & Inclusive Development:

Hansenologia Internationalis:

Indian Journal of Leprosy: 

Leprosy Review:
Leprosy Review Repository (1928-2001) :

Plos Neglected Tropical Diseases:
Revista de Leprología:
WHO Goodwill Ambassador's Newsletter for the elimination of leprosy:




Websites & Services



Global Leprosy Programme

LML - Leprosy Mailing List - a free moderated email list that allows all persons interested in this theme to share ideas, information, experiences and questions.

InfoNTD - Information on cross-cutting issues in Neglected Tropical Diseases (NTDs)



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<