Volume 61, Number 4, December 1990 LEPROSY REVIEW Published Quarterly for the British Leprosy Relief Association ISSN 0305-7518 Leprosy Review A journal contributing to the better understanding of leprosy and its control British Leprosy Relief Association LEPRA Editorial Board PRO~ESSOR J . L. TURK (Chairman and Edilor) DR R . J . W . R EES , C.M .G . (Vice-Chairman) The Royal Coll ege of Surgeons National Institute fo r Medical Research Department of Pa thology, The Ridgeway 35- 43 Lincoln's Inn Field Mill Hill, London NW7 IAA London W C2A 3PN JANE EVILLE, M .B.E. DR M . J . COLSTON 5 Sandall Close National Institute for Medical Research Ealin g The Ridgeway, Mill Hill Lo ndo n W 5 IJ E London NW7 I AA PROFESSOR P. E. M . FINE DR PATRI CIA ROSE Department of Epidemiology Allendale Ho use and Populati on Sciences A ll endale Road London School of H ygiene Hexha m N E46 2DE and Tropical Medicine Keppel Street DR M . F. R . WATERS , O .B. E. London W C I E 7HT Hospital fo r Tro pical Diseases DR S. LUCAS 4 St Pa ncras W ay School of Medicine Lo ndo n NW l OPE University Col1ege and Middlesex Medical School, London DR H . W . WH EATE , O .B.E. U ni versi ty Street 50 Avenue Road, Belmo nt, Sulto n Lo ndo n W C IE 6JJ Surrey SM2 6JB Editorial Office: Lepra, Fa irfax House, Causton Road, Colchester C01 1 PU , England Assistant Editor: Jennet Batten, 94 Church Road, Wheatley, Oxon OX9 1 LZ, England Leprosy Review is published by the British Leprosy Relief Association (LEPRA) with the main objective of contributing towards the better understanding of leprosy a nd its control. Original papers o n al1 aspects of leprosy, including research, a re welcomed. In addition, Leprosy Review seeks to publish info rmation of educational value which is of direct benefit to the contro l of leprosy under field conditio ns, a nd hence to the individual patient. The J o urnal aims to interpret what is being done in other disciplines, particularly for field workers. From time to time the Editorial Board invites specia l articles or edito ri als from experts in various parts of the world, and gives considera ti o n to the production of a supplement or special number devoted to a particula r subject or theme of major impo rta nce. British Leprosy Relief Association Registered Offices: Fa irfax House, Causton Road, Colchester C01 7PU < • CONTENTS Editorial 3 13 Recent advances in the chemotherapy of leprosy. B. JI a nd J-H . G ROSSET : . Original Articles 330 Relationships between PGL-I antigen in serum, tissue and viahility of Mycobacterium /eprae as determined by mouse footpad assay in multibacillary patients during short-term clinical trial. SUZ ANNE C HA NTE A • J-L. C AR TEL, EVEL YNE PERA NI, L. N ' DELI , J . Roux a nd J-H . GROSSET 341 Anti-phenolic glycolipid I IgM antibodies in leprosy patients and in their household contact.s. G . SULC' EIl E and M. NAK UC' I 347 Positive Mitsuda lepromin reactions in long-term treated lepromatous leprosy. M . F. R. WATERS. D . S. RIDLEY a nd S. B. LUC'AS 353 Tuberculoid relapse in lepromatous leprosy. M . F . R. WA TE RS a nd D . S. RIDLEY 366 Disabilities in leprosy patients ascertained in a total population survey in Karonga District, Northern Malawi. ITA M . PO NN IGHA US , G . BOERRI GTE R, P. E. M. FI NE, J . M . PON NIGHA US a nd J UDITH R USSELL 375 Preliminary observations on myiasis in leprosy patients. SR EE VATSA. G . N . MALAVIYA , S. H USA IN, A . GIRDHAR , H . R. BHAT and B. K . GIRDHAR 379 Leprosy in Saudi Arabia, 1986-89. M . A . IflRAHIM , M . N. KORDY, A . H . AIDEROUS and A . BAH NASSY Special Article 386 Basic requirements for implementation of multidrug therapy- ILE P MEDICAL BU LLETI N Letters to the Editor 39 1 Multidrug therapy in paucibacillary leprosy. W . H . JOPLI NG 39 1 Are dapsone hypersensitivity reactions dose related? R. DE SOLD EN HOFF 392 Implementation of multidrug therapy for leprosy control programmes. D . PORICHHA 393 Comment: Assessment of histological response to treatment. I. A . C REE 394 Experiences with repeated quality controls of skin smears in different routine services in leprosy control programmes. LYSAMMA VETTO M a nd SUSANNE PRIT ZE 396 Acid-fast and H & E stainingscan be combined beller than in theTRIFF method. T. L. MIK O and S. B. L UC' AS 398 Amyloidosis- a possible minor factor contributing to the disappearance of leprosy from Northern Europe. A . H. PA TKI 399 Effect of calendula on trophic ulcers. S. KARTIK EYAN , R . M . C HAT URVEDI and S. V. NARKAR 400 Malignancy in plantar ulcers in leprosy. R. G . RI EDE L a nd SIPRA ADHIKARI 402 Pachydermoperiostosis and leprosy. W . H . JOPLI NG 404 Prevention of peripheral nerve damage in leprosy. J . H . RI CHARD US Teaching Materials and Services 405 Ne uropathic root in leprosy, Poona , India- best film awa rd Eye health at village level. The Interna ti o nal Huma n Suffering Index INFOLEP: Leprosy In ro rmatio n Services Arrican Leprosy Aid TDR: Tropical diseases o n the increase TDR: Ca ll ror applications ror suppo rt o r resea rch tra ining ( 1991 ) Water, Engineering a nd Development Centre, Loughborough, UK Leprosy poster rro m ALM Interna ti o na l a nd Wellco me WHO publicatio ns 1986- 1990 Action Health 2000, Cambridge, UK Tuberculosis skill book , M a rie Adelaide Centre, Karachi, Pakistan TALM ILEP-Cata logue o r teaching and learning materia ls Colour transpa rency teaching sets ro r India Steam steriliza ti o n 'slide set' Clinical guidelines: diagnostic and treatment manua l Making low-cost spectacles Leprosy; a guide ro r pro ressio nal wo rkers; TLM, South Arrica C hemotherapy or leprosy ro r control progra mmes. Video Leprosy- the misunder- stood disease. Film Tra nsmissio n o r HIV in health-care settings Health Technology Directions; immunisatio n Community Health Suppo rt Services (CHESS) Appropriate Health Resources and Techno logies Acti on Group (Colltellls continue all inside back cover) (Col1/el1/.l· conlinuedForn back cover) News and Notes 414 A model system for drug supply Care of patients with chronic renal failure in the Third World- lnternational Workshop • Moniaya Tuberculosis and Leprosy Control Services Report, 1989, Nlgena Drug labelling study • Leprosy in the People's Republic of China • WHO Liasion-Newsletter of the WHO Library and Health Literature Services Thinking about computers? • Glucose-6-phosphate dehydrogenase deficiency, sulphonamides and sulphones Acworth Leprosy Hospital Research Society, 20th Anniversary • The unquiel eye; a diagnostic gUlde N. D. Dlwan Memorial Award Fund Bombay Leprosy Project, Repor! 1976-89, Handbook of Leprosy, on sale in lndia BCG vaccination in leprosy; final results from Papua New Gumea Leprosy profiles, Sasakawa Memorial Health Foundation, Japan Erratum Wellesley Bailey Scholarship • Lepros Third World edition • Medication monitoring SocIal research methods for lhe study of tropical diseases (leprosy), Workshop Report, Hyderabad, lndla Essays on lepro�y Bureau for Overseas MedicaI Service (BOMS) 419 Index * * * Leprosy Review is published quarterly (Mar., June, Sept., Dec.) by the British Leprosy Relief Association (LEPRA). 1991: Volume 62, 4 issues; no, or f6.50 per copy, inclusive of postage and packing (UK and abroad). Subscription orders or enquiries should be sent to (LEPRA), Fairfax House, Causton Road, Colchester CO I I PU, England. At its own discretion, LEPRA will continue, and also expand, its policy of sending free issues of this journal to people in various parts of the world; this will include doctors working directly with leprosy who cannot alford the above subscription, or obtain foreign currency, together with selected Iibraries covering tropical medicine. © 1990 British Leprosy Relief Association. The appearance of the code at the bottom of the first page of a paper in this journal indicates the copyright owner's consent that copies of the paper may be made for personal or internaI use, or for the personal or internaI use of specific clients in the U .S.A. This consent is given on the condition, within the U.S.A., that the copier pay the stated per­ copy fee through the Copyright Clearance Centre, Inc., I Park Avenue, New York, N.Y. 10016, for copying beyond that permitted by Sections 107 or 108 of the U.S. Copyright Law. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, for resale or for copying or distributing copies outside the U.S.A. Printed in Great Brilain aI lhe Alden Press, Oxford Lepr Rev (1990) 61, 313-329 Editorial RECENT ADVANCES IN THE CHEMOTHERAPY OF LEPROSY The classical strategy of leprosy control, based on early detection and effective chemotherapy, is likely to remain unchanged for many years.I•2 Effective chemotherapy will still be necessary for the treatment of millions of leprosy patients even after a leprosy vaccine with proved effectiveness becomes available. The most important progress made in the history of leprosy control was the development and implementation of multidrug therapy (MDT) for both paucibacillary* (PB) and multibacillary* (M B) leprosy. Due to MDT, new hopes of controlling leprosy as a major public health problem have been raised. Around the topic of MDT we are trying to review the recent advances in the chemotherapy of leprosy. Basic concept of multidrug therapy By the end of the 1970s it was clear that attempts to control leprosy by life-long dapsone monotherapy were failing, because of the rapid increase of dapsone-resistance.