Leprosy is a Neglected Tropical Disease (NTDs) caused by Mycobacterium leprae (M. leprae). The treatment is considered effective, however, the high dose Multidrug Therapy (MDT) for a long period and its adverse effects result in the abandonment of the treatment by patients. Indeed, antimicrobial resistance is still an obstacle that must be overcome in the treatment of leprosy. In the present article, we reviewed the WHO guidelines for the chemotherapy of leprosy and the methods of synthesis of these drugs.

Brazil has been at the forefront in replacing the stigmatising term \'leprosy\' with the non-pejorative alternative \'Hansen\'s disease\' (\'hanseníase\'), with use of the former word prohibited by law since 1995. This change followed decades of advocacy, including by civil society organisations representing people affected by the disease. A survey of people affected by Hansen\'s disease in Brazil found that 111/112 respondents preferred the alternative term, supporting the view that consideration of non-stigmatising terminology that respects the wishes of people affected by the disease should be part of the WHO Global Leprosy (Hansen\'s disease) Strategy to achieve \'zero stigma\' by 2030.

BACKGROUND: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution.
OBJECTIVE: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers.
METHODS: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence.
RESULTS: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology.
CONCLUSIONS: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Histoid leprosy is a rare variant of leprosy with a unique clinical presentation and bacilli rich histology. These patients are large reservoirs for disease and vectors for spread, making prompt diagnosis and treatment crucial. To date, no consensus on treatment and duration exists. This paper aims to investigate the efficacy, safety, and duration of varying treatment regimens in patients with histoid leprosy. A systematic PubMed review of all articles published before January 2020 containing the key words histoid leprosy. All patients included must have completed their prescribed treatments with comment on outcomes and treatment duration. The review generated 165 articles containing 62 cases that met inclusion criteria. A majority of cases reported excellent clinical outcomes with limited adverse events. Regimens included variations of rifampicin, dapsone, clofazimine, minocycline, ofloxacin, and sulforthormadine with most treatment duration lasting 12 or 24 months. Existing literature is limited to case reports or case series and may be subject to publication bias of successful cases. Many reports lack quantifiable data regarding outcomes and rely on clinical judgment. Continued observation for complete clearance or relapse was limited. The findings demonstrate that multibacillary-multidrug therapy is an efficacious and safe treatment for histoid leprosy. No significant differences were observed between 12 and 24 months of treatment. There remains no consensus on treatment duration for histoid leprosy.

A Delphi Exercise was undertaken with two objectives: (1) To ascertain whether operational definitions for WHO Disability Grading could be formulated by consensus. (2) To develop a set of simple guidelines based on those definitions for the guidance of health workers. Fifteen people with general expertise in prevention of disability due to leprosy were invited to participate as Delphi panel members, twelve responded positively. Eight issues that commonly cause confusion provided foci for the exercise. Operational definitions aimed at resolving those issues were developed by consensus. Simple guidelines for health workers, based on those definitions were also created and supported by consensus. This paper presents the process followed and the outcomes gained from the endeavour.

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization\'s multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

OBJECTIVE: Leprosy is a chronic, non-fatal disease caused by Mycobacterium leprae. It can cause cutaneous lesions, peripheral nerve lesions and orofacial manifestations, including destruction of the alveolar premaxillary process associated with loss of the maxillary incisors. The aims of this study were to assess orofacial manifestations of disease in patients attending the Bombay Leprosy Project clinics and develop clinical guidelines for dentists.
METHODS: A cross-sectional questionnaire based study was administered to 43 diagnosed leprosy patients. This included questions on perceived oral health status and oral hygiene habits. An extra-oral and intra-oral examination was also performed.
RESULTS: Eighty-four per cent of patients were male with a mean age of 35.9 years. Forty-nine per cent had extra-oral cutaneous lesions. Twenty-eight per cent had intra-oral lesions including hyperpigmented patches. Twenty-one per cent had cranial nerve involvement and the trigeminal nerve was most commonly affected.
CONCLUSIONS: From this data a clinical dental pathway protocol for managing patients with leprosy was developed. It highlights dental issues when managing leprosy patients. Nerve involvement may mean patients are unable to give an accurate account of their symptoms. Special tests should include cranial nerve examination and swabs of intra-oral ulcers. Low rates of infectivity means that normal infection control measures can be taken when treating these patients.

Summary In concurrence with the broad body of literature published on health-related stigma, there is a need for practical field guidance to contribute to the fight against leprosy-related stigma and discrimination. To this end, much can be gained by considering the accumulated knowledge and learned from experience with different stigmatising conditions; primarily HIV/AIDS, disability, tuberculosis, and mental health. Therefore a Stigma Research Workshop was organised from 11-14 October in Amsterdam, The Netherlands. The primary aim of the workshop was to produce scientific papers and field guidelines that could be used to target actions against health-related stigma and discrimination. Keynote presentations were offered by scientists and professionals from different health domains who shared their knowledge, experiences and research findings regarding health-related stigma. Group work was subsequently conducted to work towards agreed outputs on four different themes: i.e. research priorities, measurement, interventions, and counselling. The spectrum of expertise present enabled an interdisciplinary and inter-profession sharing of knowledge and practices. This resulted in the commencement of consensus papers and field guidelines related to the four themes. An evaluation by participants concluded that the workshop had been an informative and worthwhile activity that will strengthen the fight against stigma.

OBJECTIVE: The CBR Guidelines are being developed by UN Agencies and civil society groups including disabled people\'s organisations (DPO). The aim of the CBR guidelines is to enhance the quality of life of people with disabilities including those affected by leprosy. Strong linkages between leprosy programmes and CBR will optimise the benefit of medical care and ensure leprosy-affected people access all relevant services that promote inclusion and participation.
BACKGROUND: The World Health Organisation introduced the concept Community Based Rehabilitation (CBR) in the early 1980s. CBR was designed to enhance the quality of life for people with disabilities through community initiatives. To facilitate this, WHO published a CBR Manual \'Training in the community for people with disabilities\' in 1989. Since then there have been many developments within and outside the disability sector. Based on these global developments and as a result of stakeholder consultation, ILO, UNESCO and WHO updated the CBR Joint Position Paper (2004) and restructured CBR as a strategy for rehabilitation, equalisation of opportunities, poverty reduction and social inclusion of people with disabilities. The purpose of this Joint Position Paper was to describe and support the concept of CBR as it is evolving, with an emphasis on human rights and a call for action against poverty. The Convention on the Rights of Persons with Disabilities aims to ensure that they enjoy human rights on an equal basis with others. Guidelines on how to implement CBR respond to the demands created by the publication of the Joint Position Paper and The Convention on the Rights of Persons with Disabilities.
RESULTS: The CBR Guidelines are being developed by three UN agencies: WHO, ILO and UNESCO. It is being actively supported by 13 International Non Governmental Organisations (NGO) including Disabled People\'s Organisations (DPO). Over 150 experts from across the globe have contributed to the draft guidelines which are being field tested in 25 countries. The guidelines have five major components: health, education, livelihood, social and empowerment. Beside these five components, the Guidelines also focus on management of some special scenarios including CBR and HIV/AIDS, CBR and leprosy, CBR and mental health and CBR in crisis situations. The CBR guidelines also underline that people with leprosy-related disability are seen as members of the disability community in the wider context given the shared experiences and challenges.
CONCLUSIONS: The CBR guidelines are an important step forward in promoting CBR as a community based inclusive development strategy. The guidelines focus on meeting basic needs, reducing poverty, accessing benefits of mainstream developmental initiatives, inclusive community and empowering people with disabilities and their families. It also focuses on implementing the Convention on the Rights of Persons with Disabilities using community-based initiatives. People with leprosy are often neglected by traditional CBR programmes. These guidelines make the case for including people with leprosy in CBR programmes and in the community.

暂无摘要。