This issue begins with an important review of adverse effects related to the dapsone component of multi-drug therapy (MDT). This will add to the pressure to redesign MDT and make it safer, even though it has been an extremely effective treatment for people who develop leprosy, since it was developed by WHO in 1982. See also the Case Report, suggestive of optic atrophy caused by dapsone therapy.
Studying the differences in the clinical presentation of leprosy in different populations has always been a fascinating exercise and a paper from California compares cases originating in Latin America with those from South-East Asia. There is little evidence that different strains of M leprae cause these differences, so we assume they are mainly caused by differing host responses in different ethnic groups.
Clinical management of people with leprosy is the theme of two papers, relating to measuring visual acuity to identify early impairment and assessing the risk of fractures due to osteoporosis, respectively. Detecting potential complications early is an important part of providing excellent care, so making tests such as these more reliable and convenient is a big step forward. Sudden loss of vision due to optic atrophy, probably related to dapsone therapy, is the subject of the Case Report – although case reports normally describe rare events, it is important that clinicians are aware and ready to investigate unusual findings.
Dr Darlong’s paper is one of the first to look at parental attitudes to the diagnosis of leprosy in their children. This is an area that needs further exploration, in order to inform counselling strategies. A Short Report from a project in India describes the effects of the Covid pandemic; while basic services have generally been maintained through extra effort, the long-term effects on poverty levels and mental health are beginning to be seen.