- Congo. A colleague is on her first tropical mission and has already worked for 7 months in Congo. She is working via the Damiaanstichting [Father Damian Foundation] and is active in combating leprosy. She develops a skin spot on her left forearm. Could this be tuberculoid leprosy?
- Are there many infectious illnesses which can cause thickening of the nerves?
- What are the difficulties of developing new drugs that are active against leprosy?
- Gabon. A 42-year-old man has 2 well-delineated, conspicuous, circular skin spots with a slightly elevated edge. You can feel a thickened nerve on his neck. What do you think? Which therapy should be instituted?
- Why is foot care and regular self-inspection so important for leprosy patients?
- India. A leprosy sufferer has numerous diffuse subcutaneous callosities, is hoarse and has a chronic cold. He does not see well with his right eye. A leprosy treatment is begun. Which one? Three months later he develops painful pustules on his legs. A Gram stain shows no bacteria. What do you think and what do you do?
- Uganda. Your stock of rifampicin is used up. A new patient with tuberculoid leprosy is begun on dapsone. In spite of this therapy the lesions get worse. What is the explanation for this?
- Burma. A man with Hansen’s disease develops an acute loss of strength in his right hand. What do you do?
- Congo. An LL patient comes for his monthly supply of medication. The medical assistant says that he is not taking the medicine, but is selling it. The patient denies this. How can you test this on the spot?
- Peru. A patient with a white numb skin spot presents with 3 days of high fever, cough and difficult respiration. He has pain in his left chest. What do you think?
- Zambia. You are on the way to a remote village because you have received a report that there is an epidemic of leprosy. What do you think during the journey? When you arrive you note that many people (15 %) have small, oval, discrete scaly patches on their bodies, chiefly on the back and chest. What do you think now? What do you do?
- A 22-year-old Indian patient asks for your help in a remote dispensary for an 8 cm long, clearly depigmented and numb patch with sharply raised edges on his right upper arm. The right ulnar nerve is slightly swollen and sensitive. The other nerves are normal upon palpation. There are no other skin abnormalities. Will you treat him for paucibacillary leprosy if:
- a biopsy confirms the diagnosis?
- the lepromine test is positive?
- the earlobes are swollen and misshapen?
- acid-fast rods are detected after scarification?
- without further preconditions?
