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All Journal Journal of General Procedural Dermatology and Venereology Indonesia
Melani Marissa
Universitas Indonesia
Medicine & Pharmacology

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Failure to use routine prevention of disability (POD) assessment resulting In permanent disability Erika Zoulba; Emmy Soedarmi Sjamsoe; Sri Linuwih Menaldi; Melani Marissa; Yudo Irawan
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 2 (2016): June
Publisher : Universitas Indonesia

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Abstract

Disability is one of problems in leprosy or Morbus Hansen (MH), which can cause the patient loose his autonomy and may affect his social relationship with family and community. Disability occurs due to neurological inflammation that can manifest as silent neuritis (which develops without any pain). Silent neuritis can be recognized early with a routine prevention of disability (POD) assessment. A 19-year-old male patient was referred from a District General Hospital with a history of numbness and stiffness of his 4th and 5th fingers of his left hand since 1 month before admittance. The patient was refered by Community Health Center (CHC or PUSKESMAS) after a one year treatment and RFT. During his treatment at the CHC, no assessment of peripheral nerve or POD had ever been performed. The POD assessment at our hospital demonstrated sensory deficit at some points of assessment on both palms and reduced muscle strength of the first and 5th fingers in both hands. Nerve conduction velocity (NCV) performed at the outpatient of Neurology Department, showed multiple mononeuropathy MH with irreversible damage. Nerve damage is still considered reversible when it occurs less than 6 months. In this case, the silent neuritis was not detected early and there was delayed treatment; as showed by NCV which revealed a manifestation of irreversible nerve damage. Routine POD assessment may detect the condition and appropriate treatment may overcome the nerve damage. Keywords: Morbus Hansen, silent neuritis, prevention of disability assessment
Neural Leprosy: A case report Alida Widiawaty; Emmy Soedarmi Sjamsoe-Daili; Taruli Olivia; Sri Linuwih Menaldi; Melani Marissa; Fitri Octaviana
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 3 (2016): December
Publisher : Universitas Indonesia

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Abstract

Neural leprosy is characterized by neurological deficit without skin lesions, with a prevalence ranging from 1% to 17.7%. Diagnosis might be difficult and need a multidisciplinary approach. This is a case of axonal type motor and sensory polyradiculoneuropathy of the peripheral facial nerve. A 26-year-old woman was referred from the neurology clinic with facial paralysis, suspected as leprosy. Physical examinations were as follows: no skin lesions, left eye lagophthalmos, thickening of right lateral peroneal and bilateral posterior tibial nerves, sensory impairment, peripheral bilateral facial palsy, and wasting of bilateral distal small muscles of the hands, with normal autonomic function. Nerve Conduction Study revealed multiple demyelinating mononeuropathy of upper and lower extremities. Her serum anti-PGL-1 IgM level was 1721 μ/mL, but after three months of treatment with MDT-PB regimen, it increased to 2815μ/mL. Therefore, the treatment was switched to MDT-MB regimen and 30 mg prednisone. The patient is still undergoing treatment. There has been a slight improvement after treatment with MDT-MB regimen. Nerve biopsy is the gold standard for diagnosis but has its limitations. However, serological test of anti PGL-1 can be a marker and a useful tool as an additional test to confirm the diagnosis, especially for patients with nerve impairments. Difficulties are due to the absence of skin lesions and neuropathy which may be caused by other diseases. Both diagnosis and treatment require multidisciplinary approach. Treatment given is intended to correct nerve damage and prevent further disabilities. Keywords: Neural leprosy, anti-PGL-1, systemic corticosteroid, multidisciplinary approach
Suspected resistance of MDT-MB in Multibacillary Leprosy of Hansen's disease: Two case reports Yudo Irawan; Sri Linuwih Menaldi; Emmy Soedarmi Sjamsoe-Daili; Melani Marissa; Erika Zoulba
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 3 (2016): December
Publisher : Universitas Indonesia

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Abstract

Resistance to multidrug therapy (MDT) is one of the complications in the treatment of Hansen’s disease/Morbus Hansen (MH). There are two types of resistancy, which are primary and secondary. MDT-multibacillary (MB) resistance must be suspected when no clinical improvement and the acid-fast bacilli (AFB) index is not reduced after 12 months of therapy. A 28-year-old woman with paresthesia on her face, arms and legs since 2.5 years ago, accompanied by thickening of the right posterior tibial nerve. The AFB examination showed a bacteriological index (BI) of 15/6 and morphological index (MI) of 0.50%. The second case, a 42-year-old man came with paresthetic lesions on his face, chest, back, both arms and legs since 2 years ago, accompanied by thickening of ulnar and lateral peroneal nerve. The BI was 12/5 and the MI was 0.40%. Both patients were diagnosed with borderline lepromatous type of MH and received MDT-MB for 12 months. Diagnosis of suspected resistance was established because no clinical improvement or any significant decrease of AFB index after completing the MDT treatment. The patients had secondary resistance after polymerase chain reaction evaluation showed that they were still rifampicin-sensitive. There was clinical improvement and significant decrease in FAB index after the patients continued the MDT-MB treatment with 600 mg additional rifampicin. The diagnosis of bacterial resistance should be made based on clinical evaluation before completion of treatment. Based on the two case reports, the resistance suspected may be secondary. Treatment using additional regimen can be initiated once the resistance has been proven. Keywords: Hansen’s disease, MDT resistance, clinical improvement, acid fast bacilli index
Co-Authors Aldri Frinaldi Alida Widiawaty Emmy Soedarmi Sjamsoe Emmy Soedarmi Sjamsoe-Daili Erika Zoulba Sri L. Menaldi Taruli Olivia Yudo Irawan