BSc MD FRCP
of Tropical Medicine
I am an infectious disease physician and leprologist working at the interface of tropical medicine/infectious diseases and clinical science. I trained in clinical medicine and laboratory science and have worked in Africa, India and the United Kingdom.
I currently head a research team at the London School of Hygiene and Tropical Medicine researching the molecular aspects of nerve damage in leprosy with the aim of improving outcomes for leprosy patients with nerve damage.
At the Hospital for Tropical Diseases I provide a national referral service for leprosy patients in Britain and see new and suspected cases of leprosy. This is a challenging job and entails caring for patients in the widest sense, from their T cells to their footwear. The many facets of leprosy mean that a teamwork approach is required to address the various disease complications.
I also run the evidence based medicine programme at The Hospital for Tropical Diseases.
I edited Leprosy Review, the premier leprosy journal from 1996- 2012
I do a range of lecturing small group teaching and clinical teaching. I teach on the folowing courses
DTMH, MSc (IHT, CID, Eye health), Diploma in Tropical Nursing.
I lecture on the DTMH at the Liverpool School of Tropical Medicine and teach at St John's Institute of Dermatology.
I do postgraduate teaching at HTD
I also do undergraduate teaching at UCLH
I supervise MSc summer projects
My work focuses on improving the outcome of leprosy patients with nerve damage. My research programme has six main areas: understanding the pathogenesis of leprosy reactions, looking at the molecular effects of treatment on inflammation in reactional lesions, improving treatment for reactions, looking at risk factors for nerve damage, using strain typing of M. leprae to understand the epidemiology of leprosy, and studies on the interaction between HIV and M. leprae.
I have also led work on developing new immunosuppressant treatments for reactions with randomised controlled trials. A multi-centre randomised controlled trial of azathioprine in the treatment for reactions is in progress in India; a study using cyclosporine to treat leprosy reactions in Ethiopian patients is fully developed and about to start; a Phase 2 study on using methylprednisolone in the early treatment of reactions has concluded in Nepal.
I have also started work on identifying second line drugs for the management of Erythema Nodosum Leprosum (ENL). A study in Ethiopia has been funded and I am collaborating with colleagues in The Philippines and India on proposals. Measuring the severity of reactions and documenting improvement is critical to all these clinical studies. My team are working on developing, analysing and refining severity scales for Type and ENL reactions. Trial studies involve developing methodologies for measuring nerve function improvements that can be used in resource poor settings. This year I have been a co-author on two published Cochrane reviews.
My group, with Brazilian and Ethiopian collaborators is leading the analysis of the effect of HIV infection on leprosy and we have accumulating data showing that both immune reconstitution syndrome and upregulation occurs in patients with co-infection.
I have important overseas collaborations, most notably with the MRC/Lepra funded Blue Peter Research Centre in Hyderabad, India. I have been associated with this centre for over 15 years and much of my work arises from collaborations with this centre. Another important collaboration has been with the INFIR study, the biggest prospective cohort study of new leprosy patients at four centres in India linking together nerve function studies and immunology to identify risk factors for leprosy reactions. I am also closely associated with the IDEAL consortium which is developing new diagnostic tools for leprosy.
I am developing new studies on neuropathic pain in leprosy, and have done preliminary studies in India and Ethiopia. I spend part of my sabbatical developing proposals for funding in this new area.
My group is also developing into tropical dermatology and we have a grant to fund work on scabies.