1
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Lee RRS, Lim JHL. COVID-19 coinfection inducing type 1 leprosy reaction: an instructive case with proposed pathogenic mechanism and implications. Singapore Med J 2023:386980. [PMID: 37929557 DOI: 10.4103/singaporemedj.smj-2021-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Rayson Rui Sheng Lee
- Department of General Medicine, Tan Tock Seng Hospital; Department of Dermatology, National Skin Centre, Singapore
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2
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Fróes LAR, Toma TS, Poderoso RE, Trindade MÂB. Viral co-infections in leprosy: a scoping review. Int J Dermatol 2023; 62:547-557. [PMID: 36738114 DOI: 10.1111/ijd.16613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
CONTEXT The most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research. METHODS The authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews. RESULTS For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, co-infections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part. CONCLUSIONS This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.
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Affiliation(s)
- Luis Alberto Ribeiro Fróes
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 455, São Paulo, 01246-903, SP, Brazil
| | - Tereza Setsuko Toma
- Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | | | - Maria Ângela Bianconcini Trindade
- LIM56, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
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3
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Ianhez M, Cerqueira SR, Gomes CM, Talhari CC, Criado PR, Castro CC, Ramos PM, Miot HA. Impact of COVID-19 on leprosy reactions and of leprosy treatments on COVID-19 severity. Indian J Dermatol Venereol Leprol 2023; 89:133-134. [PMID: 36331835 DOI: 10.25259/ijdvl_1235_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/01/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Mayra Ianhez
- Departamento de Medicina Tropical e Dermatologia, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil
| | - Selma Rps Cerqueira
- Department of Dermatology, Faculdade de Medicina de Brasília, Universidade de Brasília (UnB), Brasília, Federal District, Brazil
| | - Ciro Martins Gomes
- Department of Dermatology, Faculdade de Medicina de Brasília, Universidade de Brasília (UnB), Brasília, Federal District, Brazil
| | - Carolina C Talhari
- Department of Dermatology, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Paulo R Criado
- Department of Dermatology, Centro Universitário Faculdade de Medicina do ABC and Alergoskin Alergia e Dermatologia, Santo André, São Paulo, Brazil
| | - Caio Cs Castro
- School of Medicine, Department of Dermatology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Paulo M Ramos
- Department of Dermatology, UNESP Medical School, Botucatu, São Paulo, Brazil
| | - Hélio A Miot
- Department of Dermatology, UNESP Medical School, Botucatu, São Paulo, Brazil
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4
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Shin H(C, Oh Y. Leprosy and leprostigma: A review from the past through COVID-19. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.827102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Repsold TAR, Collin SM, Bouth RC, Cerqueira SRPS, Brezinscki MS, Peixoto RRGB, Fonseca AMFDA, Peixoto MLDS, Rabelo Mendes S, Gomes CM, Salgado CG, Deps PD. Hansen's disease and COVID-19 co-infection in Brazil. Int J Dermatol 2022; 61:1506-1510. [PMID: 35775153 PMCID: PMC9349626 DOI: 10.1111/ijd.16319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/07/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The implications of COVID-19 co-infection in patients under treatment for Hansen's disease (HD, leprosy) remain uncertain. We aimed to describe clinical characteristics, treatments, and outcomes in patients with HD and COVID-19 in Brazil. METHODS Cross-sectional study recruiting adult HD patients with PCR-confirmed COVID-19 from five HD treatment centers in Brazil between March 1, 2020, and March 31, 2021. At the time of this study, no patient had received COVID-19 vaccine. RESULTS Of 1377 patients under treatment for HD, 70 (5.1%) were diagnosed with COVID-19. Of these, 41 (58.6%) had PCR-confirmed COVID-19, comprising 19 men and 22 women, aged 24-67 (median 45) years. HD was multibacillary in 39/41 patients. Eight patients ceased WHO Multi-Drug Therapy for HD, three for lack of drugs, two because of COVID-19, and three for other reasons. Of the 33 who continued treatment, 26 were on the standard regimen and seven an alternative regimen. Seventeen patients were receiving oral prednisone, including nine patients with type 1 reaction, four with type 2 reaction, three with neuritis, and one with rheumatologic disease. Twelve patients were hospitalized for COVID-19, and six patients died, of whom three had hypertension and one also had type 2 diabetes and obesity. CONCLUSIONS COVID-19 and Hansen's disease co-infection did not appear to change the clinical picture of either disease in this cross-sectional study. The wider impact of the pandemic on persons affected by HD requires follow-up and monitoring.
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Affiliation(s)
- Taynah Alves Rocha Repsold
- Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Simon M Collin
- Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil.,Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use, and Sepsis Division, United Kingdom Health Security Agency, London, UK
| | | | | | | | | | | | | | - Seyna Rabelo Mendes
- Serviço de Referência em Hansenologia, Secretaria Municipal de Saúde de Palmas, Tocantins, Brazil
| | | | | | - Patrícia D Deps
- Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil.,Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Brazil
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6
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Abstract
Leprosy is a neglected tropical disease (NTD) that continues to burden low- and
middle-income countries (LMICs), despite being eliminated as a public health
concern by the World Health Organization (WHO) in 2000. The causative agents,
Mycobacterium leprae and Mycobacterium
lepromatosis, affect nearly 200,000 individuals globally each year,
with over 19,000 new cases detected in the Americas in 2020 alone. Canada has
experienced an increasing incidence of leprosy, due to rising levels of travel
and migration from endemic areas, reaching over 37,000 individuals with leprosy
by the end of 2020. Patients experience a spectrum of signs and symptoms
including hypopigmented cutaneous macules alongside peripheral neuropathy
including peripheral neuropathic pain (PNP) and disabling sensory neuropathies.
Despite the development of effective and curative therapeutics
via multidrug therapy (MDT), many barriers to treatment
adherence and effective immunological control of the pathogen challenge the care
of patients with leprosy. Socioeconomic barriers, such as disability-related
social stigma and often undiagnosed nutritional deficiencies, have resulted in
heightened disease severity. PNP therapeutics are associated with significant
side effects and remain ineffective as the majority of individuals will not
experience a greater than 30% reduction of symptoms. Nutrient supplementation is
known to be instrumental in reducing host oxidative stress, strengthening the
immune system and mitigating comorbidities. Likewise, dietary lifestyle
interventions known to be physiologically beneficial have recently emerged as
powerful tools conferring neuroprotective effects, potentially mitigating PNP
severity. However, a significant knowledge gap concerning the effect of adequate
nutrition on host immunological control of leprosy and PNP severity exists.
Further evaluation of this relationship will provide key insight into the
pathogenesis of leprosy, strengthening the current body of literature.
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Affiliation(s)
- Michael Klowak
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Andrea K. Boggild
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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7
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de Oliveira JADP, de Athaide MM, Rahman AU, de Mattos Barbosa MG, Jardim MM, Moraes MO, Pinheiro RO. Kynurenines in the Pathogenesis of Peripheral Neuropathy During Leprosy and COVID-19. Front Cell Infect Microbiol 2022; 12:815738. [PMID: 35281455 PMCID: PMC8907883 DOI: 10.3389/fcimb.2022.815738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Inflammatory disorders are associated with the activation of tryptophan (TRYP) catabolism via the kynurenine pathway (KP). Several reports have demonstrated the role of KP in the immunopathophysiology of both leprosy and coronavirus disease 19 (COVID-19). The nervous system can be affected in infections caused by both Mycobacterium leprae and SARS-CoV-2, but the mechanisms involved in the peripheral neural damage induced by these infectious agents are not fully understood. In recent years KP has received greater attention due the importance of kynurenine metabolites in infectious diseases, immune dysfunction and nervous system disorders. In this review, we discuss how modulation of the KP may aid in controlling the damage to peripheral nerves and the effects of KP activation on neural damage during leprosy or COVID-19 individually and we speculate its role during co-infection.
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Affiliation(s)
| | | | - Atta Ur Rahman
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Marcia Maria Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Neurology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milton Ozório Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Roberta Olmo Pinheiro,
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8
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Goulart IMB, Santana MADO, Costa WVTD, Pavelka MM, Dornelas BDC. Type 2 leprosy reaction presenting as a monoarthritis post multidrug therapy. IDCases 2022; 27:e01386. [PMID: 35036324 PMCID: PMC8749206 DOI: 10.1016/j.idcr.2022.e01386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 leprosy reaction, or erythema nodosum leprosum (ENL), involves a complex interaction between the host's immune system and Mycobacterium leprae. It may occur before, during, or after treatment and have a variable clinical presentation involving different body systems, such as skin, osteoarticular, kidneys, and others. Thus, the differential diagnosis, depending on its clinical presentation, can be broad and challenging. The authors report a case of a severe monoarthritis during a type 2 reaction after the multidrug therapy (MDT) was discharged and the investigation of the differential diagnoses.
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Affiliation(s)
- Isabela Maria Bernardes Goulart
- School of Medicine, Federal University of Uberlândia (UFU), 1720, Pará avenue, Uberlândia, MG, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil.,National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil
| | - Marcela Araujo de Oliveira Santana
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 94, Capricórnio Street, Uberlândia, MG, Brazil
| | | | - Matthew Martin Pavelka
- Indiana University School of Medicine, 620 N. Chestnut Street Holmstedt Hall 135, Terre Haute, IN 47809, USA
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9
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Panda AK, Begum F, Panda M, Jena AK. Trigger of Type 2 Lepra reaction with acute foot drop following Covid-19 vaccination. J Eur Acad Dermatol Venereol 2022; 36:e334-e335. [PMID: 35015915 DOI: 10.1111/jdv.17915] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/08/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Anil Kumar Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India.,Institute of Medical Sciences and SUM Hospital, S 'O'A University, Bhubaneswar, Odisha, India
| | - Farheen Begum
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India.,Institute of Medical Sciences and SUM Hospital, S 'O'A University, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India.,Institute of Medical Sciences and SUM Hospital, S 'O'A University, Bhubaneswar, Odisha, India
| | - Ajaya Kumar Jena
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India.,Institute of Medical Sciences and SUM Hospital, S 'O'A University, Bhubaneswar, Odisha, India
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10
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Bhardwaj A, Gupta SK, Narang T, Suneetha S, Pradhan S, Agarwal P, Suvirya S, Gupta A, Chhabra N, Rao AG, Ashwini PK, Jandhyala S, Rathod S, Rao PN, Dogra S. Updates on Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by IADVL SIG Leprosy. Indian Dermatol Online J 2022; 12:S24-S30. [PMID: 34976878 PMCID: PMC8664173 DOI: 10.4103/idoj.idoj_513_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Dermatology, Venereology and Leprology, All India Institute of Medial Sciences, Jodhpur, Rajasthan, India
| | - Sunil Kumar Gupta
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medial Sciences, Patna, Bihar, India
| | - Pooja Agarwal
- Department of Dermatology, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Swastika Suvirya
- Department of Dermatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ankan Gupta
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Namrata Chhabra
- Department of Dermatology, AIIMS, Raipur, Chhattisgarh, India
| | | | - P K Ashwini
- Department of Dermatology, JSS Medical College, Mysore, Karnataka, India
| | | | - Santoshdev Rathod
- Department of Dermatology, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - P Narasimha Rao
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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Marques NP, Marques NCT, Cardozo IM, Martelli DRB, Lucena EGD, Oliveira EA, Martelli Júnior H. Impact of the coronavirus disease 2019 on the diagnoses of Hansen's disease in Brazil. Rev Soc Bras Med Trop 2021; 54:e02512021. [PMID: 34320132 PMCID: PMC8313100 DOI: 10.1590/0037-8682-0251-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has limited the access of patients with Hansen's disease (HD) to care due to changes in routine health services. METHODS To ascertain this, we compared the number of HD cases diagnosed before and after the COVID-19 pandemic. RESULTS The decrease in HD cases in Brazil reached 18,223 (-48.4%), corresponding to an average reduction of 1,518 cases per month during the COVID-19 pandemic. CONCLUSION Therefore, effective measures should be implemented to minimize the damage and the consequent negative health impact of COVID-19 on the care of HD patients.
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Affiliation(s)
- Nelson Pereira Marques
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Piracicaba, SP, Brasil
| | - Nádia Carolina Teixeira Marques
- Universidade José do Rosário Vellano, Centro de Reabilitação de Anomalias Craniofaciais, Alfenas, MG, Brasil.,Universidade José do Rosário Vellano, Departamento de Odontopediatria, Alfenas, Minas Gerais, Brasil
| | - Iberto Medeiros Cardozo
- Faculdade FUNORTE, Escola de Medicina, Instituto de Ciências da Saúde, Montes Claros, MG, Brasil
| | | | - Edson Gomes de Lucena
- Universidade Federal da Paraíba, Departamento de Clínica e Odontologia Social, João Pessoa, PB, Brasil
| | - Eduardo Araújo Oliveira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brasil.,University of California, San Diego, La Jolla, CA, USA
| | - Hercílio Martelli Júnior
- Universidade José do Rosário Vellano, Centro de Reabilitação de Anomalias Craniofaciais, Alfenas, MG, Brasil.,Universidade Estadual de Montes Claros, Programa de Pós-graduação em Ciências da Saúde, Montes Claros, MG, Brasil
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12
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Cerqueira SRPS, Deps PD, Cunha DV, Bezerra NVF, Barroso DH, Pinheiro ABS, Pillegi GS, Repsold TAR, Kurizky PS, Collin SM, Gomes CM. The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study. PLoS Negl Trop Dis 2021; 15:e0009635. [PMID: 34319982 PMCID: PMC8351963 DOI: 10.1371/journal.pntd.0009635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/09/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.
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Affiliation(s)
- Selma Regina Penha Silva Cerqueira
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Patrícia Duarte Deps
- Post-Graduation Programme of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Débora Vilela Cunha
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | - Daniel Holanda Barroso
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | | | | | - Patrícia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Simon M. Collin
- Post-Graduation Programme of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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13
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de Barros B, Lambert SM, Negera E, de Arquer GR, Sales AM, Darlong J, Dias VLA, Rozario BJ, Pai VV, Alinda MD, Listiawan MY, Hagge DA, Shah M, Lockwood DNJ, Walker SL. An assessment of the reported impact of the COVID-19 pandemic on leprosy services using an online survey of practitioners in leprosy referral centres. Trans R Soc Trop Med Hyg 2021; 115:1456-1461. [PMID: 34077950 PMCID: PMC8195135 DOI: 10.1093/trstmh/trab084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. Methods We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. Results Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. Discussion This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.
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Affiliation(s)
- Barbara de Barros
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Saba M Lambert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia
| | - Edessa Negera
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Anna M Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Vivianne L A Dias
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Medhi Denisa Alinda
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Teaching Hospital, Surabaya, Indonesia
| | - M Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Deanna A Hagge
- Department of Dermatology and Mycobacterial Research Laboratories, Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Mahesh Shah
- Department of Dermatology and Mycobacterial Research Laboratories, Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Diana N J Lockwood
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen L Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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14
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Santos Morais Junior G, Shu Kurizky P, Penha Silva Cerqueira SR, Holanda Barroso D, Schulte HL, Pires de Albuquerque C, Teles de Gois E, Salmen Espindola L, Martins Santana J, Marques Dourado Bastos I, Nunes de Araújo C, Henrique da Mota LM, Toledo Nóbrega O, Martins Gomes C. Enhanced IL-6 and IL-12B Gene Expression After SARS-CoV-2 Infection in Leprosy Patients May Increase the Risk of Neural Damage. Am J Trop Med Hyg 2021; 104:2190-2194. [PMID: 33819170 PMCID: PMC8176471 DOI: 10.4269/ajtmh.21-0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 02/03/2023] Open
Abstract
Experts have called attention to the possible negative impact of the coronavirus disease 2019 (COVID-19)–related cytokine storm syndrome on the progression of leprosy-related disabilities. We assessed the frequency of reactional states in patients co-infected with Mycobacterium leprae and severe acute respiratory syndrome (SARS) coronavirus (CoV) 2 (SARS-CoV-2). We consecutively included patients during the first peak of the COVID-19 epidemic in Brazil and analyzed the expressions of genes encoding interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12A, IL-12B, and tumor necrosis factor-α in peripheral blood mononuclear cells. We included 64 leprosy patients and 50 controls. Twelve of the leprosy patients and 14 of the controls had been diagnosed with COVID-19. Co-infection was associated with increased IL-6 (P = 0.043) and IL-12B (P = 0.017) expression. The median disability grades were higher for leprosy/COVID-19 patients; however, the difference was not significant (P = 0.194). Patients co-infected with M. leprae and SARS-CoV-2 may experience a higher-grade proinflammatory state.
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Affiliation(s)
- Gilberto Santos Morais Junior
- 1Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB) Brasília, Brazil
| | - Patrícia Shu Kurizky
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,3Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Selma Regina Penha Silva Cerqueira
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,3Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Daniel Holanda Barroso
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Heidi Luise Schulte
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Cleandro Pires de Albuquerque
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,3Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Eliana Teles de Gois
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Laila Salmen Espindola
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Jaime Martins Santana
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,4Instituto de Ciências Biológicas, Universidade de Brasília (UnB) Brasília, Brazil
| | | | - Carla Nunes de Araújo
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Licia Maria Henrique da Mota
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,3Hospital Universitário de Brasília (HUB), Brasília, Brazil
| | - Otávio Toledo Nóbrega
- 1Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB) Brasília, Brazil.,2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
| | - Ciro Martins Gomes
- 2Programa de Pós-Graduação em Ciências Médicas, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil.,3Hospital Universitário de Brasília (HUB), Brasília, Brazil.,5Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Faculdade Medicina, Universidade de Brasília (UnB) Brasília, Brazil
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15
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Arora S, Bhatnagar A, Singh GK, Pal R, Bahuguna A, Das P, Verma P. Hansen's disease in the era of COVID-19: An observation on a series of six patients with co-infection. Dermatol Ther 2021; 34:e14827. [PMID: 33527634 PMCID: PMC7995048 DOI: 10.1111/dth.14827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/19/2020] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
Since the onset of the present pandemic, effect of the novel corona virus on other infectious conditions continues to be investigated. Although the immunological responses to SARS‐Cov‐2 infection have been elaborated extensively, they fail to explain, variations in its clinical manifestations and its interaction with other diseases. Hansen's disease is known to present as a complex immunological response to the lepra bacilli, resulting in its varied spectral manifestations. An interaction between these two infectious agents, hence, may affect Hansen's disease. We came across six cases of Hansen's disease who developed COVID19 co‐infection. This series presents their clinical course and outcome, during the period of co‐infection. All cases were followed up for a minimum eight‐week period thereafter. In all these cases the active phase of coronavirus infection had no effect on Hansen's disease and those on prednisolone for their lepra reaction had a more favorable outcome, with two cases manifesting exacerbation of their lepra reactions in the follow period.
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Affiliation(s)
- Sandeep Arora
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
| | | | - Reetika Pal
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
| | - Amit Bahuguna
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Pankaj Das
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Prachi Verma
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
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16
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Abstract
Coronavirus Disease 2019 (COVID-19), a disease caused by the betacoronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has only recently emerged, while Mycobacterium leprae, the etiological agent of leprosy, has endured for more than 2,000 years. As soon as the initial reports of COVID-19 became public, several entities, including the Brazilian Leprosy Society, warned about the possible impact of COVID-19 on leprosy patients. It has been verified that COVID-19 carriers can be either asymptomatic or present varying degrees of severe respiratory failure in association with cytokine storm and death, among other diseases. Severe COVID-19 patients show increased numbers of neutrophils and serum neutrophil extracellular trap (NET) markers, in addition to alterations in the neutrophil-to-lymphocyte ratio (NLR). The absence of antiviral drugs and the speed of COVID-19 transmission have had a major impact on public health systems worldwide, leading to the almost total collapse of many national and local healthcare services. Leprosy, an infectious neurological and dermatological illness, is widely considered to be the most frequent cause of physical disabilities globally. The chronic clinical course of the disease may be interrupted by acute inflammatory episodes, named leprosy reactions. These serious immunological complications, characterized by cytokine storms, are responsible for amplifying peripheral nerve damage. From 30% to 40% of all multibacillary leprosy (MB) patients experience erythema nodosum leprosum (ENL), a neutrophilic immune-mediated condition. ENL patients often present these same COVID-19-like symptoms, including high levels of serum NET markers, altered NLR, and neutrophilia. Moreover, the consequences of a M. leprae-SARS-CoV-2 coinfection have yet to be fully investigated. The goal of the present viewpoint is to describe some of the similarities that may be found between COVID-19 and leprosy disease in the context of neutrophilic biology.
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Affiliation(s)
- Veronica Schmitz
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jéssica Brandão dos Santos
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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