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Sharma M, Dwivedi P, Joshi V, Singh P. Novel mutations found in Mycobacterium leprae DNA repair gene nth from central India. J Infect Chemother 2024; 30:531-535. [PMID: 38141720 DOI: 10.1016/j.jiac.2023.12.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/02/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION The importance of DNA repair enzymes in maintaining genomic integrity is highlighted by the hypothesis that DNA damage by reactive oxygen/nitrogen species produced inside the host cell is essential for the mutagenesis process. Endonuclease III (Nth), formamidopyrimide (Fpg) and endonuclease VIII (Nei) DNA glycosylases are essential components of the bacterial base excision repair process. Mycobacterium leprae lost both fpg/nei genes during the reductive evolution event and only has the nth (ML2301) gene. This study aims to characterize the mutations in the nth gene of M. leprae strains and explore its correlation with drug-resistance. METHOD A total of 91 M. leprae positive DNA samples extracted from skin biopsy samples of newly diagnosed leprosy patients from NSCB Hospital Jabalpur were assessed for the nth gene as well as drug resistance-associated loci of the rpoB, gyrA and folP1 genes through PCR followed by Sanger sequencing. RESULTS Of these 91 patients, a total of two insertion frameshift mutations, two synonymous and seven nonsynonymous mutations were found in nth in seven samples. Sixteen samples were found to be resistant to ofloxacin and one was found to be dapsone resistant as per the known DRDR mutations. No mutations were found in the rpoB region. Interestingly, none of the nth mutations were identified in the drug-resistant associated samples. CONCLUSION The in-silico structural analysis of the non-synonymous mutations in the Nth predicted five of them were to be deleterious. Our results suggest that the mutations in the nth gene may be potential markers for phylogenetic and epidemiological studies.
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Affiliation(s)
- Mukul Sharma
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Purna Dwivedi
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India; The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Vandana Joshi
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India; School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Pushpendra Singh
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India.
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Rakotoarisaona MF, Razafimaharo TI, Sendrasoa FA, Andrianarison M, Razanakoto NH, Ratovonjanahary VT, Raharolahy O, Ranaivo IM, Ramarozatovo LS, Rapelanoro Rabenja F. Coinfection with Leprosy and Tuberculosis: A Case Series in Malagasy Patients. Infect Drug Resist 2024; 17:1507-1513. [PMID: 38645889 PMCID: PMC11027919 DOI: 10.2147/idr.s458888] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Leprosy and tuberculosis are two of the oldest and most common mycobacterial infections, caused by Mycobacterium leprae and Mycobacteium lepramatosis for leprosy and Mycobacterium tuberculosis for tuberculosis. Dual infections have been known since ancient times; however, cases remain rarely reported in the literature, even in countries where both diseases are endemic, such as Madagascar. Purpose We report a case series of simultaneous occurrence of leprosy and tuberculosis. Patients and Methods In this retrospective study, we reviewed the medical records of patients with leprosy registered at the Department of Dermatology, University Hospital Befelatanana, Antananarivo, Madagascar, between January 2012 and June 2021. Patients with leprosy and diagnosed as coinfected by tuberculosis were included in the study. Results Of the 120 leprosy cases observed during the study period, coinfection with leprosy and tuberculosis was found in five patients. The mean age was 43.4 (SD 13.2) ranging, 21-59 years. Male gender was predominant (4/5). Four patients presented with lepromatous leprosy, and one with borderline lepromatous leprosy. Three patients experienced leprosy reaction. Four cases of pulmonary tuberculosis and one case of multifocal tuberculosis were observed. The diagnosis of leprosy preceded tuberculosis in four cases, and a coinfection diagnosis was made simultaneously in one case. The average time to develop tuberculosis was 38.8 (SD 10.2) months. HIV infection, malnutrition, alcohol consumption, and long-term corticosteroid therapy were the immunosuppressive factors reported in our patients. Three patients received concomitant multidrug therapy for leprosy and tuberculosis. Conclusion Dermatologists should be aware of the importance of screening patients affected by leprosy for latent or active tuberculosis to prevent morbidity and mortality due to coinfection and to reduce the risk of acquired resistance to rifampicin, which is the greatest risk of this association.
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Affiliation(s)
| | | | | | | | | | | | - Onivola Raharolahy
- Department of Dermatology, University of Befelatanana, Antananarivo, Madagascar
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Wang Z, Liu T, Wang Z, Mi Z, Zhang Y, Wang C, Sun L, Ma S, Xue X, Liu H, Zhang F. CYBB-Mediated Ferroptosis Associated with Immunosuppression in Mycobacterium leprae-Infected Monocyte-Derived Macrophages. J Invest Dermatol 2024; 144:874-887.e2. [PMID: 37925067 DOI: 10.1016/j.jid.2023.10.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023]
Abstract
Mycobacterium leprae-infected macrophages preferentially exhibit the regulatory M2 phenotype in vitro, which helps the immune escape unabated growth of M leprae in host cells. The mechanism that triggers macrophage polarization is still unknown. In this study, we performed single-cell RNA sequencing to determine the initial responses of human monocyte-derived macrophages against M leprae infection of 4 healthy individuals and found an increase in a major alternative-activated macrophage type that overexpressed NEAT1, CCL2, and CD163. Importantly, further functional analysis showed that ferroptosis was positively correlated with M2 polarization of macrophages, and in vitro experiments have shown that inhibition of ferroptosis promotes the survival of M leprae within macrophages. In addition, further joint analysis of our results with mutisequencing data from patients with leprosy and in vitro validation identified that CYBB was the pivotal molecule for ferroptosis that could promote the M2 polarization of M leprae-infected macrophages, resulting in the immune escape and unabated growth of pathogenic bacteria. Overall, our results suggest that M leprae facilitated its survival by inducing CYBB-mediated macrophage ferroptosis leading to its alternative activation and might reveal the potential for a new therapeutic strategy of leprosy.
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Affiliation(s)
- Zhe Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tingting Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenzhen Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yuan Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Chuan Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Lele Sun
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Shanshan Ma
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaotong Xue
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
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Ferreira M, Grijó C, Paulo J, Fonseca M, Neves Z. [Hansen's Disease: An Unusual Manifestation of an Ancient Disease]. ACTA MEDICA PORT 2024; 37:215-219. [PMID: 38271690 DOI: 10.20344/amp.20599] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
Hansen's disease, commonly known as leprosy, is an infectious disease caused by Mycobacterium leprae. Being rare in developed countries, it is an increasingly common imported disease due to the migratory flow from countries where it is endemic. We present the case of a 21-year-old man who went to the emergency department with complaints of additive polyarthralgia involving large joints, papules, and erythematous plaques on the limbs with bullae and central necrosis and fever with chills for one week. Skin biopsy was performed revealing neutrophilic infiltrate with perineural granulomas. The bacilloscopy detected acid-alcohol resistant bacilli. The diagnosis of multibacillary HD with type 2 lepromatous reaction (erythema nodosum leprosum - ENL) was established, showing clinical improvement under corticosteroid therapy. ENL usually presents with painful lesions, being an atypical presentation of leprosy, especially in the presence of bullae and necrosis, making diagnosis difficult and challenging. Social stigma is often present making it difficult to accept the disease as well as adherence to treatment.
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Affiliation(s)
- Mário Ferreira
- Medicina III. Hospital Fernando Fonseca. Amadora. Portugal
| | - Carlos Grijó
- Serviço de Medicina Interna. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Joana Paulo
- Medicina III. Hospital Fernando Fonseca. Amadora. Portugal
| | - Marta Fonseca
- Medicina III. Hospital Fernando Fonseca. Amadora. Portugal
| | - Zélia Neves
- Medicina III. Hospital Fernando Fonseca. Amadora. Portugal
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Vernal S, Gomes CM. Editorial: New insights in leprosy (Hansen's disease). Front Med (Lausanne) 2024; 11:1372149. [PMID: 38414623 PMCID: PMC10897031 DOI: 10.3389/fmed.2024.1372149] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Sebastian Vernal
- Sustentabilidade e Responsabilidade Social, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
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Shyam M, Kumar S, Singh V. Unlocking Opportunities for Mycobacterium leprae and Mycobacterium ulcerans. ACS Infect Dis 2024; 10:251-269. [PMID: 38295025 PMCID: PMC10862552 DOI: 10.1021/acsinfecdis.3c00371] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 02/02/2024]
Abstract
In the recent decade, scientific communities have toiled to tackle the emerging burden of drug-resistant tuberculosis (DR-TB) and rapidly growing opportunistic nontuberculous mycobacteria (NTM). Among these, two neglected mycobacteria species of the Acinetobacter family, Mycobacterium leprae and Mycobacterium ulcerans, are the etiological agents of leprosy and Buruli ulcer infections, respectively, and fall under the broad umbrella of neglected tropical diseases (NTDs). Unfortunately, lackluster drug discovery efforts have been made against these pathogenic bacteria in the recent decade, resulting in the discovery of only a few countable hits and majorly repurposing anti-TB drug candidates such as telacebec (Q203), P218, and TB47 for current therapeutic interventions. Major ignorance in drug candidate identification might aggravate the dramatic consequences of rapidly spreading mycobacterial NTDs in the coming days. Therefore, this Review focuses on an up-to-date account of drug discovery efforts targeting selected druggable targets from both bacilli, including the accompanying challenges that have been identified and are responsible for the slow drug discovery. Furthermore, a succinct discussion of the all-new possibilities that could be alternative solutions to mitigate the neglected mycobacterial NTD burden and subsequently accelerate the drug discovery effort is also included. We anticipate that the state-of-the-art strategies discussed here may attract major attention from the scientific community to navigate and expand the roadmap for the discovery of next-generation therapeutics against these NTDs.
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Affiliation(s)
- Mousumi Shyam
- Department
of Pharmaceutical Sciences & Technology, Birla Institute of Technology, Mersa, Ranchi, Jharkhand 835215, India
| | - Sumit Kumar
- Holistic
Drug Discovery and Development (H3D) Centre, University of Cape Town, Rondebosch 7701, South Africa
| | - Vinayak Singh
- Holistic
Drug Discovery and Development (H3D) Centre, University of Cape Town, Rondebosch 7701, South Africa
- South
African Medical Research Council Drug Discovery and Development Research
Unit, University of Cape Town, Rondebosch 7701, South Africa
- Institute
of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Observatory 7925, Cape Town, South Africa
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Zhou J, Wu Z, Tong Y, Chokkakula S, Shi Y, Jiang H, Liu J, Wang D, Zhang W, Wang C, Zhao T, Yuan K, Li T, Ma L, Yang Q, Wang S, Hong F, Wang H, Li J. Molecular epidemiological characteristics of Mycobacterium leprae in highly endemic areas of China during the COVID-19 epidemic. Front Public Health 2024; 12:1148705. [PMID: 38327578 PMCID: PMC10847240 DOI: 10.3389/fpubh.2024.1148705] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives The present study analyzed the impact of the COVID-19 pandemic on the prevalence and incidence of new leprosy cases, as well as the diversity, distribution, and temporal transmission of Mycobacterium leprae strains at the county level in leprae-endemic provinces in Southwest China. Methods A total of 219 new leprosy cases during two periods, 2018-2019 and 2020-2021, were compared. We genetically characterized 83 clinical isolates of M. leprae in Guizhou using variable number tandem repeats (VNTRs) and single nucleotide polymorphisms (SNPs). The obtained genetic profiles and cluster consequences of M. leprae were compared between the two periods. Results There was an 18.97% decrease in the number of counties and districts reporting cases. Considering the initial months (January-March) of virus emergence, the number of new cases in 2021 increased by 167% compared to 2020. The number of patients with a delay of >12 months before COVID-19 (63.56%) was significantly higher than that during COVID-19 (48.51%). Eighty-one clinical isolates (97.60%) were positive for all 17 VNTR types, whereas two (2.40%) clinical isolates were positive for 16 VNTR types. The (GTA)9, (TA)18, (TTC)21 and (TA)10 loci showed higher polymorphism than the other loci. The VNTR profile of these clinical isolates generated five clusters, among which the counties where the patients were located were adjacent or relatively close to each other. SNP typing revealed that all clinical isolates possessed the single SNP3K. Conclusion COVID-19 may have a negative/imbalanced impact on the prevention and control measures of leprosy, which could be a considerable fact for official health departments. Isolates formed clusters among counties in Guizhou, indicating that the transmission chain remained during the epidemic and was less influenced by COVID-19 preventative policies.
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Affiliation(s)
- Jiaojiao Zhou
- Key Laboratory of Environmental Pollution and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Ziwei Wu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
| | - Yi Tong
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Santosh Chokkakula
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, Republic of Korea
| | - Ying Shi
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Haiqin Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jie Liu
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - De Wang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Wenyue Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chen Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | | | - Tao Li
- Qiandongnan CDC, Qiandongnan, China
| | - Lu Ma
- Guiyang CDC, Guiyang, China
| | - Qin Yang
- Key Laboratory of Environmental Pollution and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Shizhen Wang
- The Second People’s Hospital of Bijie, Bijie, China
| | - Feng Hong
- Key Laboratory of Environmental Pollution and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Hongsheng Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, Nanjing, China
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, Republic of Korea
| | - Jinlan Li
- Key Laboratory of Environmental Pollution and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
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dos Santos DF, Borges IS, Garcia LP, Antunes DE, Luppi ADM, Goulart IMB. Description of electroneuromiographic and laboratorial findings in leprosy neuropathy, according to its clinical forms: the confirmation of a spectral disease. Front Med (Lausanne) 2024; 10:1304131. [PMID: 38259847 PMCID: PMC10801246 DOI: 10.3389/fmed.2023.1304131] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Leprosy is one of the most common infectious cause of peripheral neuropathy in the world and can lead to sequelae and physical disabilities. Electroneuromyography (ENMG) is the gold-standard test for evaluating neural impairment, detecting from subclinical abnormalities to advanced lesions. This study aims to describe the electroneuromyographic findings in patients with leprosy, according to their clinical forms. Methods The study is a retrospective observational analysis of the medical records of patients with leprosy, of a National Reference Center of Sanitary Dermatology and Leprosy in Brazil between 2014 and 2022. 513 patients underwent ENMG at leprosy diagnosis and also underwent a clinical, serological and molecular evaluation of the disease. Results The electroneuromyographic findings showed 2,671 altered nerves, with an average of 6.9 (±5.1) altered nerves per patient. The most affected sensory nerves were the superficial peroneal (25.0%; 413/1649), sural (15.1%; 397/2627) and ulnar (13.8%; 363/2627), with average of 4.3 (±3.2) affected sensory nerves per patient. The most affected motor nerves were the ulnar (33.1%; 338/1022) and common peroneal (12.1%; 319/2627), with average of 2.6 (±2.5) motor nerves affected per patient. 126 patients presented normal ENMG and, among the 387 with abnormalities in the exam, 13.2% (51/387) had mononeuropathy and 86.8% (336/387) had multiple mononeuropathy. Axonal involvement was more frequent in primary neural leprosy, borderline-tuberculoid, borderline-lepromatous and lepromatous forms. Discussion Our findings support that leprosy is a spectral disease, characterized by a balance between host immunity and bacillary load. Therefore, the impairment and electroneuromyographic characteristics are distinct and may vary according to the clinical form.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabella Sabião Borges
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Leonardo Peixoto Garcia
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Radiology Division, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
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João FM, Pennini SN, Garnelo L, Vasconcelos ZS, Talhari S, Facundo do Valle M, de Oliveira GMS, Ortiz JV, da Silva AS, de Morais RF, Guerra MDGVB, Guerra JADO. Pre- and post-surgical evaluation of the impact on Hansen disease sequealae patients' quality of life submitted to orthopedic surgery for closure of chronic plantar ulcers. Acta Trop 2024; 249:107019. [PMID: 37952867 DOI: 10.1016/j.actatropica.2023.107019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/09/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Leprosy is a chronic infectious disease that still persists as a public health problem in Brazil. Plantar ulcers are serious complications due to leprosy neuropathy and intensify the isolation and stigma of these individuals. The difficulty in closing these lesions associated with the fetid odor negatively impact the quality of life of people with these lesions. OBJECTIVE To evaluate the clinical, socioeconomic conditions, degree of satisfaction and quality of life (QoL) of patients after healing of chronic ulcers on feet submitted to orthopedic surgery. METHODOLOGY This is a qualitative, exploratory, descriptive and observational study carried out with 92 people after surgical treatment of chronic leprosy plantar ulcers. These patients were submitted to a semi-structured questionnaire raising questions of an epidemiological, socioeconomic and perception of quality-of-life order, comparing before and after the surgical procedure. RESULTS Decrease in indicators - alcohol consumption, tobacco consumption, average monthly cost of analgesic medications, fetid wound odor, foot pain and number of dressings performed weekly; Recurrence of lesions in 55.4 % of cases, related to irregular use or lack of shoes and insoles; Improvement in self-perception of Quality of Life (QoL) in 89.1 % of patients after surgery. CONCLUSION Orthopedic surgical treatment with resection of plantar bony prominences and skin grafting is an effective therapeutic method for closing chronic plantar ulcers in leprosy, resulting in a decrease in the financial costs employed and in an important improvement in the Quality-of-Life parameters of the individuals undergoing to this procedure. The availability and regular use of shoes and insoles is crucial to prevent recurrence of these injuries.
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Affiliation(s)
- Francisco Mateus João
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil; University of Amazonas State, Manaus, Amazonas, Brazil.
| | - Silmara Navarro Pennini
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Alfredo da Mata Foundation - FUAM, Manaus, Amazonas, Brazil
| | - Luíza Garnelo
- Research Center Leonidas and Maria Deane - FIOCRUZ AM, Manaus, Amazonas, Brazil
| | | | - Sinésio Talhari
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Marcello Facundo do Valle
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Guilherme Miranda Silva de Oliveira
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Jessica Vanine Ortiz
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Arinéia Soares da Silva
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Rômulo Freitas de Morais
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Maria das Graças Vale Barbosa Guerra
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
| | - Jorge Augusto de Oliveira Guerra
- Graduate program in Tropical Medicine/Amazonas State University - PPGMT UEA, Manaus, Amazonas, Brazil; Doutor Heitor Vieira Dourado Tropical Medicine Foundation - FMT HVD, Manaus, Amazonas, Brazil
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Thangaraju P, Velmurugan H, Venkatesan S. Antimicrobial Stewardship Program: Time to be Focused in Speciality Settings of Leprosy Institute and Related Health Care Setup. Recent Adv Antiinfect Drug Discov 2024; 19:90-94. [PMID: 37070443 DOI: 10.2174/2772434418666230417114640] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Abstract
Leprosy, often known as Hansen's disease is a contagious chronic infectious disease caused by Mycobacterium leprae (M. leprae). Our methodology is easily repeatable in tertiary care settings with diagnostic accuracy resources and staff capable of building a stewardship team. Comprehensive antimicrobial policies and programmes are required to properly alleviate the initial issue.
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Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur, 492099, Chhattisgarh, India
| | - Hemasri Velmurugan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur, 492099, Chhattisgarh, India
| | - Sajitha Venkatesan
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, 492099, Chhattisgarh, India
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Singh S, Sharma D, Gautam S, Arora M, Bisht D. Exploring the Cell Wall and Secretory Proteins of Mycobacterium leprae as Biomarkers. Protein Pept Lett 2024; 31:11-24. [PMID: 37962043 DOI: 10.2174/0109298665267993231026114709] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/15/2023]
Abstract
The bacterial cell wall is composed of a wide variety of intricate proteins in addition to lipids, glycolipids, and polymers. Given the diversity of cell wall proteins among bacterial species, they are a feasible target for biomarker identification and characterization in clinical research and diagnosis of the disease. The slow growth rate of Mycobacterium leprae poses a major hurdle in the accurate diagnosis of leprosy before the onset of peripheral neuropathy. The use of biomarker- based diagnostic methods can help in preventing the spread and manifestation of leprosy. Despite many advances in research methods and techniques, there remains a knowledge gap regarding the cell wall proteomes of M. leprae that can be used as biomarkers. The cell wall and secretory proteins of M. leprae are the major focus of this review article. This article enfolds the characteristics and functions of M. leprae cell wall proteins and gives an insight into those cell wall proteins that are yet to be established as biomarkers. Tools and techniques used in cell wall extraction and biomarker identification can also be explored in this article.
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Affiliation(s)
- Sakshi Singh
- Department of Biochemistry, ICMR- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, 282001, Uttar Pradesh, India
| | - Devesh Sharma
- Department of Biochemistry, ICMR- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, 282001, Uttar Pradesh, India
| | - Sakshi Gautam
- Department of Biochemistry, ICMR- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, 282001, Uttar Pradesh, India
| | - Mamta Arora
- Clinical Division, ICMR- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, 282001, Uttar Pradesh, India
| | - Deepa Bisht
- Department of Biochemistry, ICMR- National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, 282001, Uttar Pradesh, India
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Cerqueira DDN, Pereira ALS, da Costa AEC, de Souza TJ, de Sousa Fernandes MS, Souto FO, Santos PDA. Xenophagy as a Strategy for Mycobacterium leprae Elimination during Type 1 or Type 2 Leprosy Reactions: A Systematic Review. Pathogens 2023; 12:1455. [PMID: 38133338 PMCID: PMC10747110 DOI: 10.3390/pathogens12121455] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Mycobacterium leprae is an intracellular bacillus that causes leprosy, a neglected disease that affects macrophages and Schwann cells. Leprosy reactions are acute inflammatory responses to mycobacterial antigens, classified as type1 (T1R), a predominant cellular immune response, or type2 (T2R), a humoral phenomenon, leading to a high number of bacilli in infected cells and nerve structures. Xenophagy is a type of selective autophagy that targets intracellular bacteria for lysosomal degradation; however, its immune mechanisms during leprosy reactions are still unclear. This review summarizes the relationship between the autophagic process and M. leprae elimination during leprosy reactions. METHODS Three databases, PubMed/Medline (n = 91), Scopus (n = 73), and ScienceDirect (n = 124), were searched. After applying the eligibility criteria, articles were selected for independent peer reviewers in August 2023. RESULTS From a total of 288 studies retrieved, eight were included. In multibacillary (MB) patients who progressed to T1R, xenophagy blockade and increased inflammasome activation were observed, with IL-1β secretion before the reactional episode occurrence. On the other hand, recent data actually observed increased IL-15 levels before the reaction began, as well as IFN-γ production and xenophagy induction. CONCLUSION Our search results showed a dichotomy in the T1R development and their relationship with xenophagy. No T2R studies were found.
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Affiliation(s)
- Débora Dantas Nucci Cerqueira
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
- Postgraduate Program in Biology Applied to Health-PPGBAS, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil
| | - Ana Letícia Silva Pereira
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
| | - Ana Elisa Coelho da Costa
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
| | - Tarcísio Joaquim de Souza
- Life Sciences Center-NCV, Agreste Academic Center-CAA, Federal University of Pernambuco-UFPE, Caruaru 55014-900, Pernambuco, Brazil;
| | - Matheus Santos de Sousa Fernandes
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
- Postgraduate Program in Biology Applied to Health-PPGBAS, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil
| | - Fabrício Oliveira Souto
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
- Postgraduate Program in Biology Applied to Health-PPGBAS, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil
- Life Sciences Center-NCV, Agreste Academic Center-CAA, Federal University of Pernambuco-UFPE, Caruaru 55014-900, Pernambuco, Brazil;
| | - Patrícia d’Emery Alves Santos
- Department of Immunology, Keizo Asami Institute-iLIKA, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil; (D.D.N.C.); (A.L.S.P.); (A.E.C.d.C.); (M.S.d.S.F.); (F.O.S.)
- Postgraduate Program in Biology Applied to Health-PPGBAS, Federal University of Pernambuco-UFPE, Recife 50670-901, Pernambuco, Brazil
- Life Sciences Center-NCV, Agreste Academic Center-CAA, Federal University of Pernambuco-UFPE, Caruaru 55014-900, Pernambuco, Brazil;
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de Souza FG, da Silva MB, de Araújo GS, Silva CS, Pinheiro AHG, Cáceres-Durán MÁ, Santana-da-Silva MN, Pinto P, Gobbo AR, da Costa PF, Salgado CG, Ribeiro-Dos-Santos Â, Cavalcante GC. Whole mitogenome sequencing uncovers a relation between mitochondrial heteroplasmy and leprosy severity. Hum Genomics 2023; 17:110. [PMID: 38062538 PMCID: PMC10704783 DOI: 10.1186/s40246-023-00555-8] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In recent years, the mitochondria/immune system interaction has been proposed, so that variants of mitochondrial genome and levels of heteroplasmy might deregulate important metabolic processes in fighting infections, such as leprosy. METHODS We sequenced the whole mitochondrial genome to investigate variants and heteroplasmy levels, considering patients with different clinical forms of leprosy and household contacts. After sequencing, a specific pipeline was used for preparation and bioinformatics analysis to select heteroplasmic variants. RESULTS We found 116 variants in at least two of the subtypes of the case group (Borderline Tuberculoid, Borderline Lepromatous, Lepromatous), suggesting a possible clinical significance to these variants. Notably, 15 variants were exclusively found in these three clinical forms, of which five variants stand out for being missense (m.3791T > C in MT-ND1, m.5317C > A in MT-ND2, m.8545G > A in MT-ATP8, m.9044T > C in MT-ATP6 and m.15837T > C in MT-CYB). In addition, we found 26 variants shared only by leprosy poles, of which two are characterized as missense (m.4248T > C in MT-ND1 and m.8027G > A in MT-CO2). CONCLUSION We found a significant number of variants and heteroplasmy levels in the leprosy patients from our cohort, as well as six genes that may influence leprosy susceptibility, suggesting for the first time that the mitogenome might be involved with the leprosy process, distinction of clinical forms and severity. Thus, future studies are needed to help understand the genetic consequences of these variants.
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Affiliation(s)
- Felipe Gouvea de Souza
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Moisés Batista da Silva
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Gilderlanio S de Araújo
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Caio S Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Andrey Henrique Gama Pinheiro
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Miguel Ángel Cáceres-Durán
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Mayara Natália Santana-da-Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Pablo Pinto
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Patrícia Fagundes da Costa
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil.
| | - Giovanna C Cavalcante
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil.
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Santana-da-Silva MN, Sena-dos-Santos C, Cáceres-Durán MÁ, de Souza FG, Gobbo AR, Pinto P, Salgado CG, dos Santos SEB. ncRNAs: an unexplored cellular defense mechanism in leprosy. Front Genet 2023; 14:1295586. [PMID: 38116294 PMCID: PMC10729009 DOI: 10.3389/fgene.2023.1295586] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Leprosy is an infectious disease primarily caused by the obligate intracellular parasite Mycobacterium leprae. Although it has been considered eradicated in many countries, leprosy continues to be a health issue in developing nations. Besides the social stigma associated with it, individuals affected by leprosy may experience nerve damage leading to physical disabilities if the disease is not properly treated or early diagnosed. Leprosy is recognized as a complex disease wherein socioenvironmental factors, immune response, and host genetics interact to contribute to its development. Recently, a new field of study called epigenetics has emerged, revealing that the immune response and other mechanisms related to infectious diseases can be influenced by noncoding RNAs. This review aims to summarize the significant advancements concerning non-coding RNAs in leprosy, discussing the key perspectives on this novel approach to comprehending the pathophysiology of the disease and identifying molecular markers. In our view, investigations on non-coding RNAs in leprosy hold promise and warrant increased attention from researches in this field.
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Affiliation(s)
- Mayara Natália Santana-da-Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
- Laboratório de Imunologia, Seção de Virologia (SAVIR), Instituto Evandro Chagas, Ananindeua, Brazil
| | - Camille Sena-dos-Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Miguel Ángel Cáceres-Durán
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Felipe Gouvea de Souza
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Angelica Rita Gobbo
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Pablo Pinto
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Sidney Emanuel Batista dos Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas (ICB), Universidade Federal do Pará (UFPA), Belém, Brazil
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Dwivedi P, Sharma M, Singh P. Multiplex PCR-based RFLP assay for early identification of prevalent Mycobacterium leprae genotypes. Diagn Microbiol Infect Dis 2023; 107:116084. [PMID: 37832201 DOI: 10.1016/j.diagmicrobio.2023.116084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/26/2023] [Accepted: 09/09/2023] [Indexed: 10/15/2023]
Abstract
Mycobacterium leprae is classified into four SNP genotypes and 16 subtypes (from 1A to 4P) that exhibit phylogeographical association reported from around the world. Among them, genotypes 1D and 3I represent more than 60% of M. leprae strains. Here, we report a new method for M. leprae genotyping which identifies the genotypes 1D and 3I by combining multiplex PCR amplification and restriction fragment length polymorphism (RFLP) of a M. leprae DNA amplicons using AgeI restriction enzyme. Agarose gel electrophoresis showed a deletion of 11 bp only among 3I genotypes by electrophoresis. When this multiplex PCR reaction is subjected to AgeI digestion, successful restriction digestion shows three bands for all the genotypes except 1D where only two bands were observed due to loss of restriction site. This method gives us the advantage of 1-step identification of the two most prevalent strains of M. leprae without using specialized equipments such as the Sanger sequencing system or quantitative PCR.
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Affiliation(s)
- Purna Dwivedi
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India; The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Mukul Sharma
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Pushpendra Singh
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India.
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Brügger LMDO, dos Santos MML, Lara FA, Mietto BS. What happens when Schwann cells are exposed to Mycobacterium leprae - A systematic review. IBRO Neurosci Rep 2023; 15:11-16. [PMID: 38204570 PMCID: PMC10776321 DOI: 10.1016/j.ibneur.2023.05.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 01/12/2024] Open
Abstract
Mycobacterium leprae, the pathogen that causes human leprosy, has a unique affinity for infecting and persisting inside Schwann cells, the principal glia of the peripheral nervous system. Several studies have focused on this intricate host-pathogen interaction as an attempt to advance the current knowledge of the mechanisms governing nerve destruction and disease progression. However, during the chronic course of leprosy neuropathy, Schwann cells can respond to and internalize both live and dead M. leprae and bacilli-derived antigens, and this may result in divergent cellular pathobiological responses. This may also distinctly contribute to tissue degeneration, failure to repair, inflammatory reactions, and nerve fibrosis, hallmarks of the disease. Therefore, the present study systematically searched for published studies on M. leprae-Schwann cell interaction in vitro to summarize the findings and provide a focused discussion of Schwann cell dynamics following challenge with leprosy bacilli.
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Driedger M, Teo I, Roth V. Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report. BMC Infect Dis 2023; 23:815. [PMID: 37990293 PMCID: PMC10662535 DOI: 10.1186/s12879-023-08811-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Leprosy is rare within non-endemic countries such as Canada, where cases are almost exclusively imported from endemic regions, often presenting after an incubation period of as many as 20 years. Due to its rarity and prolonged incubation period, diagnosis is often delayed, which may result in neurologic impairment prior to the initiation of treatment. In this report we describe a case that is novel in its incubation period, which is the longest reported to-date and may have contributed to diagnostic delay. The case also uniquely demonstrates the challenges of distinguishing leprosy reactions from new rheumatologic manifestations in a patient with established autoimmune disease. CASE PRESENTATION We describe an 84-year-old male patient with rheumatoid arthritis on methotrexate and hydroxychloroquine, with no travel history outside Canada for 56 years, who presented in 2019 with new-onset paresthesias and rash. His paresthesias persisted despite a short course of prednisone, and his rash recurred after initial improvement. He underwent skin biopsy in May 2021, which eventually led to the diagnosis of leprosy. He was diagnosed with type 1 reaction and was started on rifampin, dapsone, clofazimine and prednisone, with which his rash resolved but his neurologic impairment remained. CONCLUSION This case report serves to highlight the potential for leprosy to present after markedly prolonged incubation periods. This is especially relevant in non-endemic countries that is home to an aging demographic of individuals who migrated decades ago from endemic countries. The importance of this concept is emphasized by the persistent neurologic impairment suffered by our case due to untreated type 1 reaction. We also demonstrate the necessity of skin biopsy in distinguishing this diagnosis from other autoimmune mimics in a patient with known autoimmune disease.
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Affiliation(s)
| | - Iris Teo
- University of Ottawa, Ottawa, ON, Canada
- Division of Anatomical Pathology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Virginia Roth
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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18
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Gama MEF, Pereira ADPC. Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008-2018. Enferm Infecc Microbiol Clin (Engl Ed) 2023:S2529-993X(23)00254-X. [PMID: 37919202 DOI: 10.1016/j.eimce.2023.06.009] [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] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae. OBJECTIVES To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality. METHODS A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil. RESULTS Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions. CONCLUSIONS The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.
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Affiliation(s)
- Maria Eugênia Farias Gama
- Municipal Health Secretariat in Recife, Health District VI, Recife, Brazil; Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil.
| | - Aline de Paula Caetano Pereira
- Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil; Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
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19
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Patel NH, Padhiyar JK, Patel KA, Patel JR, Lakum MP, Singh I. Effective amelioration of the Lucio phenomenon with adjuvant tofacitinib therapy in a patient with dual infection of Mycobacterium leprae and Mycobacterium lepromatosis: a case report from India. Access Microbiol 2023; 5:000460.v3. [PMID: 37970083 PMCID: PMC10634479 DOI: 10.1099/acmi.0.000460.v3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/10/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction The Lucio phenomenon (LP) is a characteristic reaction pattern seen in patients with diffuse lepromatous leprosy (DLL). Dual infection with Mycobacterium leprae and Mycobacterium lepromatosis in DLL has been confirmed from other endemic countries but not previously documented from India. Conventionally, LP is treated with a high dose of systemic glucocorticoid (GC) and anti-leprosy treatment (ALT). Here we report a case of leprosy lymphadenitis at initial presentation in a patient with LP and DLL due to dual infection with M. leprae and M. lepromatosis who responded favourably to tofacitinib as adjuvant to ALT and systemic GC therapy. Case report A 20- to 30-year-old man presented with swelling over the bilateral inguinal region, pus-filled skin lesions with multiple ulcers, fever and joint pain. Post-hospitalization investigations showed the presence of anaemia, leukocytosis, and elevated acute and chronic inflammatory markers. Skin and lymph node biopsies were suggestive of LP and leprosy lymphadenitis. The presence of M. leprae and M. lepromatosis was confirmed by PCR followed by DNA sequencing of PCR amplicons from tissue. Despite anti-leprosy treatment, oral GC and thalidomide therapy, the patient continued to develop new lesions. One month after the commencement of adjuvant tofacitinib, the patient showed excellent clinical improvement with healing of all existing lesions and cessation of new LP lesions. Conclusion Our case confirms the presence of dual infection with M. leprae and lepromatosis in India. Lymph node involvement as an initial presentation of DLL should be considered in endemic areas. Tofacitinib may be a promising new adjuvant therapy for recalcitrant lepra reactions.
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Affiliation(s)
| | | | | | | | | | - Itu Singh
- Stanley Browne Laboratory, TLM Community Hospital, Nand Nagari, Delhi, India
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Huang J, Tong Y, Yang X, Chen Y, Wei X, Chen X, Li J, Li S. Biosensor-Based Multiple Cross Displacement Amplification for the Rapid Detection of Mycobacterium leprae. ACS Infect Dis 2023; 9:1932-1940. [PMID: 37738642 DOI: 10.1021/acsinfecdis.3c00213] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Leprosy is an ancient disease caused by Mycobacterium leprae (ML) that remains a public health problem in poverty-stricken areas worldwide. Although many ML detection techniques have been used, a rapid and sensitive tool is essential for the early detection and treatment of leprosy. Herein, we developed a rapid ML detection technique by combining multiple cross displacement amplification (MCDA) with a nanoparticle-based lateral flow biosensor (LFB), termed ML-MCDA-LFB. MCDA induced a rapid isothermal reaction using specific primers targeting the RLEP gene, and the LFB enabled instant visual amplicon detection. The pure genomic DNA of ML and nucleic acids from various pathogens were employed to evaluate and optimize the ML-MCDA-LFB assay. The optimal conditions for ML-MCDA-LFB were 68 °C and 35 min, respectively. The limit of detection for pure ML genomic DNA was 150 fg per vessel, and the specificity of detection was 100% for the experimental strains. Additionally, the entire detection process could be performed within 40 min, including the isothermal amplification (35 min) and result confirmation (1-2 min). Hence, the ML-MCDA-LFB assay was shown to be a rapid, sensitive, and visual method for detecting ML and could be used as a potential tool for early clinical diagnosis and field screening of leprosy.
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Affiliation(s)
- Junfei Huang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Yi Tong
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Xinggui Yang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Yijiang Chen
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Xiaoyu Wei
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Xu Chen
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550003, P. R. China
| | - Jinlan Li
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
| | - Shijun Li
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou 550004, P. R. China
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Krausser L, Chauvaux E, Van Dyck-Lippens M, Yssouf A, Assoumani Y, Tortosa P, de Jong BC, Braet SM. Ticks are unlikely to play a role in leprosy transmission in the Comoros (East Africa) as they do not harbour M. leprae DNA. Front Med (Lausanne) 2023; 10:1238914. [PMID: 37859857 PMCID: PMC10582737 DOI: 10.3389/fmed.2023.1238914] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Leprosy, one of the oldest known human diseases, continues to pose a global challenge for disease control due to an incomplete understanding of its transmission pathways. Ticks have been proposed as a potential contributor in leprosy transmission due to their importance as vectors for other infectious diseases. Methods In 2010, a sampling of ticks residing on cattle was conducted on the islands Grande Comore, Anjouan, and Mohéli which constitute the Union of the Comoros where leprosy remains endemic. To investigate the potential role of ticks as a vector in transmission of leprosy disease, molecular analyses were conducted. Results Out of the 526 ticks analysed, none were found to harbour Mycobacterium leprae DNA, as determined by a quantitative polymerase chain reaction (qPCR) assay targeting a family of dispersed repeats (RLEP) specific to M. leprae. Discussion Therefore, our results suggest that in the Union of the Comoros, ticks are an unlikely vector for M. leprae.
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Affiliation(s)
- Lena Krausser
- Department of Biomedical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Elien Chauvaux
- Department of Biomedical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
| | | | - Amina Yssouf
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CHU de La Réunion, Plateforme Technologique CYROI, Sainte-Clotilde, Réunion Island, France
- Plan National de Lutte contre le Paludisme, Moroni, Comoros
| | - Younoussa Assoumani
- Damien Foundation, Brussels, Belgium
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Pablo Tortosa
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CHU de La Réunion, Plateforme Technologique CYROI, Sainte-Clotilde, Réunion Island, France
- Université de La Réunion, Fédération de recherche Environnement, Biodiversité et Santé, Saint-Denis, Réunion Island, France
| | | | - Sofie Marijke Braet
- Department of Biomedical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
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Huang J, Tong Y, Chen Y, Yang X, Wei X, Chen X, Li J, Li S. Highly sensitive and rapid determination of Mycobacterium leprae based on real-time multiple cross displacement amplification. BMC Microbiol 2023; 23:272. [PMID: 37770823 PMCID: PMC10537127 DOI: 10.1186/s12866-023-03004-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Mycobacterium leprae (ML) is the pathogen that causes leprosy, which has a long history and still exists today. ML is an intracellular mycobacterium that dominantly induces leprosy by causing permanent damage to the skin, nerves, limbs and eyes as well as deformities and disabilities. Moreover, ML grows slowly and is nonculturable in vitro. Given the prevalence of leprosy, a highly sensitive and rapid method for the early diagnosis of leprosy is urgently needed. RESULTS In this study, we devised a novel tool for the diagnosis of leprosy by combining restriction endonuclease, real-time fluorescence analysis and multiple cross displacement amplification (E-RT-MCDA). To establish the system, primers for the target gene RLEP were designed, and the optimal conditions for E-RT-MCDA at 67 °C for 36 min were determined. Genomic DNA from ML, various pathogens and clinical samples was used to evaluate and optimize the E-RT-MCDA assay. The limit of detection (LoD) was 48.6 fg per vessel for pure ML genomic DNA, and the specificity of detection was as high as 100%. In addition, the detection process could be completed in 36 min by using a real-time monitor. CONCLUSION The E-RT-MCDA method devised in the current study is a reliable, sensitive and rapid technique for leprosy diagnosis and could be used as a potential tool in clinical settings.
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Affiliation(s)
- Junfei Huang
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Yi Tong
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Yijiang Chen
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Xinggui Yang
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Xiaoyu Wei
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Xu Chen
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, 550003, People's Republic of China
| | - Jinlan Li
- Tuberculosis Control Institute, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Shijun Li
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China.
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou, 550025, People's Republic of China.
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Bylicka-Szczepanowska E, Podlasin RB, Korzeniewski K. Leprosy - neglected tropical disease in Pygmies inhabiting Central African Republic. Ann Agric Environ Med 2023; 30:570-576. [PMID: 37772537 DOI: 10.26444/aaem/161465] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Leprosy is a neglected tropical disease that is still present worldwide despite efforts aimed at elimination of the disease. The BaAka Pygmy community inhabiting rural areas in the Central African Republic is one of the most leprosy-vulnerable populations. The aim of the study was to assess the prevalence of leprosy in the BaAka Pygmy population. People living in the Dzanga Sangha protected area were regularly visited by a mobile clinic in 2019/2020. The diagnosis was based on the clinical manifestation of the disease. Deformations of skin and extremities were assessed. In a 12-month period 26 cases of leprosy were diagnosed and 25 patients received treatment. 24 of those patients were BaAka Pygmies, 10 were women, 7 were children under 15 years old and 8 were diagnosed with grade 2 disability. Presented data shows that leprosy in Dzanga Sangha region is not well controlled due to the high transmission rate. Efforts to diagnose and report new leprosy cases should be intensified.
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Affiliation(s)
- Emilia Bylicka-Szczepanowska
- 4th Department of Infectious Diseases, Hospital for Infectious Diseases, Warsaw, Poland
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Regina B Podlasin
- 4th Department of Infectious Diseases, Hospital for Infectious Diseases, Warsaw, Poland
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Krzysztof Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, Warsaw, Poland
- Department of Tropical Medicine and Epidemiology, Medical University / Institute of Maritime and Tropical Medicine, Gdańsk, Poland
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Cruz VA, de Albuquerque CP, Guimarães MFBDR, Dionello CDF, Ribeiro SLE, de Souza VA, Gomes CM, da Mota LMH. New insights at the interface between leprosy and immune-mediated rheumatic diseases. Front Med (Lausanne) 2023; 10:1239775. [PMID: 37822467 PMCID: PMC10564075 DOI: 10.3389/fmed.2023.1239775] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
Leprosy is an infectious and contagious disease of slow evolution, triggered by Mycobacterium leprae. Arthritis is its third most common manifestation, after cutaneous and peripheral nerve involvement. Since musculoskeletal symptoms may be the initial presentation of the disease, it is important for health professionals to recognize its rheumatic manifestations for early diagnosis and appropriate treatment, especially in endemic areas. In addition, cases of leprosy have increased globally, notably in patients undergoing treatment with TNF-α blockers and due to the increase in migration and travel of people from developing countries to developed countries. This review proposes to discuss the main scenarios of mimicry of different rheumatic diseases by leprosy, as well as the role of immunosuppressive drugs used in rheumatology practice in the treatment of reactional states and in the risk of developing the infection.
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25
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Bouth RC, Gobbo AR, Barreto JG, do Carmo Pinto PD, Bittencourt MS, Frade MAC, Nascimento AC, Bandeira SS, da Costa PF, Conde GAB, Avanzi C, Ribeiro-dos-Santos Â, Spencer JS, da Silva MB, Salgado CG. Specialized active leprosy search strategies in an endemic area of the Brazilian Amazon identifies a hypermutated Mycobacterium leprae strain causing primary drug resistance. Front Med (Lausanne) 2023; 10:1243571. [PMID: 37780551 PMCID: PMC10534026 DOI: 10.3389/fmed.2023.1243571] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Leprosy, an infectious disease caused by Mycobacterium leprae, remains a public health concern in endemic countries, particularly in Brazil. In this study, we conducted an active surveillance campaign in the hyperendemic city of Castanhal in the northeastern part of the state of Pará using clinical signs and symptoms combined with serological and molecular tools to diagnose new cases and to identify drug resistance of circulating M. leprae strains and their distribution in the community. Methods During an active surveillance of one week, we enrolled 318 individuals using three different strategies to enroll subjects for this study: (i) an active survey of previously treated cases from 2006 to 2016 found in the Brazil National Notifiable Disease Information System database (n = 23) and their healthy household contacts (HHC) (n = 57); (ii) an active survey of school children (SC) from two primary public schools in low-income neighborhoods (n = 178), followed by visits to the houses of these newly diagnosed SC (n = 7) to examine their HHC (n = 34) where we diagnosed additional new cases (n = 6); (iii) and those people who spontaneously presented themselves to our team or the local health center with clinical signs and/or symptoms of leprosy (n = 6) with subsequent follow-up of their HHC when the case was confirmed (n = 20) where we diagnosed two additional cases (n = 2). Individuals received a dermato-neurological examination, 5 ml of peripheral blood was collected to assess the anti-PGL-I titer by ELISA and intradermal earlobe skin scrapings were taken from HHC and cases for amplification of the M. leprae RLEP region by qPCR. Results Anti-PGL-I positivity was highest in the new leprosy case group (52%) followed by the treated group (40.9%), HHC (40%) and lowest in SC (24.6%). RLEP qPCR from SSS was performed on 124 individuals, 22 in treated cases, 24 in newly diagnosed leprosy cases, and 78 in HHC. We detected 29.0% (36/124) positivity overall in this sample set. The positivity in treated cases was 31.8% (7/22), while in newly diagnosed leprosy cases the number of positives were higher, 45.8% (11/23) and lower in HHC at 23.7% (18/76). Whole genome sequencing of M. leprae from biopsies of three infected individuals from one extended family revealed a hypermutated M. leprae strain in an unusual case of primary drug resistance while the other two strains were drug sensitive. Discussion This study represents the extent of leprosy in an active surveillance campaign during a single week in the city of Castanhal, a city that we have previously surveyed several times during the past ten years. Our results indicate the continuing high transmission of leprosy that includes fairly high rates of new cases detected in children indicating recent spread by multiple foci of infection in the community. An unusual case of a hypermutated M. leprae strain in a case of primary drug resistance was discovered. It also revealed a high hidden prevalence of overt disease and subclinical infection that remains a challenge for correct clinical diagnosis by signs and symptoms that may be aided using adjunct laboratory tests, such as RLEP qPCR and anti-PGL-I serology.
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Affiliation(s)
- Raquel Carvalho Bouth
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Spatial Epidemiology Laboratory, Federal University of Pará, Castanhal, Brazil
| | | | | | - Marco Andrey Cipriani Frade
- Divisão de Dermatologia, Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
| | - Apolônio Carvalho Nascimento
- Unidade de Referência Especializada em Dermatologia Sanitária do Estado do Pará – URE Dr. Marcelo Candia, Marituba, Pará, Brazil
| | - Sabrina Sampaio Bandeira
- Unidade de Referência Especializada em Dermatologia Sanitária do Estado do Pará – URE Dr. Marcelo Candia, Marituba, Pará, Brazil
| | | | | | - Charlotte Avanzi
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
| | | | - John Stewart Spencer
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
| | | | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Coordenação de Atenção às Doenças Transmissíveis na Atenção Primária à Saúde, Departamento de Gestão do Cuidado Integral, Secretaria de Atenção Primária à Saúde, Ministério da Saúde, Brasília, Brazil
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Costa WDL, de Oliveira AM, Aguilar GJ, Dos Santos LMAC, Dos Santos LRA, Donato DDCB, Foresto F, Frade MAC. A Review of Software and Mobile Apps to Support the Clinical Diagnosis of Hansen Disease. JMIR Dermatol 2023; 6:e47142. [PMID: 37594779 PMCID: PMC10474501 DOI: 10.2196/47142] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023] Open
Abstract
This scoping review indicates a lack of scientific articles that specifically explore software and mobile applications designed to assist in the clinical diagnosis of leprosy, and our findings have provided insights into the available tools, their usage methods, and the benefits offered by health technologies.
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Affiliation(s)
- Wilbert Dener Lemos Costa
- Intersection LTDA, Ribeirão Preto, Brazil
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Alan Maicon de Oliveira
- Intersection LTDA, Ribeirão Preto, Brazil
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme José Aguilar
- Intersection LTDA, Ribeirão Preto, Brazil
- Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Felipe Foresto
- Intersection LTDA, Ribeirão Preto, Brazil
- School of Economics, Business Administration and Accounting at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Abstract
Florida, USA, has witnessed an increased incidence of leprosy cases lacking traditional risk factors. Those trends, in addition to decreasing diagnoses in foreign-born persons, contribute to rising evidence that leprosy has become endemic in the southeastern United States. Travel to Florida should be considered when conducting leprosy contact tracing in any state.
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Gautam S, Sharma D, Singh S, Arora M, Goel A, Bisht D. Analysis of socioeconomic condition and bacillary index with respect to the development of Hansen's disease. Int J Mycobacteriol 2023; 12:254-260. [PMID: 37721229 DOI: 10.4103/ijmy.ijmy_108_23] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae or Mycobacterium lepromatosis and mainly affects the skin and peripheral nerves. Although treatable, its early intervention can significantly reduce the occurrence of disability. India accounts for more than half of new cases globally. This study was undertaken to better understand the clinical traits of newly diagnosed cases in a tertiary facility of Western Uttar Pradesh, and a few from Madhya Pradesh and Uttarakhand. Methods The observational prospective study was carried out on all the newly diagnosed leprosy cases who visited the Outpatient Department of ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, during October 2019-December 2022. After obtaining answers to a prestructured questionnaire with their consent, participants were enrolled in the study and underwent clinical examination and a slit-skin smear test. Results A total of 56 cases were investigated, and among them, 20 (35.7%) and 36 (64.3%) women and men, respectively, had positive contact with persons affected by leprosy either within family, friends, or neighbors. It is observed that due to the delayed detection of leprosy cases, paucibacillary (PB) patients converted into multibacillary (MB) patients, and the number of MB cases is much higher compared to PB cases. Conclusion Leprosy instances continue to spread frequently from sick to healthy people indicating continued transmission of leprosy in society. Multidrug therapy in the management of leprosy cases is effective; however, early diagnosis of PB cases is still a challenge and needs to be addressed on priority.
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Affiliation(s)
- Sakshi Gautam
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Devesh Sharma
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Sakshi Singh
- Clinical Division, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Mamta Arora
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Anjana Goel
- Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India
| | - Deepa Bisht
- Department of Biochemistry, ICMR-National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
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Jouet A, Braet SM, Gaudin C, Bisch G, Vasconcellos S, Epaminondas Nicacio de Oliveira do Livramento RE, Prado Palacios YY, Fontes AB, Lucena N, Rosa P, Moraes M, La K, Badalato N, Lenoir E, Ferré A, Clément M, Hasker E, Grillone SH, Abdou W, Said A, Assoumani Y, Attoumani N, Laurent Y, Cambau E, de Jong BC, Suffys PN, Supply P. Hi-plex deep amplicon sequencing for identification, high-resolution genotyping and multidrug resistance prediction of Mycobacterium leprae directly from patient biopsies by using Deeplex Myc-Lep. EBioMedicine 2023; 93:104649. [PMID: 37327675 DOI: 10.1016/j.ebiom.2023.104649] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Expansion of antimicrobial resistance monitoring and epidemiological surveillance are key components of the WHO strategy towards zero leprosy. The inability to grow Mycobacterium leprae in vitro precludes routine phenotypic drug susceptibility testing, and only limited molecular tests are available. We evaluated a culture-free targeted deep sequencing assay, for mycobacterial identification, genotyping based on 18 canonical SNPs and 11 core variable-number tandem-repeat (VNTR) markers, and detection of rifampicin, dapsone and fluoroquinolone resistance-associated mutations in rpoB/ctpC/ctpI, folP1, gyrA/gyrB, respectively, and hypermutation-associated mutations in nth. METHODS The limit of detection (LOD) was determined using DNA of M. leprae reference strains and from 246 skin biopsies and 74 slit skin smears of leprosy patients, with genome copies quantified by RLEP qPCR. Sequencing results were evaluated versus whole genome sequencing (WGS) data of 14 strains, and versus VNTR-fragment length analysis (FLA) results of 89 clinical specimens. FINDINGS The LOD for sequencing success ranged between 80 and 3000 genome copies, depending on the sample type. The LOD for minority variants was 10%. All SNPs detected in targets by WGS were identified except in a clinical sample where WGS revealed two dapsone resistance-conferring mutations instead of one by Deeplex Myc-Lep, due to partial duplication of the sulfamide-binding domain in folP1. SNPs detected uniquely by Deeplex Myc-Lep were missed by WGS due to insufficient coverage. Concordance with VNTR-FLA results was 99.4% (926/932 alleles). INTERPRETATION Deeplex Myc-Lep may help improve the diagnosis and surveillance of leprosy. Gene domain duplication is an original putative drug resistance-related genetic adaptation in M. leprae. FUNDING EDCTP2 programme supported by the European Union (grant number RIA2017NIM-1847 -PEOPLE). EDCTP, R2Stop: Effect:Hope, The Mission To End Leprosy, the Flemish Fonds Wetenschappelijk Onderzoek.
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Affiliation(s)
| | - Sofie Marijke Braet
- Institute of Tropical Medicine, Antwerp, Belgium; Department of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium; Research Foundation Flanders, Brussels, Belgium
| | | | | | - Sidra Vasconcellos
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Yrneh Yadamis Prado Palacios
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Patricia Rosa
- Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil
| | | | - Kevin La
- APHP-GHU Paris Nord Hôpital Bichat, Service de mycobactériologie spécialisée et de référence, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux - Laboratoire Associé, Paris, France; Université Paris Cité, INSERM, IAME UMR1137, Paris, France
| | | | | | | | | | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Younoussa Assoumani
- Damien Foundation, Comoros; National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | | | - Emmanuelle Cambau
- APHP-GHU Paris Nord Hôpital Bichat, Service de mycobactériologie spécialisée et de référence, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux - Laboratoire Associé, Paris, France; Université Paris Cité, INSERM, IAME UMR1137, Paris, France
| | | | - Philip Noël Suffys
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Philip Supply
- Univ. Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.
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Jin SH, Lee SB. CD11b +Gr-1 low cells that accumulate in M.leprae-induced granulomas of the footpad skin of nude mice have the characteristics of monocytic-myeloid-derived suppressor cells. Tuberculosis (Edinb) 2023; 140:102345. [PMID: 37116235 DOI: 10.1016/j.tube.2023.102345] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023]
Abstract
CD11b+Gr-1low cells that are increased in the lungs of a Mycobacterium (M) tuberculosis-infection mouse model have the characteristics of monocytic (M)-myeloid-derived suppressor cells (MDSCs) and harbor M.tuberculosis. Interestingly, a high number of M-MDSCs have also been observed in skin lesions of patients with lepromatous leprosy. We hypothesized that CD11b+Gr-1low cells might be involved in the pathogenesis of leprosy, as they are in tuberculosis. In the current study, we investigated the issue of whether CD11b+Gr-1low cells accumulate in Mycobacterium (M) leprae-induced granulomas of the footpad skin of nude mice. Our results show that CD11b+Gr-1low cells began to accumulate in the 7-month-old M.leprae-induced granulomas and were replaced by other leukocytes, including CD11b+Gr-1high over time during M.leprae infections. CD11b + Gr-1low cells expressed the surface markers of M-MDSC, Ly6Chigh and Ly6Glow. In addition, CD11b+Gr-1low cells have the nuclei of a mononuclear cell type and expressed higher levels of arginase 1 (Arg1) and inducible NO synthetase (iNOS). Furthermore, they showed a higher infection rate by M.leprae. Taken together, our results indicate that the inoculation with M.leprae induced an accumulation of CD11b + Gr-1low at a relatively early stage, 7-month-old M.leprae-induced granulomas, and that CD11b+Gr-1low have the characteristics of M-MDSC and may act as a reservoir for M.leprae.
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Affiliation(s)
- Song-Hyo Jin
- Institute of Hansen's Disease, Department of Pathology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Seong-Beom Lee
- Institute of Hansen's Disease, Department of Pathology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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Chau HTT, Nguyen PNH, Nguyen HB. Genotyping of Mycobacterium leprae strains in south central coast and central highlands of Vietnam. Iran J Microbiol 2023; 15:201-207. [PMID: 37193237 PMCID: PMC10183076 DOI: 10.18502/ijm.v15i2.12470] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background and Objectives Leprosy remains an important health problem worldwide. It is one of the oldest recorded diseases of humankind. In this study, we expanded the analysis of the geographic distribution of Mycobacterium leprae by investigating SNPs and rpoT genotypes in South Central Coast and Central Highlands clinical isolates, providing insights into the distribution and transmission of leprosy in Vietnam and in this geographic region. Materials and Methods 27 clinical isolates from the patients, determined the genotypes of M. leprae by SNP and rpoT polymorphism. SNP genotyping was performed by PCR amplification and sequencing, rpoT genotyping by PCR amplification and electrophoresis. Results All of 27 DNA samples (100%) were positive with RLEP TaqMan PCR (Ct value range is 18-32 on 3 replicates). SNP type 1 was identified in 15 isolates (56%), while SNP type 3 was detected in 12 samples (44%). SNP type 2 and type 4, were not detected. The 6-base repeat region of the rpoT gene was amplified by PCR and analyzed by 4% MetaPhor™ agarose gel electrophoresis. All isolates yielded amplification products of 91-bp, but not 97-bp. Conclusion This study showed that 56% of isolates belonged to type 1, 44% to type 3. In addition, all samples have the 3-copy hexamer genotype in the rpoT gene.
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Affiliation(s)
- Ho Tinh Tam Chau
- Department of Molecular Biology, Quy Hoa National Leprosy & Dermatology Hospital, Binh Dinh, Vietnam
| | - Phuc Nhu Ha Nguyen
- Department of Molecular Biology, Quy Hoa National Leprosy & Dermatology Hospital, Binh Dinh, Vietnam
| | - Hoang Bach Nguyen
- Department of Microbiology, Hue University of Medicine and Pharmacy, Hue, Vietnam
- Corresponding author: Hoang Bach Nguyen, Ph.D, Department of Microbiology, Hue University of Medicine and Pharmacy, Hue, Vietnam. Tel: +84-983303187, Fax: +84-2343826269,
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Romero-Alvarez D, Garzon-Chavez D, Jackson M, Avanzi C, Peterson AT. Mycobacterium leprae in Armadillo Tissues from Museum Collections, United States. Emerg Infect Dis 2023; 29:622-626. [PMID: 36823763 PMCID: PMC9973711 DOI: 10.3201/eid2903.221636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We examined armadillos from museum collections in the United States using molecular assays to detect leprosy-causing bacilli. We found Mycobacterium leprae bacilli in samples from the United States, Bolivia, and Paraguay; prevalence was 14.8% in nine-banded armadillos. US isolates belonged to subtype 3I-2, suggesting long-term circulation of this genotype.
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Thangaraju P, T Y SS, Vijayakumar AR, Navabshan I, Ansari T. A perspective into"TEL" - Tenofovir, Emtricitabine, and Lamivudine antileprotic activities by drug repurposing and exploring the possibility of combination chemotherapy with drug rescued molecules for a leprosy free mankind. Recent Adv Antiinfect Drug Discov 2023:RAAIDD-EPUB-129622. [PMID: 36803758 DOI: 10.2174/2772434418666230220123217] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/03/2022] [Accepted: 01/06/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Since leprosy bacilli cannot grow in vitro, testing for antimicrobial resistance against Mycobacterium leprae or assessing the anti-leprosy activity of new drugs remains hard. Furthermore, developing a new leprosy drug through the traditional drug development process is not economically captivating for pharmaceutical companies. As a result, repurposing existing drugs/approved medications or their derivatives to test their anti-leprotic potency is a promising alternative. It is an accelerated method to uncover different medicinal and therapeutic properties in approved drug molecules. AIM The study aims to explore the binding potential of anti-viral drugs such as Tenofovir, Emtricitabine, and Lamivudine (TEL) against Mycobacterium leprae using molecular docking. METHODS The current study evaluated and confirmed the possibility of repurposing anti-viral drugs such as TEL (Tenofovir, Emtricitabine, and Lamivudine) by transferring the graphical window of the BIOVIA DS2017 with the Crystal Structure of a phosphoglycerate mutase gpm1 from Mycobacterium leprae (PDB ID:4EO9). Utilizing the smart minimizer algorithm, the protein's energy was reduced in order to achieve a stable local minima conformation. RESULTS The protein and molecule energy minimization protocol generated stable configuration energy molecules. The protein 4EO9 energy was reduced from 14264.5 kcal/mol to -17588.1 kcal/mol. CONCLUSION The CHARMm algorithm-based CDOCKER run docked all three molecules (TEL) inside the 4EO9 protein binding pocket (Mycobacterium leprae). The interaction analysis revealed that tenofovir had a better binding molecule with a score of -37.7297 kcal/mol than the other molecules.
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Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India
| | - Sree Sudha T Y
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
| | - A R Vijayakumar
- Department of Pharmacology, Faculty of Pharmacy, Sree Balaji Medical College and Hospital, Biher, Chennai, India
| | - Irfan Navabshan
- School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science & Technology, Vandalur, Chennai-48. Tamilnadu
| | - Thameemul Ansari
- School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science & Technology, Vandalur, Chennai-48. Tamilnadu
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Yang J, Kong J, Li B, Ji Z, Liu A, Chen J, Liu M, Fan Y, Peng L, Song J, Wu X, Gao L, Ma W, Dong Y, Luo S, Bao F. Seventy years of evidence on the efficacy and safety of drugs for treating leprosy: a network meta-analysis. J Infect 2023; 86:338-351. [PMID: 36796681 DOI: 10.1016/j.jinf.2023.02.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The World Health Organization (WHO) recommends multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine for treating leprosy, which is based on very low-quality evidence. Here, we performed a network meta-analysis (NMA) to produce quantitative evidence to strengthen current WHO recommendations. METHOD All studies were obtained from Embase and PubMed from the date of establishment to October 9, 2021. Data were synthesized with frequentist random-effects network meta-analyses. Outcomes were assessed using odds ratios (ORs), 95% confidence intervals (95% CIs), and P score. RESULTS Sixty controlled clinical trials and 9256 patients were included. MDT was effective (range of OR: 1.06-1255584.25) for treating leprosy and multibacillary leprosy. Six treatments (Range of OR: 1.199-4.50) were more effective than MDT. Clofazimine (P score=0.9141) and dapsone+rifampicin (P score=0.8785) were effective for treating type 2 leprosy reaction. There were no significant differences in the safety of any of the tested drug regimens. CONCLUSIONS The WHO MDT is effective for treating leprosy and multibacillary leprosy, but it may not be effective enough. Pefloxacin and ofloxacin may be good adjunct drugs for increasing MDT efficacy. Clofazimine and dapsone+rifampicin can be used in the treatment of a type 2 leprosy reaction. Single-drug regimens are not efficient enough to treat leprosy, multibacillary leprosy, or a type 2 leprosy reaction. AVAILABILITY OF DATA AND MATERIALS All data generated or analyzed during this study are included in this published article [and its supplementary information files].
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Affiliation(s)
- Jiaru Yang
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China; Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Jing Kong
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Bingxue Li
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Zhenhua Ji
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China; The Institute of Oncology, Yunnan Cancer Hospital, Kunming Medical University, Kunming 650100, Yunnan, China
| | - Aihua Liu
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming 650030, Yunnan, China.
| | - Jingjing Chen
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Meixiao Liu
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Yuxin Fan
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Li Peng
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Jieqin Song
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Xinya Wu
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Li Gao
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Weijiang Ma
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Yan Dong
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Suyi Luo
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China
| | - Fukai Bao
- Evidence-Based Medicine Team, The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, Yunnan, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming 650030, Yunnan, China.
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Beltrame A, Fargnoli MC, Avanzi C, Sollima L, Pomari E, Mori A, Longoni SS, Moro L, Orza P, Jackson M, Perandin F. Leprosy in an Adopted Woman Diagnosed by Molecular Tools: A Case Report from a Non-Endemic Area. Pathogens 2023; 12:pathogens12020165. [PMID: 36839437 PMCID: PMC9963898 DOI: 10.3390/pathogens12020165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Coupled with its rarity in non-endemic areas, the clinical heterogeneity of leprosy makes diagnosis very challenging. We report a diagnosis of multibacillary leprosy in a 22-year-old Indian woman, adopted at the age of 10 and living in Italy. The patient presented with painful skin lesions on the face, trunk, and lower and upper extremities, associated with dysesthesia and a motor deficit in her left leg following corticosteroid therapy interruption. Histopathology results from the skin lesions suggested leprosy, but no acid-fast bacilli were identified. Molecular biology in a center specializing in tropical diseases confirmed the diagnosis, allowing prompt and adequate treatment. Genotype analysis allowed the identification of a genotype 1D of M. leprae, facilitating the epidemiological investigation of the plausible infection origin. No resistances to rifampicin, dapsone, or ofloxacin were detected. Leprosy will continue to exist in high-income nations, and the incidence may rise over time due to increasing migration and globalization. CARE guidelines were followed.
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Affiliation(s)
- Anna Beltrame
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
- Correspondence:
| | - Maria Concetta Fargnoli
- Dermatology Unit, Ospedale San Salvatore, 67100 L’Aquila, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Charlotte Avanzi
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Laura Sollima
- Pathology Unit, Ospedale San Salvatore, 67100 L’Aquila, Italy
| | - Elena Pomari
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Antonio Mori
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Silvia Stefania Longoni
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Lucia Moro
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Pierantonio Orza
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Mary Jackson
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Francesca Perandin
- Department of Infectious—Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
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Tulip A. Jhaveri, Samantha Williams, Sandeep Kancharla, Ithiel James Frame, Allison Cruse, Svenja J. Albrecht, Barbara M. Stryjewska, Risa M. Webb. Closing the Brief Case: Delayed Diagnosis of Cutaneous Mycobacterial Infection in Rural Mississippi. J Clin Microbiol; 60:e00308-22. [PMID: 36541842 DOI: 10.1128/jcm.00308-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tulip A. Jhaveri, Samantha Williams, Sandeep Kancharla, Ithiel James Frame, Allison Cruse, Svenja J. Albrecht, Barbara M. Stryjewska, Risa M. Webb. The Brief Case: Delayed Diagnosis of Cutaneous Mycobacterial Infection in Rural Mississippi. J Clin Microbiol; 60:e00307-22. [PMID: 36541843 DOI: 10.1128/jcm.00307-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Dabi YT, Degechisa ST, Bobosha K, Wassie L. Changes in plasma levels of endocrine hormones in lepromatous leprosy patients. IJID Reg 2022; 6:58-61. [PMID: 36660103 PMCID: PMC9842862 DOI: 10.1016/j.ijregi.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Background Leprosy affects various endocrine glands and causes disorders in internal organs in addition to the skin and peripheral nerves. These disorders are often silent and remain undiagnosed or underreported. In particular, patterns of hormone changes during leprosy, especially in lepromatous leprosy (LL) patients, are often associated with dysregulation of different endocrine and sex hormones. The aim of this study was to assess changes in four endocrine hormones - namely cortisol, dehydroepiandrosterone (DHEA), growth hormone (GH), and leptin - among LL patients compared with apparently healthy controls. Method In total, 80 plasma samples were systematically retrieved from a biorepository at the Armauer Hansen Research Institute (AHRI), based on quality, adequacy of sample volume, and appropriateness of linked clinical and sociodemographic data. Forty of the samples were obtained from LL patients (cases) and the remaining 40 from apparently healthy controls. Enzyme-linked immunosorbant assay (ELISA) was used to quantify levels of DHEA, cortisol, GH, and leptin hormones in the plasma samples. Data were analyzed using non-parametric statistics and the Mann-Whitney U-test (GraphPad Prism version 7.01). A p-value < 0.05 was considered statistically significant. Results Plasma levels of cortisol concentration were significantly higher in LL cases (median = 111.4 ng/ml, range = 20.54-525.7) compared with healthy controls (median = 51.98 ng/ml, range = 3.805-328.4) (p = 0.003). Levels of GH and leptin were significantly lower in LL cases compared with healthy controls (median values for GH = 1.01 µIU/ml, range = 0.4625-86.82 and 2 µIU/ml, range = 0.5838-63.36, respectively (p = 0.022); median values for leptin = 891 pg/ml, range = 728.4-21816 and 5147 pg/ml, range = 730.4-52747, respectively (p < 0.0001)). There was an apparent reduction in the plasma levels of DHEA among LL cases compared with healthy controls (p = 0.297), although this difference was not statistically significant. Conclusion Alterations in levels of endocrine hormones seen in LL patients reflect clinical and immunological conditions during lepromatous leprosy. However, large-scale studies are warranted to determine how leprosy causes such alterations in hormones and the interplay between endocrine hormones and the immune system during leprosy disease.
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Affiliation(s)
- Yosef Tsegaye Dabi
- Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia,Armauer Hansen Research Institute, Addis Ababa, Ethiopia,Corresponding author: Yosef Tsegaye Dabi, Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia, Tel: +251 911 364 465.
| | - Sisay Teka Degechisa
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Liya Wassie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Abstract
Leprosy is caused by Mycobacterium leprae (M. leprae) and M. lepromatosis, an obligate intracellular organism, and over 200,000 new cases occur every year. M. leprae parasitizes histiocytes (skin macrophages) and Schwann cells in the peripheral nerves. Although leprosy can be treated by multidrug therapy, some patients relapse or have a prolonged clinical course and/or experience leprosy reaction. These varying outcomes depend on host factors such as immune responses against bacterial components that determine a range of symptoms. To understand these host responses, knowledge of the mechanisms by which M. leprae parasitizes host cells is important. This article describes the characteristics of leprosy through bacteriology, genetics, epidemiology, immunology, animal models, routes of infection, and clinical findings. It also discusses recent diagnostic methods, treatment, and measures according to the World Health Organization (WHO), including prevention. Recently, the antibacterial activities of anti-hyperlipidaemia agents against other pathogens, such as M. tuberculosis and Staphylococcus aureus have been investigated. Our laboratory has been focused on the metabolism of lipids which constitute the cell wall of M. leprae. Our findings may be useful for the development of future treatments.
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Affiliation(s)
- Mariko Sugawara-Mikami
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,West Yokohama Sugawara Dermatology Clinic, Yokohama, Japan
| | - Kazunari Tanigawa
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Akira Kawashima
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Yoko Fujiwara
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Wang C, Wu Z, Jiang H, Shi Y, Zhang W, Zhang M, Wang H. Global prevalence of resistance to rifampicin in Mycobacterium leprae: A meta-analysis. J Glob Antimicrob Resist 2022; 31:119-127. [PMID: 36055549 DOI: 10.1016/j.jgar.2022.08.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES As the only bactericidal drug in multidrug therapy is rifampicin, monitoring of antimicrobial resistance is important in leprosy patients. Therefore, we conducted a meta-analysis on the resistance of Mycobacterium leprae (M. leprae) to rifampicin and estimated drug resistance in different therapeutic states and regions. METHODS Embase, Medline, PubMed, and Web of Science were searched to identify studies between 1 January 1993 and 1 January 2022. Two independent reviewers extracted study data. Pooled cumulative incidences were computed using random-effects meta-analyses. RESULTS We included 32 papers describing the resistance of M. leprae to rifampicin (pooled cumulative incidences, 11% [95% confidence interval {CI}, 7% to 15%]). Therapeutic states and regional distribution were obtained for subgroup analyses. A total of 51 of 1135 new cases (pooled incidence, 10% [95% CI, 5% to 16%]) and 81 of 733 relapsed cases (pooled incidence, 20% [95% CI, 13% to 27%]) had rifampicin resistance. A total of 139 participants, including 11 patients with rifampicin resistance (pooled incidence, 42% [95% CI, -21% to 105%]), were nonresponsive and intractable cases. The incidence of rifampicin resistance was highest in the Western Pacific (pooled incidence, 21% [95% CI, 13% to 29%]) and lowest in the Americas (pooled incidence, 4% [95% CI, 1% to 7%]). CONCLUSIONS Drug resistance testing and a robust and rigorous surveillance system are recommended to detect the prevalence of drug resistance in leprosy.
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Affiliation(s)
- Chen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Ziwei Wu
- Center for Global Health, School of Public Health, Nanjing Medical University; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Haiqin Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Ying Shi
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Wenyue Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Mengyan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
| | - Hongsheng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Center for Global Health, School of Public Health, Nanjing Medical University; Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, National Centre for Leprosy Control, China CDC, Nanjing, China
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Hess S, Kendall TJ, Pena M, Yamane K, Soong D, Adams L, Truman R, Rambukkana A. In vivo partial reprogramming by bacteria promotes adult liver organ growth without fibrosis and tumorigenesis. Cell Rep Med 2022; 3:100820. [PMID: 36384103 PMCID: PMC9729881 DOI: 10.1016/j.xcrm.2022.100820] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
Ideal therapies for regenerative medicine or healthy aging require healthy organ growth and rejuvenation, but no organ-level approach is currently available. Using Mycobacterium leprae (ML) with natural partial cellular reprogramming capacity and its animal host nine-banded armadillos, we present an evolutionarily refined model of adult liver growth and regeneration. In infected armadillos, ML reprogram the entire liver and significantly increase total liver/body weight ratio by increasing healthy liver lobules, including hepatocyte proliferation and proportionate expansion of vasculature, and biliary systems. ML-infected livers are microarchitecturally and functionally normal without damage, fibrosis, or tumorigenesis. Bacteria-induced reprogramming reactivates liver progenitor/developmental/fetal genes and upregulates growth-, metabolism-, and anti-aging-associated markers with minimal change in senescence and tumorigenic genes, suggesting bacterial hijacking of homeostatic, regeneration pathways to promote de novo organogenesis. This may facilitate the unraveling of endogenous pathways that effectively and safely re-engage liver organ growth, with broad therapeutic implications including organ regeneration and rejuvenation.
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Affiliation(s)
- Samuel Hess
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK,Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
| | - Timothy J. Kendall
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK,Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK,Edinburgh Pathology, The University of Edinburgh, Edinburgh, UK
| | - Maria Pena
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Program, Baton Rouge, LA, USA
| | - Keitaro Yamane
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK,Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
| | - Daniel Soong
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK,Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Linda Adams
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Program, Baton Rouge, LA, USA
| | - Richard Truman
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Program, Baton Rouge, LA, USA,Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Anura Rambukkana
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK; Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK; Edinburgh Infectious Diseases, The University of Edinburgh, Edinburgh, UK; Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, UK.
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42
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Verma S, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, Suvirya S, Parihar A, Verma R, Sharma PK, Pandey S, Uniyal R, Prakash S. Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study. J Cent Nerv Syst Dis 2022; 14:11795735221135477. [PMID: 36277272 PMCID: PMC9583215 DOI: 10.1177/11795735221135477] [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: 12/24/2021] [Revised: 06/13/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background Leprosy is primarily a disease of peripheral nerves. Some isolated case
reports and case series have communicated imaging changes in the central
nervous system (CNS) and brachial plexus in patients with leprosy. Objectives To study the neuroimaging abnormalities in patients with lepra
bacilli-positive neuropathy in the context of CNS, spinal root ganglion, and
brachial plexus. Design Prospective observational study Methods We screened newly-diagnosed patients with multibacillary leprosy presenting
with neuropathy. Patients with bacilli-positive sural nerve biopsies were
included in the study and subjected to magnetic resonance imaging (MRI) of
the brain and spinal cord. Results A total of 54 patients with bacteriologically confirmed multibacillary
leprosy were screened; Mycobacterium leprae was
demonstrated in the sural nerve biopsies of 29 patients. Five patients
(5/29; 17.24%) had MRI abnormalities in CNS, spinal root ganglion, and/or
brachial plexus. Three patients had MRI changes suggestive of either
myelitis or ganglionitis. One patient had T2/FLAIR hyperintensity in the
middle cerebellar peduncle while 1 had T2/FLAIR hyperintensity in the
brachial plexus. Conclusion CNS, spinal root ganglion, and brachial plexus are involved in patients with
leprous neuropathy. Immunological reaction against M leprae
antigen might be a plausible pathogenetic mechanism for brachial plexus and
CNS imaging abnormalities.
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Affiliation(s)
- Sumit Verma
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India,Ravindra Kumar Garg, Department of
Neurology, King George Medical University, B-22, Sector-E, Aliganj, Uttar
Pradesh, Lucknow 226003, India.
| | - Imran Rizvi
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Amita Jain
- Department of Microbiology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Swastika Suvirya
- Department of Dermatology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Anit Parihar
- Department of Radiodiagnosis, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Rajesh Verma
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Shweta Pandey
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical
University, Uttar Pradesh, Lucknow, India
| | - Shantanu Prakash
- Department of Microbiology, King George Medical
University, Uttar Pradesh, Lucknow, India
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Thaware A, Rathi R. Case of leprosy in child. Pan Afr Med J 2022; 42:324. [PMID: 36451977 PMCID: PMC9664503 DOI: 10.11604/pamj.2022.42.324.35031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Archana Thaware
- Department of Kaumarbhritya, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Renu Rathi
- Department of Kaumarbhritya, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India,Corresponding author: Renu Rathi, Department of Kaumarbhritya, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India.
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44
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Kulkarni CA, Dhage PP. Eradicated and bygone Hansen's disease with unusual features (leprosy). Pan Afr Med J 2022; 42:245. [PMID: 36303825 PMCID: PMC9587744 DOI: 10.11604/pamj.2022.42.245.35598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chaitanya Ajay Kulkarni
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Prasad Pramod Dhage
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India,Corresponding author: Prasad Pramod Dhage, Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India.
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45
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Sato CM, Rodrigues TDSV, Silva PRDS, Dos Santos ES, Xavier DR, Baptista IMFD, Cortela DDCB, Ignotti E, Ferreira SMB. Social school contacts of multibacillary leprosy cases in children living in the hyperendemic region of the Midwest of Brazil. J Pediatr (Rio J) 2022; 98:431-437. [PMID: 34968418 PMCID: PMC9432267 DOI: 10.1016/j.jped.2021.11.009] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/23/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze the prevalence of Mycobacterium leprae detection and the associated factors among social contacts in the school environment of multibacillary cases living in a hyperendemic municipality of the state of Mato Grosso. METHODS Cross-sectional study with 236 social contacts of multibacillary leprosy from public schools and residents in Cuiabá (Mato Grosso) in 2018. The sources of information were interviews and nasal swab tests for molecular analysis by polymerase chain reaction - PCR. For the prevalence ratio estimates, crude and adjusted analyses were performed using robust Poisson regression and their respective confidence intervals (95% CI). The ArcGIS 9.1 software was used for the geographic distribution analyses. RESULTS The prevalence of detection of M. leprae in social contacts was 14%. A total of 63.6% of the schools surveyed had 5.1% to 50% of the social contacts of leprosy with positive PCR. The analysis of the geographic distribution in the neighborhoods showed a high prevalence of infection, being higher than 50% in some localities. The highest proportion of positive results occurred in the northern region of the city and from a precarious socioeconomic class. CONCLUSION The results showed a high prevalence of detection of M. leprae among social contacts in areas with poor socioeconomic conditions. In these regions, there is a greater risk of infection and of getting sick.
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Affiliation(s)
- Camila Massae Sato
- Universidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brazil.
| | | | | | | | - Diego Ricardo Xavier
- Fundação Oswaldo Cruz, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil
| | | | | | - Eliane Ignotti
- Universidade do Estado de Mato Grosso, Programa de Pós-Graduação em Ciências Ambientais, Cáceres, MT, Brazil
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46
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Silva FJ, Santos-Garcia D, Zheng X, Zhang L, Han XY. Construction and Analysis of the Complete Genome Sequence of Leprosy Agent Mycobacterium lepromatosis. Microbiol Spectr 2022; 10:e0169221. [PMID: 35467405 PMCID: PMC9248898 DOI: 10.1128/spectrum.01692-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/07/2022] [Indexed: 12/29/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae and Mycobacterium lepromatosis. We report construction and analyses of the complete genome sequence of M. lepromatosis FJ924. The genome contained 3,271,694 nucleotides to encode 1,789 functional genes and 1,564 pseudogenes. It shared 1,420 genes and 885 pseudogenes (71.4%) with M. leprae but differed in 1,281 genes and pseudogenes (28.6%). In phylogeny, the leprosy bacilli started from a most recent common ancestor (MRCA) that diverged ~30 million years ago (Mya) from environmental organism Mycobacterium haemophilum. The MRCA then underwent reductive evolution with pseudogenization, gene loss, and chromosomal rearrangements. Analysis of the shared pseudogenes estimated the pseudogenization event ~14 Mya, shortly before species bifurcation. Afterwards, genomic changes occurred to lesser extent in each species. Like M. leprae, four major types of highly repetitive sequences were detected in M. lepromatosis, contributing to chromosomal rearrangements within and after MRCA. Variations in genes and copy numbers were noted, such as three copies of the gene encoding bifunctional diguanylate cyclase/phosphodiesterase in M. lepromatosis, but single copy in M. leprae; 6 genes encoding the TetR family transcriptional regulators in M. lepromatosis, but 11 such genes in M. leprae; presence of hemW gene in M. lepromatosis, but absence in M. leprae; and others. These variations likely aid unique pathogenesis, such as diffuse lepromatous leprosy associated with M. lepromatosis, while the shared genomic features should explain the common pathogenesis of dermatitis and neuritis in leprosy. Together, these findings and the genomic data of M. lepromatosis may facilitate future research and care for leprosy. IMPORTANCE Leprosy is a dreaded infection that still affects millions of people worldwide. Mycobacterium lepromatosis is a recently recognized cause in addition to the well-known Mycobacterium leprae. M. lepromatosis is likely specific for diffuse lepromatous leprosy, a severe form of the infection and endemic in Mexico. This study constructed and annotated the complete genome sequence of M. lepromatosis FJ924 and performed comparative genomic analyses with related mycobacteria. The results afford new and refined insights into the genome size, gene repertoire, pseudogenes, phylogenomic relationship, genome organization and plasticity, process and timing of reductive evolution, and genetic and proteomic basis for pathogenesis. The availability of the complete M. lepromatosis genome may prove to be useful for future research and care for the infection.
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Affiliation(s)
- Francisco J. Silva
- Institute for Integrative Systems Biology (I2SysBio), University of Valencia and CSIC, Paterna, Spain
- Genomics and Health Area, Foundation for the Promotion of Sanitary and Biomedical Research, Valencia, Spain
| | - Diego Santos-Garcia
- Laboratory of Biometry and Evolutionary Biology UMR CNRS, University of Lyon, Villeurbanne, France
| | - Xiaofeng Zheng
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Li Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiang Y. Han
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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47
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Serrano-Coll H, Cardona-Castro N. Neuropathic ulcers in leprosy: clinical features, diagnosis and treatment. J Wound Care 2022; 31:S32-S40. [PMID: 35678776 DOI: 10.12968/jowc.2022.31.sup6.s32] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers-lesions that can appear at the plantar and extra-plantar levels-are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.
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Affiliation(s)
- Héctor Serrano-Coll
- Research Group in Education and Health Sciences, UNISANGIL-San Gil, Colombia.,Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
| | - Nora Cardona-Castro
- Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
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48
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Abstract
Leprosy is a granulomatous infection caused by infection with Mycobacterium leprae or M. lepromatosis. We evaluated skin biopsy and slit skin smear samples from 92 leprosy patients in Colombia by quantitative PCR. Five (5.4%) patients tested positive for M. lepromatosis, providing evidence of the presence of this pathogen in Colombia.
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49
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Periche Fernández JD, Pou-Soarez V, Arenas R, Juárez-Duran ER, Luna-Rojas SL, Xicohtencatl-Cortes J, Martínez-Chavarría LC, Martínez-Hernández F, Hernández-Castro R. Mycobacterium leprae and Mycobacterium lepromatosis infection. A report of six multibacillary cases of leprosy in Dominican Republic. Jpn J Infect Dis 2022; 75:427-430. [PMID: 35354704 DOI: 10.7883/yoken.jjid.2021.709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The causative agents of leprosy are Mycobacterium leprae and Mycobacterium lepromatosis. M. lepromatosis was found in 2008 to cause diffuse lepromatous leprosy in Mexican patients. The objective of this work was to identify M. leprae and M. lepromatosis in paraffin-embedded skin samples from Caribbean leprosy patients. A total of 6 skin samples were obtained from the Dominican Republic. All cases presented the multibacillary form; 5 cases were nodular lepromatous leprosy, and 1 case was borderline lepromatous leprosy. All patients received multidrug therapy. Molecular identification was achieved using the M. leprae-specific repetitive element (RLEP) for M. leprae and the hemN gene for M. lepromatosis. Mycobacterium leprae was identified in two lepromatous leprosy cases and 1 borderline lepromatous leprosy case; M. lepromatosis was found in 1 nodular lepromatous leprosy case. Both Mycobacterium species were present in two nodular lepromatous leprosy cases. This is the first report of M. lepromatosis in the Dominican Republic.
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Affiliation(s)
| | - Víctor Pou-Soarez
- Dominican Dermatological Institute and Skin Surgery Dr. Huberto Bogaert, Dominican Republic
| | - Roberto Arenas
- Mycology Service, General Hospital Dr. Manuel Gea González, Mexico
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50
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Ebenezer GJ, Pena MT, Daniel AS, Truman RW, Adams L, Duthie MS, Wagner K, Zampino S, Tolf E, Tsottles D, Polydefkis M. Mycobacterium leprae induces Schwann cell proliferation and migration in a denervated milieu following intracutaneous excision axotomy in nine-banded armadillos. Exp Neurol 2022; 352:114053. [PMID: 35341747 DOI: 10.1016/j.expneurol.2022.114053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 01/23/2023]
Abstract
Nine-banded armadillos develop peripheral neuropathy after experimental Mycobacterium leprae infection that recapitulates human disease. We used an intracutaneous excision axotomy model to assess the effect of infection duration by M. leprae on axonal sprouting and Schwan cell density. 34 armadillos (17 naïve and 17 M. leprae-infected) underwent 3 mm skin biopsies to create an intracutaneous excision axotomy followed by a concentric 4-mm overlapping biopsy 3 and 12-months post M. leprae inoculation. A traditional distal leg biopsy was obtained at 15mo for intraepidermal nerve fiber (IENF) density. Serial skin sections were immunostained against a axons (PGP9.5, GAP43), and Schwann cells (p75, s100) to visualize regenerating nerves. Regenerative axons and proliferation of Schwann cells was measured and the rate of growth at each time point was assessed. Increasing anti-PGL antibody titers and intraneural M. leprae confirmed infection. 15mo following infection, there was evidence of axon loss with reduced distal leg IENF versus naïve armadillos, p < 0.05. This was associated with an increase in Schwann cell density (11,062 ± 2905 vs. 7561 ± 2715 cells/mm3, p < 0.01). Following excisional biopsy epidermal reinnervation increased monotonically at 30, 60 and 90 days; the regeneration rate was highest at 30 days, and decreased at 60 and 90 days. The reinnervation rate was highest among animals infected for 3mo vs those infected for 12mo or naïve animals (mean ± SD, 27.8 ± 7.2 vs.16.2 ± 5.8vs. 15.3 ± 6.5 mm/mm3, p < 0.05). The infected armadillos displayed a sustained Schwann cell proliferation across axotomy time points and duration of infection (3mo:182 ± 26, 12mo: 256 ± 126, naive: 139 ± 49 cells/day, p < 0.05). M. leprae infection is associated with sustained Schwann cell proliferation and distal limb nerve fiber loss. Rates of epidermal reinnervation were highest 3mo after infection and normalized by 12 mo of infection. We postulate that excess Schwann cell proliferation is the main pathogenic process and is deleterious to sensory axons. There is a compensatory initial increase in regeneration rates that may be an attempt to compensate for the injury, but it is not sustained and eventually followed by axon loss. Aberrant Schwann cell proliferation may be a novel therapeutic target to interrupt the pathogenic cascade of M. leprae.
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Affiliation(s)
| | - Maria T Pena
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | | | - Richard W Truman
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | - Linda Adams
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | | | - Kelly Wagner
- Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Eleanor Tolf
- Neurology, Johns Hopkins University, Baltimore, MD, USA
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