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Hasker E, Assoumani Y, Randrianantoandro A, Ramboarina S, Braet SM, Cauchoix B, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Attoumani N, Grillone SH, Ronse M, Peeters Grietens K, Rakoto-Andrianarivelo M, Harinjatovo H, Supply P, Snijders R, Hoof C, Tsoumanis A, Suffys P, Rasamoelina T, Corstjens P, Ortuno-Gutierrez N, Geluk A, Cambau E, de Jong BC. Post-exposure prophylaxis in leprosy (PEOPLE): a cluster randomised trial. Lancet Glob Health 2024; 12:e1017-e1026. [PMID: 38762282 DOI: 10.1016/s2214-109x(24)00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) using single-dose rifampicin reduces progression from infection with Mycobacterium leprae to leprosy disease. We compared effectiveness of different administration modalities, using a higher (20 mg/kg) dose of rifampicin-single double-dose rifampicin (SDDR)-PEP. METHODS We did a cluster randomised study in 16 villages in Madagascar and 48 villages in Comoros. Villages were randomly assigned to four study arms and inhabitants were screened once a year for leprosy, for 4 consecutive years. All permanent residents (no age restriction) were eligible to participate and all identified patients with leprosy were treated with multidrug therapy (SDDR-PEP was provided to asymptomatic contacts aged ≥2 years). Arm 1 was the comparator arm, in which no PEP was provided. In arm 2, SDDR-PEP was provided to household contacts of patients with leprosy, whereas arm 3 extended SDDR-PEP to anyone living within 100 m. In arm 4, SDDR-PEP was offered to household contacts and to anyone living within 100 m and testing positive to anti-phenolic glycolipid-I. The main outcome was the incidence rate ratio (IRR) of leprosy between the comparator arm and each of the intervention arms. We also assessed the individual protective effect of SDDR-PEP and explored spatial associations. This trial is registered with ClinicalTrials.gov, NCT03662022, and is completed. FINDINGS Between Jan 11, 2019, and Jan 16, 2023, we enrolled 109 436 individuals, of whom 95 762 had evaluable follow-up data. Our primary analysis showed a non-significant reduction in leprosy incidence in arm 2 (IRR 0·95), arm 3 (IRR 0·80), and arm 4 (IRR 0·58). After controlling for baseline prevalence, the reduction in arm 3 became stronger and significant (IRR 0·56, p=0·0030). At an individual level SDDR-PEP was also protective with an IRR of 0·55 (p=0·0050). Risk of leprosy was two to four times higher for those living within 75 m of an index patient at baseline. INTERPRETATION SDDR-PEP appears to protect against leprosy but less than anticipated. Strong spatial associations were observed within 75 m of index patients. Targeted door-to-door screening around index patients complemented by a blanket SDDR-PEP approach will probably have a substantial effect on transmission. FUNDING European and Developing Countries Clinical Trials Partnership. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Zahara Salim
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Mohammed Amidy
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Nissad Attoumani
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Philip Supply
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017, Center for Infection and Immunity of Lille, Lille, France
| | | | | | | | - Philip Suffys
- Oswaldo Cruz Institute, Fiocruz, Laboratory of Molecular Biology Applied to Mycobacteria, Rio de Janeiro, Brazil
| | | | | | | | | | - Emmanuelle Cambau
- Inserm, IAME, Université Paris Cité, UMR 1137, Paris, France; AP-HP, Hôpital Bichat, Service de Mycobacteriologie Specialisee et de Reference, Paris, France
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Asperges E, Bagnarino J, Ancarani C, Baggini G, Filardo M, Monzillo V, Barbarini D, Bruno R, Paulli M, Baldanti F. A case of leprosy in a nonendemic country. Int J Infect Dis 2024; 143:107004. [PMID: 38479578 DOI: 10.1016/j.ijid.2024.107004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Erika Asperges
- S.C. Malattie Infettive I, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy
| | - Jessica Bagnarino
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy
| | | | | | - Matteo Filardo
- U.O. Chirurgia Generale, Ospedale di Voghera, Pavia, Italy
| | - Vincenzina Monzillo
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy; Dipartimento di medicina interna e terapia medica - Università di Pavia, Pavia, Italy
| | - Daniela Barbarini
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy
| | - Raffaele Bruno
- S.C. Malattie Infettive I, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy; Dipartimento di scienze clinico-chirurgiche, diagnostiche e pediatriche, Università di Pavia, Pavia, Italy.
| | - Marco Paulli
- S.C. Anatomia Patologica, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy; Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | - Fausto Baldanti
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico di Pavia, Pavia, Italy; Dipartimento di scienze clinico-chirurgiche, diagnostiche e pediatriche, Università di Pavia, Pavia, Italy
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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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Wang H. Evidence of leprosy post exposure prophylaxis in highly endemic regions. Lancet Glob Health 2024; 12:e905-e906. [PMID: 38762292 DOI: 10.1016/s2214-109x(24)00122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Hongsheng Wang
- Department of Mycobacterium, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology & Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China.
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Allen I, Lockwood DN, Hay RJ. The Centenary of the Leprosy Relief Association (Lepra)-a moment for celebration and reflection†. Trans R Soc Trop Med Hyg 2024; 118:299-303. [PMID: 38269435 PMCID: PMC11062199 DOI: 10.1093/trstmh/trad096] [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: 11/01/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
The year 2024 is the Centenary of the foundation of the Leprosy Relief Association (Lepra), formerly the British Empire Leprosy Relief Association (BELRA). The name of the organization changed to the LEProsy Relief Association (LEPRA) in 1976 but has been known as Lepra since 2008. Over the years it has worked closely with members and office holders of the Royal Society of Tropical Medicine and Hygiene. Its work has encompassed activities from the earliest initiatives to ensure appropriate living conditions for those with the disease to the development of leprosy chemotherapy. However, this has now evolved into a strong partnership between the UK- and India-based Lepra hubs, which are carrying out research and public health initiatives ranging from elimination of prejudice against those with leprosy to adopting the recently launched WHO programme for skin NTDs to facilitate integrated control and management regimens. The fight against leprosy has always been a partnership between a wide variety of disease-specific NGOs, health-care workers and international health agencies. The story of Lepra illustrates the central role of these partnerships and national as well as international collaboration.
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Affiliation(s)
| | - Diana N Lockwood
- Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Roderick J Hay
- King's College London, St John's Institute of Dermatology, London SE1 7EP, UK
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Vangala NN, Madke B, Kashikar Y, Mahajan S. Infiltrated and nodular pinna in lepromatous leprosy. BMJ Case Rep 2024; 17:e259406. [PMID: 38663896 PMCID: PMC11043710 DOI: 10.1136/bcr-2023-259406] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Naga Nitya Vangala
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Yash Kashikar
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Shital Mahajan
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
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Inagaki T, Asahi S, Ogawa K, Nakagawa T, Ohkura T, Osada Y, Nikai T, Yamada K, Yagi T, Uchiya KI. Development of a rapid detection method for the macrolide resistance gene in Mycobacterium avium using the amplification refractory mutation system-loop-mediated isothermal amplification method. Microbiol Spectr 2024; 12:e0233923. [PMID: 38363108 PMCID: PMC10986505 DOI: 10.1128/spectrum.02339-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Macrolide antibiotics such as clarithromycin (CLR) and azithromycin are the key drugs used in multidrug therapy for Mycobacterium avium complex (MAC) diseases. For these antibacterial drugs, drug susceptibility has been correlated with clinical response in MAC diseases. We have previously demonstrated the correlation between drug susceptibility and mutations in the 23S rRNA gene, which confers resistance to macrolides. Herein, we developed a rapid detection method using the amplification refractory mutation system (ARMS)-loop-mediated isothermal amplification (LAMP) technique to identify mutations in the 23S rRNA gene of M. avium. We examined the applicability of the ARMS-LAMP method to genomic DNA extracted from six genotypes of M. avium clinical isolates. The M. avium isolates were classified into 21 CLR-resistant and 9 CLR-susceptible strains based on the results of drug susceptibility tests; the 23S rRNA genes of these strains were sequenced and analyzed using the ARMS-LAMP method. Sequence analysis revealed that the 9 CLR-sensitive strains were wild-type strains, whereas the 21 CLR-resistant strains comprised 20 mutant-type strains and one wild-type strain. Using ARMS-LAMP, no amplification from genomic DNAs of the 10 wild-type strains was observed using the mutant-type mismatch primer sets (MTPSs); however, amplification from the 20 mutant-type strain DNAs was observed using the MTPSs. The rapid detection method developed by us integrates ARMS-LAMP with a real-time turbidimeter, which can help determine drug resistance in a few hours. In conclusion, ARMS-LAMP might be a new clinically beneficial technology for rapid detection of mutations.IMPORTANCEMultidrug therapy for pulmonary Mycobacterium avium complex disease is centered on the macrolide antibiotics clarithromycin and azithromycin, and resistance to macrolides is an important prognosticator for clinical aggravation. Therefore, it is important to develop a quick and easy method for detecting resistance to macrolides. Drug resistance is known to be correlated with mutations in macrolide resistance genes. We developed a rapid detection method using amplification refractory mutation system (ARMS)-loop-mediated isothermal amplification (LAMP) to identify a mutation in the 23S rRNA gene, which is a macrolide resistance gene. Furthermore, we examined the applicability of this method using M. avium clinical isolates. The rapid method developed by us for detection of the macrolide resistance gene by integrating ARMS-LAMP and a real-time turbidimeter can help in detection of drug resistance within a few hours. Since this method does not require expensive equipment or special techniques and shows high analytical speed, it would be very useful in clinical practice.
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Affiliation(s)
- Takayuki Inagaki
- Division of Pharmaceutical Sciences I, Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
- Department of Hospital Pharmacy, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shoki Asahi
- Department of Hospital Pharmacy, Japan Organization of Occupational Health and Safety, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kenji Ogawa
- Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi, Japan
| | - Taku Nakagawa
- Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi, Japan
| | - Teruko Ohkura
- Department of Medical Technique, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yukari Osada
- Department of Medical Technique, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Toshiaki Nikai
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kei-ichi Uchiya
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
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Li X, Ma Y, Li G, Jin G, Xu L, Li Y, Wei P, Zhang L. Leprosy: treatment, prevention, immune response and gene function. Front Immunol 2024; 15:1298749. [PMID: 38440733 PMCID: PMC10909994 DOI: 10.3389/fimmu.2024.1298749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Since the leprosy cases have fallen dramatically, the incidence of leprosy has remained stable over the past years, indicating that multidrug therapy seems unable to eradicate leprosy. More seriously, the emergence of rifampicin-resistant strains also affects the effectiveness of treatment. Immunoprophylaxis was mainly carried out through vaccination with the BCG but also included vaccines such as LepVax and MiP. Meanwhile, it is well known that the infection and pathogenesis largely depend on the host's genetic background and immunity, with the onset of the disease being genetically regulated. The immune process heavily influences the clinical course of the disease. However, the impact of immune processes and genetic regulation of leprosy on pathogenesis and immunological levels is largely unknown. Therefore, we summarize the latest research progress in leprosy treatment, prevention, immunity and gene function. The comprehensive research in these areas will help elucidate the pathogenesis of leprosy and provide a basis for developing leprosy elimination strategies.
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Affiliation(s)
- Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yun Ma
- Chronic Infectious Disease Control Section, Nantong Center for Disease Control and Prevention, Nantong, China
| | - Guoli Li
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Li Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Lianhua Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Narang T, Almeida JG, Kumar B, Rao PN, Suneetha S, Andrey Cipriani Frade M, Salgado CG, Dogra S. Fixed duration multidrug therapy (12 months) in leprosy patients with high bacillary load - Need to look beyond. Indian J Dermatol Venereol Leprol 2024; 90:64-67. [PMID: 37609736 DOI: 10.25259/ijdvl_278_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joel G Almeida
- Public Health and Epidemiology, Public Health Consultancy, Mumbai, India
| | - Bhushan Kumar
- Department of Dermatology, Silver Oaks Hospital, SAS Nagar, Punjab, India
| | - P Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Telangana, Hyderabad, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana, Hyderabad, India
| | - Marco Andrey Cipriani Frade
- Department of Medical Clinics, Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chawla G, Pradhan T, Gupta O. An Insight into the Combat Strategies for the Treatment of Type 2 Diabetes Mellitus. Mini Rev Med Chem 2024; 24:403-430. [PMID: 37198989 DOI: 10.2174/1389557523666230517113936] [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: 11/24/2022] [Revised: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 05/19/2023]
Abstract
Diabetes is a chronic, and metabolic disorder that has gained epidemic proportions in the past few decades creating a threat throughout the globe. It is characterized by increased glucose levels that may be due to immune-mediated disorders (T1DM), insulin resistance or inability to produce sufficient insulin by β-pancreatic cells (T2DM), gestational, or an increasingly sedentary lifestyle. The progression of the disease is marked by several pathological changes in the body like nephropathy, retinopathy, and various cardiovascular complications. Treatment options for T1DM are majorly focused on insulin replacement therapy. While T2DM is generally treated through oral hypoglycemics that include metformin, sulfonylureas, thiazolidinediones, meglitinides, incretins, SGLT-2 inhibitors, and amylin antagonists. Multidrug therapy is often recommended when patients are found incompliant with the first-line therapy. Despite the considerable therapeutic benefits of these oral hypoglycemics, there lie greater side effects (weight variation, upset stomach, skin rashes, and risk of hepatic disease), and limitations including short half-life, frequent dosing, and differential bioavailability which inspires the researchers to pursue novel drug targets and small molecules having promising clinical efficacy posing minimum side-effects. This review summarizes some of the current emerging novel approaches along with the conventional drug targets to treat type 2 diabetes.
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Affiliation(s)
- Gita Chawla
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, 110062, India
| | - Tathagata Pradhan
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, 110062, India
| | - Ojasvi Gupta
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, 110062, India
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Rusyati LMM, Saputra H, Indah MS, Setyawati NK. Rare Variant of Leprosy Reaction (Lucio Phenomenon): A Case Series. Int J Mycobacteriol 2024; 13:105-111. [PMID: 38771288 DOI: 10.4103/ijmy.ijmy_184_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 05/22/2024] Open
Abstract
ABSTRACT Lucio phenomenon (LP) is a variant of type two leprosy, characterized by necrotizing erythema, frequently found in neglected leprosy patient who experience delayed diagnosis or inappropriate treatment. Indonesia is in the third place for highest leprosy cases worldwide. Nonetheless, LP is less common, regardless being an endemic country. In this serial case, we describe the three cases of LP in lepromatous leprosy patients in Denpasar, Bali. All three cases came to our hospital with chronic wounds complained up to a year, accompanied by swollen leg, blisters, tingling sensation, and other symptoms. They had received no suitable treatment, proving LP as a neglected case in primary health care. After a period of treatment, however, patient lesions improved clinically with no physical disability. With this case series, a better understanding toward LP initial complains together with its natural history and further examination could be achieved; thus, improving the early diagnosis and management of LP.
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Affiliation(s)
- Luh Made Mas Rusyati
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Herman Saputra
- Department of Pathology Anatomy, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Made Sanitca Indah
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Ni Kadek Setyawati
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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TETCHI EOS, KONAN YE, KPEBO D, DJOMAN MC, EKOU FK, SABLE PS, YAPI A, TANO-AKE O. [Leprosy epidemiology in Daoukro health district (Côte d'Ivoire) from 1999 to 2017]. Med Trop Sante Int 2023; 3:mtsi.v3i4.2023.294. [PMID: 38390019 PMCID: PMC10879886 DOI: 10.48327/mtsi.v3i4.2023.294] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/05/2023] [Indexed: 02/24/2024]
Abstract
Introduction Leprosy is a real problem in the Daoukro health district despite the actions of the National programme for elimination. Objective To describe the epidemiological and clinical profile of new leprosy cases in the Daoukro health district from 1999 to 2017. Method Descriptive survey including leprosy patients admitted to the dermato-leprology department from 1999 to 2017. Results From 1999 to 2017, the incidence of leprosy fluctuated from 4.4 to 0 per 100,000 with a peak of 14.2 in 2003. In 2016 and 2017 no cases of leprosy were reported. The mean age was 36.8 years (SD=20). A majority of cases were uneducated and living in rural areas. Females and children under 15 years of age accounted for 53% and 16% of cases respectively. Clinically, cutaneous signs were predominant in the patients. The multibacillary form accounted for 82%. Nearly 1 out of 4 patients had a grade 2 disability (24%). All patients received treatment (multidrug therapy). Among them, 83.8% were cured, while 0.5% were not cured. In addition, regarding 29 patients (15.7%) details of how their disease progressed were not available. Among the patients declared cured, 26% had sequels. Conclusion Leprosy control activities must be strengthened in order to maintain the achievements in this non-endemic district.
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Affiliation(s)
- Ekissi Or sot TETCHI
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Yao Eugène KONAN
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Denise KPEBO
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Mangou Christiane DJOMAN
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national d'hygiène publique, Abidjan, Côte d'Ivoire
| | - Franck Kokora EKOU
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Parfait Stéphane SABLE
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | | | - Odile TANO-AKE
- Département de santé publique et spécialités, UFR Sciences médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
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Chhabra S, Narang T, Sahu S, Sharma K, Shilpa S, Sharma A, Jain S, Singh I, Yadav R, Kaur M, Sharma R, Nadeem M, Pandey P, Minz RW, Dogra S. High frequency of ofloxacin resistance patterns of Mycobacterium leprae from India: An indication to revisit second line anti-leprosy treatment regimen. J Glob Antimicrob Resist 2023; 35:262-267. [PMID: 37852372 DOI: 10.1016/j.jgar.2023.10.006] [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: 06/27/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES Drug resistance in leprosy is an emerging concern, leading to treatment failures, recurrences, and potential spread of resistant Mycobacterium leprae in the community. In this study, we aimed to assess drug resistance prevalence and patterns amongst leprosy patients at a tertiary care referral hospital in India. METHODS Mutations in drug resistance determining regions for dapsone, rifampicin, and ofloxacin of the M. leprae genome in DNA extracted from skin biopsies of 136 leprosy patients (treatment-naive = 67, with persistent skin lesions = 35, with recurrence = 34) were analysed by polymerase chain reaction followed by Sanger sequencing. Wild-type strain (Thai-53) was used as a reference strain. RESULTS Resistance mutations were identified in a total of 23 patients, constituting 16.9% of the cohort. Within this subset of 23 cases, resistance to ofloxacin was observed in 17 individuals (12.5%), while resistance to both dapsone and rifampicin was detected in three patients each (2.2% for both). The occurrence of ofloxacin resistance showed minimal disparity between recurrent and treatment-naive cases, at 17.6% and 16.4%, respectively. Dapsone resistance emerged in two treatment-naive cases and one case with persistent skin lesions. Notably, none of the treatment-naive cases or those with recurrence/relapse exhibited rifampicin resistance. Subsequently, no statistically significant correlation was identified between other clinical variables and the presence of antimicrobial resistance. CONCLUSIONS The occurrence of resistance to the current multidrug therapy regimen (specifically dapsone and rifampicin) and to ofloxacin, a secondary antileprosy medication in M. leprae, represents a concerning scenario. This calls for an expansion towards bactericidal drug options and the establishment of robust surveillance for drug resistance in countries burdened with high leprosy rates. Moreover, the introduction of stringent antimicrobial stewardship initiatives is imperative. As a single centre study, it represents a limited, cross-sectional view of the real situation in the field.
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Affiliation(s)
- Seema Chhabra
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
| | - Tarun Narang
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India.
| | - Smrity Sahu
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Keshav Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Shilpa Shilpa
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Ayush Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Sejal Jain
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Rakesh Yadav
- Department of Medical Microbiology, PGIMER, Sector-12, Chandigarh, India
| | - Manjot Kaur
- Department of Medical Microbiology, PGIMER, Sector-12, Chandigarh, India
| | - Rahul Sharma
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Mohd Nadeem
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Pragati Pandey
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India.
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Siegel SAR, Griffith DE, Philley JV, Brown-Elliott BA, Brunton AE, Sullivan PE, Fuss C, Strnad L, Wallace RJ, Winthrop KL. Open-Label Trial of Amikacin Liposome Inhalation Suspension in Mycobacterium abscessus Lung Disease. Chest 2023; 164:846-859. [PMID: 37419144 PMCID: PMC10645596 DOI: 10.1016/j.chest.2023.05.036] [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: 11/10/2022] [Revised: 04/14/2023] [Accepted: 05/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Mycobacterium abscessus is the second most common nontuberculous mycobacterium respiratory pathogen and shows in vitro resistance to nearly all oral antimicrobials. M abscessus treatment success is low in the presence of macrolide resistance. RESEARCH QUESTION Does treatment with amikacin liposome inhalation suspension (ALIS) improve culture conversion in patients with M abscessus pulmonary disease who are treatment naive or who have treatment-refractory disease? STUDY DESIGN AND METHODS In an open-label protocol, patients were given ALIS (590 mg) added to background multidrug therapy for 12 months. The primary outcome was sputum culture conversion defined as three consecutive monthly sputum cultures showing negative results. The secondary end point included development of amikacin resistance. RESULTS Of 33 patients (36 isolates) who started ALIS with a mean age of 64 years (range, 14-81 years), 24 patients (73%) were female, 10 patients (30%) had cystic fibrosis, and nine patients (27%) had cavitary disease. Three patients (9%) could not be evaluated for the microbiologic end point because of early withdrawal. All pretreatment isolates were amikacin susceptible and only six isolates (17%) were macrolide susceptible. Eleven patients (33%) were given parenteral antibiotics. Twelve patients (40%) received clofazimine with or without azithromycin as companion therapy. Fifteen patients (50%) with evaluable longitudinal microbiologic data demonstrated culture conversion, and 10 patients (67%) sustained conversion through month 12. Six of the 33 patients (18%) demonstrated mutational amikacin resistance. All were patients using clofazimine or clofazimine plus azithromycin as companion medication(s). Few serious adverse events occurred for ALIS users; however, reduction of dosing to three times weekly was common (52%). INTERPRETATION In a cohort of patients primarily with macrolide-resistant M abscessus, one-half of the patients using ALIS showed sputum culture conversion to negative findings. The emergence of mutational amikacin resistance was not uncommon and occurred with the use of clofazimine monotherapy. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03038178; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | - David E Griffith
- The University of Texas Health Science Center at Tyler, Tyler, TX
| | - Julie V Philley
- The University of Texas Health Science Center at Tyler, Tyler, TX
| | | | | | | | | | - Luke Strnad
- Oregon Health & Science University, Portland, OR
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Harris E. Mounting Evidence Suggests Leprosy Is Endemic in Florida. JAMA 2023; 330:798. [PMID: 37585214 DOI: 10.1001/jama.2023.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
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16
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Diaz JCD, Abad-Venida ML, Espinoza-Thaebtharm A, Cathryn Salonga ME, Abad-Casintahan MF. Comparison between lymecycline with multidrug therapy and standard multidrug regimen (WHO-MDT) in the treatment of multibacillary leprosy patients: a retrospective cohort study. Int J Dermatol 2023; 62:1186-1192. [PMID: 37408116 DOI: 10.1111/ijd.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Hansen's disease or leprosy is a chronic, infectious disease that has locally and globally afflicted all populations. Despite standard treatment with multidrug therapy (WHO-MDT), the incidence of drug resistance has been an increasingly prevalent global problem in leprosy management. This study compared the effectiveness between lymecycline with WHO-MDT and standard WHO-MDT in leprosy treatment. METHODS The research is a retrospective cohort study at a tertiary hospital from January 2011 to July 2021. Pre- and post-treatment bacillary index, presence of new lesions, nerve function impairment, and leprosy reactions were obtained through chart review. RESULTS The results showed a significant difference in bacteriological index (BI) in both groups at the end of the treatment. However, a higher reduction in BI was noted for the lymecycline group. For the group that took WHO-MDT alone, BI decreased by 0.7 (P < 0.001) whereas patients who took lymecycline and WHO-MDT had a BI difference of 3 (P < 0.001) upon completion of treatment. A significant decrease in the recurrence of lesions (P = 0.006) and nerve function impairment (P = 0.038) was also noted in the lymecycline group whereas there was no significant difference in leprosy reactions between the two groups. CONCLUSION Lymecycline 600 mg daily for 3 months can be used as an adjunct in cases of leprosy resistance and treatment failure among multibacillary patients. Lymecycline significantly reduced bacillary index, recurrence of skin lesions, and nerve function impairment through its possible immunomodulatory, antiapoptotic, and neuroprotective effects.
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Affiliation(s)
| | - Ma Luisa Abad-Venida
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
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Hu S, Lin X, Yin R, Wang W, Li Q. Recurrent choriocarcinoma complicated with leprosy during chemotherapy: A case report and literature review. Medicine (Baltimore) 2023; 102:e34548. [PMID: 37565881 PMCID: PMC10419345 DOI: 10.1097/md.0000000000034548] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
RATIONALE The global prevalence of leprosy has decreased substantially, and cases of leprosy infection are extremely rare in China. In this report, we present a case of recurrent choriocarcinoma complicated by leprosy infection during chemotherapy. PATIENT CONCERNS A 24-year-old Chinese woman (gravida 3, para 2) presented to a local hospital with vaginal bleeding. Her medical history included a previous diagnosis of hydatidiform mole. DIAGNOSES, INTERVENTIONS AND OUTCOMES The patient was diagnosed with choriocarcinoma and received chemotherapy in 6 cycles. Shortly after the initial treatment was completed, the disease recurred twice with resistance to multiple chemotherapeutic agents. In her second recurrence of choriocarcinoma, she was diagnosed with leprosy with many cutaneous nodules throughout her entire body. The patient was administered chemical treatment for leprosy with the multidrug therapy regimen after being diagnosed. To prevent exacerbating the infection, no immunotherapy was utilized to treat cancer, and the infection was well-controlled at the conclusion of anticancer therapy. LESSONS Because of immunological reduction, cancer patients are susceptible to a variety of infections. For patients with cancer, prevention and early detection of rare infectious diseases should receive special attention. Immunotherapy must be used with caution when treating patients with cancer and infections.
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Affiliation(s)
- Shiqi Hu
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiaojuan Lin
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
| | - Rutie Yin
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
| | - Wei Wang
- Department of Pathology, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
| | - Qingli Li
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
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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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Michot JM, Lazarovici J. [Toxicity of targeted therapies and immunotherapy with checkpointinhibitors in Hodgkin lymphoma]. Rev Prat 2023; 73:641-650. [PMID: 37458554] [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] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
TOXICITY OF TARGETED THERAPIES AND IMMUNOTHERAPY WITH CHECKPOINT INHIBITORS IN HODGKIN LYMPHOMA. In patients at increased risk of recurrence or progression after autotransplantation, or in cases of relapse after autotransplantation or after at least two lines of treatment when intensive multidrug therapy is no longer a treatment option, targeted anti-CD30 therapy with brentuximab vedotin may be proposed. Brentuximab vedotin is a monoclonal antibody directed against CD30 and coupled with an anti-microtubule cytotoxic agent, monomethyl auristatin E (MMAE). The main adverse side effect of brentuximab vedotin is peripheral neuropathy. In patients who have relapsed after intensive chemotherapy, including autograft for patients eligible for this treatment, and after failure of brentuximab vedotin, anti-PD1 immunotherapy (nivolumab or pembrolizumab) may be offered. Anti-PD1 (Programmed cell death protein 1) side effects are immune-related, varied and unpredictable (endocrinopathies, rash, colitis, interstitial lung disease). The tolerability profiles of brentuximab vedotin and anti-PD1 and the management of the main undesirable side effects of these treatments are detailed for clinical practice.
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Affiliation(s)
- Jean-Marie Michot
- Département d'hématologie de l'institut Gustave-Roussy, université Paris-Saclay, Villejuif, France
| | - Julien Lazarovici
- Département d'hématologie de l'institut Gustave-Roussy, université Paris-Saclay, Villejuif, France
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Neves KVRN, Machado LMG, Lisboa MN, Steinmann P, Ignotti E. Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brzil, 2016-2019. CAD SAUDE PUBLICA 2023; 39:e00279421. [PMID: 37255191 PMCID: PMC10549972 DOI: 10.1590/0102-311xen279421] [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: 12/16/2021] [Revised: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 06/01/2023] Open
Abstract
This study aimed to analyze the self-reported clinical history of patients misdiagnosed with leprosy in the State of Mato Grosso, Brazil. This is a cross-sectional study of new leprosy cases diagnosed in the State of Mato Grosso from 2016 to 2019, with individuals who were released from multidrug therapy due to misdiagnosis after starting treatment. Data were collected via telephone interviews. Over the study period, 354 leprosy cases were released from treatment due to misdiagnosis, of which 162 (45.8%) could be interviewed. All interviewees expressed dissatisfaction with their treatment, which prompted them to seek a reevaluation of their diagnosis before they were released due to "misdiagnosis". Among them, 35.8% received a final diagnosis of a musculoskeletal or connective tissue disease - mainly fibromyalgia and degenerative changes in the spine - followed by 13.6% with diagnoses of skin and subcutaneous tissue diseases. For 23.5% of the respondents, no alternative diagnosis was established, whereas 7.4% were later re-diagnosed with leprosy. Fibromyalgia and spinal problems were the most common alternative diagnoses for erroneous leprosy. Although the diagnosis of leprosy is usually clinical and does not require access to technical infrastructure in most cases, some more complex situations require diagnostic support via complementary tests, as well as close collaboration between primary care and reference services.
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Affiliation(s)
| | | | - Maurício Nobre Lisboa
- Hospital Giselda Trigueiro, Secretaria de Saúde do Estado do Rio Grande do Norte, Natal, Brasil
- Instituto de Medicina Tropical, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Wang L, Wang H, Yan L, Yu M, Yang J, Li J, Li J, Ning Y, Jiang H, Shi Y, Zhang W, Xiong L, Liu J, Kuang Y, Wang H, He J, Wang D, Li B, Liu Y, Shui T, Wang Y, Chen H, Sha X, Long H, Yu X, Shen C, Shen J, Yang X, Gu H, Zhang G, Wang B. Single-Dose Rifapentine in Household Contacts of Patients with Leprosy. N Engl J Med 2023; 388:1843-1852. [PMID: 37195940 DOI: 10.1056/nejmoa2205487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Previous studies have suggested that a single dose of rifampin has protective effects against leprosy in close contacts of patients with the disease. Rifapentine was shown to have greater bactericidal activity against Mycobacterium leprae than rifampin in murine models of leprosy, but data regarding its effectiveness in preventing leprosy are lacking. METHODS We conducted a cluster-randomized, controlled trial to investigate whether single-dose rifapentine is effective in preventing leprosy in household contacts of patients with leprosy. The clusters (counties or districts in Southwest China) were assigned to one of three trial groups: single-dose rifapentine, single-dose rifampin, or control (no intervention). The primary outcome was the 4-year cumulative incidence of leprosy among household contacts. RESULTS A total of 207 clusters comprising 7450 household contacts underwent randomization; 68 clusters (2331 household contacts) were assigned to the rifapentine group, 71 (2760) to the rifampin group, and 68 (2359) to the control group. A total of 24 new cases of leprosy occurred over the 4-year follow-up, for a cumulative incidence of 0.09% (95% confidence interval [CI], 0.02 to 0.34) with rifapentine (2 cases), 0.33% (95% CI, 0.17 to 0.63) with rifampin (9 cases), and 0.55% (95% CI, 0.32 to 0.95) with no intervention (13 cases). In an intention-to-treat analysis, the cumulative incidence in the rifapentine group was 84% lower than that in the control group (cumulative incidence ratio, 0.16; multiplicity-adjusted 95% CI, 0.03 to 0.87; P = 0.02); the cumulative incidence did not differ significantly between the rifampin group and the control group (cumulative incidence ratio, 0.59; multiplicity-adjusted 95% CI, 0.22 to 1.57; P = 0.23). In a per-protocol analysis, the cumulative incidence was 0.05% with rifapentine, 0.19% with rifampin, and 0.63% with no intervention. No severe adverse events were observed. CONCLUSIONS The incidence of leprosy among household contacts over 4 years was lower with single-dose rifapentine than with no intervention. (Funded by the Ministry of Health of China and the Chinese Academy of Medical Sciences; Chinese Clinical Trial Registry number, ChiCTR-IPR-15007075.).
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Affiliation(s)
- Le Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hongsheng Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Liangbin Yan
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Meiwen Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jinlan Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Junhua Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yong Ning
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Haiqin Jiang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Shi
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Wenyue Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Li Xiong
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jie Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yanfei Kuang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hao Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun He
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - De Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Bin Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yangying Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Tiejun Shui
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Huan Chen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaowei Sha
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Long
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaojin Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Chong Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jianping Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xueyuan Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Gu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Guocheng Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Baoxi Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
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22
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Gnanenthiran SR, Agarwal A, Patel A. Frontiers of cardiovascular polypills: From atherosclerosis and beyond. Trends Cardiovasc Med 2023; 33:182-189. [PMID: 34973412 PMCID: PMC10424636 DOI: 10.1016/j.tcm.2021.12.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
Fixed-dose combination (FDC) therapies (also known as polypills) remain underutilized in clinical practice despite over two decades of evidence from randomized controlled trials demonstrating increased adherence to multidrug therapy, improved cardiovascular disease (CVD) risk factor control, and lower incidence of cardiovascular events. Evidence demonstrates that FDC-based implementation strategies can substantially complement and augment current strategies for CVD risk prevention globally. The next decade is likely to extend the frontier of cardiovascular FDC therapies, particularly given expected advances in FDC manufacturing technology and accessibility. FDC-based anti-hypertensive therapies are emerging as integral components of a pragmatic blood pressure lowering strategy. Cardiovascular FDCs are rapidly approaching its coming of age, transforming from heavily hyped research tools to pragmatic clinical instruments. This review evaluates the current evidence for cardiovascular FDCs, barriers to current use, and potential next generation advances.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Anubha Agarwal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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23
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Aoki A, Jinno H, Ogawa K, Nakagawa T, Inagaki T, Wajima T, Okamoto Y, Uchiya KI. A Rapid Screening Assay for Clarithromycin-Resistant Mycobacterium avium Complex Using Melting Curve Analysis with Nonfluorescent Labeled Probes. Microbiol Spectr 2023; 11:e0432622. [PMID: 36622171 PMCID: PMC9927575 DOI: 10.1128/spectrum.04326-22] [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: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
Mycobacterium avium complex (MAC) thrives in various environments and mainly causes lung disease in humans. Because macrolide antibiotics such as clarithromycin or azithromycin are key drugs for MAC lung disease, the emergence of macrolide-resistant strains prevents the treatment of MAC. More than 95% of macrolide-resistant MAC strains are reported to have a point mutation in 23S rRNA domain V. This study successfully developed a melting curve assay using nonfluorescent labeled probes to detect the MAC mutation at positions 2058 to 2059 of the 23S rRNA gene (AA genotype, clarithromycin susceptible; TA, GA, AG, CA, AC, and AT genotypes, clarithromycin resistant). In the AA-specific probe assay, the melting peak of the DNA fragment of the AA genotype was higher than that of DNA fragments of other genotypes. Melting temperature (Tm) values of the AA genotype and the other genotypes were about 80°C and 77°C, respectively. DNA fragments of each genotype were identified correctly in six other genotype-specific probes (TA, GA, AG, CA, AC, and AT) assays. Using genomic DNA from six genotype strains of M. avium and four genotype strains of M. intracellulare, we confirmed that all genomic DNAs could be correctly identified as individual genotypes according to the highest Tm values among the same probe assays. These results indicate that this melting curve-based assay is able to determine MAC genotypes at positions 2058 to 2059 of the 23S rRNA gene. This simple method could contribute to the rapid detection of clarithromycin-resistant MAC strains and help to provide accurate drug therapy for MAC lung disease. IMPORTANCE Since macrolide antibiotics such as clarithromycin or azithromycin are key drugs in multidrug therapy for Mycobacterium avium complex (MAC) lung diseases, the rapid detection of macrolide-resistant MAC strains has important implications for the treatment of MAC. Previous studies have reported a correlation between drug susceptibility testing and the mutation of macrolide resistance genes. In this study, we developed a novel melting curve-based assay using nonfluorescent labeled probes to identify both clarithromycin-resistant M. avium and M. intracellulare with mutations in the 23S rRNA gene, which is the clarithromycin or azithromycin resistance gene. This assay contributed to not only the detection of MAC mutations but also the determination of all genotypes at positions 2058 to 2059 of the 23S rRNA gene. Furthermore, because nonfluorescent labeled probes are used, this assay is more easily and more immediately available than other methods.
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Affiliation(s)
- Akira Aoki
- Department of Hygienic Chemistry, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Hideto Jinno
- Department of Hygienic Chemistry, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Kenji Ogawa
- Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Taku Nakagawa
- Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Takayuki Inagaki
- Division of Pharmaceutical Sciences I, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Takeaki Wajima
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Yoshinori Okamoto
- Department of Hygienic Chemistry, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Kei-ichi Uchiya
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan
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24
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Greenstein T, Aldridge BB. Tools to develop antibiotic combinations that target drug tolerance in Mycobacterium tuberculosis. Front Cell Infect Microbiol 2023; 12:1085946. [PMID: 36733851 PMCID: PMC9888313 DOI: 10.3389/fcimb.2022.1085946] [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: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 01/08/2023] Open
Abstract
Combination therapy is necessary to treat tuberculosis to decrease the rate of disease relapse and prevent the acquisition of drug resistance, and shorter regimens are urgently needed. The adaptation of Mycobacterium tuberculosis to various lesion microenvironments in infection induces various states of slow replication and non-replication and subsequent antibiotic tolerance. This non-heritable tolerance to treatment necessitates lengthy combination therapy. Therefore, it is critical to develop combination therapies that specifically target the different types of drug-tolerant cells in infection. As new tools to study drug combinations earlier in the drug development pipeline are being actively developed, we must consider how to best model the drug-tolerant cells to use these tools to design the best antibiotic combinations that target those cells and shorten tuberculosis therapy. In this review, we discuss the factors underlying types of drug tolerance, how combination therapy targets these populations of bacteria, and how drug tolerance is currently modeled for the development of tuberculosis multidrug therapy. We highlight areas for future studies to develop new tools that better model drug tolerance in tuberculosis infection specifically for combination therapy testing to bring the best drug regimens forward to the clinic.
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Affiliation(s)
- Talia Greenstein
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, United States
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States
| | - Bree B Aldridge
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, United States
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Boston, MA, United States
- Department of Biomedical Engineering, Tufts University School of Engineering, Medford, MA, United States
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25
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Shimizu T, Kobayashi Y, Fujiyoshi K, Yato Y. Tuberculous spondylitis following intravesical Bacillus Calmette-Guérin therapy for bladder cancer surgically treated through the anterior approach. BMJ Case Rep 2022; 15:e251075. [PMID: 36593635 PMCID: PMC9743316 DOI: 10.1136/bcr-2022-251075] [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] [Indexed: 12/13/2022] Open
Abstract
Intravesical BCG therapy is commonly used to treat superficial bladder cancer. Although various complications associated with this therapy have been reported, tuberculous spondylitis is uncommon. Here, we report a rare case of tuberculous spondylitis that occurred after intravesical BCG therapy for bladder cancer. A man in his 80s received BCG immunotherapy for bladder cancer and developed low back pain after treatment. Remarkably, he presented with neurological symptoms. Spondylitis was suspected on imaging. CT-guided biopsy was performed to confirm the diagnosis. Consequently, Mycobacterium bovis was identified as the causative pathogen by multiplex PCR. Multidrug therapy, administered for several months, was ineffective. Therefore, surgery was performed through an anterior approach. The symptoms, including low back pain, improved and postoperative C reactive protein tests were within the normal range. Tuberculous spondylitis following BCG therapy should be considered in cases with a history of bladder cancer treatment.
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Affiliation(s)
- Toshiyuki Shimizu
- Department of Orthopedic Surgery, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopedic Surgery, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopedic Surgery, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopedic Surgery, Murayama Medical Center, Musashimurayama, Tokyo, Japan
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26
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Negera E, Bobosha K, Aseffa A, Dockrell HM, Lockwood DNJ, Walker SL. Regulatory T cells in erythema nodosum leprosum maintain anti-inflammatory function. PLoS Negl Trop Dis 2022; 16:e0010641. [PMID: 35867720 PMCID: PMC9348709 DOI: 10.1371/journal.pntd.0010641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/03/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The numbers of circulating regulatory T cells (Tregs) are increased in lepromatous leprosy (LL) but reduced in erythema nodosum leprosum (ENL), the inflammatory complication of LL. It is unclear whether the suppressive function of Tregs is intact in both these conditions.
Methods
A longitudinal study recruited participants at ALERT Hospital, Ethiopia. Peripheral blood samples were obtained before and after 24 weeks of prednisolone treatment for ENL and multidrug therapy (MDT) for participants with LL. We evaluated the suppressive function of Tregs in the peripheral blood mononuclear cells (PBMCs) of participants with LL and ENL by analysis of TNFα, IFNγ and IL-10 responses to Mycobacterium leprae (M. leprae) stimulation before and after depletion of CD25+ cells.
Results
30 LL participants with ENL and 30 LL participants without ENL were recruited. The depletion of CD25+ cells from PBMCs was associated with enhanced TNFα and IFNγ responses to M. leprae stimulation before and after 24 weeks treatment of LL with MDT and of ENL with prednisolone. The addition of autologous CD25+ cells to CD25+ depleted PBMCs abolished these responses. In both non-reactional LL and ENL groups mitogen (PHA)-induced TNFα and IFNγ responses were not affected by depletion of CD25+ cells either before or after treatment. Depleting CD25+ cells did not affect the IL-10 response to M. leprae before and after 24 weeks of MDT in participants with LL. However, depletion of CD25+ cells was associated with an enhanced IL-10 response on stimulation with M. leprae in untreated participants with ENL and reduced IL-10 responses in treated individuals with ENL. The enhanced IL-10 in untreated ENL and the reduced IL-10 response in prednisolone treated individuals with ENL was abolished by addition of autologous CD25+ cells.
Conclusion
The findings support the hypothesis that the impaired cell-mediated immune response in individuals with LL is M. leprae antigen specific and the unresponsiveness can be reversed by depleting CD25+ cells. Our results suggest that the suppressive function of Tregs in ENL is intact despite ENL being associated with reduced numbers of Tregs. The lack of difference in IL-10 response in control PBMCs and CD25+ depleted PBMCs in individuals with LL and the increased IL-10 response following the depletion of CD25+ cells in individuals with untreated ENL suggest that the mechanism of immune regulation by Tregs in leprosy appears independent of IL-10 or that other cells may be responsible for IL-10 production in leprosy. The present findings highlight mechanisms of T cell regulation in LL and ENL and provide insights into the control of peripheral immune tolerance, identifying Tregs as a potential therapeutic target.
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Affiliation(s)
- Edessa Negera
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- World Health Organization, TDR, the Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
| | - Hazel M. Dockrell
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
| | - Diana N. J. Lockwood
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
| | - Stephen L. Walker
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
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27
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Ferreira H, Leal-Calvo T, Mendes MA, Avanzi C, Busso P, Benjak A, Sales AM, Ferreira CP, de Berrêdo-Pinho M, Cole ST, Sarno EN, Moraes MO, Pinheiro RO. Gene expression patterns associated with multidrug therapy in multibacillary leprosy. Front Cell Infect Microbiol 2022; 12:917282. [PMID: 35937686 PMCID: PMC9354612 DOI: 10.3389/fcimb.2022.917282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Multidrug therapy (MDT) has been successfully used in the treatment of leprosy. However, although patients are cured after the completion of MDT, leprosy reactions, permanent disability, and occasional relapse/reinfection are frequently observed in patients. The immune system of multibacillary patients (MB) is not able to mount an effective cellular immune response against M. leprae. Consequently, clearance of bacilli from the body is a slow process and after 12 doses of MDT not all MB patients reduce bacillary index (BI). In this context, we recruited MB patients at the uptake and after 12-month of MDT. Patients were stratified according to the level of reduction of the BI after 12 doses MDT. A reduction of at least one log in BI was necessary to be considered a responder patient. We evaluated the pattern of host gene expression in skin samples with RNA sequencing before and after MDT and between samples from patients with or without one log reduction in BI. Our results demonstrated that after 12 doses of MDT there was a reduction in genes associated with lipid metabolism, inflammatory response, and cellular immune response among responders (APOBEC3A, LGALS17A, CXCL13, CXCL9, CALHM6, and IFNG). Also, by comparing MB patients with lower BI reduction versus responder patients, we identified high expression of CDH19, TMPRSS4, PAX3, FA2H, HLA-V, FABP7, and SERPINA11 before MDT. From the most differentially expressed genes, we observed that MDT modulates pathways related to immune response and lipid metabolism in skin cells from MB patients after MDT, with higher expression of genes like CYP11A1, that are associated with cholesterol metabolism in the group with the worst response to treatment. Altogether, the data presented contribute to elucidate gene signatures and identify differentially expressed genes associated with MDT outcomes in MB patients.
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Affiliation(s)
- Helen Ferreira
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Thyago Leal-Calvo
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mayara Abud Mendes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Charlotte Avanzi
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philippe Busso
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Andrej Benjak
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cássio Porto Ferreira
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Márcia de Berrêdo-Pinho
- Cellular Microbiology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Stewart Thomas Cole
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Milton Ozório Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Roberta Olmo Pinheiro,
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Taggart M, Kelly A, Stell R, Chu E. Multibacillary leprosy with an incubation period exceeding 50 years. BMJ Case Rep 2022; 15:e250835. [PMID: 35790324 PMCID: PMC9258486 DOI: 10.1136/bcr-2022-250835] [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] [Indexed: 11/04/2022] Open
Abstract
Leprosy is a chronic granulomatous infection predominantly involving the skin and peripheral nervous system. The condition is caused by infection with the obligate intracellular bacillus Mycobacterium leprae and the clinical phenotype is largely dependent on the host immune response to the organism. Transmission is suspected to occur via respiratory secretions with infection usually requiring prolonged periods of contact. The incubation period is highly variable with disease manifestations appearing up to several decades after the initial exposure. The disease can be broadly divided into 'paucibacillary' and 'multibacillary', and treatment with multidrug therapy including dapsone, clofazimine and rifampicin offers high rates of cure. Here, we report of a case of leprosy with a suspected incubation period in excess of 50 years following occupational exposure in rural Australia. To our knowledge, this incubation period is the longest reported to date.
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Affiliation(s)
- Michael Taggart
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Albert Kelly
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Rick Stell
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Eric Chu
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Ahuja M, Singh I, Lavania M, Pathak VK, Darlong J, Turankar RP, Hembrom S, Singh SV, Sengupta U. Ofloxacin resistance in multibacillary new leprosy cases from Purulia, West Bengal: A threat to effective secondary line treatment for rifampicin resistant leprosy cases. J Glob Antimicrob Resist 2022; 30:282-285. [PMID: 35717020 DOI: 10.1016/j.jgar.2022.06.008] [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: 12/02/2021] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Purulia is one of the high endemic districts for leprosy in West Bengal [Eastern part of India]. The annual new case detection rate (ANCDR) of leprosy in West Bengal is 6.04/100000 (DGHS 2019-20). Our earlier report has already provided the evidence of presence of secondary drug resistance in relapse cases of leprosy. The primary aim of the study was to find out primary drug resistance pattern for dapsone, rifampicin and ofloxacin among new leprosy patients from Purulia, West Bengal. to find out the emergence of primary drug resistance to any of these drugs. METHODS In the present study, slit- skin smear samples were collected from 145 newly diagnosed leprosy cases from TLM Purulia hospital during the duration between 2017-2018. DNA was extracted from these samples and were analyzed for the genes associated with drug resistance in M. leprae genome by PCR and was followed by Sanger sequencing. Wild-type strain (Thai-53) and mouse footpad-derived drug-resistant (Z-4) strain was used as reference strains. RESULTS Out of 145 cases; 25 cases had shown mutation in any of the three genes of rpoB, folP and gyrA associated with rifampicin, dapsone and ofloxacin resistance as described by WHO respectively by Sanger sequencing. Among these 25 cases; 16 cases had shown the mutations in ofloxacin, 2 cases had shown the mutation in combination of ofloxacin and rifampicin, 4 cases had shown the mutation only in rifampicin, 1 case had shown mutation in combination of rifampicin and dapsone and 2 cases had shown mutation only in dapsone. DISCUSSION AND CONCLUSION Results from this study indicated the emergence of resistance to anti-leprosy drugs in new cases of leprosy. As ofloxacin is the alternate drug for the treatment of rifampicin resistant cases, the emergence of new cases with resistance to ofloxacin indicates that ofloxacin resistant M. leprae strains are actively circulating in endemic region i. e. Purulia, West Bengal of India and poses a concern about the effective treatment of rifampicin resistance cases.
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Affiliation(s)
- Madhvi Ahuja
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India; Department of Biotechnology, GLA University, Mathura, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Mallika Lavania
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India; Enteric Viruses Group, Indian Council of Medical Research National Institute of Virology, Pune, India; Formerly at Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India.
| | - Vinay Kumar Pathak
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Joydeepa Darlong
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India; The Leprosy Mission Hospital, Purulia, India
| | - Ravindra P Turankar
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - S Hembrom
- The Leprosy Mission Hospital, Purulia, India
| | | | - Utpal Sengupta
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
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Cheng Y, Wang TY, Yuan HL, Li W, Shen JP, He ZX, Chen J, Gao JY, Wang FK, Gu J. Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review. Front Cell Infect Microbiol 2022; 11:789754. [PMID: 35141169 PMCID: PMC8819730 DOI: 10.3389/fcimb.2021.789754] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/29/2021] [Indexed: 01/23/2023] Open
Abstract
Objective The multicenter literature review and case studies of 3 patients were undertaken to provide an updated understanding of nocardiosis, an opportunistic bacterial infection affecting immunosuppressed nephrotic syndrome (NS) patients receiving long-term glucocorticoid and immunosuppressant treatment. The results provided clinical and microbiological data to assist physicians in managing nocardiosis patients. Methods Three cases between 2017 and 2018 from a single center were reported. Additionally, a systematic review of multicenter cases described in the NCBI PubMed, Web of Science, and Embase in English between January 1, 2001 and May 10, 2021 was conducted. Results This study described three cases of Nocardia infection in NS patients. The systematic literature review identified 24 cases with sufficient individual patient data. A total of 27 cases extracted from the literature review showed that most patients were > 50 years of age and 70.4% were male. Furthermore, the glucocorticoid or corticosteroid mean dose was 30.9 ± 13.7 mg per day. The average time between hormone therapy and Nocardia infection was 8.5 ± 9.7 months. Pulmonary (85.2%) and skin (44.4%) infections were the most common manifestations in NS patients, with disseminated infections in 77.8% of patients. Nodule/masses and consolidations were the major radiological manifestations. Most patients showed elevated inflammatory biomarkers levels, including white blood cell counts, neutrophils percentage, and C-reactive protein. Twenty-five patients received trimethoprim-sulfamethoxazole monotherapy (18.5%) or trimethoprim-sulfamethoxazole-based multidrug therapy (74.1%), and the remaining two patients (7.4%) received biapenem monotherapy. All patients, except the two who were lost to follow-up, survived without relapse after antibiotic therapy. Conclusions Nephrotic syndrome patients are at high risk of Nocardia infection even if receiving low-dose glucocorticoid during the maintenance therapy. The most common manifestations of nocardiosis in NS patients include abnormal lungs revealing nodules and consolidations, skin and subcutaneous abscesses. The NS patients have a high rate of disseminated and cutaneous infections but a low mortality rate. Accurate and prompt microbiological diagnosis is critical for early treatment, besides the combination of appropriate antibiotic therapy and surgical drainage when needed for an improved prognosis.
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Affiliation(s)
- Yan Cheng
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Tian-yi Wang
- Department of Respiratory Medicine, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Hong-li Yuan
- Department of Radiology, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Wei Li
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing-ping Shen
- Department of Nutrition, Beidaihe Rehabilitation and Recuperation Center, Qinhuangdao, China
| | - Zheng-xin He
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing Chen
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jie-ying Gao
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Fu-kun Wang
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jiang Gu
- Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University, Chongqing, China
- *Correspondence: Jiang Gu,
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Sarkar D, Chawla H, Singh P, Verma V. Case of leprosy mimicking preseptal cellulitis: a diagnostic dilemma. BMJ Case Rep 2022; 15:e245641. [PMID: 34992064 PMCID: PMC8739066 DOI: 10.1136/bcr-2021-245641] [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] [Accepted: 12/02/2021] [Indexed: 11/03/2022] Open
Abstract
A 36-year-old Asian man presented with swelling over the left frontal region involving the upper eyelids, with associated erythema and tenderness for 1 month duration. Clinically he was diagnosed as a case of preseptal cellulitis, however, the lesion did not improve on broad-spectrum systemic antibiotics. CT showed superficial soft tissue swelling in the forehead extending till the superior part of orbit. Histopathological assessment of the lesion revealed clusters of epithelioid cells with multinucleate giant cells in the dermis along with perivascular and periadnexal lymphocytic infiltrates, suggestive of leprosy. The patient was started on oral steroids with multidrug therapy, following which the patient showed early resolution of the lesion within 10 days of treatment. Leprosy is endemic in India, leprosy with reactional episodes mimics other inflammatory and infective etiologies making diagnosis difficult. Leprosy should be present in an ophthalmologist's diagnostic repertoire while dealing with periorbital swellings for early clinical diagnosis and favourable outcomes.
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Affiliation(s)
- Deepayan Sarkar
- Ophthalmology, All India Institute of Medical Science Bhopal, Bhopal, Madhya Pradesh, India
| | - Himani Chawla
- Dermatology, All India Institute of Medical Science Bhopal, Bhopal, Madhya Pradesh, India
| | - Priti Singh
- Ophthalmology, All India Institute of Medical Science Bhopal, Bhopal, Madhya Pradesh, India
| | - Vidhya Verma
- Ophthalmology, All India Institute of Medical Science Bhopal, Bhopal, Madhya Pradesh, India
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de Bruijne ND, Urgesa K, Aseffa A, Bobosha K, Schoenmakers A, van Wijk R, Hambridge T, Waltz MM, Kasang C, Mieras L. Development of a questionnaire to determine the case detection delay of leprosy: A mixed-methods cultural validation study. PLoS Negl Trop Dis 2022; 16:e0010038. [PMID: 35025894 PMCID: PMC8758092 DOI: 10.1371/journal.pntd.0010038] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Delay in case detection is a risk factor for developing leprosy-related impairments, leading to disability and stigma. The objective of this study was to develop a questionnaire to determine the leprosy case detection delay, defined as the period between the first signs of the disease and the moment of diagnosis, calculated in total number of months. The instrument was developed as part of the PEP4LEP project, a large-scale intervention study which determines the most effective way to implement integrated skin screening and leprosy post-exposure prophylaxis with a single-dose of rifampicin (SDR-PEP) administration in Ethiopia, Mozambique and Tanzania. METHODOLOGY/PRINCIPAL FINDINGS A literature review was conducted and leprosy experts were consulted. The first draft of the questionnaire was developed in Ethiopia by exploring conceptual understanding, item relevance and operational suitability. Then, the first draft of the tool was piloted in Ethiopia, Mozambique and Tanzania. The outcome is a questionnaire comprising nine questions to determine the case detection delay and two annexes for ease of administration: a local calendar to translate the patient's indication of time to number of months and a set of pictures of the signs of leprosy. In addition, a body map was included to locate the signs. A 'Question-by-Question Guide' was added to the package, to provide support in the administration of the questionnaire. The materials will be made available in English, Oromiffa (Afaan Oromo), Portuguese and Swahili via https://www.infolep.org. CONCLUSIONS/SIGNIFICANCE It was concluded that the developed case detection delay questionnaire can be administered quickly and easily by health workers, while not inconveniencing the patient. The instrument has promising potential for use in future leprosy research. It is recommended that the tool is further validated, also in other regions or countries, to ensure cultural validity and to examine psychometric properties like test-retest reliability and interrater reliability.
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Affiliation(s)
- Naomi D. de Bruijne
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
- NLR, Amsterdam, Netherlands
| | - Kedir Urgesa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | | | - Mitzi M. Waltz
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association (DAHW), Wurzburg, Germany
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Chew R, Woods ML. Multibacillary Mid-Borderline Leprosy with Type 1 Lepra Reaction and Concurrent Latent Tuberculosis. Am J Trop Med Hyg 2021; 106:373-375. [PMID: 34695791 PMCID: PMC8832908 DOI: 10.4269/ajtmh.21-0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Rusheng Chew
- Address correspondence to Rusheng Chew, Mahidol Oxford Tropical Medicine Research Unit, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand. E-mail:
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Menaldi SL, Dinakrisma AA, Thio HB, Rengganis I, Oktaria S. Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection. PLoS Negl Trop Dis 2021; 15:e0009453. [PMID: 34314436 PMCID: PMC8315541 DOI: 10.1371/journal.pntd.0009453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.
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Affiliation(s)
- Sri Linuwih Menaldi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- * E-mail: (SLM); (IR)
| | | | - Hok Bing Thio
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- * E-mail: (SLM); (IR)
| | - Salma Oktaria
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Muniyandi M, Singh M, Singh M, Rajshekhar K, Katoch K. Cost-effectiveness of incorporating Mycobacterium indicus pranii vaccine to multidrug therapy in newly diagnosed leprosy cases for better treatment outcomes & immunoprophylaxis in contacts as leprosy control measures for National Leprosy Eradication Programme in India. Indian J Med Res 2021; 154:121-131. [PMID: 34782538 PMCID: PMC8715682 DOI: 10.4103/ijmr.ijmr_661_20] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background & objectives The elimination goal for leprosy as a public health problem at the national level was achieved in 2005 in India. However, the number of new cases reporting annually remained nearly the same during the last 10-15 years. Moreover, a substantial number of these new cases reported disabilities for the first time. Therefore, besides multidrug therapy (MDT), newer strategies with focus on effectively decreasing the number of new cases, optimizing the treatment of detected cases, averting disabilities and arresting the transmission of the disease are required. So the objective of this study was to assess the cost-effectiveness of Mycobacterium indicus pranii (MIP) vaccine implementation in National Leprosy Eradication Programme (NLEP) for newly diagnosed leprosy patients as well as their contacts to arrest/decrease the transmission and occurrence of new cases. Methods This was a model-based estimation of incremental costs, total quality-adjusted life years (QALYs) gained, new cases averted, deaths averted, incremental cost-effectiveness ratio (ICER) and budget impact of the vaccination intervention. This model included the addition of MIP treatment intervention to the newly detected leprosy patients as well as vaccination with MIP to their contacts. Results Using the societal perspective, discounted ICER was estimated to be ₹73,790 per QALY gained over a five-year time period. Probabilistic sensitivity analysis (PSA) was assessed by varying the values of input parameters. Majority (96%) of simulations fell in North East quadrant of cost-effectiveness plane, which were all below the willingness to pay threshold. Interpretation & conclusions Introduction of MIP vaccination in the NLEP appears to be a cost-effective strategy for India. Significant health gains were reduction in the number of new leprosy cases, decreased incidence and severity of reactions during treatment, and after release from treatment, prevention of disabilities, thus reducing the cost as well as stigma of the disease.
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Affiliation(s)
- Malaisamy Muniyandi
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Malkeet Singh
- Department of Health Research, Ministry of Health & Family Planning, Government of India, New Delhi, India
| | - Manjula Singh
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Kavitha Rajshekhar
- Department of Health Research, Ministry of Health & Family Planning, Government of India, New Delhi, India
| | - Kiran Katoch
- Distinguished Dr A.S. Paintal Scientist Chair of ICMR at Indian Institute of Health Management Research University, Jaipur, Rajasthan, India
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Tessarolo LD, Meneses GC, Bezerra GF, da Rocha TP, de Azevedo IEP, Silva GB, Pontes MAA, Daher EDF, Martins AMC. Endothelial activation is associated with albuminuria in multibacillary leprosy. Rev Inst Med Trop Sao Paulo 2021; 63:e44. [PMID: 34161550 PMCID: PMC8216693 DOI: 10.1590/s1678-9946202163044] [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] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
Leprosy may present kidney and endothelial abnormalities, being a risk factor for complications. However, the involvement of renal and vascular endothelia has been poorly investigated. We aimed to investigate if the levels of systemic endothelial biomarkers are associated with kidney abnormalities and the clinical forms of leprosy. This is a cross-sectional study with leprosy patients enrolled in January 2017 to December 2018, before the initiation of the multidrug therapy. Leprosy-associated clinical and epidemiological data were collected. Two groups were investigated: Paucibacillary (PB) and Multibacillary (MB) infections, for the comparisons. Serum and urine samples were obtained for laboratory analysis. In serum samples, were evaluated the endothelial biomarkers VCAM-1 and ICAM-1. In total, 101 leprosy patients were included, the mean age was 48±١٥ years and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), among which 22 had the Virchowian form. Serum creatinine was more elevated in the MB group than in PB patients. In addition, VCAM-1 was elevated in the MB group and was correlated with the bacteriological index (rho = 0.372, p <0.01), the duration of disease symptoms (rho = 0.234, p = 0.04), and the number of skin lesions (rho = 0.468, p <0.001). Moreover, in MB patients who presented albuminuria >15 mg/g of creatinine, VCAM-1 showed a significant correlation with increased albuminuria and improved the correlation with the number of skin lesions (rho= 0.563, p=0.010). In conclusion, higher systemic VCAM-1 levels were associated with the multibacillary clinical form of leprosy and with increased albuminuria. Prospective studies are necessary to establish a cause-effect and evaluate the preventive role of these biomarkers to improve the clinical care.
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Affiliation(s)
- Louise Donadello Tessarolo
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Gabriela Freire Bezerra
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Fisiologia e Farmacologia, Programa de Pós-Graduação em Farmacologia, Fortaleza,
Ceará, Brazil
| | - Thaiany Pereira da Rocha
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Isabella Evelyn Prado de Azevedo
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Geraldo Bezerra Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Faculdade de
Medicina, Programa de Pós-Graduação de Saúde Coletiva, Fortaleza, Ceará,
Brazil
| | | | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
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Tanabe MB, Group AR, Rincon L, Stryjewska BM, Sarria JC. Persistent Infection Versus Type 2 Immunological Reaction in Lepromatous Leprosy. J Investig Med High Impact Case Rep 2021; 8:2324709620927884. [PMID: 32462938 PMCID: PMC7273538 DOI: 10.1177/2324709620927884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The distinction between persistent infection and immunologic reactions in leprosy
is often difficult but critically important since their management is different.
We present the case of a 51-year-old Vietnamese female who presented in 2015
with areas of erythema and skin infiltration on face and chest, as well as edema
on her hands and feet. Skin biopsy was consistent with lepromatous leprosy. She
was treated with rifampin, clarithromycin, and levofloxacin for 2 years. Her
lower extremity edema was attributed to type 2 immunological reaction for which
she was started on prednisone and methotrexate, but she was lost to follow-up
for 19 months. She presented with new skin lesions and pain on her extremities.
New biopsies revealed an intense neutrophilic infiltrate in the dermis and
acid-fast bacilli focally within cutaneous nerve twigs. As compared with the
initial biopsy, the inflammatory infiltrates were diminished and the bacilli had
a degenerating appearance. These findings were consistent with type 2
immunological reaction. The patient was treated with thalidomide with
improvement in the appearance of the skin lesions. A follow-up biopsy showed
lack of neutrophilic infiltrates and decreased number of bacilli. This case
illustrates the importance of differentiating between persistent infection and
immunologic reactions in leprosy. Clinicians should be aware of these
complications. A high index of suspicion and accurate interpretation of skin
biopsy results are essential for appropriate diagnosis.
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Affiliation(s)
- Melinda B. Tanabe
- University of Texas Medical Branch,
Galveston, TX, USA
- Melinda B. Tanabe, MD, Department of
Infectious Diseases, University of Texas Medical Branch, 301 University Blvd,
Route 0435, Galveston, TX 77555, USA.
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Nery JAC, Sales AM, Hacker MAVB, Moraes MO, Maia RC, Sarno EN, Illarramendi X. Low rate of relapse after twelve-dose multidrug therapy for hansen's disease: A 20-year cohort study in a brazilian reference center. PLoS Negl Trop Dis 2021; 15:e0009382. [PMID: 33939710 PMCID: PMC8118692 DOI: 10.1371/journal.pntd.0009382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization has raised concerns about the increasing number of Hansen disease (HD) relapses worldwide, especially in Brazil, India, and Indonesia that report the highest number of recurrent cases. Relapses are an indicator of MDT effectiveness and can reflect Mycobacterium leprae persistence or re-infection. Relapse is also a potential marker for the development or progression of disability. In this research, we studied a large cohort of persons affected by HD treated with full fixed-dose multibacillary (MB) multidrug therapy (MDT) followed for up to 20 years and observed that relapses are a rare event. We estimated the incidence density of relapse in a cohort of patients classified to receive MB regime (bacillary index (BI) > 0), diagnosed between September 1997 and June 2017, and treated with twelve-dose MB-MDT at a HD reference center in Rio de Janeiro, Brazil. We obtained the data from the data management system of the clinic routine service. We linked the selected cases to the dataset of relapses of the national HD data to confirm possible relapse cases diagnosed elsewhere. We diagnosed ten cases of relapse in a cohort of 713 patients followed-up for a mean of 12.1 years. This resulted in an incidence rate of 1.16 relapse cases per 1000 person-year (95% CI = 0.5915-2.076). The accumulated risk was 0.025 in 20 years. The very low risk observed in this cohort of twelve-dose-treated MB patients reinforces the success of the current MDT scheme.
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Affiliation(s)
- José A. C. Nery
- Souza Araújo Outpatient Clinic, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Anna M. Sales
- Souza Araújo Outpatient Clinic, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariana A. V. B. Hacker
- Souza Araújo Outpatient Clinic, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Milton O. Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Raquel C. Maia
- Souza Araújo Outpatient Clinic, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir N. Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ximena Illarramendi
- Souza Araújo Outpatient Clinic, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- * E-mail:
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Hambridge T, Nanjan Chandran SL, Geluk A, Saunderson P, Richardus JH. Mycobacterium leprae transmission characteristics during the declining stages of leprosy incidence: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009436. [PMID: 34038422 PMCID: PMC8186771 DOI: 10.1371/journal.pntd.0009436] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/08/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Leprosy is an infectious disease caused by Mycobacterium leprae. As incidence begins to decline, the characteristics of new cases shifts away from those observed in highly endemic areas, revealing potentially important insights into possible ongoing sources of transmission. We aimed to investigate whether transmission is driven mainly by undiagnosed and untreated new leprosy cases in the community, or by incompletely treated or relapsing cases. METHODOLOGY/PRINCIPAL FINDINGS A literature search of major electronic databases was conducted in January, 2020 with 134 articles retained out of a total 4318 records identified (PROSPERO ID: CRD42020178923). We presented quantitative data from leprosy case records with supporting evidence describing the decline in incidence across several contexts. BCG vaccination, active case finding, adherence to multidrug therapy and continued surveillance following treatment were the main strategies shared by countries who achieved a substantial reduction in incidence. From 3950 leprosy case records collected across 22 low endemic countries, 48.3% were suspected to be imported, originating from transmission outside of the country. Most cases were multibacillary (64.4%) and regularly confirmed through skin biopsy, with 122 cases of suspected relapse from previous leprosy treatment. Family history was reported in 18.7% of cases, while other suspected sources included travel to high endemic areas and direct contact with armadillos. None of the countries included in the analysis reported a distinct increase in leprosy incidence in recent years. CONCLUSIONS/SIGNIFICANCE Together with socioeconomic improvement over time, several successful leprosy control programmes have been implemented in recent decades that led to a substantial decline in incidence. Most cases described in these contexts were multibacillary and numerous cases of suspected relapse were reported. Despite these observations, there was no indication that these cases led to a rise in new secondary cases, suggesting that they do not represent a large ongoing source of human-to-human transmission.
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Affiliation(s)
- Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shri Lak Nanjan Chandran
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Saunderson
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Blok DJ, Steinmann P, Tiwari A, Barth-Jaeggi T, Arif MA, Banstola NL, Baskota R, Blaney D, Bonenberger M, Budiawan T, Cavaliero A, Gani Z, Greter H, Ignotti E, Kamara DV, Kasang C, Manglani PR, Mieras L, Njako BF, Pakasi T, Saha UR, Saunderson P, Smith WCS, Stäheli R, Suriyarachchi ND, Tin Maung A, Shwe T, van Berkel J, van Brakel WH, Vander Plaetse B, Virmond M, Wijesinghe MSD, Aerts A, Richardus JH. The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study. PLoS Negl Trop Dis 2021; 15:e0009279. [PMID: 33788863 PMCID: PMC8011751 DOI: 10.1371/journal.pntd.0009279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes. The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of SDR to eligible contacts of newly diagnosed leprosy patients in states or districts of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. This study investigated the long-term impact of the LPEP program on the leprosy new case detection rate (NCDR). Our results show that LPEP could reduce the NCDR beyond the impact of the routine leprosy control programme and that many new cases could be prevented. The benefit of LPEP increases gradually over time. LPEP could accelerate the time of reaching predicted NCDR levels of 2040 under routine program by up to six years. Furthermore, we highlighted how the impact varies between countries due to differences in the number of contacts per index patient screened and differences in leprosy epidemiology and national control programme. Generally, including both household contacts and neighbours (> 20 contacts per index patient) would yield the highest impact.
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Affiliation(s)
- David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anuj Tiwari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Barth-Jaeggi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - David Blaney
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | | | - Helena Greter
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | | | | | - Blasdus F. Njako
- German Leprosy and Tuberculosis Relief Association, Dar es Salaam, Tanzania
| | - Tiara Pakasi
- Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Unnati R. Saha
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul Saunderson
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | | | | | | | | | - Tin Shwe
- American Leprosy Missions, Yangon, Myanmar
| | | | | | | | | | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Taal AT, Blok DJ, van Brakel WH, de Vlas SJ, Richardus JH. Number of people requiring post-exposure prophylaxis to end leprosy: A modeling study. PLoS Negl Trop Dis 2021; 15:e0009146. [PMID: 33630836 PMCID: PMC7906365 DOI: 10.1371/journal.pntd.0009146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Worldwide, around 210,000 new cases of leprosy are detected annually. To end leprosy, i.e. zero new leprosy cases, preventive interventions such as contact tracing and post-exposure prophylaxis (PEP) are required. This study aims to estimate the number of people requiring PEP to reduce leprosy new case detection (NCD) at national and global level by 50% and 90%. METHODOLOGY/PRINCIPAL FINDINGS The individual-based model SIMCOLEP was fitted to seven leprosy settings defined by NCD and MB proportion. Using data of all 110 countries with known leprosy patients in 2016, we assigned each country to one of these settings. We predicted the impact of administering PEP to about 25 contacts of leprosy patients on the annual NCD for 25 years and estimated the number of contacts requiring PEP per country for each year. The NCD trends show an increase in NCD in the first year (i.e. backlog cases) followed by a significant decrease thereafter. A reduction of 50% and 90% of new cases would be achieved in most countries in 5 and 22 years if 20.6 and 40.2 million people are treated with PEP over that period, respectively. For India, Brazil, and Indonesia together, a total of 32.9 million people requiring PEP to achieve a 90% reduction in 22 years. CONCLUSION/SIGNIFICANCE The leprosy problem is far greater than the 210,000 new cases reported annually. Our model estimates of the number of people requiring PEP to achieve significant reduction of new leprosy cases can be used by policymakers and program managers to develop long-term strategies to end leprosy.
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Affiliation(s)
- Anneke T. Taal
- NLR, Amsterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bezerra NTC, Schettini APM, Leturiondo AL, Mathias LHMT. Case for diagnosis. Erythematous and infiltrated plaques in the infrahyoid region. An Bras Dermatol 2021; 96:97-99. [PMID: 33288364 PMCID: PMC7838112 DOI: 10.1016/j.abd.2020.03.022] [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] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/05/2020] [Indexed: 11/23/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.
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de Barros B, Lambert SM, Shah M, Pai VV, Darlong J, Rozario BJ, Alinda MD, Sales AM, Doni S, Hagge DA, Shrestha D, Listiawan MY, Yitaye AM, Nery JAC, Neupane KD, Dias VLA, Butlin CR, Nicholls PG, Lockwood D, Walker SL. Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial. BMJ Open 2020; 10:e037700. [PMID: 33203627 PMCID: PMC7674097 DOI: 10.1136/bmjopen-2020-037700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Erythema nodosum leprosum (ENL) is an immunological complication of leprosy. ENL results in morbidity and disability and if it is not treated can lead to death. The current treatment consists of thalidomide or high doses of oral corticosteroids for prolonged periods. Thalidomide is not available in many leprosy endemic countries. The use of corticosteroids is associated with morbidity and mortality. Identifying treatment regimens that reduce the use of corticosteroids in ENL is essential. Methotrexate (MTX) is used to treat many inflammatory diseases and has been used successfully to treat patients with ENL not controlled by other drugs, including prednisolone and thalidomide. We present the protocol of the 'MTX and prednisolone study in ENL' (MaPs in ENL) a randomised controlled trial (RCT) designed to test the efficacy of MTX in the management of ENL. METHODS AND ANALYSIS MaPs in ENL is an international multicentre RCT, which will be conducted in leprosy referral centres in Bangladesh, Brazil, Ethiopia, India, Indonesia and Nepal. Patients diagnosed with ENL who consent to participate will be randomly allocated to receive 48 weeks of weekly oral MTX plus 20 weeks of prednisolone or 48 weeks of placebo plus 20 weeks of prednisolone. Participants will be stratified by type of ENL into those with acute ENL and those with chronic and recurrent ENL. The primary objective is to determine whether MTX reduces the requirement for additional prednisolone. Patients' reported outcome measures will be used to assess the efficacy of MTX. Participants will be closely monitored for adverse events. ETHICS AND DISSEMINATION Results will be submitted for publication in peer-reviewed journals. Ethical approval was obtained from the Observational/Interventions Research Ethics Committee of the London School of Hygiene & Tropical Medicine (15762); The Leprosy Mission International Bangladesh Institutional Research Board (in process); AHRI-ALERT Ethical Review Committee, Ethiopia; Ethics Committee of the Managing Committee of the Bombay Leprosy Project; and The Leprosy Mission Trust India Ethics Committee; the Nepal Health and Research Council and Health Research Ethics Committee Dr. Soetomo, Indonesia. This study is registered at www.clinicaltrials.gov. This is the first RCT of MTX for ENL and will contribute to the evidence for the management of ENL.Trial registration numberNCT 03775460.
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Affiliation(s)
- Barbara de Barros
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Saba M Lambert
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Mahesh Shah
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | | | | | | | - Medhi Denisa Alinda
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo General Hospital, Surabaya, Jawa Timur, Indonesia
| | - Anna M Sales
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Shimelis Doni
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Deanna A Hagge
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Dilip Shrestha
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - M Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo General Hospital, Surabaya, Jawa Timur, Indonesia
| | - Abeba M Yitaye
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Jose A C Nery
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Kapil D Neupane
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Vivianne L A Dias
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - C Ruth Butlin
- DBLM Hospital, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Peter G Nicholls
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Lockwood
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen L Walker
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
BACKGROUND Leprosy control achieved dramatic success in the 1980s-1990s with the implementation of short course multidrug therapy, which reduced the global prevalence of leprosy to less than 1 in 10 000 population. However, a period of relative stagnation in leprosy control followed this achievement, and only limited further declines in the global number of new cases reported have been achieved over the past decade. MAIN TEXT In 2016, major stakeholders called for the development of an innovative and comprehensive leprosy strategy aimed at reducing the incidence of leprosy, lowering the burden of disability and discrimination, and interrupting transmission. This led to the establishment of the Global Partnership for Zero Leprosy (GPZL) in 2018, with partners aligned around a shared Action Framework committed to achieving the WHO targets by 2030 through national leprosy program capacity-building, resource mobilisation and an enabling research agenda. GPZL convened over 140 experts from more than 20 countries to develop a research agenda to achieve zero leprosy. The result is a detailed research agenda focusing on diagnostics, mapping, digital technology and innovation, disability, epidemiological modelling and investment case, implementation research, stigma, post exposure prophylaxis and transmission, and vaccines. This research agenda is aligned with the research priorities identified by other stakeholders. CONCLUSIONS Developing and achieving consensus on the research agenda for zero leprosy is a significant step forward for the leprosy community. In a next step, research programmes must be developed, with individual components of the research agenda requiring distinct expertise, varying in resource needs, and operating over different timescales. Moving toward zero leprosy now requires partner alignment and new investments at all stages of the research process, from discovery to implementation.
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Affiliation(s)
- Peter Steinmann
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Courtenay Dusenbury
- Global Partnership for Zero Leprosy, Task Force for Global Health, Decatur, GA, USA
| | - David Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
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Luo Y, Tanigawa K, Kawashima A, Ishido Y, Ishii N, Suzuki K. The function of peroxisome proliferator-activated receptors PPAR-γ and PPAR-δ in Mycobacterium leprae-induced foam cell formation in host macrophages. PLoS Negl Trop Dis 2020; 14:e0008850. [PMID: 33075048 PMCID: PMC7595635 DOI: 10.1371/journal.pntd.0008850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/29/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). In lepromatous leprosy (LL), skin macrophages, harboring extensive bacterial multiplication, gain a distinctive foamy appearance due to increased intracellular lipid load. To determine the mechanism by which M. leprae modifies the lipid homeostasis in host cells, an in vitro M. leprae infection system, using human macrophage precursor THP-1 cells and M. leprae prepared from the footpads of nude mice, was employed. RNA extracted from skin smear samples of patients was used to investigate host gene expressions before and after multidrug therapy (MDT). We found that a cluster of peroxisome proliferator-activated receptor (PPAR) target genes associated with adipocyte differentiation were strongly induced in M. leprae-infected THP-1 cells, with increased intracellular lipid accumulation. PPAR-δ and PPAR-γ expressions were induced by M. leprae infection in a bacterial load-dependent manner, and their proteins underwent nuclear translocalization after infection, indicating activation of PPAR signaling in host cells. Either PPAR-δ or PPAR-γ antagonist abolished the effect of M. leprae to modify host gene expressions and inhibited intracellular lipid accumulation in host cells. M. leprae-specific gene expressions were detected in the skin smear samples both before and after MDT, whereas PPAR target gene expressions were dramatically diminished after MDT. These results suggest that M. leprae infection activates host PPAR signaling to induce an array of adipocyte differentiation-associated genes, leading to accumulation of intracellular lipids to accommodate M. leprae parasitization. Certain PPAR target genes in skin lesions may serve as biomarkers for monitoring treatment efficacy. Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). Lipid-enriched intracellular environment is important for the parasitization of M. leprae. During anti-leprosy treatment, chemotherapy-killed bacilli can remain in host tissues for a long time, making it difficult to determine the treatment efficacy by Zeihl-Nelson’s staining-based bacterial index (BI) test. In this study, we found that host peroxisome proliferator-activated receptor (PPAR) signaling is responsible for modification of intracellular lipid homeostasis to accommodate M. leprae parasitization in host macrophages. In skin smear samples of patients, M. leprae-derived gene expressions were detected both before and after anti-leprosy treatment, whereas human PPAR target gene expressions were dramatically diminished after the treatment. These results further our understanding of M. leprae intracellular parasitization, and suggest that PPAR signaling may be a novel therapeutic target for treating M. leprae infection and monitoring the expressions of certain PPAR target genes in skin lesions may be helpful to evaluate the treatment efficacy and recurrent infection.
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Affiliation(s)
- Yuqian Luo
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - 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
| | - Yuko Ishido
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail:
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Bassey IE, Inyang IE, Akpan UO, Isong IKP, Icha BE, Ayawan VM, Peter RE, Itita HA, Odumusor PU, Ekanem EG, Essien OE. Cardiovascular disease risk factors and markers of oxidative stress and DNA damage in leprosy patients in Southern Nigeria. PLoS Negl Trop Dis 2020; 14:e0008749. [PMID: 33044965 PMCID: PMC7580906 DOI: 10.1371/journal.pntd.0008749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/22/2020] [Accepted: 08/26/2020] [Indexed: 12/07/2022] Open
Abstract
Leprosy reduces quality of life of affected persons. Oxidative stress caused by reactive oxygen species may play a vital role in the pathogenesis of leprosy. This study evaluated anthropometric indices, fasting plasma glucose (FPG), lipid profile, total antioxidant capacity (TAC), total plasma peroxide (TPP), oxidative stress index (OSI), malondialdehyde (MDA), glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdg) in leprosy patients. Sixty test participants of both genders, aged 18–65years and diagnosed of multibacillary leprosy and 30 apparently healthy controls were consecutively recruited for this study. The test participants comprised of 30 patients on multidrug therapy (MDT) and 30 patients relieved from therapy (RFT). Body mass index (BMI), Waist-hip ratio (WHR), FPG, lipid profile, TAC, TPP, OSI, MDA, GSH and 8-OHdg were determined using appropriate methods. Data were analyzed using Analysis of variance; p<0.05 was considered statistically significant. The MDT group had significantly lower BMI (p = 0.0001), Total cholesterol (p = 0.001), HDL-C (p = 0.019), LDL-C (p = 0.005), TAC (p = 0.0001) and higher TPP (p = 0.001), MDA (p = 0.0001), OSI (p = 0.005) and 8-OHdg (p = 0.035) compared to the controls. The RFT group had significantly lower BMI (p = 0.001) Total cholesterol (0.0001), HDL-C (p = 0.006) LDL-C (p = 0.0001), TAC (p = 0.001) and higher WHR (p = 0.010), VLDL-C (p = 0.035), TG (p = 0.023) Atherogenic index of plasma (p = 0.0001) and TPP (p = 0.001), MDA (p = 0.0001) compared to the control group. GSH levels correlated negatively with duration of treatment (r = -0.401, p = 0.028). This study has shown that there is oxidative stress in multibacillary leprosy patients irrespective of drug treatment status. This study also shows that leprosy patients relieved from treatment may be susceptible to cardiovascular events. Antioxidants supplementation may be beneficial in the treatment of leprosy and clinical follow up on patients relieved from treatment may also be necessary to monitor health status and prevent development of cardiovascular events. This study shows that there are lower levels of total antioxidant capacity and higher levels of total plasma peroxide, malondialdehyde in leprosy patients undergoing multidrug therapy and those relieved from treatment and higher levels of 8-OHdg and oxidative stress index in leprosy patients undergoing multidrug therapy. This is suggestive of increased oxidative stress, in multibacillary leprosy patients irrespective of drug treatment status and increased oxidative DNA damage in those undergoing multidrug therapy. Antioxidants supplementation may be beneficial in the treatment of leprosy to protect against the effects of oxidative stress and DNA damage. Leprosy patients relieved from treatment may be susceptible to cardiovascular events as shown by higher levels of VLDL-cholesterol, triglycerides and atherogenic index of plasma observed in that group compared to controls. It therefore points to the need to monitor cardiovascular comorbidities in patients on multidrug therapy and those released from therapy.
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Affiliation(s)
- Iya Eze Bassey
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- * E-mail:
| | - Inyeneobong Ernest Inyang
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Uwem Okon Akpan
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Idongesit Kokoabasi Paul Isong
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Bassey Edward Icha
- Department of Chemical Pathology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Victoria Micheal Ayawan
- Department of Microbiology, Faculty of Natural Science, Caritas University, Amorji Nike, Enugu State, Nigeria
| | - Racheal Ekanem Peter
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Hopefaith Adode Itita
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Prince Ukam Odumusor
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Eyoanwan Graziani Ekanem
- Department of Microbiology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Okon Ekwerre Essien
- Department of Internal Medicine, Faculty of Medicine, University of Calabar, Calabar, Cross River State, Nigeria
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Upputuri B, Pallapati MS, Tarwater P, Srikantam A. Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India. PLoS Negl Trop Dis 2020; 14:e0008678. [PMID: 33035210 PMCID: PMC7577491 DOI: 10.1371/journal.pntd.0008678] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/21/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Erythema nodosum leprosum (ENL), or type 2 lepra reaction, is a multi-system immune-mediated complication in patients with multibacillary leprosy, frequently associated with chronicity and recurrences. Management of ENL requires high doses of oral corticosteroids, which may not be universally effective and pose serious adverse effects. Thalidomide has proven to be a steroid-sparing agent and is useful in controlling the reactions. However, many centres do not employ it in outpatient settings due to adverse effects and teratogenicity risk. Hence, we studied the feasibility of treating ENLs and reported the therapeutic outcome.This is a five-year record-based analysis of ENL leprosy patients treated with thalidomide, includingdescriptive statistics of demographic variables. Clinical characteristics were stratified by treatment compliance status (yes/no). Incidence rates and rate ratios for recovery stratified by bacillary index, type of ENL presentation and MDT treatment status were calculated.Out of 102 ENL patients treated with thalidomide, 68 (66.7%) were compliant and improved. Among them, ENL recurrence was noted in 11(16.2%) patients. The commonest thalidomide side effect was pedal oedema (73.5%). Patients with bacillary index (BI) less than or equal to 4.0 had a 37% increase in the incidence of recovery. Patients with acute ENL were almost twice as likely to recover as those with chronic ENL. Also, the improvement was two and a half times greater among those who completed MDT as compared to those on MDT. The study showed that thalidomide treatment for patients with ENL is possible in outpatientclinics. We also successfully prevented pregnancies to a larger extent through counselling for contraception.We observed that early institution of thalidomide induces faster remission and prevents ENL recurrence. Erythema nodosum leprosum (ENL), is an immune-mediated condition of leprosy.It is a multi-system disorder which can occurbefore, during or after completion of multidrug therapy for leprosy.ENL is often characterised by chronicity and recurrence. Management of ENL requires long-term oral corticosteroids which are associated with adverse effects.Thalidomide is an alternative to steroids, but many centres donot use it in their outpatient clinics due to the significant concern of drug-producing birth defects.This study provides additional evidence of the feasibility of thalidomide treatment in ENL at outpatient settings.
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Affiliation(s)
- Brahmaiah Upputuri
- Clinical Division, LEPRA Society-Blue Peter Public Health and Research Centre (BPHRC), Hyderabad, India
| | - Michael Sukumar Pallapati
- Clinical Division, LEPRA Society-Blue Peter Public Health and Research Centre (BPHRC), Hyderabad, India
| | - Patrick Tarwater
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Aparna Srikantam
- Clinical and Laboratory Research Division, LEPRA Society-Blue Peter Public Health and Research Centre (BPHRC), Hyderabad, India
- * E-mail:
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Robati RM, Mozafari N, Bidari-Zerehpoosh F, Niknejad N, Bizaval Z. Lepromatous leprosy presenting with type II reaction before and type I reaction after treatment. Dermatol Online J 2020; 26:13030/qt1f76n0b4. [PMID: 33054941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023] Open
Abstract
Lepromatous leprosy is associated with a high bacillary load and poor cellular immune response. Early dermatologic manifestations include erythematous macules, papules, nodules, and plaques with a symmetrical distribution. Leprosy also shows two major reaction states including type I (reversal reaction) and type II (vasculitis). These reactions are usually seen in some patients who are undergoing treatment. Herein, we report an interesting patient with lepromatous leprosy who presented with skin lesions of type II reaction without receiving any anti-leprosy treatment and surprisingly showed a type I reaction eight months after the beginning of the treatment.
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Affiliation(s)
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran.
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Lenz SM, Collins JH, Ray NA, Hagge DA, Lahiri R, Adams LB. Post-exposure prophylaxis (PEP) efficacy of rifampin, rifapentine, moxifloxacin, minocycline, and clarithromycin in a susceptible-subclinical model of leprosy. PLoS Negl Trop Dis 2020; 14:e0008583. [PMID: 32936818 PMCID: PMC7494095 DOI: 10.1371/journal.pntd.0008583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials. METHODOLOGY/PRINCIPAL FINDINGS Athymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation. CONCLUSIONS/SIGNIFICANCE The delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3-4 months) and late (8-9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.
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Affiliation(s)
| | - Jaymes H. Collins
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Nashone A. Ray
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Deanna A. Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Ramanuj Lahiri
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Linda B. Adams
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
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Tiwari A, Blok DJ, Arif M, Richardus JH. Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. PLoS Negl Trop Dis 2020; 14:e0008521. [PMID: 32750059 PMCID: PMC7428216 DOI: 10.1371/journal.pntd.0008521] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/14/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.
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Affiliation(s)
- Anuj Tiwari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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