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Tihanyi B, Samu L, Koncz I, Hergott K, Medgyesi P, Pálfi G, Szabó KÁ, Kis L, Marcsik A, Molnár E, Spekker O. A glimpse into the past of Hansen's disease - Re-evaluation and comparative analysis of cases with leprosy from the Avar period of the Trans-Tisza region, Hungary. Tuberculosis (Edinb) 2024; 148:102552. [PMID: 39142093 DOI: 10.1016/j.tube.2024.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
Our knowledge of how society viewed leprosy and treated its victims in the past is still scarce, especially in geographical regions and archaeological periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of five previously described, probable cases with leprosy from the Avar-period Trans-Tisza region (Hungary). The five skeletons were subject to a detailed macromorphological (re-)evaluation. Where possible, the biological and social consequences of having leprosy were reconstructed based on the observed bony changes and mortuary treatment, respectively. The retrospective, macromorphology-based diagnosis of leprosy could be established in three cases only. Based on the detected skeletal lesions, all of them suffered from near-lepromatous or lepromatous leprosy. The disease resulted in aesthetic repercussions and functional implications, which would have been disadvantageous for these individuals, and limited or changed their possibilities to participate in social situations. They could have even required heavy time investment from their respective communities. The analysis of the mortuary treatment of the confirmed leprosy cases revealed no evidence of a social stigma. These findings indicate that the afflicted have not been systematically expulsed or segregated, at least in death, in the Early Middle Ages of the Carpathian Basin.
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Affiliation(s)
- Balázs Tihanyi
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Levente Samu
- Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - István Koncz
- Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - Kristóf Hergott
- Koszta József Museum, Kossuth tér 1, H-6600, Szentes, Hungary; Department of Archaeology, University of Szeged, Egyetem utca 2, H-6722, Szeged, Hungary.
| | - Pál Medgyesi
- Munkácsy Mihály Museum, Széchenyi utca 9, H-5600, Békéscsaba, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Krisztina Ágnes Szabó
- Department of Art and Art History, University of Szeged, Brüsszeli körút 37, H-6723, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Antónia Marcsik
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Olga Spekker
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary; Ancient and Modern Human Genomics Competence Centre, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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Ramos-Cavazos CJ, Villarreal-Martinez A, Ocampo-Candiani J, Gomez-Flores M, Moreno-Pecina CA, Chavez-Alvarez S. Eyebrow trichoscopy in leprosy. Int J Dermatol 2024; 63:1071-1073. [PMID: 38374522 DOI: 10.1111/ijd.17069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Trichoscopy is a noninvasive technique based on the analysis of hair structures and the scalp, which allows for early diagnosis of different forms of alopecia. METHODS We conducted a descriptive cross-sectional study in the Dermatology Department of Hospital Universitario "Dr. José Eleuterio González" in Monterrey, Northeastern Mexico. We included 25 patients with a confirmed diagnosis of leprosy. Ten dermoscopic characteristics were assessed in the eyebrows of these patients. Images of the medial and distal portions of the eyebrows were included. Cohen's kappa coefficient was used for the analysis of coherence between the findings of two dermatologists. RESULTS Of the 25 patients, 14 were male (56%) and 11 were female (44%), with a median age of 60.28 years (IQR: 40-87). The most common findings in the medial eyebrow included vellus hair (96%) and white-yellowish structureless areas (84%). Furthermore, the most common features of the distal eyebrow included vellus hair (96%), white yellowish structureless areas (92%), and pinpoint white dots (92%). CONCLUSIONS To the best of our knowledge, this study is the first of its kind to describe trichoscopy findings in different leprosy subtypes and classify them into medial and distal eyebrow findings, which seem to be the most affected areas. Identification of these changes is easier in the distal portion of the eyebrows in every subtype of leprosy. We also discovered new trichoscopic findings in the eyebrows: perifollicular hyperpigmentation and yellow dots.
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de Almeida Gonçalves Sachett J, da Silva Moreira RM, Porto MCA, Nascimento TP, Monteiro WM. The marks of leprosy: disabilities caused by plantar lesions in discharged patients. Arch Dermatol Res 2024; 316:490. [PMID: 39066844 DOI: 10.1007/s00403-024-03227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/14/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
Leprosy is a chronic infectious disease that has a slow evolution and is characterized by dermatoneurological involvement. The health challenges surrounding this disease are closely related to the stigma that results from the physical disabilities it causes. This is due to its high rate of late diagnosis and the peculiar deformities that occur in its advanced stage. Evaluate the clinical and epidemiological aspects of patients with plantar lesions who were treated for leprosy in a dermatology referral unit. This is a cross-sectional exploratory field study that was conducted at the Reference Center in Tropical Dermatology and Venereology Alfredo da Matta (FUHAM), in Manaus, Amazonas, Brazil. We evaluated 36 patients with disabilities as a result of leprosy and who had plantar lesions. The most common ulcer site was the medial region of the plantar surface, which presented dryness and maceration with yellowish seropurulent exudate, fibrinous tissue and grade 2 depth. The study made it possible to observe the evolution of plantar ulcers resulting from the disease process, then evaluate them and discuss recommendations regarding the treatment and prevention of this type of physical disability.
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Affiliation(s)
- Jacqueline de Almeida Gonçalves Sachett
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.
- Fundação Hospitalar de Dermatologia Tropical e Venereologia "Alfredo da Matta", Manaus, Amazonas, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
| | | | | | | | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Bhardwaj R, Thounaojam AS. Employing advanced computational drug discovery techniques to identify novel inhibitors against ML2640c protein: a potential therapeutic approach for combatting leprosy. Mol Divers 2024:10.1007/s11030-024-10902-z. [PMID: 38900332 DOI: 10.1007/s11030-024-10902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024]
Abstract
Leprosy, caused by Mycobacterium leprae, remains a significant global health challenge, necessitating innovative approaches to therapeutic intervention. This study employs advanced computational drug discovery techniques to identify potential inhibitors against the ML2640c protein, a key factor in the bacterium's ability to infect and persist within host cells. Utilizing a comprehensive methodology, including virtual screening, re-docking, molecular dynamics simulations, and free energy calculations, we screened a library of compounds for their interaction with ML2640c. Four compounds (24349836, 26616083, 26648979, and 26651264) demonstrated promising inhibitory potential, each exhibiting unique binding energies and interaction patterns that suggest a strong likelihood of disrupting the protein function. The study highlights the efficacy of computational methods in identifying potential therapeutic candidates, presenting compound 26616083 as a notably potent inhibitor due to its excellent binding affinity and stability. Our findings offer a foundation for future experimental validation and optimization, marking a significant step forward in the development of new treatments for leprosy. This research not only advances the fight against leprosy but also showcases the broader applicability of computational drug discovery in tackling infectious diseases.
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Affiliation(s)
- Rima Bhardwaj
- Department of Chemistry, Poona College, Savitribai Phule Pune University, Pune, India.
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Bakoubayi AW, Haliba F, Zida-Compaore WIC, Bando PP, Konu YR, Adoli LK, Akpadja K, Alaglo K, Tchalim M, Patchali P, Djakpa Y, Amekuse K, Gnossike P, Gadah DAY, Ekouevi DK. Any resurgence of leprosy cases in the Togo's post-elimination period? Trend analysis of reported leprosy cases from 2010 to 2022. BMC Infect Dis 2024; 24:588. [PMID: 38880867 PMCID: PMC11181597 DOI: 10.1186/s12879-024-09492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. Togo achieved the target of eliminating leprosy as a public health problem in 2000 (less than 1 case/10 000 population). However, new cases of leprosy are still being reported. The aim of this study was to describe and map trends of leprosy cases notified in Togo from 2010 to 2022. METHODS This was a descriptive cross-sectional study covering a thirteen-year period from January 1, 2010, to December 31, 2022. The data of the study were leprosy surveillance system's data collected monthly between 2010 and 2022. The estimated number of leprosy cases and the incidence rate of leprosy cases were reported for the whole population by region, by district, by calendar year (2010-2022) and by target sub-population (children under 15, women and people with disabilities). Observed case incidence rates were mapped by health district and by year. RESULTS From January 1, 2010, to December 31, 2022, 1031 new cases of leprosy were diagnosed in Togo. The median age of subjects was 46 years (interquartile range: 33-60), with extremes from 4 to 96 years. Half the subjects were women (50.7%). Variations in the leprosy incidence rate by year show an increase between 2010 and 2022, from 0.7 cases /100,000 population to 1.1 /100,000 population respectively. From 2010 to 2022, the proportion of cases in children remained low, between 0 and 9%. The proportion of women fluctuated between 39.7% and 67.2% between 2010 and 2017, then stabilized at an average of 50% between 2018 and 2022. The proportion of multi-bacillary leprosy cases increased quasi-linearly between 2010 and 2022, from 70 to 96.6%. Mapping of leprosy cases showed that leprosy was notified in all Togo health districts during the study period, apart from the Lacs district, which reported no leprosy cases. CONCLUSION Togo has achieved the elimination of leprosy as a public health problem. However, the increase in the number of new leprosy cases and the proportion of leprosy cases in children indicate that transmission of the disease is continuing and that supplementary measures are needed.
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Affiliation(s)
- Akila Wimima Bakoubayi
- German Leprosy and Tuberculosis Association, Lome, BP, 2271, Togo.
- Department of Public Health, Faculty of Health Sciences, University of Lome, Lomé, Togo.
| | | | | | | | - Yao Rodion Konu
- Department of Public Health, Faculty of Health Sciences, University of Lome, Lomé, Togo
- African Center for Research in Epidemiology and Public Health, Lome, Togo
| | - Latame Komla Adoli
- Department of Public Health, Faculty of Health Sciences, University of Lome, Lomé, Togo
| | | | - Kamevor Alaglo
- National Program for Neglected Tropical Diseases, Lome, Togo
| | - Maweke Tchalim
- National Program for Neglected Tropical Diseases, Lome, Togo
| | - P'niwè Patchali
- National Program for Neglected Tropical Diseases, Lome, Togo
| | - Yaovi Djakpa
- German Leprosy and Tuberculosis Association, Lome, BP, 2271, Togo
| | - Komi Amekuse
- German Leprosy and Tuberculosis Association, Lome, BP, 2271, Togo
| | - Piham Gnossike
- National Program for Neglected Tropical Diseases, Lome, Togo
| | | | - Didier Koumavi Ekouevi
- Department of Public Health, Faculty of Health Sciences, University of Lome, Lomé, Togo
- African Center for Research in Epidemiology and Public Health, Lome, Togo
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Juan C, Lledó L, Torralba M, Gómez JR, Giménez C. Leprosy in Spain: A Descriptive Study of Admissions at Fontilles Sanatorium between 1909 and 2020. Trop Med Infect Dis 2024; 9:130. [PMID: 38922042 PMCID: PMC11209616 DOI: 10.3390/tropicalmed9060130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The study aimed to characterize patients with leprosy admitted to Fontilles throughout the 20th and 21st centuries, focusing on differences across three periods (I, II, and III). It also explored variables linked to patient survival. METHODS This was a retrospective descriptive study analyzing the medical records of Fontilles patients from 1909 to 2020. It assessed 26 clinical, sociodemographic, and temporal variables (n = 2652). RESULTS Most patients were male, single, multibacillary (MB), and farmers, from Andalusia and the Valencian Community. The origin of patients shifted over time towards being mostly foreign-born in period III. More than a half were previously admitted and had family members with leprosy. While leprosy reactions decreased over time, neurological symptoms were increasingly diagnosed. The age at onset, admission, and death increased progressively over time. The survival of patients with leprosy at Fontilles depended on the age at admission and the period. CONCLUSIONS Improved knowledge, services, and awareness regarding leprosy led to increased age at onset and more favorable outcomes. The prolonged time between symptom onset and diagnosis indicates that leprosy is still a neglected disease. Although MB forms are more severe, leprosy classification did not significantly impact the survival rates of patients at Fontilles.
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Affiliation(s)
- Cristina Juan
- Department of Biomedicine and Biotechnology, Faculty of Pharmacy, Alcalá University, 28805 Alcalá de Henares, Madrid, Spain; (L.L.); (C.G.)
| | - Lourdes Lledó
- Department of Biomedicine and Biotechnology, Faculty of Pharmacy, Alcalá University, 28805 Alcalá de Henares, Madrid, Spain; (L.L.); (C.G.)
| | - Miguel Torralba
- Internal Medicine Unit, Department of Medicine and Medical specialities, IDISCAM, Faculty of Medicine, Alcalá University, 28805 Alcalá de Henares, Madrid, Spain;
| | - José Ramón Gómez
- Sanatorium San Francisco de Borja, Fontilles, 03791 Alicante, Spain;
| | - Consuelo Giménez
- Department of Biomedicine and Biotechnology, Faculty of Pharmacy, Alcalá University, 28805 Alcalá de Henares, Madrid, Spain; (L.L.); (C.G.)
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Gurnani B, Kaur K, Savla HR, Prajjwal P, Pentapati SSK, Kutikuppala LVS. Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review. Indian J Ophthalmol 2024; 72:816-823. [PMID: 38454868 PMCID: PMC11232850 DOI: 10.4103/ijo.ijo_793_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024] Open
Abstract
Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.
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Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, Trauma, Refractive Surgery, Ocular Surface and External Diseases, ASG Eye Hospital, Jodhpur, Rajasthan, India
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus, ASG Eye Hospital, Jodhpur, Rajasthan, India
| | - Hritik R Savla
- Department of General Ophthalmology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Priyadarshi Prajjwal
- Department of Medicine, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
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Kress GT, Swerdlow M, Shin L. Lepromatous Leprosy and Charcot Neuroarthropathy of Insensate Feet: A Case Report. Cureus 2024; 16:e61362. [PMID: 38947585 PMCID: PMC11214381 DOI: 10.7759/cureus.61362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 07/02/2024] Open
Abstract
Leprosy is a chronic infection of the skin, eyes, and peripheral nerves due to the slow-growing, acid-fast bacillus Mycobacterium leprae. Devastating complications include Charcot neuroarthropathy and insensate hands and feet. We present the case of an 81-year-old female with rheumatoid arthritis and 50 years of polar lepromatous leprosy who suffered from bilateral collapsed arches, flat feet, and bone deformities of Charcot feet.
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Affiliation(s)
- Gavin T Kress
- Vascular Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Mark Swerdlow
- Vascular Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Laura Shin
- Vascular Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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Wahyuni LK, Nelfidayani N, Harini M, Anestherita F, Wardhani RK, Menaldi SL, Irawati Y, Rahayu T, Andayani G, Daniel H, Savitri I, Hariyanto PKY, Paramita IA. The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia. PLoS Negl Trop Dis 2024; 18:e0011539. [PMID: 38771890 PMCID: PMC11161106 DOI: 10.1371/journal.pntd.0011539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 06/07/2024] [Accepted: 03/29/2024] [Indexed: 05/23/2024] Open
Abstract
The International Classification of Function, Disability, and Health (ICF-WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.
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Affiliation(s)
- Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nelfidayani Nelfidayani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Melinda Harini
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fitri Anestherita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizky Kusuma Wardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sri Linuwih Menaldi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yunia Irawati
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tri Rahayu
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hisar Daniel
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Intan Savitri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrus Kanisius Yogi Hariyanto
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Isabela Andhika Paramita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Genomik Solidaritas Indonesia (GSI) Laboratory, Jakarta, Indonesia
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Rusia K, Saoji V, Madke B, Singh A. Lucio Phenomenon: An Unusual Case of Skin Necrosis. Case Rep Dermatol 2024; 16:47-54. [PMID: 38406643 PMCID: PMC10890809 DOI: 10.1159/000536370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Lucio leprosy is a non-nodular diffuse type of lepromatous leprosy first described by Lucio and Alvarado. Lucio phenomenon is a rare vasculonecrotic reaction characterized by cutaneous necrosis with minimal constitutional features. Case Presentation We describe an unusual case of a 53-year-old man from Central India who had blisters, ulcers, and widespread erosions on his foot, forearms, and arms. The diagnosis of lepromatous leprosy with the Lucio phenomenon was established after thorough evaluation by clinical findings, histopathological findings, and slit-skin smear examination. Conclusion Lucio phenomenon is an uncommon cause of cutaneous infarction and necrosis. Primary care physicians should keep a high index of suspicion in patients with cutaneous necrosis and minimal constitution features. Since leprosy is a relatively curable disease, primary care physicians should think of a rare form of lepromatous leprosy presenting with cutaneous necrosis, especially in non-endemic zones.
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Affiliation(s)
- Kaveri Rusia
- Department of Dermatology, Venereology and Leprosy, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
| | - Vikrant Saoji
- Department of Dermatology, Venereology and Leprosy, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
| | - Adarshlata Singh
- Department of Dermatology, Venereology and Leprosy, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
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Betru KT, Makua T. Challenges Experienced and Observed during the Implementation of Leprosy Strategies, Sidama Region, Southern Ethiopia: An inductive thematic analysis of qualitative study among health professionals who working with leprosy programs. PLoS Negl Trop Dis 2023; 17:e0011794. [PMID: 38033161 PMCID: PMC10715652 DOI: 10.1371/journal.pntd.0011794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/12/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Prompt diagnosis and treatment of leprosy are crucial for preventing the disease's spread as well as for avoiding negative medical and social effects and reducing the disease's burden. The likelihood of nerve damage and subsequent disability rises as the length of the diagnostic delay. We aimed to explore the challenges of health professionals faced regarding their involvement in early leprosy case detection strategies. METHODS The study employed a qualitative, descriptive and phenomenological explorative research design to answer the research questions. By the use of non-probability purposive sampling, research participants were identified. During the study, in-depth interviews were conducted to gather information regarding the experiences of health workers (medical doctors, public health officers, clinical nurses, health centre heads and regional and Woreda district health office technical and programme experts) and health extension workers. To analyse the qualitative data, inductive thematic analysis techniques were used. For analysis, open code software version 4.0 was used. The data transcription, coding, display, reduction (theme) and interpretation of the discovered results were the processes undertaken for the analysis. RESULT The findings of the study revealed that leprosy prevention and control programmes are still problematic. Themes that emerged from the data gleaned from the health workers included: lack of the existence of practice-oriented training, Integration of TB and leprosy training, lack of focus or other competing health priorities, Inadequate supportive supervision of health facilities, Multiple tasks for health workers, poor coordination and communications, lack of motivation in health workers, disruption in treatment, and Importance of training related to leprosy. CONCLUSION Strengthening comprehensive leprosy training for health workers, carrying out efficient and thorough contact tracing, enhancing monitoring, supervision, assessment and surveillance, boosting managerial skills, lobbying political commitment, and motivating healthcare workers may help in early detection of leprosy cases strategies.
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Affiliation(s)
- Kebede Tefera Betru
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
| | - Thuledi Makua
- University of South Africa, College of Human Sciences, Pretoria, South Africa
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Gutierrez-Castañeda LD, Acosta CR, Bustos MA, García DK, Bohada DP, Rodríguez R, Guerrero MI. Single Nucleotide Variants in the TLR1, TLR2 and TLR6 Genes: A Case-Control Study in a Colombian Population. Trop Med Infect Dis 2023; 8:473. [PMID: 37888601 PMCID: PMC10610572 DOI: 10.3390/tropicalmed8100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Single nucleotide variants in toll-like receptor genes play a crucial role in leprosy susceptibility or resistance. METHODS With an epidemiology case-control study, associations between SNVs rs5743618 in TLR1, rs5743708 in TLR2, and rs5743810 in TLR6 and overall susceptibility for leprosy were estimated in 114 cases and 456 controls. Following that, stratified analysis was performed. DNA was extracted from peripheral blood. Genotyping was performed using predesigned TaqMan probes. RESULTS The A/G genotype of rs5743810 behaved as a protective factor for the development of leprosy in the codominant (OR= 0.37; 95% CI = 016-0.86, p = 0.049) and over-dominant (OR = 0.38; 95% CI = 0.16-0.88, p = 0.019) inheritance models. The A/G and A/A genotypes behaved as a protective factor (OR = 0.39; 95% CI = 0.17-0.87, p = 0.016) in the dominant model. The SNVs rs5743618 and rs5743708 showed no association with any of the models. The CGG haplotype (rs5743618-rs5743708-rs5743810) behaved as a susceptibility factor for developing leprosy (OR = 1.86; 95% CI = 1.11-3.10, p = 0.019). The latter haplotype behaved as a susceptibility factor for leprosy development in women (OR = 2.39; 95% CI = 1.21-4.82, p = 0.013). CONCLUSIONS The identified variants in the genes encoding TLRs, specifically rs5743810 in TLR6 and CGG (rs5743618-rs5743708-rs5743810) haplotypes, may somehow explain leprosy susceptibility in the studied population in a leprosy endemic region in Colombia.
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Affiliation(s)
- Luz D. Gutierrez-Castañeda
- Grupo de Ciencias Básicas en Salud (CBS)-FUCS, Instituto de Investigación, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá 111411, Colombia
- Grupo Dermatología General, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E, Bogotá 111511, Colombia;
| | - Carmen R. Acosta
- Grupo Dermatología Tropical, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E, Bogotá 111511, Colombia;
| | - Mónica A. Bustos
- Grupo de Investigación en Enfermedades Parasitarias, Tropicales e Infecciosas (GIEPATI) Universidad de Pamplona, Pamplona 543058, Colombia; (M.A.B.); (D.P.B.); (R.R.)
| | - Diana K. García
- Grupo Dermatología General, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E, Bogotá 111511, Colombia;
| | - Diana P. Bohada
- Grupo de Investigación en Enfermedades Parasitarias, Tropicales e Infecciosas (GIEPATI) Universidad de Pamplona, Pamplona 543058, Colombia; (M.A.B.); (D.P.B.); (R.R.)
| | - Raúl Rodríguez
- Grupo de Investigación en Enfermedades Parasitarias, Tropicales e Infecciosas (GIEPATI) Universidad de Pamplona, Pamplona 543058, Colombia; (M.A.B.); (D.P.B.); (R.R.)
| | - Martha Inirida Guerrero
- Grupo Dermatología Tropical, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E, Bogotá 111511, Colombia;
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Quaresma TC, de Aguiar Valentim L, de Sousa JR, de Souza Aarão TL, Fuzii HT, Duarte MIS, de Souza J, Quaresma JAS. Immunohistochemical Characterization of M1, M2, and M4 Macrophages in Leprosy Skin Lesions. Pathogens 2023; 12:1225. [PMID: 37887741 PMCID: PMC10610015 DOI: 10.3390/pathogens12101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Mycobacterium leprae is the etiological agent of leprosy. Macrophages (Mφs) are key players involved in the pathogenesis of leprosy. In this study, immunohistochemical analysis was performed to examine the phenotype of Mφ subpopulations, namely M1, M2, and M4, in the skin lesions of patients diagnosed with leprosy. Based on the database of treatment-naïve patients treated between 2015 and 2019 at the Department of Dermatology of the University of the State of Pará, Belém, routine clinical screening samples were identified. The monolabeling protocol was used for M1 macrophages (iNOS, IL-6, TNF-α) and M2 macrophages (IL-10, IL-13, CD163, Arginase 1, TGF-β, FGFb), and the double-labeling protocol was used for M4 macrophages (IL-6, MMP7, MRP8, TNF-α e CD68). To confirm the M4 macrophage lineage, double labeling of the monoclonal antibodies CD68 and MRP8 was also performed. Our results demonstrated a statistically significant difference for the M1 phenotype among the Virchowian (VV) (4.5 ± 1.3, p < 0.0001), Borderline (1.6 ± 0.4, p < 0.0001), and tuberculoid (TT) (12.5 ± 1.8, p < 0.0001) clinical forms of leprosy. Additionally, the M2 phenotype showed a statistically significant difference among the VV (12.5 ± 2.3, p < 0.0001), Borderline (1.3 ± 0.2, p < 0.0001), and TT (3.2 ± 0.7, p < 0.0001) forms. For the M4 phenotype, a statistically significant difference was observed in the VV (9.8 ± 1.7, p < 0.0001), Borderline (1.2 ± 0.2, p < 0.0001), and TT (2.6 ± 0.7, p < 0.0001) forms. A significant correlation was observed between the VV M1 and M4 (r = 0.8712; p = 0.0000) and between the VV M2 × TT M1 (r = 0.834; p = 0.0002) phenotypes. The M1 Mφs constituted the predominant Mφ subpopulation in the TT and Borderline forms of leprosy, whereas the M2 Mφs showed increased immunoexpression and M4 was the predominant Mφ phenotype in VV leprosy. These results confirm the relationship of the Mφ profile with chronic pathological processes of the inflammatory response in leprosy.
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Affiliation(s)
- Tatiane Costa Quaresma
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Lívia de Aguiar Valentim
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Jorge Rodrigues de Sousa
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Tinara Leila de Souza Aarão
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
- School of Medicine, Federal University of Para-UFPA, Altamira 68440-000, Brazil
| | - Hellen Thais Fuzii
- Health Department, Tropical Medicine Center, Federal University of Para-NMT-UFPA, Belem 66055-240, Brazil
| | | | - Juarez de Souza
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
| | - Juarez Antônio Simões Quaresma
- Health Department, Center for Biological and Health Sciences, State University of Para-CCBS, UEPA, Belem 66087-662, Brazil
- School of Medicine, Federal University of Para-UFPA, Altamira 68440-000, Brazil
- Health Department, Tropical Medicine Center, Federal University of Para-NMT-UFPA, Belem 66055-240, Brazil
- School of Medicine, Sao Paulo University, Sao Paulo 01246-903, Brazil
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Irawati Y, Andayani G, Rahayu T, Zakiyah H, Kurniawardhani DR, Paramita C, Bani AP, Daniel H, Susiyanti M, Lestari YD, Friska D, Menaldi SL, Harini M. Vision-related quality of life among released from treatment cases of leprosy evaluated with NEI-VFQ-25: a cross-sectional study. BMC Ophthalmol 2023; 23:398. [PMID: 37784121 PMCID: PMC10546734 DOI: 10.1186/s12886-023-03146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND People with leprosy who have been declared Release From Treatment (RFT) are often not aware of the leprosy sequelae possibility which can decrease their quality of life. This could be because they have been adapting for a long time hence they do not feel the need to see physicians. This study seeks to compare the results of Vision-Related Quality of Life (VR-QoL) among RFT persons based on the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and WHO grading disability based on physical examination. METHODS A cross-sectional study of 325 RFT subjects from leprosy communities (Singkawang, West Kalimantan and Tangerang, Banten) was conducted between 2018 and 2019. We used the NEI-VFQ-25 questionnaire that had been validated and translated into Indonesian and distributed to the leprosy population. Relationships and comparisons among variables were evaluated using Kruskal-Wallis and Mann-Whitney tests. RESULTS There were three main results: The median composite score of VR-QoL for WHO grade 0, 1, and 2 disabilities has decreased by 13%, 25.5%, and 30% of the maximum value, respectively. Of the total, eleven subscales were statistically significant between WHO grading disability and VR-QoL based on the NEI-VFQ-25 (p < 0.05). The comparison between grade 0 and grade 2 disability in all subscales was statistically significant (p < 0.05). CONCLUSIONS The grade of disability is related to their VR-QoL assessment using the NEI-VFQ-25 questionnaire. Thus, it can be used as an initial screening in primary healthcare settings to increase awareness of disability before a thorough physical examination.
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Affiliation(s)
- Yunia Irawati
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tri Rahayu
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hindun Zakiyah
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dewinta Retno Kurniawardhani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Carennia Paramita
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anna Puspitasari Bani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hisar Daniel
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yeni Dwi Lestari
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dewi Friska
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sri Linuwih Menaldi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr.Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Melinda Harini
- Department of Rehabilitation Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Panigrahi R, Priyadarshini SR, Sahoo PK, Alam T, Saeed S, Hasan S. Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case. Cureus 2023; 15:e47859. [PMID: 38021977 PMCID: PMC10680308 DOI: 10.7759/cureus.47859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis. These bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body. Lately, there has been a notable reduction in mucosal symptoms, largely attributed to the timely diagnosis and treatment of leprosy. Nonetheless, oral lesions continue to hold significant epidemiological importance due to their crucial role in disease transmission. Oral manifestations, although rare, are frequently encountered in individuals afflicted with multi-bacillary leprosy. Chronic macrocheilia is an exceedingly rare manifestation of the disease, with only a few documented case reports and case studies. This article aims to document an exceptionally uncommon case of lepromatous leprosy with chronic macrocheilia as the sole presenting feature.
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Affiliation(s)
- Rajat Panigrahi
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Smita R Priyadarshini
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Pradyumna K Sahoo
- Department of Prosthodontics, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Tanveer Alam
- Department of Dental Surgery, College of Dentistry King Khalid University, Abha, SAU
| | - Shazina Saeed
- Department of Epidemiology and Public Health, Amity Institute of Public Health & Hospital Administration, Amity University, Noida, IND
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
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Yerke Hansen P, Myers E, Rajalingam K, Labanowski M. A Rare Case of Hansen's Disease Complicated by G6PD Deficiency. Cureus 2023; 15:e42816. [PMID: 37664264 PMCID: PMC10471196 DOI: 10.7759/cureus.42816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
We present the case of a 37-year-old Haitian male who presented with a seven-month history of skin lesions on his face and extremities, weight loss, intermittent chills, difficulty in breathing, and bilateral paresthesias in his feet. The lesions were most prominent on the pinnae of the ears. Biopsy of the lesions revealed large, rounded granulomatous infiltrates and histiocytes. Acid fast (Ziehl-Neelsen technique) and Kinyoun stains were positive for numerous acid-fast mycobacteria within the histiocytes. A polymerase chain reaction (PCR) was positive for Mycobacterium leprae, which confirmed a diagnosis of lepromatous leprosy. Further analysis revealed positive purified protein derivatives (PPD) and QuantiFERON-TB™ test (QIAGEN, Hilden, Germany) with negative chest x-ray and sputum cultures. Labs also revealed vitamin D and G6PD (glucose-6-phosphate-dehydrogenasedeficiency. The patient was started on a combined therapy regimen of rifampin, moxifloxacin, and minocycline. In addition, he was started on vitamin D supplementation. After undergoing treatment for one year, there was notable regression of the patient's cutaneous lesions. Treatment is planned to continue for a total of 24 months. This case exemplifies the successful treatment of Hansen's disease in a patient with a G6PD deficiency. The patient's G6PD deficiency required avoidance of dapsone, which is typically used in the treatment of Hansen's disease. Furthermore, the patient's positive PPD and QuantiFERON-TB tests led to a delay in the treatment in order to rule out active tuberculosis. Left untreated, Hansen's disease has a high morbidity risk. Treatment regimens require careful consideration of coexisting comorbidities.
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Affiliation(s)
- Payton Yerke Hansen
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Elisha Myers
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Karan Rajalingam
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Mary Labanowski
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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Pepito VCF, Loreche AM, Samontina RED, Abdon SJA, Fuentes DNL, Saniel OP. Factors affecting treatment adherence among leprosy patients: Perceptions of healthcare providers. Heliyon 2023; 9:e17975. [PMID: 37501956 PMCID: PMC10368771 DOI: 10.1016/j.heliyon.2023.e17975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Background Treatment adherence is a vital aspect in the management of chronic diseases like leprosy; however, most studies on treatment adherence focus on patients. This study aims to examine the perceptions of healthcare providers on factors that can promote or prevent patients from adhering to treatment. Methods We conducted three focus group discussions (FGDs) with healthcare providers who have at least one year experience in managing leprosy in three large leprosy case-holding hospitals in Metro Manila, Philippines. We audio-recorded, transcribed, translated the FGD proceedings, and analyzed the transcripts thematically to identify patient-intrinsic and patient-extrinsic enablers and barriers to treatment adherence of leprosy patients. Results Patient-intrinsic motivators to complete treatment include innate desire to be cured, fear of infecting family and friends, fear of disability, good knowledge about the disease, need for medical clearance to be considered fit to work, and experiencing leprosy reactions. Patient-extrinsic motivators to complete treatment include free treatment, immediate and sufficient counselling, flexibility in treatment, follow-up and motivation of healthcare workers, and presence of Hansen's Club and support groups. Patient-intrinsic barriers to good treatment adherence include distance between residence and hospital, financial and opportunity costs, adverse drug reactions, misconceptions about being cured, disabilities and presence of leprosy reactions, stubbornness and/or laziness, and undergoing clinical depression. Patient-extrinsic barriers to good treatment adherence include poor availability of MDT, transfer to other leprosy treatment facilities without informing current facility, and stigma. Conclusion Healthcare providers perceive that patient-intrinsic and patient-extrinsic factors influence the treatment adherence of leprosy patients through different mechanisms. We highlight the role of healthcare provider attitudes, stigma, and support groups in promoting treatment adherence.
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Affiliation(s)
- Veincent Christian F. Pepito
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Arianna Maever Loreche
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila
| | - Rae Erica D. Samontina
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Sarah Jane A. Abdon
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Department of Internal Medicine, Mandaluyong City Medical Center, Mandaluyong City, Philippines
| | - David Norman L. Fuentes
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines
| | - Ofelia P. Saniel
- College of Public Health, University of the Philippines Manila, Manila, Philippines
- Symmetrix Research Consultancy Company, Manila, Philippines
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Argentina F, Suwarsa O, Gunawan H, Berbudi A. Gene Expression of Human Beta-Defensin-3 and Cathelicidin in the Skin of Leprosy Patients, Household Contacts, and Healthy Individuals from Indonesia. Clin Cosmet Investig Dermatol 2023; 16:1485-1492. [PMID: 37333516 PMCID: PMC10275412 DOI: 10.2147/ccid.s405932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
Background Leprosy, a chronic infectious peripheral neuropathy, is caused by Mycobacterium leprae. This bacterium produces triacylated lipopeptides that can induce the immune system via the Toll-like receptor 2/1 (TLR 2/1) complex. Activation of TLR 2/1 produces proinflammatory cytokines and antimicrobial peptides (AMPs), including human beta-defensin-3 (HBD-3) and cathelicidin. Purpose To analyze differences in gene expression of HBD-3 and cathelicidin in the skin of leprosy patients, household contacts, and healthy individuals. Patients and Methods An analytic observational study was conducted at the Outpatient Clinic of Dermatology and Venereology of Dr Mohammad Hoesin General Hospital, Palembang, Indonesia, from January 2021 to June 2022. In each group of 18 subjects, 72 samples were collected, including skin lesion in leprosy patients, normal skin in leprosy patients, household contacts, and healthy individuals. A comparison of HBD-3 and cathelicidin gene expression between the four groups was analyzed using Pearson Chi Square, Kruskal-Wallis, and Mann-Whitney Test. Results The median value of HBD-3 gene expression on skin lesion in leprosy patients was 260.61 (0.19-3734.10); normal skin in leprosy patients was 1.91 (0.01-151.17); household contacts skin was 7.93 (0.27-121.10); and healthy individuals' skin was 1.00 (1.00-1.00) is highly significant difference (p < 0.0001). The median value of cathelicidin gene expression on skin lesion in leprosy patients was 38.72 (0.28-1852.17); normal skin in leprosy patients was 0.48 (0.01-15.83); household contacts skin was 9.8 (0.04-128.0); and healthy individual skin was 1.00 (1.00-1.00), also highly significant difference (p < 0.0001). Conclusion Gene expression of HBD-3 and cathelicidin increased in skin lesions of leprosy patients and household contacts.
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Affiliation(s)
- Fifa Argentina
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sriwijaya/Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Afiat Berbudi
- Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Jin SH, Lee SB. CD11b +Gr-1 low cells that accumulate in M.leprae-induced granulomas of the footpad skin of nude mice have the characteristics of monocytic-myeloid-derived suppressor cells. Tuberculosis (Edinb) 2023; 140:102345. [PMID: 37116235 DOI: 10.1016/j.tube.2023.102345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023]
Abstract
CD11b+Gr-1low cells that are increased in the lungs of a Mycobacterium (M) tuberculosis-infection mouse model have the characteristics of monocytic (M)-myeloid-derived suppressor cells (MDSCs) and harbor M.tuberculosis. Interestingly, a high number of M-MDSCs have also been observed in skin lesions of patients with lepromatous leprosy. We hypothesized that CD11b+Gr-1low cells might be involved in the pathogenesis of leprosy, as they are in tuberculosis. In the current study, we investigated the issue of whether CD11b+Gr-1low cells accumulate in Mycobacterium (M) leprae-induced granulomas of the footpad skin of nude mice. Our results show that CD11b+Gr-1low cells began to accumulate in the 7-month-old M.leprae-induced granulomas and were replaced by other leukocytes, including CD11b+Gr-1high over time during M.leprae infections. CD11b + Gr-1low cells expressed the surface markers of M-MDSC, Ly6Chigh and Ly6Glow. In addition, CD11b+Gr-1low cells have the nuclei of a mononuclear cell type and expressed higher levels of arginase 1 (Arg1) and inducible NO synthetase (iNOS). Furthermore, they showed a higher infection rate by M.leprae. Taken together, our results indicate that the inoculation with M.leprae induced an accumulation of CD11b + Gr-1low at a relatively early stage, 7-month-old M.leprae-induced granulomas, and that CD11b+Gr-1low have the characteristics of M-MDSC and may act as a reservoir for M.leprae.
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Affiliation(s)
- Song-Hyo Jin
- Institute of Hansen's Disease, Department of Pathology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Seong-Beom Lee
- Institute of Hansen's Disease, Department of Pathology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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Sisco MC, Brum Fontes AN, Lessmann LC, Rada E, Prado Palacios YY, Vasconcellos SEG, de Waard JH, Suffys PN. Antimicrobial resistance and genotyping of Mycobacterium leprae in Venezuela. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1067439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Leprosy is a neglected tropical disease that leads to physical disability and social discrimination. The active surveillance of new cases and vigilance for drug resistance can decrease the incidence, and improve the clinical outcomes of people affected by it. We analyzed, with molecular biology techniques, a set of skin biopsy samples from 25 Venezuelan patients. The patients had been diagnosed with leprosy in 2014 and early 2015, and 15 were relapse cases. The samples were tested for molecular drug resistance to dapsone, rifampicin, and fluoroquinolones. In addition, we performed molecular epidemiology analysis through multiple-locus variable-number tandem repeat analysis (MLVA) and single nucleotide polymorphism (SNP) typing. We did not find evidence of drug resistance and 76% of the samples (n = 16) had isolates belonging to SNP type 3. Genotype profiles allowed us to rule out the possibility of re-infection in a patient with persistent symptoms after treatment, as well as that of household transmission in two more patients. Although our sampling is relatively small, very similar or even identical Mycobacterium leprae genotypes were observed in Miranda State. The presence of this cluster is highly suggestive of high rates of local transmission and, in turn, the need to better control this disease. Finally, the copy number distribution of minisatellite 18–8 in a considerable number of SNP type 3 strains strongly suggests the presence of a sublineage of this disease that is particular to Venezuela.
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de Groot L, van ‘t Noordende AT, Duck M, Oraga J, Rai SS, Peters RMH, Veldhuijzen N. Meaningful Engagement of Persons Affected by Leprosy in Research: An Exploration of Its Interpretation, Barriers, and Opportunities. Trop Med Infect Dis 2023; 8:tropicalmed8010052. [PMID: 36668959 PMCID: PMC9867310 DOI: 10.3390/tropicalmed8010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Despite the growing interest in public and patient involvement in research, best practices in the leprosy context have yet to be explored. This mixed-method study aimed to explore the interpretation, barriers and opportunities of meaningful engagement of persons affected by leprosy in research through: (i) an exploratory phase consisting of key informant interviews with experts in public and patient involvement (n = 2) and experts-by-experience (i.e., persons affected by leprosy; n = 4), and (ii) an in-depth phase among leprosy researchers consisting of an online survey (n = 21) and key informant interviews (n = 7). Qualitative data were thematically analyzed. Basic descriptive statistics were used to summarize the survey data. Key informant interviewees unanimously agreed to the importance of engagement in research. Survey results indicated that the level of engagement differed across research stages. Identified barriers included a lack of skills for or awareness of engagement among both experts-by-experience and researchers, stigma and limited time and resources. Opportunities included capacity strengthening, creating a shared understanding, building rapport, and establishing a safe environment. In conclusion, this exploratory study emphasized the importance of engagement of experts-by-experience in leprosy research and identified ways forward that include, but are not limited to, the acknowledgement of its value and creating a shared understanding.
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Affiliation(s)
- Laura de Groot
- Leprosy Research Initiative, 1097 DN Amsterdam, The Netherlands
- Athena Institute, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | | | - Mathias Duck
- International Federation of Anti-Leprosy Associations (ILEP), 1204 Geneva, Switzerland
- The Leprosy Mission International, Brentford TW8 0QH, UK
| | - Joshua Oraga
- International Federation of Anti-Leprosy Associations (ILEP), 1204 Geneva, Switzerland
- International Association for Integration, Dignity and Economic Advancement (IDEA) Kenya, Nairobi 00200, Kenya
| | - Sarju Sing Rai
- Athena Institute, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ruth M. H. Peters
- Athena Institute, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
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22
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Inyang IE, Bassey IE, Okoroiwu HU. Evaluation of hematological parameters in patients with leprosy in Southern Nigeria. Germs 2022; 12:478-487. [PMID: 38021182 PMCID: PMC10660229 DOI: 10.18683/germs.2022.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/23/2022] [Accepted: 12/31/2022] [Indexed: 12/01/2023]
Abstract
Introduction Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae that mostly result in immunological reactions that affect the skin, peripheral nervous system and mucosa of the upper respiratory tract. This study aimed to evaluate hematological parameters among subjects with leprosy and deduce biomarkers for onset of leprosy reaction. Methods This was a cross-sectional study performed from September 1, 2018 to August 1, 2019. Sixty patients with leprosy (30 on multidrug therapy (MDT) and 30 that had completed MDT) and 30 apparently healthy controls were enrolled. Hematology auto-analyzer (Sysmex KX-21N by Sysmex Corporation Kobe, Japan) was used in sample analysis. ANOVA and Kruskal Wallis were used for mean comparison. Eta squared was used to assess effect size. Sensitivity and specificity were assessed using receiver operator characteristic (ROC) curve. Association was checked using bivariate logistics regression. Results The majority (68.3%) of the patients with leprosy were males and a larger proportion were either farmers or unemployed. The prevalence of leprosy reaction in the studied population was 40%. The following parameters were significantly (p<0.05) reduced: red cell count, hemoglobin and hematocrit in patients with leprosy compared to controls. Total white cell count, absolute lymphocyte, neutrophil, monocyte and eosinophil counts were significantly elevated in patients with leprosy compared to controls. The hemoglobin and mean corpuscular volume of patients with leprosy on treatment were significantly higher compared to those who had completed treatment, while the mean corpuscular hemoglobin concentration was significantly reduced. Overall, 65% of patients with leprosy were anemic. Eosinophil count showed good biomarker potential for leprosy reaction onset with AUC 0.709. Sex and absolute eosinophil count were associated with leprosy reaction (OR=11.194; 95%CI: 1.775-70.586). Conclusions This study has shown a high frequency of anemia in patients with leprosy, both those on treatment and those that had completed MDT, necessitating incorporation of post treatment plan in the management of leprosy. This study has reported absolute eosinophil as potential biomarker of leprosy reaction.
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Affiliation(s)
- Inyeneobong Ernest Inyang
- B.MLS, Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
| | - Iya Eze Bassey
- B.MLS, MSc, PhD, Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
| | - Henshaw Uchechi Okoroiwu
- B.MLS, M.Sc, Ph.D, Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Arthur Jarvis University, Brigadier Dan Archibong Drive, Ndon Obori Ikot Effanga, Akpabuyo, Cross River State, Nigeria and Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
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Sugawara-Mikami M, Tanigawa K, Kawashima A, Kiriya M, Nakamura Y, Fujiwara Y, Suzuki K. Pathogenicity and virulence of Mycobacterium leprae. Virulence 2022; 13:1985-2011. [PMID: 36326715 PMCID: PMC9635560 DOI: 10.1080/21505594.2022.2141987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae (M. leprae) and M. lepromatosis, an obligate intracellular organism, and over 200,000 new cases occur every year. M. leprae parasitizes histiocytes (skin macrophages) and Schwann cells in the peripheral nerves. Although leprosy can be treated by multidrug therapy, some patients relapse or have a prolonged clinical course and/or experience leprosy reaction. These varying outcomes depend on host factors such as immune responses against bacterial components that determine a range of symptoms. To understand these host responses, knowledge of the mechanisms by which M. leprae parasitizes host cells is important. This article describes the characteristics of leprosy through bacteriology, genetics, epidemiology, immunology, animal models, routes of infection, and clinical findings. It also discusses recent diagnostic methods, treatment, and measures according to the World Health Organization (WHO), including prevention. Recently, the antibacterial activities of anti-hyperlipidaemia agents against other pathogens, such as M. tuberculosis and Staphylococcus aureus have been investigated. Our laboratory has been focused on the metabolism of lipids which constitute the cell wall of M. leprae. Our findings may be useful for the development of future treatments.
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Affiliation(s)
- Mariko Sugawara-Mikami
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,West Yokohama Sugawara Dermatology Clinic, Yokohama, Japan
| | - Kazunari Tanigawa
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Akira Kawashima
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Yoko Fujiwara
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Sharma P, Shakya R, Singh S, Bhandari AR, Shakya R, Amatya A, Joshi C, Gurung G. Prevalence of Anxiety and Depression among People Living with Leprosy and its Relationship with Leprosy-Related Stigma. Indian J Dermatol 2022; 67:693-698. [PMID: 36998835 PMCID: PMC10043667 DOI: 10.4103/ijd.ijd_777_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background Leprosy, a chronic infectious disease, is associated with a high risk of psychiatric disorders. Aims and Objectives We aim to estimate the prevalence of anxiety and depressive symptoms among people living with leprosy at a special community residence in Nepal. We also aimed to find the correlation between anxiety and depression. Materials and Methods This is a cross-sectional descriptive study conducted in a community of people with leprosy staying at a centre in Nepal using all enumerative sampling. The semi-structured schedule, hospital anxiety and depression scale and stigma assessment and reduction of impact (SARI) stigma scale were applied among 119 participants. Results About 10.1% (n = 12) and 12.6% (n = 15) of participants scored above the threshold score indicative of definitive clinically significant anxiety and depression symptoms. In multivariable analysis, leprosy-related stigma and attribution of leprosy to bad deeds were significant correlates of anxiety; whereas leprosy-related stigma and duration of stay at the centre were significant correlates of depression. Conclusion The prevalence of depression and anxiety symptoms among people living with leprosy is higher than that in the general population. Sigma is a significant correlation for both. It is important to screen for mental health issues while managing patients with leprosy and implement strategies aimed at leprosy-related stigma reduction.
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Affiliation(s)
- Pawan Sharma
- From the Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Rabi Shakya
- From the Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Swarndeep Singh
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Anup Raj Bhandari
- From the Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | | | - Amit Amatya
- Department of Dermatology, Patan Academy of Health Sciences, School of Medicine, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Chunauti Joshi
- From the Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Grisha Gurung
- From the Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
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25
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Barbosa AM, Silva SUD, Toledo ACCG, Abreu MAMMD. Seroepidemiologic survey of the household contacts of leprosy patients. Rev Assoc Med Bras (1992) 2022; 68:1389-1393. [DOI: 10.1590/1806-9282.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
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ter Ellen F, Tielens K, Fenenga C, Mieras L, Schoenmakers A, Arif MA, Veldhuijzen N, Peters R, Ignotti E, Kasang C, Quao B, Steinmann P, Banstola NL, Oraga J, Budiawan T. Implementation approaches for leprosy prevention with single-dose rifampicin: A support tool for decision making. PLoS Negl Trop Dis 2022; 16:e0010792. [PMID: 36251696 PMCID: PMC9612816 DOI: 10.1371/journal.pntd.0010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/27/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Benedict Quao
- National Leprosy Control Programme, Ghana Health Service, Accra, Ghana
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, University of Basel, Basel, Switzerland
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The Acari Hypothesis, III: Atopic Dermatitis. Pathogens 2022; 11:pathogens11101083. [DOI: 10.3390/pathogens11101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Atopic dermatitis is a chronic relapsing dermatopathology involving IgE against allergenic materials present on mammalian epithelial surfaces. Allergens are as diverse as pet danders, and polypeptides expressed by microbes of the mammalian microbiome, e.g., Malassezia spp. The Acari Hypothesis posits that the mammalian innate immune system utilizes pathogen-bound acarian immune effectors to protect against the vectorial threat posed by mites and ticks. Per The Hypothesis, IgE-mediated allergic disease is a specious consequence of the pairing of acarian gastrointestinal materials, e.g., allergenic foodstuffs, with acarian innate immune effectors that have interspecies operability. In keeping with The Hypothesis, the IgE profile of atopic patients should include both anti-acarian antibodies and specious antibodies responsible for specific allergy. Further, the profile should inform on the diet and/or environment of the acarian vector. In this regard, the prevalence of Demodex and Dermatophagoides on the skin of persons suffering from atopic dermatitis is increased. Importantly, the diets of these mites correspond well with the allergens of affected patients. In this report, roles for these specific acarians in the pathogenesis of atopic dermatitis are proposed and elaborated.
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28
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Saini I, Joshi J, Kaur S. Unwelcome prevalence of leishmaniasis with several other infectious diseases. Int Immunopharmacol 2022; 110:109059. [DOI: 10.1016/j.intimp.2022.109059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
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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: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [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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30
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Sevilha-Santos L, Aquino DC, Hans Neto G, Costa FJQ, de Sousa CAF, Morelo EF, Santos Júnior ADCMD, Gomes CM. Sensitivity of different DNA extraction methods and PCR to detect resistance in patients with leprosy stratified by the bacilloscopic index. Braz J Infect Dis 2022; 26:102381. [PMID: 35772498 PMCID: PMC9459058 DOI: 10.1016/j.bjid.2022.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Antimicrobial resistance in leprosy is an emerging problem, and the quantitative impact of low bacilloscopic indexes (BIs) on the sensitivity of molecular tests is unknown. We aimed to evaluate the sensitivity of gene sequencing for the detection of mutations related to antimicrobial resistance in Mycobacterium leprae in patients with low BIs using an analytical model. Methods Patients with leprosy were included and divided into two groups depending on their BIs (≥ 2+ and < 2+). The sensitivities of the two DNA extraction methods were compared after amplifying and sequencing the repetitive element (RLEP), folP1, rpoB and gyrA in M. leprae. Results We included 56 patients with leprosy: 35 had BIs less than 2+ (22 had negative slit-skin smear [SSS] results) and 21 patients had BIs greater than or equal to 2+. The sensitivity of the amplification of the RLEP target and the gene sequencing of folP1, rpoB and gyrA was 50 to 70% lower in patients with a BI less than 2+ and was significantly reduced in patients with lower BIs for all targets (p < 0.001). One patient had a mutation in the folP1 gene, and 14 patients had mutations in the gyrA gene, but no mutations related to antimicrobial resistance were found. Conclusions We can conclude that the sensitivity of molecular tests is directly related to the BI, but these tests can still detect up to 20% of the targets in patients with BIs < 2+. New strategies to improve the sensitivity for detecting antimicrobial resistance in leprosy patients and reasonable clinical criteria for follow-up and the introduction of alternative treatments must be developed.
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Masresha BM, Biresaw HB, Moyehodie YA, Mulugeta SS. Time-to-Disability Determinants Among Leprosy Patients Enrolled for Treatment at ALERT Center, Addis Ababa, Ethiopia: A Survival Analysis. Infect Drug Resist 2022; 15:2729-2741. [PMID: 35668860 PMCID: PMC9166622 DOI: 10.2147/idr.s361799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mycobacterium leprae causes leprosy, which is a long-term or recurrent infection. The causative agent’s collusion with Schwann cells results in the irreversible loss of fringe nerve tissue; followed by incapacity, which includes not just actual impotence but also mental incapacity, creates a bad image of the transformed, resulting in segregation and societal humiliation of leprosy patients, as well as their families. Methods This study’s survival analysis includes a sample of 205 patients who were taking leprosy medication and had all essential data from January 2015 to December 2019 G.C. at the All African TB and Leprosy Rehabilitation and Training Centre. The Cox proportional hazard model was used to figure out what factors influence leprosy patients’ survival status during treatment. Results Among the 205 leprosy patients, 71 (34.63%) had at least one type of impairment grade during treatment. The Cox proportional model revealed that the most significant variables of impairment among leprosy patients were age, symptom duration, treatment category, living place, and sensory loss. Conclusion The study investigated and revealed characteristics associated with the survival status of leprosy patients in ALRT centers using survival analysis. Patients’ risk of worsening disability grade increased with age, was greater for patients with a long duration of symptom, was higher for defaulter patients, and was lower for patients who did not lose their sensibility throughout therapy. The existence of a difference in the survival curves between two or more groups of factors for the patient’s survival function was also discovered in this inquiry. Female patients, particularly those who were new to the medication, were shown to be more in their survival.
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Affiliation(s)
- Bezanesh Melese Masresha
- Department of Statistics, Debre Tabor University, Debre Tabor, Amhara, Ethiopia.,Department of Statistics, University of Gondar, Gondar, Amhara, Ethiopia
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Filipek KL, Roberts CA, Montgomery J, Gowland RL, Moore J, Tucker K, Evans JA. Creating communities of care: Sex estimation and mobility histories of adolescents buried in the cemetery of St. Mary Magdalen leprosarium (Winchester, England). AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9306906 DOI: 10.1002/ajpa.24498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives This study examines the biological sex and geographical origins of adolescents buried at the St Mary Magdalen leprosarium (Winchester, UK). The data are combined with archaeological and palaeopathological evidence to broaden the understanding of mobility and its relationship to leprosy and leprosaria in Medieval England. Materials and Methods Nineteen individuals (~10–25 at death) with skeletal lesions diagnostic of leprosy were analyzed using standard osteological methods. Amelogenin peptides were extracted from five individuals whose biological sex could not be assessed from macroscopic methods. Enamel samples were analyzed to produce 87Sr/86Sr and δ18O values to explore mobility histories. Results Amelogenin peptides revealed three males and two females. Tooth enamel samples provided an 87Sr/86Sr ratio range from 0.7084 to 0.7103 (mean 0.7090, ±0.0012, 2σ). δ18OP values show a wide range of 15.6‰–19.3‰ (mean 17.8 ± 1.6‰ 2σ), with corresponding δ18ODW values ranging from −9.7‰ to −4.1‰ (mean −6.3 ± 2.4‰ 2σ). Discussion Amelogenin peptide data reveal the presence of adolescent females with bone changes of leprosy, making them the youngest confirmed females with leprosy in the archaeological record. Results also show at least 12 adolescents were local, and seven were from further afield, including outside Britain. Since St. Mary Magdalen was a leprosarium, it is possible that these people traveled there specifically for care. Archaeological and palaeopathological data support the notion that care was provided at this facility and that leprosy stigma, as we understand it today, may not have existed in this time and place.
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Affiliation(s)
- Kori Lea Filipek
- Department of Archaeology Durham University Durham UK
- Human Sciences Research Centre, School of Human Sciences University of Derby Derby UK
| | | | | | | | - Joanna Moore
- Department of Archaeology Durham University Durham UK
| | - Katie Tucker
- Department of Archaeology University of Winchester Winchester UK
| | - Jane A. Evans
- National Environmental Isotope Facility British Geological Survey Keyworth UK
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Feitosa MSC, Santos GPJ, Cerqueira SRPS, Rodrigues GL, da Mota LMH, Gomes CM. Can Leprosy Reaction States Mimic Symptoms of Fibromyalgia? A Cross-Sectional Analytical Study. Front Med (Lausanne) 2022; 9:870584. [PMID: 35547233 PMCID: PMC9082667 DOI: 10.3389/fmed.2022.870584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Leprosy causes significant pain in affected patients, especially those experiencing reactional states. Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue. Confusion between the clinical manifestations of fibromyalgia and those of leprosy reactions is possible at the primary care level, the first contact with the health system in most cases. We aimed to determine whether the presence of leprosy reactional states is related to the development of signs and symptoms included in the case definition of fibromyalgia and establish recommendations for obtaining the correct diagnosis. We performed a cross-sectional study in which the main independent variable was the presence of any leprosy reactional state and the primary dependent variable was the diagnosis of fibromyalgia according to the 2016 Revisions of the 2010/2011Fibromyalgia Provisional Criteria of the American College of Rheumatology. Forty-three patients were included in the study. Twenty-eight (65.12%) patients had a type I reactional state, only 1 (2.33%) had an isolated type II reactional state, and 5 (11.63%) had both type I and type II reactional states. Only 2 patients who suffered from cooccurring type I and II reactional states obtained sufficient scores for the diagnosis of fibromyalgia. Although diffuse pain was common in leprosy patients, none of the types of reactional states were associated with a higher frequency of criteria for fibromyalgia. We can conclude that a leprosy reactional state is probably not a risk factor for fibromyalgia but can act as a confounder, as tender points may be similar in both diagnoses. In patients diagnosed with fibromyalgia, leprosy must be considered in the differential diagnosis in endemic regions.
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Affiliation(s)
| | | | | | - Gabriel Lima Rodrigues
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
| | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
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van 't Noordende AT, Aycheh MW, Moges NA, Tadesse T, Schippers AP. Family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis versus usual care in Ethiopia: study protocol for a cluster-randomised controlled trial. BMJ Open 2022; 12:e056620. [PMID: 35354636 PMCID: PMC8968636 DOI: 10.1136/bmjopen-2021-056620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Leprosy, podoconiosis and lymphatic filariasis (LF) are three skin-related neglected tropical diseases. All three conditions can lead to temporary and permanent impairments. These impairments progressively worsen and are major determinants of stigma, discrimination and participation restrictions. Self-care is essential to prevent disabilities and chronic disease complications. Many persons with leprosy-related, LF-related and podoconiosis-related disabilities need to practice self-management routines their entire life. This is difficult without support and encouragement of others. The objective of this study was to assess the effectiveness of a family-based intervention in terms of physical outcomes related to prevention and self-management of disabilities due to leprosy, podoconiosis and LF and family quality of life and well-being compared with usual practice and care. METHODS AND ANALYSIS The study will use a cluster-randomised controlled trial design with two study arms. The project will be carried out in endemic districts in East and West Gojjam zones in the Amhara region in Ethiopia. Clusters consist of kebeles (lower administrative structures in the district) that have been merged, based on their geographical proximity and the number of cases in each kebele. A total of 630 participants will be included in the study. The intervention group will consist of 105 persons affected by leprosy, 105 persons affected by LF or podoconiosis, and 210 family members. The control group will consist of 105 persons affected by leprosy and 105 persons affected by LF or podoconiosis. The family-based intervention comprises an essential care package that consists of the following three main components: (1) self-management of disabilities, (2) economic empowerment and (3) psychosocial support. Participants in the control areas will receive usual practice and care. Data analysis includes, but is not limited to, calculating the percentage of change and corresponding 95% CI of physical impairment outcomes in each group, before and after the intervention is implemented, effect sizes, intention to treat and difference in difference analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Debre Markos University Health Sciences Institutional Research Ethics Review Committee. Results will be disseminated through peer-reviewed publications, conference presentations and workshops. TRIAL REGISTRATION NUMBER PACTR202108907851342.
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Affiliation(s)
- Anna Tiny van 't Noordende
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Technical Department, NLR, Amsterdam, The Netherlands
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nurilign Abebe Moges
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Tadesse
- Programme, Ethiopian National Association of Persons Affected by Leprosy (ENAPAL), Addis Ababa, Ethiopia
| | - Alice P Schippers
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Care ethics, University of Humanistic Studies, Utrecht, The Netherlands
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Cáceres-Durán1 MÁ. [Epidemiological behavior of leprosy in several Latin American countries, 2011-2020Comportamento epidemiológico da hanseníase em vários países da América Latina, 2011-2020]. Rev Panam Salud Publica 2022; 46:e14. [PMID: 35350456 PMCID: PMC8942284 DOI: 10.26633/rpsp.2022.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the epidemiological behavior of leprosy in several Latin American countries during 2011-2020, based on World Health Organization (WHO) indicators. Methods Cross-sectional, descriptive and quantitative study with official data on incidence and prevalence in the general population, children, clinical form and cases with grade 2 disability from WHO records between 2011 and 2020. The eight countries in Latin America that reported most cases were selected and analyses were carried out using simple descriptive and comparative statistics between different variables. Results During the study period, 301 312 cases of leprosy were reported in the selected countries: Argentina, Brazil, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, and Venezuela. Brazil is the only country in the region with a prevalence greater than 1 per 10 000, representing 93.77% of all cases. Brazil and the Dominican Republic showed an increase in prevalence during 2011-2019, while in other countries the trend was decreasing. The disease is more frequent in men, and multibacillary cases significantly exceed paucibacillary ones. Brazil showed the highest incidences of cases of childhood leprosy and grade 2 disability during the evaluated period. Conclusion In Latin America, leprosy is only considered a public health problem in Brazil; however, most countries in the region continue to report cases annually, revealing a lack of adequate medical care. This study confirmed the importance of active surveillance, early diagnosis and planning of actions against the disease in all the countries evaluated with the aim of reducing its transmission.
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Affiliation(s)
- Miguel Ángel Cáceres-Durán1
- Laboratório de Genética Humana e MédicaUniversidade Federal do ParáBelémBrasilLaboratório de Genética Humana e Médica. Universidade Federal do Pará, Belém, Brasil.
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Orujyan D, Narinyan W, Rangarajan S, Rangchaikul P, Prasad C, Saviola B, Venketaraman V. Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections. Vaccines (Basel) 2022; 10:vaccines10030390. [PMID: 35335022 PMCID: PMC8952781 DOI: 10.3390/vaccines10030390] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
The genus mycobacterium includes several species that are known to cause infections in humans. The microorganisms are classified into tuberculous and non-tuberculous based on their morphological characteristics, defined by the dynamic relationship between the host defenses and the infectious agent. Non-tuberculous mycobacteria (NTM) include all the species of mycobacterium other than the ones that cause tuberculosis (TB). The group of NTM contains almost 200 different species and they are found in soil, water, animals—both domestic and wild—milk and food products, and from plumbed water resources such as sewers and showerhead sprays. A systematic review of Medline between 1946 and 2014 showed an 81% decline in TB incidence rates with a simultaneous 94% increase in infections caused by NTM. Prevalence of infections due to NTM has increased relative to infections caused by TB owing to the stringent prevention and control programs in Western countries such as the USA and Canada. While the spread of typical mycobacterial infections such as TB and leprosy involves human contact, NTM seem to spread easily from the environment without the risk of acquiring from a human contact except in the case of M. abscessus in patients with cystic fibrosis, where human transmission as well as transmission through fomites and aerosols has been recorded. NTM are opportunistic in their infectious processes, making immunocompromised individuals such as those with other systemic infections such as HIV, immunodeficiencies, pulmonary disease, or usage of medications such as long-term corticosteroids/TNF-α inhibitors more susceptible. This review provides insight on pathogenesis, treatment, and BCG vaccine efficacy against M. leprae and some important NTM infections.
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Bergman ZR, Usher M, Olson A, Chipman JG, Brunsvold ME, Beilman G, Tignanelli C, Lusczek ER. Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals. JAMA Netw Open 2022; 5:e220873. [PMID: 35238935 PMCID: PMC8895262 DOI: 10.1001/jamanetworkopen.2022.0873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Early in the SARS-CoV-2 pandemic, the M Health Fairview Hospital System established dedicated hospitals for establishing cohorts and caring for patients with COVID-19, yet the association between treatment at COVID-19-dedicated hospitals and mortality and complications is not known. OBJECTIVE To analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated data prospectively collected from March 1, 2020, through June 30, 2021, from 11 hospitals in Minnesota, including 2 hospitals created solely to care for patients with COVID-19. Data obtained included demographic characteristics, treatments, and outcomes of interest for all patients with a confirmed COVID-19 infection admitted to this hospital system during the study period. EXPOSURES Patients were grouped based on whether they received treatment from 1 of the 2 COVID-19-dedicated hospitals compared with the remainder of the hospitals within the hospital system. MAIN OUTCOMES AND MEASURES Multivariate analyses, including risk-adjusted logistic regression and propensity score matching, were performed to evaluate the primary outcome of in-hospital mortality and secondary outcomes, including complications and use of COVID-specific therapeutics. RESULTS There were 5504 patients with COVID-19 admitted during the study period (median age, 62.5 [IQR, 45.0-75.6] years; 2854 women [51.9%]). Of these, 2077 patients (37.7%) (median age, 63.4 [IQR, 50.7-76.1] years; 1080 men [52.0%]) were treated at 1 of the 2 COVID-19-dedicated hospitals compared with 3427 (62.3%; median age, 62.0 [40.0-75.1] years; 1857 women (54.2%) treated at other hospitals. The mortality rate was 11.6% (n = 241) at the dedicated hospitals compared with 8.0% (n = 274) at the other hospitals (P < .001). However, risk-adjusted in-hospital mortality was significantly lower for patients in the COVID-19-dedicated hospitals in both the unmatched group (n = 2077; odds ratio [OR], 0.75; 95% CI, 0.59-0.95) and the propensity score-matched group (n = 1317; OR, 0.78; 95% CI, 0.58-0.99). The rate of overall complications in the propensity score-matched group was significantly lower (OR, 0.81; 95% CI, 0.66-0.99) and the use of COVID-19-specific therapeutics including deep vein thrombosis prophylaxis (83.9% vs 56.9%; P < .001), high-dose corticosteroids (56.1% vs 22.2%; P < .001), remdesivir (61.5% vs 44.5%; P < .001), and tocilizumab (7.9% vs 2.0; P < .001) was significantly higher. CONCLUSIONS AND RELEVANCE In this cohort study, COVID-19-dedicated hospitals had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals owing to improved processes of care and supports the use of establishing cohorts for future pandemics.
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Affiliation(s)
| | - Michael Usher
- Department of Medicine, University of Minnesota, Minneapolis
| | - Andrew Olson
- Department of Medicine, University of Minnesota, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | | | | | - Greg Beilman
- Department of Surgery, University of Minnesota, Minneapolis
- M. Health Fairview Health System Management, Minneapolis, Minnesota
| | - Christopher Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis
- Department of Medicine, University of Minnesota, Minneapolis
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CLINICAL PROGRESSION OF LEPROSY IN EURASIAN RED SQUIRRELS ( SCIURUS VULGARIS) IN A NATURALLY INFECTED WILD POPULATION. J Zoo Wildl Med 2022; 52:1159-1166. [PMID: 34998285 DOI: 10.1638/2020-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
Leprosy has been described in Eurasian red squirrel (Sciurus vulgaris; ERS) carcasses since 2014. Studies of ERS carcasses have not provided information about incubation or disease progression in this host but have provided important insights into pathogen presence and distribution throughout the United Kingdom. Here we present field study data on 31 live ERS from an island population naturally infected with Mycobacterium leprae that were assessed longitudinally over a 2-yr time period. Clinical assessment, serologic (anti-phenolic glycolipid-I antibody [αPGL-I] detection) and molecular methods (polymerase chain reaction) were used to diagnose and categorize ERS at each assessment as a leprosy case, a leprosy suspect, colonized by M. leprae, or a contact ERS. Eight ERS (25.8%) were identified as leprosy cases: four at initial assessment, two at 6 mon and two at 24 mon after initial assessment. One ERS was categorized a leprosy suspect when it developed typical lesions 12 mon after initial assessment, despite negative serologic and molecular test results at this time, though M. leprae DNA had been isolated during the initial assessment. Seven ERS (22.6%) were categorized as colonized and of these, six were reassessed but did not develop clinical signs of leprosy within 6 (n = 2), 12 (n = 3), and 18 (n = 1) mon. Most (48.4%, n = 15) were categorized as contact ERS. Progression of leprosy lesions varied between ERS, but always increased in severity over time and was paralleled with increased antibody response. Based on our dataset, we propose the hypotheses: 1) leprosy in ERS is a chronic, slowly progressing disease in this species, similar to that described for other hosts; 2) lesions can undergo repeated ulceration-healing cycles; and 3) in some instances M. leprae DNA and αPGL-I antibodies are detectable before the onset of clinical signs of disease. Future studies addressing the progression of leprosy in ERS should follow affected animals over a longer time period and include tissue samples to pair molecular diagnostics with serologic results.
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Alecrin ESD, Oliveira ALGD, Guimarães NS, Lyon S, Martins MAP, Rocha MODC. Factors associated with the development of leprosy in Brazilian contacts: a systematic review. Rev Inst Med Trop Sao Paulo 2022; 64:e55. [PMID: 36197417 PMCID: PMC9528391 DOI: 10.1590/s1678-9946202264055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.
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Affiliation(s)
- Edilamar Silva de Alecrin
- Universidade Federal de Minas Gerais, Brazil; Hospital Eduardo de Menezes, Ambulatório de Dermatologia, Brazil
| | | | | | - Sandra Lyon
- Universidade Federal de Minas Gerais, Brazil; Faculdade de Saúde e Ecologia Humana, Brazil
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Zambare U, Musaddique Ansari S, Gupta A, Nayak C. Lucio phenomenon in a case of lepromatous leprosy. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_564_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jesus JBD, Sena CBCD, Macchi BDM, do Nascimento JLM. Cyclosporin A as an Alternative Neuroimmune Strategy to Control Neurites and Recover Neuronal Tissues in Leprosy. Neuroimmunomodulation 2022; 29:15-20. [PMID: 34350891 DOI: 10.1159/000517993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/21/2020] [Indexed: 11/19/2022] Open
Abstract
Leprosy, also known as Hansen's disease, continues to have a substantial impact on infectious diseases throughout the world. Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae and shows a wide clinical and immunopathological spectrum related to the immune response of the host. This disease affects the skin and other internal organs with a predilection to infect Schwann cells, which play an active role during axonal degeneration, affecting peripheral nerves and promoting neurological damage. This chronic inflammation influences immune function, leading to neuroimmune disorders. Leprosy is also associated with neuroimmune reactions, including type 1 (reverse) and type 2 (erythema nodosum leprosum) reactions, which are immune-mediated inflammatory complications that can occur during the disease and appear to worsen dramatically; these complications are the main concerns of patients. The reactions may induce neuritis and neuropathic pain that progressively worsen with irreversible deformity and disabilities responsible for the immunopathological damage and glial/neuronal death. However, the neuronal damage is not always associated with the reactional episode. Also, the efficacy in the treatment of reactions remains low because of the nonexistence of a specific treatment and missing informations about the immunopathogenesis of the reactional episode. There is increasing evidence that peripheral neuron dysfunction strongly depends on the activity of neurotrophins. The most important neurotrophin in leprosy is nerve growth factor (NGF), which is decreased in the course of leprosy, as well as the presence of autoantibodies against NGF in all clinical forms of leprosy and neuroimmune reactions. The levels of autoantibodies against NGF are decreased by the immunomodulatory activity of cyclosporin A, which mainly controls pain and improves motor function and sensitivity. Therefore, the suppression of anti-NGF and the regulation of NGF levels can be attractive targets for immunomodulatory treatment and for controlling the neuroimmune reactions of leprosy, although further studies are needed to clarify this point.
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Affiliation(s)
- Jessica Batista de Jesus
- Laboratory of Molecular and Cellular Neurochemistry, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Chubert Bernardo Castro de Sena
- Laboratory of Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
- National Institute of Science and Technology in Neuroimmunomodulation (INCT - NIM), Rio de Janeiro, Brazil
| | - Barbarella de Matos Macchi
- Laboratory of Molecular and Cellular Neurochemistry, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
- National Institute of Science and Technology in Neuroimmunomodulation (INCT - NIM), Rio de Janeiro, Brazil
| | - José Luiz Martins do Nascimento
- Laboratory of Molecular and Cellular Neurochemistry, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
- National Institute of Science and Technology in Neuroimmunomodulation (INCT - NIM), Rio de Janeiro, Brazil
- Graduation Program in Pharmaceutical Science, Federal University of Amapá, Macapá, Brazil
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Moraes PCD, Eidt LM, Koehler A, Pagani DM, Scroferneker ML. Epidemiological characteristics and trends of leprosy in children and adolescents under 15 years old in a low-endemic State in Southern Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e80. [PMID: 34878038 PMCID: PMC8660027 DOI: 10.1590/s1678-9946202163080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/20/2021] [Indexed: 11/22/2022] Open
Abstract
Leprosy is an infectious and contagious disease affecting skin and nerves. The number of cases in individuals under 15 years old is one of the parameters used in Brazil as an indicator of endemic permanence of the disease and its continuous transmission. Rio Grande do Sul State, in Southern Brazil, is low-endemic to leprosy. However, the disease remains a public health problem. This is a retrospective, observational and analytical study of a historical series of new cases of leprosy in children under 15 years old diagnosed in the period from 2000 to 2019, in all health units in Rio Grande do Sul State. Seventy-seven new cases were notified. The male gender was predominant in 53.2% of the cases (n=41). The average age was 10.4 years (standard deviation of 2.9), with predominance of the age group between 10 and 15 incomplete years old. The most frequent operational classification was multibacillary, in 62.3% of cases (n=48), and the most common clinical form was borderline, in 38.9% of cases (n=28). The predominant disability degree in the sample was grade zero, in 80.0% of the cases (n=60), but in 4.0% (n=3) the grade assessed was 2. In 54.0% of cases (n=27), bacilloscopy was performed, with positive results in 36.0% (n=9) of the exams. Multibacillary cases, with physical disability and/or positive bacilloscopy, draws attention that that the diagnosis is frequently not made in early stages.
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Affiliation(s)
- Paulo Cezar de Moraes
- Secretaria Estadual de Saúde do Rio Grande do Sul, Ambulatório de Dermatologia Sanitária de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Letícia Maria Eidt
- Secretaria Estadual de Saúde do Rio Grande do Sul, Ambulatório de Dermatologia Sanitária de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alessandra Koehler
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre, Rio Grande do Sul, Brazil
| | - Danielle Machado Pagani
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Microbiologia Agrícola e do Ambiente, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Lúcia Scroferneker
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Médicas, Porto Alegre, Rio Grande do Sul, Brazil.,Universidade Federal do Rio Grande do Sul, Departamento de Microbiologia, Imunologia e Parasitologia, Porto Alegre, Rio Grande do Sul, Brazil
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Saar M, Beissner M, Gültekin F, Maman I, Herbinger KH, Bretzel G. RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test. BMC Infect Dis 2021; 21:1186. [PMID: 34823479 PMCID: PMC8620619 DOI: 10.1186/s12879-021-06882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. METHODS: Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 "must not detect RLEP" samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 "must detect RLEP" samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001-10.000 bacilli/extract), low-positive samples of MB leprosy patients (1-1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. RESULTS: Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43-27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93-100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. CONCLUSIONS: The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.
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Affiliation(s)
- Malkin Saar
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany.
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Fatih Gültekin
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Issaka Maman
- Ministère de la Santé, Institut National d'Hygiène (INH), Lomé, Togo
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
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A Literature Review: The History of Psychological Impact of Illness amongst People with Leprosy (PwL) in Countries across the Globe. Dermatol Res Pract 2021; 2021:5519608. [PMID: 34795759 PMCID: PMC8595037 DOI: 10.1155/2021/5519608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/22/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Leprosy is a chronic infectious disease for which effective therapy has been long since invented. Thus, the morbidity has been decreased as technology has advanced, but the permanent disability has continuously generated stigma for centuries. The stigma causes the emergence of a poor psychological impact on people with leprosy (PwL). These impacts make new PwL reluctant to get appropriate therapy for their initial symptoms and are, thus, troublesome in accomplishing the goals of the leprosy elimination program. The aim of this review is to provide the history of psychological impact amongst PwL in countries across the globe. Methods This is a literature review study. A keyword-based search was conducted in digital libraries. Articles reporting on PwL's psychology and related issues, such as quality of life, opportunity of building a marriage, and getting hired, were included. The data were presented based on a leprosy history timeline with cutoff points, namely, the invention of promin (1941) and multidrug treatment (1970). Results In total, 38 studies were included in this review. These studies showed that PwL's knowledge towards leprosy has been increasing; nevertheless, their attitude is still lacking. The emotional response was described by various negative feelings that had persistently occurred. These poor psychological impacts were followed by poor treatment-seeking behavior and resulted in low quality of life. Conclusions From year to year, the PwL's knowledge about leprosy has been getting better; nevertheless, their attitude towards the disease is still poor. The emotional response, social participation, and quality of life of PwL are persistently poor due to the persistent stigma.
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Luo Y, Kiriya M, Tanigawa K, Kawashima A, Nakamura Y, Ishii N, Suzuki K. Host-Related Laboratory Parameters for Leprosy Reactions. Front Med (Lausanne) 2021; 8:694376. [PMID: 34746168 PMCID: PMC8568883 DOI: 10.3389/fmed.2021.694376] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 12/27/2022] Open
Abstract
Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.
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Affiliation(s)
- Yuqian Luo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - 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
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Norihisa Ishii
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,National Sanatorium Tamazenshoen, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Bersacola E, Parathian H, Frazão-Moreira A, Jaló M, Sanhá A, Regalla A, Saíd AR, Quecuta Q, Camará ST, Quade SMFF, Jaquite SM, Lopes AG, Patrono LV, Ramon M, Bessa J, Godley BJ, Bonneaud C, Leendertz FH, Hockings KJ. Developing an Evidence-Based Coexistence Strategy to Promote Human and Wildlife Health in a Biodiverse Agroforest Landscape. FRONTIERS IN CONSERVATION SCIENCE 2021. [DOI: 10.3389/fcosc.2021.735367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Agroforest mosaics represent one of the most extensive human-impacted terrestrial systems worldwide and play an increasingly critical role in wildlife conservation. In such dynamic shared landscapes, coexistence can be compromised if people view wildlife as a source of infectious disease. A cross-disciplinary One Health knowledge base can help to identify evolving proponents and threats to sustainable coexistence and establish long-term project goals. Building on an existing knowledge base of human–wildlife interactions at Cantanhez National Park (NP), Guinea-Bissau, we developed a causal pathway Theory-of-Change approach in response to a newly identified disease threat of leprosy in the Critically Endangered western chimpanzee (Pan troglodytes verus). The goals of our project are to improve knowledge and surveillance of leprosy in humans and wildlife and increase capacity to manage human–wildlife interactions. We describe the core project activities that aim to (1) quantify space use by chimpanzees across Cantanhez NP and determine the distribution of leprosy in chimpanzees; (2) understand the health system and local perceptions of disease; and (3) identify fine-scale risk sites through participatory mapping of resources shared by humans and chimpanzees across target villages. We discuss the development of a biodiversity and health monitoring programme, an evidence-based One Health campaign, and a One Health environmental management plan that incorporates the sharing of space and resources, and the disease implications of human–non-human great ape interactions. We demonstrate the importance of multi-stakeholder engagement, and the development of strategy that fully considers interactions between people, wildlife, and the environment.
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Rosdiana B, Astari L, Astindari A, Rosita Sigit Prakoeswa C, Zulkarnain I, Damayanti D, Utomo B, Listiawan MY. Risk Factors of Type 1 Leprosy Reaction in Leprosy Patients attending Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr Soetomo General Hospital in 2017–2019: A Retrospective Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by increased response of cellular-mediated immunity to Mycobacterium leprae. Manifestations include skin and nerve lesions, edema, and permanent disabilities. There are several risk factors that should be recognized to prevent disabilities.
AIM: The aim of this study was to analyze the relationship of risk factors to the occurrence of type 1 leprosy reaction in leprosy patients treated at the Outpatient Clinic of Dr. Soetomo General Hospital.
METHODS: This study was an analytical study with retrospective observational study design. Data were secondary from the medical records of leprosy patients at the Outpatient Clinic of Dr. Soetomo General Hospital from January 2017 to December 2019.
RESULTS: Out of 364 patients in the Outpatient Clinic, 190 (52.2%) had leprosy without a reaction and 65 (17.9%) had type 1 reaction. Analysis showed that age, leprosy type, and treatment regimen were significantly associated with the incidence of type 1 reaction (p = 0.023; 0.003 and 0.004, respectively), with the leprosy type as the most dominant risk factor. Age 15–34 years old; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen are risk factors for the occurrence of type I leprosy reaction.
CONCLUSION: There is a statistically significant correlation between the risk factor and the occurrence of type 1 leprosy reaction in leprosy patient. The risk factor that has significant correlation is age 15–34 years; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen. The most significant risk factor for the occurrence of type 1 leprosy reaction from our study is the type of leprosy (BB, BL, and BT).
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Bakos RM, Reinehr C, Escobar GF, Leite LL. Dermoscopy of skin infestations and infections (entomodermoscopy) - Part I: dermatozoonoses and bacterial infections. An Bras Dermatol 2021; 96:735-745. [PMID: 34620524 PMCID: PMC8790189 DOI: 10.1016/j.abd.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/30/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022] Open
Abstract
Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term "entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion.
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Affiliation(s)
| | - Clarissa Reinehr
- Postgraduation in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Leandro Linhares Leite
- Service of Dermatology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Hockings KJ, Mubemba B, Avanzi C, Pleh K, Düx A, Bersacola E, Bessa J, Ramon M, Metzger S, Patrono LV, Jaffe JE, Benjak A, Bonneaud C, Busso P, Couacy-Hymann E, Gado M, Gagneux S, Johnson RC, Kodio M, Lynton-Jenkins J, Morozova I, Mätz-Rensing K, Regalla A, Said AR, Schuenemann VJ, Sow SO, Spencer JS, Ulrich M, Zoubi H, Cole ST, Wittig RM, Calvignac-Spencer S, Leendertz FH. Leprosy in wild chimpanzees. Nature 2021; 598:652-656. [PMID: 34646009 PMCID: PMC8550970 DOI: 10.1038/s41586-021-03968-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/27/2021] [Indexed: 11/08/2022]
Abstract
Humans are considered as the main host for Mycobacterium leprae1, the aetiological agent of leprosy, but spillover has occurred to other mammals that are now maintenance hosts, such as nine-banded armadillos and red squirrels2,3. Although naturally acquired leprosy has also been described in captive nonhuman primates4-7, the exact origins of infection remain unclear. Here we describe leprosy-like lesions in two wild populations of western chimpanzees (Pan troglodytes verus) in Cantanhez National Park, Guinea-Bissau and Taï National Park, Côte d'Ivoire, West Africa. Longitudinal monitoring of both populations revealed the progression of disease symptoms compatible with advanced leprosy. Screening of faecal and necropsy samples confirmed the presence of M. leprae as the causative agent at each site and phylogenomic comparisons with other strains from humans and other animals show that the chimpanzee strains belong to different and rare genotypes (4N/O and 2F). These findings suggest that M. leprae may be circulating in more wild animals than suspected, either as a result of exposure to humans or other unknown environmental sources.
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Affiliation(s)
- Kimberley J Hockings
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
- Centre for Research in Anthropology (CRIA - NOVA FCSH), Lisbon, Portugal
| | - Benjamin Mubemba
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
- Department of Wildlife Sciences, School of Natural Resources, Copperbelt University, Kitwe, Zambia
| | - Charlotte Avanzi
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kamilla Pleh
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan, Côte d'Ivoire
| | - Ariane Düx
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
| | - Elena Bersacola
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
- Centre for Research in Anthropology (CRIA - NOVA FCSH), Lisbon, Portugal
| | - Joana Bessa
- Centre for Research in Anthropology (CRIA - NOVA FCSH), Lisbon, Portugal
- Department of Zoology, University of Oxford, Oxford, UK
| | - Marina Ramon
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
| | - Sonja Metzger
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan, Côte d'Ivoire
| | - Livia V Patrono
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
| | - Jenny E Jaffe
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan, Côte d'Ivoire
| | - Andrej Benjak
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Camille Bonneaud
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
| | - Philippe Busso
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Emmanuel Couacy-Hymann
- Laboratoire National d'Appui au Développement Agricole/Laboratoire Central de Pathologie Animale, Bingerville, Côte d'Ivoire
| | - Moussa Gado
- Programme National de Lutte Contre la Lèpre, Ministry of Public Health, Niamey, Niger
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Roch C Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, University of Abomey-Calavi, Jericho, Cotonou, Benin
- Fondation Raoul Follereau, Paris, France
| | - Mamoudou Kodio
- Centre National d'Appui à la Lutte Contre la Maladie, Bamako, Mali
| | | | - Irina Morozova
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Kerstin Mätz-Rensing
- Pathology Unit, German Primate Center, Leibniz-Institute for Primate Research, Göttingen, Germany
| | - Aissa Regalla
- Instituto da Biodiversidade e das Áreas Protegidas, Dr. Alfredo Simão da Silva (IBAP), Bissau, Guinea-Bissau
| | - Abílio R Said
- Instituto da Biodiversidade e das Áreas Protegidas, Dr. Alfredo Simão da Silva (IBAP), Bissau, Guinea-Bissau
| | | | - Samba O Sow
- Centre National d'Appui à la Lutte Contre la Maladie, Bamako, Mali
| | - John S Spencer
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Markus Ulrich
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
| | - Hyacinthe Zoubi
- Programme National d'Elimination de la Lèpre, Dakar, Senegal
| | - Stewart T Cole
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
| | - Roman M Wittig
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan, Côte d'Ivoire
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Fabian H Leendertz
- Project Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany.
- Helmholtz Institute for One Health, Greifswald, Germany.
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Ogunsumi DO, Lal V, Puchner KP, van Brakel W, Schwienhorst-Stich EM, Kasang C, Chukwu J, Kreibich S, Parisi S, Richardus JH, Blok DJ. Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey. PLoS Negl Trop Dis 2021; 15:e0009769. [PMID: 34543282 PMCID: PMC8483296 DOI: 10.1371/journal.pntd.0009769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/30/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level. METHODS We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods. RESULTS The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels 'high' and 'low' were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators. CONCLUSION There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies.
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Affiliation(s)
- Dorcas O. Ogunsumi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vivek Lal
- Sasakawa-India Leprosy Foundation, New Delhi, India
| | - Karl Philipp Puchner
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Medical Faculty/Master’s Programme Global Health and Disaster Medicine, University of Athens, Greece
| | | | - Eva-Maria Schwienhorst-Stich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Faculty of Medicine, University of Würzburg, Würzburg, Germany
| | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Joseph Chukwu
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Saskia Kreibich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Sandra Parisi
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Department for General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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