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Leprosy Transmission in Amazonian Countries: Current Status and Future Trends. CURRENT TROPICAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40475-020-00206-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Purpose of Review
Leprosy is one of the first pathologies described in the history of mankind. However, the ecology, transmission, and pathogenicity of the incriminated bacilli remain poorly understood. Despite effective treatment freely distributed worldwide since 1995, around 200,000 new cases continue to be detected yearly, mostly in the tropics. This review aims to discuss the unique characteristics of leprosy in Amazonian countries, which exhibit a very heterogeneous prevalence among human and animal reservoirs.
Recent Findings
Groundbreaking discoveries made in the last 15 years have challenged the dogmas about leprosy reservoirs, transmission, and treatment. The discovery of a new leprosy causative agent in 2008 and the scientific proof of zoonosis transmission of leprosy by nine-banded armadillos in the southern USA in 2011 challenged the prospects of leprosy eradication. In the Amazonian biome, nine-banded and other armadillo species are present but the lack of large-scale studies does not yet allow accurate assessment of the zoonotic risk. Brazil is the second country in the world reporting the highest number of new leprosy cases annually. The disease is also present, albeit with different rates, in all neighboring countries. Throughout the Amazonian biome, leprosy is mainly found in hyperendemic foci, conducive to the emergence and transmission of drug-resistant strains.
Summary
The deepening of current knowledge on leprosy reservoirs, transmission, and therapeutic issues, with the One Health approach and the help of molecular biology, will allow a better understanding and management of the public health issues and challenges related to leprosy in Amazonia.
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Ploemacher T, Faber WR, Menke H, Rutten V, Pieters T. Reservoirs and transmission routes of leprosy; A systematic review. PLoS Negl Trop Dis 2020; 14:e0008276. [PMID: 32339201 PMCID: PMC7205316 DOI: 10.1371/journal.pntd.0008276] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/07/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar pathologic conditions. They primarily target the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease, being endemic in specific locations within countries of the Americas, Asia, and Africa, while in Europe it is only rarely reported. The reason for a spatial inequality in the prevalence of leprosy in so-called endemic pockets within a country is still largely unexplained. A systematic review was conducted targeting leprosy transmission research data, using PubMed and Scopus as sources. Publications between January 1, 1945 and July 1, 2019 were included. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. The transmission of this disease is probably much more complicated than was thought before. In the Americas, the nine-banded armadillo (Dasypus novemcinctus) has been established as another natural host and reservoir of M. leprae. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. More recently, in red squirrels (Sciurus vulgaris) with leprosy-like lesions in the British Isles M. leprae and M. lepromatosis DNA was detected. This finding was unexpected, because leprosy is considered a disease of humans (with the exception of the armadillo), and because it was thought that leprosy (and M. leprae) had disappeared from the United Kingdom. Furthermore, animals can be affected by other leprosy-like diseases, caused by pathogens phylogenetically closely related to M. leprae. These mycobacteria have been proposed to be grouped as a M. leprae-complex. We argue that insights from the transmission and reservoirs of members of the M. leprae-complex might be relevant for leprosy research. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. A reduction in transmission cannot be expected to be accomplished by actions or interventions from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, to increase our understanding of the intricate picture of leprosy transmission, we propose a One Health transdisciplinary research approach. Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar stigmatizing pathologic conditions. M. leprae primarily targets the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. Reducing transmission cannot be expected from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, we propose a One Health transdisciplinary research approach.
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Affiliation(s)
- Thomas Ploemacher
- Faculty of Science, Freudenthal Institute & Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - William R. Faber
- Faculty of Medicine, Department of Dermatology, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk Menke
- Faculty of Science, Freudenthal Institute & Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Victor Rutten
- Faculty of Veterinary Medicine, Utrecht University, the Netherlands
- Dept of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Republic of South Africa
| | - Toine Pieters
- Faculty of Science, Freudenthal Institute & Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
- * E-mail:
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Deps P, Antunes JM, Santos AR, Collin SM. Prevalence of Mycobacterium leprae in armadillos in Brazil: A systematic review and meta-analysis. PLoS Negl Trop Dis 2020; 14:e0008127. [PMID: 32203502 PMCID: PMC7156091 DOI: 10.1371/journal.pntd.0008127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/14/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
Understanding the prevalence of M. leprae infection in armadillos is important because of evidence from Brazil and other countries of an association between contact with armadillos and the development of Hansen’s Disease (leprosy). Our aim was to characterize studies which have investigated natural M. leprae infection in wild armadillos in Brazil, and to quantify and explore variability in the reported prevalence of infection. We conducted a systematic review (PROSPERO CRD42019155277) of publications in MEDLINE, EMBASE, Global Health, Scopus, LILACS, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses e Dissertações de CAPES, and Biblioteca Virtual em Saúde up to 10/2019 using Mesh and text search terms (in English, Portuguese, Spanish, and French). The 10 included studies represented a total sample of 302 armadillos comprising 207 (69%) Dasypus novemcinctus, 67 (22%) Euphractus sexcinctus, 16 (5%) Priodontes maximus, 10 (3%) Cabassous unicinctus, and 2 (1%) Cabassous tatouay from 7 different states. Methods used included histopathology (4 studies), PGL-1 and LID-1 antigen detection (4 studies) and examination for clinical signs of disease (4 studies). Eight studies used PCR of which 7 targeted the RLEP repetitive element and 3 tested for inhibitory substances. M. leprae prevalence by PCR ranged from 0% (in 3 studies) to 100% in one study, with a summary estimate of 9.4% (95% CI 0.4% to 73.1%) and a predictive interval of 0–100%. The average prevalence is equivalent to 1 in 10 armadillos in Brazil being infected with M. leprae, but wide variation in sample estimates means that the prevalence in any similar study would be entirely unpredictable. We propose instead that future studies aim to investigate transmission and persistence of M. leprae within and between armadillo populations, meanwhile adopting the precautionary principle to protect human health and an endangered species in Brazil. The risk to human health of contact with armadillos infected with Mycobacterium leprae, a bacterium that causes Hansen’s Disease (leprosy), is uncertain, but evidence from Brazil and other countries appears to show a link between contact with armadillos and increased risk of Hansen’s Disease in people. How much of Hansen’s Disease in the human population is caused by contact with armadillos will depend on the size of the risk, the type and frequency of contact and how common it is in the population, and the role of other (human-to-human) transmission routes for Mycobacterium leprae. Our review has shown that one other key factor, the proportion of wild armadillos infected with Mycobacterium leprae, cannot be predicted with any certainty based on data from studies conducted to date. We suggest that much bigger and longer-term studies are needed, perhaps in partnership with animal conservation and ecology groups, to map Mycobacterium leprae infection in armadillos across Brazil and correlate this with proximity to human habitats. At the same time, data must be gathered in studies focused on populations of armadillos to characterize Mycobacterium leprae transmission and persistence within groups of animals, for example, using trackers and repeated sampling over the animals’ lifespans. In the meantime, the precautionary principle should prevail, and public health and educational efforts should be directed to improving community knowledge and changing behaviour to protect people and armadillos.
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Affiliation(s)
- Patrícia Deps
- Department of Social Medicine, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- * E-mail:
| | - João Marcelo Antunes
- Universidade Federal Rural do Semi-Árido, Hospital Veterinário Jerônimo Dix-Huit Rosado Maia, Mossoró, Rio Grande do Norte, Brazil
| | - Adalberto Rezende Santos
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (IOC/Fiocruz), Rio de Janeiro, Brazil
| | - Simon M. Collin
- National Infection Service, Public Health England, London, United Kingdom
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da Silva Ferreira J, de Carvalho FM, Vidal Pessolani MC, de Paula Antunes JMA, de Medeiros Oliveira IVP, Ferreira Moura GH, Truman RW, Peña MT, Sharma R, Duthie MS, de Paula Souza E Guimarães RJ, Nogueira Brum Fontes A, NoelSuffys P, McIntosh D. Serological and molecular detection of infection with Mycobacterium leprae in Brazilian six banded armadillos (Euphractus sexcinctus). Comp Immunol Microbiol Infect Dis 2019; 68:101397. [PMID: 31775113 DOI: 10.1016/j.cimid.2019.101397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
Leprosy was recognized as a zoonotic disease, associated with nine-banded armadillos (Dasypus novemcinctus) in the Southern United States of America in 2011. In addition, there is growing evidence to support a role for armadillos in zoonotic leprosy in South America. The current study evaluated twenty specimens of the six-banded armadillo (Euphractus sexcinctus), collected from rural locations in the state of Rio Grande do Norte (RN), Brazil for evidence of infection with Mycobacterium leprae. Serum was examined using two "in-house" enzyme-linked immunosorbent assays (ELISAs) and via two commercially available (ML flow and NDO-LID®) immunochromatographic lateral flow (LF) tests, for detection of the PGL-I and/or LID-1 antigens of the bacterium. The presence of M. leprae DNA in liver tissue was examined using the multi-copy, M. leprae-specific repetitive element (RLEP), as target in conventional and nested PCR assays. Molecular and anti-PGL-I-ELISA data indicated that 20/20 (100 %) of the armadillos were infected with M. leprae. The corresponding detection levels recorded with the LF tests were 17/20 (85 %) and 16/20 (85 %), for the NDO-LID® and ML flow tests, respectively. Our results indicate that, in common with D. novemcinctus, six banded armadillos (a species hunted and reared as a food-source in some regions of Brazil, including RN), represent a potential reservoir of M. leprae and as such, their role in a possible zoonotic cycle of leprosy within Brazil warrants further investigation.
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Affiliation(s)
- Jéssica da Silva Ferreira
- Multiuser Molecular Biology Laboratory, Department of Animal Parasitology, Institute of Veterinary Medicine, Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | | | | | | | | | | | - Richard Wayne Truman
- Department of Health and Humans Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, United States
| | - Maria Teresa Peña
- Department of Health and Humans Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, United States
| | - Rahul Sharma
- Department of Health and Humans Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, United States
| | | | | | - Amanda Nogueira Brum Fontes
- Laboratory of Molecular Biology Applied to Mycobacteria, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Philip NoelSuffys
- Laboratory of Molecular Biology Applied to Mycobacteria, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Douglas McIntosh
- Multiuser Molecular Biology Laboratory, Department of Animal Parasitology, Institute of Veterinary Medicine, Federal Rural University of Rio de Janeiro, Seropédica, Brazil.
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Oliveira IVPDM, Deps PD, Antunes JMADP. Armadillos and leprosy: from infection to biological model. Rev Inst Med Trop Sao Paulo 2019; 61:e44. [PMID: 31531622 PMCID: PMC6746198 DOI: 10.1590/s1678-9946201961044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium leprae is the primary causative agent of Hansen’s disease or leprosy. Besides human beings, natural infection has been described in animals such as mangabey monkeys and armadillos. Leprosy is considered a global health problem and its complete pathogenesis is still unknown. As M. leprae does not grow in artificial media, armadillos have become the primary experimental model for leprosy, mimicking human disease including involvement of the peripheral nervous system. Leprosy transmission occurs through continuous and close contact of susceptible people with untreated infected people. However, unknown leprosy contact has been reported in leprosy-affected people, and contact with armadillos is a risk factor for leprosy. In the USA, leprosy is considered a zoonosis and this classification has recently been accepted in Brazil. This review presents information regarding the role of wild armadillos as a source of M. leprae for human infections, as well as the pathogenesis of leprosy.
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Affiliation(s)
| | - Patrícia Duarte Deps
- Universidade Federal do Espírito Santo, Departamento de Medicina Social, Vitória, Espírito Santo, Brazil
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Leprosy survey among rural communities and wild armadillos from Amazonas state, Northern Brazil. PLoS One 2019; 14:e0209491. [PMID: 30629624 PMCID: PMC6328080 DOI: 10.1371/journal.pone.0209491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022] Open
Abstract
There is evidence that in southern US, leprosy is a zoonosis infecting wild Dasypus novemcinctus armadillos but the extent of this finding is unknown. This ecological study investigated leprosy in rural communities and in wild armadillos from the Brazilian Amazon. The study area was the Mamiá Lake of Coari municipality, Amazonas State, Northern region, a hyper endemic leprosy area where residents live on subsistence farming, fishing and armadillo hunting and its meat intake are frequent. The leprosy survey was conducted in sixteen communities by a visiting team of specialists. Local partakers provided wild armadillos to investigate M. leprae infection. Volunteers had complete dermato-neurological examination by a dermatologist with expertise in leprosy diagnosis, suspect skin lesions were biopsied for histopathology (Hematoxylin-eosin/HE, Fite-Faraco/FF staining); slit skin smears were collected. Armadillos’ tissue fragments (skins, spleens, livers, lymph nodes, adrenal glands, others) were prepared for histopathology (HE/FF) and for M. leprae repetitive element-RLEP-qPCR. Among 176 volunteers, six new indeterminate leprosy cases were identified (incidence = 3.4%). Suspect skin sections and slit skin smears were negative for bacilli. Twelve wild D. novemcinctus were investigated (48 specimens/96 slides) and histopathological features of M. leprae infection were not found, except for one skin presenting unspecific inflammatory infiltrate suggestive of indeterminate leprosy. Possible traumatic neuroma, granuloma with epithelioid and Langhans cells, foreign-body granuloma were also identified. Granulomatous/non-granulomatous dermatitides were periodic-acid-Schiff/PAS negative for fungus. M. leprae-RLEP-qPCR was negative in all armadillos’ tissues; no bacillus was found in histopathology. Our survey in rural communities confirmed the high endemicity for leprosy while one armadillo was compatible with paucibacillary M. leprae infection. At least in the highly endemic rural area of Coari, in the Brazilian Amazon region where infectious sources from untreated multibacillary leprosy are abundant, M. leprae infected armadillos may not represent a major source of infection nor a significant public health concern.
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Sharma R, Singh P, Loughry WJ, Lockhart JM, Inman WB, Duthie MS, Pena MT, Marcos LA, Scollard DM, Cole ST, Truman RW. Zoonotic Leprosy in the Southeastern United States. Emerg Infect Dis 2016; 21:2127-34. [PMID: 26583204 PMCID: PMC4672434 DOI: 10.3201/eid2112.150501] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The geographic range and complexity of this disease are increasing. Nine-banded armadillos (Dasypus novemcinctus) are naturally infected
with Mycobacterium leprae and have been implicated in zoonotic
transmission of leprosy. Early studies found this disease mainly in Texas and
Louisiana, but armadillos in the southeastern United States appeared to be free of
infection. We screened 645 armadillos from 8 locations in the southeastern United
States not known to harbor enzootic leprosy for M. leprae DNA and
antibodies. We found M. leprae–infected armadillos at each
location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using
single-nucleotide polymorphism variable number tandem repeat genotyping/genome
sequencing, we detected M. leprae genotype 3I-2-v1 among 35
armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In
comparison, 52 human patients from the same region were infected with 31 M.
leprae types. However, 42.3% (22/52) of patients were infected with 1 of
the 2 M. leprae genotype strains associated with armadillos. The
geographic range and complexity of zoonotic leprosy is expanding.
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Kerr L, Kendall C, Sousa CABD, Frota CC, Graham J, Rodrigues L, Fernandes RL, Barreto ML. Human-armadillo interaction in Ceará, Brazil: Potential for transmission of Mycobacterium leprae. Acta Trop 2015; 152:74-79. [PMID: 26232656 DOI: 10.1016/j.actatropica.2015.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
Several factors suggest that armadillos present an important risk for human leprosy infection. This study uses semi-structured interviews to better illustrate how human interaction with armadillos may increase the risk of leprosy transmission. The participants were all residents of the state of Ceará, in northeastern Brazil, all acknowledged contact with armadillos either through hunting, through cooking, or through consumption of its meat. This study raises important issues about contact between human beings and armadillos. The interviews provide evidence of numerous situations in which leprosy transmission via the armadillo is possible. At a minimum, people who hunt armadillos need to be made aware of the risk of infection.
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Balamayooran G, Pena M, Sharma R, Truman RW. The armadillo as an animal model and reservoir host for Mycobacterium leprae. Clin Dermatol 2015; 33:108-15. [PMID: 25432816 DOI: 10.1016/j.clindermatol.2014.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Apart from humans, armadillos are the only known natural hosts of Mycobacterium leprae. They are well developed as hosts for in vivo propagation of M leprae and are advancing as models for studying the pathogenesis of leprosy and translational research. Armadillos are immunologically intact. They exhibit the full Ridley-Jopling spectrum of histopathologic responses to M leprae and uniquely manifest extensive neurological involvement that closely recapitulates human leprosy. In addition, free-ranging armadillos in some regions are known to harbor a naturally occurring infection with M leprae, and zoonotic transmission between armadillos and humans has been implicated in a large number of new case presentations. We review the role of the armadillo as a model for leprosy and reservoir for human infection.
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Affiliation(s)
- Gayathriy Balamayooran
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana; Department of Health Human Services, Health Resources and Services Administration, National Hansen's Disease Program, Baton Rouge, Louisiana
| | - Maria Pena
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana; Department of Health Human Services, Health Resources and Services Administration, National Hansen's Disease Program, Baton Rouge, Louisiana
| | - Rahul Sharma
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana; Department of Health Human Services, Health Resources and Services Administration, National Hansen's Disease Program, Baton Rouge, Louisiana
| | - Richard W Truman
- Department of Health Human Services, Health Resources and Services Administration, National Hansen's Disease Program, Baton Rouge, Louisiana.
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Lastória JC, Abreu MAMMD. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - part 1. An Bras Dermatol 2014; 89:205-18. [PMID: 24770495 PMCID: PMC4008049 DOI: 10.1590/abd1806-4841.20142450] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/21/2013] [Indexed: 12/01/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It
is still endemic in many regions of the world and a public health problem in Brazil.
The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The
mechanism of transmission of leprosy consists of prolonged close contact between
susceptible and genetically predisposed individuals and untreated multibacillary
patients. Transmission occurs through inhalation of bacilli present in upper airway
secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper
understanding of the structural and biological characteristics of M. leprae, the
sequencing of its genome, along with the advances in understanding the mechanisms of
host immune response against the bacilli, dependent on genetic susceptibility, have
contributed to the understanding of the pathogenesis, variations in the clinical
characteristics, and progression of the disease. This article aims to update
dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.
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Affiliation(s)
- Joel Carlos Lastória
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
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Frota CC, Lima LNC, Rocha ADS, Suffys PN, Rolim BN, Rodrigues LC, Barreto ML, Kendall C, Kerr LRS. Mycobacterium leprae in six-banded (Euphractus sexcinctus) and nine-banded armadillos (Dasypus novemcinctus) in Northeast Brazil. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:209-13. [PMID: 23283473 DOI: 10.1590/s0074-02762012000900029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/11/2012] [Indexed: 11/21/2022] Open
Abstract
Human beings are the main reservoir of the causative agent of leprosy, Mycobacterium leprae. In the Americas, nine-banded armadillos (Dasypus novemcinctus) also act as a reservoir for the bacillus. In the state of Ceará (CE), which is located in Northeast Brazil and is an endemic area of leprosy, there are several species of armadillos, including D. novemcinctus and Euphractus sexcinctus (six-banded armadillo). Contact between humans and armadillos occur mainly through hunting, cleaning, preparing, cooking and eating. This study identified M. leprae DNA in the two main species of armadillos found in Northeast Brazil. A total of 29 wild armadillos (27 D. novemcinctus and 2 E. sexcinctus) were captured in different environments of CE countryside. Samples from the ear, nose, liver and spleen from each of these animals were tested by a nested M. leprae-specific repetitive element polymerase chain reaction assay. The samples that tested positive were confirmed by DNA sequencing. M. leprae was detected in 21% (6/29) of the animals, including five D. novemcinctus and one E. sexcinctus. This is the first Brazilian study to identify the presence of a biomarker of M. leprae in wild armadillos (D. novemcinctus and E. sexcinctus) in a leprosy hyperendemic area where there is continuous contact between humans and armadillos.
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Affiliation(s)
- Cristiane Cunha Frota
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
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Penna MLF, Penna GO. Leprosy frequency in the world, 1999-2010. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:3-12. [PMID: 23283446 DOI: 10.1590/s0074-02762012000900002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/11/2012] [Indexed: 11/22/2022] Open
Abstract
In 1991, the World Health Organization (WHO) committed to reducing the prevalence of leprosy to below 1 in 10,000 inhabitants by 2000. Significant improvements in leprosy control have occurred, but leprosy remains a public health problem in many countries due to its high incidence and rate of transmission. This paper reviews data published by the WHO in the years 2000, 2005 and 2010. These data sets included 148 countries or territories that reported to the WHO at least once. Only four countries reported higher prevalence rates in 2010 than in 2000 and eight reported higher case detection rate (CDR) in 2009 than in 1999. Prevalence rate reductions were greater for the first five-year period examined, while CDR reductions were greater in the second five-year period. Thirty-six countries and territories reported at least one prevalence value higher than 1 per 10,000 inhabitants and 32 reported at least one CDR value higher than 9 per 100,000 inhabitants. A total of 39 countries fit at least one of these criteria and all were located in tropical regions.
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Pelli A, Castellano LR, Cardoso MRS, Vasconcelos LAS, Domingues MA, Ferreira MB, Rodrigues V. Differential reactivity of serum immunoglobulins from Brazilian wild mammals to staphylococcal A and streptococcal G proteins. J Vet Diagn Invest 2012; 24:148-52. [DOI: 10.1177/1040638711434322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human pathogens have evolved to infect vertebrate hosts other than human beings without causing symptoms of the disease, thus permitting them to complete their life cycle and to develop into infectious forms. The identification and management of infected animals are alternatives to control dissemination of the disease and to prevent human illness. In the current study, the potential use of staphylococcal A or streptococcal G proteins was evaluated with enzyme-linked immunosorbent assays (ELISAs) for seroepidemiological studies. Sera were collected from animals that were representative of 23 different Brazilian wild mammals. A high protein A binding rate was observed in all animals, except for the orders Didelphimorphia, Artiodactyla, and Rodentia, in which affinity was medium or low. Affinity for streptococcal G protein was higher in animals of the order Artiodactyla, whereas no streptococcal G protein binding was observed in samples obtained from felines (order Carnivora). Bacterial protein binding to mammalian immunoglobulins was confirmed by immunoblotting. The results suggest that secondary detection systems should be better investigated in ELISA protocols before their implementation in seroepidemiological studies involving wild mammals.
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Affiliation(s)
- Afonso Pelli
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Lucio R. Castellano
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Marcos R. S. Cardoso
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Luís A. S. Vasconcelos
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Marcos A. Domingues
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Maria B. Ferreira
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
| | - Virmondes Rodrigues
- Department of Biological Sciences, Triângulo Mineiro Federal University, Minas Gerais, Brazil (Pelli, Castellano, Rodrigues), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Technical School of Health, Paraíba Federal University, Paraíba, Brazil (Castellano), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Department of Furnas Central Electric S.A., Mato Grosso, Brazil (Cardoso, Vasconcelos), Jacarandá City Zoo Park, Minas Gerais, Brazil (Domingues)
- Companhia Energética de Minas Gerais S.A., Minas Gerais, Brazil (Ferreira)
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Stone AC, Wilbur AK, Buikstra JE, Roberts CA. Tuberculosis and leprosy in perspective. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2010; 140 Suppl 49:66-94. [PMID: 19890861 DOI: 10.1002/ajpa.21185] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Two of humankind's most socially and psychologically devastating diseases, tuberculosis and leprosy, have been the subject of intensive paleopathological research due to their antiquity, a presumed association with human settlement and subsistence patterns, and their propensity to leave characteristic lesions on skeletal and mummified remains. Despite a long history of medical research and the development of effective chemotherapy, these diseases remain global health threats even in the 21st century, and as such, their causative agents Mycobacterium tuberculosis and M. leprae, respectively, have recently been the subject of molecular genetics research. The new genome-level data for several mycobacterial species have informed extensive phylogenetic analyses that call into question previously accepted theories concerning the origins and antiquity of these diseases. Of special note is the fact that all new models are in broad agreement that human TB predated that in other animals, including cattle and other domesticates, and that this disease originated at least 35,000 years ago and probably closer to 2.6 million years ago. In this work, we review current phylogenetic and biogeographic models derived from molecular biology and explore their implications for the global development of TB and leprosy, past and present. In so doing, we also briefly review the skeletal evidence for TB and leprosy, explore the current status of these pathogens, critically consider current methods for identifying ancient mycobacterial DNA, and evaluate coevolutionary models.
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Affiliation(s)
- Anne C Stone
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA.
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Deps PD, Antunes JMAP, Faria C, Bührer-Sékula S, Camargo ZP, Opromola DV, Tomimori J. Research regarding anti-PGL-I antibodies by ELISA in wild armadillos from Brazil. Rev Soc Bras Med Trop 2009; 41 Suppl 2:73-6. [PMID: 19618080 DOI: 10.1590/s0037-86822008000700015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Armadillos have been involved in leprosy transmission and are considered a source of Mycobacterium leprae in numerous reports. Clinicians from certain areas of the USA consider contact with armadillos a risk factor for leprosy. However, there is a challenge associated with the role of wild armadillos perpetuating human leprosy in the American Continent. The presence of anti-PGL-I antibodies was investigated in wild nine-banded armadillos from leprosy-endemic areas in State of Espirito Santo, Brazil, by ELISA performed on serum samples from 47 armadillos. Positive ELISA was obtained from 5 (10.6%) armadillos. Infected armadillos may play some role in leprosy transmission, disseminating bacilli in the environment, perhaps making it more difficult to interrupt transmission and reduce the number of new leprosy cases. ELISA is an efficient tool for seroepidemiological investigations of Mycobacterium leprae in armadillos.
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Affiliation(s)
- Patrícia D Deps
- Department of Social Medicine, Federal University of Espirito Santo, Vitória, Brazil.
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López-Hurtado M, Arteaga-Troncoso G, Escobedo-Guerra MR, Guerra-Infante FM. Evaluation of endocytic capacity and NADPH-oxidase activity from armadillo (Dasypus novemcinctus) eosinophils infected with microfilariae. Vet Immunol Immunopathol 2009; 127:181-5. [PMID: 18990455 DOI: 10.1016/j.vetimm.2008.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/07/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022]
Abstract
Endocytic activity of phagocytic cells from armadillos infected with viruses, parasites or bacteria is unknown. This report shows that eosinophils from armadillos infected with microfilaria act against these helmintic parasites but have deficiencies in their oxygen-dependent bacteriocidal mechanisms and also in endocytic capacity against yeast.
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Affiliation(s)
- Marcela López-Hurtado
- Laboratorio de Bioinmunología Molecular del Departamento de Infectología del Instituto Nacional de Perinatología, Montes Urales 800, México, DF, Mexico.
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Hamilton HK, Levis WR, Martiniuk F, Cabrera A, Wolf J. The role of the armadillo and sooty mangabey monkey in human leprosy. Int J Dermatol 2008; 47:545-50. [PMID: 18477141 DOI: 10.1111/j.1365-4632.2008.03722.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The armadillo was the first animal model of leprosy. Its role in the transmission of leprosy remains controversial. The sooty mangabey model of leprosy led to the discovery that rhesus monkeys were more susceptible to leprosy when coinfected with simian immunodeficiency virus (SIV), but that leprosy may play a protective role against acquired immunodeficiency syndrome (AIDS) mortality. Recently, molecular methods have been developed for leprosy and may help resolve the role of zoonoses in leprosy. OBSERVATIONS The recent identification of a case of leprosy in a native-born American on the east coast of the USA and the identification of leprosy as an immunologic reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-positive cases raise the question of what role zoonoses may play in leprosy. CONCLUSIONS Leprosy in armadillos and sooty mangabeys has been manipulated by human experimentation. In the case of the armadillo, further study, including molecular techniques, is required to elucidate the role of the armadillo as a zoonosis in human leprosy. Experimentation with the sooty mangabey led to the discovery of an interaction between SIV and leprosy in rhesus monkeys, and prompted the continued investigation of the relationship between HIV and leprosy.
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Affiliation(s)
- Heather K Hamilton
- Department of Dermatology and Baylor Clinic, Baylor College of Medicine, Houston, Texas, USA
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