1
|
Pratibha, Kavita, Mehta H, Narang T, Singh S. Task sharing for the management of leprosy by nurses in a tertiary healthcare setting of Northern India. Trans R Soc Trop Med Hyg 2024; 118:376-383. [PMID: 38240067 DOI: 10.1093/trstmh/trad101] [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: 07/31/2023] [Revised: 10/19/2023] [Accepted: 01/01/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This study aimed to assess the effectiveness of nurse-led interventions in managing leprosy due to a shortage of dermatologists and other healthcare professionals. METHODS A total of 100 leprosy patients were divided into experimental (n=50) and control groups (n=50). The intervention included face-to-face counseling by a trained nurse, motivational videos and exercise demonstrations. The control group received standard care. The primary outcome of interest was treatment adherence (Adherence to Refills and Medications Scale); other assessed outcomes included changes in perceived stigma (Stigma Assessment and Reduction of Impact scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder seven-item) and quality of life (WHO QOL-BREF Scale) from baseline to week 8. RESULTS The intervention group had better treatment adherence (p<0.001). At baseline, moderately severe and severe depression prevalence was 18% and 28%, respectively, and anxiety was 25%, with no intergroup differences. Anxiety significantly decreased in the intervention group (p<0.001), but depression remained similar (p=0.291). Perceived stigma improved notably, especially in disclosure of concern (p<0.001), internal stigma (p<0.001) and anticipated stigma (p<0.001). Quality of life scores improved in the intervention group vs controls. CONCLUSION Nurse-led interventions effectively enhanced quality of life and treatment adherence and reduced anxiety, depression and perceived stigma among leprosy patients. The study recommends strengthening the capacity of nurses for active involvement in leprosy care.
Collapse
Affiliation(s)
- Pratibha
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Kavita
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | | |
Collapse
|
2
|
Ghosh S, Saha S, Roy PK. Critical observation of WHO recommended multidrug therapy on the disease leprosy through mathematical study. J Theor Biol 2023; 567:111496. [PMID: 37080386 DOI: 10.1016/j.jtbi.2023.111496] [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: 09/15/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
Leprosy is a skin disease and it is characterized by a disorder of the peripheral nervous system which occurs due to the infection of Schwann cells. In this research article, we have formulated a four-dimensional ODE-based mathematical model which consists of the densities of healthy Schwann cells, infected Schwann cells, M. leprae bacteria, and the concentration of multidrug therapy (MDT). This work primarily aims on exploring the dynamical changes and interrelations of the system cell populations during the disease progression. Also, evaluating a critical value of the drug efficacy rate of MDT remains our key focus in this article so that a safe drug dose regimen for leprosy can be framed more effectively and realistically. We have examined the stability scenario of different equilibria and the occurrence of Hopf-bifurcation for the densities of our system cell populations with respect to the drug efficacy rate of MDT to gain insight on the precise impact of the efficiency rate on both the infected Schwann cell and the bacterial populations. Also, a necessary transversality condition for the occurrence of the bifurcation has been established. Our analytical and numerical investigations in this research work precisely explores that the process of demyelination, nerve regeneration, and infection of the healthy Schwann cells are the three most crucial factors in the leprosy pathogenesis and to control the M. leprae-induced infection of Schwann cells successfully, a more flexible version of MDT regime with efficacy rate varying in the range η∈(0.025,0.059) for 100-120 days in PB cases and 300 days in MB cases obtained in this research article should be applied. All of our analytical outcomes have been verified through numerical simulations and compared with some existing clinical findings.
Collapse
Affiliation(s)
- Salil Ghosh
- Centre for Mathematical Biology and Ecology, Department of Mathematics, Jadavpur University, Kolkata - 700032, India
| | - Shubhankar Saha
- Department of Mathematics, Sir Gurudas Mahavidyalaya, Kolkata - 700067, India
| | - Priti Kumar Roy
- Centre for Mathematical Biology and Ecology, Department of Mathematics, Jadavpur University, Kolkata - 700032, India.
| |
Collapse
|
3
|
Stennett HL, Back CR, Race PR. Derivation of a Precise and Consistent Timeline for Antibiotic Development. Antibiotics (Basel) 2022; 11:1237. [PMID: 36140015 PMCID: PMC9495031 DOI: 10.3390/antibiotics11091237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Antibiotic resistance is a global health crisis. New classes of antibiotics that can treat drug-resistant infections are urgently needed. To communicate this message, researchers have used antibiotic development timelines, but these are often contradictory or imprecise. We conducted a systematic literature review to produce an antibiotic timeline that incorporates the dates of discovery, first use, and initial reports of the emergence of resistance for the 38 classes of clinically used antibiotics. From our timeline, we derive lessons for identifying new antibiotics that are less prone to resistance. These include a required focus on molecules that exhibit multiple modes of action, possess unusually long 'resistance windows', or those that engage cellular targets whose molecular architectures are at least in part decoupled from evolutionary pressures. Our analysis also further highlights the importance of safeguarding antibiotics as a mechanism for mitigating the development of resistance. We have made our data and sources freely available so that the research community can adapt them to their own needs.
Collapse
Affiliation(s)
- Henry L. Stennett
- School of Biochemistry, University of Bristol, University Walk, Bristol BS8 1TD, UK
- BrisSynBio Synthetic Biology Research Centre, Tyndall Avenue, Bristol BS8 1TQ, UK
| | - Catherine R. Back
- School of Biochemistry, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - Paul R. Race
- School of Biochemistry, University of Bristol, University Walk, Bristol BS8 1TD, UK
- BrisSynBio Synthetic Biology Research Centre, Tyndall Avenue, Bristol BS8 1TQ, UK
| |
Collapse
|
4
|
Batista M, Cardoso J, Figueiredo A. Behind a Leonine Facies. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:413-414. [DOI: 10.1016/j.ad.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/23/2020] [Indexed: 10/18/2022] Open
|
5
|
Batista M, Cardoso J, Figueiredo A. [Artículo traducido] Tras la facies leonina. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T413-T414. [DOI: 10.1016/j.ad.2020.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/06/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
|
6
|
Masuka JT, Mkhize Z, Pillay S, Mosam A. Concurrent pulmonary tuberculosis and lepromatous leprosy in a newly diagnosed HIV positive patient: a case report. BMC Pulm Med 2021; 21:207. [PMID: 34193098 PMCID: PMC8247149 DOI: 10.1186/s12890-021-01572-w] [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: 04/08/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022] Open
Abstract
Background The leprosy-tuberculosis (TB) co-infection is rarely reported in recent times. However, this dual comorbidity is associated with high mortality and major morbidity. Unrecognised leprosy-TB co-infection may predispose affected patients to rifampicin monotherapy and subsequent drug resistance. Case presentation A 35 year old migrant, human immunodeficiency virus (HIV) positive male worker presented with 6 month history of symmetric infiltrative nodular plaques of the face and distal, upper extremities. A few days after initial dermatology presentation, a sputum positive pulmonary tuberculosis diagnosis was made at his base hospital. Subsequent dermatology investigations revealed histology confirmed lepromatous leprosy and a weakly reactive rapid plasma reagin test. The presenting clinical features and laboratory results were suggestive of lepromatous leprosy coexisting with pulmonary tuberculosis in an HIV positive patient. Conclusions This case illustrates the occurrence of leprosy with pulmonary tuberculosis in an HIV infected patient and the difficulties in interpreting non-treponemal syphilis tests in these patients. This case also highlights the need for a high index of suspicion for co-infection and the need to exclude PTB prior to initiation of rifampicin containing multi-drug therapy (MDT). Interdisciplinary management and social support are crucial in these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01572-w.
Collapse
Affiliation(s)
- Josiah T Masuka
- Department of Dermatology, Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa. .,Department of Dermatology, Edendale Hospital, 89 Selby Msimang Rd, Pleissislaer, Pietermaritzburg, 3201, South Africa. .,Harare Central Hospital, PO Box ST14, Southerton, Harare, Zimbabwe.
| | - Zamambo Mkhize
- Department of Dermatology, Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa.,Department of Dermatology, Edendale Hospital, 89 Selby Msimang Rd, Pleissislaer, Pietermaritzburg, 3201, South Africa
| | - Somasundram Pillay
- Department of Dermatology, Edendale Hospital, 89 Selby Msimang Rd, Pleissislaer, Pietermaritzburg, 3201, South Africa.,Department of Internal Medicine, Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Anisa Mosam
- Department of Dermatology, Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa
| |
Collapse
|
7
|
Chaves LL, Patriota Y, Soares-Sobrinho JL, Vieira ACC, Lima SAC, Reis S. Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication? Pharmaceutics 2020; 12:E1202. [PMID: 33322356 PMCID: PMC7763250 DOI: 10.3390/pharmaceutics12121202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Leprosy disease remains an important public health issue as it is still endemic in several countries. Mycobacterium leprae, the causative agent of leprosy, presents tropism for cells of the reticuloendothelial and peripheral nervous system. Current multidrug therapy consists of clofazimine, dapsone and rifampicin. Despite significant improvements in leprosy treatment, in most programs, successful completion of the therapy is still sub-optimal. Drug resistance has emerged in some countries. This review discusses the status of leprosy disease worldwide, providing information regarding infectious agents, clinical manifestations, diagnosis, actual treatment and future perspectives and strategies on targets for an efficient targeted delivery therapy.
Collapse
Affiliation(s)
- Luíse L. Chaves
- Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (A.C.C.V.); (S.A.C.L.)
- Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; (Y.P.); (J.L.S.-S.)
| | - Yuri Patriota
- Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; (Y.P.); (J.L.S.-S.)
| | - José L. Soares-Sobrinho
- Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; (Y.P.); (J.L.S.-S.)
| | - Alexandre C. C. Vieira
- Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (A.C.C.V.); (S.A.C.L.)
- Laboratório de Tecnologia dos Medicamentos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil
| | - Sofia A. Costa Lima
- Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (A.C.C.V.); (S.A.C.L.)
- Cooperativa de Ensino Superior Politécnico e Universitário, Instituto Universitário de Ciências da Saúde, 4585-116 Gandra, Portugal
| | - Salette Reis
- Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (A.C.C.V.); (S.A.C.L.)
| |
Collapse
|
8
|
Pinto P, da Silva MB, Moreira FC, Bouth RC, Gobbo AR, Sandoval TV, Ribeiro-Dos-Santos AM, Vidal AF, Barreto JG, Santos S, Spencer JS, Salgado CG, Ribeiro-Dos-Santos Â. Leprosy piRnome: exploring new possibilities for an old disease. Sci Rep 2020; 10:12648. [PMID: 32724108 PMCID: PMC7387468 DOI: 10.1038/s41598-020-69355-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Leprosy, which is caused by the human pathogen Mycobacterium leprae, causes nerve damage, deformity and disability in over 200,000 people every year. Because of the long doubling time of M. leprae (13 days) and the delayed onset of detectable symptoms, which is estimated to be approximately 3-7 years after infection, there is always a large percentage of subclinically infected individuals in the population who will eventually develop the disease, mainly in endemic countries. piRNAs comprise the largest group of small noncoding RNAs found in humans, and they are distinct from microRNAs (miRNAs) and small interfering RNAs (siRNAs). piRNAs function in transposon silencing, epigenetic regulation, and germline development. The functional role of piRNAs and their associated PIWI proteins have started to emerge in the development of human cancers and viral infections, but their relevance to bacterial diseases has not been investigated. The present study reports the piRNome of human skin, revealing that all but one of the piRNAs examined are downregulated in leprosy skin lesions. Considering that one of the best characterized functions of piRNAs in humans is posttranscriptional mRNA silencing, their functions are similar to what we have described for miRNAs, including acting on apoptosis, M. leprae recognition and engulfment, Schwann cell (SC) demyelination, epithelial-mesenchymal transition (EMT), loss of sensation and neuropathic pain. In addition to new findings on leprosy physiopathology, the discovery of relevant piRNAs involved in disease processes in human skin may provide new clues for therapeutic targets, specifically to control nerve damage, a prominent feature of leprosy that has no currently available pharmaceutical treatment.
Collapse
Affiliation(s)
- Pablo Pinto
- Human and Medical Genetics Laboratory, Institute of Biological Sciences (ICB), UFPA, Belém, 66075110, Brazil
- Oncology Research Center (NPO), UFPA, Belém, 66075110, Brazil
| | - Moisés Batista da Silva
- Dermato-Immunology Laboratory, Institute of Biological Sciences (ICB), UFPA, Marituba, 67200000, Brazil
| | | | - Raquel Carvalho Bouth
- Dermato-Immunology Laboratory, Institute of Biological Sciences (ICB), UFPA, Marituba, 67200000, Brazil
| | - Angélica Rita Gobbo
- Dermato-Immunology Laboratory, Institute of Biological Sciences (ICB), UFPA, Marituba, 67200000, Brazil
| | - Tatiana Vinasco Sandoval
- Human and Medical Genetics Laboratory, Institute of Biological Sciences (ICB), UFPA, Belém, 66075110, Brazil
| | | | - Amanda Ferreira Vidal
- Human and Medical Genetics Laboratory, Institute of Biological Sciences (ICB), UFPA, Belém, 66075110, Brazil
| | | | - Sidney Santos
- Human and Medical Genetics Laboratory, Institute of Biological Sciences (ICB), UFPA, Belém, 66075110, Brazil
- Oncology Research Center (NPO), UFPA, Belém, 66075110, Brazil
| | - John Stewart Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, 80523-1601, USA
| | - Claudio Guedes Salgado
- Dermato-Immunology Laboratory, Institute of Biological Sciences (ICB), UFPA, Marituba, 67200000, Brazil.
| | - Ândrea Ribeiro-Dos-Santos
- Human and Medical Genetics Laboratory, Institute of Biological Sciences (ICB), UFPA, Belém, 66075110, Brazil.
- Oncology Research Center (NPO), UFPA, Belém, 66075110, Brazil.
| |
Collapse
|
9
|
George J. Metabolism and interactions of antileprosy drugs. Biochem Pharmacol 2020; 177:113993. [PMID: 32339493 DOI: 10.1016/j.bcp.2020.113993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 01/29/2023]
Abstract
Leprosy is a chronic infectious disease caused my Mycobacterium leprae that primarily affects peripheral nervous system and extremities and is prevalent in tropical countries. Treatment for leprosy with multidrug regimens is very effective compared to monotherapy especially in multibacillary cases. The three major antileprosy drugs currently in use are 4, 4'-diaminodiphenyl sulfone (DDS, dapsone), rifampicin, and clofazimine. During multidrug therapy, the potent antibiotic rifampicin induces the metabolism of dapsone, which results in decreased plasma half-life of dapsone and its metabolites. Furthermore, rifampicin induces its own metabolism and decreases its half-life during monotherapy. Rifampicin upregulates several hepatic microsomal drug-metabolizing enzymes, especially cytochrome P450 (CYP) family that in turn induce the metabolism of dapsone. Clofazimine lacks significant induction of any drug-metabolizing enzyme including CYP family and does not interact with dapsone metabolism. Rifampicin does not induce clofazimine metabolism during combination treatment. Administration of dapsone in the acetylated form (acedapsone) can release the drug slowly into circulation up to 75 days and could be useful for the effective treatment of paucibacillary cases along with rifampicin. This review summarizes the major aspects of antileprosy drug metabolism and drug interactions and the role of cytochrome P450 family of drug metabolizing enzymes, especially CYP3A4 during multidrug regimens for the treatment of leprosy.
Collapse
Affiliation(s)
- Joseph George
- Department of Biochemistry, Central Leprosy Teaching and Research Institute, Chengalpattu 603001, Tamil Nadu, India.
| |
Collapse
|
10
|
Nag V, Kalita J, Yedale K. Spectrum of leprosy among suspected cases attending a teaching hospital in Western Rajasthan, India. J Family Med Prim Care 2020; 9:2781-2784. [PMID: 32984125 PMCID: PMC7491769 DOI: 10.4103/jfmpc.jfmpc_77_20] [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: 01/12/2020] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Aims and Objective: Materials and Methods: Results: Conclusion:
Collapse
|
11
|
Bezalel SA, Onajin O, Gonzalez-Santiago TM, Patel R, Pritt BS, Virk A, Gibson LE, Peters MS. Leprosy in a Midwestern Dermatology Clinic: Report of 9 Patients. Mayo Clin Proc 2019; 94:417-423. [PMID: 30799052 DOI: 10.1016/j.mayocp.2018.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/11/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the clinical features and epidemiology of leprosy in patients evaluated in a Midwestern dermatology clinic. PATIENTS AND METHODS We performed a retrospective review of clinical and laboratory data from patients with leprosy who were evaluated in the Department of Dermatology at Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2017. RESULTS Nine patients, 7 male and 2 female, were identified, ranging in age from 15 to 63 years (mean age, 38 years). Six of the 9 patients (67%) were foreign-born: 3 from Oceania (2 from Micronesia and 1 from Guam), 1 from Southeast Asia (Indonesia), and 2 from Mexico. Three patients were born in the United States. All 9 patients presented with skin lesions (granulomatous histopathologic type), and 8 had neuropathy. Leprosy was multibacillary in 8 patients and paucibacillary in 1. Two patients experienced a type 1 treatment reaction, and 5 had type 2 reactions. Three of the 9 patients had speciation by polymerase chain reaction (Mycobacterium leprae in 2 and Mycobacterium lepromatosis in 1). CONCLUSION Despite its rarity in the United States, leprosy should be considered in the differential diagnosis when evaluating both foreign- and US-born patients with granulomatous dermatitis and peripheral neuropathy. Because M lepromatosis was not identified until 2008 and requires polymerase chain reaction for diagnosis, the incidence of this species among patients with leprosy diagnosed in earlier years is unknown.
Collapse
Affiliation(s)
| | | | | | - Robin Patel
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Bobbi S Pritt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
12
|
Chaves LL, Costa Lima SA, Vieira ACC, Barreiros L, Segundo MA, Ferreira D, Sarmento B, Reis S. Nanosystems as modulators of intestinal dapsone and clofazimine delivery. Biomed Pharmacother 2018; 103:1392-1396. [PMID: 29864923 DOI: 10.1016/j.biopha.2018.04.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this work was to assess the feasibility of drug nanosystems combination for oral therapy of multibacillary leprosy. The anti-leprotic drugs dapsone (DAP) and clofazimine (CLZ) were incorporated within polymeric nanosystems and studied per se and in combination. DAP was loaded in Eudragit L100 nanoparticles (NPs-DAP) while CLZ was loaded in (poly(lactic-co-glycolic acid) (NPs-CLZ). The nanosystems exhibited around 200 nm in size and a drug loading of 12% for each drug. In vitro cytotoxicity on intestinal Caco-2 cells revealed that after 8 h incubation, DAP alone and within NPs were not toxic up to 100 μg mL-1, while CLZ per se was toxic, reducing cell viability to 30% at 50 μg mL-1. Caco-2 exposed to the combination of NPs-DAP (100 μg mL-1) and NPs-CLZ (50 μg mL-1) exhibited 80% of viability. Caco-2 monolayer permeability assays revealed that DAP and CLZ in the nanosystems per se or in NPs-DAP/ NPs-CLZ combination crossed the intestinal barrier. No significant differences were observed between the single nanosystems or in combination with the apparent permeability values and the amount of permeated drug. Thus, the NPs-DAP/NPs-CLZ combination seems to be a promising platform to deliver both drugs in association, representing an important step towards the improvement of multibacillary leprosy therapy.
Collapse
Affiliation(s)
- Luíse L Chaves
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Sofia A Costa Lima
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal; CESPU, Instituto de Investigacão e Formacão Avançada em Ciências e Tecnologias da Saúde, Instituto Universitário de Ciências da Saúde, Portugal
| | - Alexandre C C Vieira
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Luísa Barreiros
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Marcela A Segundo
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Domingos Ferreira
- UCIBIO, REQUIMTE, Laboratório de Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade do Porto,Portugal
| | - Bruno Sarmento
- CESPU, Instituto de Investigacão e Formacão Avançada em Ciências e Tecnologias da Saúde, Instituto Universitário de Ciências da Saúde, Portugal; I3S, Instituto de Investigacão e Inovacão em Saúde, Universidade do Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Portugal
| | - Salette Reis
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal.
| |
Collapse
|
13
|
Mohanty PS, Naaz F, Bansal AK, Gupta UD. Assessment of vocation of rifabutin and rifapentine in replace of rifampcin in drug resistance leprosy patients: a molecular simulation study. MOLECULAR BIOLOGY RESEARCH COMMUNICATIONS 2017; 6:113-122. [PMID: 29071280 PMCID: PMC5640893 DOI: 10.22099/mbrc.2017.4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The emergence of drug resistance in leprosy is a major hurdle in leprosy elimination programme. Although the problem of drug resistance is presently not acute, it is important that we collect data more systematically and monitor the trend carefully so that effective measures to combat this problem can be developed. The present study aimed at the explication of cross resistance of rifabutin and rifapentine to rifampicin which would be helpful to programme managers for implementing rifabutin or rifapentine in replace of rifampicin. In this study we built 3D model of the M. leprae rpoB using Swiss Model and the modelled structure was docked with rifampicin, rifabutin and rifapentine. We established that these 3 antibiotics interact with the same binding region in the modelled rpoB of M. leprae. Thus we conclude that vocation of rifabutin and rifapentine could not be suitable in replace of rifampicin to combat with drug resistance leprosy.
Collapse
Affiliation(s)
- Partha Sarathi Mohanty
- Microbiology and Molecular Biology National JALMA Institute for Leprosy and Other Mycobacterial Diseases Agra, India
| | - Farah Naaz
- Microbiology and Molecular Biology National JALMA Institute for Leprosy and Other Mycobacterial Diseases Agra, India
| | - Avi Kumar Bansal
- Medical Division National JALMA Institute for Leprosy and Other Mycobacterial Diseases Agra, India
| | - Umesh Datta Gupta
- National JALMA Institute for Leprosy and Other Mycobacterial Diseases Agra, India,Corresponding Author: Director Incharge National JALMA Institute for Leprosy and Other Mycobacterial Diseases Agra, India 282004, Tel: 0562-2331756, Fax: 0562-2331755 , E. mail:
| |
Collapse
|
14
|
Steinmann P, Reed SG, Mirza F, Hollingsworth TD, Richardus JH. Innovative tools and approaches to end the transmission of Mycobacterium leprae. THE LANCET. INFECTIOUS DISEASES 2017; 17:e298-e305. [DOI: 10.1016/s1473-3099(17)30314-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/26/2017] [Accepted: 04/06/2017] [Indexed: 12/23/2022]
|
15
|
Islan GA, Durán M, Cacicedo ML, Nakazato G, Kobayashi RKT, Martinez DST, Castro GR, Durán N. Nanopharmaceuticals as a solution to neglected diseases: Is it possible? Acta Trop 2017; 170:16-42. [PMID: 28232069 DOI: 10.1016/j.actatropica.2017.02.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 12/05/2016] [Accepted: 02/10/2017] [Indexed: 12/22/2022]
Abstract
The study of neglected diseases has not received much attention, especially from public and private institutions over the last years, in terms of strong support for developing treatment for these diseases. Support in the form of substantial amounts of private and public investment is greatly needed in this area. Due to the lack of novel drugs for these diseases, nanobiotechnology has appeared as an important new breakthrough for the treatment of neglected diseases. Recently, very few reviews focusing on filiarasis, leishmaniasis, leprosy, malaria, onchocerciasis, schistosomiasis, trypanosomiasis, and tuberculosis, and dengue virus have been published. New developments in nanocarriers have made promising advances in the treatment of several kinds of diseases with less toxicity, high efficacy and improved bioavailability of drugs with extended release and fewer applications. This review deals with the current status of nanobiotechnology in the treatment of neglected diseases and highlights how it provides key tools for exploring new perspectives in the treatment of a wide range of diseases.
Collapse
Affiliation(s)
- German A Islan
- Laboratorio de Nanobiomateriales, CINDEFI, Depto. de Quimica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET (CCT La Plata), 1900, La Plata, Argentina
| | - Marcela Durán
- Urogenital Carcinogenesis: Urogenitaland Immunotherapy Laboratory, Institute of Biology, University of Campinas, Campinas, SP, Brazil,; NanoBioss, Chemistry Institute, University of Campinas, SP, Brazil
| | - Maximiliano L Cacicedo
- Laboratorio de Nanobiomateriales, CINDEFI, Depto. de Quimica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET (CCT La Plata), 1900, La Plata, Argentina
| | - Gerson Nakazato
- Department of Microbiology, Biology Sciences Center, Londrina State University (UEL), Londrina, Brazil
| | - Renata K T Kobayashi
- Department of Microbiology, Biology Sciences Center, Londrina State University (UEL), Londrina, Brazil
| | - Diego S T Martinez
- NanoBioss, Chemistry Institute, University of Campinas, SP, Brazil; Brazilian Nanotechnology National Laboratory (LNNano-CNPEM), Campinas, SP, Brazil
| | - Guillermo R Castro
- Laboratorio de Nanobiomateriales, CINDEFI, Depto. de Quimica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata - CONICET (CCT La Plata), 1900, La Plata, Argentina.
| | - Nelson Durán
- NanoBioss, Chemistry Institute, University of Campinas, SP, Brazil; Brazilian Nanotechnology National Laboratory (LNNano-CNPEM), Campinas, SP, Brazil; Biological Chemistry Laboratory, Institute of Chemistry, University of Campinas, Campinas, SP. Brazil.
| |
Collapse
|
16
|
Pradeep Nair S, Vidyadharan S. A study of the prevalence of smear-positive leprosy cases in a tertiary care center in the post-elimination phase of leprosy. Int J Dermatol 2016; 55:680-6. [PMID: 26872564 DOI: 10.1111/ijd.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/19/2015] [Accepted: 11/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND India has declared leprosy to be eliminated in the country, according to the WHO criteria of attaining a prevalence of less than 1 in 10,000. However, smear-positive leprosy cases are frequently being encountered. METHODS This is an 18-year retrospective study done in the Department of Dermatology and Venereology, Government Medical College, Trivandrum. Data were collected from the records of all cases in the study period, and the prevalence of smear-positive cases was determined in the post-elimination phase and this was compared to the pre-elimination phase. RESULTS A total of 901 cases were analyzed, which comprised 538 cases in the pre- and 363 cases in the post-elimination phase. The male/female ratio in the pre and post phases was 2.61 : 1 and 2.45 : 1, respectively. Borderline tuberculoid accounted for the commonest type in both the pre and post phases comprising 45.54 and 50.69%, respectively. Type 2 lepra reactions were seen in 40.21% of the reaction cases in the post-elimination phase. The smear-positive cases in the post-elimination phase accounted for 34.99% compared to 14.68% in the pre-elimination phase. Lepromatous leprosy (LL) accounted for 67.71% of the smear-positive cases in the post phase compared to 67.08% in the pre phase. CONCLUSIONS There was an increase of 20.30% of smear-positive cases in the post-elimination phase, which was statistically significant (P < 0.001), and the majority of them were LL (P < 0.001).
Collapse
Affiliation(s)
- Sukumaran Pradeep Nair
- Department of Dermatology and Venereology, Government Medical College, Trivandrum, Kerala, India
| | - Suja Vidyadharan
- Department of Dermatology and Venereology, Government Medical College, Trivandrum, Kerala, India
| |
Collapse
|
17
|
Abstract
Despite significant improvements in leprosy (Hansen's disease) treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high, and patients often have long-term complications associated with the disease. In this article, we discuss recent findings related to genetics, susceptibility, and disease reservoirs and the implications of these findings for Hansen's disease control and health outcomes for patients. We describe the continued difficulties associated with treatment of inflammatory episodes known as "leprosy reactions," which cause much of the disability associated with the disease and can affect people for many years after MDT is complete. We also discuss some of the contemporary challenges for physicians and patients, including international and internal migration of people affected by the disease. We suggest some important areas of focus for future Hansen's disease research.
Collapse
|
18
|
Chhabra N, Grover C, Singal A, Bhattacharya SN, Kaur R. Leprosy Scenario at a Tertiary Level Hospital in Delhi: A 5-year Retrospective Study. Indian J Dermatol 2015; 60:55-9. [PMID: 25657398 PMCID: PMC4318064 DOI: 10.4103/0019-5154.147793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Leprosy has been officially eliminated from India since December, 2005; still, there are districts and blocks reporting high prevalence indicating ongoing transmission. The present study aimed at determining the current clinical profile of leprosy from a tertiary level hospital in Delhi. MATERIALS AND METHODS A retrospective, record-based study was carried out on patients diagnosed and registered in the leprosy clinic of a tertiary level teaching hospital in East district of Delhi (April 2007 to March 2012). Data regarding demographic details, clinical features, treatment started and complications was analyzed. RESULTS A total of 849 patients were registered over a 5-year period, with M: F ratio of 2.3:1. 9.3% were children (≤14 years). 54.3% patients were immigrants from adjoining states. Multibacillary leprosy was the most common clinical type (86.9%). Borderline tuberculoid leprosy was the most frequent morphologic type, seen in 56.3% followed by borderline-borderline (1.5%), borderline lepromatous (24.9%), lepromatous leprosy (8.1%), pure neuritic (8.1%), histoid and indeterminate leprosy (0.5% each). 37.4% patients presented in reaction (Type I in 30.4% cases and Type II in 7% cases). WHO grade II deformities were diagnosed in 37.9% with claw hand being the most common paralytic deformity (23.3% cases). CONCLUSION Our study offers insight into the current status of the disease in an area of otherwise low prevalence. It is seen that despite statistical elimination, multibacillary disease, leprosy reactions and deformities are commonly seen as presenting manifestations, in contrast to national projected trends. Delhi's unique demography with a high degree of migrant workers, presenting to our center (near border location) could be a possible contributing factor towards these aberrations. It highlights the need for continuation of targeted leprosy control activities and active case detection.
Collapse
Affiliation(s)
- Namrata Chhabra
- Departments of Dermatology, Venereology and Leprology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Chander Grover
- Departments of Dermatology, Venereology and Leprology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Archana Singal
- Departments of Dermatology, Venereology and Leprology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Sambit Nath Bhattacharya
- Departments of Dermatology, Venereology and Leprology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| | - Ramandeep Kaur
- Departments of Dermatology, Venereology and Leprology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
| |
Collapse
|
19
|
Mattos KA, Oliveira VCG, Berrêdo-Pinho M, Amaral JJ, Antunes LCM, Melo RCN, Acosta CCD, Moura DF, Olmo R, Han J, Rosa PS, Almeida PE, Finlay BB, Borchers CH, Sarno EN, Bozza PT, Atella GC, Pessolani MCV. Mycobacterium leprae intracellular survival relies on cholesterol accumulation in infected macrophages: a potential target for new drugs for leprosy treatment. Cell Microbiol 2014; 16:797-815. [PMID: 24552180 PMCID: PMC4262048 DOI: 10.1111/cmi.12279] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 12/19/2022]
Abstract
We recently showed that Mycobacterium leprae (ML) is able to induce lipid droplet formation in infected macrophages. We herein confirm that cholesterol (Cho) is one of the host lipid molecules that accumulate in ML-infected macrophages and investigate the effects of ML on cellular Cho metabolism responsible for its accumulation. The expression levels of LDL receptors (LDL-R, CD36, SRA-1, SR-B1, and LRP-1) and enzymes involved in Cho biosynthesis were investigated by qRT-PCR and/or Western blot and shown to be higher in lepromatous leprosy (LL) tissues when compared to borderline tuberculoid (BT) lesions. Moreover, higher levels of the active form of the sterol regulatory element-binding protein (SREBP) transcriptional factors, key regulators of the biosynthesis and uptake of cellular Cho, were found in LL skin biopsies. Functional in vitro assays confirmed the higher capacity of ML-infected macrophages to synthesize Cho and sequester exogenous LDL-Cho. Notably, Cho colocalized to ML-containing phagosomes, and Cho metabolism impairment, through either de novo synthesis inhibition by statins or depletion of exogenous Cho, decreased intracellular bacterial survival. These findings highlight the importance of metabolic integration between the host and bacteria to leprosy pathophysiology, opening new avenues for novel therapeutic strategies to leprosy.
Collapse
Affiliation(s)
- Katherine A Mattos
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, 21040-900, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Considerations on clinical trials of leprosy treatment: need of novel drug combinations. ACTA ACUST UNITED AC 2013. [DOI: 10.4155/cli.13.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
21
|
Abstract
Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.
Collapse
Affiliation(s)
- Munisamy Malathi
- From the Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Devinder Mohan Thappa
- From the Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
22
|
Dogra S, Narang T, Kumar B. Leprosy--evolution of the path to eradication. Indian J Med Res 2013; 137:15-35. [PMID: 23481049 PMCID: PMC3657879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 11/09/2022] Open
Abstract
Leprosy is among the world's oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system. All these provisions in the integrated health care approach will go a long way in further reducing the stigma. Efforts need to be made to reduce deformity through early detection, self care, physiotherapy and reconstructive surgery and developing sound surveillance systems. With all the remarkable achievements in the fight against leprosy, the stage is now set for the final assault. It is hoped that with the efforts of all the stake holders and strong political will, the disease will be eradicated in the near future.
Collapse
Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Bhushan Kumar
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
23
|
Desenfants A, Huguon E, Polfrit Y, Crouzat M, Rouleau V, Chassot V, Besson-Leaud L, Missotte I. [Leprosy with an unusual course]. Arch Pediatr 2012; 19:1182-6. [PMID: 23037580 DOI: 10.1016/j.arcped.2012.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/08/2012] [Accepted: 08/17/2012] [Indexed: 10/26/2022]
Abstract
In developed countries, Hansen disease, or leprosy, is a rare and little-known disease. Over the last few years, its prevalence in New Caledonia has remained stable (0.35 per 10,000 inhabitants). We report the case of an 11-year-old child who presented lepromatous leprosy complicated by a type 2 reaction. Despite appropriate treatment, the course was unusual with fever lasting a few weeks associated with asthenia, weight loss, and biological perturbations such as inflammatory syndrome, anemia, and hyperferritinemia. After a brief review of Hansen disease and its complications, we discuss the different hypotheses that can explain the clinical and biological progression of our patient (hemolytic anemia secondary to dapsone, type 2 reaction, and aspects of hemophagocytic syndrome) and describe therapeutic management, which led to a good outcome.
Collapse
Affiliation(s)
- A Desenfants
- Service de pédiatrie, hôpital Magenta, centre hospitalier territorial de Nouvelle-Calédonie, BP J5, 98849 Nouméa cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Drug and multidrug resistance among Mycobacterium leprae isolates from Brazilian relapsed leprosy patients. J Clin Microbiol 2012; 50:1912-7. [PMID: 22495562 DOI: 10.1128/jcm.06561-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Skin biopsy samples from 145 relapse leprosy cases and from five different regions in Brazil were submitted for sequence analysis of part of the genes associated with Mycobacterium leprae drug resistance. Single nucleotide polymorphisms (SNPs) in these genes were observed in M. leprae from 4 out of 92 cases with positive amplification (4.3%) and included a case with a mutation in rpoB only, another sample with SNPs in both folP1 and rpoB, and two cases showing mutations in folP1, rpoB, and gyrA, suggesting the existence of multidrug resistance (MDR). The nature of the mutations was as reported in earlier studies, being CCC to CGC in codon 55 in folP (Pro to Arg), while in the case of rpoB, all mutations occurred at codon 531, with two being a transition of TCG to ATG (Ser to Met), one TCG to TTC (Ser to Phe), and one TCG to TTG (Ser to Leu). The two cases with mutations in gyrA changed from GCA to GTA (Ala to Val) in codon 91. The median time from cure to relapse diagnosis was 9.45 years but was significantly shorter in patients with mutations (3.26 years; P = 0.0038). More than 70% of the relapses were multibacillary, including three of the mutation-carrying cases; one MDR relapse patient was paucibacillary.
Collapse
|