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Sharma R, Singh P, McCoy RC, Lenz SM, Donovan K, Ochoa MT, Estrada-Garcia I, Silva-Miranda M, Jurado-Santa Cruz F, Balagon MF, Stryjewska B, Scollard DM, Pena MT, Lahiri R, Williams DL, Truman RW, Adams LB. Isolation of Mycobacterium lepromatosis and Development of Molecular Diagnostic Assays to Distinguish Mycobacterium leprae and M. lepromatosis. Clin Infect Dis 2021; 71:e262-e269. [PMID: 31732729 DOI: 10.1093/cid/ciz1121] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycobacterium leprae was thought to be the exclusive causative agent of leprosy until Mycobacterium lepromatosis was identified in a rare form of leprosy known as diffuse lepromatous leprosy (DLL). METHODS We isolated M. lepromatosis from a patient with DLL and propagated it in athymic nude mouse footpads. Genomic analysis of this strain (NHDP-385) identified a unique repetitive element, RLPM, on which a specific real-time quantitative polymerase chain reaction assay was developed. The RLPM assay, and a previously developed RLEP quantitative polymerase chain reaction assay for M. leprae, were validated as clinical diagnostic assays according to Clinical Laboratory Improvement Amendments guidelines. We tested DNA from archived histological sections, patient specimens from the United States, Philippines, and Mexico, and US wild armadillos. RESULTS The limit of detection for the RLEP and RLPM assays is 30 M. leprae per specimen (0.76 bacilli per reaction; coefficient of variation, 0.65%-2.44%) and 122 M. lepromatosis per specimen (3.05 bacilli per reaction; 0.84%-2.9%), respectively. In histological sections (n = 10), 1 lepromatous leprosy (LL), 1 DLL, and 3 Lucio reactions contained M. lepromatosis; 2 LL and 2 Lucio reactions contained M. leprae; and 1 LL reaction contained both species. M. lepromatosis was detected in 3 of 218 US biopsy specimens (1.38%). All Philippines specimens (n = 180) were M. lepromatosis negative and M. leprae positive. Conversely, 15 of 47 Mexican specimens (31.91%) were positive for M. lepromatosis, 19 of 47 (40.43%) were positive for M. leprae, and 2 of 47 (4.26%) contained both organisms. All armadillos were M. lepromatosis negative. CONCLUSIONS The RLPM and RLEP assays will aid healthcare providers in the clinical diagnosis and surveillance of leprosy.
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Affiliation(s)
- Rahul Sharma
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Pushpendra Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA.,National Institute of Research in Tribal Health, Jabalpur, MP India
| | - Rajiv C McCoy
- Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kelly Donovan
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Maria T Ochoa
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Iris Estrada-Garcia
- Departamento Immunologia, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Mayra Silva-Miranda
- Consejo Nacional de Ciencia y Tecnologia (National Council of Science and Technology)-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Fermin Jurado-Santa Cruz
- Centro Dermatológico Dr. Ladislao de la Pascua, Secretaria de Salud de la Ciudad de México, Mexico City, Mexico
| | - Marivic F Balagon
- Leonard Wood Memorial, Center for Leprosy Research, Cebu, Philippines
| | - Barbara Stryjewska
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - David M Scollard
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Maria T Pena
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Ramanuj Lahiri
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Diana L Williams
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Richard W Truman
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Linda B Adams
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
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Beltrame A, Barabino G, Wei Y, Clapasson A, Orza P, Perandin F, Piubelli C, Monteiro GB, Longoni SS, Rodari P, Duranti S, Silva R, Fittipaldo VA, Bisoffi Z. Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018. Microorganisms 2020; 8:microorganisms8081113. [PMID: 32722218 PMCID: PMC7463815 DOI: 10.3390/microorganisms8081113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.
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Affiliation(s)
- Anna Beltrame
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
- Correspondence: ; Tel.: +39-045-601-4748
| | - Gianfranco Barabino
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Yiran Wei
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Andrea Clapasson
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Pierantonio Orza
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Francesca Perandin
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Geraldo Badona Monteiro
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Silvia Stefania Longoni
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Silvia Duranti
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Ronaldo Silva
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Veronica Andrea Fittipaldo
- Oncology Department, Mario Negri Institute for Pharmacological Research I.R.C.C.S., Via Giuseppe La Masa 19, 20156 Milano, Italy;
| | - Zeno Bisoffi
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
- Department of Diagnostic and Public Health, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
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Torres-Guerrero E, Sánchez-Moreno EC, Atoche-Diéguez CE, Carrillo-Casas EM, Arenas R, Xicohtencatl-Cortes J, Hernández-Castro R. Identification of Mycobacterium leprae and Mycobacterium lepromatosis in Formalin-Fixed and Paraffin-Embedded Skin Samples from Mexico. Ann Dermatol 2018; 30:562-565. [PMID: 33911479 PMCID: PMC7992488 DOI: 10.5021/ad.2018.30.5.562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background The causative agents of leprosy are the well-known Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. This agent was found in 2008, and it was found to be the cause of diffuse lepromatous leprosy in two Mexican patients. Objective The objective of this work was to determine if M. leprae and M. lepromatosis were present in formalin-fixed and paraffin-embedded skin samples from cases from different regions in Mexico. Methods A total of 41 skin samples were obtained from 11 states of Mexico. All patients' samples were diagnosed by clinical and histopathological analyses. Total DNA was isolated using a Qiagen-DNeasy blood and tissue kit and molecular identification was achieved by two semi-nested polymerase chain reactions. Results The 41 patient included 33 samples from men and 8 samples from women; 29 samples were polymerase chain reaction (PCR)-positive to Mycobacterium and 12 samples were PCR-negative. From those 29 samples, 13 were PCR-positive to M. leprae, 8 to M. lepromatosis and 8 were positive to both species. The histopathological diagnosis included; Nodular lepromatous leprosy (NLL); Diffuse lepromatous leprosy (DLL); and Borderline leprosy (BL). The 29 PCR-positive samples were classified as follow: 14 NLL, 4 DLL, and 11 BL. In the 12 samples negative to Mycobacterium, 7 showed the NLL, 2 DLL and 3 BL. Conclusion These findings add evidence to the M. leprae and M. lepromatous distribution, clinical forms and participation of dual infections in Mexico.
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Affiliation(s)
- Edoardo Torres-Guerrero
- Mycology Service, Dermatological Center of Yucatan Dr. Fernando Latapi, Yucatan 97000, Mexico
| | | | | | - Erika Margarita Carrillo-Casas
- Department of Molecular Biology and Histocompatibility, General Hospital Dr. Manuel Gea Gonzalez, Mexico City 14080, Mexico
| | - Roberto Arenas
- Mycology Service, General Hospital Dr. Manuel Gea Gonzalez, Mexico City 14080, Mexico
| | - Juan Xicohtencatl-Cortes
- Intestinal Bacteriology Laboratory, Childrens Hospital of Mexico Dr. Federico Gomez, Mexico City 06720, Mexico
| | - Rigoberto Hernández-Castro
- Department of Ecology of Pathogen Agents, General Hospital Dr. Manuel Gea Gonzalez, Mexico City 14080, Mexico
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