Clinico-immunological spectrum of American tegumentary leishmaniasis and leprosy coinfection: A case series in Southeastern Brazil

Vernal, Sebastián; Filho, Roberto Bueno; Gomes, Ciro Martins; Roselino, Ana Maria

doi:10.1590/0037-8682-0172-2018

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…This was most likely due to the IL10-mediated down-regulation effect that M. leprae antigens have on the IFN-γ response induced by Leishmania antigens. On the other hand, by analyzing a series of cases, Vernal et al 6 concluded that the occurrence of leprosy and ATL in the same individual presents independent immunological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…Although some case reports have suggested that leprosy/ATL coinfected patients develop a specific immune response to each pathogen 4 , the occurrence of both diseases in the same individual may impact the clinical features of leprosy and ATL 5 . Some authors 6 have shown that the occurrence of leprosy and ATL in the same patient is a rare event. However, in a retrospective cohort, our research group has recently reviewed and identified a relevant number of patients who were diagnosed with both diseases over a 10-year period in a hyperendemic area for leprosy and ATL in Brazil.…”

Section: Introductionmentioning

confidence: 99%

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Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

Carvalho

Luz

Steinmann

et al. 2022

Rev. Inst. Med. trop. S. Paulo

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This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

Carvalho

Luz

Steinmann

et al. 2022

Rev. Inst. Med. trop. S. Paulo

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“…This contrasts with the few reports about such associations in the scientific literature, and suggests that the topic has not been properly studied. In fact, to date, only case reports/cases series have been published [ 4 , 5 , 33 , 34 ]. The occurrence of leprosy and CL in the same patients does not seem to be a rare event, as we found many more cases with both diseases than expected if the distribution were truly random.…”

Section: Discussionmentioning

confidence: 99%

Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil

et al. 2021

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Background Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. Methodology/principal findings A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7–2.9) and low schooling level (HR: 1.5; 95% CI: 1.2–1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40–55 years. Conclusions/significance Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals.

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“…Co-infection of leprosy and leishmaniasis is an infrequent occurrence, even in regions where both diseases are endemic. Historically, only a handful of cases, approximately 34, were documented in the literature, with no indication of a clinical interaction between the two diseases [87][88][89][90][91][92][93][94][95][96][97]. However, recent comprehensive studies carried out in Brazil spanning over a decade, involving a sample of 28,204 leprosy cases and 24,771 American Tegumentary Leishmaniasis cases, identified 414 instances of co-infection [98,99].…”

Section: Leishmaniasismentioning

confidence: 99%

“…Studies have shown that different immunological mechanisms may underlie the development of various forms of leishmaniasis and leprosy in patients. For instance, Th1-localized or Th2-anergic diffuse leishmaniasis have been associated with lepromatous leprosy [87,88,103]. Additionally, concomitant cases of Th1-mucocutaneous leishmaniasis and Th2-lepromatous leprosy, as well as post-kala-azar dermal Th2-leishmaniasis and leprosy of varied forms, have been reported [89,96,[103][104][105][106][107].…”

Section: Leishmaniasismentioning

confidence: 99%

Bacterial, fungal and parasitic co-infections in leprosy: A scoping review

et al. 2023

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Background In leprosy patients, the most commonly reported non-viral co-infections are Tuberculosis, Leishmaniasis, Chromoblastomycosis and Helminths. The presence of a secondary infection is believed to increase the likelihood of leprosy reactions. The purpose of this review was to describe the clinical and epidemiological characteristics of the most reported bacterial, fungal, and parasitic co-infections in leprosy. Methodology/Principal findings Following the PRISMA Extension for Scoping Reviews guidelines, a systematic literature search was conducted by two independent reviewers, resulting in the inclusion of 89 studies. For tuberculosis, a total of 211 cases were identified, with a median age of 36 years and male predominance (82%). Leprosy was the initial infection in 89% of cases, 82% of individuals had multibacillary disease, and 17% developed leprosy reactions. For leishmaniasis, 464 cases were identified, with a median age of 44 years and male predominance (83%). Leprosy was the initial infection in 44% of cases, 76% of individuals presented with multibacillary disease, and 18% developed leprosy reactions. Regarding chromoblastomycosis, we identified 19 cases with a median age of 54 years and male predominance (88%). Leprosy was the primary infection in 66% of cases, 70% of individuals had multibacillary disease, and 35% developed leprosy reactions. Additionally, we found 151 cases of co-infection with leprosy and helminths, with a median age of 43 years and male predominance (68%). Leprosy was the primary infection in 66% of cases, and 76% of individuals presented with multibacillary disease, while the occurrence of leprosy reactions varied from 37% to 81% across studies. Conclusion We observed a male-dominated pattern of co-infections among working-age individuals with multibacillary leprosy. Unlike prior studies reporting increased leprosy reactions in chronic viral co-infections, our findings did not indicate any increase among bacterial, fungal, or parasitic co-infections. Rather, co-infections with tuberculosis and leishmaniasis appeared to reduce leprosy reactions.

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Clinico-immunological spectrum of American tegumentary leishmaniasis and leprosy coinfection: A case series in Southeastern Brazil

Cited by 5 publications

References 12 publications

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases?

Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil

Bacterial, fungal and parasitic co-infections in leprosy: A scoping review

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