“…These observations indicate that clinical manifestation of leprosy varies widely. The exact mechanism of fecal excretion of M. leprae can be more complex, as presumed in previous studies (1,4,5), and may be associated with high bacillary burden (as in lepromatous leprosy), gastrointestinal symptoms (abdominal pain or diarrhea), disseminated disease, environmental factors, or combinations of these aspects. Verification of transmission routes of M. leprae to fecal samples using genotyping techniques (i.e., whole-genome sequencing) is crucial to establish the diagnostic utility of fecal specimens in leprosy.…”