Leprosy and Tuberculosis Co-Infection: Clinical and Immunological Report of Two Cases and Review of the Literature

Abstract

Abstract. A review of the records of patients seen between 2004 and 2011 at the Dermatology Clinic of the Sã o Paulo University Medical School showed that only two leprosy patients had been co-infected with tuberculosis (TB). One patient showed a type 1 leprosy reaction during the first 3 months of treatment of pleural TB and in the other patient, pulmonary TB was diagnosed during the first 3 months of treatment of a type 1 leprosy reaction. Both patients showed normal cellular immune response tests, including those of the interferon-gamma (IFN-γ)/interleukin 12 (IL-12) axis. Although both mycobacterial infections are endemic in developing countries like Brazil, the co-infection has hardly been reported in the last decade. There is no suitable explanation for this observation. The reports on the interaction between the two mycobacteria are highly speculative: some studies suggest that leprosy, especially the anergic form, would predispose to TB, whereas other investigations suggested an antagonism between the two diseases.

Tuberculosis and Leprosy

“…Coinfection with M tuberculosis and M leprae was common before the availability of good antimycobacterial treatment, but is uncommon today. 102 Coinfection is usually seen in immunocompromised or immunosuppressed patients.…”

A Rare Case of Coexistence of Borderline Lepromatous Leprosy with Tuberculosis Verrucosa Cutis

“…A number of reasons have been put forth against the simultaneous occurrence of the two infections [8–11]. However studies have suggested that multibacillary (anergic form) leprosy predisposes to tuberculosis [12]. Few reasons have been put forth against the simultaneous occurrence of the two infections.…”

“…However, the issue of the interaction between the two mycobacterial infections still remains to be clarified. Studies have suggested that leprosy, especially the anergic form, predisposes to tuberculosis [12]. It has been argued that the impaired cell-mediated response to Mycobacterium leprae of lepromatous leprosy patients would favor the advance of the more virulent pathogen Mycobacterium tuberculosis [12].…”

“…Studies have suggested that leprosy, especially the anergic form, predisposes to tuberculosis [12]. It has been argued that the impaired cell-mediated response to Mycobacterium leprae of lepromatous leprosy patients would favor the advance of the more virulent pathogen Mycobacterium tuberculosis [12]. It has also been suggested tuberculosis is more severe in coinfections [12].…”

Representações sociais da Enfermagem sobre biossegurança: saúde ocupacional e o cuidar prevencionista

“…Yearly, more than 200,000 new cases of leprosy and more than nine million new cases of tuberculosis are reported worldwide. Both of these diseases are highly prominent in Brazil, especially in the North, Northeast, and Central-West regions, with approximately 30 thousand and 700 new cases of leprosy and tuberculosis, respectively, reported yearly in the country (21) . As a result of airborne diseases, the use of facemasks with respirators (N95), the key PPE in the context of respiratory diseases, such as tuberculosis, becomes necessary (22)(23) .…”