The Missing Millions: A Threat to the Elimination of Leprosy

Smith, W. C.; Brakel, Wim H. van; Gillis, Tom; Saunderson, Paul; Richardus, Jan Hendrik

doi:10.1371/journal.pntd.0003658

Cited by 137 publications

(137 citation statements)

References 6 publications

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“…Leprosy is a mycobacterial infection caused by Mycobacterium leprae that tends to be chronic and to compromise human societies by producing peripheral nerve damage, limb loss, blindness, and disfiguring skin lesions (4,72,74). Leprosy occupies a prominent position among infectious diseases due to its high frequency of disability and associated stigma (75)(76)(77)(78).…”

Section: Leprosymentioning

confidence: 99%

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Cutaneous Mycobacterial Infections

et al. 2018

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SUMMARY Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.

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Section: Leprosymentioning

confidence: 99%

“…Nevertheless, since 2005, the number of reported new cases has remained consistently stable despite continued use of multidrug therapy (4,93,95). The number of new cases will reach the 4 million mark by 2020 (since 2000) (76). Many of these new patients already have grade 2 neurological disability by the time of their diagnosis (96,97).…”

Section: Leprosymentioning

confidence: 99%

Cutaneous Mycobacterial Infections

et al. 2018

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“…The reported annual number of new cases has plateaued at 200 000–250 000 globally in the past decade; with 213 899 new diagnoses reported in 2015 12 This stagnation, and the fact that still about 10% of the new diagnoses occur in children, suggests ongoing leprosy transmission,4 7 while the continuing detection of patients with advanced disease indicates serious diagnostic delays 7. As a result, alternative control strategies are needed to interrupt transmission of Mycobacterium leprae and accelerate case detection.…”

Section: Introductionmentioning

confidence: 99%

Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

et al. 2016

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IntroductionThe reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post-exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50–60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data.Methods and analysisThe LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented.Ethics and disseminationEthical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies.

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“…The potential reasons to have Hansen's disease present in endemic areas are related to the late detection and treatment, the underreporting of cases, scarce housing and overcrowding conditions, low education level, poverty, and migratory movements, which all help to spread the disease (5,6). It is worth to mention that a continuous contact with infected people is the most important route of contamination, thus leading to the constant transmission of the illness (7,8).…”

Section: Introductionmentioning

confidence: 99%

Fatores influenciadores do conhecimento dos estudantes de enfermagem sobre hanseníase: estudo transversal

Garcês

Neto²,

Silva

et al. 2017

Online braz j nurs

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Aim: to identify the factors that influence Nursing students' knowledge about Hansen's disease. Method: this is a cross-section study with a quantitative approach, performed from May to June 2016. The sample was composed by 167 Nursing students of a public university located in the Northeastern region of Brazil. Result: the majority of students knows the main aspects of the disease. Factors such as being single, not having another occupation or income, to live with few other people, and search for information with professor were associated to a higher level of understanding about leprosy. Female students demonstrated less chances to know about Hansen's disease. Conclusion: Nursing students know about leprosy, however there are still questions regarding the transmission of the illness.

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The Missing Millions: A Threat to the Elimination of Leprosy

Cited by 137 publications

References 6 publications

Cutaneous Mycobacterial Infections

Cutaneous Mycobacterial Infections

Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

Fatores influenciadores do conhecimento dos estudantes de enfermagem sobre hanseníase: estudo transversal

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