Occurrence of leprosy among patients with cutaneous leishmaniasis in a hyperendemic area for both diseases
Introduction: Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) that share many characteristics, such as the areas of occurrence and the affected populations. Despite these similarities, leprosy and CL coinfection has been little addressed in literature. Existing report...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224007525 |
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| Summary: | Introduction: Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) that share many characteristics, such as the areas of occurrence and the affected populations. Despite these similarities, leprosy and CL coinfection has been little addressed in literature. Existing reports of this association are limited to case reports or case series. We investigated the occurrence of leprosy among patients with CL from a hyperendemic area for both diseases in Central-Western Brazil. Methods: All new cases of CL reported in the municipality of Rondonópolis (245,000 inhabitants), from July 2021 to September 2023, and who agreed to participate were included. Previous cases of leprosy or individuals who could not be approached for data collection were excluded. During the administration of intravenous treatment of CL, patients underwent a dermato-neurological clinical examination to investigate manifestations compatible with leprosy. Furthermore, peripheral blood samples were obtained to perform serological screening for IgM antibodies against Mycobacterium leprae by enzyme-linked immunosorbent assay using native phenolic glycolipid-I (PGL-I) antigen. A real-time quantitative PCR (qPCR) was also performed to detect M. leprae DNA in buffy coat samples using a shared region of the multicopy repeat sequence (RLEP) specific to M. leprae. Leprosy and CL coinfection was defined if at least one of the tests performed was positive. Patients’ socioeconomic characteristics were recorded and compared between the coinfected and non-coinfected groups. Results: Forty-three CL patients were screened for leprosy, of which 11.6% (5/43) had leprosy and CL coinfection. Among the coinfected individuals, one presented clinical manifestation compatible with leprosy, three were positive for anti-PGL-I IgM, and only one had a positive RLEP qPCR result from buffy coat. The coinfected and non-coinfected groups differed significantly only in relation to sex (p=0.023). With the exception of the patient diagnosed with clinical leprosy, all other coinfected patients were female. In fact, coinfected individuals presented higher odds of being female (OR=17.7; p<0.001). Discussion: Our findings contrast with previous reports that leprosy and CL coinfection would be a rare event. It is noteworthy that one infection may have a clinical impact on the progression of the other. However, follow-up studies are needed to further clarify these impacts. From an epidemiological perspective, our results reinforce the World Health Organization recommendations for the integration of NTDs control actions to achieve cost-effectiveness, sustainability, and improved health care. The higher occurrence of coinfection among females contrasts with the higher incidence among males often observed for leprosy and CL individually. Higher IgM levels already observed for women could partially explain the observed discrepancy, as we defined most cases of coinfection based on serological criterion. Conclusion: This was the first study demonstrating a high occurrence (11.6%) of leprosy and CL coinfection among CL patients from a Brazilian hyperendemic area for both diseases. |
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| ISSN: | 1201-9712 |