Leprosy: review of the epidemiological, clinical, and etiopathogenic
aspects - Part 1*

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Abstract

Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.

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Most cited references 217

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Genomewide association study of leprosy.

Fu-Ren Zhang, Wei Huang, Shu-Min Chen … (2009)

The narrow host range of Mycobacterium leprae and the fact that it is refractory to growth in culture has limited research on and the biologic understanding of leprosy. Host genetic factors are thought to influence susceptibility to infection as well as disease progression. We performed a two-stage genomewide association study by genotyping 706 patients and 1225 controls using the Human610-Quad BeadChip (Illumina). We then tested three independent replication sets for an association between the presence of leprosy and 93 single-nucleotide polymorphisms (SNPs) that were most strongly associated with the disease in the genomewide association study. Together, these replication sets comprised 3254 patients and 5955 controls. We also carried out tests of heterogeneity of the associations (or lack thereof) between these 93 SNPs and disease, stratified according to clinical subtype (multibacillary vs. paucibacillary). We observed a significant association (P<1.00x10(-10)) between SNPs in the genes CCDC122, C13orf31, NOD2, TNFSF15, HLA-DR, and RIPK2 and a trend toward an association (P=5.10x10(-5)) with a SNP in LRRK2. The associations between the SNPs in C13orf31, LRRK2, NOD2, and RIPK2 and multibacillary leprosy were stronger than the associations between these SNPs and paucibacillary leprosy. Variants of genes in the NOD2-mediated signaling pathway (which regulates the innate immune response) are associated with susceptibility to infection with M. leprae. 2009 Massachusetts Medical Society

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The continuing challenges of leprosy.

D Scollard, L. ADAMS, T P Gillis … (2006)

Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.

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Author and article information

Journal

Journal ID (nlm-ta): An Bras Dermatol

Journal ID (iso-abbrev): An Bras Dermatol

Journal ID (publisher-id): An Bras Dermatol

Title: Anais Brasileiros de Dermatologia

Publisher: Sociedade Brasileira de Dermatologia

ISSN (Print): 0365-0596

ISSN (Electronic): 1806-4841

Publication date (Print): Mar-Apr 2014

Volume: 89

Issue: 2

Pages: 205-218

Affiliations

[1 ] Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (FMB-UNESP) - Botucatu (SP), Brazil.

[2 ] Hospital Regional de Presidente Prudente - Universidade do Oeste Paulista (HRPP-UNOESTE) - Presidente Prudente (SP), Brazil.

Author notes

MAILING ADDRESS: Marilda Aparecida Milanez Morgado de Abreu, Hospital Regional de Presidente Prudente, Rua José Bongiovani, 1297, Cidade Universitária, 19050-680 - Presidente Prudente - SP, Brazil. E-mail: marildaderma@ 123456bol.com.br

Article

DOI: 10.1590/abd1806-4841.20142450

PMC ID: 4008049

PubMed ID: 24770495

SO-VID: b17d0366-6c27-45b1-be1a-23c87d073b1d

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.