Abstract
There is evidence that in southern US, leprosy is a zoonosis infecting wild Dasypus novemcinctus armadillos but the extent of this finding is unknown. This ecological study investigated leprosy in rural communities and in wild armadillos from the Brazilian Amazon. The study area was the Mamiá Lake of Coari municipality, Amazonas State, Northern region, a hyper endemic leprosy area where residents live on subsistence farming, fishing and armadillo hunting and its meat intake are frequent. The leprosy survey was conducted in sixteen communities by a visiting team of specialists. Local partakers provided wild armadillos to investigate M. leprae infection. Volunteers had complete dermato-neurological examination by a dermatologist with expertise in leprosy diagnosis, suspect skin lesions were biopsied for histopathology (Hematoxylin-eosin/HE, Fite-Faraco/FF staining); slit skin smears were collected. Armadillos’ tissue fragments (skins, spleens, livers, lymph nodes, adrenal glands, others) were prepared for histopathology (HE/FF) and for M. leprae repetitive element-RLEP-qPCR. Among 176 volunteers, six new indeterminate leprosy cases were identified (incidence = 3.4%). Suspect skin sections and slit skin smears were negative for bacilli. Twelve wild D. novemcinctus were investigated (48 specimens/96 slides) and histopathological features of M. leprae infection were not found, except for one skin presenting unspecific inflammatory infiltrate suggestive of indeterminate leprosy. Possible traumatic neuroma, granuloma with epithelioid and Langhans cells, foreign-body granuloma were also identified. Granulomatous/non-granulomatous dermatitides were periodic-acid-Schiff/PAS negative for fungus. M. leprae-RLEP-qPCR was negative in all armadillos’ tissues; no bacillus was found in histopathology. Our survey in rural communities confirmed the high endemicity for leprosy while one armadillo was compatible with paucibacillary M. leprae infection. At least in the highly endemic rural area of Coari, in the Brazilian Amazon region where infectious sources from untreated multibacillary leprosy are abundant, M. leprae infected armadillos may not represent a major source of infection nor a significant public health concern.
Highlights
Leprosy or Hansen’s disease is a chronic contagious infection caused by Mycobacterium leprae that affects mostly the skin macrophages and the Schwann cells of peripheral nerves [1]
In this study we investigated the existence of natural infection of armadillos with M. leprae and the possible link with human disease in Amazonas state, a hyper endemic leprosy area in the Brazilian Amazon where armadillo hunting and its meat intake are recurrent
Four of the newly diagnosed leprosy patients were from Jacarecommunity, one was from Xibiu and the other was from Plano de Deus community
Summary
Leprosy or Hansen’s disease is a chronic contagious infection caused by Mycobacterium leprae that affects mostly the skin macrophages and the Schwann cells of peripheral nerves [1]. The infection of Schwann cells with M. leprae can trigger immune-inflammatory mediated mechanisms, which reduce myelin production and lead to nerve fiber damage resulting in the loss of sensitivity, disfigurement and disabilities, which are considered the hallmarks of leprosy [1, 2]. Despite wide implementation of multidrug therapy (MDT) more than three decades ago, many countries, such as India and Brazil still report high incidence and over 200,000 new leprosy cases have been reported globally each year [3]. Untreated multibacillary leprosy patients represent both the main shedders of bacilli by aerial route and the major cause of inter-human transmission through recurrent and close contact with susceptible hosts [1]. The majority of infected individuals do not develop disease symptoms, but depending on genetic, nutritional and immunological factors, about 10% of the exposed individuals may manifest clinical disease [4]
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