Abstract
Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.
Highlights
Leprosy is a chronic infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis.[1]
Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations
Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of COVID-19
Summary
Leprosy is a chronic infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis.[1]. Leprosy reactions are inflammatory conditions that are triggered by diverse factors, including bacillus destruction and viral infection.[5] Most patients infected by M. leprae do not develop clinical disease, but the clinical presentation of the disease is clearly dependent on the Th1/Th2 immune response.[6] Leprosy patients who initiate a Th1-polarized cellular-based immune response develop limited skin lesions, with few bacilli. Immune mediators, such as tumour necrosis factor (TNF), interferon-γ (IFN-γ), interleukin-6 (IL-6) and IL-12, are essential for disease control but are responsible for neural damage.[4] In contrast, patients who initiate a humoral Th2-based response develop diffuse and infiltrative diseases. We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19
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