Leprosy Cases Research Articles

P-177. Contemporary Clinical Characteristics and Outcomes of Leprosy— a Multicenter Network Analysis

Abstract Background Leprosy, also known as Hansen's disease, is a chronic infectious disease caused primarily by Mycobacterium leprae, endemic to tropical countries. In 2022, WHO registered 165,459 cases of leprosy. We lack more contemporary clinical descriptions and outcomes of the disease. Understanding its clinical characteristics is essential for improving diagnosis, treatment, and patient outcomes. We aim to describe the clinical manifestations and outcomes associated with leprosy using a "real-world" database. US Map of the proportion of captured cases by region Methods We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with Leprosy by ICD-10 code. We captured demographics, comorbidities, clinical manifestations, treatments, and outcomes within 1 year. Clinical characteristics and outcomes of leprosy patients by region Results We captured 1,237 patients, with 965 (78%) originating from the US health system. The mean age was 48, and most were women (60.4%). US patients were predominantly from the South and West (Figure 1) and were predominantly White, Native Hawaiian, or Asian (table 1). The most common clinical manifestations included neuralgia, rash, neuropathy, and malaise. Blindness, corneal abrasions, and burns were present among 2-3% of US patients. Orchitis, iritis, and the Lucio phenomena were relatively uncommon. Rifampin, dapsone, and minocycline were most commonly used. However, significant geographical differences were noted in treatment regimens. Notably, clofazimine use was minimal. Steroids were used in 60% of cases, with a higher prevalence in US-based patients. Other immunosuppressants were uncommon, although methotrexate use was more frequent internationally. TB co-infection was 2%. The overall 1-year mortality was 24.3%. Clinical characteristics and outcomes of leprosy patients by region Conclusion Women from the southern and western US were the most significantly affected demographic groups. Severe complications like blindness, corneal abrasions, and burns, though less frequent, underscore the potential impact on quality of life. The presence of conditions like TB co-infection and the use of steroids in treatment point to the need for comprehensive preventive care strategies. With an overall 1-year mortality of 24.3%, our findings stress the importance of early diagnosis and treatment to improve outcomes and reduce mortality rates. Clinical characteristics and outcomes of leprosy patients by region Disclosures All Authors: No reported disclosures

P-135. Exploring Nutritional Status, Food Security, and Perceptions of Leprosy to Better Understand Factors Associated with Leprosy in Addis Ababa, Ethiopia

Abstract Background Ethiopia reports 5,000 new leprosy cases yearly, making it the 5th highest country globally. While studies have established links between food insecurity, nutrition and leprosy, many gaps in knowledge about risk and transmission have led to stagnant case rates globally. Our study seeks to better understand links between nutrition, disease knowledge, and leprosy to better inform control strategies. Descriptive statistics of demographic characteristics with univariate comparisons using t-test or chi-sq where appropriate, p-value < 0.05 considered statistically significant. Methods We conducted a case-control study in adults attending the outpatient clinics of the All African Leprosy Rehabilitation and Training (ALERT) hospital. Surveys on demographics, food insecurity, and leprosy transmission knowledge were administered. Height, weight, and mid upper arm circumference (MUAC) were measured. Healthy controls were tested with a serum anti-PGL-1 antibody lateral flow assay to determine exposure to M. leprae infection. Descriptive, univariate, and multivariable logistic regression measured differences. Leprosy knowledge comparison between cases and controls using chi-squared test. P value <0.05 is considered statistically significant. Results Fifty-four individuals with leprosy and 319 controls were enrolled with more female controls than cases (66% vs 35%, p < 0.0001); and younger mean ages in cases (33 vs 42 years, p < 0.0001) (table 1). More than a third of controls were positive for anti-PGL1 antibody (n=118, 37%). The mean BMI for controls was higher than cases (23.68 vs 21.19 kg/m2, p < 0.0001), and the mean MUAC for controls was higher than cases (25.98 vs 24.37 cm, p=0.0002). Yet, cases had lower odds of being food insecure (as measured by reporting need to cut meals) when adjusted for age, sex, and SES (aOR 0.45, 95% CI 0.21, 0.98). This aOR remained similar when separating controls into anti-PGL1+ or anti-PGL1-. Cases were as likely to identify inhalation as a transmission route as controls but were less likely to identify animal exposure or hygiene practices (table 2). Comparing BMI among study groups using a t-test. p value <0.05 was considered statistically significant. Conclusion Lower BMI and MUAC in cases suggest a difference in nutritional status compared to controls. But the paradoxical better food security in cases reinforces the challenges in understanding the directionality between nutritional status and disease. The knowledge results suggest a wide range of perceptions on leprosy highlighting the need for education in at-risk communities, especially given the high proportion of seropositivity in individuals living near ALERT. Comparing MUAC among study groups using a t-test. p value <0.05 was considered statistically significant. Disclosures All Authors: No reported disclosures

P-769. A chromosome 4p14 locus associates with higher protection from Leprosy in close family contacts of Lepromatous Leprosy cases in endemic regions

Abstract Background Leprosy presents as an infectious disease with intricate genetic and immunological underpinnings. Genetic variations affecting cytokine genes and immune receptors, such as Toll-like receptor 1 (TLR1), may influence disease susceptibility. Close family contacts of individuals with slit skin positive lepromatous leprosy face a notably heightened risk of transmission. It is crucial to implement rigorous screening and early intervention protocols to promptly identify and manage latent infections, thereby curtailing potential disease dissemination within households and communities. Methods We conducted a genome-wide association study involving close family contacts of individuals with positive slit skin smears for Mycobacterium leprae. Our study comprised 131 lepromatous leprosy patients from prospective cohorts in an endemic region. Genotyping was performed using real-time polymerase chain reaction (RT-PCR) on the 7500 Real Time PCR System, employing SNP genotyping assays for pre-selected SNPs (rs7842033 and rs4167826) with specific primers and probes corresponding to the SNP of interest. Results Two-locus analyses of association of variants near rs7842033 showed a haplotype comprised of rs977477 and an IL9 missense variant, rs943138945, had the most significant association (p = 1.26x10-12).Our results showed no association between the SNP rs4052176 in NOD2 and leprosy in this population. Conclusion Situated on chromosome four (4p14), the TLR1 gene encodes a receptor that identifies glycolipids and lipopolysaccharides of M. leprae, stimulating the transcription factor nuclear factor-kappa B (NF-kβ) and enhancing the expression of pro-inflammatory genes. This gene may confer a degree of protection to close contacts against Leprosy. Disclosures All Authors: No reported disclosures

P-2107. Diagnostic accuracy of Nucleic Acid Amplification Tests for detection of Mycobacterium leprae in suspected leprosy patients from northern region of India

Abstract Background Leprosy is a chronic infectious disease, still remains a significant health problem in several parts of the world. A rapid and accurate diagnosis of the disease is essential for better management of Leprosy cases. In this study we compared three molecular methods i.e. PCR, Real TIME PCR and Loop-mediated isothermal amplification (LAMP) assay for detection of mycobacterium leprae. Methods A total of 114 samples were taken from 92 clinically leprosy suspected patients and contacts. DNA was extracted from the samples and molecular assays i.e. PCR, Real TIME PCR and LAMP was performed in parallel. Diagnostic accuracy of each test and Cohen's kappa coefficient was calculated using medcal online software. Results Among the 114 samples tested, the M leprae was detected in 35.09%(40/114), 34.2% (39/114) and 32.4%(37/114) by LAMP, conventional PCR, and real-time PCR, respectively. The overall agreement between conventional PCR and LAMP for detection of M leprae was 97.3% with a Cohen's kappa coefficient of 0.94, indicating perfect agreement. Similarly, the agreement between real-time PCR and LAMP for detection of M leprae was 97.3% with a Cohen's kappa coefficient of 0.94. However, the overall diagnostic accuracy of PCR, Real Time PCR and LAMP for detection of M leprae was 83.2%, 81.2% and 81.2%, respectively. Conclusion All molecular assays i.e. PCR, Real TIME PCR and LAMP had shown a similar diagnostic accuracy for detection of mycobacterium leprae. Disclosures All Authors: No reported disclosures

ASPECTOS CLÍNICO-EPIDEMIOLÓGICOS ASSOCIADOS À INCAPACIDADE FÍSICA POR HANSENÍASE NA VI REGIÃO DE SAÚDE DE PERNAMBUCO

Clinical and epidemiological monitoring of leprosy is crucial for assessing the quality of services and programs for patient care. This study aimed to analyze the clinical and epidemiological aspects associated with physical disability caused by leprosy among residents of the Arcoverde Health Region, Pernambuco. This is an analytical, cross-sectional, retrospective epidemiological study using leprosy notification data from the study area, recorded in the Information System for Notifiable Diseases from January 2022 to June 2023. Descriptive statistics were used. The research was approved by the Ethics Committee of São Leopoldo Mandic College (Opinion: 5.704.506). Seventy cases of leprosy were recorded. The detection rate of new cases in the general population was 13.30 cases per 100,000 inhabitants, classified as high. However, the detection rate in the population under 15 years old and in patients with grade II physical disability was classified as low. There was a predominance of cases in males, mixed race individuals, age group from 15 to 29 years, tuberculoid clinical form, and grade zero disability. However, discrepancies were found between the evaluation of this disability and the recording of affected numbers. It is believed that this could be related to flaws in information recording on the notification form or failures in conducting neurological assessments of patients. It is concluded that leprosy is distributed across the territory of the Arcoverde-PE regional health management, with some localities experiencing active transmission and delayed early detection of cases. It is suggested that local health managers plan actions to update the health team regarding the diagnosis and treatment of the disease.

Insight into Paediatric Versus Adult Leprosy: A Comparative, Analytical Study from India

Abstract Background: Pediatric leprosy, though relatively less common compared to adult cases, presents challenges in diagnosis, treatment, and management. Despite global efforts to eradicate leprosy, it remains endemic in certain regions, particularly low-resource settings. Objectives: To analyse differences in clinical presentation of pediatric leprosy as compared to adult leprosy from leprosy clinic records of a tertiary care hospital and outline the clinical implications. Methods: A retrospective analysis of the records of all the registered paediatric (aged ≤ 18 years) and adult cases of leprosy from January 2010 to December 2021 (12-year period) who presented to the leprosy clinic of Guru Teg Bahadur Hospital in Delhi was carried out. History, examination, and investigation parameters were noted from standardised case record forms. The variables were compared between cases of childhood and adult leprosy. Results: Out of total 1006 recorded cases of leprosy, 16.8% were children and 83.2% were adults. Maximum cases (65.7%) were of borderline tuberculoid (BT) leprosy in children compared to 41.7% BT cases in adults. Type 1 and type 2 leprosy reactions were seen in 11.2% and 7.1% paediatric cases, respectively, compared to 9.8% and 12.3% cases in adults, respectively. Paralytic deformity was seen in 32.5% child cases and 35% adult cases. Claw hand and foot drop was seen in 17.2% and 3.6% cases of leprosy in children and 16.1% and 6.5% cases in adults. A total of 11.8% children developed facial palsy. Slit skin smear was positive in 15.4% paediatric and 30.1% adult cases. Treatment was completed in 65.1% child cases and 27.8% children defaulted. In adult cases, treatment was completed in 61.8% cases and 28.9% cases defaulted. Conclusion: Paediatric leprosy in our study had a high number of cases of type 1 lepra reaction, paralytic deformities, disabilities, pure neuritic leprosy, and default rate. Our study highlights the need of early detection, timely intervention, and increasing community awareness to ensure early and adequate management of paediatric leprosy.

Unveiling hidden leprosy in underserved populations of the Amazonas state through active case-finding-the Amazon Skin Health Program (2023).

Active case-finding is an effective strategy for combating leprosy, especially in early multibacillary cases in endemic regions. This early approach includes systematic actions such as epidemiological investigations, community surveys, and awareness campaigns to identify leprosy cases. This study reports new leprosy cases diagnosed through an active case-finding initiative conducted in 12 underserved populations from Amazonas in 2023. This is a cross-sectional descriptive study focused on patients diagnosed with leprosy and other dermatological diseases during the multi-professional Amazon Skin Health Program. Data collected for all suspected cases of leprosy encompassed epidemiological information, clinical details, slit skin smear test, histopathological examination, and polymerase chain reaction (PCR) test. Among 13,023 individuals examined, 69 (0.53%) new cases of leprosy were detected: 46.38% were characterized as paucibacillary and 53.62% as multibacillary. Regarding their age and neurologic involvement, 10.1% were detected in children under 15 years, and 20.9% had grade II disability. This effort accounted for an increase of 21.8% in the year-based diagnoses of leprosy in the state of Amazonas. Active case-finding can unveil hidden cases of leprosy in endemic areas, contributing to early detection to prevent neurological impairment and limit disease transmission. Additionally, the results advocate for targeted public health interventions, including the involvement of dermatologists in the diagnostic process and enhanced training for health professionals in differentiating leprosy from other cutaneous diseases.

Understanding reasons for delay in diagnosis of leprosy in Pakistan: A qualitative study.

Recent epidemiological data shows significant rates of grade 2 disability at point-of-diagnosis among new leprosy cases in Pakistan. This indicates a feature of extensive diagnostic delay; the disability burden appears unmoving and disproportionate to the falling leprosy incidence rates. Therefore, this study was required to understand reasons for delay in diagnosis and treatment of leprosy. A qualitative design of 7 semi-structured interviews was employed to reveal perceptions and understandings of various leprosy stakeholders in Pakistan, termed "leprosy experts". Subsequent inductive analysis was used to identify themes and subthemes concerned with delay in the diagnosis and treatment of leprosy. Leprosy experts identified three main areas, or domains, to which delay can be attributed: 1. Awareness and beliefs about leprosy, within the general population, 2. Knowledge and clinical experience of leprosy, among healthcare professionals, 3. Leprosy control program infrastructure, allocation of resources and institutional funding. These domains were each viewed as consequent to the larger theme of 'low-endemicity'. Strong correlations between diagnostic delay and socioeconomic status, gender, geography and health system challenges, were also mentioned, and which intersected the three major themes. Reasons for diagnostic delay are evident in all tiers of the healthcare hierarchy in Pakistan. Thus, an approach at multiple levels is justified, to improve the general awareness of leprosy, education of healthcare professionals, and organizational structuring. Additionally, cultural features relevant to different communities in Pakistan which might be different from other care access frameworks demonstrated a need for further study into the health beliefs of Pakistani patients in a wide range of communities.

Challenges of the public health response to a rare case of non-autochthonous Mycobacterium leprae, Ireland, 2024.

This case report details the public health response to a multibacillary leprosy case in Ireland. The case presented with hypopigmented skin lesions and neurological symptoms. Challenges included delayed recognition in the clinical setting, contact tracing within a congregate setting and lack of specific Irish guidelines. Comprehensive contact tracing, chemoprophylaxis and follow-up care were implemented, guided by international protocols. This case underscores the need for tailored guidelines and stigma mitigation strategies for this neglected tropical disease in non-endemic regions.

Innovation Trends: Untilization of Social Media and Interective Video in Leprosy-Related Health Promotion

Leprosy is an infectious disease caused by Mycobacterium Leprae. This disease has become a health problem in several countries, one of which is Indonesia. The impact of leprosy is physical, economic and psychological disability. Health promotion is an effort by individuals and communities to increase their abilities in several factors that influence health so that they can improve their health. Health promotion activities regarding leprosy are carried out by making videos regarding education the prevention of leprosy using promotional media in the form of Instagram. The method used is qualitative content analysis from educational videos related to leprosy which are posted on the Instagram page @komkes.ikmb.22. There are 2 processes in this activity: 1) formulation of material and content ideas related to leprosy prevention; and 2) creating leprosy health promotion media. Leprosy education using social media can be done by disseminating accurate and educative information about leprosy through social media platforms and not causing discrimination against leprosy sufferers. Instagram can be used as a means of health promotion and health communication tool to fight leprosy. Instagram is effective medium, because it is widely used and has a large number of active users. The Indonesian Ministry of Health stated that there are still a number of challenges in eliminating leprosy cases in Indonesia. Therefore, an effective solution is needed to overcome this. Through social media, especially Instagram, it is hoped that efforts to deal with leprosy in society will become more systematic, comprehensive and effective

Geospatial Analysis of Child Leprosy Cases and Block-Level Endemicity in Raigad District, Maharashtra (2018-19 to 2023-24)

Background: Leprosy remains a public health Problem in few pockets of India, including the Raigad district, where prevalence rate exceeds 1/10000 population and child proportion is notably high. Understanding its spatial distribution is a crucial guide for targeted public health interventions as it reflects the community's ongoing case transmission especially in endemic areas due to possibility of close contact transmission and high exposure levels in community. Aims: The study aimed to analyse the spatial distribution and geographical patterns of child leprosy in Raigad district, Maharashtra to identify high-risk areas. Methods: A retrospective data analysis of 3,927 leprosy cases, including 572 children aged ≤14 years was conducted using open-source GIS software (Version 3.8) from April 2018 to March 2024. Results: Children constituted 12% of the cases, with a child rate of 3.3 per 100,000 population. The spatial analysis identified Karjat and Panvel as hotspots with over 100 new cases annually. Other blocks exhibited varying levels of endemicity with uneven distribution of Child leprosy cases. Kernel density estimation revealed high-density hotspots of PB and MB child leprosy cases in multiple habitats. Conclusion: The study highlights the heterogeneity in the spatial distribution of child leprosy, emphasizing that GIS mapping and spatial analysis can be essential tools for devising targeted strategies to reduce the incidence of child leprosy.

Slit skin smear versus anti-phenolic glycolipid-I serology in diagnosis of leprosy: a cross sectional study.

Leprosy is a chronic infectious disease which mainly affects the skin, nasal mucosa, and peripheral nerves. The aim of this study was to compare between the efficacies of serum anti-phenolic glycolipid 1 (APGL-I) level versus slit skin smear (SSS) in diagnosis of leprosy. This study involved 58 leprosy cases who were clinically examined, slit-skin smears were taken from all at diagnosis from four sites and APGL-I levels were seroassayed using ELISA. The mean age of studied group was 39.42 ± 15.2, 44.8% of patients were males and 55.2% were females. The majority of patients (72.4%) had multibacillary leprosy (MBL) followed by (27.6%) of patients had paucibacillary leprosy (PBL). SSS had sensitivity of 71.5% and specificity of 84% (area under curve; AUC = 0.763, 95% CI 0.427-0.823) while APGL-I had a sensitivity of 80% and specificity of 85% (area under curve; AUC = 0.830, 95% CI 0.424-0.852). Both serum Anti-PGL-1 levels and slit skin smear are useful in diagnosing leprosy, but their effectiveness depends on disease stage and patient's immune response. Being inexpensive, easy and noninvasive technique, APGL1 can be an adjunct method for the detection of leprosy in the population while slit skin smear having higher specificity. Combining both methods or using sequential diagnostic approaches could enhance accuracy and reduce missed diagnoses.

Relevance of reporting leprosy related disability at the completion of multi drug therapy: A 5-year retrospective analysis of disability in persons affected by leprosy at ALERT Hospital Ethiopia.

Leprosy is one of the neglected tropical diseases associated with significant morbidity in endemic regions. It causes disability affecting the daily activities and social participation of affected individuals. Understanding the prevalence and trend of leprosy-related disability throughout the world and the accuracy of disability data counted by WHO is crucial in guiding efforts to be made towards the targets set by WHO to be achieved by 2030. This study aims to show the significance of reporting leprosy-related disability at the end of MDT and critique how disability is counted in the context of WHO data. This is a mixed method study with a 5-year retrospective analysis of outcomes of newly diagnosed leprosy patients at ALERT Hospital in Ethiopia from 2016 to 2020. A comparative review and analysis of leprosy related G2D (Grade 2 Disability), globally, regionally, and in Ethiopia using WHO data was also done. In addition, semi-structured interview of health workers (HCWs) and professionals working in the field of leprosy at various organizations was conducted. The trend of G2D among newly diagnosed leprosy patients shows no decline globally for the past 20 years. It is increasing in Africa and stable in the Southeast Asian and American regions where majority of leprosy patients are found showing the gap in early case identification and prompt treatment of leprosy cases. The total number of newly diagnosed leprosy cases at ALERT hospital between January 2016 and December 2020 were 1032 and among those patients who had completed treatment the prevalence of G2D was 33% at diagnosis and 23% at completion. The interview has also shown gaps in the completeness and quality of disability data reported to WHO and how disability is counted. Leprosy related G2D among newly diagnosed patient is not declining worldwide and even increasing in endemic regions like Ethiopia. More training should be given to health professionals in assessing disability. WHO should make some changes in the way it counts disability as the current definitions are prone to interpretation bias and lacks uniformity among various programmes and health workers. Prospective studies are needed in assessing disability progression post MDT so as design interventions and strategies in preventing worsening of disability after patients are discharged from treatment centre.

Photogallery. A case of lepromatous leprosy

Leprosy is a chronic disabling disease of infectious nature caused by Mycobacterium leprae hominis and accompanied by lesion of the skin, mucous membranes, peripheral nervous system, musculoskeletal system and viscera [1,2]. According to the World Health Organization in 2018 208.641 new cases of leprosy have been registered in the world. The major share of morbidity is accounted for countries such as Angola, the Democratic Republic of the Congo, Central African Republic, India, Mozambique, Madagascar, Brazil, Nepal, United Republic of Tanzania. However, due to migration, expansion of trade and economic ties and tourism development, there have been sporadic cases of leprosy in other countries, too [2, 3]. This article describes the illustration of the clinical case of 24-year-old patient S., who turned to our clinic with complaints of rashes on the skin of the face, limbs, auricles of the ears, accompanied by itching. From anamnesis: the patient lived in the Republic of Chad, Central Africa, until 2019, when he moved to Moscow and entered Moscow Institute of Technology, and lived in a dormitory. Patient hasn`t left Moscow since 2019. Comorbidity: chronic viral hepatitis B. According to the patients words relatives dont have complaints. The patient reckons he fell ill about 3 years ago when he noticed rashes on his face the first time. Later on, rashes appeared on the skin of the limbs and body. Over the last year, he has experienced swelling of the hands and the feet. Starting in March 2023, he repeatedly was consulted by dermatologists and haematologists. Among the proposed diagnoses were lichen planus, multiple eruptive xanthoma, non-Langerhans cell histiocytosis (Erdheim-Chestern's disease). Treatment with topical glucocorticosteroids has proved ineffective. Following that the patient visited V.A. Rakhmanov Department of Skin and Venereal diseases, where he was diagnosed with leprosy (multiple hemispherical elevated lepromas on the skin of the body, limbs, face and auricles of the ears, bloody nasal discharge, hypopigmented spots with loss of tactile sensitivity especially on the skin of the limbs, papular rashes on the oral mucosa) and recommended bacterioscopic examination of skin scarificates and nasal mucosa scrapings for detection of Mycobacterium leprae.

Burden of Infectious Diseases in Mobile Migrants in Gold Mining Areas in Suriname's Interior.

Mobile migrants are subject to restricted healthcare access, which may result in the spread of certain infectious diseases. The aim of this study is to evaluate the burden of a subset of priority infectious diseases in mobile migrants in remote gold mining areas in the forested interior of Suriname. This cross-sectional study enrolled mobile migrants in 13 study sites between January and June 2022. Participants underwent a structured interview, physical examination, and additional diagnostic procedures if applicable. Frequency tables were used to calculate the burden of disease. Among the 370 participants, weight loss (21%), coughing (21%), and fever (16%) were the most common symptoms. Six HIV infections, two cases of leprosy, and 15 cases of cutaneous leishmaniasis (CL) were detected. The prevalence of CL was 4.1%, of HIV (in age group 15 - 49 yrs) was 1.5%, and of leprosy was 0.5%. No cases of active pulmonary tuberculosis (pTB) were identified. Our study revealed significant numbers of the infectious diseases examined, except for pTB. This emphasizes the urge to improve healthcare access in remote and underserved populations to prevent poor outcomes if individuals remain undiagnosed and untreated and to prevent the further spread of contagious infectious diseases among the general population.

Effectiveness of ongoing single dose rifampicin post-exposure prophylaxis (SDR-PEP) implementation under routine programme conditions-An observational study in Nepal.

Leprosy control remains a challenge in Nepal. Single-dose rifampicin post-exposure prophylaxis (SDR-PEP) shows promise in reducing leprosy incidence among contacts of index cases, contributing to reducing the transmission of Mycobacterium (M.) leprae. This study evaluates the effectiveness of routine SDR-PEP implementation in Nepal in addition to contact screening, focusing on its impact on reducing leprosy risk among contacts and potential population-level effects. We conducted a retrospective cohort study to compare leprosy case notification rates and leprosy risk among close contacts. We compared two districts implementing SDR-PEP (the intervention group) and two without (the comparator group). Data from 2015 onwards included demographics, index case types, and contact relationships. Statistical analyses, including Cox regression and Kaplan-Meier survival curves, assessed the impact of SDR-PEP implementation. All four districts showed a decrease in case notification rates since 2015, with the steepest decline in the intervention districts. The risk of developing leprosy among contacts was significantly lower in the intervention districts (HR 0.28, 95% CI 0.18-0.44). SDR-PEP offered 72% protection, consistent over time, as shown in Kaplan-Meier plots. The protective effect was equally strong in blood-related contacts (HR 0.29 versus 0.27 in others, p = 0.32), and the proportion of MB cases among incident cases was not significantly different post-PEP (51.4% vs. 53.6%, p = 0.82). This study demonstrates the substantial protective effect of integrating SDR-PEP in routine leprosy control programs with contact screening, significantly lowering leprosy risk among contacts. SDR-PEP is equally effective for blood-related contacts and does not preferentially prevent PB cases. While suggesting potential population-level impact, the study design does not allow for firm conclusions at this level. Further research is needed to fully assess SDR-PEP's effectiveness in diverse contexts and optimize its implementation. Integrating SDR-PEP within well-organized contact screening programs is effective and is expected to reduce leprosy transmission when applied as a rolling intervention.

Tracing Leprosy: The paleopathological study of the individuals excavated from the Sant Llàtzer leprosarium in Barcelona, Spain (12th-18th c.)

ObjectiveOur objectives are twofold: to analyse the frequency of leprosy-related pathological lesions in the cemetery of Sant Llàtzer Hospital (12th-18th c.); and to examine how individuals affected by the disease were perceived and integrated into society during that period in Barcelona. MaterialsThe skeletal remains of 87 individuals recovered from the cemetery. MethodsAll remains were analysed macroscopically and, when required, radiographed. ResultsOf the total number of individuals (n=87), 21 (24.1 %) showed evidence indicative of leprosy. Notably, the frequency of leprosy cases was lower in the 13th-15th c. (10 %; n = 50), the only period for which multi-person graves were documented. ConclusionsThe frequency of leprosy-related lesions in Sant Llàtzer is similar to that observed in other European Christian leprosaria, although it varies across the centuries. There is no funerary evidence that leprosy sufferers were treated differently than other citizens. SignificanceThe cemetery of Sant Llàtzer, the first in Spain directly linked to a leprosarium, uniquely spans a significant period of activity. Its exceptionally preserved remains and rich records have offered unparalleled insight into the disease and its profound social implications. LimitationsLeprosy affects the bone in only a small percentage of untreated cases. Moreover, poor preservation of skeletal remains may prevent diagnosis. Suggestions for Further ResearchBiochemistry, genomics, and proteomics might provide new insights into the disease, the origin and migrations of the individuals buried in Sant Llàtzer, as well as other aspects of their daily lives.

Tackling the unseen consequences: The COVID-19 pandemic’s impact on new paediatric leprosy cases in Brazil

Tackling the unseen consequences: The COVID-19 pandemic’s impact on new paediatric leprosy cases in Brazil

Impact of the COVID-19 Pandemic on the Detection of Leprosy in Micro-Regions with a High Risk of Illness in Minas Gerais, Brazil.

Leprosy control remains challenging in Brazil and has been aggravated by the COVID-19 pandemic. To analyze the impact of the COVID-19 pandemic on the epidemiological scenario of leprosy through the detection rate of new cases, the risk of illness, and the hidden prevalence of leprosy according to high-risk micro-region in Minas Gerais, Brazil. An ecological study conducted in the health micro-regions of Minas Gerais, using data on new leprosy cases diagnosed between 2015 and 2023. The annual detection rate of new cases, the risk of illness index and the hidden prevalence of leprosy were evaluated. The time trend was evaluated by calculating the annual percentage change (APC) of the detection rate, based on segmented linear regression, considered significant when it showed p < 0.05. The state of Minas Gerais showed a significant negative annual increase between 2015 and 2020 (APC = -7.91; 95%CI -21.76--1.72), and in 2020 it showed an inflection point, with an annual increase of 9.91 in the period from 2020 to 2023. When evaluating the hidden prevalence of leprosy in Minas Gerais, we observed a reduction in the estimates' average from 2015-2019 (2.78) to 2020-2023 (2.00). The state as a whole showed an upward trend in the risk of illness, with the average index varying from 0.28 (medium risk) to 0.55 (high risk). The pandemic has had a considerable and heterogeneous impact on the detection of new cases, as well as on the risk of becoming ill and the hidden prevalence of leprosy, with repercussions for the control of the endemic in populations. There is a need to implement public health policies that prioritize the early identification of cases and ensure that vulnerable populations are monitored.

Hyperpigmented macules surrounded by hypopigmented rim in a case of lepromatous leprosy

Introduction: leprosy is a chronic infectious mycobacterial disease caused by M. leprae. It primarily involves the skin and nerves, presenting with skin lesions and nerve enlargement. The skin lesions vary from hypopigmented, anesthetic macules/plaques to erythematous papules, plaques, and nodules, depending upon the type of leprosy.Hyperpigmented lesions in leprosy are rarely reported. Although hypopigmented lesions are commonly seen, perilesional hypopigmentation is a rare occurrence in leprosy. Perilesional hypopigmentation is seen as Woronoff’s ring around resolving lesions of psoriasis. A similar phenomenon called the halo phenomenon is associated with various skin tumors. Case Presentation: we describe a rare presentation of a leprosy case presenting with hyperpigmented lesions surrounded by a perilesional hypopigmented rim.