03092nas a2200301   4500000000100000008004100001260003700042653002400079653005700103653001700160653002700177653002400204653002700228653001200255100001500267700001200282700001400294700001400308700001600322700001700338700002100355245007900376856009900455300000900554490000700563520220600570022001402776       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aCo-infection10aBacterial co-infection10afungal co-infection10aparasitic co-infection10aLeprosy1 aFróes LAR1 aToma TS1 aJachiet M1 aRousset L1 aPoderoso RE1 aTrindade MAB1 aFranco-Paredes C00aBacterial, fungal and parasitic co-infections in leprosy: A scoping review  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011334&type=printable  a1-180 v173 a<p><strong>Background:</strong> In leprosy patients, the most commonly reported non-viral co-infections are Tuberculosis, Leishmaniasis, Chromoblastomycosis and Helminths. The presence of a secondary infection is believed to increase the likelihood of leprosy reactions. The purpose of this review was to describe the clinical and epidemiological characteristics of the most reported bacterial, fungal, and parasitic co-infections in leprosy.</p>

<p><strong>Methodology/Principal findings:</strong> Following the PRISMA Extension for Scoping Reviews guidelines, a systematic literature search was conducted by two independent reviewers, resulting in the inclusion of 89 studies. For tuberculosis, a total of 211 cases were identified, with a median age of 36 years and male predominance (82%). Leprosy was the initial infection in 89% of cases, 82% of individuals had multibacillary disease, and 17% developed leprosy reactions. For leishmaniasis, 464 cases were identified, with a median age of 44 years and male predominance (83%). Leprosy was the initial infection in 44% of cases, 76% of individuals presented with multibacillary disease, and 18% developed leprosy reactions. Regarding chromoblastomycosis, we identified 19 cases with a median age of 54 years and male predominance (88%). Leprosy was the primary infection in 66% of cases, 70% of individuals had multibacillary disease, and 35% developed leprosy reactions. Additionally, we found 151 cases of co-infection with leprosy and helminths, with a median age of 43 years and male predominance (68%). Leprosy was the primary infection in 66% of cases, and 76% of individuals presented with multibacillary disease, while the occurrence of leprosy reactions varied from 37% to 81% across studies.</p>

<p><strong>Conclusion:</strong> We observed a male-dominated pattern of co-infections among working-age individuals with multibacillary leprosy. Unlike prior studies reporting increased leprosy reactions in chronic viral co-infections, our findings did not indicate any increase among bacterial, fungal, or parasitic co-infections. Rather, co-infections with tuberculosis and leishmaniasis appeared to reduce leprosy reactions.</p>
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