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Leprosy Associated with Atypical Cutaneous Leishmaniasis in Nicaragua and Honduras.

Abstract

In Central America, few cases of leprosy have been reported, but the disease may be unrecognized. Diagnosis is based on clinical criteria and histology. Preliminary field work in Nicaragua and Honduras found patients, including many children, with skin lesions clinically suggestive of atypical cutaneous leishmaniasis or indeterminate leprosy. Histology could not distinguish these diseases although acid-fast organisms were visible in a few biopsies. Lesions healed after standard antimicrobial therapy for leprosy. In the present study, patients, family members, and other community members were skin-tested and provided nasal swabs and blood samples. Biopsies were taken from a subgroup of patients with clinical signs of infection. Two laboratories analyzed samples, using local in-house techniques. Mycobacterium leprae, Leishmania spp. and Leishmania infantum were detected using polymerase chain reactions. Mycobacterium leprae DNA was detected in blood samples and nasal swabs, including some cases where leprosy was not clinically suspected. Leishmania spp. were also detected in blood and nasal swabs. Most biopsies contained Leishmania DNA and coinfection of Leishmania spp. with M. leprae occurred in 33% of cases. Mycobacterium leprae DNA was also detected and sequenced from Nicaraguan and Honduran environmental samples. In conclusion, leprosy and leishmaniasis are present in both regions, and leprosy appears to be widespread. The nature of any relationship between these two pathogens and the epidemiology of these infections need to be elucidated.

More information

Type
Journal Article
Author
Soto LA
Caballero N
Fuentes LR
Muñoz PT
Gómez Echevarría JR
López MP
Bornay Llinares FJ
Stanford JL
Stanford CA
Donoghue HD
Year of Publication
2017
Journal
The American journal of tropical medicine and hygiene
Volume
97
Issue
4
Number of Pages
1103-1110
Language
eng
ISSN Number
1476-1645
DOI
10.4269/ajtmh.16-0622
Alternate Journal
Am. J. Trop. Med. Hyg.
Publication Language
eng