Primary and secondary drug resistance in leprosy a community based study

Abstract

Leprosy is a chronic infectious disease caused by M. leprae, a slow-growing intracellular mycobacterium with tropism for Schwann cell in nerves and macrophages in the skin. In some patients, the disease is challenging to diagnose since there is no gold-standard method to differentiate between infection and disease. Leprosy is also a neglected disease, being endemic in developing countries, where detection rates show a trend toward slight decrease in number of leprosy cases, in spite of good treatment and the efforts of the World Health Organization (WHO) to improve the quality of leprosy control programs (Talhari et al., 2012). It is accepted that transmission occurs from human to human through the upper airways, although intermediate hosts like armadillos may play a role in certain places, for example in United States (Truman et al., 2011). A general notion is that untreated multibacillary (MB) patients are the most important source of transmission, which occurs when bacilli are spread, usually by airborne droplets from nasal and/or mouth. Hence, leprosy patients, especially those with high bacterial load, release billions of bacilli that can potentially contaminate their close relatives or household contacts. As a result, the contacts of leprosy patients are known to have increased the detection rate of less severe clinical presentations with lower bacteriological indices (Hacker et al., 2012, Ezenduka et al., 2012). Discontinuation of treatments and monotherapy play a major role in production of drug resistant strain of M. leprae. newline