Identification and comparison of Mycobacterium leprae genotypes in two geographical regions of Colombia.

OBJECTIVE: To evaluate and establish genomic strain typing markers suitable for the identification of transmission patterns of leprosy in different regions of Colombia. DESIGN: Patients from Agua de Dios, Barranquilla and Cartagena cities and neighbouring towns were enrolled during 2006-2007. Slit skin smears or biopsies were obtained from newly detected untreated patients, and those undergoing multidrug therapy. DNA was extracted from the clinical samples and tested using 15 different short tandem repeat and three SNP polymorphic markers. RESULTS AND CONCLUSION: Differences or similarities between strain types from the northeast (n = 20) and central regions of Colombia (n = 18) were noted. The alleles at two loci, 27-5 and 12-5 were different in the M. leprae in the two regions. The other microsatellite loci may be useful for further intra-population differentiation. There was strong association of 27-5 and 12-5 alleles with the SNP types. The 4-5 combination of alleles was associated with SNP type 3, while the 5-4 combination was mostly associated with SNP type 1, 2 or 4. The SNP type 4 m. leprae isolates were seen in patients in the northeast, but not in the central part.

La Lepra en agua de Dios 1999-2003 / Leprosy in Agua de Dios, 1999-2003

Agua de Dios es un municipio de 13.500 habitantes, situado a dos horas de Bogotá por carro, que nació en 1870 como lugar de recusión obligatoria para los enfermos de lepra, disposición abolida en 1961. En el municipio residen personal del Programa de Lepra del Sanatorio. Analizamos la incidencia y las recidivas de la lepra en el municipio, estudiamos los convivientes de los caso nuevos y comentamos la manera de lograr una mejor adherencia a la poliquimioterapia antileprosa (1999-2003). Mediante la revisión de las historia clínicas, de los registros estadísticos del Sanatorio, los exámenes clínicos de los pacientes, la baciloscopia, la biopsia de piel y la entrevista personal o de grupo para discutir las inquietudes de los enfermos, se demostraron 34 casos nuevos de lepra, 68% multibacilares, para una incidencia entre 1,46 y 6,8 por 10.000 habitantes; se detectaron 38 recidivas en pacientes con lepra lepromatosa, tratados por varios años con monoterapia con DDS o con poliquimioterapia irregular; cuatro pacientes presentaron recidiva luego de recibir terapia con supervisión estricta. La prevalencia varió entre 23 y 39 enfermos por 10.000 habitantes, la más alta del país. Cuando se examinó el 96% de los convivientes, se encontraron dos casos nuevos de lepra. El diálogo con los enfermos mejoró la adhesión a la terapia que es ahora del 97%. La lepra en Agua de Dios requiere personal competente en temas clínicos epidemiológicos, de biología molecular (resistencia a las drogas, recidivas) y psicosociales: comunicación del personal de salud con el paciente

Agua de Dios is a Town with 13,500 inhabitants, located two hours away by car from Bogotá. It was founded in 1870 as a place to lock away leprosy patients, a law abolished in 1961. About 1,100 patients, most of them with sequelae due to leprosy, and their families, inhabit the town; they receive medical attention from sanitary personnel of the local Leprosy Sanatorium. We analyzed the occurrence of new leprosy cases (1999-2003), study their household contacts, and the relapses among the 1,100 patients, and comment on the way to achieve a better compliance to the antileprosy multidrug therapy (MDT). Through clinical record revision and the Statistical Archives of the Sanatorium, patient physical exams, baciloscopy, skin biopsies and personnel or groups interviews to discuss patient´s doubts or complaints, we demonstrate 34 new leprosy cases in the period of study, 68% of which were multibacillary (incidence between, 1.46 and 6.8 per 10,000); 38 relapses have been detected in lepromatous patients, treated by years with monotherapy with DDS and with irregular and usually non-supervised MDT. However, four MB patients had relapses after strictly supervised MDT. Prevalence varied between 23 and 29 per 10,000 the highest in our country. When 96% of contacts were examined, two new cases of leprosy were found. Dialogue with the patients considerably improved MDT adherence, which reached the present status of 97% Leprosy in Agua de Dios requires the presence of expert personnel in clinical, epidemiological, molecular biology (resistance of Mycobacterium leprae to drugs, relapses), and psychosocial aspects: proper communication of health personnel with patients