Association between serum level of vitamin D (25-hydroxyvitamin D) and plasma level of vitamin D receptor with bacteriological index in leprosy patients.

Macrophages respond against Mycobacterium leprae infection through interacting with vitamin D and vitamin D receptor (VDR). There has been no study analyzing the association between vitamin D and VDR with bacteriological index (BI) in leprosy patients in Indonesia. To analyze the serum level of 25- hydroxyvitamin D (25(OH)D) and plasma level of VDR as well as their association with BI in leprosy patients in Indonesia. This is a cross-sectional study. Serum level of 25(OH)D was assessed with in vitro chemiluminescent immunoassay. Plasma level of VDR was assessed with enzyme linked immunosorbent assay method. Median serum level of 25(OH)D was 12.68 ng/mL. There was no correlation between serum level of 25(OH)D and BI (r=0.033; p=0.869). Median plasma level of VDR was 1.36 ng/mL. There was no correlation between plasma level of VDR and BI (r=- 0.063; p=0.749) and no significant association between BI and serum level of 25(OH) and plasma level of VDR (R2=0.055). There was no association between serum level of 25(OH)D and plasma level of VDR with BI in leprosy patients.

Correlation of Histomorphological Findings with Bacteriological Index in Leprosy Patients.

BACKGROUND & OBJECTIVE: Leprosy is characterized by various clinicopathological forms depending on the host's body. Therefore, the correlation of histopathological findings with bacteriological index is helpful in diagnosing, classification, and monitoring the treatment. We aimed to analyze the histomorphological findings correlation with the bacteriological index in different types of leprosy. Then, study the histopathological spectrum of leprosy. METHODS: We carried out a histomorphological study of skin biopsies obtained from 100 new patients tested clinically in OPD (Out Patients Department) on the basis and calculation of bacteriological index on a slit-skin smear. The histomorphological findings correlation with the bacteriological index was to be found in different types of leprosy. RESULTS: In the histopathological studies, 52% of the patients were diagnosed with borderline tuberculoid (BT) followed by 20% with borderline lepromatous (BL), 13% with lepromatous leprosy (LL), 8% with tuberculoid (TT), 4% with histoid Hansen's disease, and 3% with mid-borderline (BB). On the clinical and histopathological examinations, correlation was found for 80% of the cases. Considering the correlation of histopathological features with the bacteriological index, 63% of the cases showed good correlation which was comparable with that of other studies. CONCLUSION: Because of the underlying symptoms of leprosy, there is a difference between different types of leprosy and the clinical and environmental perceptions. Thus, the correlation of clinical, histopathological, and bacteriological indices could be more helpful in the diagnosis of leprosy rather than considering only one parameter.

Molecular surveillance of antimicrobial resistance and transmission pattern of Mycobacterium leprae in Chinese leprosy patients.

Reports on antimicrobial resistance (AMR) of Mycobacterium leprae, relationship with bacteriological index (BI), and transmission in China are limited. We investigated the emergence of AMR mutations, the relationship between BI and AMR in complete, moderate and lack of BI decline cases, and molecular epidemiological features of AMR cases by enrolling 290 leprosy cases from four endemic provinces. Seven (2.41%), one (0.34%), five (1.72%), one (0.34%), and one (0.34%) strains had single mutations in folP1, rpoC, gyrA, gyrB, and 23S rRNA, respectively. Double mutations in folP1 and gyrA, rpoB and gyrA, and gyrA and 23S rRNA were observed in one (0.34%) strain each. Mutated strains occurred in three out of 81 (95% CI-0.005-0.079, p = 0.083) cases with complete BI decline, in seven out of 103 (95% CI 0.018-0.117, p = 0.008) cases with moderate BI decline, and in four out of 34 (95% CI 0.003-0.231, p = 0.044) cases with lack of BI decline. Most of these mutated strains were geographically separated and diverged genotypically. AMR mutations may not be the main cause of the lack of BI decline. The low transmission of AMR strains at the county level indicates an ongoing transmission at close contact levels.

A Study of Selenium in Leprosy.

INTRODUCTION: Leprosy is a chronic infection caused by Mycobacterium leprae. Selenium, on the other hand, is a substance, which is needed for its protective role against microorganism infection. AIM: This study aims to know the association between selenium serum levels with bacteriological index. METHODS: This is an analytical cross-sectional study model. Sampling was done with consecutive sampling method in Pirngadi General Hospital, Lau Simomo Leprosy Hospital and H. Adam Malik General Hospital. Samples were taken from patients' venous blood serum then selenium levels were measured. RESULTS: This study found 30 leprosy patients consisted of 19 patients with paucibacillary (PB) leprosy and 11 patients with multibacillary (MB) leprosy. Selenium serum levels of patients with PB leprosy (mean = 97.16 µg/dL) were found to be significantly higher than MB leprosy (mean = 77.27 µg/dL) with p = 0.008 using t-test. The negative correlation between selenium serum levels with bacterial index in patients with leprosy was also found in this study using Spearman's rho test (r = - 0.499, p = 0.005). CONCLUSIONS: Selenium serum levels of patients with PB leprosy are higher than patients with MB leprosy, and high bacteriological index in patients with leprosy were correlated with low selenium serum levels.

Genomic diversity in Mycobacterium leprae isolates from leprosy cases in South India.

OBJECTIVE: The Objective of this study was to identify the strain diversity of Mycobacterium leprae in terms of SNP types and subtypes stratified as per genomic single nucleotide polymorphisms, in clinical isolates of leprosy patients from a tertiary care leprosy center in South India. Further, the associations of SNP types with clinical outcomes in leprosy were also investigated. METHODS: DNA was extracted from excisional skin biopsies of a total of 172 newly diagnosed untreated leprosy patients from a clinic in Tamil Nadu, in south India, that also serves patients from neighboring states. All the leprosy patients were those who voluntarily reported at the clinic during the study period of one year i.e., 2015. Clinical and histopathological details were collected at diagnosis and leprosy was confirmed through bacteriological smear examination and PCR for M. leprae specific RLEP region. SNP types and subtypes were determined by PCR amplification and Sanger sequencing of PCR products. RESULTS: M. leprae specific RLEP gene amplification was achieved in 160 out of 172 patients. Among 160 specimens 118(73.75%) were type 1 and 42 (26.25%) were type 2 and on subtyping it was noted that 88/160 (55.00%) were 1D, 25/160 (15.62%) 1C, 5/160 (3.12%) 1A, 33/160 (20.62%) 2G and 9/160 (5.62%) were 2H. CONCLUSION: Our results indicated that subtype 1D is predominant in the south Indian population. We also noted 2G, 1C and 1A in the patient sample tested. Additionally we identified subtype 2H for the first time in India.

Mycobacterium leprae specific genomic target in the promoter region of probable 4-alpha-glucanotransferase (ML1545) gene with potential sensitivity for polymerase chain reaction based diagnosis of leprosy.

With the absence of an effective diagnostic tool for leprosy, cases with negative bacteriological index and limited clinical manifestations often pose diagnostic challenges. In this study, we investigated the utility of a novel Mycobacterium leprae specific 112-bp DNA sequence in the promoter region of probable 4-alpha-glucanotransferase (pseudogene, ML1545) for polymerase chain reaction (PCR) based diagnosis of leprosy in comparison to that of the RLEP gene. DNA was extracted from slit skin scrapings of 180 newly diagnosed untreated leprosy cases that were classified as per Ridley Jopling classifications and bacteriological index (BI). Primers were designed using Primer Blast 3.0 and PCR was performed with annealing temperatures of 61°C for ML1545 and 58°C for the RLEP gene using conventional gradient PCR. The results indicated a significant increase in PCR positivity of ML1545 when compared to RLEP across the study groups (164/180 [91.11%] were positive for ML1545 whereas 114/180 (63.33%) were positive for RLEP [p<.0001, z=6.3]). Among 58 leprosy cases with negative BI, 28 (48.28%) were positive for RLEP and 48 (82.76%) were positive for ML1545 (p=.0001, z=3.8). Of the 42 borderline tuberculoid leprosy cases, 23 (54.76%) were positive for RLEP whereas 37 (88.09%) were positive for ML1545 (p<.0001, z=3.9). Increase in PCR positivity for ML1545 was also noted in lepromatous leprosy and BI-positive groups. ML1545 can be a potential gene target for PCR-based diagnosis of leprosy especially in cases where clinical manifestations were minimal.