Tecnologias em saúde da hanseníase no âmbito da Atenção Primária à Saúde: revisão de escopo / Leprosy health technologies in Primary Health Care: a scoping review / Tecnologías en salud de la lepra en el ámbito de la Atención Primaria a la Salud: revisión del alcance

Objetivo: mapear as tecnologias em saúde para manejo no cuidado à pessoa com hanseníase na Atenção Primária à Saúde. Método: revisão de escopo baseada na metodologia do JBI, em seis bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram incluídos estudos publicados em qualquer idioma, com diferentes abordagens metodológicas. Resultados: os 14 estudos incluídos na revisão mostram que a aplicabilidade de tecnologias para o manejo do cuidado a pessoa com hanseníase na Atenção Primária à Saúde, possibilitam a confirmação de diagnóstico, acompanhamento, monitoramento e prevenção de incapacidades. Conclusão: nota-se que tecnologia em saúde se apresentam como ferramentas que auxiliam no processo de cuidado na assistência a pessoas com hanseníase, a fim de permitir aos profissionais de saúde conhecimento sobre a doença, proporcionando qualidade na sua prática de saúde.

Objective: to map health technologies for managing the care of people with leprosy in Primary Health Care. Method: scoping review based on the JBI methodology in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Studies published in any language were included, with different methodological approaches. Results: the 14 studies included in the review show that the applicability of technologies for the management of care for people with leprosy in Primary Health Care makes it possible to confirm diagnosis, follow-up, monitoring, and prevention of disabilities. Conclusion: it has been noted that health technologies are tools that help in the process of caring for people with leprosy, to provide health professionals with knowledge about the disease, improving quality of health practice.

Objetivo: mapear las tecnologías en salud para el manejo en el cuidado a la persona con lepra en la Atención Primaria a la Salud. Método: revisión del alcance basada en la metodología del JBI, en seis bases de datos, siguiendo la checklist Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Se han incluido estudios publicados en cualquier idioma, con diferentes enfoques metodológicos. Resultados: los 14 estudios incluidos en la revisión muestran que la aplicabilidad de tecnologías para el manejo del cuidado a la persona con lepra en la Atención Primaria a la Salud posibilita la confirmación de diagnóstico, seguimiento, monitoreo y prevención de incapacidades. Conclusión: se percibe que las tecnologías en salud se presentan como herramientas que ayudan en el proceso de cuidado en la asistencia a personas con lepra, con fines de permitir a los profesionales de salud el acceso al conocimiento sobre la enfermedad, proporcionando calidad en su práctica de salud.

Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy.

BACKGROUND: Treatment failure (TF) in leprosy following multidrug therapy (MDT) presents a significant challenge. The current World Health Organization (WHO) fixed-duration MDT regimen, based on lesion count, might not be adequate. Leprosy lacks clear-cut objective cure criteria, and the predictive value of post-MDT histopathological findings remains uncertain. This study aims to identify predictive factors for TF among leprosy patients who have completed the WHO-recommended MDT. METHODS: An analysis was conducted on 80 individuals from a national leprosy reference center, comprising 40 TF cases (with a mean relapse at 13.0 months) and 40 controls (with a mean of 113.1 months without disease signs). Various epidemiological and clinical-laboratory parameters were assessed post-MDT. RESULTS: In skin samples, the presence of foamy granuloma (OR = 7.36; 95%CI2.20-24.60; p = 0.0012) and histological bacillary index (hBI) ≥ 1+ (OR = 1.55; 95%CI1. 22-1.99; p = 0.0004) were significantly associated with TF, with odds ratios of 7.36 and 1.55, respectively. Individuals who experienced TF had a mean hBI of 3.02+ (SD ± 2.02), while the control group exhibited a mean hBI of 1.8+ (SD ± 1.88). An hBI ≥ 3 + showed a sensitivity of 73% and a specificity of 78% for TF detection (AUC: 0.75; p = 0.0001). Other histopathological features like epithelioid granulomas, and skin changes did not show significant associations (p > 0.05). Additionally, higher anti-phenolic glycolipid-I (anti-PGL-I) ELISA index (EI) levels were linked to a 1.4-fold increased likelihood for TF (OR = 1.4; 95%CI1.13-1.74; p = 0.0019). A mean EI of 4.48 (SD ± 2.80) was observed, with an EI ≥ 3.95 showing a sensitivity of 79% and a specificity of 59% for TF detection (AUC: 0.74; p = 0.0001). Moreover, the presence of Mycobacterium leprae (M. leprae) DNA in real-time polymerase chain reaction (qPCR) was associated with a 3.43-fold higher likelihood of TF. Multivariate regression analysis indicated that concurrent presentation of neural/perineural lymphocytic infiltrate, foamy granuloma, hBI ≥ 1+, and EI ≥ 1 markedly increased the likelihood of TF by up to 95.41%. CONCLUSION: Persistence of nerve-selective lymphocytic infiltrate, foamy granulomas, and bacilli in skin biopsies, and elevated EI post-MDT, may serve as predictive factors for identifying individuals at higher probability of TF.

Transforming Lives: A Qualitative Study Seeking Insights Into Reconstructive Surgery for Leprosy Patients in Western Maharashtra.

Introduction Leprosy remains a significant health issue, especially in areas where diagnosis and treatment face numerous barriers, leading to preventable deformities and disabilities. This study aims to explore the obstacles to reconstructive surgery for leprosy patients, from both patient and healthcare provider perspectives. By conducting a qualitative analysis, the study seeks to assess the impact of reconstructive surgery on patients' quality of life, encompassing their physical, psychological, emotional, and social well-being. Methods This qualitative study was conducted from April to May 2024. One focus group discussion (FGD) for 12 participants, along with two in-depth interviews, was conducted for the patients at a leprosy rehabilitation center in western Maharashtra who have completed leprosy treatment and have undergone reconstructive surgeries for their disability. One in-depth interview was conducted with the key informant (a healthcare provider who is a surgeon who performs reconstructive surgeries for leprosy patients). Participants were selected through purposive sampling until information saturation was achieved. Interviews were conducted in local languages and analyzed using thematic analysis to identify key barriers and themes. Results A qualitative analysis of feedback from leprosy patients who underwent reconstructive surgery (RCS) highlights the importance of family support and the transformative impact of surgery on functionality and psychological well-being. Stigmatization and fear often delayed treatment-seeking behavior, but government incentives alleviated economic burdens, and participants expressed readiness to recommend RCS to others. Surgeons emphasize the variety of surgeries performed, eligibility criteria, recovery period, and success rate of 85-90%, noting the importance of financial accessibility and a multidisciplinary approach. Suggestions for improvement include infrastructure enhancement, adequate funding, and active case detection by the National Leprosy Eradication Programme (NLEP). Conclusion The findings highlight the complex interplay of factors contributing to delays in reconstructive surgery for leprosy patients in India. Addressing these barriers requires multifaceted interventions, including increasing public awareness, improving healthcare infrastructure, and enhancing support systems for patients. Policy development should focus on these areas to reduce disparities and improve the outcomes of reconstructive surgery in resource-limited settings.

Immune-Mediated Glomerulonephritis as Type 2 Lepra Reaction Posttreatment of Lepromatous Leprosy: A Case Report.

Leprosy, an infectious disease known for its debilitating effects on the skin and nerves, can trigger immunologic reactions affecting multiple organs. We present the case of a 57-year-old male who developed acute glomerulonephritis following leprosy treatment. Clinical examination revealed newly developed pitting edema in the legs, along with residual nerve thickening and skin changes. Laboratory findings showed elevated serum creatinine (3.2mg/dl) accompanied by low C3 and C4 levels. Urinalysis supported the diagnosis of glomerulonephritis. Renal biopsy demonstrated immune complex deposition on immunofluorescence, suggesting a diagnosis of leprosy-related post-treatment immune-mediated glomerulonephritis. Treatment with oral steroids led to complete resolution of the condition.

High-risk spatiotemporal patterns of leprosy in the southeastern region of Yunnan province from 2010 to 2022: an analysis at the township level.

BACKGROUND: Despite being preventable and curable, leprosy remains endemic in some undeveloped regions, including China. Wenshan Zhuang and Miao Autonomous Prefecture (Wenshan prefecture) currently bears the highest leprosy burden in China. In this ecological study, we aimed to analyze the epidemiological characteristics as well as identify and visualize the high-risk townships of Wenshan prefecture using the most updated leprosy data from 2010 to 2022. METHODS: Geographical information system combined with spatial scan statistics was used for newly detected leprosy cases abstracted from the Leprosy Management Information System in China. Global Moran's I index was used to uncover the spatial pattern of leprosy at the township level. Spatial scan statistics, encompassing purely temporal, purely spatial, spatial variation in temporal trends, and space-time analysis, were implemented for detecting the risk clusters. RESULTS: Between 2010 and 2022, Wenshan prefecture detected 532 new leprosy cases, comprising 352 (66.17%) males and 180 (33.83%) females. The aggregated time primarily occurred between October 2010 and March 2014. The distribution pattern of newly detected leprosy cases was spatially clustered. We identified four high-risk spatial clusters encompassing 54.51% of the new cases. Furthermore, spatial variation in temporal trends highlighted one cluster as a potential high-risk area. Finally, two space-time clusters were detected, and the most likely cluster was predominantly located in the central and northwest regions of Wenshan prefecture, spanning from January 2010 to September 2013. CONCLUSIONS: In this ecology study, we characterized the epidemiological features and temporal and spatial patterns of leprosy in Wenshan prefecture using the most recent leprosy data between 2010 and 2022. Our findings offer scientific insights into the epidemiological profiles and spatiotemporal dynamics of leprosy in Wenshan prefecture. Clinicians and policymakers should pay particular attention to the identified clusters for the prevention and control of leprosy.

Dr. Vasant Ramji Khanolkar: A Revolutionary Pathologist in India.

Dr. Vasant Ramji Khanolkar is known as the Father of Pathology in India. His outstanding contributions include research on the epidemiology of cancer in India, leprosy, reproduction anatomy, and family planning practices in India. He had the lion's share in medical education in India and started the subjects of Biophysics and Applied Biology at Bombay University. He recognized the importance of basic science, experimental biology, biochemistry, biophysics, and numerology in medical education. He suggested many changes in the medical education curriculum of India and strengthened the research facilities in medical education. Dr. Vasant Ramji Khanolkar was honored with Padma Bhushan, a prestigious award by the Government of India.

A reparação possível: o respeito aos direitos humanos das pessoas com hanseníase / The Possible Reparation: Respect for the Human Rights of People with Leprosy / La reparación posible: el respeto a los derechos humanos de las personas con lepra

A hanseníase é uma das enfermidades mais antigas que se tem notícia, com registros que remontam a antiguidade. Ao longo dos tempos, as pessoas com a doença foram despojadas de seus direitos humanos por meio de políticas de isolamento, exclusão e até de cunho eugênico, apartando seus filhos do convívio com pais e mães portadores. O desafio, na atualidade, é a promoção, pelas Nações que viveram a moléstia em sua história, de políticas voltadas a prevenir abusos e afronta aos direitos humanos e reparar, inclusive com indenizações, os males sofridos no apartheid histórico.

Leprosy is one of the oldest known illnesses, with records dating back to antiquity. Over time, people with the disease have been stripped of their human rights through policies of isolation, exclusion and even eugenic policies, separating their children from their mothers and fathers who are carriers. The challenge today is the promotion, by Nations that have experienced the disease in their history, of promoting policies aimed at preventing abuses and affronts to human rights and repairing, including with compensation, the evils suffered during historical apartheid.

La lepra es una de las enfermedades más antiguas conocidas, con registros que se remontan a la antigüedad. Con el tiempo, las personas con la enfermedad han sido despojadas de sus derechos humanos mediante políticas de aislamiento, exclusión e incluso políticas eugenésicas, separando a sus hijos de sus madres y padres portadores. El desafío hoy es la promoción, por parte de las Naciones que han experimentado la enfermedad en su historia, de promover políticas destinadas a prevenir abusos y afrentas a los derechos humanos y reparar, incluso mediante compensaciones, los males sufridos durante el apartheid histórico.

Dr. Indira Nath: Innovator in Leprosy Immunology and a Beacon of Scientific Excellence.

Dr. Indira Nath, an Indian immunologist, was born on January 14, 1938 and passed away on October 24, 2021. Dr. Indira Nath is considered one of the pioneers of immunology in India. Immunologists study the role of the immune system in human health and diseases. While many immunologists prefer to study cancers and autoimmune conditions, in contrast, Dr. Indira Nath chose to study the immunology of leprosy, a neglected tropical disease that had a considerable disease burden and social stigma in India. She returned to India and joined her alma mater, where she continued the rest of the journey until her formal retirement. Meanwhile, Dr. Nath also oversaw the establishment of a new department of biotechnology at the All India Institute of Medical Sciences (AIIMS), New Delhi, where she served as the founding head and further advanced her new-age research on the immunology of leprosy.

Shared challenges to the control of complex intracellular neglected pathogens.

The complex intracellular pathogens Mycobacterium tuberculosis, Mycobacterium leprae, Leishmania spp., and Burkholderia pseudomallei, which cause tuberculosis, leprosy, leishmaniasis, and melioidosis respectively, represent major health threats with a significant global burden concentrated in low- and middle-income countries. While these diseases vary in their aetiology, pathology and epidemiology, they share key similarities in the biological and sociodemographic factors influencing their incidence and impact worldwide. In particular, their occurrence in resource-limited settings has important implications for research and development, disease prevalence and associated risk factors, as well as access to diagnostics and therapeutics. In accordance with the vision of the VALIDATE (VAccine deveLopment for complex Intracellular neglecteD pAThogeEns) Network, we consider shared challenges to the effective prevention, diagnosis and treatment of these diseases as shaped by both biological and social factors, illustrating the importance of taking an interdisciplinary approach. We further highlight how a cross-pathogen perspective may provide valuable insights for understanding and addressing challenges to the control of all four pathogens.

Dr. Nitya Anand: The Visionary Behind Saheli and the Advances in Medicinal Chemistry.

Dr. Nitya Anand was a leading figure in Indian pharmaceutical research. His career spanned several decades, during which he significantly contributed to advancement in drug development and public health. His innovation of Centchroman (Saheli), the world's first non-steroidal oral contraceptive pill, changes the course of contraception use in India. He had done groundbreaking work in leprosy treatment, synthetic peptides, and antibiotics. With over 400 publications and 130 patents, he supervised over 100 PhD students. His work has been recognized with many prestigious awards, including the Padma Shri and the National Nehru Science Award, which have left a long-lasting impact on medicinal chemistry and public health.

Fever of unknown origin, blood and cerebrospinal fluid involvement: a leprosy case report.

Leprosy is a chronic infectious disease that mainly affects the skin and peripheral nerves, it can also invade deeper tissues and organs, including mucous membranes, lymph nodes, testes, eyes, and internal organs. Severe cases can result in deformities and disabilities. We encountered the case of a 39-year-old male with unexplained fever, headache and rash. The patient's lesions were taken for histopathological examination and slit skin smear analysis. Further, the patient was detected of Mycobacterium leprae (M.leprae) nucleic acid sequences in the cerebrospinal fluid (CSF) and plasma, and M.leprae gene targets in the skin lesion tissue and blood. The patient was eventually diagnosed with multibacillary leprosy and type II leprosy reaction. These results suggest the possibility of bacteremia in patients with leprosy to some extent, and observation implies the potential invasion of CSF by M.leprae or its genetic material.

Exploring the Chemical Space of Mycobacterial Oxidative Phosphorylation Inhibitors Using Molecular Modeling.

Mycobacteria are opportunistic intracellular pathogens that have plagued humans and other animals throughout history and still are today. They manipulate and hijack phagocytic cells of immune systems, enabling them to occupy this peculiar infection niche. Mycobacteria exploit a plethora of mechanisms to resist antimicrobials (e. g., waxy cell walls, efflux pumps, target modification, biofilms, etc.) thereby evolving into superbugs, such as extensively drug-resistant tuberculosis (XDR TB) bacilli and the emerging pathogenic Mycobacterium abscessus complex. This review summarizes the mechanisms of action of some of the surging antimycobacterial strategies. Exploiting the fact that mycobacteria are obligate aerobes and the differences between their oxidative phosphorylation pathways versus their human counterpart opens a promising avenue for drug discovery. The polymorphism of respiratory complexes across mycobacterial pathogens imposes challenges on the repositioning of antimycobacterial agents to battle the rise in nontuberculous mycobacterial infections. In silico strategies exploiting mycobacterial respiratory machinery data to design novel therapeutic agents are touched upon. The potential druggability of mycobacterial respiratory elements is reviewed. Future research addressing the health challenges associated with mycobacterial pathogens is discussed.

Pure neuritic leprosy: Latest advancements and diagnostic modalities: Diagnosis of Pure Neuritic Leprosy.

Pure neuritic leprosy (PNL) is characterized by exclusive peripheral neuropathy without dermatological alterations. Diagnosis is difficult since skin lesions and acid-fast bacilli (AFB) in slit smears are absent. Presently, the gold standard for diagnosis is the histopathological examination of peripheral nerve biopsy. Even then, the detection of bacteria is difficult, and histological findings may be non-specific. Nerve biopsy is an invasive procedure that is possible only in specialized centers and limited to certain sensory nerves. Therefore, the establishment of serological, immunological, and molecular laboratory tests could be more beneficial for diagnosing pure neuritic leprosy to achieve effective treatment and reduction in its consequent disabilities. This review suggests that the presence of Mycobacterium leprae (M.leprae) in PNL cases can be proven by using non-invasive procedures, viz., multiplex polymerase chain reaction (M-PCR), serological findings, immunological profiling, and improved nerve-imaging. Findings also indicate the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic PNL.

An update on leprosy immunopathogenesis: systematic review.

Introduction: Leprosy is a chronic infectious condition and the main cause of neuropathy that occurs brought on by M. leprae. It is known that the biological characteristics of the human host, such as the immunological ones, have a higher influence on the pathology of this disease than the intrinsic mechanisms of the bacterium. The objective of this work was to review the scientific knowledge about the relationship between immunopathology and the severity of leprosy. Methods: A systematic review following the PRISMA 2020 recommendations was conducted in the PUBMED, LILACS, SciELO and Science Direct databases using articles in English, Portuguese or Spanish between January 2011 and May 2022 with the descriptors "Leprosy/Immunology", "Cytokines" and "Mycobacterium leprae". A methodological quality assessment was carried out using the JBI checklists. Results: A total of 49 articles were included. There is a relationship of greater severity of infection associated with lower release of MHC molecules in response to PGL-1 that inhibit the promotion of resolving T lymphocytes arising from dendritic cells (DCs) stimulation. In addition, the differentiation of macrophage phenotypes dependent on the activation of PRRs can define activation and the distinct type of T helper (Th) cells involved according to severity. Activated CD8+ T cells also have distinct types at the appropriate poles of the disease, and B cells show at the most severe pole of the LL, specific induction of IgA and more Treg-type CD8+ T cells that further contribute to T cell anergy. Conclusion: Therefore, the adaptive immune system aggravates nerve damage and defines the type of leprosy, while the innate immune system is considerably more significant in the onset of nerve damage, symptomatic of the initial presentation of illness and in several critical immune responses, including inflammation and elimination of dead M. leprae.

Malignant transformation of a long-term ulcer in a patient with leprosy sequelae: a case report.

Marjolin's ulcer (MU) is a rare condition defined as a malignant skin tumor arising from chronic wounds and inflammation. The most common histological findings in MUs are squamous cell carcinomas (SCC) (or spinocellular carcinomas [SPC]), such as basal cell carcinomas (BCC) and malignant melanomas (MM). The aim of this study is to report the case of a patient with sequelae of leprosy who presented malignant transformation in a long-standing ulcer on the right leg, thereby contributing to understanding of the progression and significance of early diagnosis of MU. The MU was diagnosed by incisional biopsy of the lesion and upon obtaining a positive result the patient was referred to an oncology service. Treatment of MU is multidisciplinary and surgical excision is the first therapeutic option. Proper management and surveillance of chronic ulcers by the healthcare team are necessary for early recognition of MU.

Leprosy in Brazil: an analysis of the Global Burden of Disease estimates between 1990 and 2019.

OBJECTIVE: To analyze the occurrence of leprosy in Brazil and its states between 1990 and 2019, according to Global Burden of Disease (GBD) estimates, and its correlation with development status. STUDY DESIGN: A descriptive and analytical ecological epidemiological study. METHODS: Rates of incidence, prevalence, and years lived with disability (YLD) due to leprosy, standardized by age, per 100,000 inhabitants, were analyzed. The trend analysis consisted of the joinpoint regression model and the average annual percentage change. The correlation between the incidence rate and the sociodemographic index (SDI) was investigated (Spearman test) at a 5% significance level. Incidence, prevalence and YLD rates were presented by country's states, sex, and age. RESULTS: There was an average percentage decrease of -1.1% per year (P < 0.001) in the incidence rate in the country and, between 1990 and 2019, a decline from 4.8 to 3.5 per 100,000 inhabitants; prevalence from 26.1 to 22.2, and YLD from 1.1 to 1.0. The incidence rate was higher among men and the elderly. Maranhão (7.0 in 1990; 4.2 in 2019), Alagoas (6.6 in 1990; 4.1 in 2019), Acre (6.1 in 1990; 4.0 in 2019), Mato Grosso (5.2 in 1990 and 3.7 in 2019), and Mato Grosso do Sul (4.8 in 1990 and 3.7 in 2019) presented the highest incidence rates. A negative correlation was observed between SDI levels and leprosy incidence rates in 1990 (R = -0.71; P < 0.0001) and 2019 (R = -0.81; P < 0.0001). CONCLUSIONS: Despite the decrease in the rates of leprosy incidence, prevalence, and YLDs over the analyzed period, Brazil has a long way towards achieving its eradication. The greater burden of the disease in males stands out. The estimated risk of the disease was higher in the states with the lowest SDI levels. Therefore, interventions must consider the heterogeneity of the disease burden geographically and between sociodemographic groups.

Implications of drug resistance in leprosy: disease course, reactions and the use of novel drugs.

Leprosy remains a significant neglected tropical disease despite the goal of elimination having been achieved in various endemic nations over the past two decades. Reactional episodes complicate the disease course, resulting in deformities and disability. The main aim of treatment is to kill Mycobacterium leprae and decrease the bacterial load, which could help prevent further bacilli transmission. A major concern in breaking the chain of transmission and possibly for recurrent reactions is the role of drug-resistant bacilli. Though some data is available on the background prevalence of drug resistance in leprosy, there is a paucity of studies that look for resistance specifically in leprosy reactions. Administration of long-term steroids or immunosuppressants for chronic and recurrent responses in the presence of drug resistance has the twin effect of perpetuating the multiplication of resistant bacilli and encouraging the dissemination of leprosy. The increasing trend of prescribing second-line drugs for leprosy or type 2 reactions without prior assessment of drug resistance can potentially precipitate a severe public health problem as this can promote the development of resistance to second-line drugs as well. A comprehensive multicenter study, including drug resistance surveillance testing in cases of reactions, is necessary, along with the current measures to stop the spread of leprosy. Here, we have detailed the history of drug resistance in leprosy, given pointers on when to suspect drug resistance, described the role of resistance in reactions, methods of resistance testing, and the management of resistant cases with second-line therapy.

Exploring the therapeutic and prophylactic potential of bedaquiline in leprosy.

Leprosy remains a significant public health concern despite major strides in treatment and control efforts. The Global Leprosy Strategy 2021-2030 and the National Strategic Plan for Leprosy 2023-2027 majorly focus on facilitating action to reach the goal of zero leprosy. Exploration of new treatment regimens is emphasized as one of the verticals of the multipronged approach for reaching the aforementioned goals. This becomes particularly pertinent in the wake of growing evidence for resistance to the drugs currently being used in the management of leprosy. Repurposed molecules present a very good approach in this direction. The present review aims to explore the potential of bedaquiline, a drug used for multidrug-resistant tuberculosis, as a potential addition to the therapeutic armamentarium of leprosy. Through this narrative review, the authors attempt to look into the available proof of concept, clinical evidence, potential risks, and possible ways forward with bedaquiline in leprosy.

A Case of Multibacillary Borderline Lepromatous Leprosy in the United States Treated With Alternative Therapy.

Hansen's disease (leprosy) is a rare infectious disease with less than 300 recorded cases in the United States every year. In this report, we present an 80-year-old White male with a three-year history of slowly progressive, pink, well-demarcated, and annular patches, plaques, and papules that started on his thighs and spread to his abdomen, chest, back, and upper extremities. After sequence identification on biopsies confirmed the diagnosis of leprosy, the patient was treated with an alternative regimen of monthly moxifloxacin, rifabutin, and minocycline. After a month of treatment, the patient reported a reduction in his rash. This report highlights a case of multibacillary leprosy in the southeastern United States. It is a very interesting study as the selection of this patient's treatment was complex, and he ultimately received an alternative therapeutic regimen. This case also highlights the rising incidence of leprosy in this region of the United States and stresses the importance of monitoring for warning signs indicative of this diagnosis to facilitate early treatment and attenuation of this disease.