Reibel F, Cambau E, Aubry A
Sorbonne universités, UPMC Univ Paris 06, CR7, Centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Inserm, U1135, centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Bactériologie-hygiène, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Centre national de référence des mycobactéries et de la résistance des mycobactéries aux antituberculeux, bactériologie-hygiène, 75013 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Inserm, UMR 1137 IAME, 75018 Paris, France; Service de bactériologie, hôpital Lariboisière, AP-HP, 75010 Paris, France.
Med Mal Infect. 2015 Sep;45(9):383-93. doi: 10.1016/j.medmal.2015.09.002. Epub 2015 Oct 1.
Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate <1 patient per 10,000 population, was achieved in the year 2000, but more than 200,000 new case patients are still reported each year, particularly in India, Brazil, and Indonesia. Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary.
麻风病是一种已有2000多年报告历史的传染病。世界卫生组织（WHO）设定的麻风病消除目标，即全球患病率<每10000人口1例患者，已于2000年实现，但每年仍报告有超过20万新病例患者，特别是在印度、巴西和印度尼西亚。麻风病是一种特殊感染：（i）它是一种主要影响皮肤和周围神经的慢性感染；（ii）麻风分枝杆菌是医学上最后一批无法在体外培养的细菌物种之一（主要是由于其基因组的简化进化）；（iii）传播和病理生理数据仍然有限。该疾病的各种表现（里德利-乔普林分类法和WHO分类法）与患者的免疫反应、细菌载量以及诊断前的延迟有关。自1982年以来，多药联合疗法（氨苯砜、利福平，可加或不加氯法齐明）一直被推荐为麻风病的标准治疗方法；少菌型麻风病患者治疗6个月，多菌型麻风病患者治疗12个月。麻风病药物在全球的使用始于20世纪80年代，自1995年以来免费提供这些药物促使新病例患者数量大幅下降。然而，尽管使用了多药联合疗法，耐药菌株仍在出现；识别和监测耐药性仍然很有必要。
