Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, U1135, AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, 75013 Paris, France.
Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil.
Infect Dis Now. 2022 Aug;52(5):243-251. doi: 10.1016/j.idnow.2022.04.001. Epub 2022 Apr 26.
Leprosy is one of the oldest infectious diseases, reported for more than 2000years. Leprosy elimination goal as a public health problem set by the World Health Organization, aiming for a global prevalence rate<1 patient in a population of 10,000, was achieved in 2000 mainly thanks to the worldwide use of leprosy drugs starting in the 1980s and their access at no cost for patients since 1995. However, around 200,000 new cases are still reported each year, particularly in India, Brazil, and Indonesia. As with other bacteria of medical interest, antimicrobial resistance is observed in Mycobacterium leprae strains in several parts of the world, despite multidrug therapy being the recommended standard leprosy treatment to avoid resistance selection since 1982. Therefore, identifying and monitoring resistance is necessary. We provide an overview of the historical facts that led to the current drug resistance situation, the antibiotics effective against M. leprae, their mechanisms of action and resistance, and resistance detection methods. We also discuss therapeutic management of the resistant cases, new genes with potential roles in drug resistance and bacterial adaptation, new drugs under investigation, and the risk for resistance selection with the chemoprophylaxis measures.
麻风病是最古老的传染病之一，有超过 2000 年的报告历史。世界卫生组织设定了消除麻风病作为公共卫生问题的目标，即全球患病率<每 10000 人中 1 例，这一目标于 2000 年实现，主要归功于 20 世纪 80 年代开始在全球范围内使用麻风病药物，以及自 1995 年以来患者可免费获得这些药物。然而，每年仍报告约 20 万例新病例，特别是在印度、巴西和印度尼西亚。与其他具有医学意义的细菌一样，尽管自 1982 年以来，多药治疗被推荐为避免耐药性选择的标准麻风病治疗方法，但在世界上的一些地区，麻风分枝杆菌菌株仍观察到了抗药性。因此，有必要识别和监测耐药性。我们概述了导致当前耐药情况的历史事实，以及有效对抗 M.leprae 的抗生素、它们的作用机制和耐药性、耐药性检测方法。我们还讨论了耐药病例的治疗管理、具有耐药性和细菌适应潜在作用的新基因、正在研究中的新药，以及化学预防措施导致耐药性选择的风险。
