Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Nat Rev Dis Primers. 2024 Nov 28;10(1):90. doi: 10.1038/s41572-024-00575-1.
Leprosy, a neglected tropical disease, causes significant morbidity in marginalized communities. Before the COVID-19 pandemic, annual new case detection plateaued for over a decade at ~200,000 new cases. The clinical phenotypes of leprosy strongly parallel host immunity to its causative agents Mycobacterium leprae and Mycobacterium lepromatosis. The resulting spectrum spans from paucibacillary leprosy, characterized by vigorous pro-inflammatory immunity with few bacteria, to multibacillary leprosy, harbouring large numbers of bacteria with high levels of seemingly non-protective, anti-M. leprae antibodies. Leprosy diagnosis remains clinical, leaving asymptomatic individuals with infection undetected. Antimicrobial treatment is effective with recommended multidrug therapy for 6 months for paucibacillary leprosy and 12 months for multibacillary leprosy. The incubation period ranges from 2 to 6 years, although longer periods have been described. Given this lengthy incubation period and dwindling clinical expertise, there is an urgent need to create innovative, low-complexity diagnostic tools for detection of M. leprae infection. Such advancements are vital for enabling swift therapeutic and preventive interventions, ultimately transforming patient outcomes. National health-care programmes should prioritize early case detection and consider post-exposure prophylaxis for individuals in close contact with affected persons. These measures will help interrupt transmission, prevent disease progression, and mitigate the risk of nerve damage and disabilities to achieve the WHO goal 'Towards Zero Leprosy' and reduce the burden of leprosy.
麻风病是一种被忽视的热带病，在边缘化社区造成了严重的发病率。在 COVID-19 大流行之前，每年新病例的发现量在过去十年中一直稳定在 20 万例左右。麻风病的临床表型与宿主对其病原体麻风分枝杆菌和麻风分枝杆菌的免疫反应强烈平行。由此产生的谱系从少菌型麻风病跨越到多菌型麻风病，前者表现为强烈的促炎免疫反应，细菌数量较少，后者则存在大量细菌，且高水平的看似非保护性抗麻风分枝杆菌抗体。麻风病的诊断仍然依赖于临床，使得无症状感染者未被发现。抗菌治疗是有效的，推荐使用多药物治疗，少菌型麻风病治疗 6 个月，多菌型麻风病治疗 12 个月。潜伏期从 2 年到 6 年不等，尽管也有更长的潜伏期。鉴于潜伏期较长且临床专业知识不断减少，迫切需要开发创新、低复杂度的诊断工具来检测麻风分枝杆菌感染。这些进展对于实现迅速的治疗和预防干预至关重要，最终将改变患者的结局。国家卫生保健计划应优先考虑早期病例发现，并考虑对与感染者密切接触的个体进行接触后预防。这些措施将有助于阻断传播、防止疾病进展，并降低神经损伤和残疾的风险，以实现世卫组织的“零麻风病”目标，并减轻麻风病的负担。
