BackgroundPoverty has long been considered a risk factor for leprosy and is related to nutritional deficiencies. In this study, we aim to investigate the association between poverty-related diet and nutrition with leprosy.Methodology/Principal findingsIn rural leprosy-endemic areas in Indonesia, we conducted a household-based case-control study using two controls for each case patient (100 recently diagnosed leprosy patients and 200 controls), matched for age and gender. All participants were interviewed to collect information on their demographics, socioeconomic situation, health, and diet. Body mass index, dietary diversity score, as well as anemia and iron micronutrient profiles were also obtained. By means of univariate, block-wise multivariate, and integrated logistic regression analyses, we calculated odds ratios between the variables and the occurrence of leprosy. Unstable income (odds ratio [OR], 5.67; 95% confidence interval [CI], 2.54–12.64; p = 0.000), anemia (OR, 4.01; 95% CI, 2.10–7.64; p = 0.000), and higher household food insecurity (OR, 1.13; 95% CI, 1.06–1.21; p = 0.000) are significantly associated with an increased risk of having leprosy. Meanwhile, higher education (OR, 0.34; 95% CI, 0.15–0.77; p = 0.009) and land ownership (OR, 0.39; 95% CI, 0.18–0.86; p = 0.019) have significant protective associations against leprosy. Although lower dietary diversity, lack of food stock, food shortage, low serum iron, and high ferritin were found more commonly in those with leprosy, the occurrence of leprosy was not significantly associated with iron deficiency (OR, 1.06; 95% CI, 0.10–11.37; p = 0.963).Conclusions/SignificanceFood poverty is an important risk factor for leprosy susceptibility, yet the mechanisms underlying this association other than nutrient deficiencies still need to be identified. With a stable incidence rate of leprosy despite the implementation of chemoprophylaxis and multidrug therapy, improving dietary diversity through food-based approaches should be initiated and directed toward high-prevalence villages. The possible underlying factors that link poverty to leprosy other than nutrient deficiencies also need to be identified.

BackgroundThe clinical spectrum of leprosy is dependent on the host immune response against Mycobacterium leprae or the newly discovered Mycobacterium lepromatosis antigen. Helminth infections have been shown to affect the development of several diseases through immune regulation and thus may play a role in the clinical manifestations of leprosy and leprosy reactions. The purpose of this study is to determine the proportion of helminth infections in leprosy and its association with the type of leprosy and type 2 leprosy reaction (T2R).MethodsHistory or episode of T2R was obtained and direct smear, formalin-ether sedimentation technique, and Kato-Katz smear were performed on 20 paucibacillary (PB) and 61 multibacillary (MB) leprosy participants.ResultsThere are more helminth-positive participants in MB leprosy compared to PB (11/61 versus 0/20, p = 0.034) and in T2R participants compared to non-T2R (8/31 versus 3/50, p = 0.018).ConclusionsOur results suggest that soil-transmitted helminth infections may have a role in the progression to a more severe type of leprosy, as well as the occurrence of T2R. These findings could serve as a fundamental base for clinicians to perform parasitological feces examination in patients who have MB leprosy and severe recurrent reactions to rule out the possibility of helminth infection. Further secondary confirmation of findings are needed to support these conclusions.

Background Leprosy is a chronic infectious disease that can lead to severe life-long disabilities. Close contacts of leprosy patients have a higher risk of acquiring the disease. Nevertheless, there is a lack of reliable markers to predict Mycobacterium leprae infection. We aim to identify new potential markers for developing clinical leprosy among contacts. Methods Serum levels of IL-6, IL-8, IL-10, hemoglobin, ferritin and transferrin saturation were measured in 67 multibacillary leprosy (MB) patients, 65 household contacts (HC) of MB patients, and 127 endemic controls (EC). By means of multivariate logistic regression and ROC analyses, we analyze baseline variables and laboratory parameters that showed significant differences between MB with HC and EC groups and obtained the respective areas under the curve (AUC). Optimal cut-off value of the associated cytokines was also determined. Results Elevated IL-6 level was observed in MB compared to HC and EC (p=0.022 and 0.0041, respectively). Anemia and iron deficiency were also higher in MB group compared to HC or EC (p<0.001). Likewise, we observed an increased risk of having MB leprosy in underweight HC [OR 2.599 (0.991; 6.820)] and underweight EC [2.176 (1.010; 4.692)]. Further analysis with ROC showed that high serum IL-6 level, underweight, anemia, and iron deficiency can discriminate leprosy from their household contacts [AUC 0.843 (95% CI 0.771-0.914); p=0.000; optimal cut-off value of IL-6 = 9.14 pg/ml]. Conclusions Our results suggest that serum IL-6 and nutrition status could serve as potential prognostic markers for the development of clinical leprosy in infected individuals.