An 86-year-old female patient from northeast Mexico presented with diffuse lepromatous leprosy (DLL). Sequence analysis of four genes (rrs, rpoB, sigA, and hsp65) from the skin biopsy specimen identified "Mycobacterium lepromatosis." This is the first independent confirmation of a case of DLL due to M. lepromatosis. CASE REPORTIn 2005, an 86-year-old female with no prior medical history of leprosy was admitted to our hospital due to a 10-day bout of distal cyanosis of the extremities (Fig. 1). Physical examination also showed generalized dermatosis characterized by diffuse infiltration of the skin, predominantly in the face, with thickening of the superciliary region and ears plus an accompanying absence of eyebrows and eyelashes. In the rest of the body, the skin had an atrophic "cigarette paper"-like appearance and diminished or absent body hair. The neurological examination revealed extensive areas of dysesthesia. The areas of diffuse lepromatous leprosy (DLL) associated with Lucio's phenomenon were characterized by a purpuric appearance, with necrosis and ulceration in some of the areas, leading to sloughing in acral sites such as fingers and toes. A presumptive diagnosis of cryoglobulinemia versus other vasculitis disorders was considered, and laboratory examination showed microcytic hypochromic anemia, thrombocytosis, leukocytosis, and a rheumatoid factor of 80. A skin biopsy was performed and treatment with pentoxifylline initiated. During the first week, the rheumatologist prescribed cyclophosphamide, but the patient did not improve and developed necrosis in areas that were previously cyanotic (Fig. 1). The skin biopsy specimen showed vasculitis with thrombosis and perivascular and periadnexial lymphocytic infiltrates (Fig. 2) as well as numerous acid-fast bacilli, leading to diagnosis of diffuse lepromatous leprosy (DLL) and Lucio's phenomenon. Treatment with prednisone and multidrug therapy for multibacillary leprosy was initiated. The patient improved after 10 days of treatment, was discharged after 2 weeks in stable condition, but died at home 3 months later of unknown cause.Leprosy is one of the oldest recorded human afflictions. Depending upon the immune response mounted against the bacilli, the disease presents with a broad clinical spectrum. At one pole are the tuberculoid (TT) patients, with effective T cell-mediated immunity resulting in very low bacterial numbers, while at the other, the lepromatous (LL) patients mount an ineffective humoral response and exhibit a high bacillary load. Other unstable forms, with characteristics between these poles, can also be observed. A particular variation of lepromatous leprosy involving diffuse nonnodular lesions is more frequent in Mexico and the Caribbean than in any other part of the world (2). This variation has been referred to as diffuse lepromatous leprosy (DLL) or Lucio's phenomenon (6, 11).All these forms of leprosy have been attributed to various host responses to the causative pathogen, Mycobacterium leprae. However, M. leprae exhibits exception...
Eurasian red squirrels (Sciurus vulgaris) in the British Isles are the most recently discovered animal reservoir for the leprosy bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Initial data suggest that prevalence of leprosy infection is variable and often low in different squirrel populations. Nothing is known about the presence of leprosy bacilli in other wild squirrel species despite two others (Siberian chipmunk [Tamias sibiricus], and Thirteen-lined ground squirrel [Ictidomys tridecemlineatus]) having been reported to be susceptible to experimental infection with M. leprae. Rats, a food-source in some countries where human leprosy occurs, have been suggested as potential reservoirs for leprosy bacilli, but no evidence supporting this hypothesis is currently available. We screened 301 squirrel samples covering four species [96 Eurasian red squirrels, 67 Eastern gray squirrels (Sciurus carolinensis), 35 Siberian chipmunks, and 103 Pallas's squirrels (Callosciurus erythraeus)] from Europe and 72 Mexican white-throated woodrats (Neotoma albigula) for the presence of M. leprae and M. lepromatosis using validated PCR protocols. No DNA from leprosy bacilli was detected in any of the samples tested. Given our sample-size, the pathogen should have been detected if the prevalence and/or bacillary load in the populations investigated were similar to those found for British red squirrels.
The in vitro activity of a novel oxazolidinone, linezolid, was studied by comparing the activity of linezolid with those of amikacin, trimethoprim-sulfamethoxazole, and amoxicillin-clavulanic acid against 25 strains of Nocardia brasiliensis isolated from patients with mycetoma. All N. brasiliensis strains tested were sensitive to linezolid (MIC at which 90% of strains are inhibited [MIC 90 ], 2 g/ml; MIC 50 , 1 g/ml). This antimicrobial might constitute a good alternative for treatment of actinomycetoma.
The frequency of infection caused by the recently described pathogen Mycobacterium lepromatosis is unknown. Here, we describe the demographics, clinical characteristics, and therapeutic outcomes of five lepromatous leprosy patients suffering from M. lepromatosis infection in Nuevo Léon, Mexico. Diagnosis was facilitated by a new highly specific PCR procedure. Mycobacterium leprae causes Hansen's disease, or leprosy, a chronic infection transmitted from human to human by close contact and manifests clinically in several forms. Leprosy was recently declared to have been eliminated from most regions of the world (1). Since its original description by Armauer Hansen in 1873, the diagnosis of leprosy has relied on the detection of acid-fast bacilli (AFB) in clinical samples. In 2008, a new etiologic agent, Mycobacterium lepromatosis, was associated with leprosy in the United States (2). It was detected in autopsy specimens from two patients of Mexican ethnicity, using molecular biology techniques. On screening samples from patients attending our dermatology clinic who were diagnosed with Hansen's disease, we detected M. lepromatosis in a diffuse lepromatous leprosy (DLL) case (3) but found no evidence for M. leprae in the biopsy sample. Subsequently, cases of M. lepromatosis infection have been reported in Canada, Singapore, Brazil, and Myanmar (4, 5).In Mexico, the largest study conducted was that of Han et al. (6), and this included 120 samples from patients with various clinical forms of leprosy; 63.2% of the cases harbored M. lepromatosis alone, and 16% were mixed infections in which both M. leprae and M. lepromatosis were present. In all these cases, the bacteria were identified using a PCR assay employing primers for the 16S rRNA gene. The genome sequence of M. lepromatosis was recently obtained (7), and loci present in M. lepromatosis, but absent from M. leprae, were identified, thus enabling a highly specific PCR procedure to be established.In the present work, we screened biopsy specimens from patients currently receiving treatment at our clinic to determine the prevalence of M. lepromatosis, or of mixed infections, using a new specific PCR procedure. A diagnosis was initially made clinically and confirmed by the detection of AFB in Fite-Faraco-stained skin biopsy specimens. For molecular analysis, DNA was extracted from the biopsy specimen and used in PCR assays with primers designed to detect M. leprae (RLEP-7 and RLEP-8) or M. lepromatosis (LPM244-F [5=-GTTCCTCCACCGACAAACAC-3=] and LPM244-R [5=-TTCGTGAGGTACCGGTGAAA-3=]) (7). The pair for M. lepromatosis amplifies a 244-bp fragment from the hemN gene missing in M. leprae (7).A total of 38 patients were analyzed; among them, we observed 5 cases positive for M. lepromatosis (Table 1), constituting 13% of the total cases. Four were from Nuevo León and one from the neighboring state of San Luis Potosi, and none were related. Four presented with lepromatous leprosy, of whom three were diagnosed with DLL and one with nodular lepromatous leprosy (NLL); none of t...
The in vitro activities of ACH-702 and other antimicrobials against 30 Nocardia brasiliensis isolates were tested. The MIC 50 (MIC for 50% of the strains tested) and MIC 90 values of ACH-702 were 0.125 and 0.5 g/ml.The same values for econazole were 2 and 4 g/ml. The MIC 50 and MIC 90 values of imipenem and meropenem were 64 and >64 g/ml and 2 and 8 g/ml, respectively; the addition of clavulanic acid to the carbapenems had no effect.
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