Co-Morbid Infections in Hansen's Disease Patients in the United States: Considerations for Treatment

Bilodeau, Madeline; Burns, Stephanie; Gawoski, John; Moschella, Samuel L.; Ooi, Winnie W.

doi:10.4269/ajtmh.13-0167

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…4 Co-infections can also pose additional challenges through drug interactions between leprosy multidrug therapy (MDT) and other antimicrobials. 5 The literature on leprosy viral co-infections has focused on HIV, HTLV, hepatitis B, and hepatitis C. [6][7][8][9][10][11] Recently, we have ª 2023 the International Society of Dermatology.…”

Section: Introductionmentioning

confidence: 99%

“…The literature on leprosy viral co‐infections has focused on HIV, HTLV, hepatitis B, and hepatitis C 6–11 . Recently, we have also seen reports of cases of COVID‐19 in leprosy patients, in a context of strained healthcare services that most severely affected developing countries and delayed progress towards leprosy elimination 12,13 .…”

Section: Introductionmentioning

confidence: 99%

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Viral co‐infections in leprosy: a scoping review

et al. 2023

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ContextThe most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research. MethodsThe authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews.Results For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, coinfections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part.Conclusions This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Viral co‐infections in leprosy: a scoping review

et al. 2023

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“…Additional articles that reported data on Strongyloides relevant to the use of methotrexate or other immunosuppressive therapy but did not meet study inclusion criteria are reported in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Numerically, more patients experienced dissemination or hyperinfection in the high-dose group (75% vs. 52% P = ns; Table 1). Additional articles that reported data on Strongyloides relevant to the use of methotrexate or other immunosuppressive therapy but did not meet study inclusion criteria are reported in Table 3 [16][17][18][19][20][21].…”

Section: High-compared To Low-dose Mtxmentioning

confidence: 99%

Methotrexate exposure and risk of strongyloidiasis

Richards

Penner

Colmegna

et al. 2019

Tropical Med Int Health

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Objective Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown. Methods We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease. Results After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low‐dose MTX; 75% high‐dose MTX). Death occurred in 34% of cases (19% low‐dose MTX; 75% high‐dose MTX, P < 0.01). All eight patients on high‐dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low‐dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides. Conclusions Serious Strongyloides infection can occur with low‐dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low‐ to middle‐income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low‐dose MTX therapy, particularly if combined with additional immunosuppression.

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“…1 The unprecedented challenge that persists for leprosy patients is the development of comorbidities during treatment due to reactivation or interaction with other asymptomatic infections. 3 There has been evidence for the presence of co-morbidities such as chronic hepatitis, latent tuberculosis, chronic strongyloidiasis, Chagas' disease, diabetes mellitus and human immunodeficiency virus (HIV). 4 The other co-morbidities include neuropathic ulcers, hearing impairment, mental disorders, restless leg syndrome and renal amyloidosis.…”

Section: Introductionmentioning

confidence: 99%

Leprosy patients in Bengaluru, India: associated comorbidities, costs for management and linkages to welfare schemes

Ranganatha¹,

Nagaraja²,

Shivanna³

2020

LEPROSY

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Introduction: India accounts for the 60% of the global burden of leprosy. We conducted a study to identify the various comorbid conditions, costs incurred for its management and the status of linkages to public welfare schemes amongst leprosy patients admitted at a leprosy hospital in Bengaluru, India. Methods: A cross sectional study was conducted between March and July, 2018, at a leprosy hospital in Bengaluru, India. All the admitted patients were interviewed using a semi-structured questionnaire. The quantitative data was double entered using EpiData data entry software and was analysed using EpiData analysis software for numbers, proportions and range. Results: A total of 80 admitted in-patients were interviewed of which the male to female ratio was 3:1. A majority (90%) of them had comorbid conditions, including neuropathic ulcers, diabetes mellitus, hypertension, mental illnesses and cellulitis. Most of them had incurred some expenses for morbidity management. Only half of the patients were found to be linked to public social welfare schemes. Conclusion: Leprosy is associated with comorbid conditions and as a policy all diagnosed and registered patients under the programme should be screened for diabetes mellitus, hypertension, HIV and mental illnesses at regular intervals. Efforts are to be made to integrate the primary health care services and bring down the patients costs on comorbidities.

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Co-Morbid Infections in Hansen's Disease Patients in the United States: Considerations for Treatment

Cited by 4 publications

References 13 publications

Viral co‐infections in leprosy: a scoping review

Viral co‐infections in leprosy: a scoping review

Methotrexate exposure and risk of strongyloidiasis

Leprosy patients in Bengaluru, India: associated comorbidities, costs for management and linkages to welfare schemes

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