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(1) Background: The global burden of leprosy is not shared equally; with the majority of cases being diagnosed in Brazil, India, and Indonesia. Understanding the methods of active case detection (ACD) used in high and low endemic regions is vital for the development of future screening programs. (2) Methods: A systematic search of three databases, PubMed, Embase and Web of Science, was conducted for English language papers, published since the year 2000, which discussed the use of active case detection methods for leprosy screening. The paper utilised the Integrated Screening Action Model (I-SAM) as a tool for the analysis of these methods. (3) Results: 23 papers were identified from 11 different countries. The papers identified 6 different methods of active case detection: Household contact/social contact identification; door-to-door case detection; screening questionnaire distribution; rapid village surveys; school-based screening; and prison-based screening. 15 were located in high endemic regions and 8 of these were located in low endemic regions. (4) Conclusions: For selecting the appropriate methods of active case finding, the leprosy endemicity must be taken into consideration. The findings contribute to policy decision making allowing for more successful future leprosy case detection programs to be designed, ultimately reducing the global burden of the disease, and achieving the WHO's aim of zero leprosy. [ABSTRACT FROM AUTHOR]

Background: Leprosy, caused by Mycobacterium leprae, affects multiple body systems and can lead to preventable disability if untreated. While multidrug therapy (MDT) has been available since 1982, historical evidence suggests that untreated leprosy can resolve spontaneously. Nevertheless, the prevalence of self-healing worldwide, as well as factors determining self-healing, remain unclear. Methods: A systematic review was conducted in 2023 with data from PubMed, Infolep, and Web of Sciences data bases, along with a google search. Data extraction and analysis followed PRISMA guidelines and were summarized in a separate Excel sheet. Included were English-language studies on self-healing in leprosy, regardless the year of publication. Results: We included six studies spanning from 1938 to 1978 exploring the incidence of self-healing in different countries and continents. Children, paucibacillary (PB) cases, and possibly males showed a higher probability of self-healing with an average healing time of two years. Discussion/Conclusion: Recent research on self-healing in leprosy is scarce and evidence limited. This is primarily due to ethical concerns regarding withholding effective treatment of diagnosed patients, and because of the absence of an agreed definition of self-healing. Nevertheless, self-healing appears to be a plausible phenomenon influenced by geographic and demographic factors, and the type of leprosy. We recommend further research on self-healing in leprosy, as it provides insight into the human immune system and the determinants of this phenomenon. More insight could help adapt clinical practices and public health strategies, thereby contributing to an effective management and control of this disease. Author summary: Leprosy, a chronic infectious disease caused by Mycobacterium leprae, presents significant health challenges worldwide, with the potential for avoidable disabilities if left untreated. While MDT has substantially reduced the disease burden since its introduction in 1982, historical records suggest that some cases of leprosy exhibit spontaneous resolution without medical intervention. However, the prevalence of self-healing globally and the factors influencing this phenomenon remain unclear. The review identified six studies conducted between 1938 and 1978, which examined the occurrence of self-healing in various countries. These studies revealed that children and individuals with PB leprosy demonstrated a higher likelihood of self-healing, typically within an average period of two years. Despite the limited recent evidence due to ethical considerations, self-healing appears to be a plausible phenomenon influenced by patient-specific characteristics and the type of leprosy infection. Ultimately, this paper presents a compelling case for future research on self-healing in leprosy, as it provides an interesting view on the human immune system as well as the determinants of this phenomenon. Our recommendations emphasize the necessity of such investigations to adapt clinical practices and public health strategies, thereby contributing to an effective management and control of this disease. [ABSTRACT FROM AUTHOR]

The prevention and treatment of leprosy is a public health and social issue of global concern. China has become the first country in the world to put forward a proposal on the elimination of the harm caused by leprosy. This paper briefly introduces the status of the spread of leprosy in China, and systematically reviews the evolution of policies and measures at different stages of the disease in China, from the serious epidemic of leprosy to the control of the infection, to the basic elimination, and to the elimination of the hazards. On this basis, five main lessons learned from the control and elimination of leprosy in China were also summarized. These provide the basis for promoting the complete global elimination of leprosy and preventing its re-transmission, thereby benefiting all those who still suffer from the scourge of leprosy. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention. [ABSTRACT FROM AUTHOR]

Leprosy continues to be stigmatized, causing harm to fundamental rights, pain and hopelessness in those who have suffered from it and their families. From its relationship with public and mental health, effective strategies must be implemented to reduce stigma and unlearn myths and wrong perceptions, support families, and improve quality of life through early care and detection. This article shows that those affected by leprosy are capable, functional people with much to contribute to society anywhere in the world. [ABSTRACT FROM AUTHOR]

Background: Leprosy is caused by Mycobacterium leprae which affects skin, nerves, eyes, and nasal mucosa. Despite global elimination efforts, Tanzania remains among 13 countries reporting more than 1000 leprosy cases annually. In 2021, Tanzania identified 1,511 new cases, with 10% having grade II disability. Moreover, 14 councils recorded leprosy rates exceeding 10 cases per 100,000 population. This study aimed to assess the burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020. Methodology: A retrospective cross-sectional study was conducted to investigate all registered treated leprosy patients from January 2017 to December 2020. The Leprosy Burden Score (LBS) was used to assess the disease burden, while binary logistic regression was employed to evaluate the risk factors for disability. Result: A total of 6,963 leprosy cases were identified from 2017 to 2020. During this period, the point prevalence of leprosy declined from 0.32 to 0.25 per 10,000 people, and the new case detection rate decreased from 3.1 to 2.4 per 100,000 people; however, these changes were not statistically significant (p > 0.05). Independent risk factors for leprosy-related disabilities included male sex (Adjusted Odds Ratio (AOR) = 1.38, 95% Confidence Interval (CI) 1.22–1.57), age 15 years and above (AOR = 2.42, 95% CI 1.60–3.67), previous treatment history (AOR = 2.18, 95% CI 1.69–2.82), and positive Human Immunodeficiency Virus (HIV) status (AOR = 1.60, 95% CI 1.11–2.30). Conclusion: This study identified male sex, older age, positive HIV status, and prior treatment history as independent risk factors for leprosy-related disabilities. Additionally, despite the observed decline in point prevalence and new case detection rates, these changes were not statistically significant. To address leprosy-related disabilities, it is crucial to implement specific prevention strategies that focus on high-risk groups. This can be accomplished by enhancing screening and contact tracing efforts for early patient identification to prevent delays in intervention. Further research is warranted to analyze the burden of leprosy over a more extended period and to explore additional risk factors not covered in this study. [ABSTRACT FROM AUTHOR]

Introduction: Leprosy and lymphatic filariasis (LF) are among the most disabling neglected tropical diseases (NTDs) that affect the citizens of Mozambique, especially in the Northern provinces. The irreversible impairments caused by these NTDs often lead to psychosocial consequences, including poor mental wellbeing, stigma and reduced social participation. Limited data on these consequences are available for Mozambique, which are urgently needed to better understand the true disease burden and support advocacy for scaling up interventions. Methods: A cross-sectional mixed-methods study was conducted. Mental distress was assessed with the Self Reporting Questionnaire (SRQ-20), participation restriction was assessed with the Participation Scale Short (PSS) and perceived stigma was assessed with the Explanatory Model Interview Catalogue affected persons stigma scale (EMIC-AP). Additionally, semi-structured interviews were conducted with persons affected by leprosy or LF. Results: In total, 127 persons affected by leprosy and 184 persons affected by LF were included in the quantitative portion of the study. For the qualitative portion, eight semi-structured interviews were conducted. In both disease groups, mental distress was found in 70% of participants. Moreover, 80% of persons affected by leprosy and 90% of persons affected by LF perceived stigma. Moderate to extreme participation restriction was found in approximately 43% of persons affected by leprosy and in 26% of the persons affected by LF. Persons affected by leprosy and LF felt excluded from society and experienced financial problems. More severe disabilities were associated with more severe outcomes for mental wellbeing, participation restriction and stigma. By contrast, participation in a self-care group was suggested to have a positive impact on these outcomes. Conclusion: The findings provide evidence that persons affected by leprosy and LF must not only confront physical impairments but also experience significant disability in the psychosocial domain, including mental distress, participation restriction and stigma. These challenges must be urgently addressed by NTD programmes to promote the inclusion and wellbeing of persons affected by NTDs. Author summary: Leprosy and lymphatic filariasis (LF) are severe tropical diseases that affect over 1 billion people worldwide, especially in poor regions. In Mozambique, where 11 neglected tropical diseases (NTDs) are common, there is limited information about the impact of leprosy and LF on people's mental and social wellbeing. The current study, which occurred in northern Mozambique, with support from NLR Mozambique and health authorities, aims to understand this impact. The research team examined mental distress, participation restriction and stigma using surveys and interviews. In total, 127 persons affected by leprosy and 184 persons affected by LF were included in the quantitative portion of the study. In addition, eight semi-structured interviews were conducted. Our findings showed that many participants face mental distress (70%), participation restriction (55%) and health-related stigma (86%), with the severity of leprosy and LF linked to greater challenges. Moreover, our analysis revealed that disability, stigma and marital status played a significant role in the presence or absence of psychosocial challenges. Participation in self-care groups was suggested to have a positive impact on mental and social wellbeing. Despite some limitations, our study highlights the urgent need for better mental and social support for persons affected by disabling NTDs. It is crucial to address mental health, promote inclusion and adapt services to local needs. To this end, we recommend more research with diverse groups and suggest the integration of mental health care into programmes for NTDs. This study emphasises the importance of looking after the overall wellbeing of those affected by leprosy and LF in Mozambique. [ABSTRACT FROM AUTHOR]

Background: There are several studies on thyroid functions and thyroid gland features in patients with leprosy in the literature. The relationship between them have not been clarified yet. These studies are time-expired and don't contain ultrasonography examination. The purpose of the study is to investigate thyroid functions and gland characteristics in leprosy patients by ultrasonography (US) and current laboratory techniques. Patients and Methods: This retrospective study was conducted by collecting the data of patients with lepramatous leprosy. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti-thyroid peroxidase, antithyroglobulin, and thyroglobulin values and thyroid ultrasonography reports were collected from previous records. Results: The mean age is 75.12±9.89 years of total 17 subjects and 10 patients (58.8%) were male. Thyroid US was performed on 14 of the patients, nodules were detected in a total of 7 (50%) patients. The mean FT3, FT4, TSH, Anti-Tpo, Anti-TG, and TG values of the patients were found to be within normal limits. Conclusion: In the present study, no changes were detected in the thyroid functions and structures of the patients with Lepromatous Leprosy. We consider that prospective randomized studies that will include larger sample sizes are needed to determine whether there is a relationship between leprosy and thyroid disease. Author summary: Leprosy is also known as Hansen's disease, caused by the bacillus Mycobacterium leprae. This ancient disease continues to be a serious healt problem worldwide. Currently it is more common in subtropical regions. Although leprosy cases are decreasing, they are still seen in Turkey. Mycobacterium Leprae lead to an chronic granulamatous infection mainly on skin and peripheral nerves however, it can also affect other tissues such as eyes, mucous membranes, bones and testicles, and may occur different clinical manifestations. It has been shown that it also causes changes in endocrine organ functions. There are some studies on thyroid functions, but the effects of leprosy on thyroid functions and structure are not clear. In this study, we examined the structural features and functional status of the thyroid gland, in a small number of patients because of Leprosy is non endemic common in our country. No changes were detected in the thyroid functions and structures of the patients with Lepromatous Leprosy in a thyroid-endemic region in this study. We consider that it is necessary prospective randomized studies included larger sample sizes on this topic [ABSTRACT FROM AUTHOR]

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Background: Skin neglected tropical diseases including leprosy and Buruli ulcer (BU)are a group of stigmatizing and disability-inducing conditions and these aspects of the diseases could lead to poor mental health. The study was designed to assess the burden of poor mental health and wellbeing among persons affected by leprosy or BU in Nigeria Methods: A community based cross-sectional study design was employed. The study involved persons affected by leprosy or BU. Ten local government areas with the highest number of notified leprosy or BU cases between 2014 and 2018 in southern Nigeria were purposively selected. Information were obtained using Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and OSLO Social Support Scale. Outcome measure was poor mental health/wellbeing and was determined by proportion of respondents who had depressive symptoms, anxiety disorder and poor mental wellbeing. Results: A total of 635 persons affected by leprosy or BU participated in the study. The mean age of respondents was 43.8±17.0 years and highest proportion, 22.2% were in age group, 40–49 years. Majority of respondents, 50.7% were males. A higher proportion of respondents, 89.9% had depressive symptoms, 79.4% had anxiety disorders and 66.1% had poor mental wellbeing. Majority, 57.2% had poor mental health/wellbeing. Among the respondents, there was a strong positive correlation between depression and anxiety scores, (r = 0.772, p<0.001). There was a weak negative correlation between depression score and WEMWBS score, (r = -0.457, p<0.001); anxiety score and WEMWBS score, (r = -0.483, p<0.001). Predictors of poor mental health/wellbeing included having no formal education, (AOR = 1.9, 95%CI: 1.1–3.3), being unemployed, (AOR = 3.4, 95%CI: 2.2–5.3), being affected by leprosy, (AOR = 0.2, 95%CI: 0.1–0.4) and having poor social support, (AOR = 6.6, 95%CI: 3.7–11.8). Conclusions: The burden of poor mental health/wellbeing among persons affected by leprosy or BU is very high. There is need to include mental health interventions in the management of persons affected with leprosy or BU. Equally important is finding a feasible, cost-effective and sustainable approach to delivering mental health care for persons affected with leprosy or BU at the community level. Improving educational status and social support of persons affected by leprosy or BU are essential. Engaging them in productive activities will be of essence. [ABSTRACT FROM AUTHOR]

Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. The disease may evolve for inflammatory reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL), the major cause of irreversible neuropathy in leprosy, which occur in 1 in 3 people with leprosy, even with effective treatment of M. leprae. Leprosy remains persistently endemic in our region where it predominantly affects lowest socioeconomic conditions people, as Toxoplasma gondii infection in the municipality studied. Previously, we have shown T. gondii coinfection as a risk marker for leprosy, mainly in its severe form. This present study assessed whether T. gondii infection is also a risk factor for leprosy reactions and the predictive value of immunoglobulin production prior to development of leprosy reactions. Patients with leprosy (n = 180), co-infected or not with T. gondii, had their serum investigated for levels of IgA, IgE, IgG1, IgG2, IgG3 and IgG4 anti-PGL-1 by ELISA prior to development of leprosy reactions. The serologic prevalence for T. gondii infection was 87.7% in leprosy reaction patients reaching 90.9% in those with ENL. The leprosy reaction risk increased in T. gondii seropositive individuals was two-fold ([OR] = 2.366; 95% confidence interval [CI 95%]: 1.024–5.469) higher than those seronegative, and considering the risk of ENL, this increase was even more evident (OR = 6.753; 95% CI: 1.050–72.85) in coinfected individuals. When evaluated the prediction of anti-PGL-1 immunoglobulin levels for development of leprosy reactions in patients coinfected or not with T. gondii, only the increase IgE levels were associated to occurrence of reactional episodes of leprosy, specifically ENL type, in patients coinfected with T. gondii, compared to those not coinfected or no reaction. Thus, the immunomodulation in co-parasitism T. gondii–M. leprae suggest increased levels of IgE as a biomarker for early detection of these acute inflammatory episodes and thereby help prevent permanent neuropathy and disability in leprosy patients. [ABSTRACT FROM AUTHOR]

Leprosy, a significant global health concern affecting primarily the peripheral nerves and integumentary system, is influenced by the host immune system's response, affecting its pathology, disease progression, and reaction occurrence. MCP-1, integral to leprosy's immunological processes, holds promise as a diagnostic tool and predictor of reaction occurrence. This systematic review aimed to investigate MCP-1's involvement in leprosy. Literature search, employing specified MeSH keywords, covered databases such as PubMed, Scopus, ScienceDirect, and Wiley Online Library until September 30th, 2023, yielding seventeen relevant studies. Assessing each study's quality with the Newcastle-Ottawa Scale (NOS) and investigating bias using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS), a narrative synthesis compiled findings. Seventeen distinct studies were included, each characterized by diverse designs, sample sizes, demographics, and outcome measures, highlighting MCP-1's potential in diagnosing leprosy, differentiating it from control groups, and discerning leprosy types. Furthermore, MCP-1 shows promise in predicting leprosy reversal reactions. Although MCP-1 offers clinical benefits, including early diagnosis and type differentiation, further research with larger sample sizes and standardized methodologies is imperative to confirm its diagnostic utility fully. [ABSTRACT FROM AUTHOR]

The International Classification of Function, Disability, and Health (ICF—WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia. Author summary: Disability is the long-term outcome of untreated leprosy or Hansen's disease, which is caused by peripheral nerve invasion of the Mycobacterium leprae. It is a serious and life-limiting complication for leprosy patients. Currently, seven regions in Indonesia have not yet achieved the state of disease elimination. In addition, Indonesia has not succeeded in achieving the sub-target of the rate of new cases with grade 2 disability in 2023. The concept of disability and health including the body structure, body function, personal and environmental domains, activity limitation, and participation restriction, is provided by the ICF. Through the framework, we could assess the aspects of disability and its relationship to one another in leprosy patients. Furthermore, the early detection, screening, and management programs for leprosy have not included aspects of disability and rehabilitative measures for restoration. Thus, the purpose of this study is to find the impact of leprosy-related disability on the patients' body function, activity, and participation. We reported 150 leprosy patients from two rural areas of Indonesia and found significant relationships between specific indicators, which would be useful for rehabilitative management programs in the future. [ABSTRACT FROM AUTHOR]

Introduction: Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs. Methods: We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I2 statistic. Results: Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0–11.0%), dengue (12.5%), and lymphatic filariasis (0.0–23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9–99.3%) and visceral leishmaniasis (24.6–91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65–80%, n = 2, I2 = 0.00%). Costs of visceral leishmaniasis impoverished 20–26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare. Conclusion: NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors. Author summary: Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs. We found that NTDs lead to a substantial number of households facing financial hardship. CHS risk due to direct OOP costs was relatively low among patients with leprosy (0.0–11.0%), dengue (12.5%), and lymphatic filariasis (0.0–23.0%), and relatively high among patients with Buruli ulcers (45.6%). CHS risk varied widely among patients with chikungunya (11.9–99.3%) and visceral leishmaniasis (24.6–91.8%). Costs of visceral leishmaniasis impoverished 20–26% of 61 households, depending on the costs captured. Nevertheless, financial hardship caused by NTDs was not comprehensively evaluated in the literature. Therefore, to develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors. [ABSTRACT FROM AUTHOR]

Leprosy has a high rate of cripplehood and lacks available early effective diagnosis methods for prevention and treatment, thus novel effective molecule markers are urgently required. In this study, we conducted bioinformatics analysis with leprosy and normal samples acquired from the GEO database(GSE84893, GSE74481, GSE17763, GSE16844 and GSE443). Through WGCNA analysis, 85 hub genes were screened(GS > 0.7 and MM > 0.8). Through DEG analysis, 82 up-regulated and 3 down-regulated genes were screened(|Log2FC| > 3 and FDR < 0.05). Then 49 intersection genes were considered as crucial and subjected to GO annotation, KEGG pathway and PPI analysis to determine the biological significance in the pathogenesis of leprosy. Finally, we identified a gene-pathway network, suggesting ITK, CD48, IL2RG, CCR5, FGR, JAK3, STAT1, LCK, PTPRC, CXCR4 can be used as biomarkers and these genes are active in 6 immune system pathways, including Chemokine signaling pathway, Th1 and Th2 cell differentiation, Th17 cell differentiation, T cell receptor signaling pathway, Natural killer cell mediated cytotoxicity and Leukocyte transendothelial migration. We identified 10 crucial gene markers and related important pathways that acted as essential components in the etiology of leprosy. Our study provides potential targets for diagnostic biomarkers and therapy of leprosy. [ABSTRACT FROM AUTHOR]

Introduction: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. Methods: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2–3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. Results: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. Conclusion: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability. [ABSTRACT FROM AUTHOR]

Introduction: Autologous blood products like Platelet Rich Plasma (PRP) and Leukocyte and Platelets Rich Fibrin (L-PRF) have been used for many years across many types of skin ulcers. However, the effectiveness of autologous blood products on wound healing is not well established. Methods: We evaluated the 'second generation' autologous product- Leukocyte and Platelet- Rich Fibrin (L-PRF). Our trial was undertaken on patients suffering from neuropathic leprosy ulcers at the Anandaban hospital which serves the entire country of Nepal. We conducted a 1:1 (n = 130) individually randomised trial of L-PRF (intervention) vs. normal saline dressing (control) to compare rate of healing and time to complete healing. Rate of healing was estimated using blind assessments of ulcer areas based on three different measurement methods. Time to complete healing was measured by the local unblinded clinicians and by blind assessment of ulcer images. Results: The point estimates for both outcomes were favourable to L-PRF but the effect sizes were small. Unadjusted mean differences (intervention vs control) in mean daily healing rates (cm2) were respectively 0.012 (95% confidence interval 0.001 to 0.023, p = 0.027); 0.016 (0.004 to 0.027, p = 0.008) and 0.005 (-0.005 to 0.016, p = 0.313) across the three measurement methods. Time to complete healing at 42 days yielded Hazard Ratios (unadjusted) of 1.3 (0.8 to 2.1, p = 0.300) assessed by unblinded local clinicians and 1.2 (0.7 to 2.0, p = 0.462) on blind assessment. Conclusion: Any benefit from L-PRF appears insufficient to justify routine use in care of neuropathic ulcers in leprosy. Trial registration: ISRCTN14933421. Date of trial registration: 16 June 2020. Author summary: Autologous Blood Products such as Leucocyte and Platelets Rich Fibrin (L-PRF) gel have been widely used in the treatment of skin ulcers, including Leprosy ulcers. L-PRF gel contains a high concentration of platelets and leucocytes rich in growth factors that might promote wound healing. However, our systematic review showed that there is a lack of high-quality trial evidence for the effectiveness of L-PRF. To evaluate the efficacy of L-PRF we conducted an individual randomised controlled trial (n = 130) of L-PRF gel vs conventional normal saline dressings. Photographs were taken during twice weekly dressing changes in both intervention and control groups. The ulcer photographs were assessed by blinded assessors using three different ulcer area measurement methods. Outcomes were rate of healing and time to complete epithelialisation. Point estimates for intervention effects across outcomes and measurement methods, intervention vs control was favorable to L-PRF but the effect sizes were small and mostly not statistically significant. [ABSTRACT FROM AUTHOR]

Background Hansen's disease is a chronic, infectious and transmissible disease that is considered a public health problem in Brazil. Hansen's disease is marked by stigma and prejudice, because it carries with it a strong negative social image, reinforced by policies of social isolation in the community. Methods A qualitative study was conducted in Ribeirão Preto, an inland city of the state of São Paulo, Brazil. Eleven patients under treatment for the disease were interviewed. The interviews were audio recorded and transcribed in full, then were analyzed through the stages of transcription, transposition and reconstitution, as informed by concepts proposed by Goffman. Results The results showed that the marks of stigma are still present in the twenty-first century and were presented in two axes: 'Stigma and work for the person affected by Hansen's disease' and 'The experience of stigma in the family'. The participants refer to fears of losing their jobs and of being ridiculed, which stops them talking about the disease. Regarding their families, the participants reported episodes of discrimination, the creation of family secrets and fear of relatives' reactions. Conclusions All these aspects interfere in the follow-up and treatment of patients and need to be considered and welcomed by health professionals. It is recommended that these aspects are addressed in the initial training and continuing education of health professionals. Contexte La maladie de Hansen est une maladie chronique, infectieuse et transmissible, considérée comme un problème de santé publique au Brésil. La maladie de Hansen est marquée par la stigmatisation et les préjugés, car elle véhicule une image sociale fortement négative, renforcée par des politiques d'isolement social au sein de la communauté. Méthodes Étude qualitative menée à Ribeirão Preto, une ville intérieure de l'État de São Paulo, au Brésil. Onze patients traités pour la maladie ont été interrogés. Les entretiens ont été enregistrés et transcrits intégralement, et ont été analysés en suivant les étapes de transcription, de transposition et de reconstitution, selon les concepts proposés par Goffman. Résultats Les résultats montrent que les marques de la stigmatisation sont toujours présentes au 21ème siècle et ont été présentées selon deux axes : 'La stigmatisation et le travail pour la personne affectée par la maladie de Hansen' et 'L'expérience de la stigmatisation dans la famille'. Les participants évoquent la peur de perdre leur emploi, la peur d'être ridiculisés, ce qui les pousse à ne pas parler de la maladie. En ce qui concerne les familles, les participants ont rapporté des épisodes de discrimination, la création de secrets de famille et la peur des réactions des proches. Conclusions Tous ces aspects interfèrent dans le suivi et le traitement des patients et doivent être pris en compte et accueillis par les professionnels de la santé. Il est recommandé que ces aspects soient abordés dans la formation initiale et la formation continue des professionnels de la santé. Antecedentes La enfermedad de Hansen es una enfermedad crónica, infecciosa y transmisible, considerada un problema de salud pública en Brasil. La enfermedad de Hansen está marcada por el estigma y el prejuicio, ya que conlleva una fuerte imagen social negativa, reforzada por políticas de aislamiento social en la comunidad. Métodos Estudio cualitativo realizado en Ribeirão Preto, una ciudad del interior del estado de São Paulo, Brasil. Se entrevistaron a once pacientes en tratamiento para la enfermedad. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas a través de etapas de transcripción, transposición y reconstitución, según los conceptos propuestos por Goffman. Resultados Los resultados muestran que las marcas del estigma siguen presentes en el siglo XXI y se presentaron en dos ejes: 'Estigma y trabajo para la persona afectada por la enfermedad de Hansen' y 'La experiencia del estigma en la familia'. Los participantes mencionan el miedo a perder sus trabajos, el temor a ser ridiculizados, lo que les impide comentar sobre la enfermedad. En cuanto a las familias, los participantes reportaron episodios de discriminación, la creación de secretos familiares y el miedo a las reacciones de los familiares. Conclusiones Todos estos aspectos interfieren en el seguimiento y tratamiento de los pacientes y deben ser considerados y acogidos por los profesionales sanitarios. Se recomienda abordar estos aspectos en la formación inicial y la educación continua de los profesionales sanitarios. [ABSTRACT FROM AUTHOR]

Introduction: Involvement of a chemokine known as C-X-C motif chemokine ligand 10 or CXCL10 in the immunopathology of leprosy has emerged as a possible immunological marker for leprosy diagnosis and needed to be investigate further. The purpose of this systematic review is to assess CXCL10's potential utility as a leprosy diagnostic tool and evaluation of therapy. Methods: This systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. A thorough search was carried out to find relevant studies only in English and limited in humans published up until September 2023 using PubMed, Scopus, Science Direct, and Wiley Online Library database with keywords based on medical subject headings (MeSH) and no exclusion criteria. The Newcastle-Ottawa Scale (NOS) was utilized for quality assessment, while the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was utilized for assessing the risk of bias. Additionally, a narrative synthesis was conducted to provide a comprehensive review of the results. Results: We collected a total of 115 studies using defined keywords and 82 studies were eliminated after titles and abstracts were screened. We assessed the eligibility of the remaining 26 reports in full text and excluded four studies due to inappropriate study design and two studies with incomplete outcome data. There were twenty included studies in total with total of 2.525 samples. The included studies received NOS quality evaluation scores ranging from 6 to 8. The majority of items in the risk bias assessment, using RoBANS, across all included studies yielded low scores. However, certain items related to the selection of participants and confounding variables showed variations. Most of studies indicate that CXCL10 may be a helpful immunological marker for leprosy diagnosis, particularly in leprosy reactions as stated in seven studies. The results are better when paired with other immunological markers. Its effectiveness in field-friendly diagnostic tools makes it one of the potential biomarkers used in diagnosing leprosy patients. Additionally, CXCL10 may be utilized to assess the efficacy of multidrug therapy (MDT) in leprosy patients as stated in three studies. Conclusion: The results presented in this systematic review supports the importance of CXCL10 in leprosy diagnosis, particularly in leprosy responses and in tracking the efficacy of MDT therapy. Using CXCL10 in clinical settings might help with leprosy early diagnosis. Yet the findings are heterogenous, thus more investigation is required to determine the roles of CXCL10 in leprosy while taking into account for additional confounding variables. [ABSTRACT FROM AUTHOR]

Introduction: The hands are the most common site of disability in leprosy. Hand dysfunction could result in difficulty performing activities of daily living. Therefore, hand function should be regularly assessed to ensure that any decrease in hand function could be diagnosed earlier. Methods: This study included 110 patients with leprosy from Likupang and Lembata, Indonesia. Hand function was assessed using the modified Jebsen test to measure hand function respective of the dominance. The grip and pinch strength were used as objective measures of clinical arm function. The World Health Organization (WHO) hand disability grade were used to determine the degree of impairment. Other factors such as age, sex and the type of leprosy were also considered. All factors were analysed using backward logistic regression. Results: Among the 110 participants, a decrease in the dominant (48.2%) and non-dominant (50.9%) hand functions were found. Pinch strength (OR: 3.39; 95% CI: 1.13-10.19) and age (OR: 4.91; 95% CI: 1.72-14.03) were significantly associated with hand function irrespective of the dominance. Conversely, the WHO hand disability grade (OR: 2.97; 95% CI: 1.10-8.04) and type of leprosy (OR: 0.34; 95% CI: 0.12-0.97) were significantly associated with only function of the dominant hand. Conclusion: There is a significant association of age and pinch strength with hand function regardless of the hand dominance. In contrast, the WHO hand disability grade and type of leprosy are significantly associated with the function of the dominant hand only. [ABSTRACT FROM AUTHOR]

Leprosy is an infectious disease characterized by slow and chronic evolution, caused by Mycobacterium leprae and or Mycobacterium lepromatosis, an intracellular alcohol-acid-resistant (BAAR) bacillus. The objective of this study was to provide an epidemiological, clinical, and geographic characterization of leprosy in the city of Santarém-Pará during the period 2011–2020. A cross-sectional, descriptive, and quantitative approach was used, employing maps and tables to illustrate clinical and epidemiological variables, including: sex, age, race, area of residence, operational classification, clinical form, number of skin lesions, number of affected nerves, and health units. During the analyzed period, 581 cases of leprosy were diagnosed, resulting in the following cumulative incidence rates: male (60%); age over 15 years (94%); urban area (73%); multibacillary (74%); borderline form (46%); skin lesions greater than 5 (34%); and no nerves affected (68%). In the urban perimeter, a higher cumulative incidence of cases was observed in the central area with 133 cases. However, the health unit reporting the largest number of cases belonged to the southern area, specifically the Basic Health Unit of Nova República, with 48 cases. This study highlights the need to characterize the nuances of leprosy and its variability within the urban environment, according to different areas. Further research is essential to inform the implementation of public policies aimed at addressing the population with the highest vulnerability index, thereby reducing leprosy rates in Santarém. Author summary: This article addresses the incidence of leprosy in Santarém, Brazil, during the COVID-19 pandemic. In 2020, there was a 41% reduction in cases compared to the average between 2015 and 2019, possibly due to the cancellation and rescheduling of appointments, affecting diagnoses and follow-up. Men constituted 60% of the cases, with their hesitation to seek care associated with late diagnoses. Alarmingly, 6% of patients were under 14 years old, indicating possible intrafamilial transmission. Socioeconomic and ethnic inequalities were evident, with 74% of cases in individuals of mixed race. The article emphasizes the importance of addressing leprosy not only as a public health challenge but also as a reflection of social and economic inequalities in Brazil. It proposes comprehensive health policies, expansion of medical services in remote regions, and educational initiatives for awareness and early diagnosis, especially in vulnerable communities. The association between age and clinical form of the disease, as well as spatial distribution analyses, provides crucial insights for developing targeted prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Since the leprosy cases have fallen dramatically, the incidence of leprosy has remained stable over the past years, indicating that multidrug therapy seems unable to eradicate leprosy. More seriously, the emergence of rifampicinresistant strains also affects the effectiveness of treatment. Immunoprophylaxis was mainly carried out through vaccination with the BCG but also included vaccines such as LepVax and MiP. Meanwhile, it is well known that the infection and pathogenesis largely depend on the host's genetic background and immunity, with the onset of the disease being genetically regulated. The immune process heavily influences the clinical course of the disease. However, the impact of immune processes and genetic regulation of leprosy on pathogenesis and immunological levels is largely unknown. Therefore, we summarize the latest research progress in leprosy treatment, prevention, immunity and gene function. The comprehensive research in these areas will help elucidate the pathogenesis of leprosy and provide a basis for developing leprosy elimination strategies. [ABSTRACT FROM AUTHOR]

Background: Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. Methods: The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 − 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 − 600 mg) and clarithromycin (150 − 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox' proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. Discussion: Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. Trial registration: NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060 [ABSTRACT FROM AUTHOR]

A recent revisit of the history of leprosy in East and Southeast Asia led to the establishment of museums of Hansen's disease. Given that the history of leprosy has been a touchy subject due to its social stigma and complicated colonial past, these museums become spaces for the curious to comprehend memories of the forgotten past. In this article, we investigate contradictory purposes of reappraising the heritage value of the history of leprosy for present needs. Museum exhibitions in three colonial leprosaria in Malaysia, South Korea, and Taiwan are examined, specifically focusing on three areas of interpretation: the medical past in a post-colonial present, the difficult life of former patients, and the unsettled present. In contrast with the traditional museum as a place for the repository of glorious national identity, museums of Hansen's disease offer diverse pathways to new museum culture created by activists, museum visitors, and officials. [ABSTRACT FROM AUTHOR]

Background: The occurrence of adverse drug events (ADEs) during dapsone (DDS) treatment in patients with leprosy can constitute a significant barrier to the successful completion of the standardized therapeutic regimen for this disease. Well-known DDS-ADEs are hemolytic anemia, methemoglobinemia, hepatotoxicity, agranulocytosis, and hypersensitivity reactions. Identifying risk factors for ADEs before starting World Health Organization recommended standard multidrug therapy (WHO/MDT) can guide therapeutic planning for the patient. The objective of this study was to develop a predictive model for DDS-ADEs in patients with leprosy receiving standard WHO/MDT. Methodology: This is a case-control study that involved the review of medical records of adult (≥18 years) patients registered at a Leprosy Reference Center in Rio de Janeiro, Brazil. The cohort included individuals that received standard WHO/MDT between January 2000 to December 2021. A prediction nomogram was developed by means of multivariable logistic regression (LR) using variables. The Hosmer–Lemeshow test was used to determine the model fit. Odds ratios (ORs) and their respective 95% confidence intervals (CIs) were estimated. The predictive ability of the LRM was assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 329 medical records were assessed, comprising 120 cases and 209 controls. Based on the final LRM analysis, female sex (OR = 3.61; 95% CI: 2.03–6.59), multibacillary classification (OR = 2.5; 95% CI: 1.39–4.66), and higher education level (completed primary education) (OR = 1.97; 95% CI: 1.14–3.47) were considered factors to predict ADEs that caused standard WHO/MDT discontinuation. The prediction model developed had an AUC of 0.7208, that is 72% capable of predicting DDS-ADEs. Conclusion: We propose a clinical model that could become a helpful tool for physicians in predicting ADEs in DDS-treated leprosy patients. Author summary: Adverse events (AE) produced by the drugs used to treat leprosy can hinder the successful completion of the therapeutic regimen. Well-known AE produced by dapsone (DDS) are related to liver problems, allergic reactions, or to the destruction of red and/or white blood cells, causing anemia. Helping the physician to recognize a patient that may develop these adverse reactions can be useful. Thus, we developed a model to predict AE in patients with leprosy receiving standard World Health Organization-recommended multidrug therapy (WHO/MDT). Our question was whether we could use sociodemographic and clinical variables to generate a predictive model for DDS-ADEs. The model developed in this study could be a useful tool to assist physicians in predicting DDS-ADEs when treating patients with standard WHO/MDT for leprosy, and thus, establish a safer therapeutic plan for patients with a greater ADE risk. [ABSTRACT FROM AUTHOR]

Leprosy is still found mainly in lower-middle-income countries. Breaking the chain of leprosy transmission requires various ways, especially by increasing knowledge of leprosy prevention through health education. Although several studies have mentioned the effectiveness of health education, there is still uncertainty about the best method to use. Therefore, the review question should be answered: what forms of health education have been developed about Leprosy in the community? This review study complies with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) version 2020. The search for relevant literature involved PubMed, ScienceDirect, ERIC, Cochrane, and ProQuest databases for the studies published in the 2000 to 2023 period with the inclusion criteria such as increasing knowledge, changing attitudes and behavior, and increasing positive stigma. The quality of the study was assessed using the Critical Appraisal Skills Program, and the Risk of Bias using the Cochrane RoB tool. Overall search on databases resulted in a total of 184,681 articles. Only six studies were eligible to be included in this review. Various educational methods were used in the eligible studies, including MH Mobile, the myth or truth on Leprosy game, posters, leaflets, community meetings, tele-education: the web, discussion lists, chats, activity diaries, iconographic 3D videos, classes on video streaming, video conference, case simulation, lecture, and the contact intervention (education, testimonies (direct contact), videos, and comics). All of the methods used had the potential to improve knowledge, attitude, and practice and reduce negative stigma regarding Leprosy. There is no method of health education superior to another on Leprosy prevention. [ABSTRACT FROM AUTHOR]

Leprosy is a neglected tropical disease that can cause physical injury and mental disability. Diagnosis is primarily clinical, but can be inconclusive due to the absence of initial symptoms and similarity to other dermatological diseases. Artificial intelligence (AI) techniques have been used in dermatology, assisting clinical procedures and diagnostics. In particular, AI-supported solutions have been proposed in the literature to aid in the diagnosis of leprosy, and this Systematic Literature Review (SLR) aims to characterize the state of the art. This SLR followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework and was conducted in the following databases: ACM Digital Library, IEEE Digital Library, ISI Web of Science, Scopus, and PubMed. Potentially relevant research articles were retrieved. The researchers applied criteria to select the studies, assess their quality, and perform the data extraction process. Moreover, 1659 studies were retrieved, of which 21 were included in the review after selection. Most of the studies used images of skin lesions, classical machine learning algorithms, and multi-class classification tasks to develop models to diagnose dermatological diseases. Most of the reviewed articles did not target leprosy as the study's primary objective but rather the classification of different skin diseases (among them, leprosy). Although AI-supported leprosy diagnosis is constantly evolving, research in this area is still in its early stage, then studies are required to make AI solutions mature enough to be transformed into clinical practice. Expanding research efforts on leprosy diagnosis, coupled with the advocacy of open science in leveraging AI for diagnostic support, can yield robust and influential outcomes. [ABSTRACT FROM AUTHOR]

Fixed duration multidrug therapy (FDT–12 months) is recommended by the WHO for multibacillary (MB) Hansen's disease (HD). However, highly bacillated patients tend to experience problems such as painful neuritis, worsening nerve function, delayed regression of lesions, and relapses. There is also concern about the increasing rate of relapse and antimicrobial resistance. Persistent or slowly regressing skin lesions and disabilities can occur even after completion of treatment. The decline in expertise to diagnose and treat Hansen's disease and poor treatment adherence are additional challenges. It is suggested that prolonging antimicrobial therapy, adding immunotherapy, increasing the dosage of rifampicin, adding more potent bactericidal drugs, and improving diagnostic services and treatment adherence may help manage highly bacillated patients. [Extracted from the article]

Introduction: Lucio leprosy is a non-nodular diffuse type of lepromatous leprosy first described by Lucio and Alvarado. Lucio phenomenon is a rare vasculonecrotic reaction characterized by cutaneous necrosis with minimal constitutional features. Case Presentation: We describe an unusual case of a 53-year-old man from Central India who had blisters, ulcers, and widespread erosions on his foot, forearms, and arms. The diagnosis of lepromatous leprosy with the Lucio phenomenon was established after thorough evaluation by clinical findings, histopathological findings, and slit-skin smear examination. Conclusion: Lucio phenomenon is an uncommon cause of cutaneous infarction and necrosis. Primary care physicians should keep a high index of suspicion in patients with cutaneous necrosis and minimal constitution features. Since leprosy is a relatively curable disease, primary care physicians should think of a rare form of lepromatous leprosy presenting with cutaneous necrosis, especially in non-endemic zones. [ABSTRACT FROM AUTHOR]

This article is a reflection from a person with lived experience of leprosy, who has been working as a global advocate and champion for the rights of persons affected by neglected tropical diseases for the last decade. Synthesising learning from the collection of pieces included within this special supplement that are written from the perspective of people affected by neglected tropical diseases, I argue that it is time to centre the lived experiences of people affected by neglected tropical diseases. These are diseases of neglected people, and it is now time to let them talk while we listen. [ABSTRACT FROM AUTHOR]

This document is a response letter to an article titled "Coinfection with Leprosy and Tuberculosis: A Case Series in Malagasy Patients." The authors congratulate the researchers for their study on the coinfection of leprosy and tuberculosis in Madagascar. However, they suggest adding serology data to confirm the infections, as serological testing is a valid and sensitive diagnosis for leprosy. They also recommend including bacteriological data on tuberculosis, as culturing is the gold standard for diagnosing tuberculosis infection. The authors express their gratitude and look forward to further research on mycobacterial coinfections. [Extracted from the article]