Mallika Lavania1, Itu Singh2, Ravindra P Turankar2, Madhvi Ahuja2, Vinay Pathak2, Utpal Sengupta2, Loretta Das3, Archana Kumar4, Joydeepa Darlong5, Rajeev Nathan6, Asha Maseey7. 1. Stanley Browne Research Laboratory, The Leprosy Mission (TLM) Community Hospital, Nand Nagri, Shahdara, New Delhi 110093, India. Electronic address: mallika.lavania@leprosymission.in. 2. Stanley Browne Research Laboratory, The Leprosy Mission (TLM) Community Hospital, Nand Nagri, Shahdara, New Delhi 110093, India. 3. The Leprosy Mission Hospital, Naini, Uttar Pradesh, India. 4. The Leprosy Mission Bethesda Hospital, Champa, Chhattisgarh 495 67, India. 5. The Leprosy Mission Home & Hospital, Purulia, West Bengal 723 101, India. 6. TLM Community Hospital Nand Nagri, Shahdara, Delhi 110093, India. 7. TLM Kothara Community Hospital, Kothara, Maharashtra 444 805, India.
Abstract
OBJECTIVES: The emergence of multidrug-resistant (MDR) organisms for any infectious disease is a public health concern. Global efforts to control leprosy by intensive chemotherapy have led to a significant decrease in the number of registered patients. Currently recommended control measures for treating leprosy with multidrug therapy (MDT) were designed to prevent the spread of dapsone-resistant Mycobacterium leprae strains. Here we report the identification of MDR M. leprae from relapse leprosy patients from endemic regions in India. METHODS: Resistance profiles to rifampicin, dapsone and ofloxacin of the isolated strains were confirmed by identification of mutations in genes previously shown to be associated with resistance to each drug. Between 2009-2016, slit-skin smear samples were collected from 239 relapse and 11 new leprosy cases from hospitals of The Leprosy Mission across India. DNA was extracted from the samples and was analysed by PCR targeting the rpoB, folP and gyrA genes associated with resistance to rifampicin, dapsone and ofloxacin, respectively, in M. leprae. M. leprae Thai-53 (wild-type) and Zensho-4 (MDR) were used as reference strains. RESULTS: Fifteen strains showed representative mutations in at least two resistance genes. Two strains showed mutations in all three genes responsible for drug resistance. Seven, seven and one strain, respectively, showed mutations in genes responsible for rifampicin and dapsone resistance, for dapsone and ofloxacin resistance and for rifampicin and ofloxacin resistance. CONCLUSION: This study showed the emergence of MDR M. leprae in MDT-treated leprosy patients from endemic regions of India.
OBJECTIVES: The emergence of multidrug-resistant (MDR) organisms for any infectious disease is a public health concern. Global efforts to control leprosy by intensive chemotherapy have led to a significant decrease in the number of registered patients. Currently recommended control measures for treating leprosy with multidrug therapy (MDT) were designed to prevent the spread of dapsone-resistant Mycobacterium leprae strains. Here we report the identification of MDR M. leprae from relapse leprosypatients from endemic regions in India. METHODS: Resistance profiles to rifampicin, dapsone and ofloxacin of the isolated strains were confirmed by identification of mutations in genes previously shown to be associated with resistance to each drug. Between 2009-2016, slit-skin smear samples were collected from 239 relapse and 11 new leprosy cases from hospitals of The Leprosy Mission across India. DNA was extracted from the samples and was analysed by PCR targeting the rpoB, folP and gyrA genes associated with resistance to rifampicin, dapsone and ofloxacin, respectively, in M. leprae. M. leprae Thai-53 (wild-type) and Zensho-4 (MDR) were used as reference strains. RESULTS: Fifteen strains showed representative mutations in at least two resistance genes. Two strains showed mutations in all three genes responsible for drug resistance. Seven, seven and one strain, respectively, showed mutations in genes responsible for rifampicin and dapsone resistance, for dapsone and ofloxacin resistance and for rifampicin and ofloxacin resistance. CONCLUSION: This study showed the emergence of MDR M. leprae in MDT-treated leprosypatients from endemic regions of India.
Authors: Patrícia S Rosa; Helena R S D'Espindula; Ana C L Melo; Amanda N B Fontes; Amanda J Finardi; Andréa F F Belone; Beatriz G C Sartori; Carla A A Pires; Cleverson T Soares; Flávio B Marques; Francisco J D Branco; Ida M F D Baptista; Lázara M Trino; Luciana R V Fachin; Marília B Xavier; Marcos C Floriano; Somei Ura; Suzana M Diório; Wladimir F B Delanina; Milton O Moraes; Marcos C L Virmond; Philip N Suffys; Marcelo T Mira Journal: Clin Infect Dis Date: 2020-05-06 Impact factor: 9.079