Emergence and Transmission of Drug-/Multidrug-resistant Mycobacterium leprae in a Former Leprosy Colony in the Brazilian Amazon.

Autor:	Rosa PS; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., D'Espindula HRS; Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil., Melo ACL; Centro de Referência Nacional em Dermatologia Sanitária Dona Libânia, Fortaleza, Ceará, Brazil., Fontes ANB; Laboratory of Molecular Biology Applied in Mycobacteria, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Finardi AJ; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Belone AFF; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Sartori BGC; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Pires CAA; Core of Tropical Diseases, Universidade Federal do Pará, Belém, Brazil., Soares CT; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Marques FB; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Branco FJD; Centro de Referência Nacional em Dermatologia Sanitária Dona Libânia, Fortaleza, Ceará, Brazil., Baptista IMFD; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Trino LM; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Fachin LRV; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Xavier MB; Core of Tropical Diseases, Universidade Federal do Pará, Belém, Brazil.; Center for Biological and Health Sciences, Universidade do Estado do Pará, Belém, Brazil., Floriano MC; Department of Dermatology, Universidade Federal de São Paulo, Brazil., Ura S; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Diório SM; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Delanina WFB; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Moraes MO; Laboratory of Molecular Biology Applied in Mycobacteria, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Virmond MCL; Division of Research and Education, Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil., Suffys PN; Laboratory of Molecular Biology Applied in Mycobacteria, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Mira MT; Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2020 May 06; Vol. 70 (10), pp. 2054-2061.
DOI:	10.1093/cid/ciz570
Abstrakt:	Background: Leprosy has been treated with multidrug therapy, which has been distributed for free across the globe and regarded as highly efficient. However, the impossibility of growing Mycobacterium leprae in axenic media has historically impaired assessments of M. leprae resistance, a parameter only recently detectable through molecular methods. Methods: A systematic, population-based search for M. leprae resistance in suspected leprosy relapse cases and contacts was performed in Prata Village, an isolated, hyperendemic, former leprosy colony located in the Brazilian Amazon. Results led to an extended active search involving the entire Prata population. Confirmed leprosy cases were investigated for bacterial resistance using a combination of in vivo testing and direct sequencing of resistance genes folP1, rpoB, and gyrA. A molecular epidemiology analysis was performed using data from 17 variable number tandem repeats (VNTR). Results: Mycobacterium leprae was obtained from biopsies of 37 leprosy cases (18 relapses and 19 new cases): 16 (43.24%) displayed drug-resistance variants. Multidrug resistance to rifampicin and dapsone was observed in 8 relapses and 4 new cases. Single resistance to rifampicin was detected in 1 new case. Resistance to dapsone was present in 2 relapses and 1 new case. Combined molecular resistance and VNTR data revealed evidence of intra-familial primary transmission of resistant M. leprae. Conclusions: A comprehensive, population-based systematic approach to investigate M. leprae resistance in a unique population revealed an alarming scenario of the emergence and transmission of resistant strains. These findings may be used for the development of new strategies for surveillance of drug resistance in other populations. (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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