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Transmission of Leprosy: A Study of Skin and Nasal Secretions of Household Contacts of Leprosy Patients Using PCR

It is generally held that dissemination of Mycobacterium leprae is from nasal mucosa and not through the skin of infected patients. In this study, we evaluated M. leprae in the unbroken skin and nasal secretions of multibacillary (MB) leprosy patients and their contacts. Specimens were examined by direct microscopy and polymerase chain reaction (PCR) for M. leprae DNA. Results showed that 60% of untreated MB leprosy patients examined histologically had acid-fast bacilli in the keratin layer. By PCR studies it was found that 80% of the patients had M. leprae DNA in skin washings and 60% had M. leprae DNA on swabs obtained from the nasal mucosa. Ninety-three contacts of the untreated MB cases were also tested for exposure to M. leprae by analyzing skin washings and nasal secretions by PCR. PCR analysis showed significant skin (17% positive) and nasal muscosal (4%) exposure in contacts before instituting treatment of the index cases. After 2 months of treating the index cases, all contacts tested were negative for M. leprae DNA. These data suggested that both skin and nasal epithelia of untreated MB leprosy patients contribute to the shedding of M. leprae into the environment and contacts of untreated MB cases are at risk for contact with M. leprae through both the nasal mucosa and exposed surfaces of their skin.

Received August 16, 2007. Accepted for publication December 7, 2007.

Acknowledgments: The authors acknowledge the technical assistance of Naoko Robbins and Cheryl Lewis and David M. Scollard for the photograph used in Figure 1.

Financial support: This study was supported in part by the American Leprosy Missions, Greenville, SC.

^* Address correspondence to Thomas P. Gillis, Laboratory Research Branch, National Hansen’s Disease Programs at LSU School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70893. E-mail: tgillis{at}lsu.edu

Authors’ addresses: Charles K. Job, St. Thomas Hospital and Leprosy Centre, Chettupattu 606801, Tiruvannamalai District, Tamil Nadu, India, Telephone: 0416-221055, Fax: 4181-252366. Joseph Jayakumar, St Thomas Hospital and Leprosy Centre, Chettupattu 606801, Tiruvannamalai District, Tamil Nadu, India, Telephone: 4181-252365, Fax: 4181-252366. Michael Kearney, Department of Pathobiology, LSU School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70893, Telephone: 225-578-9667, Fax: 225-578-9665. Thomas P. Gillis, Laboratory Research Branch, National Hansens ’ Disease Programs at LSU School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70893, Telephone: 225-578-9836, Fax: 225-578-9856.

Reprint requests: Thomas P. Gillis, Laboratory Research Branch, National Hansen’s Disease Programs at LSU School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70893.