Challenges in Diagnosis of Extrapulmonary Tuberculosis

Even in the era of twenty-first century tuberculosis is still considered as a major health burden around the globe particularly around the Indian sub-continent. Though Pulmonary system is the principal site for Mycobacterium but extra-pulmonary involvement is not so common. Extra-pulmonary involvement can be seen in isolation or even with pulmonary involvement also. Immunocompromised individuals like HIV-affected individuals carries a greater risk for disseminated tuberculosis with involvement of multiple extra-pulmonary sites but Immunocompetent persons also can develop extra-pulmonary manifestation. Among all sites, Lymph nodes are the commonest in extra-pulmonary involvement. Though conventional Sputum smear examination and culture sensitivity is still reliable in diagnosis of pulmonary tuberculosis but are less helpful in extra-pulmonary cases due to its paucibacillary nature. Modern molecular methods in background of strong clinical suspicion with or without radiological evidences forms the pathway to confirm the diagnosis. These Diagnostic difficulty makes the delay in response to treatment in these patients

A case report of leprosy reaction combined with bullous pemphigoid after treatment of paucibacillary leprosy / 上海预防医学

ObjectiveTo investigate the clinical characteristics of leprosy-related neuritis with bullous pemphigoid after treatment of paucibacillary leprosy. MethodsThe treatment of leprosy reaction combined with bullous pemphigoid of a cured case of leprosy was analysed. ResultsFive years after standard treatment for leprosy， erythema and vesicles appeared in the limbs without obvious inducement， and the disease became more and more severe. With clinical diagnosis and pathological examination， pemphigoid was confirmed， and the patients were given hormone treatment for leprosy reaction and anti-immunotherapy， as well as symptomatic supportive treatment. ConclusionLeprosy reaction and pemphigoid are both related to immunity， but the occurrence of both at the same time is relatively rare， so in the clinical process we should attach great importance to early detection， early diagnosis and prompt treatment to prevent further harm to the patient.

A clinical study of association of genital tuberculosis with infertility in a tertiary centre of Jharkhand, India

Background: The worldwide incidence of GTB is approximately 5- 10% in infertile women. It varies from as low as 0.69% in some developed countries to as high as 19% in India. It is diagnosed by culture of the tubercle bacillus from tissue sampled from the genital tract is the yardstick for diagnosis and remains the gold standard.Methods: A prospective study was carried out between January 2012 and January 2015 on 100 women presenting with infertility.Results: A total (27%) women were diagnosed as genital tuberculosis by combination of hystero laparoscopic findings, histopathological and endometrial DNA-PCR technique confirmation. Of these (40.62%) had secondary infertility and remaining (59.38%) had primary infertility. (15.62%) were previously diagnosed with pulmonary or extra pulmonary tuberculosis and had completed a full course of Anti-tubercular treatment as per WHO CAT 1 regime.Conclusions: Therefore, in countries where TB is endemic, early and aggressive strategies should be pursued to diagnose and treat TB.

A Ten Year Study of Pediatric Leprosy Cases in a Tertiary Care Centre in South Kerala

Leprosy in children is a valuable marker of impact of programme. This study has been carried out to analyse the clinical and histopathological characteristics of pediatric leprosy cases attending a tertiary health care centre in South Kerala bordering Tamil Nadu. This is a retrospective, analytical study of pediatric leprosy cases seen from 01 January 2007 to 31 December 2016 in the Dermatology out-patient department of Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala. Seven of the 52 leprosy cases in this hospital during this study period children (age group of 6 to 14), of which 6 were females. Two cases among these were borderline lepromatous and the rest were indeterminate leprosy. Three patients had contact with lepromatous leprosy (familial). Histopathology correlated well with our clinical diagnosis. Grade 2 deformity was seen in one child, who had taken incomplete treatment earlier. While the number of cases reporting to this centre may or may not reflect true epidemiological picture at population level, data may be used to plan proper research cum intervention studies. The prevalence of childhood leprosy can be reduced if we are vigilant and improve the surveillance of contacts, as 43% of cases in this study had a contact of leprosy in the family.

Epidemiological profile of leprosy reactions in a referral center in Campinas (SP), Brazil, 2010-2015

Abstract: Leprosy patients can present reactions during the course of the disease. There are no official data on these reactions in Brazil. We aimed to describe the epidemiological characteristics of patients with such reactions, analyzing information from patient records at a referral center in Campinas (SP), from 2010 to 2015.

Childhood Leprosy in an Endemic Area of Central India.

Objective: To study clinical-epidemiological aspects of children affected with leprosy in a high-endemicity area. Methods: Hospital-based study (April 2010 to March 2015) of newly diagnosed children (£18 years) with leprosy, from a leprosy research institute in Chhattisgarh, India. Results: 551 new childhood cases were diagnosed constituting 16% of the total newly leprosy cases examined; 221 (40.1%) were multibacillary cases with 11.2% smear positivity. 243 (44.1%) had known contact history of leprosy, 17.6% of children developed Lepra reaction, and 17.4% had visible deformity. 68% of subjects completed treatment within the prescribed time. Conclusion: Transmission of leprosy is still continuing in the area, and high disability and deformity rates are seen in children.

Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination.

Background: Leprosy, a chronic disease caused by Mycobacterium leprae, is a public health concern in certain countries, including India. Although the prevalence of the disease has fallen drastically over time, new cases continue to occur at nearly the same rate in many regions. Several endemic pockets have been observed in India and elsewhere. The precise dynamics of leprosy transmission are still not clearly understood. Both live bacilli as well as M. leprae DNA have been detected in the soil and water of endemic areas; they possibly play an important role in disease transmission. Aims: To study the occurrence of viable M. leprae in environmental samples collected from areas of residence of patients with active leprosy. Methods: The study was conducted on 169 newly diagnosed leprosy patients in Ghatampur, Uttar Pradesh, India. Soil and water samples were collected from their areas of residence using a standardized protocol. An equal number of soil and water samples were also collected from non-patient areas of the same or adjoining villages. The environmental samples collected from the patients surroundings were subjected to 16S ribosomal RNA gene analysis after obtaining informed consent. Results: About a quarter of the environmental samples collected from patient areas, (25.4% of soil samples and 24.2% of water samples) were found to be positive for specifi c 16S ribosomal RNA genes of M. leprae. Environmental samples collected from non-patient areas were all found negative for M. leprae 16S ribosomal RNA genes. Limitations: The major limitation of the study was that the sample size was small. Conclusion: The study demonstrated the presence of viable strains of M. leprae in skin smear samples of paucibacillary patients and multibacillary patients, as well as in the environmental samples obtained from around their houses. This could play an important role in the continued transmission of leprosy.

Leprosy in a University Hospital in Southern Brazil

AbstractBACKGROUND:Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVES:To evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODS: This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTS:The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONS:This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.

A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India.

To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT) with monthly rifampicin, ofl oxacin, and minocycline for six months (ROM-6) among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001–2004, who had paucibacillary (PB) leprosy having 1–5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the fi rst day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for fi rst 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Chi square test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not signifi cant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group) giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053; statistically not signifi cant). Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6), 4 during 5–8 years (3 in PB-MDT and 1 in ROM-6), and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional diffi culties in the fi eld. Conclusion: The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate.

Diagnostic challenges of single plaque-like lesion paucibacillary leprosy

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.

Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients

The present study analysed the concordance among four different molecular diagnostic methods for tuberculosis (TB) in pulmonary and blood samples from immunocompromised patients. A total of 165 blood and 194 sputum samples were collected from 181 human immunodeficiency virus (HIV)-infected patients with upper respiratory complaints, regardless of suspicious for TB. The samples were submitted for smear microscopy, culture and molecular tests: a laboratory-developed conventional polymerase chain reaction (PCR) and real-time quantitative PCR (qPCR) and the Gen-Probe and Detect-TB Ampligenix kits. The samples were handled blindly by all the technicians involved, from sample processing to results analysis. For sputum, the sensitivity and specificity were 100% and 96.7% for qPCR, 81.8% and 94.5% for Gen-Probe and 100% and 66.3% for Detect-TB, respectively. qPCR presented the best concordance with sputum culture [kappa (k) = 0.864)], followed by Gen-Probe (k = 0.682). For blood samples, qPCR showed 100% sensitivity and 92.3% specificity, with a substantial correlation with sputum culture (k = 0.754) and with the qPCR results obtained from sputum of the corresponding patient (k = 0.630). Conventional PCR demonstrated the worst results for sputa and blood, with a sensitivity of 100% vs. 88.9% and a specificity of 46.3% vs. 32%, respectively. Commercial or laboratory-developed molecular assays can overcome the difficulties in the diagnosis of TB in paucibacillary patients using conventional methods available in most laboratories.

Hanseníase: pauci e multibacilares estão sendo diferentes? / Leprosy: are pauci and multibacillary being diferent?

Modelo do estudo: Estudo observacional descritivo transversal. Introdução: A estratégia atual de controle da hanseníase preconizada pela Organização Mundial da Saúde é baseada no respectivo tratamento segundo classificação operacional, se multibacilar ou paucibacilar. Objetivo: Comparar perfis de hansenianos de ambas as formas atendidos em Unidade Hospitalar. Metodologia: Coleta de dados em Fichas de Investigação de Hanseníase do Sistema de Informação de Agravos de Notificação, no Hospital e Maternidade Celso Pierro, PUC Campinas, anos 2007 a 2011. Registro em planilha codificada, armazenamento em banco de dados específico, e processamento estatístico por meio do SPSS. Associações de variáveis investigadas pela prova de Goodman para contraste entre e intra populações multinomiais e pelo teste não-paramétrico de Mann-Whitney, ao nível de 5% de significância. Resultados: Averiguaram-se 57 casos novos, obtendo-se 14 paucibacilares e 43 multibacilares com indicadores compatíveis com o esperado. No entanto, constataram-se, entre as inconsistências apuradas: i) cinco registros de recidiva, os quais não se confirmaram nosograficamente; ii) caso multibacilar tratado como paucibacilar; iii) quanto a modo de detecção, frequências assemelhadas de encaminhamento e demanda espontânea entre os multibacilares; iv) predomínio de grau zero de incapacidade entre paucibacilares, majoritariamente tuberculóides. Conclusões: Estes resultados indicam a necessidadede vigilância epidemiológica permanente visando à interlocução entre a rede básica e os centros de referência quanto aos procedimentos de controle, com vistas à adequação da gestão técnica dos respectivos Serviços de Saúde.

Study design: Cross sectional descriptive observational study. Introduction: Present strategy for leprosy control according to World Health Organization is based on respective treatment for pauci or multibacillary patients. Objectives: To compare leper’s profiles cared by an university hospital. Materials and Method: Data collected from Leprosy Notification Protocols, Information System for Notifiable Diseases, Celso Pierro Hospital and Maternity, PUC Campinas, years 2007 to 2011. Registers on codified sheets, storagein specific data base and statistical processing by SPSS program. Associations by Goodman’s test for contrasts among multinomial populations and by non-parametric Mann-Whitney’s, at 5% significance level. Results: 57 new cases have been ascertained, 14 paucibacillary and 43 multibacillary, showing clinical epidemiologic behaviors as expected. Nevertheless, inconsistencies have been observed, as: i) five cases of relapse registered, but not clinically confirmed; ii) a multibacillary case treated as paucibacillary; iii) in relation to forms of detection, similar frequencies of recommendation and spontaneous demand in the multibacillary group; iv) predominance of grade zero disabilities in the paucibacillary group. Conclusions: Results point to the necessity of permanent epidemiological surveillance on leprosy control in order to keep enough dialogue between basic units and reference centers.

Indeterminate leprosy and lepromatous index case: four cases in the same family / Hanseniase indeterminada e caso indice virchowiano: 4 casos na mesma familia

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. Brazil remains as the country with the second largest number of cases in the world. We report the case of three patients diagnosed with indeterminate leprosy in the same family. Two patients were HIV positive. An active search led to the discovery of the index case. It was crucial to persist in the search of the index case. This report shows how important it is to teach physicians and the general population about the signs and symptoms of leprosy. Early diagnosis and treatment are necessary to prevent sequelae and to eliminate the disease as a public health problem.

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que afeta principalmente a pele e nervos periféricos. O Brasil continua sendo o segundo país do mundo com maior número de casos. Aqui relatamos três pacientes diagnosticados com hanseníase indeterminada, pertencentes à mesma família, cuja busca ativa levou à descoberta do caso índice. Dois pacientes eram HIV positivos. Foi de imensa importância a insistência na procura pelo caso índice. Este relato ilustra a importância do ensino sobre sinais e sintomas de hanseníase na formação médica e à população. O pronto reconhecimento e tratamento são necessários para prevenir sequelas e eliminar a doença como problema de saúde pública.

Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy / Compreender melhor o estado reacional tipo 1 para o diagnostico e tratamento precoces: uma forma de se evitar as incapacidades na hanseniase

A type 1 reaction or reversal reaction is expressed clinically by inflammatory exacerbation of the skin lesions and nerve trunks, consequently leading to sensory and motor alterations. It occurs in non-polar forms of leprosy, although it can occur in a small percentage of sub-polar LL treated patients. Disabilities, deformities and morbidity, still present in leprosy, are mainly caused by these acute episodes. The recognition of reactional states is imperative for an early approach and efficient management, to avoid the emergence of disabilities that stigmatize the disease. This review aims to describe the clinical aspects, immunopathogenesis, epidemiology, histopathological features and therapeutics of type 1 reactions.

A reação do tipo 1 ou reação reversa expressa-se clinicamente por uma exacerbação inflamatória das lesões de pele e de troncos nervosos, levando a alterações sensitivas e motoras. Ocorre nas formas não-polares da hanseníase, embora possa ocorrer numa pequena percentagem de pacientes LL tratados. As incapacidades físicas, deformidades e morbidade, ainda presentes na hanseníase, são causadas principalmente por esses episódios agudos. O reconhecimento dos estados reacionais é imperativo para uma abordagem precoce e manejo adequado, evitando a instalação de incapacidades que tanto estigmatizam a doença. Esta revisão tem como objetivo descrever aspectos clínicos, imunopatogênese, epidemiologia, características histopatológicas e terapêutica do estado reacional do tipo 1.

Leprosy - evolution of the path to eradication.

Leprosy is among the world’s oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system. All these provisions in the integrated health care approach will go a long way in further reducing the stigma. Efforts need to be made to reduce deformity through early detection, self care, physiotherapy and reconstructive surgery and developing sound surveillance systems. With all the remarkable achievements in the fight against leprosy, the stage is now set for the final assault. It is hoped that with the efforts of all the stake holders and strong political will, the disease will be eradicated in the near future.

Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects

This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.

Concordance between expected and observed bacilloscopy results of clinical forms of leprosy: a 6-year retrospective study in Recife, State of Pernambuco, Brazil / Concordância entre os resultados observados e esperados da forma clinica da hanseníase de acordo com a baciloscopia: um estudo retrospectivo de seis anos em Recife, Estado de Pernambuco, Brasil

INTRODUCTION: Operational classification of leprosy based on the number of skin lesions was conceived to screen patients presenting severe forms of the disease to enable their reception of a more intense multidrug regimen without having to undergo lymph smear testing. We evaluated the concordance between operational classification and bacilloscopy to define multibacillary and paucibacillary leprosy. METHODS: We selected 1,213 records of individuals with leprosy, who were untreated (new cases) and admitted to a dermatology clinic in Recife, Brazil, from 2000 to 2005, and who underwent bacteriological examination at diagnosis for ratification of the operational classification. RESULTS: Compared to bacilloscopy, operational classification demonstrated 88.6% sensitivity, 76.9% specificity, a positive predictive value of 61.8%, and a negative predictive value of 94.1%, with 80% accuracy and a moderate kappa index. Among the bacilloscopy-negative cases, 23% had more than 5 skin lesions. Additionally, 11% of the bacilloscopy-positive cases had up to 5 lesions, which would have led to multibacillary cases being treated as paucibacillary leprosy if the operational classification had not been confirmed by bacilloscopy. CONCLUSIONS: Operational classification has limitations that are more obvious in borderline cases, suggesting that in these cases, lymph smear testing is advisable to enable the selection of true multibacillary cases for more intense treatment, thereby contributing to minimization of resistant strain selection and possible relapse.

INTRODUÇÃO: A classificação operacional da hanseníase baseada no número de lesões de pele foi concebida para selecionar pacientes que apresentam formas graves da doença para receber regime terapêutico mais intenso com múltiplas drogas sem o exame de baciloscopia da linfa. Nós avaliamos a concordância entre a classificação operacional e a baciloscopia para a definição de hanseníase multibacilar e paucibacilar. MÉTODOS: Nós selecionamos 1.213 registros de indivíduos com hanseníase não tratada (casos novos), atendidos em um Ambulatório de Dermatologia, em Recife, Brasil, no período de 2000 a 2005, que foram submetidos a exame bacteriológico ao diagnóstico para a ratificação da classificação operacional. RESULTADOS: Comparando com a baciloscopia, a classificação operacional baseada no número de lesões cutâneas mostrou sensibilidade de 88,6%, especificidade 76,9%, valor preditivo positivo de 61,8% e valor preditivo negativo de 94,1%, com uma precisão de 80% e um moderado índice kappa. Entre os casos com baciloscopia negativa, 23% tinham mais de cinco lesões de pele, recebendo um tratamento mais intensivo. Além disso, 11% dos casos baciloscopia positiva tinham até cinco lesões, o que induziriam casos multibacilares de serem tratados com hanseníase paucibacilar se a classificação operacional não tivesse sido confirmada pela baciloscopia. CONCLUSÕES: Concluímos que a classificação operacional tem limitações mais visíveis nos casos borderline, sugerindo que, nestes casos, o esfregaço seria aconselhável por permitir que os verdadeiros casos multibacilares fossem selecionados para um tratamento mais intenso, contribuindo para minimizar a seleção de cepas resistentes e uma possível recidiva.

Lepra: enfermedad milenaria y actual / Leprosy: an ancient and present-day disease

El desconocimiento de la lepra es común en la población general al igual que entre los médicos y el personal de la salud. Se cree que esta enfermedad ya no existe; tal vez su imagen bíblica y milenaria refuerce la idea de su eliminación. Sin embargo, la lepra continúa siendo un problema de salud pública en varios países; entre los más afectados están India y Brasil. Después del inicio de la poliquimioterapia (PQT) en la novena década del siglo XX la prevalencia de la lepra disminuyó considerablemente pero no ocurrió lo mismo con la incidencia, lo que se atribuye al poco impacto de dicho tratamiento sobre el control de la transmisión y a la existencia de un reservorio aún no identificado con exactitud. Los convivientes de los leprosos tienen alto riesgo de sufrir la enfermedad en cualquier momento de la vida, pero hasta ahora no se ha podido determinar cuáles convivientes infectados desarrollarán la enfermedad. En Colombia se informan de 400 a 550 casos de lepra cada año, lo cual sugiere que la transmisión del Mycobacterium leprae continúa a pesar de que el país está considerado en la fase de poseliminación. Este artículo presenta una revisión histórica de la lepra desde los primeros informes disponibles hasta los avances moleculares más recientes. Incluye cómo ha evolucionado la comprensión de la enfermedad, su caracterización clínica, las medidas de control y saneamiento, el tratamiento y la epidemiología.

Ignorance about leprosy is common both in the general population and among physicians and health personnel. It is believed that this disease no longer exists. Perhaps its image as a biblic and ancient scourge reinforces the idea of its elimination. However, leprosy continues to be a public health problem in several countries; among the most affected are India and Brazil. After multidrug therapy (MDT) started during the ninth decade of the XX century prevalence of leprosy dramatically decreased. Incidence, however, did not follow the same trend, probably because of the low impact of MDT on transmission, and the existence of an as yet unidentified reservoir. Familial contacts of leprosy patients are at high risk of suffering the disease at any moment in their lives. So far it has not been possible to determine which ones of the infected contacts will develop the disease. Between 400 and 550 cases of leprosy are reported every year in Colombia. This fact suggests that transmission of Mycobacterium leprae still occurs despite the country being classified as in the postelimination phase. This article presents a historical review on leprosy from the earliest available reports to the more recent advances in the molecular understanding of the disease and its agent. It includes how the comprehension about it has evolved, its clinical characterization, public health control measures, therapy and epidemiology.