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Leprosy in a low-incidence setting

Case report relevant to metagenomic next generation sequencing applications

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Summary

Leprosy is a disease caused by Mycobacterium leprae that results in disability. In 2000 the World Health Organization announced that leprosy had been eradicated. In nonendemic areas diagnosing leprosy is becoming a challenge for inexperienced clinicians. This case involves a male patient suffering from chronic numbness, hand deformity and recurrent erythema. Skin biopsy revealed granuloma and acid-fast staining of short-rod bacteria. Peripheral venous blood was subjected to metagenomic next generation sequencing and bioinformatics analysis, which revealed 3 unique sequence reads of M. leprae. Paraffin-embedded tissue and fresh samples scraped from skin lesions were subjected to in-house PCR targeting 16S rRNA, hsp65, rpoB, rpoT, ribF-rpsO, and mmaA. Sanger sequencing of amplicons from fresh samples and paraffin-embedded tissue verified the presence of M. leprae. For inexperienced clinicians in nonendemic areas nucleic acid amplification tests, such as in-house PCR, are helpful for diagnosing leprosy but sequence reads from metagenomic next generation sequencing may also provide evidence when interpreted cautiously.

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References

  1. Rodrigues LC, Lockwood DNJ. Leprosy now: epidemiology, progress, challenges, and research gaps. Lancet Infect Dis. 2011;11:464–70.

    Article  Google Scholar 

  2. World Health Organization. The final push strategy to eliminate leprosy as a public health problem. Questions and answers. 2nd ed. Geneva: World Health Organization; 2003.

    Google Scholar 

  3. World Health Organization. Weekly epidemiological record (WER). 2013. https://www.who.int/wer/2013/wer8835/. Accessed 30 Aug 2013.

  4. Liu YY, Ning Y, Wang H, Xiong JH. Epidemiological analysis of leprosy in Sichuan China from 2000 to 2014. Chin J Derm Venereol. 2016;30:362–5.

    Google Scholar 

  5. Simner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases. Clin Infect Dis. 2018;66:778–88.

    Article  CAS  Google Scholar 

  6. Han XY, Seo YH, Sizer KC, et al. A new Mycobacterium species causing diffuse lepromatous leprosy. Am J Clin Pathol. 2008;130:856–64.

    Article  CAS  Google Scholar 

  7. Smith CS, Aerts A, Saunderson P, et al. Multidrug therapy for leprosy: a game changer on the path to elimination. Lancet Infect Dis. 2017;17:e293–7.

    Article  Google Scholar 

  8. Rao PN. Global leprosy strategy 2016–2020: Issues and concerns. Indian J Dermatol Venereol Leprol. 2017;83:4–6.

    Article  Google Scholar 

  9. Gupta L, Zanwar A, Wakhlu A, Agarwal V. Leprosy in the rheumatology clinic: an update on this great mimic. Int J Rheum Dis. 2016;19:941–5.

    Article  Google Scholar 

  10. Haroon N. Does a positive HLA-B27 test increase your risk of mortality? J Rheumatol. 2015;42:559–60.

    Article  CAS  Google Scholar 

  11. Ebringer A. The cross-tolerance hypothesis, HLA B27 and ankylosing spondylitis. Br J Rheumatol. 1983;22(2):53–66.

    Article  CAS  Google Scholar 

  12. Reis EM, Araujo S, Lobato J, et al. Mycobacterium leprae DNA in peripheral blood may indicate a bacilli migration route and high-risk for leprosy onset. Clin Microbiol Infect. 2014;20(5):447–52.

    Article  CAS  Google Scholar 

  13. Wen Y, Xing Y, Yuan LC, et al. Whole-blood nested-PCR amplification of M. leprae-specific DNA for early diagnosis of leprosy. Am J Trop Med Hyg. 2013;88:918–22.

    Article  CAS  Google Scholar 

  14. Li HN, Gao H, Meng H, et al. Detection of pulmonary infectious pathogens from lung biopsy tissues by metagenomic next-generation sequencing. Front Cell Infect Microbiol. 2018;8:205.

    Article  Google Scholar 

  15. Miao Q, Ma YY, Wang QQ, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice. Clin Infect Dis. 2018;67(2):S231–40.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Xuejing Gou and Yu Feng for their technical support and Xiaoju Lv for consultation. We are grateful to the patient and his family for their consent for sample collection and publication of this manuscript.

Funding

This study was supported by the Technology Support Program of Sichuan Provincial Science and Technology Agency, China (project no. 2018HH0031).

Author information

Authors and Affiliations

  1. Center for Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China

    Min Quan, Lina Liu, Taoyou Zhou, Xiaohui Wang & Zhiyong Zong

  2. Division of Infectious Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China

    Lina Liu, Xiaohui Wang & Zhiyong Zong

  3. Department of Pathology, West China Hospital of Sichuan University, Chengdu, China

    Yong Jiang

  4. Infection Prevention and Control Department, West China Hospital of Sichuan University, Chengdu, China

    Zhiyong Zong

Authors
  1. Min Quan
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  2. Lina Liu
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  3. Taoyou Zhou
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  4. Yong Jiang
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  5. Xiaohui Wang
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  6. Zhiyong Zong
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Corresponding author

Correspondence to Xiaohui Wang.

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Conflict of interest

M. Quan, L. Liu, T. Zhou, Y. Jiang, X. Wang, and Z. Zong declare that they have no competing interests.

Ethical standards

This study was approved by the Ethics Committee of West China Hospital. Consent was acquired from the patient to collect samples.

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Quan, M., Liu, L., Zhou, T. et al. Leprosy in a low-incidence setting. Wien Klin Wochenschr 132, 589–592 (2020). https://doi.org/10.1007/s00508-020-01644-7

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  • DOI: https://doi.org/10.1007/s00508-020-01644-7

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