Systematic Review of Hansen Disease Attributed to Mycobacterium lepromatosis

Abstract

In 2008, bacilli from 2 Hansen disease (leprosy) cases were identified as a new species, Mycobacterium lepromatosis. We conducted a systematic review of studies investigating M. lepromatosis as a cause of HD. Twenty-one case reports described 27 patients with PCR-confirmed M. lepromatosis infection (6 dual M. leprae/M. lepromatosis): 10 case-patients in the United States (7 originally from Mexico), 6 in Mexico, 3 in the Dominican Republic, 2 each in Singapore and Myanmar, and 1 each in Indonesia, Paraguay, Cuba, and Canada. Twelve specimen surveys reported 1,098 PCR-positive findings from 1,428 specimens, including M. lepromatosis in 44.9% (133/296) from Mexico, 3.8% (5/133) in Colombia, 12.5% (10/80) in Brazil, and 0.9% (2/224) from the Asia-Pacific region. Biases toward investigating M. lepromatosis as an agent in cases of diffuse lepromatous leprosy or from Mesoamerica precluded conclusions about clinicopathologic manifestations and geographic distribution. Current multidrug treatments seem effective for this infection.

Keywords: Brazil; Hansen disease; Mexico; Mycobacterium lepromatosis; United States; bacteria; leprosy; mycobacteria; tuberculosis and other mycobacteria; zoonoses.

Figure 1

Flow diagram for studies included in literature review of Hansen disease attributed to Mycobacterium lepromatosis.

Figure 2

Types of Hansen disease and reactional states in reports included in literature review of PCR-confirmed cases attributed to M. lepromatosis. BL, borderline lepromatous leprosy; DLL, diffuse lepromatous leprosy; ENL, erythema nodosum leprosum (type 2 reaction); LL, lepromatous leprosy; LP, Lucio’s phenomenon (erythema necroticans, type 3 reaction)

Figure 3

Types of Hansen disease by case-patient sex in reports included in literature review of PCR-confirmed cases attributed to M. lepromatosis. BL, borderline lepromatous leprosy; DLL, diffuse lepromatous leprosy; LL, lepromatous leprosy.