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Volume 25, Number 2—February 2019
Letter

Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas

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To the Editor: Virk et al. (1) reported a Mycobacterium lepromatosis infection in a US citizen with a history of multiple international travels and concluded that M. lepromatosis lepromatous leprosy is a travel-related hazard for travelers to endemic areas. The conclusions drawn, however, need extensive support of thoroughly conducted case studies before generalizing M. lepromatosis as a travel-related hazard.

In the case report, the exact source of M. lepromatosis infection was unclear. Moreover, experimental evidence used in this work are not enough to prove that M. lepromatosis is a travel-related hazard. Confirming a source of infection by DNA fingerprinting of M. lepromatosis can be ideal to rule out infection from unreported native patients or environmental reservoirs (2).

It is possible that the patient in this report may have contracted M. lepromatosis infection as a result of his host-susceptible genetic factors. Host genetic susceptibility to leprosy is complicated because of the genetics of M. lepromatosis, interaction between genetic and environmental factors, gene–gene interactions, and ethnicity (3). Host genetics plays a major role in determining a person’s risk of developing clinical leprosy. Thus, even a short trip to a leprosy-endemic country is sufficient for a host susceptible to M. lepromatosis to acquire an infection. The host immune response influences the course of leprosy infection; it is challenging to understand the genetics of disease susceptibility and immunopathogenesis of leprosy (4,5).

With an inference of only a single case study, it is hard to say that M. lepromatosis lepromatous leprosy is a travel-related hazard for all US citizens. More surveillance data, such as patients’ immunity toward the disease, their genetic susceptibility, and travel history, are needed to explore the travel-related hazard. In addition, evolutionary knowledge and how widely the disease is circulating in nonendemic regions will help in understanding the nature of the disease.

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Gaurav SharmaComments to Author  and Vishnu Dutt Sharma

Author affiliations: University of Miami, Miami, Florida, USA (G. Sharma); National Jalma Institute for Leprosy and Other Mycobacterial Diseases, Agra, India (V.D. Sharma)

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References

  1. Virk  A, Pritt  B, Patel  R, Uhl  JR, Bezalel  SA, Gibson  LE, et al. Mycobacterium lepromatosis lepromatous leprosy in US citizen who traveled to disease-endemic areas. Emerg Infect Dis. 2017;23:18646. DOIPubMed
  2. Singh  P, Benjak  A, Schuenemann  VJ, Herbig  A, Avanzi  C, Busso  P, et al. Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis. Proc Natl Acad Sci U S A. 2015;112:445964. DOIPubMed
  3. Pinheiro  RO, de Souza Salles  J, Sarno  EN, Sampaio  EP. Mycobacterium leprae–host-cell interactions and genetic determinants in leprosy: an overview. Future Microbiol. 2011;6:21730. DOIPubMed
  4. Araújo  S, Lobato  J, Reis  EM, Souza  DOB, Gonçalves  MA, Costa  AV, et al. Unveiling healthy carriers and subclinical infections among household contacts of leprosy patients who play potential roles in the disease chain of transmission. Mem Inst Oswaldo Cruz. 2012;107(Suppl 1):559. DOIPubMed
  5. Blake  LA, West  BC, Lary  CH, Todd  JR IV. Environmental nonhuman sources of leprosy. Rev Infect Dis. 1987;9:56277. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2502.171895

Original Publication Date: 1/7/2019

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Table of Contents – Volume 25, Number 2—February 2019

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Gaurav Sharma, Department of Chemistry, University of Miami, 1301 Memorial Dr, Coral Gables, FL 33146, USA

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Page created: January 18, 2019
Page updated: January 18, 2019
Page reviewed: January 18, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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