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Volume 26, Number 8—August 2020
Letter

Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China

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To the Editor: Chen et al. (1) reported intact Mycobacterium leprae in homogenate of placenta of a pregnant woman with untreated histoid leproma, highlighting the effectiveness of the placental barrier in stopping vertical transmission of leprosy (Hansen disease). However, reports in the published literature indicate that this claim is not absolutely correct.

Several early studies provided evidence of transplacental transmission of M. leprae; these studies revealed M. leprae in umbilical cords (25/104) (2) and cord blood (10/12) (3) of neonates born to mothers with leprosy, as well as in the placentae (57/104 and 9/12) (2,3) of those mothers (2,3). Furthermore, transplacental infection with M. leprae has been supported by an increased concentration of IgA in cord blood (4) and M. leprae IgA and IgM in cord serum (5) of babies of mothers with leprosy. These observations indicate that in some mothers with leprosy, whole M. leprae, its antigens, or both can cross the placenta, possibly inducing the fetal immune system to produce antibodies against M. leprae antigens. Therefore, we believe that vertical transmission of M. leprae is a complex, uncommon, and multifactorial event that might depend on the presence of M. leprae in maternal blood, maternal and fetal immune responses, fetal gestational age at infection, and other placental factors.

Consequently, the claim of Chen et al. (1) needs to be read with attention to the limitations of the underlying data and might not be generalizable to all mothers with leprosy. Further studies are needed to clarify the mechanisms of transplacental transmission of leprosy. The follow-up care of newborns of mothers with leprosy is necessary for early detection of the disease and to ensure appropriate general healthcare, especially considering that babies of mothers with leprosy have lower fetoplacental weights, slower growth, more fatal infections, and higher rates of infant mortality than those of mothers without leprosy.

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Ajay Vir SinghComments to Author , Harpreet Singh Pawar, Rajbala Yadav, and Devendra Singh Chauhan

Author affiliations: Indian Council of Medical Research–National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, India

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References

  1. Chen  Z, Kuang  Y, Jiang  H, Zhang  W, Shi  Y, Chokkakula  S, et al. Intact Mycobacterium leprae isolated from placenta of a pregnant woman, China. Emerg Infect Dis. 2019;25:16047. DOIPubMed
  2. Pineda  EV. The presence of Mycobacterium leprae in the placenta and umbilical cord. J Philipp Med Assoc. 1928;VIII:6770.
  3. Sugai  T, Monobe  J. Uber histologische befunde in der placenta tuberkulose und leprakranker. zentralblatt für bakteriol-ogie, Parasitenkunde. Infektionskrankheiten und Hygiene. 1913;13:262.
  4. Melsom  R, Duncan  ME, Bjune  G. Immunoglobulin concentration in mothers with leprosy and in healthy controls and their babies at the time of birth. Lepr Rev. 1980;51:1928. DOIPubMed
  5. Melsom  R, Harboe  M, Duncan  ME, Bergsvik  H. IgA and IgM antibodies against Mycobacterium leprae in cord sera and in patients with leprosy: an indicator of intrauterine infection in leprosy. Scand J Immunol. 1981;14:34352. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2608.191149

Original Publication Date: June 25, 2020

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Table of Contents – Volume 26, Number 8—August 2020

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Ajay Vir Singh, Department of Microbiology and Molecular Biology, ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, Pin-282001, India

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Page created: April 13, 2020
Page updated: July 18, 2020
Page reviewed: July 18, 2020
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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