Article
Antimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan
Registro en:
ANDRADE, Elaine Silva Nascimento et al. Antimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan. Antimicrobial Agents and Chemotherapy, v,. 66, n. 5, p. 1 - 9, April 2022.
1098-6596
10.1128/aac.02170-21
Autor
Andrade, Elaine Silva Nascimento
Brandão, Jurema Guerrieri
Silva, Juliana Souza da
Coriolano, Carmelita Ribeiro Filha
Rosa, Patricia Sammarco
Moraes, Milton Ozório
Ferreira, Cynthia de Oliveira
Gomes, Ciro Martins
Araújo, Wildo Navegantes de
Resumen
Brazil ranks second among countries for new cases and first for relapse
cases of leprosy worldwide. The Mycobacterium leprae Resistance Surveillance Plan was
established. We aimed to present the results of a 2-year follow-up of the National
Surveillance Plan in Brazil. A cross-sectional study of leprosy cases was performed to
investigate antimicrobial resistance (AMR) in Brazil from October 2018 to September
2020. Molecular screening targeting genes related to dapsone (folP1), rifampin (rpoB),
and ofloxacin resistance (gyrA) was performed. During the referral period, 63,520 active
leprosy patients were registered in Brazil, and 1,183 fulfilled the inclusion criteria for molecular
AMR investigation. In total, only 16 (1.4%) patients had genetic polymorphisms
associated with AMR. Of these, 8 (50%) had cases of leprosy relapse, 7 (43.8%) had cases
of suspected therapeutic failure with standard treatment, and 1 (6.2%) was a case of
new leprosy presentation. M. leprae strains with AMR-associated mutations were found
for all three genes screened. Isolates from two patients showed simultaneous resistance
to dapsone and rifampin, indicating multidrug resistance (MDR). No significant relationship
between clinical variables and the presence of AMR was identified. Our study
revealed a low frequency of AMR in Brazil. Isolates were resistant mainly to dapsone,
and a very low number of isolates were resistant to rifampin, the main bactericidal agent
for leprosy, or presented MDR, reinforcing the importance of the standard World Health
Organization multidrug therapy. The greater frequency of AMR among relapsed patients
supports the need to constantly monitor this group.