title: Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment.
abstract: BACKGROUND
  There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods.
  
  
  OBJECTIVE
  To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period.
  
  
  METHODS
  We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses.
  
  
  RESULTS
  From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined.
  
  
  CONCLUSIONS
  The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.
authors: Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C, Colombia.
authors: Martha Inírida
authors: MI
authors: Guerrero
authors: Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C, Colombia.
authors: Claudia Lucía
authors: CL
authors: Colorado
authors: Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C, Colombia.
authors: José Fernando
authors: JF
authors: Torres
authors: Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C, Colombia.
authors: Clara Inés
authors: CI
authors: León
mesh_terms: D000293:Adolescent; D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D001706:Biopsy; D002648:Child; D003105:Colombia / Q000453:epidemiology; D004269:DNA, Bacterial / Q000235:genetics; D003622:Dapsone / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D006801:Humans; D007917:Leprostatic Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D056006:Leprosy, Multibacillary / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015242:Ofloxacin / Q000494:pharmacology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; D007917:Leprostatic Agents; D003622:Dapsone; D015242:Ofloxacin; D012293:Rifampin