title: Analysis of the leprosy agents Mycobacterium leprae and Mycobacterium lepromatosis in four countries.
abstract: OBJECTIVE
  To differentiate the leprosy agents Mycobacterium leprae and Mycobacterium lepromatosis and correlate them with geographic distribution and clinicopathologic features.
  
  
  METHODS
  Species-specific polymerase chain reactions were used to detect each bacillus in archived skin biopsy specimens from patients with leprosy from Brazil (n = 52), Malaysia (n = 31), Myanmar (n = 9), and Uganda (n = 4). Findings were correlated with clinical and pathologic data.
  
  
  RESULTS
  Etiologic species was detected in 46 of the 52 Brazilian patients, including 36 patients with M leprae, seven with M lepromatosis, and three with both bacilli. The seven patients with sole M lepromatosis all had tuberculoid leprosy, whereas only nine of the 36 patients infected with M leprae exhibited this type, and the rest were lepromatous (P < .001). All patients with dual infections had lepromatous leprosy. Of the nine patients from Myanmar, six were test positive: four with M leprae and two with M lepromatosis. Of the Malaysian and Ugandan patients, only M leprae was detected in 27 of the 31 Malaysians and two of the four Ugandans.
  
  
  CONCLUSIONS
  The leprosy agents vary in geographic distribution. Finding M lepromatosis in Brazil and Myanmar suggests wide existence of this newly discovered species. The leprosy manifestations likely vary with the etiologic agents.
authors.affiliation: From the Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston; xhan@mdanderson.org.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Han
authors.affiliation: From the Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston;
authors.forename: Fleur M
authors.initials: FM
authors.lastname: Aung
authors.affiliation: Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia; and.
authors.forename: Siew Eng
authors.initials: SE
authors.lastname: Choon
authors.affiliation: Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Betina
authors.initials: B
authors.lastname: Werner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007918:Leprosy / Q000382:microbiology*; D015440:Leprosy, Lepromatous / Q000382:microbiology*; D015441:Leprosy, Tuberculoid / Q000382:microbiology*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D009161:Mycobacterium / Q000302:isolation & purification*; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D013045:Species Specificity; D014454:Uganda; D055815:Young Adult
keywords: Geographic medicine; Leprosy; Molecular diagnosis; Mycobacterium leprae; Mycobacterium lepromatosis