title: Update on the epidemiology, diagnosis, and treatment of leprosy.
abstract: Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate <1 patient per 10,000 population, was achieved in the year 2000, but more than 200,000 new case patients are still reported each year, particularly in India, Brazil, and Indonesia. Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary.
authors.affiliation: Sorbonne universités, UPMC Univ Paris 06, CR7, Centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Inserm, U1135, centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Bactériologie-hygiène, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Reibel
authors.affiliation: Centre national de référence des mycobactéries et de la résistance des mycobactéries aux antituberculeux, bactériologie-hygiène, 75013 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Inserm, UMR 1137 IAME, 75018 Paris, France; Service de bactériologie, hôpital Lariboisière, AP-HP, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Cambau
authors.affiliation: Sorbonne universités, UPMC Univ Paris 06, CR7, Centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Inserm, U1135, centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France; Bactériologie-hygiène, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France. Electronic address: alexandra.aubry@upmc.fr.
authors.forename: A
authors.initials: A
authors.lastname: Aubry
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood; D001431:Bacteriological Techniques; D001706:Biopsy; D002991:Clofazimine / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D016680:Genome, Bacterial; D014943:Global Health; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049690:History, Ancient; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use; D007918:Leprosy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000266:history / Q000503:physiopathology / Q000635:transmission; D025202:Molecular Diagnostic Techniques; D009166:Mycobacterium leprae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D010802:Phylogeny; D015995:Prevalence; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D007917:Leprostatic Agents; D003622:Dapsone; D002991:Clofazimine; D012293:Rifampin
keywords: Leprosy; Lèpre; Multidrug therapy; Mycobacterium leprae; Polychimiothérapie