Mycobacterium lepromatosis was identified as a new species and second causal agent of Hansen’s disease (HD, or leprosy) in 2008, 150years after the disease was first attributed to Mycobacterium leprae. M. lepromatosis has been implicated in a small number of HD cases, and clinical aspects of HD caused by M. lepromatosis are poorly characterized. HD is a recognized zoonosis through transmission of M. leprae from armadillos, but the role of M. lepromatosis as a zoonotic agent of HD is unknown. M. lepromatosis was initially associated with diffuse lepromatous leprosy, but subsequent case reports and surveys have linked it to other forms of HD. HD caused by M. lepromatosis has been reported from three endemic countries: Brazil, Myanmar, and Philippines, and three non-endemic countries: Mexico, Malaysia, and United States. Contact with armadillos in Mexico was mentioned in 2/21 M. lepromatosis HD case reports since 2008. M. lepromatosis in animals has been investigated only in non-endemic countries, in squirrels and chipmunks in Europe, white-throated woodrats in Mexico, and armadillos in the United States. To date, there have only been a small number of positive findings in Eurasian red squirrels in Britain and Ireland. A single study of environmental samples found no M. lepromatosis in soil from a Scottish red squirrel habitat. Future studies must focus on endemic countries to determine the true proportion of HD cases caused by M. lepromatosis, and whether viable M. lepromatosis occurs in non-human sources.

Introduction The WHO MDT for leprosy treatment was officially introduced in Brazil in 1991 and comprises three drugs: dapsone, rifampicin and clofazimine. There are few good studies on the frequency of side-effects attributable to MDT in Brazil. Methods A retrospective and descriptive study carried out in a LCP in Vitória, State of Espírito Santo, Brazil. A specific and detailed protocol about side-effects was prepared and filled in from the patient records. Results One hundred ninety four patients’ records were analysed looking for side-effects attributable to MDT. Side-effects were attributed to at least one MDT component in 88 (45%) patients and 85 had side-effects due to dapsone, 24 due to rifampicin and 18 due to clofazimine. 185 episodes were identified. The suspected drug was stopped in 47 out of 88 episodes (24% patients); 46 had dapsone stopped, 5 had rifampicin stopped and no-one had clofazimine stopped. Conclusion Side-effects attributed to MDT is more frequent than previously described, resulting in interruption of treatment in many patients.

Immune reconstitution inflammatory syndrome (IRIS) may occur in HIV-infected patients after starting highly active antiretroviral therapy (HAART). Since 2003, 19 cases were published as IRIS. Leprosy has been reported as an example of an IRIS, and it is important that this syndrome should be recognized in leprosy-endemic areas. The case definition of leprosy as IRIS is based on clinical presentation of leprosy, evidence of immune restoration and timing of onset. Case definition should include the following: (1) leprosy and/or leprosy type 1 reaction presenting within six months of starting HAART; (2) advanced HIV infection; (3) low CD4+ count before start HAART; (4) CD4+ count increasing after HAART has been started. Although pathogenic mechanisms are still unclear, it is likely that leprosy-associated IRIS will be increasingly reported in those countries endemic for both diseases and as access to HAART becomes more widely available.

This paper reports on the time between the onset of the first lesion and diagnosis, defined as delay, and is based on results obtained by interviewers from a survey carried out amongst 450 leprosy patients in a leprosy endemic area in the Metropolitan Region of Vitória (MRV), state of Espírito Santo, Brazil. The mean age at diagnosis in all cases was 41.47 years and the median was 42.5 years. The mean age at diagnosis in MB (42.9 years) was greater than in PB (38.5 years). The mean of the delay in all cases was 25.25 months, median 12 months and range 0–360 months. The mean of the delay in MB (27.2 months) was greater than in PB (21.3 months). The results of this study suggest that although the delay in leprosy diagnosis in this region of Brazil was not too long when it was compared with other studies in endemic countries, it is still a problem: 65.4% of patients were diagnosed after a delay of 6 months. The Leprosy Control Programme in this state needs more effective health education in order to reduce the current period of delay before diagnosis.

Objectives To describe dental and periodontal diseases and oral lesions in newly diagnosed leprosy patients. Design Cohort study with 99 leprosy patients carried out at the Leprosy Control Programme Outpatient Clinic, Serra-ES, Brazil. A questionnaire about demographic and clinical data was used. Clinical oral examination was performed through the decayed, missing and filled teeth index (DMFT index), the use and need of prosthesis, periodontal disease and the presence of mucous membrane oral lesions. Skin and oral mucous biopsies were also undertaken. Results Decayed teeth were present in 73% of the patients, at least one lost tooth was present in 71.4%, the mean of the number of lost teeth among the patients in this survey was 8.8; and 60.3% of the patients did not have their teeth filled. Periodontal disease was present in 80.8%, and gingival bleeding in 92% of the patients. DMFT index average was 14.4. Nine out of the 63 patients presented with oral clinical lesions, however, most of them presented with unspecific chronic inflammation and typical epithelial hyperplasia. Conclusions These newly diagnosed leprosy patients were similar in respect of oral health to the normal Brazilian population. Serious dental loss and edentulism were observed, as were a high DMFT index and frequency of periodontal diseases. These data highlight a lack of oral health prevention and treatment and poor access even when available.