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      Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia

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          Abstract

          Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosoma mansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.

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          Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

          Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. A case-control study in four municipalities. cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (>or=biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.
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            Current knowledge on Mycobacterium leprae transmission: a systematic literature review.

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              The role of free-living pathogenic amoeba in the transmission of leprosy: a proof of principle.

              Leprosy transmission remains poorly understood, though, prolonged skin contact and/or infection via nasal mucosa, are considered likely. Problematic in any transmission hypothesis is the fastidious nature of Mycobacterium leprae outside its host cell and the requirement for temporary survival in the environment, soil or water. Experiments were carried out to test the hypothesis that free living pathogenic amoeba might serve as host cells for M. leprae, protecting them from adverse environmental conditions. In this study we employed cultures of Acanthamoeba castellanii, a free-living pathogenic soil amoeba, to determine whether these protozoa can ingest M. leprae and whether the intracellular bacilli remain viable. More than 90% of cultured amoeba ingested M. leprae at a 20:1 multiplicity of infection while the infected amoebae thrived and multiplied normally. The ingested M. leprae were not degraded and remained viable for at least 72 hours as determined by their metabolic activity (radiorespirometry) and cell wall integrity (viability staining). M. leprae isolated from infected amoebae multiplied at the same rate as freshly harvested bacilli in the foot pads of nu/nu mice. These findings provide proof of principle that free-living pathogenic amoebae are capable of ingesting and supporting the viability of M. leprae expelled into the environment. Studies are underway to determine whether M. leprae-infected A. castellanii and other pathogenic amoebae may also play a role in transporting leprosy bacilli through broken skin or the nasal mucosa.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                20 August 2020
                September 2020
                : 17
                : 17
                : 6061
                Affiliations
                [1 ]Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; lisa.emerson@ 123456ufl.edu (L.E.E.); puneetanantharam@ 123456gmail.com (P.A.)
                [2 ]College of Medicine and Health Sciences, University of Gondar, P.O. Box 196 Gondar, Ethiopia; mogesfeleke@ 123456gmail.com (F.M.Y.); annisabefekadu@ 123456gmail.com (A.B.T.)
                [3 ]School of Medicine, Emory University, Atlanta, GA 30322, USA; kbilcha@ 123456emory.edu
                Author notes
                Article
                ijerph-17-06061
                10.3390/ijerph17176061
                7504265
                32825398
                ae3b2977-5f93-4e48-a3f7-6a5f03b7a747
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 June 2020
                : 16 August 2020
                Categories
                Article

                Public health
                leprosy,ntd,wash,water,sanitation,hygiene,ethiopia
                Public health
                leprosy, ntd, wash, water, sanitation, hygiene, ethiopia

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