Mycobacterium leprae-Helminth Co-Infections and Vitamin D Deficiency as Potential Risk Factors for Leprosy: A Case-Control Study in Southeastern Brazil
Int J Infect Dis . 2021 Feb 13;S1201-9712(21)00134-X. doi: 10.1016/j.ijid.2021.02.048
Cori L.DennisonaLorena B.de OliveirabLucia A. de O.FragabRosemary S. eLimacJosé A.FerreiradJulie A.ClennoneLaurade MondesertaJessicaStephensfErica B.MaguetagAlexandre CasteloBrancohMichelle de CarvalhoRezendeiDeborahNegrão-CorrêaiMaria Aparecida de F.GrossidJessica K.Fairleyj
Leprosy, low Vitamin D and poor Vitamin D Receptor
Cure/Prevention: Give lots of Vitamin D and/or activate Vitamin D Receptor
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Background: Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. Our aim was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy through a case-control study design.
Methods: From 2016-2018, individuals ages 3 years and older were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in 3 groups: cases of leprosy, household contacts and community-matched controls. Helminths were diagnosed through stool Kato Katz exams and serum reactivity to anti-SWAP IgG4. Serum ferritin, 25-OH vitamin D, and retinol concentrations were measured. Multivariate logistic regression was conducted to identify associations with active leprosy.
Results: We recruited 79 cases of leprosy, 96 household contacts, and 81 non-contact controls; 48.1% male with a median age of 40 years old. Helminths were found in 7.1% of participants by Kato Katz with all but one S. mansoni, and 32.3% were positive for S. mansoni serology. In multivariate analysis, cases were more likely be infected with helminths (diagnosed by stool) compared to contacts (aOR: 8.69 95% CI 1.50, 50.51).
Vitamin D deficiency was common and associated with leprosy when compared to non-contact controls (aOR=4.66, 95% CI 1.42, 15.33). Iron deficiency was not associated with leprosy and we did not detect vitamin A deficiency.
Conclusion: These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy disease. Co-morbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programs to improve leprosy control.