FRS Prakoeswa, - and H Soebono, - and D Husada, - and Hari Basuki Notobroto, - and MY Listiawan, - and A Endaryanto and CRS Prakoeswa, - (2020) Towards Prevention and Eradication of Leprosy : Current Status and Research Needed in Community Health & Immune Dysregulation. Indian Journal of Leprosy, 92. pp. 257-278. ISSN 0254-9395

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Abstract

Leprosy, a disease caused by , mainly affects dermis and peripheral nerve but is feared for its complications, and disabilities. Despite major reduction in leprosy cases after use of multi-drug therapy, blocking the transmission of leprosy is an arduous task due to factors that are possibly involved, these include agent (microbial characteristics), host and environmental factors. These factors including the immune dysregulations may increase the vulnerability towards leprosy, especially in women and children. This review article is aimed at understanding the current knowledge about such factors related to leprosy; and to identify the necessary steps and research needed to eradicate leprosy. A systematic literature search on PubMed, OVID, EMBASE, the Cochrane Library, Scopus,Web of Science, and Science Direct was done with the keywords "leprosy", "immune dysregulation in leprosy", and "risk factors of leprosy" to select published literature for this analysis. Several factors are identified as probable contributors to immune dysregulation/ incapability related to leprosy. These include host factors, health services and environmental factors. Important host related factors and interventions relate to stigma, vaccination, chemoprophylaxis, nutritional status, antenatal care, proper breast feeding. Environmental health factors relate to residential aspects including type of floor, humidity, intensity of sunlight, ventilation, clean water facilities, which may be contributing to persistent transmission. Health services play a role in ending leprosy transmission, both promotive, and rehabilitative treatment. In developing countries like Indonesia, health services suffer huge adverse impact from stigma..Some studies have showed the importance of an immunoprophylaxis strategy with Bacillus CalmetteñGuÈrin (BCG) vaccination, vaccination and single dose rifampicin chemoprophylaxis, as preventive measures for blocking the leprosy transmission. PEP carboxylase (PPC) is likely to be essential for the intracellular survival of and since it is absent in humans, it can be a potential target for treatment of leprosy. Studies show that vitamin D receptor (VDR) and vitamin D and role of food in leprosy needs in depth investigation. Pregnant women with poor nutritional status are prone to anaemia and malnutrition; these may be immune dysregulation and may be linked to leprosy infection. Further research is needed to better understand specific roles of said contributors towards immune dysregulation(s), thereby increasing the vulnerability of some person towards leprosy.

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