Coinfection with Leprosy and Tuberculosis: A Case Series in Malagasy Patients

Abstract

Mendrika Fifaliana Rakotoarisaona,1,* Tsiory Iarintsoa Razafimaharo,2,* Fandresena Arilala Sendrasoa,2,* Malalaniaina Andrianarison,1,* Naina Harinjara Razanakoto,3,* Volatantely Tobiniaina Ratovonjanahary,2,* Onivola Raharolahy,2,* Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology, University Hospital of Analakely, Antananarivo, Madagascar; 2Department of Dermatology, University of Befelatanana, Antananarivo, Madagascar; 3Department of Dermatology, University Hospital of Mahavoky Antsimo, Mahajanga, Madagascar; 4Department of Dermatology, University Hospital of Morafeno, Tamatavy, Madagascar*These authors contributed equally to this workCorrespondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital of Analakely, Antananarivo, 101, Madagascar, Tel [phone], Email [email protected]: Leprosy and tuberculosis are two of the oldest and most common mycobacterial infections, caused by Mycobacterium leprae and Mycobacteium lepramatosis for leprosy and Mycobacterium tuberculosis for tuberculosis. Dual infections have been known since ancient times; however, cases remain rarely reported in the literature, even in countries where both diseases are endemic, such as Madagascar.Purpose: We report a case series of simultaneous occurrence of leprosy and tuberculosis.Patients and Methods: In this retrospective study, we reviewed the medical records of patients with leprosy registered at the Department of Dermatology, University Hospital Befelatanana, Antananarivo, Madagascar, between January 2012 and June 2021. Patients with leprosy and diagnosed as coinfected by tuberculosis were included in the study.Results: Of the 120 leprosy cases observed during the study period, coinfection with leprosy and tuberculosis was found in five patients. The mean age was 43.4 (SD 13.2) ranging, 21– 59 years. Male gender was predominant (4/5). Four patients presented with lepromatous leprosy, and one with borderline lepromatous leprosy. Three patients experienced leprosy reaction. Four cases of pulmonary tuberculosis and one case of multifocal tuberculosis were observed. The diagnosis of leprosy preceded tuberculosis in four cases, and a coinfection diagnosis was made simultaneously in one case. The average time to develop tuberculosis was 38.8 (SD 10.2) months. HIV infection, malnutrition, alcohol consumption, and long-term corticosteroid therapy were the immunosuppressive factors reported in our patients. Three patients received concomitant multidrug therapy for leprosy and tuberculosis.Conclusion: Dermatologists should be aware of the importance of screening patients affected by leprosy for latent or active tuberculosis to prevent morbidity and mortality due to coinfection and to reduce the risk of acquired resistance to rifampicin, which is the greatest risk of this association.Keywords: Madagascar, Mycobacterium leprae, rifampicin

Keywords

• madagascar. mycobacterium leprae. rifampicin.