Leprosy Mailing List Blog

Wednesday, May 20, 2026

Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy. ASpril, 2026.

Leprosy Mailing List – May 20, 2026

Ref.: (LML) Infolep monthly overview of new publications on leprosy. ASpril, 2026.

From: Elizabeth Talatu Williams, Amsterdam, the Netherlands

____________________________________________________________________________

Dear colleagues,

We are pleased to share the April 2026 edition of the Infolep Newsletter, featuring recent publications, case reports, and global updates from the leprosy field.

This month’s featured articles focus on key developments in disability, mental health, digital innovation, and patient engagement. Topics covered include new research on how the relationship between disability, stigma, and mental health impacts persons affected by leprosy, the WHO Skin NTDs App enhanced with artificial intelligence, and studies on clinical trial inclusion, contact management, and the economic burden of Hansen’s disease.

The case reports in this issue reflect the ongoing diagnostic and clinical challenges in leprosy, including atypical presentations, co-infections, chronic ulcers, and long-term complications, underlining the importance of early diagnosis, appropriate management, and long-term follow-up.

We also feature new publications on chemoprophylaxis, antimicrobial resistance, neuropathy, health-seeking behaviour, mental health, and surveillance, alongside the latest news on policy developments, legal reforms, and global NTD initiatives.

This edition also includes information on upcoming events, including the Seventy-ninth World Health Assembly and the World Health Assembly Side Event on implementation of the WHA Resolution on Skin Diseases in Geneva.

We hope this edition provides useful insights and supports your continued work in advancing leprosy research, care, and inclusion.

Warm regards,
Elizabeth Talatu Williams

www.leprosy-information.org
info@infolep.org

Featured Research Spotlight

The World Health Organization Skin Neglected Tropical Diseases App: A dynamic capacity building training tool enhanced with artificial intelligence
Pons J, Romero-Lopez A, Muñoz I, et al. The Journal of investigative dermatology. 2026.

Pattern of Disability and its Relationship with Disease Related Physical Involvement, Stigma, and Mental Health Status among People Living with Leprosy
Sharma P, Bhandari AR, Singh S, et al. Nepal Journal of Dermatology, Venereology & Leprology. Nepal Journals Online (JOL). 2026; 24 (1): 4 - 10.

Involvement of African patient populations in clinical trials on leprosy: a scoping review
Haarmann M, Ansah R, Meneguim A, et al. Tropical medicine and health. 2026; 54 (1): 1 - 19.

Engagement strategies for people living with leprosy: a scoping review of studies published from 1992 to 2024
de Souza L, Perin J, Drumond M, et al. Archives of public health = Archives belges de sante publique. 2026; 84 (1): 1 - 20.

Implementation of ML Flow for leprosy contacts in Brazil: Opportunities, pitfalls, and safeguards
Talhari C, Farias C, Miot H, et al. PLoS neglected tropical diseases. 2026; 20 (4): 1 - 8.

Economic cost of Hansen's disease: an overview of social security expenditures
Castro J, Lima F, Frade M, et al. Frontiers in public health. 2026.

Other New Publications

Feel free to contact us to receive full-text versions if these cannot be found through the Infolep portal.

Factors affecting the health-seeking behaviour of leprosy patients in a tertiary referral hospital in the Philippines
Miralpes Ebisawa N, San Juan J, Go Baluyot KR, et al. Leprosy Review. Lepra. 2026; 97 (2): 1 - 10.

Effectiveness of Rifampicin Chemoprophylaxis in Preventing Leprosy in Close Contacts: A Systematic Review
Franatha Sembiring R, Donarta Tarigan C. International Journal of Health and Pharmaceutical (IJHP). International Journal of Educational Research & Social Sciences (IJERSC). 2026; 6 (1): 513-522.

Peripheral Nerve Ultrasound Findings in Leprosy: A Scoping Review of Echogenicity, Cross-Sectional Area, and Vascularization Across 15 Studies
Gunawan H, Khairuddin R, Hidayah R, et al. Clinical, cosmetic and investigational dermatology. 2026.

Factors associated with incomplete treatment among leprosy patients in Sabah, Malaysia, between 2012 and 2016
Ab Aziz MZ, Wan Mohammad WMZ, Gantul VJ, et al. Leprosy Review. Lepra. 2026; 97 (2): 1 - 11.

Mapping Child Leprosy Cases and its Factors Associated in Indonesia Using Geographically Weighted Poisson Regression Model
Darnah D, Suyitno S, Nor Hayati M, et al. Elsevier BV. 2026; 56 (5): 1654 - 1667.

Need for rethinking on chemoprophylaxis strategies for leprosy control
Kumar B, Singh S, Narang T, et al. Indian Journal of Dermatology, Venereology and Leprology. Scientific Scholar. 2026.

Functional single nucleotide polymorphisms in CACNA2D3 and other autophagy-related genes are associated with leprosy among Brazilians
Espasandin I, Cardoso CC, Leal-Calvo T, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (4): 1 - 22.

Sensitivity of immunohistochemistry in the laboratory diagnosis of leprosy: a systematic review protocol
Neto M, de Lima M, da Silva C, et al. BMJ open. 2026; 16 (4): 1 - 6.

Cured but not healed: the mental health crisis in leprosy we continue to ignore.
Fastenau A, Asboeck A, Egbule D, et al. BMC global and public health. 2026; 4 (1): 1 - 3.

Structured digital health intervention for leprosy awareness: a case study of analyzing public engagement and sentiment in a Sri Lankan leprosy awareness campaign on Facebook
Wijesinghe M, Pathirana A, Karawita U, et al. BMC infectious diseases. 2026.

Diagnostic performance of peripheral nerve palpation compared with ultrasonography in leprosy neuropathy: A prospective real-world clinical evaluation
Mendes J, da Silva T, Cruz P, et al. PLoS neglected tropical diseases. 2026; 20 (4): 1 - 15.

Armadillo meat consumption and Hansen's disease (leprosy): a case-control study in Brazil.
Repsold T, Collin S, Amorim B, et al. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2026.

Single-Dose Rifampicin Prophylaxis for Leprosy Contacts: Aligning with Antimicrobial Stewardship Principles
Thangaraju P. Journal of Antimicrobial Stewardship Practices and Infectious diseases. Society of Antimicrobial Stewardship PractIces (SASPI). 2026; 4 (1): 06-08.

Assessment of Antimicrobial Resistance in M. leprae Strains From Kiribati
Campbell P, Bauro T, Rimon E, et al. Tropical medicine & international health: TM & IH. 2026.

Impact of the Covid-19 Pandemic on Leprosy: Evidence From an Endemic City in Northeastern Brazil
Ana Flávia Sobral de Medeiros, Aline Lidiane Batista, Sidnei Miyoshi Sakamoto, et al. Journal of the Brazilian Society of Tropical Medicine. 2026.

The Influence of Health Services Factor on the Maintenance of Leprosy Elimination Status at Community Health Centers in Timor-Leste
Barreto J, Martins NE, Reis LD. Journal of World Science. Riviera Publishing. 2026; 5 (3): 339-345.

Case Reports

Lepromatous Leprosy Mimicking Sarcoidosis With Elevated Serum ACE Levels: A Deceptive Granulomatous Presentation
Prashanth G, T D. Cureus. Springer Science and Business Media LLC. 2026; 18 (5): 1 - 7.

Dual Mycobacterial Infection with Tuberculosis and Leprosy: A Case Highlighting Diagnostic and Programmatic Challenges in Endemic Settings
Vaishnav B, Sanghani B, Kshitij, et al. National Journal of Community Medicine. Medsci Publications. 2026; 17 (04): 315-319.

Topical Insulin: A Game Changer for Non-Healing Leprosy Ulcers – A Case Series
Ratnaparkhi A, Fale P, Rahangdale V, et al. Nepal Journal of Dermatology, Venereology & Leprology. Nepal Journals Online (JOL). 2026; 24 (1): 54-57.

IgA Dominant Infection-Related Glomerulonephritis due to Mycobacterium avium: A Case Report
Visch R, van Laarhoven A, Smits L, et al. Kidney Medicine. Elsevier BV. 2026.

The Uncommon Coexistence of Mid-Borderline Leprosy and Generalized Pustular Psoriasis
Gunawan H, Hidayah R, Dwiyana R, et al. Clinical, cosmetic and investigational dermatology. 2026.

Metastatic squamous cell carcinoma complicating a chronic leprosy ulcer: Highlighting the need for long-term surveillance of ‘cured’ leprosy patients
Anand GR, Pragya P, Dixit S, et al. Indian Journal of Dermatology, Venereology and Leprology. Scientific Scholar. 2026.

Thursday, May 14, 2026

Fw: Ref.: (LML) Update about Hantavirus breakout

Leprosy Mailing List – May 14, 2026

Ref.: (LML) Update about Hantavirus breakout

From: Francesca Cando Gajete, Manila, the Philippines

____________________________________________________________________________

Note editor: This is not about leprosy, but otherwise an interesting story. I assume that many of you have followed this saga, but may be some are not in the position to receive such news. Normally, we would not publish such information, but in this case we made an exception.

Dear Pieter,

Sharing this latest update from Dr Edsel Maurice Salvana, Infectious Diseases Consultant Researcher WHO DOH

HANTAVIRUS Latest update: There are now eleven cases, nine of which have been confirmed. The three new cases are one American, one French woman and one Spaniard. There have been no additional deaths from the initial three. Most passengers and crew have disembarked and are being quarantined. Contact tracing is ongoing for passengers who disembarked earlier and who may have exposed others.

As long as protocols are followed and everyone cooperates, the risk of further transmission remains LOW. Stay safe.

Outbreak in the High Seas

The recent report of an outbreak of hantavirus on a cruise ship gave feelings of double déjà vu to those of us in the infectious diseases field. The first déjà vu moment is that of the COVID-19 outbreak on the cruise ship the Diamond Princess, which was the first such SARS-CoV-2 outbreak of its nature and resulted in the ship being bounced around, and finally allowed to dock and discharge its beleaguered passengers after two weeks of quarantine. The second déjà vu moment is the hantavirus infection that claimed the lives of classical pianist Betsy Arakawa and, by extension, her husband Gene Hackman in their New Mexico home just over a year ago. Betsy had apparently contracted hantavirus pulmonary syndrome from rodent nests found around their house and subsequently died at home, while Gene Hackman who had advanced Alzheimer’s was unable to call for help and died of heart failure.

The current outbreak on the cruise ship MV Hondius has already killed three people as I write this article, and at least five others have fallen ill. Six of the eight cases have tested positive for the Andes hantavirus on genomic sequencing. The rest of the sick patients are presumed to have hantavirus infection until they can be properly tested since they are showing symptoms consistent with the disease. The ship is currently docked off the coast of Praia in Cape Verde, and some of the sick passengers have been evacuated. The rest of the passengers and crew are likely going to be quarantined either onboard or transferred to a facility for this purpose. The MV Hondius originated from Argentina, where hantavirus is endemic, particularly the Andes virus which is the only hantavirus that has been documented to be capable of human-to-human transmission. According to reports, the cruise ship also stopped in Uruguay and Chile where there have been periodic outbreaks of hantavirus. Authorities in these countries are racing to find the potential source and contain any local infections as well.

What is hantavirus? Hantavirus is a family of viruses that can cause two distinct deadly syndromes: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). Hantavirus disease usually starts off with a flu-like illness characterized by fever, malaise, muscle pain and headaches and can easily be mistaken for more common illnesses. Patients who progress to HPS end up with shortness of breath that can progress to severe respiratory failure and death. If they survive, recovery can be prolonged for up to six months. Patients who progress to HFRS have symptoms that are very similar to leptospirosis, with decreased urine output, bleeding in the urine and the stool, and potentially bleeding in the lungs as well. Low platelets can be found in both syndromes, and so hantavirus infection can be mistaken for dengue fever.

Hantavirus is a zoonosis, which is an infectious disease transmitted from animals. The natural host of hantaviruses are rodents, and humans are infected when they inhale aerosolized dried rodent feces, urine or saliva. Rodents do not manifest signs of symptoms of disease, and so these serve as persistent reservoirs of infection. Hantaviruses are found all over the world.

Hantaan virus was the very first hantavirus to be described and gave the virus family its name. It was discovered during the Korean War when it caused an outbreak of HFRS among soldiers stationed along the Hantan River. Hantaviruses in the Americas (New World hantavirus) such as Sin Nombre and Andes can cause HPS which have a 30 to 60% mortality. Old World hantaviruses include Hantaan, Seoul, Puumala and Dubrava-Belgrade viruses and these cause the relatively milder HFRS with a mortality rate of 1-15%. Puumanla and Dubrava-Berlgrade viruses cause less severe disease than Hantaan and Seoul.

There are no effective antivirals for any of the hantaviruses. Supportive care for HPS is the mainstay of treatment, including the use of ventilators and high-flow oxygen to support recovery of lung function. For HFRS, hydration and management of electrolytes is crucial. In case of renal failure, dialysis may be necessary either as a temporary measure if the kidneys recover, or as an ongoing measure until renal transplant can be performed. There is no widely available vaccine for hantavirus. Some inactivated vaccines have been developed in China and Korea and seem effective for preventing HFRS although the duration of protection is unclear. Other vaccines are in development including DNA, protein and virus-like particles formats and preliminary results are promising.

Prevention of infection starts with good pest control to minimize exposure to aerosolized mouse droppings. Wearing protective equipment such as masks when cleaning out rodent nests, especially those with dried mouse droppings, can decrease the risk of exposure and infection. It is still unclear how human to human transmission occurs with the Andes virus. Previous reports suggest close contact, but at least one transmission event occurred with only transient contact between the infected case and the subsequent victim.

The transmission pattern on the MV Hondius remains unclear. The victims could have all been exposed to rat droppings at the same time and manifested disease at different times. The incubation period of the Andes virus can take up to six weeks, and so there is a possibility of a single exposure. However, the previous documentation of human-to-human transmission for this specific hantavirus also makes it possible that some of the infected patients were subsequently exposed onboard to the sick passengers. Active investigation is ongoing and contact tracing for those passengers that were able to leave before the vessel was quarantined is being done.

One of the most important questions I get asked a lot is whether there is a chance this could turn into another pandemic. The World Health Organization (WHO) has already stated that this is unlikely. While the current outbreak seems to involve human-to-human transmission, this usually occurs only with prolonged and close contact. The period in which a patient is contagious is very short and only happens when he or she has a fever. The fever typically lasts only one day, although the other symptoms can persist. Finally, the long incubation period means that proper contact tracing and quarantine can interrupt transmission. Hantavirus can be controlled and contained. The most important thing is that we remain vigilant and listen to properly vetted advice from trustworthy sources like WHO and the Department of Health.

A guide especially for our seafarers and travelers.

Francesca

Dr Francesca Cando Gajete, MHA,FPLS

Member, WHO DOH ADHOC NTAG NTDS

Member, International Leprosy Association

Former National Leprosy Control Program Manager

email address: francesca_gajete@yahoo.com

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Sunday, May 10, 2026

Fw: Ref.: (LML) Did capsule P have a dramatic impact?

Leprosy Mailing List – May 10, 2026

Ref.: (LML) Did capsule P have a dramatic impact?

From: Joel Almeida, Mumbai, India

____________________________________________________________________________

Dear Pieter,

ref: (LML) Did capsule P have a dramatic impact (LML May 5, 2026)?

re capsule X, para 3

Correct:

15% decrease in incidence rate of PB with 2 to 5 lesions, between the initial 2 years and years 3 and 4.

With all sincerity,

Joel Almeida

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Fw: Ref.: (LML) Macrophages and eyes/hands/feet

Leprosy Mailing List – May 10, 2026

Ref.: (LML) Macrophages and eyes/hands/feet

From: Joel Almeida, Mumbai, India

____________________________________________________________________________

Dear Pieter and colleagues

Macrophages form an important first line of defence. They can limit or even eliminate the bacillus, including via autophagy and vit D-induced cathelicidin. Most of the genomic polymorphisms known to modify the risk of HD, and LL HD, are related to macrophage function (hLife 2024;2:6–17). The well-known importance of nutrition, schooling, income etc is likely to be partly via upholding macrophage function. Infection with the bacilli has been demonstrated in as many as 50% of all individuals in endemic areas [BMJ. 1973; 3:557-559], but new cases of disease are relatively rare in endemic populations, often <1 in 10,000/year. Apparently, most infected persons self-limit or eliminate the bacilli without signs of disease, or sequelae, or onward transmission. They are harmless.

Macrophage function unfortunately can be subverted, by producing bacillary debris (eg., DNA) in the cytosol (J Inf Dis 2016, 214:311-320). Once the bacilli within macrophages are damaged by any means, the resulting molecular cascade of harm (cGAS-STING-IRF3-IFNB-OASL) suppresses autophagy and cathelicidin (J Inf Dis 2016, 214:311-320). The disarmed macrophage is vulnerable to regrowth or reinfection when anti-microbial cover is prematurely withdrawn. The bacillary debris is not cleared immediately, given suppression of autophagy. Therefore the duration of anti-microbial cover is no less important than bactericidal potency. As long as concentrated viable bacilli remain available in the household, or market place, or workplace, or neighbourhood, the disarmed macrophage following the withdrawal of anti-microbial protection forms a hospitable niche for bacilli to replicate.

Bacilli replicate by elongation [Nature Comms (2020) 11:452], boosting the surface area and surface virulence factors per bacillus (Mce1A for invasiveness/cell entry [PLoS Negl Trop Dis 13(3): e0006704] and PGL1 for damage to axonal mitochondria via macrophage iNOS- excess NO [Cell (2017)170, 973–985]). Replicating bacilli have high phenotypic virulence. The predicted outcome of prematurely withdrawn antimicrobials is boosted transmission, more frequent multi-case households, more "silent" nerve damage via PGL1-iNOS-NO. Worse, visible deformity via "silent" nerve damage is predicted to more frequently form the first detectable sign of disease in a subclinically infected contact who was given chemoprophylaxis.

Is it wise to sabotage macrophage defences in asymptomatic contacts?

With all sincerity,

Joel Almeida

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Friday, May 8, 2026

Fw: Ref.: (LML) Need for rethinking on chemoprophylaxis strategies for leprosy control

Leprosy Mailing List – May 8, 2026

Ref.: (LML) Need for rethinking on chemoprophylaxis strategies for leprosy control

From: Ben Naafs, Munnekeburen, the Netherlands

____________________________________________________________________________

Dear Pieter and colleagues,

We like to refer to the following article in the attached file:

Need for rethinking on chemoprophylaxis strategies for leprosy control

By Bhushan Kumar, Sukhdeep Singh, Tarun Narang , Nusrat Shafiq, , Sunil Dogra

Department of Dermatology, Shalby Hospital, Punjab, Departments of

Dermatology, Venereology and Leprology and Clinical Pharmacology,

Institute of Medical Education and Research, Chandigarh, India

I read with pleasure the above article voicing worries I also have. The solution; treat the index case and examen the contacts and treat the ones needed treatment and vaccinate with BCG or similar vaccine is a good one.

You will prevent leprosy in the contacts who can develop a protective immunity. But they need a booster if this booster is not supplied by the environmental bacteria.

The problem stays with the ones who can not develop protective immunity and will, when infected, develop polar Lepromatous Leprosy.

The patients with a high BI should be treated longer then the WHO advises and followed up with serology in order to detect early a relapse or reinfection. Polar Lepromatous Leprosy patients in an endemic society should be treated for life. Remember Almeida’s contributions!

With regards

Ben

____________________________________________________________________________

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << edit...@gmail.com

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Leprosy Mailing List Blog

Pages

Wednesday, May 20, 2026

Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy. ASpril, 2026.

Thursday, May 14, 2026

Fw: Ref.: (LML) Update about Hantavirus breakout

Sunday, May 10, 2026

Fw: Ref.: (LML) Did capsule P have a dramatic impact?

Fw: Ref.: (LML) Macrophages and eyes/hands/feet

Friday, May 8, 2026

Fw: Ref.: (LML) Need for rethinking on chemoprophylaxis strategies for leprosy control

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