The leprosy agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico

Background Mycobacterium leprae was the only known cause of leprosy until 2008, when a new species, named Mycobacterium lepromatosis, was found to cause diffuse lepromatous leprosy (DLL), a unique form of leprosy endemic in Mexico. Methods We sought to differentiate the leprosy agents among 120 Mexican patients with various clinical forms of leprosy and to compare their relative prevalences and disease features. Archived skin biopsy specimens from these patients were tested for both M.similar to leprae and M.similar to lepromatosis using polymerase chain reaction-based species-specific assays. Results Etiologic species were confirmed in 87 (72.5%) patients, of whom 55 were infected with M.similar to lepromatosis, 18 with M.similar to leprae, and 14 with both organisms. The endemic regions of each agent differed but overlapped. Patients with M.similar to lepromatosis were younger and were distributed across more states; their clinical diagnoses included DLL (n = 13), lepromatous leprosy (LL) (n = 34), and eight other forms of leprosy. By contrast, the diagnoses of patients with M.similar to leprae did not include DLL but did include LL (n = 15) and three other forms of leprosy. Thus, M.similar to lepromatosis caused DLL specifically (P = 0.023). Patients with M.similar to lepromatosis also showed more variable skin lesions; the extremities were the most common sites of biopsy in these patients. Finally, patients with dual infections manifested all clinical forms and accounted for 16.1% of all species-confirmed cases. Conclusions Mycobacterium lepromatosis is another cause of leprosy and is probably more prevalent than M.similar to leprae in Mexico. It mainly causes LL and also specifically DLL. Dual infections caused by both species may occur in endemic areas.