The transmission of leprosy remains poorly understood. If we are to end transmission of the disease, we must understand the mechanism of transmission better than we currently do.
Stanley Browne Laboratory (SBL) in India is an established leader in molecular studies focused on environmental reservoirs, transmission in households and communities, and nasal carriage.
The Mycobacterial Research Laboratories (MRL) in Nepal have been investigating transmission, including monitoring of leprosy drug resistance for over 40 years.
Meanwhile, our Leprosy Field Research in Bangladesh Program (LFRB) enables large transmission studies to consider factors among blood relatives, household members, and various degrees of contact, as well as the clinical aspects that need investigating in relation to transmission.
An early diagnosis of leprosy can reduce transmission and the risks that lead to permanent physical problems, such as reactions, nerve damage, and disability.
SBL in India is conducting immunological research and developing a PCR test for leprosy.
Both LFRB and MRL, in partnership with the University of Leiden Medical Center are developing and trialling a field-friendly finger-prick test for leprosy and reactions using biomarkers.
In Nepal, MRL and Anandaban Hospital are working with the University of Latvia to develop a spectral imaging tool that could potentially enable a smartphone to detect leprosy.
Around 30-50 percent of leprosy patients develop one or more episodes of reaction. Leprosy reactions are the primary cause of nerve damage and disability development.
Our hospitals and laboratories are involved in clinical trials to innovate treatment, investigations of potential causes and biomarkers, and chart reviews utilising decades of medical records. In Nepal, MRL has been investigating associations between soil-transmitted helminth co-infections with leprosy and reactions (opening a can of worms).Bangladesh, India, and Nepal are members of the Erythema Nodosum Leprosum International Study (ENLIST) Group which is a consortium that conducts global, multi-centric studies, such as profiling ENL across countries and developing an ENL Severity Scale.
Around 20 percent of leprosy patients are at risk of developing ulcers. After their first ulcer, a patient is at high risk of developing future ulcers, which can lead to recurrent hospitalisations resulting in potential loss of income, employment, family, home and/or limbs (amputation). Approximately 50-90 percent of inpatients in our hospitals are ulcer cases who may require months or even more than a year to heal.
Among a number of projects on this topic, our team in Nepal is working on a new treatment for leprosy ulcers, known as LPRF. This new and innovative technique has so far shown a dramatic improvement in the recovery time for leprosy ulcers. Their research is also considering how ulcers can be prevented through interventions at the community level to address issues such as livelihoods that increase the risk of developing ulcers.
Studies show that around 70 percent of people affected by leprosy experience anxiety and/or depression. However, mental health support for those affected by leprosy is extremely limited or absent for global cases. Research is needed to enable better screening, how to develop and optimise care options in limited resource contexts, identify risk factors, validate treatment options, and map pathways for any available integrated services.
Cover photo credit: Sabrina Dangol
We are supporting others who are leading the way in the following areas
1. Global Chemoprophylaxis Studies (PEP) TLM and our partners are involved in a number of PEP trials across the world, including PEP++
2. Global monitoring of leprosy relapse and antimicrobial resistanceOur laboratories in India and Nepal are part of the global network of laboratories that monitor relapse and resistance.
3. Field trials or operational studies of global initiatives and innovationsTLM has a unique geographical footprint of hospitals, field programmes, and laboratories that allow us to support and trial new innovations, such as vaccines, in order to reduce leprosy transmission.