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Background: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19., Methodology/principal Findings: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19., Conclusions/significance: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19., Competing Interests: The authors have declared that no competing interests exist.

Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease., Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity., Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05)., Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscopy removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis (ozena), and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.

Serological tests for subclinical Mycobacterium leprae infection based on antibodies to phenolic glycolipid-1 (PGL-1) and leprosy IDRI diagnostic-1 (LID-1) have not been compared in HIV-infected and uninfected individuals. PGL-1 seropositivity by ELISA was 6.0 % (21/350) in HIV-infected compared with 29.1 % (102/350) in HIV-uninfected individuals (p < 0.001); LID-1 seropositivity was 45.4 % (159/350) in HIV-infected compared with 50.3 % (153/304) in HIV-uninfected individuals (p = 0.21). In HIV-infected individuals, LID-1 but not PGL-1 antibody levels were inversely associated with CD4+ cell count (p = 0.02). These differential associations of HIV infection and CD4 count with PGL-1 and LID-1 have implications for M leprae immunodiagnostic tools and require replication., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Mycobacterium leprae is the primary causative agent of Hansen's disease or leprosy. Besides human beings, natural infection has been described in animals such as mangabey monkeys and armadillos. Leprosy is considered a global health problem and its complete pathogenesis is still unknown. As M. leprae does not grow in artificial media, armadillos have become the primary experimental model for leprosy, mimicking human disease including involvement of the peripheral nervous system. Leprosy transmission occurs through continuous and close contact of susceptible people with untreated infected people. However, unknown leprosy contact has been reported in leprosy-affected people, and contact with armadillos is a risk factor for leprosy. In the USA, leprosy is considered a zoonosis and this classification has recently been accepted in Brazil. This review presents information regarding the role of wild armadillos as a source of M. leprae for human infections, as well as the pathogenesis of leprosy.

Onychomycosis is the most frequent nail disease, with an estimated prevalence of 2-8%. Current treatment strategies include the use of oral and topical antifungals, despite low cure rates following these treatments. The objectives of this study were to assess the therapeutic response of patients with onychomycosis to 1,064-nm Nd:YAG laser treatment, the clinical evaluation method available for this therapy, and the possible side effects of this treatment. Twenty patients with onychomycosis underwent laser therapy. A total of 34 nails with onychomycosis were assessed according to the Onychomycosis Severity Index (OSI). This index generates scores that classify onychomycosis as mild, moderate, or severe. The OSI was determined before treatment and after a mean follow-up period of 8 months. The comparison between the initial and the final OSI for all 34 nails treated with laser therapy showed a significant difference; however, a low association was shown between these variables. A general reduction in the area of involvement and in the OSI numerical scores was observed. These data show a trend toward improvement in onychomycosis treated with 1,064-nm Nd:YAG laser. The OSI allowed an adequate clinical assessment of the response to laser therapy. Laser treatment did not cause marked discomfort in most patients, indicating that laser is a well-tolerated procedure.

Mycobaterium leprae infection was investigated in armadillos from the State of Espírito Santo, Brazil. The ML Flow test was performed on 37 nine-banded armadillos and positive results were found in 11 (29.7%). The ML Flow test may be used to identify possible sources of Mycobaterium leprae among wild armadillos.