The growing threat of antimicrobial resistance in Mycobacterium leprae: A literature review

Hansen's disease, or leprosy, is a chronic infection that affects the skin and peripheral nerves, often leading to disability if left untreated. The World Health Organization (WHO) recommends Multi-Drug Therapy (MDT) as the standard treatment. However, the increasing prevalence of MDT resistance introduces significant challenges to global leprosy control, particularly in endemic countries like Brazil, India, and Indonesia. This literature review involves 60 sources related to leprosy and antimicrobial resistance in leprosy, which is currently one of the critical challenges in leprosy treatment. The literature was gathered using manual search techniques. This review identifies genetic mutations in folP1, rpoB, and gyrA as primary contributors to antimicrobial resistance in Mycobacterium leprae, corresponding to resistance to dapsone, rifampicin, and ofloxacin, respectively. These mutations directly impact the effectiveness of Multi-Drug Therapy (MDT). Cases of resistance, particularly among relapse patients, show longer treatment durations and more significant risks of spreading resistant strains in endemic regions such as Brazil, India, and Indonesia. MDT resistance in M. leprae prolongs treatment duration and raises the risk of serious complications, including disability in patients. Addressing MDT resistance requires intensive monitoring, especially in endemic countries, as well as collaborative efforts and improved access to modern therapies to meet the goal of leprosy elimination.