ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Hidden burden of leprosy in incarcerated populations in northeast Brazil: active case detection and serological assessment.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeprosy remains a public health challenge in Brazil's Northeast, where prison overcrowding may facilitate transmission. Limited data exist on leprosy screening strategies in incarcerated populations.
methodsThis observational, cross-sectional study was conducted at Baldomero Cavalcante Male Penitentiary in Maceió, Alagoas, Brazil. A total of 915 inmates were approached using the Leprosy Suspicion Questionnaire (LSQ) as an active case-finding tool. Neurodermatological examinations were performed on 260 participants, and serological testing for anti-PGL-I (IgM) and anti-Mce1A antibodies (IgA, IgM, IgG) was conducted on 244 plasma samples using indirect ELISA.
resultsOf 842/915 returned questionnaires (92%), 240/842 (28.5%) were positive in the LSQ. Clinical examination revealed 8 new leprosy cases among 260/842 evaluated inmates with positive and negative LSQ, yielding an overall new case detection rate (NCDR) of 3.08%, which increased to 6.52% among symptomatic individuals. All diagnosed patients were classified as having multibacillary disease, with 100% presenting some grade of physical disability at diagnosis, and 75% LSQ were positive (p = 0.0249), while only 34.1% in the non-leprosy group. Anti-Mce1A IgM showed 37.7% seropositivity rate, and 19.9% for anti-PGL-I among clinically unaffected individuals. IgA (100%), IgM (37.5%), and IgG (25%) anti-Mce1A antibodies were positive in the leprosy group.
conclusionsThe LSQ may be effective as a screening tool. The study confirms significant underdiagnosis of leprosy in prison populations and highlights that anti-Mce1A serology showed higher positivity among diagnosed cases than anti-PGL-I, particularly for the detection of early-stage and neural forms of the disease. These findings support enhanced active surveillance strategies in high-risk populations to achieve leprosy elimination goals.
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