Type 2 reaction associated sensorineural hearing loss in a drug resistant lepromatous leprosy patient: A case report

Rationale:Leprosy,a chronic granulomatous disease often present clinically as erythema nodosum leprosum,a type 2 reaction.The involvement of cochlear part of audiovestibular system is a rarity.Patient concerns:A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss(SNHL)during type 2 reactional episode.Diagnosis:Recurrent erythema nodosum leprosum in rifampicin-resistant lepromatous leprosy.Interventions:Corticosteroids and second-line multidrug therapy.Outcomes:The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss.Lessons:The hearing impairment is a rare complication of type 2 reaction.Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required.All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.

Three-dimensional models of antigens with serodiagnostic potential for leprosy:An in silico study

BACKGROUND Leprosy is a disease caused by Mycobacterium leprae(M.leprae),an intracellular pathogen that has tropism and affects skin and nervous system cells.The disease has two forms of presentation:Paucibacillary and multibacillary,with different clinical and immunological manifestations.Unlike what occurs in the multibacillary form,the diagnostic tests for the paucibacillary form are nonspecific and not very sensitive,allowing the existence of infected individuals without treatment,which contributes to the spread of the pathogen in the population.To mitigate this contamination,more sensitive diagnostic tests capable of detecting paucibacillary patients are needed.AIM To predict the three-dimensional structure models of M.leprae antigens with serodiagnostic potential for leprosy.METHODS In this in silico study,satisfactory templates were selected in the Protein Data Bank(PDB)using Basic Local Alignment Search Tool to predict the structural templates of ML2038,ML0286,ML0050,and 85B antigens by comparative modeling.The templates were selected according to general criteria such as sequence identity,coverage,X-ray resolution,Global Model Quality Estimate value and phylogenetic relationship;Clustal X 2.1 software was used in this analysis.Molecular modeling was completed using the software Modeller 9v13.Visualization of the models was made using ViewerLite 4.2 and PyMol software,and analysis of the quality of the predicted models was performed using the QMEAN score and Z-score.Finally,the three-dimensional moels were validated using the MolProbity and Verify 3D platforms.RESULTS The three-dimensional structure models of ML2038,ML0286,ML0050,and 85B antigens of M.leprae were predicted using the templates PDB:3UOI(90.51%identity),PDB:3EKL(87.46%identity),PDB:3FAV(40.00%identity),and PDB:1F0N(85.21%identity),respectively.The QMEAN and Z-score values indicated the good quality of the structure models.These data refer to the monomeric units of antigens,since some of these antigens have quaternary structure.The validation of the models was performed with the final three-dimensional structure-monomer(ML0050 and 85B antigens)and quaternary structures(ML2038 and ML0286).The majority of amino acid residues were observed in favorable and allowed regions in the Ramachandran plot,indicating correct positioning of the side chain and absence of steric impediment.The MolProbity score value and Verify 3D results of all models indicated a satisfactory prediction.CONCLUSION The polarized immune response against M.leprae creates a problem in leprosy detection.The selection of immunodominant epitopes is essential for the development of more sensitive serodiagnostic tests,for this it is important to know the three-dimensional structure of the antigens,which can be predicted with bioinformatics tools.

Culture Circle as a Teaching Approach in the Education of Teenager Health Multipliers on Leprosy Awareness

Objective: The study aims to evaluate the use of a teaching method proposed by Paulo Freire, Culture Circles, in the education of teenagers multipliers on leprosy awareness. Methods: It is an action-research study with a qualitative approach developed in a public school in Pernambuco, Brazil. Five Culture Circles were conducted involving the participation of 26 teenagers. The followings were used as data collection tools: observation, field notes, photography and filming. Results: The educational intervention on health addressed the following topics: 1) Definition and transmission of leprosy;2) Characteristics and diagnosis of leprosy;3) Treatment of leprosy;4) Aesthetics, prejudice and mental health related to leprosy;and 5) Planning of educational activities for teenagers as health multipliers on leprosy awareness. The educational action on health provided this age group to perceive themselves, act as political subjects in the development of Culture Circles, and act as protagonists in the dissemination of knowledge on leprosy. Conclusions: This study highlights that the application of active methodologies, such as Culture Circles, is able to encourage the engagement of young people in community empowerment and bring together health professionals and the school community in an intersectoral work in order to develop action strategies involving the promotion of health in the context of neglected diseases such as leprosy.

Clinical characteristics predicting erythema nodosum leprosum(ENL) among patients with multibacillary leprosy(MBL) in Sarawak

Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital from 1992 to 2007 were analyzed.They were divided into 2 groups,one with ENL and one without. Analysis of the presenting clinical features was done to determine the risk factors for ENL.Chi square and student t test was used for statistical analysis.Level of significance was set at 0.05.Results:ENL was present in 40%patients,all with lepromatous leprosy(LL).Clinical features that were seen more frequently in patients developing ENL include earlobe thickening(100%cf.25%,P =0.00),loss of the lateral third of the eyebrows(75%cf.16.7%,P=0.02) and mean bacteriology index(BI)(5.1 cf.2.9,P=0.03) and mean morphological index(MI)(17.8 cf.7.0,P =0.02).Number of thickened nerves(mean 2.5 cf. 1.4,P = 0.12),number of skin lesions(mean 19.4 cf.10.9,P = 0.15) and duration of illness(mean 15. 3 cf.12.8 months,P =0.68) did not predict ENL development.Conclusion:Finding LL patients with thickened earlobes,loss of lateral third of the eyebrow,high BI and MI should alert treating clinician to the possibility of ENL in a non endemic leprosy area.

EFFECT OF THREE-YEAR MULTIDRUG THERAPY IN MULTIBACILLARY LEPROSY PATIENTS

The feasibility and effects of a 3-year treatment using rifampicin(RFP),clofazimine(B663)and dapsone(DDS)in multibacillary leprosy patients in Yangzhou Prefecture and DongtaiCounty(1983-1986)are reported.Among 591 active multibaeillary leprosy patients in thetwo areas,569 (96.30%)were treated with this regimen.of 303 cases available for analysis,196(64.7%)cases showed negative skin smears and clinical inactivity.The rest showeddifferent degrees of improvement.The average reduction of BI was 0.78.The intensityand frequency of ENL and neuritis decreased markedly with treatment.The main side-effects were pigmentation and ichthyosiform changes of the skin,but these did not influencetreatment.

Limbal leproma in lepromatous leprosy

Dear Sir, W e are writing to you to present an unusual case of leproma growing at the limbus of a lepromatous leprosy patient. This the first report of ocular leprosy in Brunei, where leprosy is extremely rare. Leprosy, otherwise known as Hansen’s disease, is a chronic granulomatous communicable infection caused by Mycobacterium leprae and its genetic variant (Mycobacterium lepromatosis) [1]. A leproma is a superficial, ci

Theoretical Assessment of the Transmission Dynamics of Leprosy

Leprosy is a communicable disease which can cause hideous deformities to the afflicted and social stigmatization to them and their families. The continued high endemicity of leprosy in pockets of Sub-Saharan Africa is a source of bafflement to researchers. In this paper, we investigate non-compliant behavior by patients on treatment and possible inadequacy of the prescribed treatments as the reason for the persistence of the disease in the region. We construct theoretical, deterministic mathematical models of the transmission dynamics of leprosy. These models are modified to encapsulate non-compliance and inadequate treatment. The models are then analyzed to gain insight into the qualitative features of the equilibrium states, which enable us to determine the basic reproduction number. We also employ analytical and numerical techniques to investigate the impact of non-compliance and inadequate treatment on the transmission dynamics of the disease. Our results show that, as long as there is treatment, leprosy will eventually be eliminated from the region and that the disposition under investigation only serves to slow the rate at which the disease is eradicated.

A Clinco-Bacteriological Study of Leprosy in Paediatric Age Group

Clinico-bacteriological study was done in 51 leprosy patients below 14 years of age. Majority of the patients were males in the age group of 11-14 years. Nearly 84% had not received any prior treatment because of lack of awareness and financial constraints. Only 11.76% had a positive contact history. Skin lesions were present in all cases and 84.3% had lesions mainly on the exposed areas of the body and their number was found to increase significantly with advancing age (p < 0.005). These lesions were hypo-pigmented patches in 88% cases. 88% of cases had hypo-anesthesia and nerve thickening was observed in 24% cases. The most common type of skin lesion was borderline tuberculoid (BT) in 53% cases. Positivity of the skin smears increased significantly as the number of the skin lesions per patient increased (p 0.001). Multibacillary cases were seen in 15.6% of cases and found only in the age group of 10-14 years of age. No statistically significant association between BCG vaccination and prevention of leprosy was seen.

Assessment of Risks of Cardiovascular Diseases among Leprosy Patients Settlement at Ossiomo-Ogan Rehabilitation Center, Edo State, Nigeria

Background/Aim: Quality of life is reduced in people living with leprosy as a result of its impact on human activities. Lipid profile means pattern of lipids in the blood, which is routinely done to assess cardiovascular risk. The aim of this study is to assess the risk of cardiovascular diseases among the leprosy patients settlement at Ossiomo-Ogan, Edo state. Method: Blood samples were collected from a total number of one hundred and eight (108) (57 leprosy patients and 51 controls) subjects. The lipid profiles of the participants were determined using standard methods. Results: Significantly (p < 0.001) higher mean serum levels of total cholesterol, triglycerides, HDL and LDL in leprosy patients compared with the healthy controls were obtained. There is significant positive correlation between artherogenic index and levels of total cholesterol (r = 0.663;p < 0.001);triglyceride (r = 0.901;p < 0.001);HDL (r = 0.284;p = 0.003);and LDL (r = 0.626;p < 0.001) in leprosy patients. However, all the control subjects and 54 (94.7%) of the leprosy patients had low cardiovascular disease risk, while 3 (2.8%) indicated moderate CVD risk. None of the participants had high risk of developing cardiovascular disease. Conclusion: In this study, lipid profile levels of leprosy patients significantly increased despite moderate level of BMI. This study also showed significant positive correlation between the anthrogenic index of plasma and all the lipid profile. Many of the leprosy patients are not conscious of their diet which was tilted towards heavy carbohydrate and fatty meals. None of the participants is at high risk of cardiovascular diseases but the risk may increase with further elevation of the lipid profiles. Efforts should be made by all stakeholders to improve on the awareness of leprosy disease and encourage the sufferers to live decent lives.

Serum Levels of Prostate Specific Antigen Parameters among Male Patients with Lepromatous Leprosy in Edo State, Nigeria

Aim: This study is aimed at determining the total PSA (tPSA), free PSA (fPSA) concentrations and free to total PSA ratio (f/tPSA) and their utility in prostate cancer (PCa) risk stratification among male lepromatous leprosy patients in Edo state, Nigeria. Methods: Forty participants and thirty controls participated in this study. A structured questionnaire was administered to each participant to elicit details such as their personal data, age, sex, residence, medications, alcohol consumption, smoking habit, length of time of diagnosis, sexual activities, as well as the history of any other underlying diseases. Blood samples were collected from the participants. Total and free PSA concentrations in the samples were measured using ELISA method. Results: Significantly (p = 0.042) higher serum fPSA among the leprosy patients (0.22 ± 0.12 ng/ml) compared with the healthy controls (0.17 ± 0.09 ng/ml). There were no significant (p = 0.055) difference in the mean tPSA between the leprosy patients (2.69 ± 2.25 ng/ml) compared with the control (1.95 ± 0.69 ng/ml). Similarly, no significant (p = 0.548) difference was observed in PSA ratio between the control (0.08 ± 0.04) and the leprosy patients (0.09 ± 0.03). Conclusion: Our study indicated no significant differences in tPSA and f/tPSA between the leprosy patients and their healthy control. Elevated tPSA as well as f/tPSA levels that fell within the high risk zones of PCa were more prevalent among patients aged ≥ 70 years, not married, who rarely had sexual intercourse and those with longer disease duration.

Polymorphisms of the Toll-Like Receptor-2 Gene in Patients with Leprosy and Their Healthy Contacts

Leprosy is an immunopathology caused by M. leprae;its evolution depends on immunological and genetic aspects of the host. The objective was verifying the relationship between SNPs 2029 and 2258 of the TLR-2 gene and leprosy. Blood samples from 127 individuals were analyzed: 45 patients, being 34 multibacillary (MB) and 11 paucibacillary (PB) and 82 contacts, in the municipalities of the State of Pará-Brazil. SNPs 2029 and 2258 of the TLR-2 gene were genotyped by sequencing on the ABI 3130 Genetic Analyzer (Applied Biosystems), analyzed using Fisher’s exact test. Distribution of SNP 2029 genotypes: all MB individuals presented the C/C genotype and the mutant (C/T) genotype was observed in contacts and PB. Alleles: all MB individuals presented only C allele and the mutant allele (T) was observed in contacts and PB. SNP 2258 genotypes: 79 contacts had G/G genotype and only 3 had G/A genotype, the MB group had only G/G genotype and the PB group was predominant G/G, with only 1 G/A genotype. Alleles: all MB individuals had allele G and the mutant allele (A) was observed in contacts and PB. The association between the SNPs and the susceptibility or protection to leprosy was not observed.

Human Rights and Social Stigma Review for Leprosy Patients in Korea

Leprosy is a chronic disease caused by a low multiplying bacillus, Mycobacterium leprae, which primarily affects the skin and the extremities. Multidrug therapy (MDT) and Bacillus Calmette-Guérin (BCG) vaccinations are effective at treatment of the disease, but social misconceptions about the disease inhibit efficient health care for affected individuals. In South Korea, leprosy patients face social, economic, and political discrimination. Korean leprosy patients are isolated into Sorokdo island and face challenges such as difficulty receiving education and limited job opportunities. Leprosy cognitively, emotionally, and socially impacts patients’ lives, and represents a serious social inequality issue. To raise awareness, dispel myths about the disease, and to end patient discrimination that destroys families, we conducted case studies based on scientific journals. The paper specifically focuses on difficulties faced by Korean leprosy patients, and subsequent initiatives by the government to aid patients. To reach the WHO’s target of health and wellbeing for all by 2030, we need to educate the masses about leprosy and address relevant social inequality issues.

Foot and Ankle Muscles Activation and Plantar Sensory Deficit in Leprosy and Its Implication to Foot Deformity and Walking Capacity

Objective: To observe extrinsic foot muscle activity ratio and sensory disturbance in Leprosy and its implication to foot deformity and walking capacity. Design: Cross sectional study in Singkawang, West Kalimantan. Materials and Methods: Thirty-three leprosy patients without walking aids and/or orthotic prosthetic were enrolled using consecutive sampling. Foot deformity score was calculated and muscle activity was measured using surface EMG. Muscle activation ratio was calculated in Tibialis anterior-to-Gastrocnemius (TA/GA) and Tibialis Anterior-to-Peroneal (TA/PE). Walking capacity was assessed using Timed up and Go test. Results: Significant differences of foot ulcer (p = 0.001) and foot deformities (p = 0.001) were found in plantar sensory deficit group. There was strong correlation between foot deformities and decreased TA/GA ratio (p = 0.001, r = ﹣0.787) and decreased TA/PE ratio (p = 0.001, r = ﹣0.663). There were significant differences of TA/GA ratio (p = 0.00) and TA/PE ratio (p = 0.09) based on the foot ulcer, and no significant difference of Timed Up and Go Test result within plantar sensory deficit group (p = 0.427). No significant correlation was found between walking capacity and TA/GA ratio (p = 0.055), and TA/PE ratio (p = 0.165). Conclusion: Plantar sensory deficit and decreased extrinsic muscle activation ratio during gait had been proven to affect foot impairment, but have not been proven to inhibit walking capacity.

Sensitivity of a Rapid Mix Test with Combined Synthetic Antigens Derived from Mycobacterium Leprae PGL-1 for Diagnosis and Surveillance of Leprosy

Introduction: In the Americas, Brazil contributes 91.63% of the total cases and the state of Pará still has high endemia for leprosy. Objective: To analyze the performance of a rapid test for the diagnosis and epidemiological surveillance of leprosy in endemic areas. Methods: The sample consisted of 70 MB multibacillary leprosy (MB) patients, 63 paucibacillary (PB) patients, and 80 intradomiciliary consanguineous contacts (ICSCO) of patients. A rapid test with a 15-minute reading was applied using two prototypes: prototype 1, double test with trisaccharide antigen (NT-P-BSA) at 1a. line (83.2 ng/test) and disaccharide antigen (ND-O-BSA) at 2a. (83.2 ng/test), both with a flow of 0.08 μL/mm with a 10 μC membrane, anti-IgM conjugate with a flow of 0.040 μL/mm and a Tris-Triton and prototype 2 runner buffer with MIX antigen (trisaccharide + disaccharide) in the same concentrations and conditions of prototype 1. Results: The comparison of the MIX test positivity rate and the disaccharide or trisaccharide doublet test across all samples was statistically significant, demonstrating that the MIX test had higher seropositivity rates compared to the ND-O-BSA or NT-P-BSA. It was demonstrated that the MIX test showed a good performance, with 25.39% of the PB patients negative for the disaccharide and trisaccharide duplet test, but positive for MIX. Conclusions: These data suggest the potential for further optimizing the performance by adding other synthetic antigens to the MIX antigens.

Advances in the pathogenic, genetic and immunological studies of leprosy

Leprosy is an infectious granulomatous disease caused by Mycobacterium leprae that affects the skin and can lead to deformity by damaging peripheral nerves.Although leprosy is no longer an incurable disease,its epidemic has not been well controlled because of its unclear routes of transmission and the lack of an effective vaccine.Moreover,leprosy has long been an ideal disease model for the study of genetics and immunology of infectious diseases due to its strong genetic predisposition and immune-dependent spectrum of clinical manifestations.Here,we review the latest and important findings of the pathogenesis of leprosy.Recent studies have shown that the highly conserved M.leprae is zoonotic,which further complicates the ambiguous transmission of M.leprae.Genetically,genome-wide association studies of leprosy have reported dozens of susceptibility genes,most of which are immune-related,and thus systematically elucidate the immunogenetic basis of the disease.Immunologically,plenty of novel mechanisms of host defense against intracellular bacterial infection and the modulation of host immunity by M.leprae have been depicted.Despite these great achievements,there are still gaps between pathogenic biology,genetics,and immunology of leprosy,limiting our in-depth understanding of leprosy pathogenesis.Further efforts,such as multi-omics data integration and the development of viable animal models for immunogenetic studies are urgently needed to accelerate advances in the precise prevention and treatment of leprosy.

Pseudoainhum Associated With Lepromatous Leprosy:A Very Rare Association in Modern World

Introduction:Pseudoainhum(dactylolysis spontanea)is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation.Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions.Here,we present a rare case of pseudoainhum patient,which describes a very rare association of pseudoainhum with leprosy.Case presentation:A 48 year old male with lepromatous leprosy,with resorption of digits,charcot joints and tropical ulcers was seen in the clinic.The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx.He could not recall the duration of the ainhum.He was not suffering from any pain.Discussion:The current report describes a very rare association of pseudoainhum with leprosy.The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum.Conclusion:This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits,especially in leprosy.

Evaluating active leprosy case identifcation methods in six districts of Nepal

Background Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009,but 17 districts and 3 provinces with 41%(10,907,128)of Nepal’s population have yet to eliminate the disease.Pediatric cases and grade-2 disabilities(G2D)indicate recent transmission and late diagnosis,respectively,which necessitate active and early case detection.This operational research was performed to identify approaches best suited for early case detection,determine community-based leprosy epidemiology,and identify hidden leprosy cases early and respond with prompt treatment.Methods Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy,Madhesh Province(40%national cases)and Lumbini Province(18%)and at-risk prison populations in Madhesh,Lumbini and Bagmati provinces.Case detection was performed by(1)house-to-house visits among vulnerable populations(n=26,469);(2)contact examination and tracing(n=7608);in Madhesh and Lumbini Provinces and,(3)screening prison populations(n=4428)in Madhesh,Lumbini and Bagmati Provinces of Nepal.Per case direct medical and nonmedical costs for each approach were calculated.Results New case detection rates were highest for contact tracing(250),followed by house-to-house visits(102)and prison screening(45)per 100,000 population screened.However,the cost per case identifed was cheapest for house-to-house visits[Nepalese rupee(NPR)76,500/case],followed by contact tracing(NPR 90,286/case)and prison screening(NPR 298,300/case).House-to-house and contact tracing case paucibacillary/multibacillary(PB:MB)ratios were 59:41 and 68:32;female/male ratios 63:37 and 57:43;pediatric cases 11%in both approaches;and grade-2 disabilities(G2D)11%and 5%,respectively.Developing leprosy was not signifcantly diferent among household and neighbor contacts[odds ratios(OR)=1.4,95%confdence interval(CI):0.24-5.85]and for contacts of MB versus PB cases(OR=0.7,95%CI 0.26-2.0).Attack rates were not signifcantly diferent among household contacts of MB cases(0.32%,95%CI 0.07-0.94%)and PB cases(0.13%,95%CI 0.03-0.73)(χ^(2)=0.07,df=1,P=0.9)and neighbor contacts of MB cases(0.23%,0.1-0.46)and PB cases(0.48%,0.19-0.98)(χ^(2)=0.8,df=1,P=0.7).BCG vaccination with scar presence had a signifcant protective efect against leprosy(OR=0.42,0.22-0.81).Conclusions The most efective case identifcation approach here is contact tracing,followed by house-to-house visits in vulnerable populations and screening in prisons,although house-to-house visits are cheaper.The fndings suggest that hidden cases,recent transmission,and late diagnosis in the community exist and highlight the importance of early case detection.

Establishing a standard method for analysing case detection delay in leprosy using a Bayesian modelling approach

Background Leprosy is an infectious disease caused by Mycobacterium leprae and remains a source of preventable disability if left undetected.Case detection delay is an important epidemiological indicator for progress in interrupting transmission and preventing disability in a community.However,no standard method exists to effectively analyse and interpret this type of data.In this study,we aim to evaluate the characteristics of leprosy case detection delay data and select an appropriate model for the variability of detection delays based on the best fitting distribution type.Methods Two sets of leprosy case detection delay data were evaluated:a cohort of 181 patients from the post exposure prophylaxis for leprosy(PEP4LEP)study in high endemic districts of Ethiopia,Mozambique,and Tanzania;and self-reported delays from 87 individuals in 8 low endemic countries collected as part of a systematic literature review.Bayesian models were fit to each dataset to assess which probability distribution(log-normal,gamma or Weibull)best describes variation in observed case detection delays using leave-one-out cross-validation,and to estimate the effects of individual factors.Results For both datasets,detection delays were best described with a log-normal distribution combined with covariates age,sex and leprosy subtype[expected log predictive density(ELPD)for the joint model:-1123.9].Patients with multibacillary(MB)leprosy experienced longer delays compared to paucibacillary(PB)leprosy,with a relative difference of 1.57[95%Bayesian credible interval(BCI):1.14-2.15].Those in the PEP4LEP cohort had 1.51(95%BCI:1.08-2.13)times longer case detection delay compared to the self-reported patient delays in the systematic review.Conclusions The log-normal model presented here could be used to compare leprosy case detection delay datasets,including PEP4LEP where the primary outcome measure is reduction in case detection delay.We recommend the application of this modelling approach to test different probability distributions and covariate effects in studies with similar outcomes in the field of leprosy and other skin-NTDs.

The Global Leprosy Assessment Index(GLAI):A new approach for measuring the severity of disease in Brazil

Background:In Brazil,the Ministry of Health(MH)monitors leprosy using 15 indicators,with the aim of imple-menting and evaluating evidence-based public policies.However,an excessive number of variables can compli-cate the definition of objectives and verification of epidemiological goals.Methods:In this paper,we develop the Global Leprosy Assessment Index(GLAI),a composite measure that integrates two key dimensions for the control the disease:epidemiological and operational.Using a confirmatory factor analysis model to examine 2020 state-level data,we have standardized GLAI to a range of 0 to 1.Results:Higher values within this range indicate a greater severity of the disease.The mean value of the GLAI was 0.67,with a standard deviation of 0.22.Roraima has the highest value,followed by Paraíba with 0.88 while Tocantins records the lowest value of the indicator,followed by Mato Grosso with 0.14.The epidemiological and operational indicators have a positive but statistically insignificant correlation(r=0.25;p-value=0.20).Conclusions:The development of evidence-based public policies depends on the availability of valid and reliable indicators.The GLAI presented in this paper is easily reproducible and can be used to monitor the disease with disaggregated information.Furthermore,the GLAI has the potential to serve as a more robust parameter for evaluating the impact of actions designed to eradicate leprosy in Brazil.