Preface

Chapter 6 **RNA Association, RNA Interference, and microRNA Pathways in**

**Dengue Fever Virus-Host Interaction 93**

Chapter 7 **HIV/AIDS in a Community of Western Cameroon 117**

**Pathogenicity and Diagnosis 151**

Chapter 8 **Ebola Virus Disease: Progress So Far in the Management of**

Chapter 9 **A Reemerging Lassa Virus: Aspects of Its Structure, Replication,**

**Section 3 Other Viral Diseases in the Tropics 115**

Sevidzem Silas Lendzele

**the Disease 129** Godwill Azeh Engwa

Victor B. Oti

Imran Shahid

**VI** Contents

Tropical emerging diseases pose a significant risk for the circulation of old and new patho‐ gens in areas previously unknown, which implies the possibility of new morbidities and mortalities and new consequences for naïve populations. Globalization, migration and trav‐ el [1–5], as well climate change and variability [6–10], are key factors for tropical diseases, and represent the need for integration of tropical medicine, travel medicine and epidemiolo‐ gy in the understanding of such complex situations. Among these, neglected tropical diseas‐ es (NTDs) are relevant especially in the more vulnerable populations [11–13]. According to the World Health Organization (WHO), NTDs constitute a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries. These affect more than one billion people and cost developing economies billions of dollars every year; a significant burden in multiple terms. Populations living in poverty [14,15], without ade‐ quate sanitation and in close contact with infectious vectors and domestic animals and live‐ stock, are those worst affected. Leprosy and Chagas are examples of diseases in which new advances and evidence are relevant for NTDs deserving further studies [16].

Recently, viruses transmitted by vectors (arboviruses) affecting not only people living in the tropics but also travelers and migrating populations, such as dengue, chikungunya, Zika, Mayaro, and encephalitis, among others, have been causing epidemics, and emerging and reemerging in multiple regions of the world, as occurred in the Americas (2013–2017) with chikungunya and Zika [17].

However, in the tropics, old conditions, such as the human immunodeficiency virus (HIV), Ebola virus [18–20], and arenaviruses, continue to cause morbidity and mortality among de‐ veloping countries in Africa, Asia, and America.

Keeping these issues in mind, this book includes different topics regarding research and clini‐ cal topics related to those relevant tropical emerging infectious diseases, including their im‐ plications for public health and travel medicine. This book has been organized into three major sections: I. Neglected Tropical Diseases; II. Arboviral Diseases; and III. Other Viral Dis‐ eases in the Tropics. Section I includes topics related to leprosy, Chagas disease and other NTDs with impact on kidney function. Section II includes experiences on arboviral diseases in Asia and Europe, such as dengue. Section III discusses HIV and Ebola in Africa, as well as arenaviruses.

The commissioning of this book by InTechOpen editorial has been related in part to my long commitment to vector-borne, zoonotic and tropical diseases, being involved as Co-Chair of the Working Group on Zoonoses of the International Society for Chemotherapy (WGZ-ISC), as well in Colombia at the Committee on Tropical Medicine, Zoonoses and Travel Medicine of the Colombian Association of Infectious Diseases (Asociación Colombiana de Infectología, ACIN) and more importantly as the Chair of the Colombian Collaborative Network of Re‐ search on Zika (Red Colombiana de Colaboración en Zika)(RECOLZIKA), since January 2016.

Lagos-Grisales, MD, MPH. Members of our research group and incubator consist of young and enthusiastic medical students and some veterinary medical students as well as young medical doctors, who are pursuing significant improvements in the understanding of the epi‐ demiology of zoonotic, vector-borne, parasitic and in general, infectious diseases in our coun‐ try with international projection. The year 2018 was a complex year, but still productive for this recognized group, which was classified in 2017 by the national agency of science, Colcien‐ cias, with the highest rank "A1", which is positioning as a leader in infectious diseases epi‐

Preface IX

Finally, I hope our readers enjoy this publication as much as I did reading the chapters of

travelers of Colombia? Infectio 2018 Oct–Dec; 22(4):171–172.

[1] Rodríguez-Morales AJ, Villamil-Gómez WE. Yellow fever: still of concern for

[2] Rodriguez-Morales AJ, Cardona-Ospina JA, Ramirez-Jaramillo V, Gaviria JA, González-Moreno GM, Castrillón-Spitia JD, López-Villegas A, Morales-Jiménez E, Ramírez-Zapata V, Rueda-Merchán GE, Trujillo AM, Tabares-Villa FA, Henao-SanMartin V, Murillo-Garcia DR, Herrera-Soto JA, Buitrago-Cañas ML, Collins MH, Sepúlveda-Arias JC, Londoño JJ, Bedoya-Rendón HD, Cárdenas-Pérez JJ, Olaya SX, Lagos-Grisales GJ. Diagnosis and outcomes of pregnant women with Zika virus infection in two municipalities of Risaralda, Colombia: second report of the ZIKERNCOL study. Travel Med Infect Dis 2018 Sep–Oct; 25(10):20–25. [3] Chaves TSS, Orduna T, Lepetic A, Macchi A, Verbanaz S, Risquez A, Perret C, Echazarreta S, Rodríguez-Morales AJ, Lloveras SC. Yellow fever in Brazil: epide‐ miological aspects and implications for travelers. Travel Med Infect Dis 2018

[4] Alvarado-Socarras JL, Idrovo AJ, Contreras-García GA, Rodriguez-Morales AJ, Audcent TA, Mogollon-Mendoza AC, Paniz-Mondolfi A. Congenital microcepha‐ ly: a diagnostic challenge during Zika epidemics. Travel Med Infect Dis 2018

[5] Rodriguez-Morales AJ, Yepes-Echeverri MC, Acevedo-Mendoza WF, Marín-Rin‐ cón HA, Culquichicón C, Parra-Valencia E, Cardona-Ospina JA, Flisser A. Map‐ ping the residual incidence of taeniasis and cysticercosis in Colombia, 2009–2013, using geographical information systems: implications for public health and travel

[6] Chowdhury FR, Ibrahim QSU, Bari S, Alam MMJ, Dunachie SJ, Rodriguez-Mo‐ rales AJ, Patwary I. The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in Bangladesh. PLoS One 2018;

[7] Quintero-Herrera LL, Ramírez-Jaramillo V, Bernal-Gutiérrez S, Cárdenas-Giraldo EV, Guerrero-Matituy EA, Molina-Delgado AH, Montoya-Arias CP, Rico-Gallego JA, Herrera-Giraldo AC, Botero-Franco S, Rodríguez-Morales AJ. Potential im‐ pact of climatic variability on the epidemiology of Dengue in Risaralda, Colom‐

bia, 2010–2011. J Infect Public Health 2015 May–June; 8(3):291–297.

medicine. Travel Med Infect Dis 2018 Mar–Apr; 22(2):51–57.

13(6):e0199579. doi 10.1371/ journal.pone.0199579

demiology research in the coffee-triangle region and in the country.

*Current Topics in Tropical Emerging Diseases and Travel Medicine.*

May–Jun; 23(3):1–3.

May–Jun; 23(3):14–20.

**References**

I have been involved in vector-borne diseases (VBDs) for the last two decades, including malaria, leishmaniasis, Chagas disease as well as dengue, and since 2014 with chikungunya and emerging arboviruses such as Zika and Mayaro. After moving from Venezuela to Co‐ lombia in 2011, I have been involved in research of VBDs in Risaralda, such as malaria and leishmaniasis (still prevalent in the area), where we still keep working on these important tropical diseases. Part of all this is a clear reflection of the work impulse at the Research Group Infection Public Health and Infection (classified A1 by Colciencias) of the Faculty of Health Sciences of the Universidad Tecnológica de Pereira, directed by Dr. Guillermo Javier Lagos-Grisales, who is not just a partner, but a colleague and mainly a friend and extreme believer in our work in vector-borne and zoonotic diseases. However, I must recognize also the beginning of a significant collaboration after a meeting in Cartagena in 2013, during the Colombian Congress of Infectious Diseases, where I met Dr. Wilmer Ernesto Villamil-Gó‐ mez from Sincelejo, Sucre, Colombia, also part of the former Committee of Zoonoses and Hemorrhagic Fevers of the Colombian Association of Infectious Diseases (Asociación Co‐ lombiana de Infectología, ACIN) (now called Committee of Zoonoses and Tropical Medi‐ cine), who became my most important collaborator on arboviruses, including Zika. In addition to that, since 2002 I have been involved in tropical medicine and travel medicine, participating in multiple studies on malaria, Chagas disease, leishmaniasis, toxocariasis, giardiasis, and other intestinal parasitoses, tuberculosis and HIV. Currently in Colombia, we continue to study most of them, including now their assessment in internally displaced pop‐ ulations.

Following the same philosophy as we did on my seven previous books with InTechOpen, *Current Topics in Tropical Medicine* [21], *Current Topics in Public Health* [22], *Current Topics in Echinococcosis* [23], *Current Topics in Chikungunya* [24], *Current Topics in Malaria* [25], *Current Topics in Giardiasis* [26], and *Current Topics in Zika* [27], this book does not intend to be an exhaustive compilation and this first edition has included not just multiple different topics but also a wide geographical participation from many countries of different regions of the world. Its online availability through the InTechOpen website, as well the possibility to up‐ load the complete book or their chapters from personal websites and institutions' reposito‐ ries, allows it to reach a wider audience. Continuing with the series of *Current Topics* books, we are planning to develop other projects such as *Current Topics in Zoonoses*.

I would like to give a very special thanks to InTechOpen (for the fourth time), and particu‐ larly to Maja Bozicevic, Irina Stefanic, Markus Mattila, Romina Rovan and Nina Kalinic (Au‐ thor Service Managers), for the opportunity to edit this interesting and important book, as well for their constant support.

I want to take the opportunity as always to dedicate this book to my beloved family (Aurora, Alfonso José, Alejandro, and Andrea, the neurologist), and also to my friends and my under‐ graduate and postgraduate students of health sciences in Colombia, Venezuela, and around Latin America. Also it is time to say thanks to my colleagues at the Working Group on Zoono‐ ses, International Society for Chemotherapy and the Committee on Zoonoses, Tropical Medi‐ cine and Travel Medicine (formerly the Committee on Zoonoses and Haemorrhagic Fevers) of the Colombian Infectious Diseases Society (ACIN) and a large list of members of RECOLZIKA (www.RECOLZIKA.org). Special thanks again to my friend and colleague Dr. Guillermo J.

Lagos-Grisales, MD, MPH. Members of our research group and incubator consist of young and enthusiastic medical students and some veterinary medical students as well as young medical doctors, who are pursuing significant improvements in the understanding of the epi‐ demiology of zoonotic, vector-borne, parasitic and in general, infectious diseases in our coun‐ try with international projection. The year 2018 was a complex year, but still productive for this recognized group, which was classified in 2017 by the national agency of science, Colcien‐ cias, with the highest rank "A1", which is positioning as a leader in infectious diseases epi‐ demiology research in the coffee-triangle region and in the country.

Finally, I hope our readers enjoy this publication as much as I did reading the chapters of *Current Topics in Tropical Emerging Diseases and Travel Medicine.*

#### **References**

ACIN) and more importantly as the Chair of the Colombian Collaborative Network of Re‐ search on Zika (Red Colombiana de Colaboración en Zika)(RECOLZIKA), since January 2016. I have been involved in vector-borne diseases (VBDs) for the last two decades, including malaria, leishmaniasis, Chagas disease as well as dengue, and since 2014 with chikungunya and emerging arboviruses such as Zika and Mayaro. After moving from Venezuela to Co‐ lombia in 2011, I have been involved in research of VBDs in Risaralda, such as malaria and leishmaniasis (still prevalent in the area), where we still keep working on these important tropical diseases. Part of all this is a clear reflection of the work impulse at the Research Group Infection Public Health and Infection (classified A1 by Colciencias) of the Faculty of Health Sciences of the Universidad Tecnológica de Pereira, directed by Dr. Guillermo Javier Lagos-Grisales, who is not just a partner, but a colleague and mainly a friend and extreme believer in our work in vector-borne and zoonotic diseases. However, I must recognize also the beginning of a significant collaboration after a meeting in Cartagena in 2013, during the Colombian Congress of Infectious Diseases, where I met Dr. Wilmer Ernesto Villamil-Gó‐ mez from Sincelejo, Sucre, Colombia, also part of the former Committee of Zoonoses and Hemorrhagic Fevers of the Colombian Association of Infectious Diseases (Asociación Co‐ lombiana de Infectología, ACIN) (now called Committee of Zoonoses and Tropical Medi‐ cine), who became my most important collaborator on arboviruses, including Zika. In addition to that, since 2002 I have been involved in tropical medicine and travel medicine, participating in multiple studies on malaria, Chagas disease, leishmaniasis, toxocariasis, giardiasis, and other intestinal parasitoses, tuberculosis and HIV. Currently in Colombia, we continue to study most of them, including now their assessment in internally displaced pop‐

Following the same philosophy as we did on my seven previous books with InTechOpen, *Current Topics in Tropical Medicine* [21], *Current Topics in Public Health* [22], *Current Topics in Echinococcosis* [23], *Current Topics in Chikungunya* [24], *Current Topics in Malaria* [25], *Current Topics in Giardiasis* [26], and *Current Topics in Zika* [27], this book does not intend to be an exhaustive compilation and this first edition has included not just multiple different topics but also a wide geographical participation from many countries of different regions of the world. Its online availability through the InTechOpen website, as well the possibility to up‐ load the complete book or their chapters from personal websites and institutions' reposito‐ ries, allows it to reach a wider audience. Continuing with the series of *Current Topics* books,

I would like to give a very special thanks to InTechOpen (for the fourth time), and particu‐ larly to Maja Bozicevic, Irina Stefanic, Markus Mattila, Romina Rovan and Nina Kalinic (Au‐ thor Service Managers), for the opportunity to edit this interesting and important book, as

I want to take the opportunity as always to dedicate this book to my beloved family (Aurora, Alfonso José, Alejandro, and Andrea, the neurologist), and also to my friends and my under‐ graduate and postgraduate students of health sciences in Colombia, Venezuela, and around Latin America. Also it is time to say thanks to my colleagues at the Working Group on Zoono‐ ses, International Society for Chemotherapy and the Committee on Zoonoses, Tropical Medi‐ cine and Travel Medicine (formerly the Committee on Zoonoses and Haemorrhagic Fevers) of the Colombian Infectious Diseases Society (ACIN) and a large list of members of RECOLZIKA (www.RECOLZIKA.org). Special thanks again to my friend and colleague Dr. Guillermo J.

we are planning to develop other projects such as *Current Topics in Zoonoses*.

ulations.

VIII Preface

well for their constant support.


[8] Escobedo AA, Almirall P, Rumbaut R, Rodríguez-Morales AJ. Potential impact of macroclimatic variability on the epidemiology of Giardiasis in three provinces of Cuba, 2010–2012. J Infect Public Health 2015 Jan–Feb; 8(1):80–89.

[21] Rodriguez-Morales AJ. (ed.). Current Topics in Tropical Medicine. ISBN 978-953-51-0274-8. InTech, Croatia, Mar 2012. Available at: http://www.intechop‐

[22] Rodriguez-Morales AJ. (ed.). Current Topics in Public Health. ISBN 978-953-51-1121-4. InTech, Croatia, May 2013. Available at: http://www.intechop‐

[23] Rodriguez-Morales AJ. (ed.). Current Topics in Echinococcosis. ISBN 978-953-51-2159-6. InTech, Croatia, Sep 2015. http://www.intechopen.com/books/

[24] Rodriguez-Morales AJ. (ed.). Current Topics in Chikungunya. ISBN 978-953-51-2595-2. InTech, Croatia, Aug 2016. http://www.intechopen.com/books/

[25] Rodriguez-Morales AJ. (ed.). Current Topics in Malaria. ISBN 978-953-51-2790-1. InTech, Croatia, Nov 2016. http://www.intechopen.com/books/current-topics-in-

[26] Rodriguez-Morales AJ. (ed.). Current Topics in Giardiasis. ISBN 978-953-51-5260-6. InTech, Croatia, Dec 2017. http://www.intechopen.com/books/

[27] Rodriguez-Morales AJ. (ed.). Current Topics in Zika. ISBN 978-1-78923-271-4. In‐ Tech, United Kingdom, Jun 2018. https://www.intechopen.com/books/current-

MD, MSc, DTM&H, FRSTMH(Lon), FFTM RCPS(Glasg), FACE, PhD(c), Dr h c(HonDSc).

Lecturer, Frontiers Research, Research II and Research IV, School of Veterinary Medicine &

Director of Research, Faculty of Health Sciences, Universidad Tecnológica de Pereira,

Co-Chair, Working Group on Zoonoses, International Society for Chemotherapy (ISC)

Member of the Committee on Tropical Medicine, Zoonoses and Travel Medicine, ACIN

Editor, Current Topics in Tropical Emerging Diseases and Travel

Chair, Colombian Network of Research in Zika (RECOLZIKA)

Secretary, Colombian Association of Infectious Diseases (ACIN)

President, ACIN Chapter Coffee Triangle Region

President, Committee on Travel Medicine Pan-American Association of Infectious Diseases Senior Researcher, Colciencias (2017–2019)

Department of Community Medicine, School of Medicine

Part-Time Faculty Instructor, Risk Factors (Epidemiology) (Coordinator)

**Prof. Alfonso J. Rodriguez-Morales**

Pereira, Risaralda, Colombia

Zootechnics

Preface XI

en.com/books/current-topics-in-tropical-medicine

en.com/books/current-topics-in-public-health

current-topics-in-echinococcosis

current-topics-in-chikungunya

current-topics-in-giardiasis

malaria

topics-in-zika


[21] Rodriguez-Morales AJ. (ed.). Current Topics in Tropical Medicine. ISBN 978-953-51-0274-8. InTech, Croatia, Mar 2012. Available at: http://www.intechop‐ en.com/books/current-topics-in-tropical-medicine

[8] Escobedo AA, Almirall P, Rumbaut R, Rodríguez-Morales AJ. Potential impact of macroclimatic variability on the epidemiology of Giardiasis in three provinces of

[9] Mattar S, Morales V, Cassab A, Rodríguez-Morales AJ. Effect of climate variables on dengue incidence in a tropical Caribbean municipality of Colombia, Cerete,

[10] Rodriguez-Morales AJ. Climate change, climate variability and brucellosis. Re‐

[11] Von A, Zaragoza E, Jones D, Rodríguez-Morales AJ, Franco-Paredes C. New in‐ sights into Chagas disease: a neglected disease in Latin America. J Infect Dev

[12] Franco-Paredes C, Jones D, Rodriguez-Morales AJ, Santos-Preciado JI. Commen‐ tary: improving the health of neglected populations in Latin America. BMC Pub‐

[13] Rodriguez-Morales AJ, Bolívar-Mejía A, Alarcón-Olave C, Calvo-Betancourt LS. Plasmodium vivax Malaria in Latin America. In: C Franco-Paredes, JI Santos-Pre‐ ciado (eds.). Neglected Tropical Diseases—Latin America and the Caribbean, Ne‐ glected Tropical Diseases. Springer-Verlag Wien, 2015. doi:

10.1007/978-3-7091-1422-3\_5. Pages 23. ISBN 978-3-7091-1421-6. Pp: 89–111. [14] Franco-Paredes C, Rodríguez-Morales AJ. Awakening Hippocrates: a primer on

[15] Quintero K, Durán C, Duri D, Medina F, Garcia J, Hidalgo G, Nakal S, Echever‐ ria-Ortega M, Albano C, Nino Incani R, Cortez J, Jiménez S, Díaz M, Maldonado C, Matute F, Rodriguez-Morales AJ. Household social determinants of ascariasis and trichuriasis in North Central Venezuela. Int Health 2012 Jun; 4(2): 103–110. [16] Franco-Paredes C, Rodriguez-Morales AJ. Unsolved matters in leprosy: a descrip‐ tive review and call for further research. Ann Clin Microbiol Antimicrob 2016 May 21; 15:33. http://ann-clinmicrob.biomedcentral.com/articles/10.1186/

[17] Musso D, Rodriguez-Morales AJ, Levi JE, Cao-Lormeau VM, Gubler DJ. Unex‐ pected outbreaks of arbovirus infections: lessons learned from the Pacific and

[18] Patiño-Barbosa AM, Arroyave-Valencia F, García-Ramírez LM, Vallejo-Atehortúa E, Arciniegas-Pantoja M, Rodriguez-Morales AJ, Paniz-Mondolfi AE. Healthcare students and workers' knowledge about epidemiology and symptoms of Ebola in

[19] Rodríguez-Morales AJ, Marín-Rincón HA, Sepúlveda-Arias JC, Paniz-Mondolfi AE. Assessing the potential migration of people from Ebola affected West African countries to Latin America. Travel Med Infect Dis 2015 May–Jun; 13(3):264–266. [20] Cruz-Calderón S, Nasner-Posso KM, Alfaro-Toloza P, Paniz-Mondolfi AE, Rodrí‐ guez-Morales AJ. A bibliometric analysis of global Ebola research. Travel Med In‐

tropical America. Lancet Infect Dis 2018 Nov; 18(11):e355–e361.

one city of Colombia. J Hosp Infect 2015 Ago; 90(4):356–358.

fect Dis 2015 Mar–Apr; 13(2):202–204.

health, poverty, and global service. JAMA 2006 Aug 2; 296(5): 591.

Cuba, 2010–2012. J Infect Public Health 2015 Jan–Feb; 8(1):80–89.

2003–2008. Int J Infect Dis 2013 May; 17(5):e358–e359.

cent Pat Antiinfect Drug Discov 2013; 8(1):4–12.

Ctries 2007 Oct; 1(2):99–111.

X Preface

lic Health 2007 Jan 23;7:11.

s12941-016-0149-x


#### **Prof. Alfonso J. Rodriguez-Morales**

MD, MSc, DTM&H, FRSTMH(Lon), FFTM RCPS(Glasg), FACE, PhD(c), Dr h c(HonDSc). Editor, Current Topics in Tropical Emerging Diseases and Travel Part-Time Faculty Instructor, Risk Factors (Epidemiology) (Coordinator) Department of Community Medicine, School of Medicine Lecturer, Frontiers Research, Research II and Research IV, School of Veterinary Medicine & Zootechnics Director of Research, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia Chair, Colombian Network of Research in Zika (RECOLZIKA) Co-Chair, Working Group on Zoonoses, International Society for Chemotherapy (ISC) Secretary, Colombian Association of Infectious Diseases (ACIN) Member of the Committee on Tropical Medicine, Zoonoses and Travel Medicine, ACIN President, ACIN Chapter Coffee Triangle Region President, Committee on Travel Medicine Pan-American Association of Infectious Diseases Senior Researcher, Colciencias (2017–2019)

**Section 1**

**Neglected Tropical Diseases**

**Neglected Tropical Diseases**

**Chapter 1**

Provisional chapter

**Leprosy: The Ancient and Stubborn Disease**

Leprosy can be caused by an infection of Mycobacterium leprae commonly acquired through contact with an infected person. Clinical presentation depends on the patient's immune status at the time of infection and during the course of disease. Leprosy is associated with disability and marginalization. The Global Leprosy Strategy 2016–2020 released in April 2016 underscored its goal of "accelerating towards a leprosy free-world." Today's leprosy differs from the leprosy of the past, but yet there are still many things that are not immediately known, so it is still a broad socioeconomic challenge for scientists to solve. Leprosy has low pathogenicity, only a small proportion of infected people develop signs of the disease. If leprosy is not diagnosed and treated in the early stages, further progress of the disease is determined by the strength of the patient's immune response. Various clinical signs can be known during the early phase of leprosy, defined as indeterminate phase, so that it is difficult to diagnose the disease. Multidrug therapy (MDT) was recommended as the standard treatment. The morbidity report of leprosy will be important in epidemiology because it is based on real events and not based on estimate.

DOI: 10.5772/intechopen.79984

Leprosy or Hansen disease is caused by an infection of Mycobacterium leprae, an acid-fast, rodshaped bacillus, usually acquired through contact with an infected person. However, not every person exposed to an infected contact will develop leprosy [1]. M. leprae multiplies slowly, and the incubation period of the disease, on average, is 5 years. In some cases, symptoms may occur within 1 year but can also take as long as 20 years to occur. Clinical presentation depends on the patients' immune status at the time of infection and during the course of disease. Leprosy is

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Leprosy: The Ancient and Stubborn Disease

Keywords: leprosy, multidrug therapy, Mycobacterium leprae

associated with disability and marginalization [2].

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79984

Prasetyadi Mawardi

Prasetyadi Mawardi

Abstract

1. Introduction

#### **Chapter 1** Provisional chapter

#### **Leprosy: The Ancient and Stubborn Disease** Leprosy: The Ancient and Stubborn Disease

DOI: 10.5772/intechopen.79984

#### Prasetyadi Mawardi Prasetyadi Mawardi

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79984

#### Abstract

Leprosy can be caused by an infection of Mycobacterium leprae commonly acquired through contact with an infected person. Clinical presentation depends on the patient's immune status at the time of infection and during the course of disease. Leprosy is associated with disability and marginalization. The Global Leprosy Strategy 2016–2020 released in April 2016 underscored its goal of "accelerating towards a leprosy free-world." Today's leprosy differs from the leprosy of the past, but yet there are still many things that are not immediately known, so it is still a broad socioeconomic challenge for scientists to solve. Leprosy has low pathogenicity, only a small proportion of infected people develop signs of the disease. If leprosy is not diagnosed and treated in the early stages, further progress of the disease is determined by the strength of the patient's immune response. Various clinical signs can be known during the early phase of leprosy, defined as indeterminate phase, so that it is difficult to diagnose the disease. Multidrug therapy (MDT) was recommended as the standard treatment. The morbidity report of leprosy will be important in epidemiology because it is based on real events and not based on estimate.

Keywords: leprosy, multidrug therapy, Mycobacterium leprae
