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Volume 27, Number 9—September 2021

Fecal Excretion of Mycobacterium leprae, Burkina Faso

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To the Editor: Millogo et al. (1) documented presence of Mycobacterium leprae in a fecal sample from a patient in Burkina Faso, raising questions about the role of fecal excretion of M. leprae in the natural history and diagnosis of leprosy. They speculated that M. leprae were swallowed by the patient along with blood or upper respiratory secretions during leprosy rhinitis and epistaxis (1) but failed to address other factors that could influence fecal excretion of M. leprae and utility of fecal specimens in diagnosing leprosy.

Previous studies have demonstrated the presence of M. leprae in water and soil samples from habitations of patients with leprosy (2,3). This finding means that patients, contacts, or healthy persons can ingest M. leprae from environmental sources through drinking contaminated water or eating M. leprae–containing food and may excrete leprosy bacilli in their feces without establishing an infection. The role of environmental sources and simple pass-through phenomena in fecal excretion of M. leprae has not been investigated by Millogo et al. (1) and other studies (4,5).

Koshy et al. (4) reported the presence of leprosy bacilli in gastric juice of 9 of 16 patients with lepromatous leprosy; 3 were found to excrete the bacilli in their feces. Manzullo et al. (5) demonstrated the presence of acid-fast bacilli in biliary secretions of 7 of 20 patients with leprosy and in 2 of 7 fecal samples. These observations indicate that clinical manifestation of leprosy varies widely. The exact mechanism of fecal excretion of M. leprae can be more complex, as presumed in previous studies (1,4,5), and may be associated with high bacillary burden (as in lepromatous leprosy), gastrointestinal symptoms (abdominal pain or diarrhea), disseminated disease, environmental factors, or combinations of these aspects. Verification of transmission routes of M. leprae to fecal samples using genotyping techniques (i.e., whole-genome sequencing) is crucial to establish the diagnostic utility of fecal specimens in leprosy.


Ajay Vir SinghComments to Author , Rajbala Yadav, Harpreet Singh Pawar, and Devendra Singh Chauhan
Author affiliation: ICMR–National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, India



  1. Millogo  A, Loukil  A, L’Ollivier  C, Djibougou  DA, Godreuil  S, Drancourt  M. Fecal excretion of Mycobacterium leprae, Burkina Faso. Emerg Infect Dis. 2021;27:175860. DOIPubMedGoogle Scholar
  2. Mohanty  PS, Naaz  F, Katara  D, Misba  L, Kumar  D, Dwivedi  DK, et al. Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination. Indian J Dermatol Venereol Leprol. 2016;82:237. DOIPubMedGoogle Scholar
  3. Turankar  RP, Lavania  M, Singh  M, Sengupta  U, Siva Sai  K, Jadhav  RS. Presence of viable Mycobacterium leprae in environmental specimens around houses of leprosy patients. Indian J Med Microbiol. 2016;34:31521. DOIPubMedGoogle Scholar
  4. Koshy  A, Karat  ABA. A study of acid-fast bacilli in the urine, gastric juice and faeces of patients with lepromatous leprosy. Lepr India. 1971;43:37.
  5. Manzullo  A, Manzi  RO, Lefevre  A, Oteiza  ML. Investigation of acid-fast bacilli in the digestive tract of leprosy patients. Leprologia. 1965;10:146.


Cite This Article

DOI: 10.3201/eid2709.211262

Original Publication Date: August 09, 2021

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Ajay Vir Singh, Department of Microbiology and Molecular Biology, ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, Pin-282001, India

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Page created: June 23, 2021
Page updated: August 18, 2021
Page reviewed: August 18, 2021
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