{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:52:19Z","timestamp":1791305539697,"version":"4.3.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background:<\/jats:title>\n \n Leprosy remains a major cause of chronic dermatoneurological morbidity in endemic settings, and early etiologic confirmation is often challenging in primary care, where diagnosis may remain syndromic. Molecular testing can strengthen confirmation of\n Mycobacterium leprae<\/jats:italic>\n , yet performance depends on specimen type and target selection, and leprosy-like phenotypes may overlap with cutaneous disease caused by nontuberculous mycobacteria (NTM). This study evaluated paired nasal versus buccal mucosal swabs from patients with chronic skin lesions and clinical suspicion of leprosy to characterize mycobacterial deoxyribonucleic acid (DNA) signals using a stepwise molecular workflow.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n A cross-sectional study (September\u2013November 2025) enrolled consecutive patients presenting to primary health centers (Puskesmas) in Palu City, Indonesia, with chronic cutaneous lesions (>2 weeks). Each participant contributed paired nasal and buccal swabs (140 specimens from 70 participants). DNA was extracted using a silica column method. Conventional polymerase chain reaction (PCR) targeting the\n M. leprae<\/jats:italic>\n proline-rich antigen (PRA) gene was performed, followed \u2013 when indicated \u2013 by genus-level\n Mycobacterium<\/jats:italic>\n 16S ribosomal ribonucleic acid (16S rRNA) PCR and additional species-associated targets; 16S rRNA-positive amplicons underwent Sanger sequencing with Basic Local Alignment Search Tool (BLAST)-based taxonomic assignment. Paired nasal\u2013buccal positivity was compared using McNemar testing.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n All mucosal specimens were negative for\n M. leprae<\/jats:italic>\n by PRA PCR (0\/140). Genus-level 16S rRNA PCR detected\n Mycobacterium<\/jats:italic>\n spp. DNA in 20\/140 specimens (14.3%; 95% confidence interval [CI]: 9.4\u201321.0) and in 20\/70 participants (28.6%; 95% CI: 19.3\u201340.1). Positivity was substantially higher in nasal swabs (18\/70; 25.7%) than buccal swabs (2\/70; 2.9%), with discordant paired results and no participants positive at both sites (McNemar exact\n P<\/jats:italic>\n = 0.0004). Sequencing produced valid BLAST similarity outputs in 19\/20 positive specimens; closest matches were most frequently to\n Mycobacterium parmense<\/jats:italic>\n (13\/19; 68.4%) and\n Mycobacterium kyogaense<\/jats:italic>\n (6\/19; 31.6%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n In this endemic primary care cohort with chronic skin lesions, mucosal swab PCR targeting the single-gene PRA locus did not detect\n M. leprae<\/jats:italic>\n , while a subset showed genus-level\n Mycobacterium<\/jats:italic>\n DNA signals \u2013 predominantly from nasal swabs \u2013 with 16S rRNA sequences most closely aligned with uncommon NTM lineages. These findings support broadening diagnostic consideration beyond\n M. leprae<\/jats:italic>\n when mucosal single-target PCR is uniformly negative. Because mucosal detection cannot establish lesion causality and partial 16S rRNA reads have limited species-level resolution, lesion-based sampling and higher-resolution confirmation (culture and\/or multilocus sequencing) are warranted; escalation to more sensitive\n M. leprae<\/jats:italic>\n targets (e.g., multicopy loci) may also be appropriate when clinical suspicion persists.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijmy.ijmy_45_26","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:00:18Z","timestamp":1790823618000},"page":"206-213","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["When \u201cLeprosy\u201d Is Not Leprosy by Polymerase Chain Reaction: Detection of Nontuberculous Mycobacterial Deoxyribonucleic Acid in Nasal Swabs from Patients with Chronic Skin Lesions in a Leprosy-endemic Area"],"prefix":"10.4103","volume":"15","author":[{"given":"Amelia","family":"Hasanah","sequence":"first","affiliation":[{"name":"Master Program of Biomedical Science, Postgraduate School of Hasanuddin University, Makassar, Indonesia"},{"name":"Department of Microbiology, Faculty of Medicine, Muhammadiyah Palu University, Palu, Central Sulawesi, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdaus","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"},{"name":"Biofilm and Superbugs Research (BISA) Team, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Rahmat","family":"Ramadhan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Muhammadiyah Palu University, Palu, Central Sulawesi, Indonesia"},{"name":"Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"},{"name":"Biofilm and Superbugs Research (BISA) Team, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunialthy D.","family":"Pertiwi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"},{"name":"Biofilm and Superbugs Research (BISA) Team, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Aswad","sequence":"additional","affiliation":[{"name":"Biofilm and Superbugs Research (BISA) Team, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"},{"name":"Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3022-4690","authenticated-orcid":false,"given":"Andi Rofian","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"},{"name":"Biofilm and Superbugs Research (BISA) Team, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"R1-20261006","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-024-00575-1","article-title":"Leprosy","volume":"10","author":"Grijsen","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"R2-20261006","doi-asserted-by":"crossref","first-page":"893653","DOI":"10.3389\/fitd.2022.893653","article-title":"Advances in the diagnosis of leprosy","volume":"3","author":"Sharma","year":"2022","journal-title":"Front Trop Dis"},{"key":"R3-20261006","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1186\/s12879-021-06882-2","article-title":"RLEP LAMP for the laboratory confirmation of leprosy: Towards a point-of-care test","volume":"21","author":"Saar","year":"2021","journal-title":"BMC Infect Dis"},{"key":"R4-20261006","doi-asserted-by":"crossref","first-page":"e0009850","DOI":"10.1371\/journal.pntd.0009850","article-title":"Development and validation of a multiplex real-time qPCR assay using GMP-grade reagents for leprosy diagnosis","volume":"16","author":"Manta","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"R5-20261006","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/QCO.0000000000000820","article-title":"Mycobacterial skin infection","volume":"35","author":"Gardini","year":"2022","journal-title":"Curr Opin Infect 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History"}},{"value":"2026-05-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}