This cross-sectional study screened 915 male inmates at a penitentiary in Maceió, Alagoas, Brazil using the Leprosy Suspicion Questionnaire (LSQ), neurodermatological examination (n=260), and serological testing for anti-PGL-I (IgM) and anti-Mce1A antibodies (IgA, IgM, IgG) via indirect ELISA (n=244) to assess leprosy burden and screening strategies in an incarcerated population.
8 new leprosy cases were found among 260 examined inmates, yielding an overall new case detection rate (NCDR) of 3.08% (6.52% among LSQ-positive/symptomatic individuals). All 8 cases were multibacillary, and 100% had some degree of physical disability at diagnosis. Anti-Mce1A IgA was positive in 100% of diagnosed cases vs. anti-PGL-I positivity in only 19.9% of clinically unaffected individuals; 75% of leprosy cases had a positive LSQ vs. 34.1% in the non-leprosy group (p=0.0249).
- Single-site, single-sex (male) facility limits generalizability to other prison settings or female populations. - Not all 915 inmates underwent clinical examination (only 260 evaluated), introducing selection bias. - Cross-sectional design precludes causal inference or assessment of transmission dynamics over time.
Clinicians and public health teams should consider active leprosy screening with LSQ plus clinical examination in overcrowded incarcerated settings in endemic regions, as NCDR exceeded 3% with all detected cases being multibacillary and presenting physical disability. Anti-Mce1A serology—especially IgA—may improve detection of early-stage and neural leprosy compared to anti-PGL-I alone.
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