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de Alecrin ES, Martins MAP, de Oliveira ALG, Lyon S, Lages ATC, Reis IA, Pereira FH, Oliveira D, Goulart IMB, da Costa Rocha MO. Models for predicting the risk of illness in leprosy contacts in Brazil: Leprosy prediction models in Brazilian contacts. Trop Med Int Health 2024; 29:680-696. [PMID: 38961761 DOI: 10.1111/tmi.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVE This study aims to develop and validate predictive models that assess the risk of leprosy development among contacts, contributing to an enhanced understanding of disease occurrence in this population. METHODS A cohort of 600 contacts of people with leprosy treated at the National Reference Center for Leprosy and Health Dermatology at the Federal University of Uberlândia (CREDESH/HC-UFU) was followed up between 2002 and 2022. The database was divided into two parts: two-third to construct the disease risk score and one-third to validate this score. Multivariate logistic regression models were used to construct the disease score. RESULTS Of the four models constructed, model 3, which included the variables anti-phenolic glycolipid I immunoglobulin M positive, absence of Bacillus Calmette-Guérin vaccine scar and age ≥60 years, was considered the best for identifying a higher risk of illness, with a specificity of 89.2%, a positive predictive value of 60% and an accuracy of 78%. CONCLUSIONS Risk prediction models can contribute to the management of leprosy contacts and the systematisation of contact surveillance protocols.
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Affiliation(s)
- Edilamar Silva de Alecrin
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Laura Grossi de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Lyon
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes Hospital, Belo Horizonte, Minas Gerais, Brazil
- Curso de Medicina, Faculdade de Saúde e Ecologia Humana, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Thereza Chaves Lages
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ilka Afonso Reis
- Departamento de Estatística, Instituto de ciências exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Henrique Pereira
- Pró-Reitoria de Graduação, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dulcinea Oliveira
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital das Clínicas, Universidade Federal de Uberlândia (UFU/EBSERH), Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital das Clínicas, Universidade Federal de Uberlândia (UFU/EBSERH), Uberlândia, Minas Gerais, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Uberlândia Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Manoel Otávio da Costa Rocha
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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2
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Costa MRD, Magliano CADS, Barros BM, Morais QCD, Braga AA, Senna KMSE, Gomes CM, Macedo ACD, Santos MDS. A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective. CAD SAUDE PUBLICA 2024; 40:e00038723. [PMID: 38198381 PMCID: PMC10775967 DOI: 10.1590/0102-311xen038723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 01/12/2024] Open
Abstract
Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.
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Affiliation(s)
- Milene Rangel da Costa
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Quenia Cristina Dias Morais
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Brasil
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ML Flow serological test: complementary tool in leprosy. An Bras Dermatol 2023; 98:331-338. [PMID: 36890048 PMCID: PMC10173075 DOI: 10.1016/j.abd.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The evaluation of household contacts of leprosy cases allows the early diagnosis of new cases. OBJECTIVE To associate the results of the ML Flow test with the clinical characteristics of leprosy cases and to verify their positivity in household contacts, in addition to describing the epidemiological profile of both. METHODS Prospective study with patients diagnosed over the course of one year (n = 26), without prior treatment, and their household contacts (n = 44) in six municipalities in northwestern São Paulo, Brazil. RESULTS There was a predominance of men among the leprosy cases, of 61.5% (16/26); 77% (20/26) were over 35 years old; 86.4% (22/26) were multibacillary; 61.5% (16/26) had a positive bacilloscopy; and 65.4% (17/26) had no physical disability. The ML Flow test was positive in 53.8% (14/26) of the leprosy cases and was associated with those who had a positive bacilloscopy and were diagnosed as multibacillary (p-value <0.05). Among the household contacts, 52.3% (23/44) were women and aged over 35 years; 81.8% (36/44) had been vaccinated with BCG ‒ Bacillus Calmette-Guérin. The ML Flow test was positive in 27.3% (12/44) of household contacts, all of whom lived with multibacillary cases; seven lived with positive bacilloscopy cases and six with consanguineous cases. STUDY LIMITATIONS Difficulty in convincing the contacts to undergo the evaluation and collection of the clinical sample. CONCLUSION The ML Flow test, when positive in household contacts, can help the identification of cases that require more attention by the health team, as it indicates a predisposition to disease development, especially when they are household contacts of multibacillary cases, with positive bacilloscopy and consanguineous. The ML Flow test also helps in the correct clinical classification of the leprosy cases.
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Romero CP, Castro R, do Brasil PEA, Pereira DR, Pinheiro RO, Toscano CM, de Oliveira MRF. Accuracy of rapid point-of-care serological tests for leprosy diagnosis: a systematic review and meta-analysis. Mem Inst Oswaldo Cruz 2022; 117:e220317. [PMID: 35416839 PMCID: PMC9000963 DOI: 10.1590/0074-02760220317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease, still endemic in many countries that may lead to neurological, ophthalmic, and motor sequelae if not treated early. Access to timely diagnosis and multidrug therapy (MDT) remains a crucial element in the World Health Organization’s strategy to eliminate the disease as a public health problem. OBJECTIVES This systematic review aims to evaluate the accuracy of rapid point-of-care (POC) tests for diagnosis of leprosy. METHODS Searches were carried out in electronic databases (PubMed, EMBASE, CRD, Cochrane Library and LILACS) in April 2021 for patients with suspicion or confirmatory diagnostic of leprosy, classified in multibacillary (MB) or paucibacillary (PB) cases, performing rapid POC serological tests compared to clinical evaluation, smear microscopy and immunohistochemistry analysis. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A meta-analysis was undertaken to generate pooled estimates of diagnostic parameters, presenting sensitivity, specificity and diagnostic odds ratio (DOR) values. The review protocol was registered at PROSPERO, CRD # 42014009658. FINDINGS From 893 potentially relevant references, 12 articles were included reporting 16 diagnostic tests accuracy studies with 5395 individuals enrolled. Meta-analysis of NDO-LID and PGL-I tests data in MB patients showed sensitivity and specificity [95% confidence interval (CI)] of 0.83 (0.71-0.91), 0.91 (0.72-0.97); and 0.92 (0.86-0.96), 0.93 (0.78-0.98); respectively, with high heterogeneity among the studies. MAIN CONCLUSIONS Our results can inform policymakers regarding the possibility of implementing accurate, rapid POC tests for leprosy in public health services, especially within primary health care.
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Affiliation(s)
- Carmen Phang Romero
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Rio de Janeiro, RJ, Brasil
| | - Rodolfo Castro
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Pedro Emmanuel A do Brasil
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Roberta Olmo Pinheiro
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Cristiana M Toscano
- Universidade Federal de Goiás, Goiânia, GO, Brasil.,Conselho Nacional de Desenvolvimento Científico e Tecnológico, Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | - Maria Regina Fernandes de Oliveira
- Conselho Nacional de Desenvolvimento Científico e Tecnológico, Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil.,Universidade de Brasília, Brasília, DF, Brasil
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Alecrin ESD, Oliveira ALGD, Guimarães NS, Lyon S, Martins MAP, Rocha MODC. Factors associated with the development of leprosy in Brazilian contacts: a systematic review. Rev Inst Med Trop Sao Paulo 2022; 64:e55. [PMID: 36197417 PMCID: PMC9528391 DOI: 10.1590/s1678-9946202264055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.
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Affiliation(s)
- Edilamar Silva de Alecrin
- Universidade Federal de Minas Gerais, Brazil; Hospital Eduardo de Menezes, Ambulatório de Dermatologia, Brazil
| | | | | | - Sandra Lyon
- Universidade Federal de Minas Gerais, Brazil; Faculdade de Saúde e Ecologia Humana, Brazil
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Ule Belotti NC, Tonelli Nardi SM, Arco Paschoal VD, Martins Montanha JO, Paro Pedro HDS, Gazetta CE. Laboratory diagnosis of leprosy: Two staining methods from bacilloscopy and rapid ml flow test. Int J Mycobacteriol 2021; 10:393-397. [PMID: 34916457 DOI: 10.4103/ijmy.ijmy_206_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The diagnosis of leprosy is based on the characteristic signs and symptoms of the disease, subsidized by laboratory tests. When positive, the bacilloscopy closes the diagnosis for leprosy. Phenolic glycolipid-I, or PGL-I, is a molecule in the bacillus cell wall that confers a greater immune response. The ML Flow test is an immunochromatographic test for the detection of anti-PGL-I IgM in human blood or serum. Methods A prospective study with data collection and biological materials in patients with suspected leprosy from August 2020 to May 2021. For microscopy, intradermal smears were stained with Auramine O, and after reading under a fluorescence microscope, reviewed by Ziehl-Neelsen. The ML flow test was performed according to the Bührer-Sékula protocol. To assess the agreement between the methods, the Kappa index was estimated. Results Of the 94 suspected leprosy patients, 31 (32.9%) were diagnosed with leprosy. There was moderate agreement between the results of the ML Flow and Auramine O tests (Kappa = 0.58) and substantial agreement between the ML Flow and Ziehl-Neelsen microscopy (Kappa = 0.72). In paucibacillary cases, serology was positive in 100% of patients. Conclusions This study concluded that the Ziehl-Neelsen technique remains the best option for standard leprosy staining, and the ML flow test is more positive among the three techniques evaluated and can be an effective tool in the early diagnosis of leprosy cases.
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Affiliation(s)
| | | | | | | | | | - Claudia Eli Gazetta
- Nursing Department, University of Medicine, São José do Rio Preto, São Paulo, Brazil
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7
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Sensitivity and specificity of multibacillary and paucibacillary leprosy laboratory tests: A systematic review and meta-analysis. Diagn Microbiol Infect Dis 2021; 100:115337. [PMID: 33610964 DOI: 10.1016/j.diagmicrobio.2021.115337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 12/11/2022]
Abstract
This systematic review (number register: CRD42018112736) was performed to compare the sensitivity and specificity of leprosy diagnostic methods. The search was conducted in 3 electronic databases in January 2021. Studies evaluating leprosy diagnostic tests were included according the eligibility criteria. Meta-analysis was performed to calculate the sensibility and specificity of the groups. We included 36 studies. The test sensitivity for paucibacillary patients was 0.31 (95%CI: 0.29-0.33) and the specificity was 0.92 (95%CI: 0.92-0.93). In multibacillary patients, the sensitivity was 0.78 (95%CI: 0.77-0.80) and specificity was 0.92 (95%CI: 0.92-0.93). Comparing the sensitivity and specificity of the different techniques included, it should be noted that polymerase chain reaction (PCR) test presented the highest sensitivity for paucibacillary patients, while the western blot technique showed the highest sensitivity for multibacillary patients. However, further studies are needed to optimise the diagnosis of leprosy, requiring research with a larger number of samples and more uniform protocols.
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8
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Binhardi FMT, Nardi SMT, Patine FDS, Pedro HDSP, Montanha JOM, Santi MPD, Belotti NCU, Paschoal VDA. Diagnosis of the leprosy laboratory care network in Regional Health Department XV, São José do Rio Preto, São Paulo, Brazil. ACTA ACUST UNITED AC 2020; 29:e2020127. [PMID: 33295588 DOI: 10.1590/s1679-49742020000500019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/06/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To present the situational diagnosis of the leprosy laboratory reference network in the region of São José do Rio Preto, SP, Brazil. METHODS This was an evaluation study with a descriptive design. The data were collected by means of an online form filled in by those in charge of the leprosy program in 2018. RESULTS All 102 municipalities that make up the region provided the requested data, 82.4% (84/102) requested slit-skin smear microscopy and of these 68 received training. Of the total, 11.7% sent slit-skin smears to other laboratories outside the reference network. Only 57.8% (59/102) requested a biopsy, of these 47 had a doctor responsible for taking the biopsy sample and 31 did not send biopsy samples for analysis in the reference network. Lack of an adequate room, few trained professionals, absence of material for transportation and absence of printed test requisitions were described as aspects that hinder leprosy case diagnosis in the region. CONCLUSION The laboratory network is fragile and needs to be restructured.
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Affiliation(s)
| | | | - Flávia Dos Santos Patine
- Grupo de Vigilância Epidemiológica 29, Programa Regional de Controle da Hanseníase, São José do Rio Preto, SP, Brasil
| | | | | | | | | | - Vania Del Arco Paschoal
- Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem em Saúde Coletiva e Orientação Profissional, São José do Rio Preto, SP, Brasil
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Abstract
Leprosy is a disease caused by Mycobacterium leprae (ML) with diverse clinical manifestations, which are strongly correlated with the host's immune response. Skin lesions may be accompanied by peripheral neural damage, leading to sensory and motor losses, as well as deformities of the hands and feet. Both innate and acquired immune responses are involved, but the disease has been classically described along a Th1/Th2 spectrum, where the Th1 pole corresponds to the most limited presentations and the Th2 to the most disseminated ones. We discuss this dichotomy in the light of current knowledge of cytokines, Th subpopulations and regulatory T cells taking part in each leprosy presentation. Leprosy reactions are associated with an increase in inflammatory activity both in limited and disseminated presentations, leading to a worsening of previous symptoms or the development of new symptoms. Despite the efforts of many research groups around the world, there is still no adequate serological test for diagnosis in endemic areas, hindering the eradication of leprosy in these regions.
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Affiliation(s)
| | - Maria Angela Bianconcini Trindade
- Departamento de Patologia, University of Sao Paulo, São Paulo, Brazil.,Imunodermatologia, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
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do Carmo Gonçalves A, Hungria EM, Freitas AA, Sékula-Bührer S, Gomes CM, Coelho AC, Nascimento LB, de Araújo Stefani MM. Leprosy surveillance study in a highly endemic Brazilian area using leprosy specific serologic tests and IFNγ whole blood assay. Eur J Clin Microbiol Infect Dis 2020; 39:2345-2360. [PMID: 32666479 DOI: 10.1007/s10096-020-03979-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Abstract
This surveillance study evaluated leprosy-serologic tests and the IFNγ whole-blood-assay/WBA as adjunct diagnostic tools. Previously diagnosed leprosy index cases, intradomiciliary, peridomiciliary contacts from a Brazilian endemic area were enrolled during domiciliary visits. Physical evaluation was performed by trained nurses and leprosy diagnosis confirmed by expert dermatologist. ELISA detected IgM anti-PGL-I, IgG anti-LID-1, and IgM/IgG anti-ND-O-LID antibodies. Heparinized WBA plasma stimulated with LID-1, 46f + LID-1, ML0276 + LID-1 (24 h, 37 °C, 5% CO2) was tested for human IFNγ (QuantiFERON®-TB Gold/QFT-G; Qiagen). The survey included 1731 participants: 44 leprosy index cases, 64 intradomiciliary, 1623 peridomiciliary contacts. Women represented 57.7%, median age was 32 years, 72.2% had BCG scar. Leprosy prevalence was higher in intradomiciliary (8.57%) versus peridomiciliary contacts (0.67%), p < 0.001. Among 23 suspects, five leprosy cases were confirmed: 4 multibacillary/MB and 1 paucibacillary/PB. Leprosy incidence was 0.30%: 1.56% in intradomiciliary versus 0.25% in peridomiciliary (p = 0.028). Seropositivity rates were 1.9% to PGL-I, 4.9% to LID-1, and 1.0% to ND-O-LID. LID-1 positivity was higher in all groups; incident cases were LID-1 seropositive. ND-O-LID positivity was higher in intra- versus peridomiciliary contacts (p = 0.022). IFNγ WBA (40 index cases, 19 suspects, 35 intradomiciliary, 74 peridomiciliary contacts) showed higher LID-1/WBA positivity in peridomiciliary contacts (p > 0.05); significant differences among groups were seen with 46f + LID-1 but 0276 + LID-1 induced higher IFNγ levels. Incident cases were LID-1 seropositive, while IFNγ-WBA had marginal diagnostic application. As seropositivity indicates exposed individuals at higher risk of disease development, the utility of serologic screening for surveillance and prophylactic measures remains to be demonstrated.
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Affiliation(s)
- Aline do Carmo Gonçalves
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aline Araújo Freitas
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Samira Sékula-Bührer
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Ana Cecília Coelho
- Superintendência de Vigilância em Saúde, Secretaria Municipal de Saúde de Goiânia, Goiânia, Goiás, Brazil
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11
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Röltgen K, Pluschke G, Spencer JS, Brennan PJ, Avanzi C. The immunology of other mycobacteria: M. ulcerans, M. leprae. Semin Immunopathol 2020; 42:333-353. [PMID: 32100087 PMCID: PMC7224112 DOI: 10.1007/s00281-020-00790-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
Mycobacterial pathogens can be categorized into three broad groups: Mycobacterium tuberculosis complex causing tuberculosis, M. leprae and M. lepromatosis causing leprosy, and atypical mycobacteria, or non-tuberculous mycobacteria (NTM), responsible for a wide range of diseases. Among the NTMs, M. ulcerans is responsible for the neglected tropical skin disease Buruli ulcer (BU). Most pathogenic mycobacteria, including M. leprae, evade effector mechanisms of the humoral immune system by hiding and replicating inside host cells and are furthermore excellent modulators of host immune responses. In contrast, M. ulcerans replicates predominantly extracellularly, sheltered from host immune responses through the cytotoxic and immunosuppressive effects of mycolactone, a macrolide produced by the bacteria. In the year 2018, 208,613 new cases of leprosy and 2713 new cases of BU were reported to WHO, figures which are notoriously skewed by vast underreporting of these diseases.
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Affiliation(s)
- Katharina Röltgen
- Department of Pathology, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Gerd Pluschke
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - John Stewart Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Patrick Joseph Brennan
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Charlotte Avanzi
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
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12
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Carvalho APM, Coelho ADCO, Correa-Oliveira R, Lana FCF. Specific antigen serologic tests in leprosy: implications for epidemiological surveillance of leprosy cases and household contacts. Mem Inst Oswaldo Cruz 2017; 112:609-616. [PMID: 28902286 PMCID: PMC5572446 DOI: 10.1590/0074-02760160505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of straightforward tests for field application and known biomarkers for predicting leprosy progression in infected individuals. OBJECTIVE The aim was to analyse the response to infection by Mycobacterium leprae based on the reactivity of specific antigens: natural disaccharide linked to human serum albumin via an octyl (NDOHSA), a semisynthetic phenolic glycolipid-I (PGL-I); Leprosy Infectious Disease Research Institute Diagnostic-1 (LID-1) and natural disaccharide octyl - Leprosy Infectious Disease Research Institute Diagnostic-1 (NDOLID). METHODS The study population consisted of 130 leprosy cases diagnosed between 2010 and 2015 and 277 household contacts. An enzyme-linked immunosorbent assay (ELISA) was used to analyse the reactivity of antibodies against NDOHSA, LID-1 and NDOLID. The samples and controls were tested in duplicate, and the antibody titer was expressed as an ELISA index. Data collection was made by home visits with application of questionnaire and dermatological evaluation of all household contacts to identify signs and symptoms of leprosy. FINDINGS Significant differences in the median ELISA results were observed among leprosy cases in treatment, leprosy cases that had completed treatment and household contacts. Higher proportions of seropositivity were observed in leprosy cases in treatment. Seropositivity was also higher in multibacillary in relation to paucibacillary, with the difference reaching statistical significance. Lower titers were observed among cases with a longer treatment time or discharge. For household contacts, the differences according to the clinical characteristics of the leprosy index case were less pronounced than expected. Other factors, such as the endemicity of leprosy, exposure outside the residence and genetic characteristics, appeared to have a greater influence on the seropositivity. MAIN CONCLUSIONS Serologic tests could be used as auxiliary tools for determining the operational classification, in addition to identifying infected individuals and as a strategy for surveillance of household contacts.
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Affiliation(s)
- Ana Paula Mendes Carvalho
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil
| | | | - Rodrigo Correa-Oliveira
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou, Laboratório de Imunologia Celular e Molecular, Belo Horizonte, MG, Brasil
| | - Francisco Carlos Félix Lana
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brasil
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Carvalho APM, da Conceição Oliveira Coelho Fabri A, Corrêa Oliveira R, Lana FCF. Factors associated with anti-phenolic glycolipid-I seropositivity among the household contacts of leprosy cases. BMC Infect Dis 2015; 15:219. [PMID: 26024906 PMCID: PMC4449587 DOI: 10.1186/s12879-015-0955-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/20/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The diagnosis of leprosy is based on clinical symptoms of the disease, which may not be sufficient to ensure early diagnosis. The development of effective tools for the early detection of infection, such as rapid tests that can be applied by non-specialists for early-stage leprosy identification, has been considered a research priority and may contribute to overcoming the complications associated with late diagnosis. The aim of this study was to analyze the factors associated with anti-phenolic glycolipid-I (PGL-I) seropositivity among the household contacts of leprosy cases. METHODS A cross-sectional study of individuals from the northeastern municipalities of the state of Minas Gerais, Brazil, was performed. Anti-PGL-I seropositivity was evaluated by assessing specific antibody production using the ML Flow test. A Poisson regression with a robust error variance was used to evaluate the relationship between anti-PGL-I seropositivity and the independent variables investigated. RESULTS The overall anti-PGL-I seropositivity was 13.5 %, and among the contacts of leprosy cases that were classified as paucibacillary or multibacillary, it was 8.4 and 17.3 %, respectively. The factors associated with the variation of anti-PGL-I seropositivity among the study population were the presence of signs suggestive of leprosy (PR = 3.68; 95 % CI: 1.56-8.71), the operational leprosy classification (PR = 2.17; 95 % CI: 1.22-3.86) and grade 1 (PR = 1.83; 95 % CI: 1.02-3.26) or grade 2 disability (PR = 2.42; 95 % CI: 1.02-5.47) of the index leprosy case. CONCLUSIONS The presence of signs suggestive of leprosy and the operational classification of leprosy cases were associated with anti-PGL-I seropositivity. The serological tests available for leprosy are not considered to be diagnostic tests but can be used as auxiliary assessments in combination with clinical parameters to identify exposed individuals at high risk of developing leprosy and those exhibiting the initial stages of this disease.
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Affiliation(s)
- Ana Paula Mendes Carvalho
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
| | - Angélica da Conceição Oliveira Coelho Fabri
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Department of Basic Nursing, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora-UFJF, Juiz de Fora, MG, Brasil.
| | - Rodrigo Corrêa Oliveira
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Laboratory of Cellular and Molecular Immunology, Centro de Pesquisas René Rachou-CPqRR, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, MG, Brasil.
- Laboratory of Immunology, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto-UFOP, Ouro Preto, MG, Brasil.
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais-INCT-DT, Belo Horizonte, Brasil.
| | - Francisco Carlos Félix Lana
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
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Calado KLS, Magnanini MMF, Moura RSD, Gallo MEN, Bührer-Sékula S, Oliveira MLWDRD. Serology with ML Flow test in health professionals from three different states of Brazil. An Bras Dermatol 2014; 88:918-23. [PMID: 24474100 PMCID: PMC3900342 DOI: 10.1590/abd1806-4841.20132139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/11/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In highly endemic countries, transmission and sub-clinical infection of leprosy
are likely and the disease manifests itself in individuals without any known close
contact with a leprosy patient. Health workers are social contacts belonging to
the same network (the Health System) and some of them share the same social
environment (nursing assistants) as patients with known patients and / or
carriers. OBJECTIVE To identify ML Flow seropositivity among health professionals. METHODS We conducted a cross-sectional study using a serological survey with the ML Flow
test in 450 health professionals (doctors, nurses and nursing assistants), in
order to detect seropositivity in areas of high and low endemicity in
municipalities from three Brazilian states (RJ, MS and RS). RESULTS The results showed general 16% seropositivity, higher in low endemic areas,
regardless of whether there was direct care for leprosy patients. Paradoxically, a
statistical association was observed between the area studied and seropositivity,
as the place with the lowest endemicity (CA) had the highest seropositivity rate
(p = 0.033). CONCLUSION The authors suggest these results are associated with a presence of an
unspecified link to bovine serum albumin (BSA), carrier of PGL-1 in the ML Flow
test, and recommend expanded seroepidemiological research utilizing tests with
human and bovine albumin.
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Affiliation(s)
- Karla Lucena Sampaio Calado
- Federal University of Rio de Janeiro, Rio de JaneiroRJ, Brazil, Master's in Dermatology, Federal University of Rio de Janeiro (UFRJ) - Assistant Professor of Dermatology, Federal University of Grande Dourados (UFGD). PhD in Tropical Medicine from the Oswaldo Cruz Foundation (FIOCRUZ) - Rio de Janeiro (RJ), Brazil
| | - Mônica Maria Ferreira Magnanini
- Oswaldo Cruz Foundation, Rio de JaneiroRJ, Brazil, PhD in Public Health from the Oswaldo Cruz Foundation (FIOCRUZ). Statistics, Federal University of Rio de Janeiro (UFRJ) - Rio de Janeiro (RJ), Brazil
| | - Rodrigo Scaliante de Moura
- Federal University of Goiás, GoiâniaGO, Brazil, Biomedical doctor. Master's in Tropical Medicine, Federal University of Goiás (UFG) - Goiânia (GO), Brazil
| | - Maria Eugenia Noviski Gallo
- Oswaldo Cruz Foundation, Rio de JaneiroRJ, Brazil, PhD in Tropical Medicine from the Oswaldo Cruz Foundation (FIOCRUZ). Professor at the Oswaldo Cruz Foundation (FIOCRUZ) - Rio de Janeiro (RJ), Brazil
| | - Samira Bührer-Sékula
- Universiteit van Amsterdam, Netherlands, Netherlands, PhD in Immunology from the Universiteit van Amsterdam, Netherlands - Collaborating Professor at the Federal University of Goiás (UFG) - Goiânia (GO), Brazil
| | - Maria Leide Wand-Del-Rey de Oliveira
- Federal University of Rio de Janeiro, Rio de JaneiroRJ, Brazil, PhD in Dermatology from the Federal University of Rio de Janeiro (UFRJ)-Federal Adjuct Professor, University of Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil
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Alban SM, de Moura JF, Minozzo JC, Mira MT, Soccol VT. Identification of mimotopes of Mycobacterium leprae as potential diagnostic reagents. BMC Infect Dis 2013; 13:42. [PMID: 23351151 PMCID: PMC3585472 DOI: 10.1186/1471-2334-13-42] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An early diagnostic test for detecting infection in leprosy is fundamental for reducing patients' sequelae. The currently used lepromin is not adequate for disease diagnosis and, so far, no antigen to be used in intradermoreaction has proved to be sensitive and specific for that purpose. Aiming at identifying new reagents to be used in skin tests, candidate antigens were investigated. METHODS Random peptide phage display libraries were screened by using antibodies from leprosy patients in order to identify peptides as diagnostic reagents. RESULTS Seven different phage clones were identified using purified antibodies pooled from sera of leprosy patients. When the clones were tested with serum samples by ELISA, three of them, 5A, 6A and 1B, allowed detecting a larger number of leprosy patients when compared to controls. The corresponding peptides expressed by selected phage clones were chemically synthesized. A pilot study was undertaken to assess the use of peptides in skin tests. The intradermal challenge with peptides in animals previously sensitized with Mycobacterium leprae induced a delayed-type hypersensitivity with peptide 5A (2/5) and peptide 1B (1/5). In positive controls, there was a 3/5 reactivity for lepromin and a 4/5 reactivity of the sensitized animals with soluble extract of M. leprae. CONCLUSIONS The preliminary data suggest that may be possible to develop reagents with diagnostic potential based on peptide mimotopes selected by phage display using polyclonal human antibodies.
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Affiliation(s)
- Silvana M Alban
- Engenharia de Bioprocessos e Biotecnologia, Universidade Federal do Paraná, Curitiba 81531-990, Brasil
| | | | - João Carlos Minozzo
- Centro de Produção e Pesquisa de Imunobiológicos, Secretária de Saúde do Estado do Paraná, Piraquara, 83302-160, Brazil
| | - Marcelo Távora Mira
- Centro de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, 80215-901, Brazil
| | - Vanete Thomaz Soccol
- Engenharia de Bioprocessos e Biotecnologia, Universidade Federal do Paraná, Curitiba 81531-990, Brasil
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Suzuki K, Tanigawa K, Kawashima A, Miyamura T, Ishii N. Chimpanzees used for medical research shed light on the pathoetiology of leprosy. Future Microbiol 2011; 6:1151-7. [PMID: 22004034 DOI: 10.2217/fmb.11.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Leprosy is a chronic infectious disorder caused by Mycobacterium leprae, which mainly affects skin and peripheral nerves. It is classified as either paucibacillary or multibacillary based upon clinical manifestations and slit-skin smear results. It is speculated that leprosy develops after a long latency period following M. leprae infection. However, the actual time of infection and the duration of latency have never been proven in human patients. To date, four cases of spontaneous leprosy have been reported in chimpanzees who were caught in West Africa in infancy and used for medical research in the USA and Japan. One of these chimpanzees was extensively studied in Japan, and single-nucleotide polymorphism analysis for the M. leprae genome was conducted. This analysis revealed that the chimpanzee was infected with M. leprae during infancy in West Africa and the pathognomonic signs of leprosy appeared after at least 30 years of incubation. Analysis of leprosy in chimpanzees can contribute not only to medical research but also to the understanding of the pathoetiology of leprosy.
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Affiliation(s)
- Koichi Suzuki
- Laboratory of Molecular Diagnostics, Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho, Higashimurayama, Tokyo 189-0002, Japan.
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Suzuki K, Akama T, Kawashima A, Yoshihara A, Yotsu RR, Ishii N. Current status of leprosy: epidemiology, basic science and clinical perspectives. J Dermatol 2011; 39:121-9. [PMID: 21973237 DOI: 10.1111/j.1346-8138.2011.01370.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Leprosy has affected humans for millennia and remains an important health problem worldwide, as evidenced by nearly 250 000 new cases detected every year. It is a chronic infectious disorder, caused by Mycobacterium leprae, that primarily affects the skin and peripheral nerves. Recent advances in basic science have improved our knowledge of the disease. Variation in the cellular immune response is the basis of a range of clinical manifestations. The introduction of multidrug therapy has significantly contributed to a decrease in the prevalence of the disease. However, leprosy control activities, including monitoring and prevention programs, must be maintained.
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Affiliation(s)
- Koichi Suzuki
- Leprosy Research Center, National Institute of Infectious Diseases Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
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