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Lima MIS, Corrêa MBC, Moraes ECDS, Oliveira JDDD, de Souza Santos P, de Souza AG, Goulart IMB, Goulart LR. HSP60 mimetic peptides from Mycobacterium leprae as new antigens for immunodiagnosis of Leprosy. AMB Express 2023; 13:120. [PMID: 37891336 PMCID: PMC10611693 DOI: 10.1186/s13568-023-01625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
The early diagnosis of leprosy serves as an important tool to reduce the incidence of this disease in the world. Phage display (PD) technology can be used for mapping new antigens to the development of immunodiagnostic platforms. Our objective was to identify peptides that mimic Mycobacterium leprae proteins as serological markers using phage display technology. The phages were obtained in the biopanning using negative and positive serum from household contacts and leprosy patients, respectively. Then, the peptides were synthesized and validated in silico and in vitro for detection of IgG from patients and contacts. To characterize the native protein of M. leprae, scFv antibodies were selected against the synthetic peptides by PD. The scFv binding protein was obtained by immunocapture and confirmed using mass spectrometry. We selected two phase-fused peptides, MPML12 and MPML14, which mimic the HSP60 protein from M. leprae. The peptides MPML12 and MPML14 obtained 100% and 92.85% positivity in lepromatous patients. MPML12 and MPM14 detect IgG, especially in the multibacillary forms. The MPML12 and MPML14 peptides had positivity of 11.1% and 16.6% in household contacts, respectively. There was no cross-reaction in patient's samples with visceral leishmaniasis, tuberculosis and other mycobacteriosis for both peptides. Given these results and the easy obtainment of mimetic antigens, our peptides are promising markers for application in the diagnosis of leprosy, especially in endemic and hyperendemic regions.
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Affiliation(s)
- Mayara Ingrid Sousa Lima
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, São Luís, MA, Brazil.
- Postgraduate Program on Health and Environment and Postgraduate Program on Health Sciences, Federal University of Maranhão, São Luís, MA, Brazil.
| | | | | | | | - Paula de Souza Santos
- Institute of Biotechnology, Federal University of Uberlandia, Uberlandia, MG, Brazil
| | - Aline Gomes de Souza
- Institute of Biotechnology, Federal University of Uberlandia, Uberlandia, MG, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center in Sanitary Dermatology and Leprosy, School of Medicine, Clinics' Hospital, Federal University of Uberlandia, Uberlandia, MG, Brazil.
| | - Luiz Ricardo Goulart
- Institute of Biotechnology, Federal University of Uberlandia, Uberlandia, MG, Brazil
- Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA
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Luppi ADM, Ferreira GE, Prudêncio DL, Antunes DE, Araújo L, Dos Santos DF, Nogueira-Barbosa MH, Goulart IMB. High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts. PLoS One 2023; 18:e0285450. [PMID: 37220153 DOI: 10.1371/journal.pone.0285450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.
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Affiliation(s)
- Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Radiology Division, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Guilherme Emilio Ferreira
- Radiology Division, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
| | - Denis Luiz Prudêncio
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Lúcio Araújo
- Department of Mathematics, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Radiology Division, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, São Paulo, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics' Hospital, Federal University of Uberlândia (UFU/EBSERH), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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dos Santos DF, Garcia LP, Borges IS, Oliveira TJ, Antunes DE, Luppi ADM, Goulart IMB. Early diagnosis of neural impairment in seropositive leprosy household contacts: The experience of a reference center in Brazil. Front Med (Lausanne) 2023; 10:1143402. [PMID: 36993802 PMCID: PMC10040679 DOI: 10.3389/fmed.2023.1143402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionLeprosy is an infectious disease that remains with a high number of new cases in developing countries. Household contacts have a higher risk for the development of the disease, but the neural impairment in this group is not well elucidated yet. Here, we measured the chance of occurrence of peripheral neural impairment in asymptomatic leprosy household.MethodsContacts who present anti-PGL-I IgM seropositivity, through electroneuromyography (ENMG) evaluation. We recruited 361 seropositive contacts (SPC) from 2017 to 2021, who were subjected to an extensive protocol that included clinical, molecular, and electroneuromyographic evaluations.ResultsOur data revealed a positivity of slit skin smear and skin biopsy qPCR of 35.5% (128/361) and 25.8% (93/361) respectively. The electroneuromyographic evaluation of the SPC showed neural impairment in 23.5% (85/361), with the predominance of a mononeuropathy pattern in 62.3% (53/85). Clinical neural thickening was observed in 17.5% (63/361) of seropositive contacts, but among the individuals with abnormal ENMG, only 25.9% (22/85) presented neural thickening in the clinical exam.DiscussionOurs results corroborates the need to make the approach to asymptomatic contacts in endemic countries more timely. Since leprosy in its early stages can present an indolent and subclinical evolution, serological, molecular, and neurophysiological tools are essential to break the disease transmission chain.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- *Correspondence: Diogo Fernandes dos Santos,
| | - Leonardo Peixoto Garcia
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabella Sabião Borges
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Thales Junqueira Oliveira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Brazil
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Voltan G, Marques-Júnior W, Santana JM, Lincoln Silva CM, Leite MN, De Paula NA, Bernardes Filho F, Barreto JG, Da Silva MB, Conde G, Salgado CG, Frade MAC. Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease. Front Med (Lausanne) 2023; 9:1059448. [PMID: 36733931 PMCID: PMC9887334 DOI: 10.3389/fmed.2022.1059448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Hansen's disease (HD) primarily infects peripheral nerves, with patients without HD being free of peripheral nerve damage. Household contacts (HHCs) of patients with HD are at a 5-10 times higher risk of HD than the general population. Neural thickening is one of the three cardinal signs that define a case of HD according to WHO guidelines, exclusively considering palpation examination that is subjective and may not detect the condition in the earliest cases even when performed by well-trained professionals. High-resolution ultrasound (HRUS) can evaluate most peripheral nerves, a validated technique with good reproducibility allowing detailed and accurate examination. Objective This study aimed to use the peripheral nerve HRUS test according to the HD protocol as a diagnostic method for neuropathy comparing HHCs with healthy volunteers (HVs) and patients with HD. Methods In municipalities from 14 different areas of Brazil we selected at random 83 HHC of MB-patients to be submitted to peripheral nerve ultrasound and compared to 49 HVs and 176 HD-patients. Results Household contacts assessed by HRUS showed higher median and mean absolute peripheral nerve cross-sectional area (CSA) values and greater asymmetries (ΔCSA) compared to HVs at the same points. Median and mean absolute peripheral nerve CSA values were higher in patients with HD compared to HCCs at almost all points, while ΔCSA values were equal at all points. Mean ± SD focality (ΔTpT) values for HHCs and patients with HD, respectively, were 2.7 ± 2.2/2.6 ± 2.2 for the median nerve, 2.9 ± 2.7/3.3 ± 2.9 for the common fibular nerve (p > 0.05), and 1.3 ± 1.3/2.2 ± 3.9 for the ulnar nerve (p < 0.0001). Discussion Considering HRUS findings for HHCs, asymmetric multiple mononeuropathy signs (thickening or asymmetry) in at least 20% of the nerves evaluated could already indicates evidence of HD neuropathy. Thus, if more nerve points are assessed in HHCs (14 instead of 10), the contacts become more like patients with HD according to nerve thickening determined by HRUS, which should be a cutting-edge tool for an early diagnosis of leprosy cases.
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Affiliation(s)
- Glauber Voltan
- Healing and Hansen's Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wilson Marques-Júnior
- Division of Neuromuscular Disorders, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaci Maria Santana
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Claudia Maria Lincoln Silva
- Healing and Hansen's Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marcel Nani Leite
- Healing and Hansen's Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Natália Aparecida De Paula
- Healing and Hansen's Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fred Bernardes Filho
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Josafá Gonçalves Barreto
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Pará, Marituba, Brazil
| | - Moises Batista Da Silva
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Pará, Marituba, Brazil
| | - Guilherme Conde
- Decision Support Laboratory, Federal University of Pará West, Santarem, Brazil
| | - Claudio Guedes Salgado
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Pará, Marituba, Brazil
| | - Marco Andrey Cipriani Frade
- Healing and Hansen's Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Referral Center for Sanitary Dermatology and Hansen's Disease, Dermatology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Saar M, Beissner M, Gültekin F, Maman I, Herbinger KH, Bretzel G. RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test. BMC Infect Dis 2021; 21:1186. [PMID: 34823479 PMCID: PMC8620619 DOI: 10.1186/s12879-021-06882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. METHODS: Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 "must not detect RLEP" samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 "must detect RLEP" samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001-10.000 bacilli/extract), low-positive samples of MB leprosy patients (1-1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. RESULTS: Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43-27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93-100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. CONCLUSIONS: The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.
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Affiliation(s)
- Malkin Saar
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany.
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Fatih Gültekin
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Issaka Maman
- Ministère de la Santé, Institut National d'Hygiène (INH), Lomé, Togo
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
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Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros. PLoS Negl Trop Dis 2021; 15:e0009924. [PMID: 34758041 PMCID: PMC8580230 DOI: 10.1371/journal.pntd.0009924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
The World Health Organization (WHO) endorsed diagnosis of leprosy (also known as Hansen’s disease) entirely based on clinical cardinal signs, without microbiological confirmation, which may lead to late or misdiagnosis. The use of slit skin smears is variable, but lacks sensitivity. In 2017–2018 during the ComLep study, on the island of Anjouan (Union of the Comoros; High priority country according to WHO, 310 patients were diagnosed with leprosy (paucibacillary = 159; multibacillary = 151), of whom 263 were sampled for a skin biopsy and fingerstick blood, and 260 for a minimally-invasive nasal swab. In 74.5% of all skin biopsies and in 15.4% of all nasal swabs, M. leprae DNA was detected. In 63.1% of fingerstick blood samples, M. leprae specific antibodies were detected with the quantitative αPGL-I test. Results show a strong correlation of αPGL-I IgM levels in fingerstick blood and RLEP-qPCR positivity of nasal swabs, with the M. leprae bacterial load measured by RLEP-qPCR of skin biopsies. Patients with a high bacterial load (≥50,000 bacilli in a skin biopsy) can be identified with combination of counting lesions and the αPGL-I test. To our knowledge, this is the first study that compared αPGL-I IgM levels in fingerstick blood with the bacterial load determined by RLEP-qPCR in skin biopsies of leprosy patients. The demonstrated potential of minimally invasive sampling such as fingerstick blood samples to identify high bacterial load persons likely to be accountable for the ongoing transmission, merits further evaluation in follow-up studies. Leprosy is the oldest infectious disease known to humankind. We still do not succeed in curbing its transmission, with more than 200,000 new patients detected worldwide each year. Identifying persons with a high burden of bacteria is key to curb transmission. To identify these persons, bacteria are counted in invasive and painful samples like slit skin smears and skin biopsies. We evaluated whether we can use less invasive samples, like fingerstick blood or nasal swabs, to determine the bacterial load. We found that the level of antibodies against M. leprae (αPGL-I IgM) in fingerstick blood correlates well with the bacterial load determined in skin biopsies from the same leprosy patient. Therefore, a high level of antibodies against M. leprae in fingerstick blood might identify persons who pose a potential risk for transmission of leprosy and could be prioritized for contact screening, which is essential for control of the disease.
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Tomaselli PJ, Dos Santos DF, Dos Santos ACJ, Antunes DE, Marques VD, Foss NT, Moreira CL, Nogueira PTB, Nascimento OJM, Neder L, Barreira AA, Frade MA, Goulart IMB, Marques W. Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression. Brain 2021; 145:1499-1506. [PMID: 34664630 DOI: 10.1093/brain/awab396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/25/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤ 12 months) and long (> 12 months) disease duration. Positive and negative symptoms mediated by small-fibre were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (p < 0,001), as well as motor deficits (p = 0,002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (p < 0,001). Primary neural leprosy progress over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes.
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Affiliation(s)
- Pedro J Tomaselli
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD
| | - Diogo F Dos Santos
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - André C J Dos Santos
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Douglas E Antunes
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Vanessa D Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Norma T Foss
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Carolina L Moreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Patrícia T B Nogueira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Osvaldo J M Nascimento
- Antonio Pedro University Hospital (HUAP), Fluminense Federal University, Niterói, 24033-900, Brazil
| | - Luciano Neder
- Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos, 14784-400, Brazil
| | - Amilton A Barreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Marco A Frade
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Isabela M B Goulart
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Wilson Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD.,National Institute for Science and Technology for Translational Medicine, INCT, Brazil
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da Silva SF, da Silva Cavalcante LR, Fonseca Junior EA, da Silva JM, Lopes JC, Damazo AS. Analysis of the myeloid-derived suppressor cells and annexin A1 in multibacillary leprosy and reactional episodes. BMC Infect Dis 2021; 21:1050. [PMID: 34627197 PMCID: PMC8502368 DOI: 10.1186/s12879-021-06744-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Patients have distinct clinical forms, and the host´s immunological response regulate those manifestations. In this work, the presence of the myeloid-derived suppressor cell and the regulatory protein annexin A1 is described in patients with multibacillary leprosy and with type 1 and 2 reactions.
Methods Patients were submitted to skin biopsy for histopathological analysis to obtain a bacilloscopic index. Immunofluorescence was used to detect myeloid-derived suppressor cells and annexin A1. Results The data demonstrated that the presence of granulocytic and monocytic myeloid-derived suppressor cells in leprosy patients. A high number of monocytic myeloid-derived suppressor cells were observed in lepromatous leprosy and type 2 reactional patients. The presence of annexin A1 was observed in all myeloid-derived suppressor cells. In particular, the monocytic myeloid-derived suppressor cell in the lepromatous patients has higher levels of this protein when compared to the reactional patients. This data suggest that the higher expression of this protein may be related to regulatory response against a severe infection, contributing to anergic response. In type 1 reactional patients, the expression of annexin A1 was reduced. Conclusions Myeloid-derived suppressor cell are present in leprosy patients and annexin A1 might be regulated the host response against Mycobacterium leprae. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06744-x.
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Affiliation(s)
- Stephanni Figueiredo da Silva
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Universidade Federal de Mato Grosso (UFMT), 2367 Fernando Correa da Costa Avenue, Cuiabá, MT, 78060-900, Brazil.,Coordenator of the Laboratory of Clinical Analysis in Jangada, Jangada, MT, 78490-000, Brazil
| | - Leticia Rossetto da Silva Cavalcante
- Ambulatory of Leprosy, University Hospital Julio Müller, Luis Philippe Pereira Leite Street, Cuiabá, MT, 78048-902, Brazil.,Post-Graduate Program in Professional Master in Science Applied at Hospital Attention, University Hospital Julio Müller, Luis Philippe Pereira Leite Street, Cuiabá, MT, 78048-902, Brazil
| | - Ezequiel Angelo Fonseca Junior
- Ambulatory of Leprosy, University Hospital Julio Müller, Luis Philippe Pereira Leite Street, Cuiabá, MT, 78048-902, Brazil
| | - Joselina Maria da Silva
- Department of Basic Sciences in Health, Faculty of Medicine (FM), School of Medicine, Universidade Federal de Mato Grosso (UFMT), 2367 Fernando Correa da Costa Avenue, MT, 78060-900, Cuiabá, Brazil
| | - José Cabral Lopes
- Ambulatory of Leprosy, University Hospital Julio Müller, Luis Philippe Pereira Leite Street, Cuiabá, MT, 78048-902, Brazil
| | - Amilcar Sabino Damazo
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Universidade Federal de Mato Grosso (UFMT), 2367 Fernando Correa da Costa Avenue, Cuiabá, MT, 78060-900, Brazil. .,Post-Graduate Program in Professional Master in Science Applied at Hospital Attention, University Hospital Julio Müller, Luis Philippe Pereira Leite Street, Cuiabá, MT, 78048-902, Brazil. .,Department of Basic Sciences in Health, Faculty of Medicine (FM), School of Medicine, Universidade Federal de Mato Grosso (UFMT), 2367 Fernando Correa da Costa Avenue, MT, 78060-900, Cuiabá, Brazil.
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A 5-year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy. Biomed Rep 2021; 15:88. [PMID: 34589216 DOI: 10.3892/br.2021.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/02/2021] [Indexed: 11/05/2022] Open
Abstract
Subclinical leprosy is an infectious disease in which the immune system remains infected with Mycobacterium leprae (M. leprae). The progress of subclinical leprosy to clinical cases within 1 year of infection is 1.5%, with an increase to 6% in the following 4 years. Rifampicin is frequently used for prevention of leprosy, and clarithromycin has a bactericidal effect on M. leprae. Thus, the combination of both is expected to improve disease control in patients with subclinical leprosy. The aim of the present study was to evaluate the efficacy of a chemoprophylactic treatment involving rifampicin and clarithromycin against subclinical leprosy in elementary school children from endemic areas of East Java over a 5-year period. The study was performed between 2011 and 2015. Samples were collected from 2,548 healthy elementary school children in Nguling (Pasuruan) and Raas (Sumenep), and analysed using ELISA for anti-PGL (phenolic glycolipid)-1 IgM antibodies. Children who were seropositive for anti-PGL-1 IgM antibodies received a chemoprophylactic regimen consisting of rifampicin (300 mg/day) and clarithromycin (250 mg/day) daily for the initial 10 days, followed by the same regimen every 2 weeks for 3 months. Clinical and serological evaluations were performed annually for 5 years. Amongst the 2,548 healthy elementary school children, 200 were seropositive. The anti-PGL-1 IgM antibody levels significantly decreased between 2011 and 2015 in Nguling (from 1,066.7 to 137.4 U/ml) and Raas (from 773.1 to 563.4 U/ml), the levels decreased every year. In addition, the proportion of patients with decreased anti-PGL-1 IgM antibody levels was consistently higher than patients with increased anti-PGL-1 IgM antibody levels in all periods, except during 2013-2014, in Nguling and Raas. Chemoprophylactic treatment involving rifampicin and clarithromycin may thus be effective against subclinical leprosy amongst elementary school children.
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Kumaran MS, Narang T, Chabbra S, Ashraf R, Dogra S. Mycobacterium indicus pranii vaccine immunoprophylaxis in anti-phenolic glycolipid-1-positive leprosy contacts - A pilot study from a tertiary care center in North India. Indian J Dermatol Venereol Leprol 2021; 88:47-50. [PMID: 34379957 DOI: 10.25259/ijdvl_882_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Contacts of leprosy patients have an increased risk of infection with Mycobacterium leprae. Contact tracing and chemo- or immunoprophylaxis are important means of preventing leprosy transmission. AIMS We aimed to evaluate the efficacy of immunoprophylaxis with Mycobacterium indicus pranii vaccine in reducing anti-phenolic glycolipid-1 titers in household contacts of leprosy patients. METHODS This prospective single-center study was conducted in a tertiary care center in North India from January 2015 to December 2016. Contacts of leprosy patients (both paucibacillary and multibacillary) were screened for anti-phenolic glycolipid-1 antibodies with enzyme-linked immunosorbent assay. Those found positive were given immunoprophylaxis with a single dose of Mycobacterium indicus pranii vaccine, and anti-phenolic glycolipid-1 titers were evaluated at six and 12 months. All contacts were clinically followed for three years. RESULTS Of the 135 contacts of 98 leprosy patients that were screened, 128 were recruited. Seventeen of these contacts were positive for anti-phenolic glycolipid-1 antibodies and were given Mycobacterium indicus pranii vaccine. Two contacts were lost to follow-up. After immunoprophylaxis, anti-phenolic glycolipid-1 titers were negative in all patients at all intervals, and no contact developed any clinical signs or symptoms of leprosy during the three-year follow-up. LIMITATIONS The small number of contacts studied, the short follow-up period and the absence of a control group were limitations of this study. Dicussion: We could not find any papers on natural decline of PGL 1 titres in contacts, although in leprosy patients, these titres may even increase after completion of treatment. However the titres do correlate with bacterial load (reference: Int J Lepr Other Mycobact Dis. 1998 Sep;66(3):356-64) so if the tires decrease or become negative it may be considered as an indirect evidence of bacillary clearance. Hence we may suggest the protective efficacy. Furthermore, as the editor mentioned, considering the small number of positive patients, a control group was not possible in the present pilot study, but such studies may be carried out in the future. CONCLUSION Immunoprophylaxis with Mycobacterium indicus pranii vaccine is effective and safe in preventing disease in contacts of leprosy patients. However, these findings need to be replicated in larger studies.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatalogy, Venereology and Leprology Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatalogy, Venereology and Leprology Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chabbra
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raihan Ashraf
- Department of Dermatalogy, Venereology and Leprology Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatalogy, Venereology and Leprology Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Niitsuma ENA, Bueno IDC, Arantes EO, Carvalho APM, Xavier Junior GF, Fernandes GDR, Lana FCF. Factors associated with the development of leprosy in contacts: a systematic review and meta-analysis. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210039. [PMID: 34231829 DOI: 10.1590/1980-549720210039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/20/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the risk factors associated with leprosy in contacts of patients. METHOD We carried out a systematic review and meta-analysis by searching the databases MEDLINE, Embase, Cochrane Library, CINAHL, LILACS, Scopus, and Web of Science until September 2019. Four reviewers carried out the selection, analysis, and evaluation of quality of studies. The random effects model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (95% CI) when heterogeneity was greater than 50%. RESULTS The search resulted in 2,148 references and included 24 reports. Most of the studies had been conducted in Brazil and India, had a cohort design and included household, neighbors, and social contacts. The risk factors associated with illness due to leprosy in contacts were: illiteracy (RR = 1,48; 95%CI 1,22 - 1,79), living in the same house (RR = 2,41; 95%CI 1,87 - 3,10) of a case of leprosy with high bacillary load (RR = 2.40; 95%CI 1.69 - 3.41), seropositivity to the Mycobacterium leprae PGL-1 (phenolic glycolipid-1) antigen (RR = 3.54; 95%CI 2.21 - 5.67), presence of the bacillus in the bloodstream (RR = 10.61; 95%CI 4.74 - 23.77) and negative Mitsuda reaction (RR = 2,68; 95%CI 1,76 - 4,07). Immunization with BCG (bacillus Calmette-Guérin) vaccine had a protective effect against leprosy. CONCLUSION Leprosy in contacts of patients involves social determination, individual susceptibility, and difficulties in access to disease control actions, but modifiable risk factors are the main determinants of illness in this population.
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Affiliation(s)
- Eyleen Nabyla Alvarenga Niitsuma
- Instituto Federal de Educação, Ciência e Tecnologia do Norte de Minas Gerais - Almenara (MG), Brasil.,Programa de Pós-graduação em Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Isabela de Caux Bueno
- Programa de Pós-graduação em Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Elis Oliveira Arantes
- Programa de Pós-graduação em Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Ana Paula Mendes Carvalho
- Diretoria de Vigilância de Condições Crônicas, Secretaria de Estado de Saúde de Minas Gerais - Belo Horizonte (MG), Brasil
| | | | | | - Francisco Carlos Félix Lana
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Jian L, Xiujian S, Yuangang Y, Yan X, Lianchao Y, Duthie MS, Yan W. Evaluation of antibody detection against the NDO-BSA, LID-1 and NDO-LID antigens as confirmatory tests to support the diagnosis of leprosy in Yunnan province, southwest China. Trans R Soc Trop Med Hyg 2021; 114:193-199. [PMID: 31667502 PMCID: PMC7092950 DOI: 10.1093/trstmh/trz089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/13/2019] [Accepted: 08/01/2019] [Indexed: 01/26/2023] Open
Abstract
Although multidrug therapy (MDT) has been widely used for the treatment of leprosy for nearly 40 y, the disease remains a public health concern in some areas. The early detection of leprosy cases is vital to interrupt Mycobacterium leprae transmission, but currently diagnosis is typically achieved during the recognition of clinical symptoms by professional staff performing physical examinations in conjunction with microbiological assessment of slit skin smears (SSSs) and histopathology. In the last 10 y, serum antibody detection tests have emerged to aid leprosy diagnosis. Here we evaluated the ability of antigens NDO-BSA and LID-1 (ML0405 and ML2331) and the conjugate of these, NDO-LID, to detect antibodies in the sera of 113 leprosy patients and 166 control individuals in Yunnan province in southwest China. We found that each antigen was readily detected by sera from multibacillary (MB) patients, with sensitivities of 97.3%, 97.3% and 98.6% for NDO-BSA, LID-1 and NDO-LID, respectively. Even among paucibacillary (PB) patients the antigens detected antibodies in 74.4%, 56.4% and 69.2% of serum samples, respectively. Receiver operating characteristics (ROC) curve analysis indicated that, irrespective of the leprosy case classification as MB or PB, the detection efficiency obtained with NDO-LID was better than that obtained with the other two antigens (with LID-1 being a slightly better than NDO-BSA). Our results indicate the utility of NDO-LID in assisting in the diagnosis of PB and MB leprosy patients and that these antibody detection assays represent powerful diagnostic tools. We suggest that could be implemented into the procedures of local health centres in leprosy-endemic regions to assist in earlier diagnosis.
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Affiliation(s)
- Liu Jian
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases (100086), Capital Medical University, Beijing 100050, China
| | - Shang Xiujian
- Xinjiang Uygur Autonomous Region Centers for Disease Control and Prevention, Urumqi 830001, China
| | - You Yuangang
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases (100086), Capital Medical University, Beijing 100050, China
| | - Xing Yan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases (100086), Capital Medical University, Beijing 100050, China
| | - Yuan Lianchao
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases (100086), Capital Medical University, Beijing 100050, China
| | - Malcolm S Duthie
- Infectious Disease Research Institute, 1616 Eastlake Ave. E, Seattle, WA 98102, USA
| | - Wen Yan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.,Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases (100086), Capital Medical University, Beijing 100050, China
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13
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Gama RS, Leite LA, Colombo LT, Fraga LADO. Prospects for new leprosy diagnostic tools, a narrative review considering ELISA and PCR assays. Rev Soc Bras Med Trop 2020; 53:e20200197. [PMID: 33263683 PMCID: PMC7723377 DOI: 10.1590/0037-8682-0197-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Slit skin smear and histopathological examinations are currently the main laboratory tools used to aid the diagnosis of leprosy. However, their sensitivity is low, and many cases are not detected. New methodologies have been studied to develop more accurate tests. This narrative review aims to raise attention to the results of molecular (polymerase chain reaction) and serological (Enzyme-Linked Immunosorbent Assay) tests applied to the diagnosis of leprosy, and to summarize the available information about the former. Original scientific articles published in indexed international journals, whose study involved aspects of the diagnosis and classification of leprosy cases or home contacts, were selected. The data were extracted independently using a standardized method that dictated the inclusion of the following information: diagnosis in Paucibacillary and Multibacillary cases and in household contacts; sample number; sample type; study design; studied variables; statistical analysis employed; main results; and limitations identified. In clinical practice, the results from molecular and serological tests are assessed separately, with moderate sensitivity and specificity. However, an integrated study of these methodologies has been suggested for greater accuracy in diagnosis.
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Affiliation(s)
- Rafael Silva Gama
- Universidade Vale do Rio Doce, Laboratório de Biologia Molecular, Governador Valadares, MG, Brasil
| | - Lázaro Azevedo Leite
- Universidade Vale do Rio Doce, Laboratório de Biologia Molecular, Governador Valadares, MG, Brasil
| | - Lívia Tavares Colombo
- Universidade Vale do Rio Doce, Laboratório de Biologia Molecular, Governador Valadares, MG, Brasil
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Factors associated with leprosy in children contacts of notified adults in an endemic region of Midwest Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Rodrigues TSV, Gomes LC, Cortela DCB, Silva EA, Silva CAL, Ferreira SMB. Factors associated with leprosy in children contacts of notified adults in an endemic region of Midwest Brazil. J Pediatr (Rio J) 2020; 96:593-599. [PMID: 31176691 PMCID: PMC9432038 DOI: 10.1016/j.jped.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To analyze the factors associated with leprosy in children who were intradomiciliary contacts of notified adults with the disease in an endemic municipality in Mato Grosso, Brazil. METHOD Case-control study with 204 children under 15 years of age, living in an endemic municipality. Cases (n=40) were considered as the children with leprosy registered at the National Information System of Notifiable Diseases in 2014 and 2015, who were intradomiciliary contacts of at least one adult diagnosed with the disease in the family, and as a control group (n=164) of children living within a radius of up to 100m of the notified cases. Data were obtained through medical file analysis, interviews, and blood samples for anti-PGL-I serological test by the ELISA method. The binary logistic regression technique was used, with p≤0.05. RESULTS After adjustments, the following were associated with leprosy: age (95% CI: 1.24-9.39, p=0.018), area of residence (95% CI: 1.11-6.09, p=0.027), waste disposal (95% CI: 1.91-27.98, p=0.004), family history of the disease (95% CI: 3.41-22.50, p=0.000), and time of residence (95% CI: 1.45-7.78, p=0.005). CONCLUSION Factors associated with the disease indicate greater vulnerability of children aged 8-14 years, associated with living conditions and time of residence, as well as the family history of the disease.
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Affiliation(s)
- Thaísa S V Rodrigues
- Universidade Federal de Mato Grosso (UFMT), Departamento de Enfermagem, Cuiabá, MT, Brazil.
| | - Luciane C Gomes
- Universidade Federal de Mato Grosso (UFMT), Departamento de Enfermagem, Cuiabá, MT, Brazil
| | - Denise C B Cortela
- Universidade do Estado de Mato Grosso (UNEMAT), Departamento de Medicina, Cáceres, MT, Brazil
| | - Eliane A Silva
- Instituto Lauro de Souza Lima, Laboratório de Biologia Molecular, Bauru, SP, Brazil
| | - Cristiane A L Silva
- Universidade de Cuiabá (UNIC), Departamento de Pós Graduação, Mestrado em Ambiente Saúde, Cuiabá, MT, Brazil
| | - Silvana M B Ferreira
- Universidade Federal de Mato Grosso (UFMT), Departamento de Enfermagem, Cuiabá, MT, Brazil; Universidade de Cuiabá (UNIC), Departamento de Pós Graduação, Mestrado em Ambiente Saúde, Cuiabá, MT, Brazil
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Das M, Diana D, Wedderburn A, Rajan L, Rao S, Horo I, Vedithi SC. Molecular epidemiology and transmission dynamics of leprosy among multicase families and case-contact pairs. Int J Infect Dis 2020; 96:172-179. [DOI: 10.1016/j.ijid.2020.04.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022] Open
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Ruiz-Fuentes JL, Rumbaut Castillo R, Hurtado Gascón LDLC, Pastrana F. Leprosy in children: a Cuban experience on leprosy control. BMJ Paediatr Open 2019; 3:e000500. [PMID: 31799450 PMCID: PMC6863670 DOI: 10.1136/bmjpo-2019-000500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Children are believed to be the most vulnerable group to leprosy. Childhood leprosy reflects disease transmission in the community as well as the efficiency of ongoing disease control programmes. In Cuba, leprosy is not a national health problem; however, new childhood leprosy cases are diagnosed every year. OBJECTIVE We summarise the experience of Cuba on childhood leprosy control over the past two decades. RESULTS Between 2000 and 2017, a total of 103 children in Cuba have been diagnosed with leprosy, showing that active transmission of cases remains in 13 of 15 provinces of Cuba. The majority of cases were multibacillary (66%), and 34% were paucibacillary cases. Clinically 60% of children have more than five lesions all over their body. Voluntary reporting was the principal method of case detection. The presence of familial and extrafamilial contact with leprosy cases may be a cause of concern, as it implies continuing transmission of the disease. Only four children had disabilities (one with grade 2 disabilities and three with grade 1 disabilities). A set of national investigations have been developed to intervene in a timely manner. Intervention strategies that combine clinical surveillance and laboratory test could be an option for early detection of childhood leprosy. CONCLUSIONS Early detection of cases due to effective health education campaigns, regular and complete treatment with MDT, and contact tracing may be important in reducing the burden of leprosy in the community.
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Pathak VK, Singh I, Turankar RP, Lavania M, Ahuja M, Singh V, Sengupta U. Utility of multiplex PCR for early diagnosis and household contact surveillance for leprosy. Diagn Microbiol Infect Dis 2019; 95:114855. [DOI: 10.1016/j.diagmicrobio.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Development of a combined RLEP/16S rRNA (RT) qPCR assay for the detection of viable M. leprae from nasal swab samples. BMC Infect Dis 2019; 19:753. [PMID: 31462296 PMCID: PMC6714382 DOI: 10.1186/s12879-019-4349-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background Leprosy continues to be a health problem in endemic areas. More than 200,000 new cases of leprosy per year suggest that transmission of the disease is still ongoing, presumably as airborne infection through nasal droplets. Late diagnosis supports continued transmission and increases the individual risk for functional disabilities. Laboratory tools are considered beneficial to facilitate early detection and clinical assessment of cases. The aim of this study was to validate molecular tools allowing detection, quantification and assessment of viability of M. leprae from nasal swab samples which are easy to obtain without the need of any invasive procedures. Methods Validation of two real-time PCRs detecting M. leprae DNA (RLEP qPCR) and RNA (16S rRNA RT qPCR) was conducted on “must not detect”/“must detect” samples and 160 pre-treatment nasal swab samples from 20 clinically diagnosed multibacillary (MB) leprosy patients from Togo. Results Both assays were 100% M. leprae specific and showed analytical sensitivities of three templates each. Out of 20 clinically diagnosed MB leprosy patients, 15 (75.0%) had a positive RLEP qPCR result from nasal swab samples. The 16S rRNA RT qPCR detected viable bacilli in nasal swab samples of ten out of these 15 RLEP positive patients (66.7%). Conclusion The combined RLEP/16S rRNA (RT) qPCR assay provides a sensitive and specific tool to determine the bacterial load and viability of M. leprae from nasal swab samples and is applicable for early diagnosis, monitoring treatment response and investigating the role of nasal carriage of M. leprae in human-to-human transmission through aerosol infection. Electronic supplementary material The online version of this article (10.1186/s12879-019-4349-9) contains supplementary material, which is available to authorized users.
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A novel integrated molecular and serological analysis method to predict new cases of leprosy amongst household contacts. PLoS Negl Trop Dis 2019; 13:e0007400. [PMID: 31181059 PMCID: PMC6586366 DOI: 10.1371/journal.pntd.0007400] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 06/20/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Early detection of Mycobacterium leprae is a key strategy for disrupting the transmission chain of leprosy and preventing the potential onset of physical disabilities. Clinical diagnosis is essential, but some of the presented symptoms may go unnoticed, even by specialists. In areas of greater endemicity, serological and molecular tests have been performed and analyzed separately for the follow-up of household contacts, who are at high risk of developing the disease. The accuracy of these tests is still debated, and it is necessary to make them more reliable, especially for the identification of cases of leprosy between contacts. We proposed an integrated analysis of molecular and serological methods using artificial intelligence by the random forest (RF) algorithm to better diagnose and predict new cases of leprosy. Methods The study was developed in Governador Valadares, Brazil, a hyperendemic region for leprosy. A longitudinal study was performed, including new cases diagnosed in 2011 and their respective household contacts, who were followed in 2011, 2012, and 2016. All contacts were diligently evaluated by clinicians from Reference Center for Endemic Diseases (CREDEN-PES) before being classified as asymptomatic. Samples of slit skin smears (SSS) from the earlobe of the patients and household contacts were collected for quantitative polymerase chain reaction (qPCR) of 16S rRNA, and peripheral blood samples were collected for ELISA assays to detect LID-1 and ND-O-LID. Results The statistical analysis of the tests revealed sensitivity for anti-LID-1 (63.2%), anti-ND-O-LID (57.9%), qPCR SSS (36.8%), and smear microscopy (30.2%). However, the use of RF allowed for an expressive increase in sensitivity in the diagnosis of multibacillary leprosy (90.5%) and especially paucibacillary leprosy (70.6%). It is important to report that the specificity was 92.5%. Conclusion The proposed model using RF allows for the diagnosis of leprosy with high sensitivity and specificity and the early identification of new cases among household contacts. Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) that can infect cells in the skin and nerves. Despite efforts to eliminate leprosy, the number of M. leprae infected individuals who develop leprosy is still substantial in the world. The diagnosis relies mainly on clinical parameters. Histopathological and bacteriological analysis help to classify clinical forms of patients. Serology and polymerase chain reaction (PCR) assays are claimed by health professionals as auxiliary tools, but until now these tests have been used almost exclusively in research, with minor use in leprosy reference centers throughout Brazil. Here, we tested quantitative PCR (qPCR) designed to amplify specific M. leprae targets and ELISA assays to detect antibody response to recombinant antigens (LID-1, ND-O-LID). All results were analyzed by multivariate analysis based in artificial intelligence. We chose random forest as a classification algorithm to aid in the diagnosis and the monitoring of contacts. The results allowed us to diagnose cases of leprosy with high sensitivity and specificity and the early identification of new cases among household contacts.
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Gurung P, Gomes CM, Vernal S, Leeflang MMG. Diagnostic accuracy of tests for leprosy: a systematic review and meta-analysis. Clin Microbiol Infect 2019; 25:1315-1327. [PMID: 31158516 DOI: 10.1016/j.cmi.2019.05.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Owing to difficulties in the clinical diagnosis of leprosy, several complementary tests have been developed and used. The aim was to systematically summarize the accuracy of diagnostic tests for leprosy. METHODS We searched for relevant articles in Embase, Medline, and Global Health databases, until June 2017. Studies evaluating the accuracy of any diagnostic techniques for differentiating between people with and without leprosy were included. Studies solely focusing on differentiating between the separate forms of leprosy were excluded. Our protocol was registered on PROSPERO (CRD42017071803). We assessed study quality using the QUADAS-2 checklist. A bivariate random effects regression model was used for the meta-analyses. RESULTS We included 78 studies, most of those evaluating the detection of IgM antibodies against phenolic glycolipid I using ELISA. Sensitivity of the 39 studies evaluating ELISA was 63.8% (95% CI 55.0-71.8); specificity 91.0% (95% CI 86.9-93.9). The lateral flow test (nine studies) and the agglutination test (five studies) had a slightly higher sensitivity and a slightly lower specificity. Sensitivity of qPCR was (five studies) 78.5% (95% CI 61.9-89.2) and specificity 89.3% (95% CI 61.4-97.8). Sensitivity of conventional PCR was (17 studies) 75.3% (95% CI 67.9-81.5) and specificity 94.5% (95% CI 91.4-96.5). CONCLUSIONS Although the test accuracy looks reasonable, the studies suffered from heterogeneity and low methodological quality.
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Affiliation(s)
- P Gurung
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health, Amsterdam, The Netherlands
| | - C M Gomes
- Diagnostic Dermatology Group, Núcleo de Medicina Tropical, Pós-graduação em Ciências Médicas, Laboratório de Dermatomicologia, Faculdade de Medicina, Universidade de Brasília - UnB, Brasília, Brazil.
| | - S Vernal
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Divisão de Dermatologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto-SP, Brazil
| | - M M G Leeflang
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health, Amsterdam, The Netherlands
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Sharma G, Sharma VD. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis 2019; 25:389-390. [PMID: 30666944 PMCID: PMC6346460 DOI: 10.3201/eid2502.171895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Singh AV, Chauhan DS. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis 2018; 24:951-952. [PMID: 29664381 PMCID: PMC5938782 DOI: 10.3201/eid2405.171972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts. PLoS Negl Trop Dis 2018; 12:e0006494. [PMID: 29782495 PMCID: PMC5983863 DOI: 10.1371/journal.pntd.0006494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/01/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022] Open
Abstract
Background Household contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs. Methods We have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations. Results/Principal findings The positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044). Conclusions/Significance ELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment. Despite the apparent progress observed in recent years in leprosy control, early identification of cases remains one of the primary objectives of control programs. In addition, the failure of the current therapeutic scheme on the incidence of leprosy demonstrates that the disease elimination as a public health program promoted by the World Health Organization (WHO) depends on an incisive action to interrupt its transmission chain. The long incubation period of leprosy, its insidious symptoms and signs may difficult its diagnosis. Several studies have recently demonstrated that IgM anti-PGL-I seropositive contacts present higher chances to become ill than seronegative ones. Therefore, our question was: do seropositive contacts at greater risk of becoming sick already present subclinical neural damage? Therefore, our approach was to analyse anti-PGL-I seropositive contacts through electroneuromyography. The development and implementation of more specific and sensitive methods for the detection of M. leprae and its neural impairment, using immunological, molecular and neurophysiological tools are mandatory to increase the knowledge of leprosy epidemiology, to break its chain of transmission, thereby enabling effective control of this disease. This report demonstrated that seropositive contacts is the population group with higher chances of neural impairment.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Biotechnology, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- * E-mail:
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Marques LÉC, Frota CC, Quetz JDS, Bindá AH, Mota RMS, Pontes MADA, Gonçalves HDS, Kendall C, Kerr LRFS. Evaluation of 16S rRNA qPCR for detection of Mycobacterium leprae DNA in nasal secretion and skin biopsy samples from multibacillary and paucibacillary leprosy cases. Pathog Glob Health 2018; 112:72-78. [PMID: 29279044 PMCID: PMC6056823 DOI: 10.1080/20477724.2017.1415736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mycobacterium leprae bacilli are mainly transmitted by the dissemination of nasal aerosols from multibacillary (MB) patients to susceptible individuals through inhalation. The upper respiratory tract represents the main entry and exit routes of M. leprae. Therefore, this study aimed to evaluate the sensitivity and specificity of real-time quantitative polymerase chain reaction (qPCR) in detecting M. leprae in nasal secretion (NS) and skin biopsy (SB) samples from MB and paucibacillary (PB) cases. Fifty-four NS samples were obtained from leprosy patients at the Dona Libânia National Reference Centre for Sanitary Dermatology in Ceará, Brazil. Among them, 19 MB cases provided both NS and SB samples. Bacilloscopy index assays were conducted and qPCR amplification was performed using specific primers for M. leprae 16S rRNA gene, generating a 124-bp fragment. Primer specificity was verified by determining the amplicon melting temperature (Tm = 79.5 °C) and detection limit of qPCR was 20 fg of M. leprae DNA. Results were positive for 89.7 and 73.3% of NS samples from MB and PB cases, respectively. SB samples from MB patients were 100% positive. The number of bacilli detected in NS samples were 1.39 × 103-8.02 × 105, and in SB samples from MB patients were 1.87 × 103-1.50 × 106. Therefore, qPCR assays using SYBR Green targeting M. leprae 16S rRNA region can be employed in detecting M. leprae in nasal swabs from leprosy patients, validating this method for epidemiological studies aiming to identify healthy carriers among household contacts or within populations of an endemic area.
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Affiliation(s)
- Lívia Érika Carlos Marques
- Department of Pathology and Legal Medicine, Medicine School, Federal University of Ceará, Fortaleza, Brazil
| | - Cristiane Cunha Frota
- Department of Pathology and Legal Medicine, Medicine School, Federal University of Ceará, Fortaleza, Brazil
| | - Josiane da Silva Quetz
- Biomedicine Institute of the Brazilian Semiarid and Clinical Research Unit, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Havt Bindá
- Biomedicine Institute of the Brazilian Semiarid and Clinical Research Unit, Federal University of Ceará, Fortaleza, Brazil
| | - Rosa Maria Salane Mota
- Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
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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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dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects. PLoS Negl Trop Dis 2017; 11:e0006086. [PMID: 29176796 PMCID: PMC5720806 DOI: 10.1371/journal.pntd.0006086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2017] [Accepted: 10/31/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Leprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study. METHODOLOGY/PRINCIPAL FINDINGS Seventy patients diagnosed with primary neural leprosy from 2014 to 2016 underwent clinical, laboratorial and neurophysiological evaluation. All patients presented an asymmetric neural impairment, with nerve thickening in 58.6%. Electroneuromyography showed a pattern of mononeuropathy in 51.4%. Positivity for ELISA anti-PGL1 was 52.9%, while the qPCR of slit skin smear was 78.6%. The qPCR of nerve biopsies was positive in 60.8%. Patients with multiple mononeuropathy patterns showed lower levels of anti-PGL-1 (p = 0.0006), and higher frequency of neural thickening (p = 0.0008) and sensory symptoms (p = 0.01) than those with mononeuropathy. CONCLUSIONS/SIGNIFICANCE PNL is not a synonym of pure neural leprosy, as this condition may include a generalized immune response and also a skin involvement, documented by molecular findings. Immunological, molecular, and neurophysiological tools must be implemented for diagnosing primary neural leprosy to achieve effective treatment and reduction of its resultant disabilities that still represent a public health problem in several developing nations. Finally, we propose a algorithm and recommendations for the diagnosis of primary neural leprosy based on the combination of the three clinical-laboratorial tools.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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Soto LA, Caballero N, Fuentes LR, Muñoz PT, Gómez Echevarría JR, López MP, Bornay Llinares FJ, Stanford JL, Stanford CA, Donoghue HD. Leprosy Associated with Atypical Cutaneous Leishmaniasis in Nicaragua and Honduras. Am J Trop Med Hyg 2017; 97:1103-1110. [PMID: 29031287 PMCID: PMC5637581 DOI: 10.4269/ajtmh.16-0622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 07/17/2017] [Indexed: 11/07/2022] Open
Abstract
In Central America, few cases of leprosy have been reported, but the disease may be unrecognized. Diagnosis is based on clinical criteria and histology. Preliminary field work in Nicaragua and Honduras found patients, including many children, with skin lesions clinically suggestive of atypical cutaneous leishmaniasis or indeterminate leprosy. Histology could not distinguish these diseases although acid-fast organisms were visible in a few biopsies. Lesions healed after standard antimicrobial therapy for leprosy. In the present study, patients, family members, and other community members were skin-tested and provided nasal swabs and blood samples. Biopsies were taken from a subgroup of patients with clinical signs of infection. Two laboratories analyzed samples, using local in-house techniques. Mycobacterium leprae, Leishmania spp. and Leishmania infantum were detected using polymerase chain reactions. Mycobacterium leprae DNA was detected in blood samples and nasal swabs, including some cases where leprosy was not clinically suspected. Leishmania spp. were also detected in blood and nasal swabs. Most biopsies contained Leishmania DNA and coinfection of Leishmania spp. with M. leprae occurred in 33% of cases. Mycobacterium leprae DNA was also detected and sequenced from Nicaraguan and Honduran environmental samples. In conclusion, leprosy and leishmaniasis are present in both regions, and leprosy appears to be widespread. The nature of any relationship between these two pathogens and the epidemiology of these infections need to be elucidated.
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Affiliation(s)
- Lucrecia Acosta Soto
- Sanatorio Fontilles, Alicante, Spain
- Universidad Miguel Hernández de Elche, Alicante, Spain
| | | | | | | | | | | | | | - John L. Stanford
- University College London, London, United Kingdom
- Catriona Hargreaves Charitable Trust, Mill House, Claygate, Kent, United Kingdom
| | - Cynthia A. Stanford
- Catriona Hargreaves Charitable Trust, Mill House, Claygate, Kent, United Kingdom
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Fabri ADCOC, Carvalho APM, Vieira NF, Bueno IDC, Rodrigues RN, Monteiro TBM, Correa-Oliveira R, Duthie MS, Lana FCF. Integrative literature review of the reported uses of serological tests in leprosy management. Rev Soc Bras Med Trop 2016; 49:158-64. [PMID: 27192583 DOI: 10.1590/0037-8682-0226-2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
Abstract
An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.
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Affiliation(s)
| | - Ana Paula Mendes Carvalho
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Nayara Figueiredo Vieira
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabela de Caux Bueno
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rayssa Nogueira Rodrigues
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Rodrigo Correa-Oliveira
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Francisco Carlos Félix Lana
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Nicchio MV, Araujo S, Martins LC, Pinheiro AV, Pereira DC, Borges A, Antunes DE, Barreto JG, Goulart IMB. Spatial and temporal epidemiology of Mycobacterium leprae infection among leprosy patients and household contacts of an endemic region in Southeast Brazil. Acta Trop 2016; 163:38-45. [PMID: 27469619 DOI: 10.1016/j.actatropica.2016.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/04/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Leprosy is a chronic infectious disease that remains a public health problem in low- and middle-income countries. Household contacts of leprosy patients (HHCs) have increased risk of developing disease and are important links in the chain of transmission of Mycobacterium leprae. Based on epidemiological and operational factors, the global elimination strategy depends on the geographic stratification of endemic areas to intensify control activities. The purpose of the study was to integrate epidemiological indicators and serology into the spatial and temporal analysis of M. leprae infection, in order to understanding of the dynamics of transmission, essential information for the control of leprosy. METHODOLOGY Using location-based technologies and epidemiological data obtained from leprosy cases (N=371) and HHCs (N=53), during a 11year period (2004-2014), we explored the spatial and temporal distribution of diagnosed cases: stratified according their disease manifestation; and of subclinical infection among HHCs: determined by serology (anti-PGL-I ELISA and anti-NDO-LID rapid lateral-flow test); in order to assess the distribution pattern of the disease and the areas of greatest risk of illness, in a highly endemic municipality (Ituiutaba, MG) in the southeast region of Brazil. RESULTS Seropositivity among HHCs was: 17% (9/53) for anti-PGL-I ELISA; and 42% for the NDO-LID rapid lateral-flow test. Forty-nine percent of the contacts were seropositive to at least one of the immunological tests. DISCUSSION We observed substantial spatial heterogeneity of cases throughout the urban perimeter. Even so, four main clusters of patients and three main clusters of subclinical infection were identified. CONCLUSIONS Spatio-temporal epidemiology associated to serological assessment can identify high-risk areas imbedded within the overall epidemic municipality, to prioritize active search of new cases as well support prevention strategies in these locations of greater disease burden and transmission. Such techniques should become increasingly useful and important in future action planning of health interventions, as decisions must be made to effectively allocate limited resources.
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Araujo S, Freitas LO, Goulart LR, Goulart IMB. Molecular Evidence for the Aerial Route of Infection of Mycobacterium leprae and the Role of Asymptomatic Carriers in the Persistence of Leprosy. Clin Infect Dis 2016; 63:1412-1420. [PMID: 27558564 DOI: 10.1093/cid/ciw570] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Leprosy persists as a public health problem. The chain of transmission and mechanism of infection are not completely understood. In the current study, we investigated the route of infection and of disease onset, from airway exposure, colonization, and bloodstream dissemination. METHODS Mycobacterium leprae DNA was detected through quantitative polymerase chain reaction in nasal vestibule, nasal turbinate mucosa, and peripheral blood samples, along with anti-phenolic glycolipid I serology and skin tests from the same individual, from 113 leprosy patients and 104 household contacts of patients (HHCs). Bivariate statistics and multiple correspondence analysis were employed. RESULTS The rates of DNA positivity among patients were 66.4% (75 of 113) for nasal swab samples, 71.7% (81 of 113) for nasal turbinate biopsy samples, 19.5% (22 of 113) for blood samples, with seropositivity of 62.8% (71 of 113 samples) and with increasing incidences toward the multibacillary pole of the clinical spectrum. Positivity among HHCs were as follows: 49% (51 of 104) for nasal swab samples, 53.8% (56 of 104) for nasal biopsy samples, 6.7% (7 of 104) for blood samples, and 18.3% (19 of 104 samples) for anti-phenolic glycolipid I serology. During the follow-up of 5-7 years, out of 104 HHCs, 7 developed leprosy (6.7%). Risk for the disease outcome was estimated by comparing results in HHCs who develop leprosy with those not affected. Neither nasal passage nor mucosa positivity was determinant of later disease onset; however, blood presence increased the risk for disease development (relative risk/positive likelihood ratio, 5.54; 95% confidence interval, 1.30-23.62), as did seropositivity (positive likelihood ratio, 3.69 [1.67-8.16]; relative risk, 5.97 [1.45-24.5]). CONCLUSIONS Our findings strongly suggest that the aerosol route of infection and transmission is predominant and that HHCs contribute to the infection risk to themselves and probably to others.
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Affiliation(s)
- Sergio Araujo
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital.,Postgraduate Program in Health Sciences, School of Medicine
| | | | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital.,Postgraduate Program in Health Sciences, School of Medicine.,Institute of Biochemistry and Genetics, Federal University of Uberlandia, Minas Gerais, Brazil.,Department of Medical Microbiology and Immunology, University of California, Davis
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital.,Postgraduate Program in Health Sciences, School of Medicine
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Lima LNGC, Frota CC, Mota RMS, Almeida RLF, Pontes MADA, Gonçalves HDS, Rodrigues LC, Kendall C, Kerr L. Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil. Mem Inst Oswaldo Cruz 2016; 110:898-905. [PMID: 26560980 PMCID: PMC4660619 DOI: 10.1590/0074-02760150178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/02/2015] [Indexed: 11/21/2022] Open
Abstract
A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.
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Affiliation(s)
| | - Cristiane Cunha Frota
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Rosa Livia Freitas Almeida
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | | | - Heitor de Sá Gonçalves
- Centro de Referência Nacional em Dermatologia Sanitária Dona Libânia, Fortaleza, CE, Brasil
| | - Laura Cunha Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ligia Kerr
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Araujo S, Rezende MMF, Sousa DCRD, Rosa MR, Santos DCD, Goulart LR, Goulart IMB. Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients. Rev Soc Bras Med Trop 2016; 48:739-45. [PMID: 26676499 DOI: 10.1590/0037-8682-0245-2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/28/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS The adoption of these combined assays may impose measures for leprosy control strategies.
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Affiliation(s)
- Sergio Araujo
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Marina Monteiro Figueiredo Rezende
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Diogo Carrijo Rodrigues de Sousa
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Maraísa Resende Rosa
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Danielle Cristina Dos Santos
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Luiz Ricardo Goulart
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase, Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
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Duthie MS, Balagon MF. Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy. Risk Manag Healthc Policy 2016; 9:43-53. [PMID: 27175099 PMCID: PMC4854245 DOI: 10.2147/rmhp.s76058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Leprosy is a complex infectious disease caused by Mycobacterium leprae that is a leading cause of nontraumatic peripheral neuropathy. Current control strategies, with a goal of early diagnosis and treatment in the form of multidrug therapy, have maintained new case reports at ~225,000 per year. Diagnostic capabilities are limited and even with revisions to multidrug therapy regimen, treatment can still require up to a year of daily drug intake. Although alternate chemotherapies or adjunct immune therapies that could provide shorter or simpler treatment regimen appear possible, only a limited number of trials have been conducted. More proactive strategies appear necessary in the drive to elimination. As a prevention strategy, most chemoprophylaxis campaigns to date have provided about a 2-year protective window. Vaccination, in the form of a single bacillus Calmette–Guérin (BCG) immunization, generally provides ~50% reduction in leprosy cases. Adapting control strategies to provide both chemoprophylaxis and immunoprophylaxis has distinct appeal, with chemoprophylaxis theoretically buttressed by vaccination to generate immediate protection that can be sustained in the long term. We also discuss simple assays measuring biomarkers as surrogates for disease development or replacements for invasive, but not particularly sensitive, direct measures of M. leprae infection. Such assays could facilitate the clinical trials required to develop these new chemoprophylaxis, immunoprophylaxis strategies, and transition into wider use.
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Affiliation(s)
| | - Marivic F Balagon
- Cebu Skin Clinic, Leonard Wood Memorial Center for Leprosy Research, Cebu City, the Philippines
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Laudien M. Orphan diseases of the nose and paranasal sinuses: Pathogenesis - clinic - therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc04. [PMID: 26770278 PMCID: PMC4702053 DOI: 10.3205/cto000119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rare rhinological diseases are a diagnostic challenge. Sometimes it takes months or even years from the primary manifestation of the disease until the definitive diagnosis is establibshed. During these times the disease proceeds in an uncontrolled or insufficiently treated way. (Irreversible) damage results and sometimes life-threatening situations occur. The unexpected course of a (misdiagnosed) disease should lead to further diagnostic reflections and steps in order to detect also rare diseases as early as possible. The present paper discusses granulomatous diseases of the nose and paranasal sinuses caused by mycobacteria, treponema, Klebsiella, fungi, and protozoa as well as vasculitis, sarcoidosis, rosacea, cocaine-induced midline destruction, nasal extranodal NK/T cell lymphoma, and cholesterol granuloma. Furthermore, diseases with disorders of the mucociliary clearance such as primary ciliary dyskinesia and cystic fibrosis are presented, taking into consideration the current literature.
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Affiliation(s)
- Martin Laudien
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine of Kiel, Christian-Albrechts-University, Kiel, Germany
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36
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Barreto JG, Bisanzio D, Frade MAC, Moraes TMP, Gobbo AR, de Souza Guimarães L, da Silva MB, Vazquez-Prokopec GM, Spencer JS, Kitron U, Salgado CG. Spatial epidemiology and serologic cohorts increase the early detection of leprosy. BMC Infect Dis 2015; 15:527. [PMID: 26573912 PMCID: PMC4647818 DOI: 10.1186/s12879-015-1254-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/27/2015] [Indexed: 11/21/2022] Open
Abstract
Background Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children. Methods We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups. Results Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in “positive houses” compared to “negative houses” (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years. Conclusions Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.
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Affiliation(s)
- Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. .,Universidade Federal do Pará, Campus Castanhal, Marituba, Pará, Brazil.
| | - Donal Bisanzio
- Department of Environmental Sciences, Emory University, Atlanta, GA, USA.
| | - Marco Andrey Cipriani Frade
- Divison of Dermatology of Internal Medicine Department of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Tania Mara Pires Moraes
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil.
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil.
| | - Layana de Souza Guimarães
- Unidade de Referência Especializada em Dermatologia Sanitária Dr. Marcello Candia, Marituba, Pará, Brazil.
| | - Moisés Batista da Silva
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. .,Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil.
| | | | - John Stewart Spencer
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA.
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA, USA.
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. .,Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil.
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Brook CE, Beauclair R, Ngwenya O, Worden L, Ndeffo-Mbah M, Lietman TM, Satpathy SK, Galvani AP, Porco TC. Spatial heterogeneity in projected leprosy trends in India. Parasit Vectors 2015; 8:542. [PMID: 26490137 PMCID: PMC4618538 DOI: 10.1186/s13071-015-1124-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Leprosy is caused by infection with Mycobacterium leprae and is characterized by peripheral nerve damage and skin lesions. The disease is classified into paucibacillary (PB) and multibacillary (MB) leprosy. The 2012 London Declaration formulated the following targets for leprosy control: (1) global interruption of transmission or elimination by 2020, and (2) reduction of grade-2 disabilities in newly detected cases to below 1 per million population at a global level by 2020. Leprosy is treatable, but diagnosis, access to treatment and treatment adherence (all necessary to curtail transmission) represent major challenges. Globally, new case detection rates for leprosy have remained fairly stable in the past decade, with India responsible for more than half of cases reported annually. METHODS We analyzed publicly available data from the Indian Ministry of Health and Family Welfare, and fit linear mixed-effects regression models to leprosy case detection trends reported at the district level. We assessed correlation of the new district-level case detection rate for leprosy with several state-level regressors: TB incidence, BCG coverage, fraction of cases exhibiting grade 2 disability at diagnosis, fraction of cases in children, and fraction multibacillary. RESULTS Our analyses suggest an endemic disease in very slow decline, with substantial spatial heterogeneity at both district and state levels. Enhanced active case finding was associated with a higher case detection rate. CONCLUSIONS Trend analysis of reported new detection rates from India does not support a thesis of rapid progress in leprosy control.
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Affiliation(s)
- Cara E Brook
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Roxanne Beauclair
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,The South African Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Olina Ngwenya
- The South African Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Lee Worden
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sudhir K Satpathy
- School of Public Health, KIIT University, Bhubaneswar, Odisha, India
| | | | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA. .,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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Asymptomatic Leprosy Infection among Blood Donors May Predict Disease Development and Suggests a Potential Mode of Transmission. J Clin Microbiol 2015. [PMID: 26202111 DOI: 10.1128/jcm.01305-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Blood donor samples (1,007) were assessed for anti-phenolic glycolipid 1 (PGL-1) IgM antibodies and Mycobacterium leprae DNA presence, which had 3.8% and 0.3% positivity, respectively. After a 5-year follow-up period, six individuals with positive markers developed leprosy, raising the hypothesis that asymptomatic infection among blood donors may be an undisclosed mode of leprosy transmission via transfusion.
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da Conceição Oliveira Coelho Fabri A, Carvalho APM, Araujo S, Goulart LR, de Mattos AMM, Teixeira HC, Goulart IMB, Duthie MS, Correa-Oliveira R, Lana FCF. Antigen-specific assessment of the immunological status of various groups in a leprosy endemic region. BMC Infect Dis 2015; 15:218. [PMID: 26021317 PMCID: PMC4448205 DOI: 10.1186/s12879-015-0962-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/21/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Serological tests can be important tools to assist in the diagnosis of leprosy and can contribute to an earlier diagnosis. The aim of this study was to evaluate the antibody responses against phenolic glycolipid-1 (PGL-1), natural disaccharide linked to human serum albumin via an octyl (NDO-HSA), Leprosy IDRI Diagnostic-1 (LID-1) and natural disaccharide octyl--Leprosy IDRI Diagnostic-1 (NDO-LID) in leprosy patients, household contacts of patients and the general population. METHODS Enzyme-linked immunosorbent assays were used to analyze the antigen-specific antibody responses of 94 leprosy cases, 104 household contacts of cases and 2.494 individuals from the general population. RESULTS A positive correlation was observed for the antibody responses to all antigens studied. A higher proportion of seropositivity for all antigens, along with stronger magnitude of response, was observed in multibacillary (MB) leprosy patients and household contacts of MB leprosy patients compared with the levels observed in paucibacillary (PB) leprosy patients and household contacts of PB leprosy patients. A substantial and significant positive correlation was found between seropositivity and the bacterial index for the leprosy patients. Anti-PGL-1 tests were more frequently positive than anti-NDO-HSA tests among patients with all clinical forms of leprosy and among the group of household contacts. The LID-1 and NDO-LID antigens showed a greater capacity to identify household contacts and individuals from the general population infected with M. leprae. CONCLUSIONS Tests that measure the antibody responses against LID-1, NDO-LID, NDO-HSA and PGL-1 were effective tools for the detection of patients with MB leprosy. Our data indicate that the anti-LID-1 and anti-NDO-LID responses were more effective than an anti-NDO-HSA response for the identification of individuals with subclinical infection.
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Affiliation(s)
- Angélica da Conceição Oliveira Coelho Fabri
- Department of Basic Nursing, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brazil.
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
| | - Ana Paula Mendes Carvalho
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
| | - Sergio Araujo
- National Reference Center for Sanitary Dermatology and Leprosy - CREDESH, Hospital das Clínicas, Universidade Federal de Uberlandia - UFU, Uberlândia, MG, Brazil.
| | - Luiz Ricardo Goulart
- Institute of Genetics and Biochemistry, Universidade Federal de Uberlandia - UFU, Uberlândia, MG, Brazil.
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA, USA.
| | - Ana Márcia Menezes de Mattos
- Postgraduate Program in Biological Science - Immunology and Infectious Parasitic Disease, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brazil.
| | - Henrique Couto Teixeira
- Department of Parasitology, Microbiology and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brazil.
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy - CREDESH, Hospital das Clínicas, Universidade Federal de Uberlandia - UFU, Uberlândia, MG, Brazil.
| | | | - Rodrigo Correa-Oliveira
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
- Laboratory of Cellular and Molecular Immunology, Centro de Pesquisas René Rachou - CPqRR, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, MG, Brazil.
- Laboratory of Immunology, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto - UFOP, Ouro Preto, MG, Brazil.
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais - INCT-DT, Belo Horizonte, Brazil.
| | - Francisco Carlos Félix Lana
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brazil.
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Abstract
Leprosy or Hansen's disease is an infectious disease caused by the bacterium Mycobacterium leprae. The annual number of new leprosy cases registered worldwide has remained stable over the past years at over 200,000. Early case finding and multidrug therapy have not been able interrupt transmission completely. Elimination requires innovation in control and sustained commitment. Mathematical models can be used to predict the course of leprosy incidence and the effect of intervention strategies. Two compartmental models and one individual-based model have been described in the literature. Both compartmental models investigate the course of leprosy in populations and the long-term impact of control strategies. The individual-based model focusses on transmission within households and the impact of case finding among contacts of new leprosy patients. Major improvement of these models should result from a better understanding of individual differences in exposure to infection and developing leprosy after exposure. Most relevant are contact heterogeneity, heterogeneity in susceptibility and spatial heterogeneity. Furthermore, the existing models have only been applied to a limited number of countries. Parameterization of the models for other areas, in particular those with high incidence, is essential to support current initiatives for the global elimination of leprosy. Many challenges remain in understanding and dealing with leprosy. The support of mathematical models for understanding leprosy epidemiology and supporting policy decision making remains vital.
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Brito KKGD, Andrade SSDC, Santana EMFD, Peixoto VB, Nogueira JDA, Soares MJGO. [Epidemiological analysis of leprosy in an endemic state of northeastern Brazil]. Rev Gaucha Enferm 2015; 36 Spec No:24-30. [PMID: 27057698 DOI: 10.1590/1983-1447.2015.esp.55284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/04/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterise the trend of leprosy according to epidemiological and operational indicators in the state of Paraíba in the period of 2001-2011 with projections for the years 2012-2014. METHODS An epidemiological, retrospective, documentary study of a temporal sequence conducted with 10,476 reported cases of leprosy diagnosed in adults between 2001 and 2011 in 223 municipalities in the state of Paraiba, Brazil. The results were composed and analysed using two epidemiological indicators, an operational indicator and statistical software. RESULTS The annual detection rate of new cases showed an upward slope between 2001 and 2005 and a declining trend from 2006. Disability showed a cyclic variation with a downward tendency and a medium level of efficiency. CONCLUSION The results show that the disease continues to be a problem in the state and reveal the need for shorter assessments that focus on health programmes and strategies that are used to fight leprosy.
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PCR-based techniques for leprosy diagnosis: from the laboratory to the clinic. PLoS Negl Trop Dis 2014; 8:e2655. [PMID: 24722358 PMCID: PMC3983108 DOI: 10.1371/journal.pntd.0002655] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/07/2013] [Indexed: 12/16/2022] Open
Abstract
In leprosy, classic diagnostic tools based on bacillary counts and histopathology have been facing hurdles, especially in distinguishing latent infection from active disease and diagnosing paucibacillary clinical forms. Serological tests and IFN-gamma releasing assays (IGRA) that employ humoral and cellular immune parameters, respectively, are also being used, but recent results indicate that quantitative PCR (qPCR) is a key technique due to its higher sensitivity and specificity. In fact, advances concerning the structure and function of the Mycobacterium leprae genome led to the development of specific PCR-based gene amplification assays for leprosy diagnosis and monitoring of household contacts. Also, based on the validation of point-of-care technologies for M. tuberculosis DNA detection, it is clear that the same advantages of rapid DNA detection could be observed in respect to leprosy. So far, PCR has proven useful in the determination of transmission routes, M. leprae viability, and drug resistance in leprosy. However, PCR has been ascertained to be especially valuable in diagnosing difficult cases like pure neural leprosy (PNL), paucibacillary (PB), and patients with atypical clinical presentation and histopathological features compatible with leprosy. Also, the detection of M. leprae DNA in different samples of the household contacts of leprosy patients is very promising. Although a positive PCR result is not sufficient to establish a causal relationship with disease outcome, quantitation provided by qPCR is clearly capable of indicating increased risk of developing the disease and could alert clinicians to follow these contacts more closely or even define rules for chemoprophylaxis.
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Barreto JG, Bisanzio D, Guimarães LDS, Spencer JS, Vazquez-Prokopec GM, Kitron U, Salgado CG. Spatial analysis spotlighting early childhood leprosy transmission in a hyperendemic municipality of the Brazilian Amazon region. PLoS Negl Trop Dis 2014; 8:e2665. [PMID: 24516679 PMCID: PMC3916250 DOI: 10.1371/journal.pntd.0002665] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/12/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND More than 200,000 new cases of leprosy were reported by 105 countries in 2011. The disease is a public health problem in Brazil, particularly within high-burden pockets in the Amazon region where leprosy is hyperendemic among children. METHODOLOGY We applied geographic information systems and spatial analysis to determine the spatio-temporal pattern of leprosy cases in a hyperendemic municipality of the Brazilian Amazon region (Castanhal). Moreover, we performed active surveillance to collect clinical, epidemiological and serological data of the household contacts of people affected by leprosy and school children in the general population. The occurrence of subclinical infection and overt disease among the evaluated individuals was correlated with the spatio-temporal pattern of leprosy. PRINCIPAL FINDINGS The pattern of leprosy cases showed significant spatio-temporal heterogeneity (p<0.01). Considering 499 mapped cases, we found spatial clusters of high and low detection rates and spatial autocorrelation of individual cases at fine spatio-temporal scales. The relative risk of contracting leprosy in one specific cluster with a high detection rate is almost four times the risk in the areas of low detection rate (RR = 3.86; 95% CI = 2.26-6.59; p<0.0001). Eight new cases were detected among 302 evaluated household contacts: two living in areas of clusters of high detection rate and six in hyperendemic census tracts. Of 188 examined students, 134 (71.3%) lived in hyperendemic areas, 120 (63.8%) were dwelling less than 100 meters of at least one reported leprosy case, 125 (66.5%) showed immunological evidence (positive anti-PGL-I IgM titer) of subclinical infection, and 9 (4.8%) were diagnosed with leprosy (8 within 200 meters of a case living in the same area). CONCLUSIONS/SIGNIFICANCE Spatial analysis provided a better understanding of the high rate of early childhood leprosy transmission in this region. These findings can be applied to guide leprosy control programs to target intervention to high risk areas.
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Affiliation(s)
- Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Marituba, Pará, Brasil
- Universidade Federal do Pará, Campus Castanhal, Pará, Brasil
| | - Donal Bisanzio
- Department of Environmental Studies, Emory University, Atlanta, Georgia, United States of America
| | - Layana de Souza Guimarães
- Unidade de Referência Especializada em Dermatologia Sanitária Dr. Marcello Candia, Marituba, Pará, Brasil
| | - John Stewart Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | | | - Uriel Kitron
- Department of Environmental Studies, Emory University, Atlanta, Georgia, United States of America
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Marituba, Pará, Brasil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brasil
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