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Silva KKDPE, de Oliveira EE, Elias CMM, Pereira IE, Pinheiro RO, Sarno EN, Duthie MS, Teixeira HC. Serum IgA Antibodies Specific to M. leprae Antigens as Biomarkers for Leprosy Detection and Household Contact Tracking. Front Med (Lausanne) 2021; 8:698495. [PMID: 34447763 PMCID: PMC8382955 DOI: 10.3389/fmed.2021.698495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Leprosy remains endemic in several developing countries, such as India and Brazil, in part due to delayed diagnosis that facilitates ongoing transmission. Although immunoglobulins against several Mycobacterium leprae antigens have been indicated for the early diagnosis, and IgA participates in the early stages of leprosy and in subclinical infection, relatively little research has examined anti-M. leprae IgA responses. Here, we investigated serum IgA reactivity against NDO-HSA, LID-1 and NDO-LID, in paucibacillary (PB) and multibacillary (MB) patients and their household contacts, using enzyme-linked immunosorbent assay (ELISA). Diagnostic accuracy of each ELISA was evaluated by receiver operating characteristic (ROC) curve analysis. Our data reveal elevated IgA serum levels against the three M. leprae specific antigens in MB patients, whereas IgA reactivity in PB patients was increased only to NDO-HSA. Further, MB and PB household contacts displayed higher IgA reactivity to NDO-HSA than non-endemic controls. Our data suggest measurement of serum IgA against NDO-HSA as an additional tool in the diagnosis and classification of the disease, with potential utility for household contact follow-up.
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Affiliation(s)
- Kyssia Karen de Paiva E Silva
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Erick Esteves de Oliveira
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Carolina Martins Moreira Elias
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Ingrid Estevam Pereira
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Henrique Couto Teixeira
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duthie MS, Roferos FO, Maghanoy AA, Balagon MF. Acceptability of rapid diagnostic tests among patients and their contacts in the Philippines is sustained beyond the completion of treatment. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zhao Q, Sun Y, Liu H, Zhang F. Prevention and Treatment of Leprosy - China, 2009-2019. China CDC Wkly 2020; 2:53-56. [PMID: 34594761 PMCID: PMC8393067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/16/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Qing Zhao
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yonghu Sun
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China,Furen Zhang,
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Gama RS, Souza MLM, Sarno EN, Moraes MO, Gonçalves A, Stefani MMA, Garcia RMG, Fraga LAO. 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 DOI: 10.1371/journal.pntd.0007400] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Chen X, You YG, Yuan YH, Yuan LC, Wen Y. Host immune responses induced by specific Mycobacterium leprae antigens in an overnight whole-blood assay correlate with the diagnosis of paucibacillary leprosy patients in China. PLoS Negl Trop Dis 2019; 13:e0007318. [PMID: 31017900 PMCID: PMC6481774 DOI: 10.1371/journal.pntd.0007318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy, caused by Mycobacterium leprae, affects over 200,000 people annually worldwide and remains endemic in the ethnically diverse, mountainous and underdeveloped southwestern provinces of China. Delayed diagnosis of leprosy persists in China, thus, additional knowledge to support early diagnosis, especially early diagnosis of paucibacillary (PB) patients, based on the host immune responses induced by specific M. leprae antigens is needed. The current study aimed to investigate leprosy patients and controls in Southwest China by comparing supernatants after stimulation with specific M. leprae antigens in an overnight whole-blood assay (WBA) to determine whether host markers induced by specific M. leprae antigens improve the diagnosis or discrimination of PB patients with leprosy. METHODOLOGY/PRINCIPAL FINDINGS Leprosy patients [13 multibacillary (MB) patients and 7 PB patients] and nonleprosy controls [21 healthy household contacts (HHCs), 20 endemic controls (ECs) and 19 tuberculosis (TB) patients] were enrolled in this study. The supernatant levels of ten host markers stimulated by specific M. leprae antigens were evaluated by overnight WBA and multiplex Luminex assays. The diagnostic value in PB patients and ECs and the discriminatory value between PB patients and HHCs or TB patients were evaluated by receiver operator characteristics (ROC) analysis. ML2044-stimulated CXCL8/IL-8 achieved the highest sensitivity of 100%, with a specificity of 73.68%, for PB diagnosis. Compared to single markers, a 3-marker combination model that included ML2044-induced CXCL8/IL-8, CCL4/MIP-1 beta, and IL-6 improved the diagnostic specificity to 94.7% for PB patients. ML2044-stimulated IL-4 and CXCL8/IL-8 achieved the highest sensitivity (85.71% and 100%) and the highest specificity (95.24% and 84.21%) for discriminating PB patients from HHCs and TB patients, respectively. CONCLUSIONS Our findings suggest that the host markers induced by specific M. leprae antigens in an overnight WBA increase diagnostic and discriminatory value in PB patients with leprosy, with a particularly strong association with interleukin 8.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
| | - Yuan-Gang You
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - You-Hua Yuan
- Department of Laboratory, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Lian C. Yuan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yan Wen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
- * E-mail: (XC); (YW)
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Abstract
The present review briefly summarizes the highlights of the recent advances in Mycobacterium leprae-specific tests for early diagnosis of leprosy. In addition to establishing the diagnosis of clinical cases of leprosy, these tests have also been used to detect subclinical infections in endemic population. Several attempts have been made from 1980 onward for standardization of specific diagnostic assays for early detection of leprosy. Brief account about the development and use of these assays has been described in this review article.
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Affiliation(s)
- Utpal Sengupta
- Departemnt of Microbiology and Immunology, Stanley Browne Laboratory, TLM Community Hospital, Nand Nagri, New Delhi, India
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Chen X, You YG, Yuan YH, Yuan LC, Zhang Y, Yan W. Evaluation of antigen-specific immune responses for leprosy diagnosis in a hyperendemic area in China. PLoS Negl Trop Dis 2018; 12:e0006777. [PMID: 30248098 PMCID: PMC6152862 DOI: 10.1371/journal.pntd.0006777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/23/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate antigen-specific immune responses for leprosy diagnosis in a hyperendemic area in China. METHODS Eighty-three leprosy patients and 161 non-leprosy controls were enrolled from Hani-yi Autonomous Prefecture of Honghe, Yunnan Province, China. Leprosy patients were divided into multibacillary (MB, n = 38), paucibacillary (PB, n = 23), and post-multi-drug therapy (MDT, n = 22) groups. Controls were divided into the following groups: healthy household contacts (HHC, n = 119), tuberculosis (TB, n = 11), and endemic controls (EC, n = 31). The NDO-LID Rapid Test, M. leprae antigen-specific ELISA and antigen-specific IFN-γ secretion in a whole blood assay (WBA) were used to evaluate these subjects. RESULTS The NDO-LID Rapid Test achieved higher positive response rates in MB than in PB patients[94.7%(36/38) vs 65.2%(15/23)], and these rates were higher than those observed by ELISA using anti-LID-1[92.1%(35/38) vs 52.2%(12/23)], anti-NDO-LID[92.1%(35/38) vs 47.8% (11/23)], and anti-ND-O-BSA[89.5%(34/38) vs 60.9%(14/23)]. However, the NDO-LID Rapid Test also showed a higher positive response rate in the EC group (33.3%,10/31), which was higher than the rates observed for anti-NDO-LID (12.9%,4/31) and anti-ND-O-BSA (16.1%,5/31). M. leprae antigen-specific ELISA demonstrated relatively high specificity (86.84-97.37%) but low sensitivity (15.97-72.73%) in discriminating between leprosy patients and non-leprosy controls by ROC curve analysis. In contrast, M. leprae antigen-specific IFN-γ secretion detection achieved higher positive response rates in PB than in MB patients (positive ratio of MB vs PB: 40% vs 56% for LID-1, 28.6% vs 47.8% for ML89, 31.4% vs 60.7% for ML2044, and 31.4 vs 47.8% for ML2028) and could distinguish MB from EC when stimulated with ML89(AUC = 0.6664) and PB fromTB when stimulated with ML2044 and ML2028(AUC = 0.7549 and 0.7372, respectively). CONCLUSION The NDO-LID Rapid Test and M. leprae antigen-specific ELISA are useful tools to assist in the diagnosis of leprosy patients, especially MB patients, although the former had higher sensitivity but lower specificity than the latter. M. leprae antigen-specific IFN-γ release assessed by WBA has diagnostic value for distinguishing PB from TB but not for distinguishing PB from HHC or EC. Screening novel M. leprae-specific antigens, combining different M. leprae antigens and a multi-cytokine analyte model may be needed for more effective diagnosis of leprosy.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Yuan-Gang You
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - You-Hua Yuan
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Lian Chao Yuan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Wen Yan
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
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Marçal PHF, Fraga LADO, Mattos AMMD, Menegati L, Coelho ADCO, Pinheiro RO, Sarno EN, Duthie MS, Teixeira HC. Utility of immunoglobulin isotypes against LID-1 and NDO-LID for, particularly IgG1, confirming the diagnosis of multibacillary leprosy. Mem Inst Oswaldo Cruz 2018. [PMID: 29513821 PMCID: PMC5851060 DOI: 10.1590/0074-02760170467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Leprosy remains a health problem in many countries, with difficulties in
diagnosis resulting in delayed treatment and more severe disabilities.
Antibodies against several Mycobacterium leprae antigens
have, however, shown value as diagnostic and/or prognostic markers. OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM
and IgG subclass reactivity against three M. leprae
specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide
bound to human serum albumin; LID-1, the fusion protein product of the
ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO. METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB)
leprosy patients, and their respective household contacts, were evaluated
for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies
by enzyme-linked immunosorbent assay (ELISA). The sensitivity and
specificity of each ELISA were evaluated by receiver operating
characteristic (ROC) curve analysis. FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG
antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are
markedly increased in MB patients. For the first time, our data reveal a
selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in
MB patients, demonstrating that these antibody isotypes are suitable for
differentiation between MB and PB patients. ROC curve analysis indicates an
improved capacity for diagnosing MB leprosy patients using the detection of
IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID
over the performance levels attained with NDO-HSA. CONCLUSIONS Our findings indicate that serological tests based on the detection of
antigen-specific IgG1 antibodies are a useful tool to differentiate MB from
PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID
antigens in the serodiagnosis of leprosy.
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Affiliation(s)
- Pedro Henrique Ferreira Marçal
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | | | - Ana Márcia Menezes de Mattos
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Laura Menegati
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | | | - Roberta Olmo Pinheiro
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Euzenir Nunes Sarno
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | | | - Henrique Couto Teixeira
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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Frade MAC, de Paula NA, Gomes CM, Vernal S, Bernardes Filho F, Lugão HB, de Abreu MMM, Botini P, Duthie MS, Spencer JS, Soares RCFR, Foss NT. Unexpectedly high leprosy seroprevalence detected using a random surveillance strategy in midwestern Brazil: A comparison of ELISA and a rapid diagnostic test. PLoS Negl Trop Dis 2017; 11:e0005375. [PMID: 28231244 PMCID: PMC5358972 DOI: 10.1371/journal.pntd.0005375] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/20/2017] [Accepted: 01/30/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Leprosy diagnosis is mainly based on clinical evaluation, although this approach is difficult, especially for untrained physicians. We conducted a temporary campaign to detect previously unknown leprosy cases in midwestern Brazil and to compare the performance of different serological tests. METHODS A mobile clinic was stationed at the main bus terminal in Brasília, Brazil. Volunteers were quizzed and given a clinical exam to allow categorization as either patients, known contacts of patients or non-contacts, and blood was collected to determine anti-PGL-I and anti-LID-1 antibody titers by ELISA and by the NDO-LID rapid test. New cases of leprosy and the impact of performing this broad random surveillance strategy were evaluated. Accuracy values and concordance between the test results were evaluated among all groups. RESULTS Four hundred thirty-four individuals were evaluated, and 44 (10.1%) were diagnosed with leprosy. Borderline forms were the most frequent presentation. Both tests presented higher positivity in those individuals with multibacillary disease. Serological tests demonstrated specificities arround 70% for anti-PGL-1 and anti-LID ELISA; and arround 40% for NDO-LID. Sensitivities ranged from 48 to 62%. A substantial agreement between NDO-LID and ELISA with concomitant positive results was found within leprosy patients (Kappa index = 0.79 CI95% 0.36-1.22). CONCLUSIONS The unexpectedly high leprosy prevalence in this population indicates ongoing community-based exposure to Mycobacterium leprae antigens and high rates of subclinical infection. All tests showed low specificity and sensitivity values and therefore cannot be considered for use as stand-alone diagnostics. Rather, considering their positivity among MB patients and non-patients, these tests can be considered effective tools for screening and identifying individuals at high risk who might benefit from regular monitoring.
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Affiliation(s)
- Marco Andrey C. Frade
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- * E-mail:
| | - Natália A. de Paula
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ciro M. Gomes
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Dermatology Division, Department of Medical Clinics, Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Sebastian Vernal
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fred Bernardes Filho
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helena B. Lugão
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Patrícia Botini
- Service of Dermatology, University of Oeste Paulista, Presidente Prudente, Brazil
| | - Malcolm S. Duthie
- Infectious Diseases Research Institute, 1616 Eastlake Av. E, Seattle, WA, United States of America
| | - John S. Spencer
- Colorado State University, Department of Microbiology, Immunology and Pathology, Fort Collins, CO, United States of America
| | - Rosa Castália F. R. Soares
- General Coordination of Leprosy and Eliminating Diseases, Surveillance Secretariat in Health, Brazilian Health Ministry, Brasília, Distrito Federal, Brazil
| | - Norma T. Foss
- Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, 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] [What about the content of this article? (0)] [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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Amorim FM, Nobre ML, Ferreira LC, Nascimento LS, Miranda AM, Monteiro GRG, Dupnik KM, Duthie MS, Reed SG, Jeronimo SMB. Identifying Leprosy and Those at Risk of Developing Leprosy by Detection of Antibodies against LID-1 and LID-NDO. PLoS Negl Trop Dis 2016; 10:e0004934. [PMID: 27658042 PMCID: PMC5033353 DOI: 10.1371/journal.pntd.0004934] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae infection and remains a major public health problem in many areas of the world. Challenges to its timely diagnosis result in delay in treatment, which is usually associated with severe disability. Although phenolic glycolipid (PGL)-I has been reported as auxiliary diagnostic tool, currently there is no serological assay routinely used in leprosy diagnosis. The aim of this study was to evaluate the effectiveness of two related reagents, LID-1 and LID-NDO, for the detection of M. leprae infection. Sera from 98 leprosy patients, 365 household contacts (HHC) and 98 endemic controls from Rio Grande do Norte, Brazil, were evaluated. A subgroup of the HHC living in a hyperendemic area was followed for 7–10 years. Antigen-specific antibody responses were highest in multibacillary (MB) at the lepromatous pole (LL/BL) and lowest in paucibacillary (PB) at the tuberculoid pole (TT/BT). A positive correlation for both anti-LID-1 and anti-LID-NDO antibodies was found with bacterial burden (LID-1, r = 0.84, p<0.001; LID-NDO, r = 0.82, p<0.001), with higher sensitivity than bacilloscopy. According to Receiver Operating Curve, LID-1 and LID-NDO performed similarly. The sensitivity for MB cases was 89% for LID-1 and 95% for LID-NDO; the specificity was 96% for LID-1 and 88% for LID-NDO. Of the 332 HHC that were followed, 12 (3.6%) were diagnosed with leprosy in a median time of 31 (3–79) months after recruitment. A linear generalized model using LID-1 or LID-NDO as a predictor estimated that 8.3% and 10.4% of the HHC would become a leprosy case, respectively. Together, our findings support a role for the LID-1 and LID-NDO antigens in diagnosing MB leprosy and identifying people at greater risk of developing clinical disease. These assays have the potential to improve the diagnostic capacity at local health centers and aid development of strategies for the eventual control and elimination of leprosy from endemic areas. Despite the substantial decrease in its prevalence, leprosy continues to be a worldwide challenge. Early diagnosis and treatment are important to interrupt transmission. Currently, there is no gold standard for the diagnosis of leprosy. Bacilloscopy and histopathology studies are complementary exams that provide high specificity but low sensitivity. It is therefore important to seek alternative tools to achieve rapid and accurate diagnosis. The state of Rio Grande do Norte, in Brazil, has municipalities’ that are considered hyperendemic for leprosy, such as Mossoró, the one included in this study. This city presented an average of new case detection rate (NCDR) of 45.4/100.000 inhabitants per year from 2001 to 2013, much higher than Brazil’s NCDR, which is currently 15.3. Here, we show that the utility of the recombinant antigens LID-1 and LID-NDO to diagnose MB patients and detect asymptomatic M. leprae infection. In addition, we showed that antibody levels were related to the clinical form of leprosy as well as to the bacillary load. Interestingly, we observed that serum levels of LID-1/LID-NDO antibodies can be used to predict leprosy development among HHC. The assays have the potential to eventually be implemented as point of care at local health centers.
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Affiliation(s)
- Francianne M. Amorim
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maurício L. Nobre
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Post-graduate Program in Tropical Medicine, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
- Hospital Giselda Trigueiro, Rio Grande do Norte Health Secretariat, Natal, Rio Grande do Norte, Brazil
| | - Leonardo C. Ferreira
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Larissa S. Nascimento
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Alesson M. Miranda
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Glória R. G. Monteiro
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kathryn M. Dupnik
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Malcolm S. Duthie
- Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Steven G. Reed
- Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Selma M. B. Jeronimo
- Department of Biochemistry, Bioscience Center, and Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador, Bahia, Brazil
- * E-mail:
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Mizoguti DDF, Hungria EM, Freitas AA, Oliveira RM, Cardoso LPV, Costa MB, Sousa ALM, Duthie MS, Stefani MMA. Multibacillary leprosy patients with high and persistent serum antibodies to leprosy IDRI diagnostic-1/LID-1: higher susceptibility to develop type 2 reactions. Mem Inst Oswaldo Cruz 2016; 110:914-20. [PMID: 26560982 PMCID: PMC4660621 DOI: 10.1590/0074-02760150198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/21/2015] [Indexed: 05/28/2023] Open
Abstract
Leprosy inflammatory episodes [type 1 (T1R) and type 2 (T2R) reactions] represent the major cause of irreversible nerve damage. Leprosy serology is known to be influenced by the patient's bacterial index (BI) with higher positivity in multibacillary patients (MB) and specific multidrug therapy (MDT) reduces antibody production. This study evaluated by ELISA antibody responses to leprosy Infectious Disease Research Institute diagnostic-1 (LID-1) fusion protein and phenolic glycolipid I (PGL-I) in 100 paired serum samples of 50 MB patients collected in the presence/absence of reactions and in nonreactional patients before/after MDT. Patients who presented T2R had a median BI of 3+, while MB patients with T1R and nonreactional patients had median BI of 2.5+ (p > 0.05). Anti-LID-1 and anti-PGL-I antibodies declined in patients diagnosed during T1R (p < 0.05). Anti-LID-1 levels waned in MB with T2R at diagnosis and nonreactional MB patients (p < 0.05). Higher anti-LID-1 levels were seen in patients with T2R at diagnosis (vs. patients with T1R at diagnosis, p = 0.008; vs. nonreactional patients, p = 0.020) and in patients with T2R during MDT (vs. nonreactional MB, p = 0.020). In MB patients, high and persistent anti-LID-1 antibody levels might be a useful tool for clinicians to predict which patients are more susceptible to develop leprosy T2R.
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Affiliation(s)
| | - Emerith Mayra Hungria
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Aline Araújo Freitas
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | | | | | - Mauricio Barcelos Costa
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Ana Lúcia Maroclo Sousa
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
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Duthie MS, Orcullo FM, Abbelana J, Maghanoy A, Balagon MF. Comparative evaluation of antibody detection tests to facilitate the diagnosis of multibacillary leprosy. Appl Microbiol Biotechnol 2016; 100:3267-75. [PMID: 26820649 DOI: 10.1007/s00253-016-7328-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
Despite control efforts, leprosy persists as a significant health concern in many regions. Diagnosis is achieved by a combination of clinical, histopathological, and bacteriological examinations, each of which presents a barrier to expeditious diagnosis, particularly by non-experts. Immunological investigations in research laboratories have clearly indicated that antibody detection tests could aid the diagnosis of leprosy. In this study, we detected circulating antibodies with two rapid diagnostic tests (RDT) involving immunochromatographic lateral flow platforms and one rapid ELISA system. Leprosy patients were identified with a high degree of sensitivity in each assay (over 80% in all; over 90% among cases with bacterial indices >1+), although critical differences were observed in specificity. While the specificity of CTK OnSite Leprosy Ab Rapid Test and InBios Leprosy Detect™ fast ELISA were high (96.4 and 93.7% in the general population, respectively), there was a marked reduction in OrangeLife NDO-LID® RDT (only 25.0%). As anticipated, seropositivity rates were marginally higher in contacts of leprosy patients than in endemic controls. Although we observed a slight drop in test band intensity when blood, rather than serum, was used to develop OnSite Leprosy Ab Rapid Tests, the sensitivity and specificity of these tests was unaffected. When we contrasted test performance with clinical and bacteriological information, we found that RDT and ELISA results positively correlated with the bacteriological index. These data indicate that these assays could be a ready replacement of invasive, insensitive, and time consuming skin slit smear procedures that additionally require expert microscopic examinations. We propose that, due to their speed and point of care applicability, the RDT could be used as an initial entry point to the diagnostic protocols, with confirmation of results attained in a highly quantitative manner following serum transfer to a reference laboratory.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Leprosy, caused by noncultivable Mycobacterium leprae (ML), has varied manifestations, which are associated with the host immune responses. The dermal involvement is accompanied by peripheral nerve damage, which leads to sensory motor loss and deformities. Both innate and acquired immune responses are involved. The main cell to be compromised is the CD4 + T helper cell, which shows antigen specific unresponsiveness to only ML and not to other common antigens in the bacilliferous generalized lepromatous form of the disease. In contrast, the paucibacillary localized tuberculoid form shows appropriate T cell functions and poor antibody response. The dichotomy between T cell functions and antibodies are discussed against the current information on cytokines, Th subsets, and regulatory T cells. During lepromatous reactions, there is a temporary, heightened T cell immunity, even in lepromatous subjects. The dermal lesions confirm many features observed with peripheral blood mononuclear cells and give additional information on local immune responses. Nerve damage involves both immune and nonimmune mechanisms. Leprosy is a model disease for understanding host immune responses to intracellular bacilli. There are challenges in diagnosing early leprosy. In spite of intensive efforts by many groups, consensus on a universal test suitable for endemic areas is awaited.
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Affiliation(s)
- Indira Nath
- Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India.
| | - Chaman Saini
- Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
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Carvalho APM, da Conceição Oliveira Coelho Fabri A, Corrêa Oliveira R, Lana FCF. Factors associated with anti-phenolic glycolipid-I seropositivity among the household contacts of leprosy cases. BMC Infect Dis 2015; 15:219. [PMID: 26024906 PMCID: PMC4449587 DOI: 10.1186/s12879-015-0955-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/20/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The diagnosis of leprosy is based on clinical symptoms of the disease, which may not be sufficient to ensure early diagnosis. The development of effective tools for the early detection of infection, such as rapid tests that can be applied by non-specialists for early-stage leprosy identification, has been considered a research priority and may contribute to overcoming the complications associated with late diagnosis. The aim of this study was to analyze the factors associated with anti-phenolic glycolipid-I (PGL-I) seropositivity among the household contacts of leprosy cases. METHODS A cross-sectional study of individuals from the northeastern municipalities of the state of Minas Gerais, Brazil, was performed. Anti-PGL-I seropositivity was evaluated by assessing specific antibody production using the ML Flow test. A Poisson regression with a robust error variance was used to evaluate the relationship between anti-PGL-I seropositivity and the independent variables investigated. RESULTS The overall anti-PGL-I seropositivity was 13.5 %, and among the contacts of leprosy cases that were classified as paucibacillary or multibacillary, it was 8.4 and 17.3 %, respectively. The factors associated with the variation of anti-PGL-I seropositivity among the study population were the presence of signs suggestive of leprosy (PR = 3.68; 95 % CI: 1.56-8.71), the operational leprosy classification (PR = 2.17; 95 % CI: 1.22-3.86) and grade 1 (PR = 1.83; 95 % CI: 1.02-3.26) or grade 2 disability (PR = 2.42; 95 % CI: 1.02-5.47) of the index leprosy case. CONCLUSIONS The presence of signs suggestive of leprosy and the operational classification of leprosy cases were associated with anti-PGL-I seropositivity. The serological tests available for leprosy are not considered to be diagnostic tests but can be used as auxiliary assessments in combination with clinical parameters to identify exposed individuals at high risk of developing leprosy and those exhibiting the initial stages of this disease.
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Affiliation(s)
- Ana Paula Mendes Carvalho
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
| | - Angélica da Conceição Oliveira Coelho Fabri
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Department of Basic Nursing, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora-UFJF, Juiz de Fora, MG, Brasil.
| | - Rodrigo Corrêa Oliveira
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Laboratory of Cellular and Molecular Immunology, Centro de Pesquisas René Rachou-CPqRR, Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, MG, Brasil.
- Laboratory of Immunology, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto-UFOP, Ouro Preto, MG, Brasil.
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais-INCT-DT, Belo Horizonte, Brasil.
| | - Francisco Carlos Félix Lana
- Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brasil.
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Moura RS, Penna GO, Fujiwara T, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Cardoso LPV, Stefani MMDA, Bührer-Sékula S. Evaluation of a rapid serological test for leprosy classification using human serum albumin as the antigen carrier. J Immunol Methods 2014; 412:35-41. [PMID: 24983877 DOI: 10.1016/j.jim.2014.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 12/25/2022]
Abstract
The presence of anti-BSA antibodies may interfere in serological tests, as ELISA or immunochromatographic assays. BSA is frequently used as a blocking agent or as "inert" carrier of antigens, such as the NT-P-BSA, the semi-synthetic trisaccharide analogue of the PGL-I (phenolic glycolipid-I) antigen from the cell wall of the Mycobacterium leprae. PGL-I was prepared and linked to human serum albumin based in the hypothesis that replacing BSA by a human protein carrier would enhance the performance of leprosy serological tests. A total of 1162 serum samples were tested by ELISA and by the ML Flow rapid test using NT-P-BSA or NT-P-HSA antigens. When grouping leprosy patients as paucibacillary (PB) or multibacillary (MB) according to the Ridley & Jopling classification, ML Flow BSA and ML Flow HSA tests correctly allocated 70.9% and 68.6% of patients in the PB group, and 87% and 81% of patients in the MB group, respectively. Concordant results were found in 82.0% (953/1162) (kappa value=0.637; sd=0.023) of samples between ML Flow tests and 85.7% (996/1162) (kappa value=0.703; sd=0.021) between ELISA tests. ML Flow results were statistically similar and the same was true for ELISA tests using HSA or BSA. However, we noticed a tendency to decreased capacity to detect MB patients and an increased positivity among PB patients, HHC, TB patients and healthy controls by the HSA carrier in both ML Flow and ELISA. The PGL-I serology performed by the ML Flow test with BSA or HSA as antigen carriers can be a useful, friendly auxiliary tool to identify patients with higher bacterial load.
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Affiliation(s)
- Rodrigo Scaliante Moura
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | | | | | | | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil.
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Duthie MS, Raychaudhuri R, Tutterrow YL, Misquith A, Bowman J, Casey A, Balagon MF, Maghanoy A, Beltran-alzate JC, Romero-alzate M, Cardona-castro N, Reed SG. A rapid ELISA for the diagnosis of MB leprosy based on complementary detection of antibodies against a novel protein-glycolipid conjugate. Diagn Microbiol Infect Dis 2014; 79:233-9. [DOI: 10.1016/j.diagmicrobio.2014.02.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 11/23/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duthie MS, Balagon MF, Maghanoy A, Orcullo FM, Cang M, Dias RF, Collovati M, Reed SG. Rapid quantitative serological test for detection of infection with Mycobacterium leprae, the causative agent of leprosy. J Clin Microbiol 2014; 52:613-9. [PMID: 24478496 DOI: 10.1128/JCM.02085-13] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leprosy remains an important health problem in a number of regions. Early detection of infection, followed by effective treatment, is critical to reduce disease progression. New sensitive and specific tools for early detection of infection will be a critical component of an effective leprosy elimination campaign. Diagnosis is made by recognizing clinical signs and symptoms, but few clinicians are able to confidently identify these. Simple tests to facilitate referral to leprosy experts are not widely available, and the correct diagnosis of leprosy is often delayed. In this report, we evaluate the performance of a new leprosy serological test (NDO-LID). As expected, the test readily detected clinically confirmed samples from patients with multibacillary (MB) leprosy, and the rate of positive results declined with bacterial burden. NDO-LID detected larger proportions of MB and paucibacillary (PB) leprosy than the alternative, the Standard Diagnostics leprosy test (87.0% versus 81.7% and 32.3% versus 6.5%, respectively), while also demonstrating improved specificity (97.4% versus 90.4%). Coupled with a new cell phone-based test reader platform (Smart Reader), the NDO-LID test provided consistent, objective test interpretation that could facilitate wider use in nonspecialized settings. In addition, results obtained from sera at the time of diagnosis, versus at the end of treatment, indicated that the quantifiable nature of this system can also be used to monitor treatment efficacy. Taken together, these data indicate that the NDO-LID/Smart Reader system can assist in the diagnosis and monitoring of MB leprosy and can detect a significant number of earlier-stage infections.
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Paula Vaz Cardoso L, Dias RF, Freitas AA, Hungria EM, Oliveira RM, Collovati M, Reed SG, Duthie MS, Martins Araújo Stefani M. Development of a quantitative rapid diagnostic test for multibacillary leprosy using smart phone technology. BMC Infect Dis 2013; 13:497. [PMID: 24152601 DOI: 10.1186/1471-2334-13-497] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/17/2013] [Indexed: 11/24/2022] Open
Abstract
Background Despite efforts to eliminate leprosy as public health problem, delayed diagnosis and disabilities still occur in many countries. Leprosy diagnosis remains based on clinical manifestations and the number of clinicians with expertise in leprosy diagnosis is in decline. We have developed a new immunochromatographic test with the goal of producing a simple and rapid system that can be used, with a minimal amount of training, to provide an objective and consistent diagnosis of multibacillary leprosy. Methods The test immobilizes two antigens that have been recognized as excellent candidates for serologic diagnosis (the PGL-I mimetic, ND-O, and LID-1), on a nitrocellulose membrane. This allows the detection of specific IgM and IgG antibodies within 20 minutes of the addition of patient sera. Furthermore, we coupled the NDO-LID® rapid tests with a new cell phone-based test reader platform (Smart Reader®) to provide objective interpretation that was both quantifiable and consistent. Results Direct comparison of serologic responses indicated that the rapid test detected a greater proportion of leprosy patients than a lab-based PGL-I ELISA. While positive responses were detected by PGL-I ELISA in 83.3% of multibacillary patients and 15.4% of paucibacillary patients, these numbers were increased to 87% and 21.2%, respectively, when a combination of the NDO-LID® test and Smart Reader® was used. Among multibacillary leprosy the sensitivity of NDO-LID® test assessed by Smart Reader® was 87% (95% CI, 79.2-92.7%) and the specificity was 96.1% (95% CI, 91.7- 98.6%). The positive predictive value and the negative predictive value of NDO-LID® tests were 94% (95% CI, 87.4-97.8%) and 91.4% (95% CI, 85.9-95.2%), respectively. Conclusion The widespread provision of rapid diagnostic tests to facilitate the diagnosis or prognosis of multibacillary leprosy could impact on leprosy control programs by aiding early detection, directing appropriate treatment and potentially interrupting Mycobacterium leprae transmission.
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