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Narang T, Almeida JG, Kumar B, Rao PN, Suneetha S, Andrey Cipriani Frade M, Salgado CG, Dogra S. Fixed duration multidrug therapy (12 months) in leprosy patients with high bacillary load - Need to look beyond. Indian J Dermatol Venereol Leprol 2024; 90:64-67. [PMID: 37609736 DOI: 10.25259/ijdvl_278_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joel G Almeida
- Public Health and Epidemiology, Public Health Consultancy, Mumbai, India
| | - Bhushan Kumar
- Department of Dermatology, Silver Oaks Hospital, SAS Nagar, Punjab, India
| | - P Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Telangana, Hyderabad, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana, Hyderabad, India
| | - Marco Andrey Cipriani Frade
- Department of Medical Clinics, Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Suneetha S, Rao PN. 21 st International Leprosy Congress - ILC 2022: A Report on the Conference. Indian Dermatol Online J 2023; 14:454-456. [PMID: 37266101 PMCID: PMC10231693 DOI: 10.4103/idoj.idoj_148_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Sujai Suneetha
- Director, Nireekshna-Acet, Narayanaguda, Hyderabad, India
| | - P Narasimha Rao
- Professor of Dermatology, Bhaskar Medical College, KNR University of Health Sciences, Telangana, India
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Dasi G, Lavanya T, Suneetha S, Vijayakumar S, Shim JJ, Thangaraju K. Raman and X-ray photoelectron spectroscopic investigation of solution processed Alq 3/ZnO hybrid thin films. Spectrochim Acta A Mol Biomol Spectrosc 2022; 265:120377. [PMID: 34537631 DOI: 10.1016/j.saa.2021.120377] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 09/05/2021] [Indexed: 06/13/2023]
Abstract
In this study, we characterize the solution processed tris-(8-hydroxyquinoline)aluminum(Alq3)/ZnO hybrid thin films using Raman and X-ray photoelectron spectroscopic (XPS) techniques. Raman studies reveal the sol-gel derived spin-coated ZnO thin film has hexagonal wurtzite structure. The incorporation of Alq3 molecules in the hybrid film results in the formation of bonding onto the surface of highly crystalline ZnO nanoparticles. The XPS confirms the incorporation of Alq3 in the hybrid thin films and corroborates that the Alq3 molecules may be adsorbed onto the surface of ZnO nanoparticles (chemisorption), showing the existence of chemical interaction between Alq3 and ZnO in the hybrid films. These studies support that the chemisorbed Alq3 molecules onto the ZnO nanoparticles may facilitate the charge transfer (non-radiative) between Alq3 and ZnO in the hybrid thin films which will be useful to enhance the optical and electrical properties for the optoelectronic device applications.
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Affiliation(s)
- Gnyaneshwar Dasi
- Organic Optoelectronic Device Lab, Department of Physics, National Institute of Technology, Warangal 506004, Telangana, India
| | - Thyda Lavanya
- Organic Optoelectronic Device Lab, Department of Physics, National Institute of Technology, Warangal 506004, Telangana, India
| | - S Suneetha
- Organic Optoelectronic Device Lab, Department of Physics, National Institute of Technology, Warangal 506004, Telangana, India
| | - S Vijayakumar
- School of Chemical Engineering, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Jae-Jin Shim
- School of Chemical Engineering, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kuppusamy Thangaraju
- Organic Optoelectronic Device Lab, Department of Physics, National Institute of Technology, Warangal 506004, Telangana, India; Centre for Advanced Materials (CAM), National Institute of Technology, Warangal 506004, Telangana, India.
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Bhardwaj A, Gupta SK, Narang T, Suneetha S, Pradhan S, Agarwal P, Suvirya S, Gupta A, Chhabra N, Rao AG, Ashwini PK, Jandhyala S, Rathod S, Rao PN, Dogra S. Updates on Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by IADVL SIG Leprosy. Indian Dermatol Online J 2022; 12:S24-S30. [PMID: 34976878 PMCID: PMC8664173 DOI: 10.4103/idoj.idoj_513_21] [Citation(s) in RCA: 2] [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: 08/10/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Dermatology, Venereology and Leprology, All India Institute of Medial Sciences, Jodhpur, Rajasthan, India
| | - Sunil Kumar Gupta
- Department of Dermatology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medial Sciences, Patna, Bihar, India
| | - Pooja Agarwal
- Department of Dermatology, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Swastika Suvirya
- Department of Dermatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ankan Gupta
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Namrata Chhabra
- Department of Dermatology, AIIMS, Raipur, Chhattisgarh, India
| | | | - P K Ashwini
- Department of Dermatology, JSS Medical College, Mysore, Karnataka, India
| | | | - Santoshdev Rathod
- Department of Dermatology, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - P Narasimha Rao
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rathod S, Rao PN, Suneetha S, Narang T, Dogra S, Singal A, Gupta S, Vora R. Dermlep study part 3: Post-RFT events in leprosy patients presenting to dermatologists. Indian Dermatol Online J 2022; 13:340-345. [PMID: 36226023 PMCID: PMC9549560 DOI: 10.4103/idoj.idoj_683_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Presently the leprosy program has no defined surveillance protocols for patients who complete the fixed duration multidrug therapy and are released from treatment (RFT). Hence, the information about the post-RFT events in these patients is sparse and qualitative and quantitative data regarding their health care requirements is missing. During the DermLep survey carried out by the Indian Association of Dermatologists,Venereologists and Leprologists (IADVL), a number of patients presented to dermatologists during the post RFT period for a variety of symptoms. This paper analyses the events in these patients during the post RFT period. Results: Out of a total of 3701 leprosy patients who presented to 201 dermatologists across India during the DermLep survey, 708 (26.2%) were in the post RFT period (488 males; 220 females). Of these, 21% were PB and 79% MB patients as per their treatment records. Majority were in the age group of 31-59 years (55.5%); however, a significant proportion of them (20.7%) were elderly (>60 years). Majority of the patients (45.5%) presented within the first year of RFT with variable symptoms; 28% were between 1-5 years, 5.5% between 5-10 years; and 11.0% presented more than 10 years after RFT. Most common presenting complaint being persistent skin lesions as perceived by patients in 21.2%, followed by neuritis in 14.5%; trophic ulcers in 13.8%; deformities in 67 (11.8%); lepra reactions in 66 (11.6%); and recurrence of original symptoms in 6.7%. Conclusion: The DermLep Survey highlights the importance of ‘post RFT’ patients as an important subset of leprosy patients who visit dermatologists for various health related issues. The most common complaints in this subset were active/persistent skin lesions, lepra reactions and neuritis. In these patients, who are a sub-group of ‘persons affected with leprosy’ the disease related issues can persist for many years post RFT. Hence, it is important to provide services in the programme to monitor and manage these complications for the prevention of impairments, disability and the related social issues.
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Rao PN, Bahunuthula R, Varala S, Suneetha S. Recording of leprosy cases in India: Need for a user-friendly and effective app. Indian Dermatol Online J 2022; 13:697-700. [PMID: 36386737 PMCID: PMC9650759 DOI: 10.4103/idoj.idoj_245_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/02/2022] [Accepted: 07/23/2022] [Indexed: 11/07/2022] Open
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Bala Anki Reddy P, Suneetha S, Subbarayudu K, Al-Arabi T, Rashad A. Exploration of physical features of homogeneous–heterogeneous chemical action in a nanofluid film dispensed with MOS2 in diathermic oils. Journal of Taibah University for Science 2021. [DOI: 10.1080/16583655.2021.2004728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- P. Bala Anki Reddy
- Department of Mathematics, School of Advanced Sciences, VIT, Vellore, India
| | - S. Suneetha
- Department of Applied Mathematics, Yogi Vemana University, Kadapa, India
| | - K. Subbarayudu
- Department of S& H, Sri Venkateswara Institute of Science and Technology, Kadapa, India
| | - T.H. Al-Arabi
- Department of Mathematics, Faculty of Science, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - A.M. Rashad
- Department of Mathematics, Faculty of Science, Aswan University, Aswan, Egypt
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Rao PN, Rathod S, Suneetha S, Dogra S, Gupta SK, Vora R, Kamoji S, Tambe S. The DermLep Study I: Results of Prospective Nation-Wide Survey of the Number & Profile of Leprosy Patients seen by Dermatologists in India. Indian Dermatol Online J 2020; 11:701-711. [PMID: 33235834 PMCID: PMC7678510 DOI: 10.4103/idoj.idoj_466_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: There is evidence to suggest that there is a mismatch between the number of reported cases of leprosy in India and the number of actual cases in the country. One reason could be that many patients are diagnosed and treated outside the NLEP network and dermatologists may be managing some of these patients not captured by official statistics. To estimate these missing numbers, the DermLep survey was carried out to study the number and profile of leprosy patients seen by dermatologists and their significance. Methodology: The DermLep survey was a questionnaire-based study to be filled in by participating dermatologists from all over India, both in private practice and in medical institutions. Participating dermatologists provided information on old and new leprosy patients seen in their clinic over a 3-month period. Results: Total of 201 dermatologists from 20 states of India participated in the survey. 3701 leprosy patients (M: F ratio 2.1:1) were seen. Of them 46.62% (n = 1680) were new; 22.89% (n = 825) were under-treatment; and 19.65% (n = 708) were post RFT patients. Children <15 years constituted 4.29%, while elderly >60 years were 22.21%. As per WHO classification, MB were 73.36% and PB 28.46%. Of all patients 30.91% had lepra reactions, with T2R being more frequent. While 23.58% of all patients in the survey had G2D; in new patients 17.79%; and in post RFT patients 37% had G2D. Among the 1680 new cases seen, 59% were reported to NLEP by the dermatologists and 41% remained unreported mainly by the private dermatologists, among whom for 20% of the cases they mentioned “no access to register”. Source of MDT was WHO-MDT in 60.09% of new cases and for rest of 39.91% it was private pharmacies where private dermatologists had no access to MDT blister packs. Conclusion: This survey suggests that a good number of new-untreated leprosy patients, treatment defaulters and post RFT cases are managed by dermatologists in India. About 40% of the new patients managed mainly by private dermatologists are not being reported to NLEP for various reasons, and these constitute the “missing numbers” from government statistics. If extrapolated to the large of number of practicing dermatologists in India, these numbers could be very significant. The high percentage of G2D noted in patients surveyed (23.58%) and post RFT patient issues observed need special attention. There is a need to develop access for dermatologists to confidentially report leprosy patients treated at their clinics to the NLEP.
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Affiliation(s)
- P Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Hyderabad, Telangana, India
| | - Santoshdev Rathod
- Department of Dermatology, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Rita Vora
- Department of Dermatology, Sree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Shushruth Kamoji
- Department of Dermatology, Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Swagta Tambe
- Innovation Skin Clinic, Mumbai, Maharashtra, India
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Rao PN, Rathod S, Suneetha S, Dogra S, Vora R, Gupta SK. The Dermlep Study Part 2: Results of a Nation-Wide Survey of Dermatologists' Access to Quality Leprosy Services at their Clinics and Hospitals in India. Indian Dermatol Online J 2020; 11:895-903. [PMID: 33344336 PMCID: PMC7735004 DOI: 10.4103/idoj.idoj_668_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/18/2020] [Revised: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dermatologists in India are trained and qualified to treat leprosy and there is evidence to suggest that they are involved in the diagnosis and management of a significant number of leprosy patients in the country. The present study evaluated the access to quality leprosy services at their clinics and hospitals to understand the extent of their role in providing comprehensive care to people affected by leprosy and how it can be organized further. METHODS The DermLep Study was a pan-India questionnaire-based survey carried out to evaluate the role that dermatologists play in leprosy management in the country. It included as part-2 of the survey, 11 questions on the access of the dermatologist to various quality leprosy services available at the clinic or institution including skin smears, skin biopsy, multidrug therapy (MDT) blister packs, basic physiotherapy services, and reporting to the national program (NLEP). RESULTS The dermatologists who participated in the survey included 101 private practitioners and 100 working in Government or private medical institutions. The key findings of the survey were that 78% of the participating dermatologists still encounter leprosy patients frequently in their clinics; 81.0% of them had access to skin smears; and 93.4% to skin biopsy. The World Health Organization (WHO) MDT regimen was followed by 79.0% of the dermatologists in the study, majority of whom were those working in medical colleges (88%); however overall, 87.4% extended the regimen beyond the fixed duration, mostly on a case to case basis. Thalidomide was available for 61.1% of them to treat type 2 reactions. Basic physiotherapy services were available with 70.2% of dermatologists surveyed; 58.9% dermatologists had access to MCR footwear; and RCS facility access known to 45.5% of them. About 83.5% of the dermatologists working in institutions were reporting their leprosy cases to the NLEP, whereas from a high percentage (71.4%) of dermatologists in private practice, cases were not captured in routine under NLEP. CONCLUSION Dermatologists in India have the clinical skill, expertise, and access to most of the basic services, including skin smear and skin biopsy facilities needed to provide comprehensive care to leprosy patients in post-elimination era of integration of leprosy services. While dermatologists are already managing leprosy patients both at medical institutes and private clinics across India, their "structured" involvement at all levels in the national program will facilitate improved reporting and cataloging of cases seen by them. It will also elevate standards of leprosy care; create an effective public-private partnership and disease expertise; and assist develop a comprehensive, patient-tailored approach in the leprosy program in India.
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Affiliation(s)
- P. Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Hyderabad, Telangana, India
| | - Santoshdev Rathod
- Department of Dermatology, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rita Vora
- Department of Dermatology, Sree Krishna Hospital, Karamsad, Anand, Gujarat, India
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Rathod S, Suneetha S, Narang T, Bhardwaj A, Gupta SK, Kamoji SG, Ashwini PK, Pradhan S, Rather SP, Patnaik S, Shankar V, Jandhyala S, Rao PN, Dogra S. Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy). Indian Dermatol Online J 2020; 11:345-348. [PMID: 32695691 PMCID: PMC7367564 DOI: 10.4103/idoj.idoj_234_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Santoshdev Rathod
- Department of Dermatology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Sujai Suneetha
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Bhardwaj
- Department of Dermatology, Venereology and Leprology, All India Institute of Medial Sciences, Jodhpur, Rajasthan, India
| | - Sunil K Gupta
- Department of Dermatology, All India Institute of Medial Sciences, Gorakhpur, Uttar Pradesh, India
| | - Sushruth G Kamoji
- Department of Dermatology, Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - P K Ashwini
- Department of Dermatology, JSS Medical College, Mysore, Karnataka, India
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medial Sciences, Patna, Bihar, India
| | | | | | - Vikas Shankar
- Department of Dermatology, Patna Medical College and Hospital, Patna, Bihar, India
| | | | - P Narasimha Rao
- Institute for Specialized Services in Leprosy (INSSIL), Nireekshana ACET, Hyderabad, Telangana, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Marsakatla P, Suneetha S, Lee J, Swaminathan PD, Vasudevan L, Supriya R, Suneetha LM. Insights from the sequence similarity of Zika virus proteins with the Human nerve proteins. Bioinformation 2018; 14:194-200. [PMID: 30108415 PMCID: PMC6077820 DOI: 10.6026/97320630014194] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/10/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
Massive peptide sharing between the Zika virus polyprotein and host tissue proteins could elicit significant host-pathogen interactions and cross-reactions leading to autoimmune diseases. This study found similarities in the Zika V proteins and human nerve tissue proteins. 63 human nerve proteins were screened for similarities with the Zika V of which Neuromodulin, Nestin, Galanin, Bombesin, Calcium-binding protein were found to have similarities to the Zika V poly protein C at different sequence regions. These sequence similarities could be significant in regulating pathogenic interactions/autoimmunity, as Polyprotein C is known to be a virulent factor.
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Affiliation(s)
| | - Sujai Suneetha
- CODEWEL Nireekshana ACET, Narayanaguda, Hyderabad -500029, Telangana, India
| | - Joshua Lee
- York University, Department of Science, 4700 Keele St, Toronto, ON M3J 1P3, Canada
| | | | | | - Rachael Supriya
- CODEWEL Nireekshana ACET, Narayanaguda, Hyderabad -500029, Telangana, India
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Chaduvula MV, Visser LH, Suneetha S, Suneetha L, Devaraju B, Ellanti R, Raju R, Jain S. High-Resolution Sonography as an Additional Diagnostic and Prognostic Tool to Monitor Disease Activity in Leprosy: A Two-Year Prospective Study. Ultraschall Med 2018; 39:80-89. [PMID: 27273176 DOI: 10.1055/s-0042-108430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Early diagnosis and treatment of leprosy and leprosy reactions are essential to prevent stigmatizing deformities and disability. Although the incidence of leprosy has decreased enormously, grade 2 disability due to nerve injury has remained the same. New tools are needed to better diagnose and monitor leprosy reactions and associated neuritis and this study assessed whether high-resolution sonography (HRUS) can be used as such a tool. MATERIALS AND METHODS During a prospective follow-up period of 2 years at regular intervals, we performed clinical examination to assess sensory and motor function and HRUS of the four main peripheral nerves in 57 patients, of whom 36 were with reactions and 21 were without reactions. Normative data of the cross-sectional area (CSA) of these nerves were obtained from 55 healthy subjects (HS). Color Doppler (CD) was used to study blood flow in the nerves. RESULTS At the baseline visit and during follow-up, all four nerves were significantly thicker in patients with leprosy reactions in comparison to HS (p < 0.0001) and to a lesser extent also in comparison to patients without reactions ranging from a p-value of < 0.05 to < 0.0001 in the different nerves tested. During follow-up, the nerve size did not change significantly in patients without reactions, while it decreased significantly in patients with reactions. At baseline, endoneural blood flow was present only in patients with reactions. This occurred in 20 of the 36 (55 %) patients (49 nerves) and decreased to only 1 patient (2.7 %) at the end of the follow-up period. CONCLUSION This prospective study demonstrates the ability of HRUS to monitor disease activity and the effect of treatment in patients with leprosy reactions by determining changes in nerve size and vascularity, which are indicators of peripheral nerve involvement and damage.
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Affiliation(s)
- Meher Vani Chaduvula
- Immunology & Molecular Biology division, LEPRA Society Blue Peter Public Health & Research Centre, Hyderabad, India
| | - Leo H Visser
- Dept of Neurology and Clinical Neurophysiology, Postbus 90151, 5000 LC, St Elisabeth Hospital, Tilburg, Netherlands
| | - Sujai Suneetha
- Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India
| | - Lavanya Suneetha
- Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India
| | - Balakrishna Devaraju
- Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India
| | - Ramesh Ellanti
- Clinical Division, Near City Civil Court, Chatta Bazar, Purani Havelli, Thalassemia & Sickle Cell Society, Hyderabad, India
| | - Renuka Raju
- Laboratório de Hanseníase, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Suman Jain
- Clinical Division, Near City Civil Court, Chatta Bazar, Purani Havelli, Thalassemia & Sickle Cell Society, Hyderabad, India
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Abstract
The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication.
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Affiliation(s)
- P Narasimha Rao
- Comprehensive Dermatology Clinic, Masab Tank, Hyderabad, Telangana, India
| | - Sujai Suneetha
- Codewel-Nireekshana, Narayanaguda, Hyderabad, Telangana, India
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Sykam A, Gutlapalli VR, Tenali SP, Meena AK, Chandran P, Suneetha S, Suneetha LM. Anticeramide antibody and butyrylcholinesterase in peripheral neuropathies. J Clin Neurosci 2017; 42:204-208. [PMID: 28576432 DOI: 10.1016/j.jocn.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/02/2016] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
Ceramide is a glycosphingolipid, a component of nerve and non neuronal cell membrane and plays a role in maintaining the integrity of neuronal tissue. Butyrylcholinesterase (BChE) is a multifunctional enzyme, its involvement in neurodegenerative diseases has been well established. Anticeramide antibody (Ab-Cer) and enzyme BChE have been implicated in peripheral neuropathies. The present study investigates whether there is an association between Ab-Cer and BChE activities and peripheral neuropathies. Patients included: human immunodeficiency virus associated peripheral neuropathy (HIV-PN, n=39), paucibacillary leprosy (PB-L, n=36), multibacillary leprosy (MB-L, n=52), diabetic neuropathy (DN, n=22), demyelinating sensory motor polyneuropathy (DSMN, n=13) and chronic inflammatory demyelinating polyneuropathy (CIDP, n=10). Plasma Ab-Cer was measured by indirect enzyme linked immune assay (ELISA) and BChE activity in plasma was measured by colorimetric method. Ab-Cer levels were significantly elevated in MB-L and DN as compared to healthy subjects (HS). BChE levels were significantly higher in MB-L and DN as well as in HIV and HIV-PN. There is no significant difference in either Ab-Cer or BChE levels in DSMN and CIDP. Elevated plasma Ab-Cer and BChE levels may be considered significant in the pathogenesis of neuropathies. The variation in concurrent involvement of both the molecules in the neuropathies of the study, suggest their unique involvement in neurodegenerative pathways.
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Affiliation(s)
- Aparna Sykam
- Nireekshana-ACET/CODEWEL, Hyderabad, Telangana 500029, India; Centre for Biotechnology, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur, Andhra Pradesh 522510, India
| | - V R Gutlapalli
- Nireekshana-ACET/CODEWEL, Hyderabad, Telangana 500029, India; Centre for Biotechnology, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur, Andhra Pradesh 522510, India
| | | | - A K Meena
- Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082, India
| | - Priscilla Chandran
- Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082, India
| | - Sujai Suneetha
- Nireekshana-ACET/CODEWEL, Hyderabad, Telangana 500029, India
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Gutlapalli VR, Sykam A, Tenali SP, Suneetha S, Suneetha LM. High levels of plasma interferon gamma and +874T/A gene polymorphism is associated with HIV-TB co-infection. Hum Immunol 2016; 77:1264-1270. [PMID: 27521485 DOI: 10.1016/j.humimm.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 09/16/2015] [Revised: 07/19/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tuberculosis (TB) is one of the most frequent opportunistic infections in HIV patients leading to increased morbidity and death rate. This study was carried out to investigate the role of the cytokines IFN-γ and TNF-α level and their single nucleotide polymorphisms (SNPs) in HIV-TB co-infection. METHODS 247 HIV-TB (124 HIV-pulmonary TB, 123 HIV-extra pulmonary TB), 126 HIV positive individuals without tuberculosis and 129 healthy subjects (HS) were included to measure plasma levels of IFN-γ and TNF-α by sandwich ELISA and One way ANOVA statistical analysis was carried out among the groups. The SNPs of TNF-α-308 G/A, -238 G/A and IFN-γ+874 T/A were also investigated using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). The frequencies between the groups were compared by Pearson's chi square statistical analysis. RESULTS Plasma IFN-γ and TNF-α were significantly elevated in HIV-TB and TB (p<0.05) as compared to those in HS group. There was significant association between IFN-γ+874 'A' allele and AA genotype in HIV-TB groups compared to HS and HIV (p<0.05) and no such association was found for TNF-α-308 and -238. The plasma cytokine levels of TNF-α and IFN-γ reveals no significant association with levels of IFN-γ+874 T/A, TNF-α -308 G/Aand-238 G/A genotypes in any of the study groups. CONCLUSION In conclusion, the present study revealed elevated plasma IFN-γ and its +874 'A' allele are associated with HIV-TB co-infection indicating 1.6 times increased risk for TB susceptibility. Elevated TNF-α levels in TB and HIV-TB suggest its involvement in TB pathogenesis.
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Affiliation(s)
- V R Gutlapalli
- CODEWEL Nireekshana-ACET, Narayanaguda, Hyderabad, Telangana 500029, India; Centre for Biotechnology, Acharya Nagarjuna University, Guntur, Andhra Pradesh 522510, India
| | - Aparna Sykam
- CODEWEL Nireekshana-ACET, Narayanaguda, Hyderabad, Telangana 500029, India; Centre for Biotechnology, Acharya Nagarjuna University, Guntur, Andhra Pradesh 522510, India
| | - Sandeep P Tenali
- CODEWEL Nireekshana-ACET, Narayanaguda, Hyderabad, Telangana 500029, India; Centre for Biotechnology, Acharya Nagarjuna University, Guntur, Andhra Pradesh 522510, India
| | - Sujai Suneetha
- CODEWEL Nireekshana-ACET, Narayanaguda, Hyderabad, Telangana 500029, India
| | - Lavanya M Suneetha
- CODEWEL Nireekshana-ACET, Narayanaguda, Hyderabad, Telangana 500029, India.
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Gutlapalli R, Sykam A, Tenali SP, Chandran P, Suneetha S, Suneetha LM. Detection of Tuberculosis in HIV Co-infected Individuals: Use of Multiple ELISA Responses to 38kDa, Lipoarabinomannan and ESAT- 6 of M. tuberculosis. J Clin Diagn Res 2016; 10:KC01-4. [PMID: 27042484 DOI: 10.7860/jcdr/2016/16559.7322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/31/2015] [Accepted: 12/22/2015] [Indexed: 01/06/2023]
Abstract
INTRODUCTION There is a constant search for more sensitive and specific laboratory markers for tuberculosis (TB) infection. The early detection of TB in HIV co infected individuals is a diagnostic challenge. This is further compounded in those harbouring extrapulmonary disease. AIM To evaluate the use of multiple Enzyme Linked Immunosorbent Assays (ELISA) quantifying antibody responses to 38kDa, LAM and ESAT-6 M.tb antigens in detection of TB in patients with TB and HIV-TB co-infection. MATERIALS AND METHODS This is a cross-sectional study carried out in Hyderabad, India. Patient groups included 124 HIV-TB {62 with pulmonary TB (PTB) and 62 with extrapulmonary TB (ETB)}, 39 TB, 56 HIV and 57 healthy subjects (HS). A combination of anti 38kDa and LAM ELISAs measuring IgG, IgM and IgA levels and another ELISA measuring anti ESAT-6 combined antibody levels of IgG, IgM and IgA were evaluated. One-way ANOVA was performed to compare antibody responses among groups. To assess the efficacy of multiple ELISAs in detecting TB, concomitant seropositivity of an individual for all four ELISAs were evaluated for sensitivity and specificity. RESULTS A single ELISA carried out to detect TB in HIV patients showed a sensitivity ranging from 39% to 72%. The sensitivities of concomitant evaluation of multiple ELISAs were 92% for any single, 72% for any two, 44% for any three and 14% for any four. Based on the specificities, a simple algorithm for TB detection can be deduced. When four ELISAs are positive (specificity 100%) in a patient-confirmed TB; when three ELISAs are positive (specificity 98%) - probably TB; when two ELISAs are positive (specificity 95%) - possibly TB; and when one ELISA is positive (specificity 70%) - suspicion of TB. CONCLUSION The present study establishes the value of combining two or more M.tb antigen based ELISAs to enhance the sensitivity and specificity of TB detection in patients with tuberculosis as well as in those co-infected with HIV.
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Affiliation(s)
- Ravi Gutlapalli
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Aparna Sykam
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Sandeep P Tenali
- Research Scholar, Nirekshana-CODEWEL & Centre for Biotechnology, Acharya Nagarjuna University , Nagarjuna Nagar, Guntur, Andhra Pradesh, India
| | - Priscilla Chandran
- Professor and Head, Department of Biochemistry, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, Telangana, India
| | - Sujai Suneetha
- Director, CODEWEL-Nireekshana-ACET (AIDS Care Education and Training) , Hyderabad, Telangana, India
| | - Lavanya M Suneetha
- Research Director, CODEWEL-Nireekshana-ACET (AIDS Care Education and Training) , Hyderabad, Telangana, India
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Gutlapalli VR, Sykam A, Nayarisseri A, Suneetha S, Suneetha LM. Insights from the predicted epitope similarity between Mycobacterium tuberculosis virulent factors and its human homologs. Bioinformation 2015; 11:517-24. [PMID: 26770024 PMCID: PMC4702028 DOI: 10.6026/97320630011517] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 11/21/2015] [Revised: 12/13/2015] [Accepted: 12/13/2015] [Indexed: 01/22/2023] Open
Abstract
Mycobacterium tuberculosis is known to be associated with several autoimmune diseases such as systemic lupus erythematous, rheumatoid arthritis and multiple sclerosis. This is attributed to sequence similarity between virulent factors and human proteins. Therefore, it is of interest to identify such regions in the virulent factors to assess potential autoimmune related information. M. tb specific virulent factors were downloaded from the VFDB database and its human homologs were identified using the sequence comparison search tool BLASTP. Both virulent proteins and their corresponding human homologs were further scanned for epitopes (B cell and HLA class I and II allele specific) using prediction programs (BCPRED and NETMHC). Data shows the presence of matching 22 B-cell, 79 HLA class II and 16 HLA class I specific predicted epitopes in these virulent factors having human homologs. A known peptide (HAFYLQYKNVKVDFA) associated with autoimmune atopic dermatitis is shown in the superoxide dismutase homolog structures of the bacterium (PDB ID: 1IDS) and human (PDB ID: 2QKC). This data provides insight into the understanding of infection-associated auto-immunity.
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Affiliation(s)
- Venkata Ravi Gutlapalli
- CODEWEL Nireekshana-ACET, Hyderabad, Telangana-500029, India; Centre for Biotechnology, AcharyaNagarjuna University, Nagarjuna Nagar, Guntur, Andhra Pradesh 522510, India
| | - Aparna Sykam
- CODEWEL Nireekshana-ACET, Hyderabad, Telangana-500029, India; Centre for Biotechnology, AcharyaNagarjuna University, Nagarjuna Nagar, Guntur, Andhra Pradesh 522510, India
| | - Anuraj Nayarisseri
- Bioinformatics Research Laboratory, Eminent Biosciences, Vijaynagar, Indore - 452010, Madhya Pradesh, India
| | - Sujai Suneetha
- CODEWEL Nireekshana-ACET, Hyderabad, Telangana-500029, India
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Affiliation(s)
- P Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Hyderabad, Telangana, India. E-mail:
| | - Sunil Dogra
- Department of Dermatology Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujai Suneetha
- CODEWEL-Nireekshana, Narayanaguda, Hyderabad, Telangana, India
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Rao PN, Suneetha S. "Be the change you want to see in the world". Indian J Lepr 2015; 87:175-179. [PMID: 26999991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kumar JV, Baghirath PV, Naishadham PP, Suneetha S, Suneetha L, Sreedevi P. Relationship of long-term highly active antiretroviral therapy on salivary flow rate and CD4 Count among HIV-infected patients. J Oral Maxillofac Pathol 2015; 19:58-63. [PMID: 26097309 PMCID: PMC4451670 DOI: 10.4103/0973-029x.157203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 01/22/2014] [Accepted: 03/25/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine if long-term highly active antiretroviral therapy (HAART) therapy alters salivary flow rate and also to compare its relation of CD4 count with unstimulated and stimulated whole saliva. Materials and Methods: A cross-sectional study was performed on 150 individuals divided into three groups. Group I (50 human immunodeficiency virus (HIV) seropositive patients, but not on HAART therapy), Group II (50 HIV-infected subjects and on HAART for less than 3 years called short-term HAART), Group III (50 HIV-infected subjects and on HAART for more than or equal to 3 years called long-term HAART). Spitting method proposed by Navazesh and Kumar was used for the measurement of unstimulated and stimulated salivary flow rate. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis. Results: The mean CD4 count was 424.78 ± 187.03, 497.82 ± 206.11 and 537.6 ± 264.00 in the respective groups. Majority of the patients in all the groups had a CD4 count between 401 and 600. Both unstimulated and stimulated whole salivary (UWS and SWS) flow rates in Group I was found to be significantly higher than in Group II (P < 0.05). Unstimulated salivary flow rate between Group II and III subjects were also found to be statistically significant (P < 0.05). ANOVA performed between CD4 count and unstimulated and stimulated whole saliva in each group demonstrated a statistically significant relationship in Group II (P < 0.05). There were no significant results found between CD4 count and stimulated whole saliva in each groups. Conclusion: The reduction in CD4 cell counts were significantly associated with salivary flow rates of HIV-infected individuals who are on long-term HAART.
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Affiliation(s)
- J Vijay Kumar
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - P Venkat Baghirath
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - P Parameswar Naishadham
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
| | - Sujai Suneetha
- Research and Training, Nireekshana AIDS care Education and Training (ACET) Hyderabad, Telangana, India
| | - Lavanya Suneetha
- Research and Training, Nireekshana AIDS care Education and Training (ACET) Hyderabad, Telangana, India
| | - P Sreedevi
- Department of Oral and Maxillofacial Pathology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Telangana, India
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Raju R, Suneetha S, Jadhav RS, Chaduvula M, Atkinson S, Jain S, Visser LH, Das L, Panhalkar R, Shinde V, Reddy PP, Barkataki P, Lockwood DNJ, Van Brakel WH, Suneetha LM. Serological responses to prednisolone treatment in leprosy reactions: study of TNF-α, antibodies to phenolic glycolipid-1, lipoarabinomanan, ceramide and S100-B. Lipids Health Dis 2014; 13:119. [PMID: 25070345 PMCID: PMC4124507 DOI: 10.1186/1476-511x-13-119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/18/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Corticosteroids have been extensively used in the treatment of immunological reactions and neuritis in leprosy. The present study evaluates the serological response to steroid treatment in leprosy reactions and neuritis. METHODS Seven serological markers [TNF-α, antibodies to Phenolic glycolipid-1 (PGL-1 IgM and IgG), Lipoarabinomannan (LAM IgG1 and IgG3), C2-Ceramide and S100 B] were analyzed longitudinally in 72 leprosy patients before, during and after the reaction. At the onset of reaction these patients received a standard course of prednisolone. The levels of the above markers were measured by Enzyme linked immunosorbent assay (ELISA) and compared with the individuals own value in the month prior to the reaction and presented as percentage increase. RESULTS One month before the reaction individuals showed a varying increase in the level of different markers such as TNF-α (53%) and antibodies to Ceramide (53%), followed by to PGL-1 (51%), S100B (50%) and LAM (26%). The increase was significantly associated with clinical finding of nerve pain, tenderness and new nerve function impairment. After one month prednisolone therapy, there was a fall in the levels [TNF-α (60%), C2-Ceramide (54%), S100B (67%), PGL-1(47%) and LAM (52%)] with each marker responding differently to steroid. CONCLUSION Reactions in leprosy are inflammatory processes wherein a rise in set of serological markers can be detected a month before the clinical onset of reaction, some of which remain elevated during their action and steroid treatment induces a variable fall in the levels, and this forms the basis for a variable individual response to steroid therapy.
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Affiliation(s)
- Renuka Raju
- CODEWEL Nireekshana ACET India, Narayanaguda, Hyderabad 500029 AP, India
| | - Sujai Suneetha
- CODEWEL Nireekshana ACET India, Narayanaguda, Hyderabad 500029 AP, India
| | - Rupendra S Jadhav
- Department of Microbiology, Government Institute of Science, Madame Cama Road, Mumbai, India
| | | | - Sara Atkinson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Suman Jain
- CODEWEL Nireekshana ACET India, Narayanaguda, Hyderabad 500029 AP, India
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Loretta Das
- The Leprosy Mission Hospital, Naini, Allahabad, UP, India
| | | | - Vidyagouri Shinde
- Blue Peter Public Health & Research Centre (BPHRC), Hyderabad, AP, India
| | - Parphananda P Reddy
- Mahavir Medical Research Center, 37/165, BhagwanMahavir Marg, AC Guards, Masab Tank, Hyderabad, AP, India
| | | | | | - Wim H Van Brakel
- Leprosy Unit, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Lavanya M Suneetha
- CODEWEL Nireekshana ACET India, Narayanaguda, Hyderabad 500029 AP, India
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Jain S, Visser LH, Yerasu MR, Raju R, Meena A, Lokesh B, Suneetha S. Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: a case report. LEPROSY REV 2013. [DOI: 10.47276/lr.84.2.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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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Jain S, Visser LH, Yerasu MR, Raju R, Meena AK, Lokesh B, Suneetha S. Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: a case report. LEPROSY REV 2013; 84:161-165. [PMID: 24171244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Suman Jain
- CODEWEL Nireekshana ACET, Narayanaguda, Hyderabad, India.
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Raju R, Suneetha S, Sagili K, Meher VC, Saraswathi V, Satyanarayana AVV, Suneetha LM. Diagnostic role of the antibody response to the 38kDa, 16kDa proteins and lipoarabinomannan of mycobacterium tuberculosis. Indian J Clin Biochem 2012; 20:123-8. [PMID: 23105508 DOI: 10.1007/bf02893056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The antibody response to the 38kDa, 16kDa and Lipoarabinomannan (LAM) antigens ofMycobacterium tuberculosis was evaluated using three different ELISAs based on these antigens. The study group included tuberculosis patients (n=52), patients with HIV and TB co-infection (n=10), other chest symptomatics (n=5), HIV infected individuals (n=10), leprosy cases (n=7) and healthy controls (n=75). The results indicate that the 38kDa and LAM based ELISA for IgM/IgG has a low specificity (ranging from 69-85%) and sensitivity (ranging from 55-78%). When three ELISAs are carried out on a single patient the probability of detection of tuberculosis was significantly increased to 95.2% indicating that a single ELISA test is of low sensitivity and that a combination of ELISA's may be needed to be of any value as a diagnostic test for tuberculosis. Additionally, a western blot assay of the serum antibody response to protein fraction ofM. tuberculosis was analysed in 15 tuberculosis patients and five healthy controls. A multiple antibody response to various M.tuberculosis proteins was observed which varied from patient to patient as compared to controls who showed a single 38-39 kDa protein band positivity. These finding suggest that a western blot assay which determines the antibody response to a set of antigenic components ofM. tuberculosis could be a better serological test for the diagnosis of tuberculosis in our population.
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Affiliation(s)
- Renuka Raju
- Blue Peter Research Centre, LEPRA India, Hyderabad, India
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Lockwood DNJ, Nicholls P, Smith WCS, Das L, Barkataki P, van Brakel W, Suneetha S. Comparing the clinical and histological diagnosis of leprosy and leprosy reactions in the INFIR cohort of Indian patients with multibacillary leprosy. PLoS Negl Trop Dis 2012; 6:e1702. [PMID: 22745841 PMCID: PMC3383736 DOI: 10.1371/journal.pntd.0001702] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 02/07/2012] [Accepted: 05/04/2012] [Indexed: 11/26/2022] Open
Abstract
Background The ILEP Nerve Function Impairment in Reaction (INFIR) is a cohort study designed to identify predictors of reactions and nerve function impairment in leprosy. The aim was to study correlations between clinical and histological diagnosis of reactions. Methodology/Principal Findings Three hundred and three newly diagnosed patients with World Health Organization multibacillary (MB) leprosy from two centres in India were enrolled in the study. Skin biopsies taken at enrolment were assessed using a standardised proforma to collect data on the histological diagnosis of leprosy, leprosy reactions and the certainty level of the diagnosis. The pathologist diagnosed definite or probable Type 1 Reactions (T1R) in 113 of 265 biopsies from patients at risk of developing reactions whereas clinicians diagnosed skin only reactions in 39 patients and 19 with skin and nerve involvement. Patients with Borderline Tuberculoid (BT) leprosy had a clinical diagnosis rate of reactions of 43% and a histological diagnosis rate of 61%; for patients with Borderline Lepromatous (BL) leprosy the clinical and histological diagnosis rates were 53.7% and 46.2% respectively. The sensitivity and specificity of clinical diagnosis for T1R was 53.1% and 61.9% for BT patients and 61.1% and 71.0% for BL patients. Erythema Nodosum Leprosum (ENL) was diagnosed clinically in two patients but histologically in 13 patients. The Ridley-Jopling classification of patients (n = 303) was 42.8% BT, 27.4% BL, 9.4% Lepromatous Leprosy (LL), 13.0% Indeterminate and 7.4% with non-specific inflammation. This data shows that MB classification is very heterogeneous and encompasses patients with no detectable bacteria and high immunological activity through to patients with high bacterial loads. Conclusions/Significance Leprosy reactions may be under-diagnosed by clinicians and increasing biopsy rates would help in the diagnosis of reactions. Future studies should look at sub-clinical T1R and ENL and whether they have impact on clinical outcomes. Leprosy affects skin and peripheral nerves. Although we have antibiotics to treat the mycobacterial infection, the accompanying inflammation is a major part of the disease process. This can worsen after starting antibacterial treatment with episodes of immune mediated inflammation, so called reactions. These are associated with worsening of nerve damage. However, diagnosing these reactions is not straightforward. They can be diagnosed clinically by examination or by microscopic examination of the skin biopsies. We studied a cohort of 303 newly diagnosed leprosy patients in India and compared the diagnosis rates by clinical examination and microscopy and found that the microscopic diagnosis has higher rates of diagnosis for both types of reaction. This suggests that clinicians and pathologists have different thresholds for diagnosing reactions. More work is needed to optimise both clinical and pathological diagnosis. In this cohort 43% of patients had Borderline Tuberculoid leprosy, an immunologically active type, and 20% of the biopsies showed only minimal inflammation, perhaps these patients had very early disease or self-healing. The public health implication of this work is that leprosy centres need to be supported by pathologists to help with the clinical management of difficult cases.
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Affiliation(s)
- Diana N J Lockwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J. Morphological changes of the epineurium in leprosy: A new finding detected by high-resolution sonography. Muscle Nerve 2012; 46:38-41. [DOI: 10.1002/mus.23269] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/07/2022]
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Lockwood DNJ, Suneetha L, Sagili KD, Chaduvula MV, Mohammed I, van Brakel W, Smith WC, Nicholls P, Suneetha S. Cytokine and protein markers of leprosy reactions in skin and nerves: baseline results for the North Indian INFIR cohort. PLoS Negl Trop Dis 2011; 5:e1327. [PMID: 22180790 PMCID: PMC3236729 DOI: 10.1371/journal.pntd.0001327] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [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: 04/07/2011] [Accepted: 08/07/2011] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies investigating the role of cytokines in the pathogenesis of leprosy have either been on only small numbers of patients or have not combined clinical and histological data. The INFIR Cohort study is a prospective study of 303 new multibacillary leprosy patients to identify risk factors for reaction and nerve damage. This study characterised the cellular infiltrate in skin and nerve biopsies using light microscopic and immunohistochemical techniques to identify any association of cytokine markers, nerve and cell markers with leprosy reactions. Methodology/Principal Findings TNF-α, TGF-β and iNOS protein in skin and nerve biopsies were detected using monoclonal antibody detection immunohistochemistry techniques in 299 skin biopsies and 68 nerve biopsies taken from patients at recruitment. The tissues were stained with hematoxylin and eosin, modified Fite Faraco, CD68 macrophage cell marker and S100. Conclusions/Significance Histological analysis of the biopsies showed that 43% had borderline tuberculoid (BT) leprosy, 27% borderline lepromatous leprosy, 9% lepromatous leprosy, 13% indeterminate leprosy types and 7% had no inflammation. Forty-six percent had histological evidence of a Type 1 Reaction (T1R) and 10% of Erythema Nodosum Leprosum. TNF-α was detected in 78% of skin biopsies (181/232), iNOS in 78% and TGF-β in 94%. All three molecules were detected at higher levels in patients with BT leprosy. TNF-α was localised within macrophages and epithelioid cells in the granuloma, in the epidermis and in dermal nerves in a few cases. TNF-α, iNOS and TGF-β were all significantly associated with T1R (p<0.001). Sixty-eight nerve biopsies were analysed. CD68, TNF-α and iNOS staining were detectable in 88%, 38% and 28% of the biopsies respectively. The three cytokines TNF-α, iNOS and TGF-β detected by immunohistochemistry showed a significant association with the presence of skin reaction. This study is the first to demonstrate an association of iNOS and TGF-β with T1R. Leprosy affects skin and peripheral nerves. Although we have effective antibiotics to treat the mycobacterial infection, a key part of the disease process is the accompanying inflammation. This can worsen after starting antibacterial treatment with episodes of immune mediated inflammation, so called ‘reactions’. These reactions are associated with worsening of the nerve damage. We recruited a cohort of 303 newly diagnosed leprosy patients in North India with the aim of understanding and defining the pathological processes better. We took skin and nerve biopsies from patients and examined them to define which molecules and mediators of inflammation were present. We found high levels of the cytokines Tumour Necrosis Factor alpha, Transforming Growth Factor beta and inducible Nitric Oxide Synthase in biopsies from patients with reactions. We also found high levels of bacteria and inflammation in the nerves. These experiments tell us that we need to determine which other molecules are present and to explore ways of switching off the production of these pro-inflammatory molecules.
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Affiliation(s)
- Diana N J Lockwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Narasimha Rao P, Suneetha S, Pratap DVS. Changes in the size and number of skin lesions in PB leprosy on treatment and follow-up. LEPROSY REV 2011. [DOI: 10.47276/lr.82.3.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Rao PN, Suneetha S, Pratap DVS. Changes in the size and number of skin lesions in PB leprosy on treatment and follow-up. LEPROSY REV 2011; 82:244-252. [PMID: 22125932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The increase in size of existing skin lesions and appearance of new skin lesions are considered important signs of clinical activity both in untreated and treated leprosy. To confirm such activity, the number and size of lesions need to be recorded methodically prior to therapy and on follow-up, especially in PB leprosy where clinical signs alone define the reactivation of the disease. However, no systematic follow-up studies are available on changes in size and number of skin lesions in PB leprosy before and after therapy. OBJECTIVES To measure changes in the number and size of skin lesions in PB leprosy patients before starting MDT PB and after 18 months follow-up in order to evaluate their relevance in assessing clinical improvement and identifying possible relapses. DESIGN In 32 untreated leprosy patients with 1-5 skin lesions, the number of skin lesions were recorded on body charts and their size measured using a grid chart method to arrive at total area of involvement in each patient prior to starting MDT PB and after 18 months. Skin smears and skin biopsies were performed at entry and follow-up to assist the clinical evaluation. RESULTS Twenty three patients had single skin lesion (SSL), followed by three each with two and three skin lesions respectively, two with four and one with five skin lesions. The area of involvement ranged from six to 1686 sq cm. Few patients with SSL had higher areas of involvement than those who had multiple skin lesions. On follow-up at 18 months, in 14 (44%) patients skin lesions were not measurable, while in 18 (56%) they were measurable, with eight (25%) patients showing no change, three (9%) showing decrease and seven (22%) showing increase in area of involvement. Of the seven patients showing increase, in three it was due to the spread of existing skin lesions alone, in one it was due to a new skin lesion alone and in three due to the spread of existing skin lesions and the appearance of new skin lesions. New skin lesions were multiple (> 3) in two patients. T1R was observed in three out of four patients with new skin lesions, and this was persistent at 18 months in one patient. When histopathology at the entry and 18 month follow-up was compared, in one patient with persistent T1R with appearance of multiple new skin lesions, there was increase in GF from 10 to 40% with histological features of T1R and a BI of granuloma of 1+. CONCLUSIONS In 32 treated patients of PB leprosy on 18 month follow-up for changes in size and number of skin lesions, of six patients showing increase in area of involvement of existing skin lesions, 3 (50%) developed new skin lesions, indicating persistent disease activity. The new lesions which were associated with T1R increased the total number of skin lesions to > 5 in two of these patients requiring a change of drug regimen from PB to MB MDT, with one of them fulfilling clinical and histopathological criteria for relapse of leprosy. Hence, although new lesions are known to occur as part of T1R in PB patients, they are events of great significance which need to be assessed in a methodical manner for their influence on classification and therapy of leprosy.
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Affiliation(s)
- P Narasimha Rao
- Bhaskar Medical College, Yenkapally, RR District, A.P., India.
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Jadhav R, Suneetha L, Kamble R, Shinde V, Devi K, Chaduvula MV, Raju R, Suneetha S, Nicholls PG, van Brakel WH, Lockwood DNJ. Analysis of antibody and cytokine markers for leprosy nerve damage and reactions in the INFIR cohort in India. PLoS Negl Trop Dis 2011; 5:e977. [PMID: 21408123 PMCID: PMC3050910 DOI: 10.1371/journal.pntd.0000977] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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: 02/03/2010] [Accepted: 02/04/2011] [Indexed: 11/25/2022] Open
Abstract
Background The ILEP Nerve Function Impairment in Reaction (INFIR) is a cohort study designed to identify predictors of reactions and nerve function impairment (NFI) in leprosy. Aim of the Study Antibodies to mycobacteria, nerve components and serum cytokine were measured as potential markers for their possible association with reactions and NFI. Patients and Methods 303 newly diagnosed leprosy patients from two centres in North India were enrolled. Antibodies to PGL-1, LAM (IgG1 and IgG3), ceramide, S100 and TNFα levels were measured using ELISA techniques. Results S-100, PGL IgG and IgM antibody levels were lowest in patients with BT leprosy and highest in patients with lepromatous leprosy. LAM IgG1 and LAM IgG3 antibody levels were highest in patients with BL leprosy. Ceramide antibody levels were not correlated with type of leprosy. Levels of all the antibodies tested and TNF α were lowest in patients with only skin reaction. PGL IgM antibody levels were elevated in patients with skin reactions and NFI. Old sensory NFI is associated with significant elevation of PGL IgG, LAM IgG and S100 antibody levels. Conclusion These results reveal that the antibody response to mycobacterial antigens, nerve antigens and cytokines are in a dynamic flux and could collectively contribute to NFI in leprosy. The association of multiple markers with old NFI may indicate the contribution of different pathological processes. Leprosy is one of the oldest known diseases. In spite of the established fact that it is least infectious and a completely curable disease, the social stigma associated with it still lingers in many countries and remains a major obstacle to self reporting and early treatment. The nerve damage that occurs in leprosy is the most serious aspect of this disease as nerve damage leads to progressive impairment and disability. It is important to identify markers of nerve damage so that preventive measures can be taken. This prospective cohort study was designed to look at the potential association of some serological markers with reactions and nerve function impairment. Three hundred and three newly diagnosed patients from north India were recruited for this study. The study attempts to reflect a model of nerve damage initiated by mycobacterial antigens and maintained by ongoing inflammation through cytokines such as Tumour Necrosis Factor alpha and perhaps extended by antibodies against nerve components.
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Affiliation(s)
- Rupendra Jadhav
- Stanley Brown Laboratories, The Leprosy Mission, Shahdara, New Delhi, India.
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Raju R, Devi SK, Mehervani C, Kumar AS, Meena AK, Reddy PP, Pranay P, Jain S, Archelos-Gracia JJ, Suneetha S, Suneetha LM. Antibodies to Myelin P0 and Ceramide Perpetuate Neuropathy in Long Standing Treated Leprosy Patients. Neurochem Res 2011; 36:766-73. [DOI: 10.1007/s11064-010-0397-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2010] [Indexed: 01/14/2023]
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Smith WCS, Nicholls PG, Das L, Barkataki P, Suneetha S, Suneetha L, Jadhav R, Sundar Rao PSS, Wilder-Smith EP, Lockwood DNJ, van Brakel WH. Predicting neuropathy and reactions in leprosy at diagnosis and before incident events-results from the INFIR cohort study. PLoS Negl Trop Dis 2009; 3:e500. [PMID: 19668358 PMCID: PMC2716523 DOI: 10.1371/journal.pntd.0000500] [Citation(s) in RCA: 30] [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: 10/15/2008] [Accepted: 07/13/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy is a disease of skin and peripheral nerves. The process of nerve injury occurs gradually through the course of the disease as well as acutely in association with reactions. The INFIR (ILEP Nerve Function Impairment and Reactions) Cohort was established to identify clinically relevant neurological and immunological predictors for nerve injury and reactions. METHODOLOGY/PRINCIPAL FINDINGS The study, in two centres in India, recruited 188 new, previously untreated patients with multi-bacillary leprosy who had no recent nerve damage. These patients underwent a series of novel blood tests and nerve function testing including motor and sensory nerve conduction, warm and cold detection thresholds, vibrometry, dynamometry, monofilament sensory testing and voluntary muscle testing at diagnosis and at monthly follow up for the first year and every second month for the second year. During the 2 year follow up a total of 74 incident events were detected. Sub-clinical changes to nerve function at diagnosis and during follow-up predicted these new nerve events. Serological assays at baseline and immediately before an event were not predictive; however, change in TNF alpha before an event was a statistically significant predictor of that event. CONCLUSIONS/SIGNIFICANCE These findings increase our understanding of the processes of nerve damage in leprosy showing that nerve function impairment is more widespread than previously appreciated. Any nerve involvement, including sub-clinical changes, is predictive of further nerve function impairment. These new factors could be used to identify patients at high risk of developing impairment and disability.
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Affiliation(s)
| | | | - Loretta Das
- Naini Community Hospital, Uttar Pradesh, India
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Rao PN, Suneetha S, Pratap DVS. Comparative study of uniform-MDT and WHO MDT in Pauci and Multi bacillary leprosy patients over 24 months of observation. LEPROSY REV 2009; 80:143-155. [PMID: 19743618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN An open comparative study between WHO MDT and U-MDT regimen in all types of leprosy over 24 months of observation was carried out at Gandhi Hospital, Secunderabad, India. Periodic assessment of clinical and histopathological parameters at 6 monthly intervals was performed in both groups of patients for grading response to the treatment regimens. PATIENTS AND METHODS One hundred and twenty-seven newly diagnosed, untreated leprosy patients classified into PB (< or = 5 skin lesions) and MB leprosy (> 5 skin lesions) were alternately allocated into Study (U-MDT for 6 months) and Control groups (WHO MDT) at entry. Out of the 127 patients included, 64 patients (M-44, F-20; PB leprosy 32 & MB leprosy 32) could be followed-up regularly. These 64 patients were clinically assessed and graded into Good, Moderate and Poor response at 6, 12 and 18 months of the study, and 44 of these patients were also assessed at 24 months of the study. Histopathological assessments were also done at the above intervals. RESULTS PB PATIENTS: The control and study groups comprised of 14 and 18 patients respectively. When clinical grades were compared, the numbers of Moderate and Good responses were 78% and 61% at 6 months, 86% and 94% at 18 months and 82% and 100% at 24 months in the PB Control and Study groups respectively, suggesting better progressive improvement in the Study group compared to Control group, but the differences were not significant (At 6 months P = 02195, at 18 months 0.7305, at 24 months P = 0.3500) Histopathological assessment at 12 months, showed higher percentage of Good responses (100%) in the PB-Study group than in the PB-Control group (86%). MB PATIENTS: The MB Control and Study groups comprised of 22 and 10 patients respectively. In clinical improvement grades, Good responses in the Control group was 36%, 45% and 77% at 12, 18 and 24 months of study, whereas the Study group did not have a single Good response at 12 and 18 months with the Poor responses being 50%, 67% and 75% at 12, 18 and 24 months. These differences between the groups were significant at all periods of assessment. (At 12 months P = 0.0465, at 18 months P = 0.0014, at 24 months P = 0.0064). Histopathological assessment showed higher the percentage of Good responses in Control group (100%) compared to Study group (50%) at 18 months. CONCLUSION U-MDT of 6 months duration was well tolerated and effective in patients with PB leprosy but was too short a regimen adequately to treat patients with MB leprosy.
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Affiliation(s)
- P Narasimha Rao
- Bhaskar Medical College & Clinical Consultant, Blue Peter Research Centre-LEPRA Society, Hyderabad, India.
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Rao P, Suneetha S, Pratap D. Comparative study of Uniform-MDT and WHO MDT in Pauci and Multi bacillary leprosy patients over 24 months of observation. LEPROSY REV 2009. [DOI: 10.47276/lr.80.2.143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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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NarasimhaRao P, Pratap D, Suneetha S. Acute Generalized Exanthematous Pustulosis (AGEP) due to Dapsone in a patient with leprosy. LEPROSY REV 2009. [DOI: 10.47276/lr.80.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Narasimharao P, Pratap DVS, Suneetha S. Acute Generalized Exanthematous Pustulosis (AGEP) due to dapsone in a patient with leprosy. LEPROSY REV 2009; 80:81-84. [PMID: 19472855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- P Narasimharao
- Bhaskar Medical College, Ranga Reddy District, Andhra Pradesh, India.
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Sagili KD, Raju R, Reddy VR, Anandaraj MPJS, Suneetha S, Suneetha LM. Protein phosphorylation pattern in the immune cells of leprosy affected individuals. J Infect Dev Ctries 2008; 2:124-129. [PMID: 19738337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Leprosy is an infectious disease in which the susceptibility to the pathogen Mycobacterium leprae and the clinical manifestations are attributed to host immune cell response. Receptor mediated events and signalling in the immune cells are mediated by protein phosphorylation. The main signalling pathways and protein kinases known to be involved in the regulation of immune cells are cAMP dependent kinases, calcium/calmodulin dependent kinases, protein kinase C and mitogen activated protein kinases. The cumulative consequence of alterations in signalling pathways can be evaluated by intrinsic cellular protein phosphorylation by gamma-P32 ATP. The present study was designed to assess the protein phosphorylation in the immune cells of leprosy patients as compared with normal individuals. METHODOLOGY Lymphocyte protein phosphorylation was conducted in 15 leprosy patients and 9 normal individuals. Protein phosphorylation of lymphocytes was carried out in the presence/absence of protein kinase modulators. The phosphorylation patterns were documented and analysed consequent to SDS-PAGE, staining, destaining, drying and autoradiography. RESULTS The major phosphorylated proteins in lymphocytes were of molecular weights 20-22, 24-29, 30-35, 43, 46-50 and 66-68 kDa. In general, the major phosphorylated proteins were similar in the controls and in the patients. The phosphorylatability of these proteins varied with different modulators. Variations in the phosphorylation pattern were observed in 25% of the leprosy patients where there was a decrease of the 66 kDa protein and a decrease of 20-22 kDa protein phosphorylation. CONCLUSION The observed alterations in the protein phosphorylation pattern could be due to alteration in kinases and/or their substrates or due to the effect of M. leprae on immune cells.
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Affiliation(s)
- Karuna Devi Sagili
- Institute of Genetics and Hospital for Genetic Diseases, Begumpet, Hyderabad-16, Andhra Pradesh, India
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Suneetha LM, Sagili KD, Raju R, Reddy VR, Anandaraj MJ, Suneetha S. Protein phosphorylation pattern in the immune cells of leprosy affected individuals. J Infect Dev Ctries 2008. [DOI: 10.3855/jidc.283] [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: 10/31/2022] Open
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Lockwood DNJ, Lucas SB, Desikan KV, Ebenezer G, Suneetha S, Nicholls P. The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol 2008; 61:595-600. [PMID: 18326022 DOI: 10.1136/jcp.2007.053389] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Type 1 leprosy reactions (T1R) are a major inflammatory complication of leprosy affecting 30% of patients with borderline leprosy, but there has been no diagnostic evaluation of the histological diagnosis of this entity. METHODS In a prospective study based in India, skin biopsies were taken from 99 patients with clinically diagnosed T1R and 52 non-reactional controls. These were assessed histologically by four histopathologists whose assessments were then compared. RESULTS Reactions were under-diagnosed, with 32-62% of clinically diagnosed reactions being given a histological diagnosis. The pathologists showed good specificities (range 72% to 93%) but much poorer sensitivities (range 42% to 78%). The most commonly reported histological features of TIR were cell maturity, oedema and giant cells. Five key variables were identified that the pathologists used in diagnosing a reaction: intra-granuloma oedema, giant cell size, giant cell numbers, dermal oedema and HLA-DR expression. A predictive model for the diagnosis of T1R was developed using stepwise logistic regression analysis, with clinical diagnosis of reaction as an outcome, and then identification of the key variables that each pathologist used in making the diagnosis of T1R. 34-53% of the variation between pathologists could be accounted for. The four pathologists used a similar diagnostic model and for all of them their estimations of epithelioid cell granuloma oedema, dermal oedema, plasma cells and granuloma fraction were significant variables in the diagnosis of T1R. Each pathologist then added in variables that were specific to themselves. CONCLUSIONS This study has identified T1R as being under-diagnosed in comparison with clinical assessments. Key variables for diagnosing T1R were established. This comparative masked study highlights the need for such studies in other inflammatory conditions.
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Affiliation(s)
- D N J Lockwood
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Sagili KD, Raju R, Reddy VR, M.P.J.S A, Awaidy SA, Suneetha S, Suneetha LM. Protein phosphorylation pattern in the immune cells of leprosy affected individuals. J Infect Dev Ctries 2008. [DOI: 10.3855/t2.2.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Lund C, Koskinen M, Suneetha S, Lockwood D, HAANPÄÄ M, Haapasalo H, Hietaharju A. Histopathological and clinical findings in leprosy patients with chronic neuropathic pain: a study from Hyderabad, India. LEPROSY REV 2007. [DOI: 10.47276/lr.78.4.369] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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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Lund C, Koskinen M, Suneetha S, Lockwood DNJ, Haanpää M, Haapasalo H, Hietaharju A. Histopathological and clinical findings in leprosy patients with chronic neuropathic pain: a study from Hyderabad, India. LEPROSY REV 2007; 78:369-380. [PMID: 18309711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Chronic neuropathic pain in leprosy patients after completion of multi-drug therapy (MDT) is an under-researched problem. The reason why some leprosy patients develop it is unknown. In this study we evaluated the role of ongoing inflammation and small-fibre neuropathy as possible contributing factors for neuropathic pain. METHODS We assessed chronic neuropathic pain in 17 leprosy patients who had completed MDT and were attending a referral clinic in Hyderabad, India. All patients had a clinical assessment, intraepidermal nerve (IENF) assessment and quantitative sensory testing (QST), which included the testing of tactile and pinprick sensations using Semmes-Weinstein monofilaments and weighted needles method. Nine patients had a sural nerve biopsy (SNB). RESULTS Thirteen patients had a glove and stocking pattern of neuropathy. All nerve biopsies showed inflammation with intraneural inflammation and perineural thickening, and intraneural acid fast bacilli were observed in five biopsies. IENF analysis of the skin biopsy specimens in 16/17 patients showed a statistically significant reduction in IENF density (P < 0.001, Mann Whitney test) compared to control skin biopsies. Complete depletion of intraepidermal nerves was observed in six patients. QST also showed marked abnormalities. In 11 patients total sensory loss for all modalities was found, and in the other six patients the sensory function was seriously impaired. DISCUSSION There is evidence of ongoing intraneural inflammation in leprosy patients who have completed MDT. This may explain the occurrence of chronic neuropathic pain. Using IENF density measurement we have found significant small-fibre neuropathy in leprosy patients and the use of this tool could be expanded.
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Affiliation(s)
- Caroline Lund
- Department of Neurology, Sentralsykehuset I Vestfold, Tønsberg, Norway
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Andersson AK, Atkinson SE, Khanolkar-Young S, Chaduvula M, Jain S, Suneetha L, Suneetha S, Lockwood DNJ. Alteration of the cortisol–cortisone shuttle in leprosy type 1 reactions in leprosy patients in Hyderabad, India. Immunol Lett 2007; 109:72-5. [PMID: 17320974 DOI: 10.1016/j.imlet.2007.01.004] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 01/14/2007] [Accepted: 01/14/2007] [Indexed: 10/23/2022]
Abstract
Regulation of inflammation in leprosy may be influenced by local concentrations of active cortisol and inactive cortisone, whose concentrations are regulated by enzymes in the cortisol-cortisone shuttle. We investigated the cortisol-cortisone shuttle enzymes in the skin of leprosy patients with type 1 reactions (T1R), which are characterised by skin and nerve inflammation. Gene expression of the shuttle enzymes were quantified in skin biopsies from 15 leprosy patients with new T1R before and during prednisolone treatment and compared with levels in skin biopsies from 10 borderline leprosy patients without reactions. Gene expression of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type 2, which converts cortisol to cortisone, is down-regulated in skin from T1R lesions. However expression levels of 11beta-HSD type 1, which converts cortisone to cortisol, were similar in skin with and without reactions and did not change during anti-leprosy drug treatment. Prednisolone treatment of patients with reactions is associated with an upregulation of 11beta-HSD2 expression in skin. The down regulation of 11beta-HSD2 at the beginning of a reaction may be caused by pro-inflammatory cytokines in the leprosy reactional lesion and may be a local attempt to down-regulate inflammation. However in leprosy reactions this local response is insufficient and exogenous steroids are required to control inflammation.
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Affiliation(s)
- Anna K Andersson
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, Lockwood DNJ. Clinical course of erythema nodosum leprosum: an 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg 2006; 74:868-79. [PMID: 16687695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Erythema nodosum leprosum (ENL) or type 2 lepra reactions complicate lepromatous leprosy and borderline lepromatous leprosy. We report an 11-year retrospective case record analysis of 481 outpatients with borderline lepromatous and lepromatous leprosy at the Dhoolpet Leprosy Research Center in Hyderabad, India.. The overall prevalence of ENL was 24%, 49.4% among cases of lepromatous leprosy (LL) and 9% among cases of borderline lepromatous (BL) leprosy. Logistic regression analysis identified LL (odds ratio [OR] = 8.4, 95% confidence interval [CI] = 4.6-15.4, P < 0.001) and BL with a bacterial index > or = 4+ (OR = 5.2, 95% CI = 2.1-12.9, P = 0.001) as major risk factors. The average patient with ENL was male, 34.7 years of age, and had multiple episodes of ENL (mean = 3.1) over an 18.5-month period. Three types of ENL were identified: single acute ENL, multiple acute ENL (repeated discrete episodes), and chronic ENL (continuous episodes). Acute single ENL is rare, accounting for only 8% of cases. Chronic ENL accounted for 62.5% of the cohort. Chronic ENL was of longer duration and more severe. An age > or = 35 years was a risk factor for developing chronic ENL. Patients with chronic ENL were more compliant with multi-drug therapy, especially during the first six doses of multi-drug therapy. Distinguishing these different types of ENL would be useful for patient management and developing improved treatment of these debilitating reactions. Improved strategies for treatment and management of these reactions need to be developed.
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Affiliation(s)
- Leonor Pocaterra
- Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Andersson AK, Chaduvula M, Atkinson SE, Khanolkar-Young S, Jain S, Suneetha L, Suneetha S, Lockwood DNJ. Effects of prednisolone treatment on cytokine expression in patients with leprosy type 1 reactions. Infect Immun 2005; 73:3725-33. [PMID: 15908402 PMCID: PMC1111887 DOI: 10.1128/iai.73.6.3725-3733.2005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 01/31/2005] [Accepted: 02/09/2005] [Indexed: 11/20/2022] Open
Abstract
Leprosy type 1 reactions (T1R) are due to increased cell-mediated immunity and result in localized tissue damage. The anti-inflammatory drug prednisolone is used for treatment, but there is little good in vivo data on the molecular actions of prednisolone. We investigated the effect of prednisolone treatment on tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-10, and transforming growth factor beta1 (TGF-beta1) mRNA and protein expression in blood and skin biopsies from 30 patients with T1R in India. After 1 month of prednisolone treatment the sizes of the skin granulomas were reduced, as were the grades of cells positive for TNF-alpha and IL-10 in skin lesions. Increased production of TGF-beta1 was seen in skin lesions after 6 months of prednisolone treatment. Expression of mRNA for TNF-alpha, IL-1beta, and TGF-beta1 was reduced, whereas no change in IL-10 mRNA expression was detected during treatment. The circulating cytokine profiles were similar in patients with and without T1R, and prednisolone treatment had no detectable effects on cytokine expression in the blood. The data emphasize the compartmentalization of pathology in T1R and the importance of the immune response in the skin. Clinical improvement and cytokine expression were compared. Surprisingly, patients with improved skin and nerve function and patients with nonimproved skin and nerve function had similar cytokine profiles, suggesting that clinical improvement is not directly mediated by the cytokines studied here. This in vivo well-controlled study of the immunosuppressive effects of prednisolone showed that the drug does not switch off cytokine responses effectively.
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Affiliation(s)
- Anna K Andersson
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E HTM, United Kingdom
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Lockwood DNJ, Suneetha S. Leprosy: too complex a disease for a simple elimination paradigm. Bull World Health Organ 2005; 83:230-235. [PMID: 15798849 PMCID: PMC2624210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Can leprosy be eliminated? This paper considers the question against the background of the WHO programme to eliminate leprosy. In 1991 the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. Elimination was defined as reaching a prevalence of < 1 case per 10 000 people. The elimination programme has been successful in delivering highly effective antibiotic therapy worldwide. However, despite this advance, new-case detection rates remain stable in countries with the highest rates of endemic leprosy, such as Brazil and India. This suggests that infection has not been adequately controlled by antibiotics alone. Leprosy is perhaps more appropriately classed as a chronic stable disease than as an acute infectious disease responsive to elimination strategies. In many countries activities to control and treat leprosy are being integrated into the general health-care system. This reduces the stigma associated with leprosy. However, leprosy causes long-term immunological complications, disability and deformity. The health-care activities of treating and preventing disabilities need to be provided in an integrated setting. Detecting new cases and monitoring disability caused by leprosy will be a challenge. One solution is to implement long-term surveillance in selected countries with the highest rates of endemic disease so that an accurate estimate of the burden of leprosy can be determined. It is also critical that broad-based research into this challenging disease continues until the problems are truly solved.
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Abstract
BACKGROUND Primary neuritic leprosy (PNL) is a rare form of leprosy where the characteristic skin lesions are absent. Investigations of apparently normal skin from the areas of sensory change have revealed microscopic evidence of nerve involvement. Clinical studies have found that a proportion of patients develop visible skin lesions during follow-up. The aim of the study was to perform a clinical and histological analysis of PNL patients who developed visible skin lesions during treatment and follow-up, to gain insight into the pathogenesis of the disease. METHODS Twenty-nine individuals in a series of 182 PNL patients developed visible skin lesions during follow-up. Analysis of the number, location, histology and time of onset of the new skin lesions in relation to the type and regularity of the treatment regimen were noted. A biopsy from the new skin lesion when available was compared with the nerve biopsy findings at the time of initial diagnosis. RESULTS Thirty-eight per cent of patients developed a single patch and 28% developed two patches. Over three-quarters of these were on the lower limb (47%) or the upper limb (29%). Sixty-two per cent of patients developed the lesions within 2 years of the onset of symptoms. Patients on regular treatment developed patches earlier than those on irregular treatment or no treatment. A skin biopsy from the new patch revealed borderline tuberculoid leprosy histology in 47% of the patients. CONCLUSIONS The findings suggest that leprosy primarily affects the nerve and that a neuritic phase precedes the development of visible cutaneous lesions.
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Affiliation(s)
- Sujai Suneetha
- Schieffelin Leprosy Research & Training Center, Karigiri, Vellore District, Tamil Nadu, India.
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Young SK, Taylor GM, Jain S, Suneetha LM, Suneetha S, Lockwood DNJ, Young DB. Microsatellite mapping of Mycobacterium leprae populations in infected humans. J Clin Microbiol 2005; 42:4931-6. [PMID: 15528676 PMCID: PMC525249 DOI: 10.1128/jcm.42.11.4931-4936.2004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To investigate genetic diversity in a bacterial population, we measured the copy numbers of simple sequence repeats, or microsatellites, in Mycobacterium leprae from patients living in and around Hyderabad, India. Three microsatellite loci containing trinucleotide or dinucleotide repeats were amplified from infected tissues, and the copy numbers were established by sequence analysis. Extensive diversity was observed in a cross-sectional survey of 33 patients, but closely related profiles were found for members of a multicase family likely to share a common transmission source. Sampling of multiple tissues from single individuals demonstrated identical microsatellite profiles in the skin, nasal cavity, and bloodstream but revealed differences at one or more loci for M. leprae present in nerves. Microsatellite mapping of M. leprae represents a useful tool for tracking short transmission chains. Comparison of skin and nerve lesions suggests that the evolution of disease within an individual involves the expansion of multiple distinct subpopulations of M. leprae.
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Affiliation(s)
- Saroj K Young
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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