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Fogaça MBT, Saavedra DP, Lopes-Luz L, Ribeiro BM, da Silva Pinto L, Nagata T, Conceição FR, Stefani MMDA, Buhrer-Sékula S. Development and evaluation of a Lateral flow immunoassay (LFIA) prototype for the detection of IgG anti-SARS-CoV-2 antibodies. Heliyon 2024; 10:e29938. [PMID: 38707409 PMCID: PMC11066624 DOI: 10.1016/j.heliyon.2024.e29938] [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: 01/05/2024] [Revised: 03/19/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Lateral flow immunoassays (LFIA) for antibody detection represent cost-effective and user-friendly tools for serology assessment. This study evaluated a new LFIA prototype developed with a recombinant chimeric antigen from the spike/S and nucleocapsid/N proteins to detect anti-SARS-CoV-2 IgG antibodies. The evaluation of LFIA sensitivity and specificity used 811 serum samples from 349 hospitalized, SARS-CoV-2 RT-qPCR positive COVID-19 patients, collected at different time points and 193 serum samples from healthy controls. The agreement between ELISA results with the S/N chimeric antigen and LFIA results was calculated. The LFIA prototype for SARS-CoV-2 using the chimeric S/N protein demonstrated 85 % sensitivity on the first week post symptoms onset, reaching 94 % in samples collected at the fourth week of disease. The agreement between LFIA and ELISA with the same antigen was 92.7 %, 0.827 kappa Cohen value (95 % CI [0.765-0.889]). Further improvements are needed to standardize the prototype for whole blood use. The inclusion of the novel chimeric S + N antigen in the COVID-19 IgG antibody LFIA demonstrated optimal agreement with results from a comparable ELISA, highlighting the prototype's potential for accurate large-scale serologic assessments in the field in a rapid and user-friendly format.
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Affiliation(s)
- Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Luciano da Silva Pinto
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia, Aplicada, Universidade Federal de Pelotas, Pelotas, 96010-610, RS, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Fabricio Rochedo Conceição
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia, Aplicada, Universidade Federal de Pelotas, Pelotas, 96010-610, RS, Brazil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Samira Buhrer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
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Lopes-Luz L, Saavedra DP, Fogaça MBT, Bührer-Sékula S, Stefani MMDA. Challenges and advances in serological and molecular tests to aid leprosy diagnosis. Exp Biol Med (Maywood) 2023; 248:2083-2094. [PMID: 38059475 PMCID: PMC10800132 DOI: 10.1177/15353702231209422] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Leprosy is a neglected chronic infectious disease caused by obligate intracellular bacilli, Mycobacterium leprae and Mycobacterium lepromatosis. Despite multidrug therapy (MDT) success, leprosy accounts for more than 200,000 new cases yearly. Leprosy diagnosis remains based on the dermato-neurologic examination, but histopathology of skin biopsy and bacilloscopy of intradermal scraping are subsidiary diagnostic tests that require expertise and laboratory infrastructure. This minireview summarizes the state of the art of serologic tests to aid leprosy diagnosis, highlighting enzyme-linked immunosorbent assay (ELISA) and point-of-care tests (POCT) biotechnologies. Also, the impact of the postgenomic era on the description of new recombinantly expressed M. leprae-specific protein antigens, such as leprosy Infectious Disease Research Institute (IDRI) diagnostic (LID)-1 is summarized. Highly specific and sensitive molecular techniques to detect M. leprae DNA as the quantitative polymerase chain reaction (qPCR) and the loop-mediated isothermal amplification (LAMP) are briefly reviewed. Serology studies using phenolic glycolipid-I (PGL-I) semi-synthetic antigens, LID-1 fusion antigen, and the single fusion complex natural disaccharide-octyl (NDO)-LID show high sensitivity in multibacillary (MB) patients. However, serology is not applicable to paucibacillary patients, as they have weak humoral response and robust cell-mediated response, requiring tests for cellular biomarkers. Unlike ELISA-based tests, leprosy-specific POCT based on semi-synthetic PGL-I antigens and NDO-LID 1 antigen is easy to perform, cheaper, equipment-free, and can contribute to early diagnosis avoiding permanent incapacities and helping to interrupt M. leprae transmission. Besides its use to help diagnosis of household contacts or at-risk populations in endemic areas, potential applications of leprosy serology include monitoring MDT efficacy, identification of recent infection, especially in young children, as surrogate markers of disease progression to orient adult chemoprophylaxis and as a predictor of type 2 leprosy reactions. Advances in molecular biology techniques have reduced the complexity and execution time of qPCR confirming its utility to help diagnosis while leprosy-specific LAMP holds promise as an adjunct test to detect M. leprae DNA.
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Affiliation(s)
- Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
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de Andrade Rodrigues RS, Heise EFJ, Hartmann LF, Rocha GE, Olandoski M, de Araújo Stefani MM, Latini ACP, Soares CT, Belone A, Rosa PS, de Andrade Pontes MA, de Sá Gonçalves H, Cruz R, Penna MLF, Carvalho DR, Fava VM, Bührer-Sékula S, Penna GO, Moro CMC, Nievola JC, Mira MT. Prediction of the occurrence of leprosy reactions based on Bayesian networks. Front Med (Lausanne) 2023; 10:1233220. [PMID: 37564037 PMCID: PMC10411956 DOI: 10.3389/fmed.2023.1233220] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Leprosy reactions (LR) are severe episodes of intense activation of the host inflammatory response of uncertain etiology, today the leading cause of permanent nerve damage in leprosy patients. Several genetic and non-genetic risk factors for LR have been described; however, there are limited attempts to combine this information to estimate the risk of a leprosy patient developing LR. Here we present an artificial intelligence (AI)-based system that can assess LR risk using clinical, demographic, and genetic data. Methods The study includes four datasets from different regions of Brazil, totalizing 1,450 leprosy patients followed prospectively for at least 2 years to assess the occurrence of LR. Data mining using WEKA software was performed following a two-step protocol to select the variables included in the AI system, based on Bayesian Networks, and developed using the NETICA software. Results Analysis of the complete database resulted in a system able to estimate LR risk with 82.7% accuracy, 79.3% sensitivity, and 86.2% specificity. When using only databases for which host genetic information associated with LR was included, the performance increased to 87.7% accuracy, 85.7% sensitivity, and 89.4% specificity. Conclusion We produced an easy-to-use, online, free-access system that identifies leprosy patients at risk of developing LR. Risk assessment of LR for individual patients may detect candidates for close monitoring, with a potentially positive impact on the prevention of permanent disabilities, the quality of life of the patients, and upon leprosy control programs.
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Affiliation(s)
- Rafael Saraiva de Andrade Rodrigues
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | - Eduardo Ferreira José Heise
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | | | | | - Marcia Olandoski
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | | | | | | | - Andrea Belone
- Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil
| | | | | | | | - Rossilene Cruz
- Tropical Dermatology and Venerology Alfredo da Matta Foundation, Amazonas, Brazil
| | | | | | - Vinicius Medeiros Fava
- Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, and The McGill International TB Centre, Departments of Human Genetics and Medicine, McGill University, Montreal, QC, Canada
| | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Brazil
| | - Gerson Oliveira Penna
- Tropical Medicine Centre, University of Brasília, and Fiocruz School of Government – Brasilia, Brasília, Brazil
| | | | | | - Marcelo Távora Mira
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
- Pharmacy Program, School of Health and Biosciences, PUCPR, Curitiba, Paraná, Brazil
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Lopes-Luz L, Silva-Filho E, Mendonça M, Moreira ÂN, Venceslau A, de Sousa DR, Sánchez TG, de Moura RS, Conceição FR, Kipnis A, Stefani MMDA, Bührer-Sékula S. Combined antibodies against internalins A and B proteins have potential application in immunoassay for detection of Listeria monocytogenes. J Food Sci Technol 2023; 60:123-131. [PMID: 36618043 PMCID: PMC9813296 DOI: 10.1007/s13197-022-05597-9] [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] [Subscribe] [Scholar Register] [Revised: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022]
Abstract
Listeria monocytogenes is a food-borne bacterium that causes listeriosis upon the ingestion of contaminated food. Traditional methods to detect L. monocytogenes require pre-enrichment broths to increase its concentration. To improve the screening of contaminated food and prevent listeriosis outbreaks, rapid, specific and sensitive assays are needed to detect L. monocytogenes. This study developed a prototype lateral flow immunochromatographic assay (LFIA) employing antibodies against L. monocytogenes Internalin A (InlA) and Internalin B (InlB) proteins, that are involved in non-phagocytic cell invasion. The following antibodies were used to capture L. monocytogenes antigenic targets: mouse anti-Internalin A monoclonal antibody (MAb-2D12) conjugated to colloidal gold nanoparticles and a mouse anti-Internalin B polyclonal antibody. This test was able to detect pure L. monocytogenes from culture with a limit of detection (LOD) ranging from 5.9 × 103 to 1.5 × 104 CFU/mL. In milk artificially contaminated with L. monocytogenes, the LOD was 1 × 105 CFU/mL. This prototype test discriminated L. monocytogenes from other bacterial species (Listeria innocua, Enterobacter cloacae, Bacillus cereus). Results indicate that this LFIA developed using antibodies against L. monocytogenes InlA and InlB proteins is a sensitive and specific tool that can be potentially useful to rapidly detect L. monocytogenes in contaminated food. Supplementary Information The online version contains supplementary material available at 10.1007/s13197-022-05597-9.
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Affiliation(s)
- Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Ernandes Silva-Filho
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Marcelo Mendonça
- Universidade Federal Do Agreste Pernambuco, Curso de Medicina Veterinária, Garanhuns, Pernambuco 55292-270 Brasil
| | - Ângela Nunes Moreira
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia Aplicada, Universidade Federal de Pelotas, Pelotas, RS 96010-610 Brasil
| | - Andressa Venceslau
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Dienny Rodrigues de Sousa
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Tatiana Galvez Sánchez
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | | | - Fabricio Rochedo Conceição
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia Aplicada, Universidade Federal de Pelotas, Pelotas, RS 96010-610 Brasil
| | - André Kipnis
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
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Pinheiro RS, Carvalho PMRDS, Matos MAD, Caetano KAA, Paula ACD, Carneiro MADS, Reis MNDG, Martins RMB, Stefani MMDA, Teles SA. Human immunodeficiency virus infection and syphilis among homeless people in a large city of Central-Western Brazil: prevalence, risk factors, human immunodeficiency virus-1 genetic diversity, and drug resistance mutations. Braz J Infect Dis 2020; 25:101036. [PMID: 33248020 PMCID: PMC9392128 DOI: 10.1016/j.bjid.2020.11.001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
Homeless people are at high risk for sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV) infection and syphilis. We investigated the epidemiology of HIV-1 infection and syphilis among homeless individuals in a large city in Central-Western Brazil. In this cross-sectional study, we interviewed and tested 355 individuals from September 2014 to August 2015. Rapid test samples positive for syphilis were retested using the Venereal Disease Research Laboratory (VDRL) test. Blood samples from HIV-infected participants were collected for POL sequencing using HIV-1 RNA extracted from plasma, reverse transcription, and nested polymerase chain reaction. Anti-HIV-1-positive samples were subtyped by sequencing the nucleotides of HIV-1 protease and part of the HIV-1 reverse transcriptase genes. Transmitted and acquired drug resistance mutations and susceptibility to antiretroviral drugs were also analyzed. Anti-HIV was positive in 14 patients (3.9%; 95% confidence interval [CI]: 2.3–6.4). HIV-1 RNA was detected in 8 of the 14 samples. Two of the eight (25%) isolates showed HIV-1 drug resistance mutations. Furthermore, 78 (22%; 95% CI: 17.9–26.5) and 29 (8.2%; 95% CI: 5.6–11.4) homeless individuals tested positive for syphilis using the rapid test and VDRL test, respectively. Two individuals were anti-HIV-1 and VDRL test positive. Daily alcohol use (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.0–10.4), sex with people living with HIV (PLWH) infection (AOR: 6.8, 95% CI: 1.9–25.0), and sex with people of the same sex (AOR: 5.4, 95% CI: 1.7–17.5) were predictors of HIV infection. Age ≤35 years (AOR: 3.8, 95% CI: 1.4–10.8), previous syphilis testing (AOR: 3.5, 95% CI: 1.4–8.4), history of genital lesions (AOR: 4.9, 95% CI: 1.3–19.1), and crack use in the last six months (AOR: 3.1, 95% CI: 1.3–7.6) were predictors of syphilis. Our findings highlight the importance of STI prevention and control strategies among the homeless.
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Affiliation(s)
| | | | | | | | | | | | | | - Regina Maria Bringel Martins
- Universidade Federal de Goiás (UFG), Instituto de Patologia Tropical e Saúde Pública (IPTSP), Goiânia, GO, Brazil
| | | | - Sheila Araujo Teles
- Universidade Federal de Goiás (UFG), Faculdade de Enfermagem, Goiânia, GO, Brazil.
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do Carmo Gonçalves A, Hungria EM, Freitas AA, Sékula-Bührer S, Gomes CM, Coelho AC, Nascimento LB, de Araújo Stefani MM. Leprosy surveillance study in a highly endemic Brazilian area using leprosy specific serologic tests and IFNγ whole blood assay. Eur J Clin Microbiol Infect Dis 2020; 39:2345-2360. [PMID: 32666479 DOI: 10.1007/s10096-020-03979-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Abstract
This surveillance study evaluated leprosy-serologic tests and the IFNγ whole-blood-assay/WBA as adjunct diagnostic tools. Previously diagnosed leprosy index cases, intradomiciliary, peridomiciliary contacts from a Brazilian endemic area were enrolled during domiciliary visits. Physical evaluation was performed by trained nurses and leprosy diagnosis confirmed by expert dermatologist. ELISA detected IgM anti-PGL-I, IgG anti-LID-1, and IgM/IgG anti-ND-O-LID antibodies. Heparinized WBA plasma stimulated with LID-1, 46f + LID-1, ML0276 + LID-1 (24 h, 37 °C, 5% CO2) was tested for human IFNγ (QuantiFERON®-TB Gold/QFT-G; Qiagen). The survey included 1731 participants: 44 leprosy index cases, 64 intradomiciliary, 1623 peridomiciliary contacts. Women represented 57.7%, median age was 32 years, 72.2% had BCG scar. Leprosy prevalence was higher in intradomiciliary (8.57%) versus peridomiciliary contacts (0.67%), p < 0.001. Among 23 suspects, five leprosy cases were confirmed: 4 multibacillary/MB and 1 paucibacillary/PB. Leprosy incidence was 0.30%: 1.56% in intradomiciliary versus 0.25% in peridomiciliary (p = 0.028). Seropositivity rates were 1.9% to PGL-I, 4.9% to LID-1, and 1.0% to ND-O-LID. LID-1 positivity was higher in all groups; incident cases were LID-1 seropositive. ND-O-LID positivity was higher in intra- versus peridomiciliary contacts (p = 0.022). IFNγ WBA (40 index cases, 19 suspects, 35 intradomiciliary, 74 peridomiciliary contacts) showed higher LID-1/WBA positivity in peridomiciliary contacts (p > 0.05); significant differences among groups were seen with 46f + LID-1 but 0276 + LID-1 induced higher IFNγ levels. Incident cases were LID-1 seropositive, while IFNγ-WBA had marginal diagnostic application. As seropositivity indicates exposed individuals at higher risk of disease development, the utility of serologic screening for surveillance and prophylactic measures remains to be demonstrated.
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Affiliation(s)
- Aline do Carmo Gonçalves
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aline Araújo Freitas
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Samira Sékula-Bührer
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Ana Cecília Coelho
- Superintendência de Vigilância em Saúde, Secretaria Municipal de Saúde de Goiânia, Goiânia, Goiás, Brazil
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Cruz RCDS, Bührer-Sékula S, Penna GO, de Moraes MEA, Gonçalves HDS, Stefani MMDA, Penna MLF, Pontes MADA, Talhari S. Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach. An Bras Dermatol 2018; 93:377-384. [PMID: 29924240 PMCID: PMC6001105 DOI: 10.1590/abd1806-4841.20186709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). PATIENTS AND METHODS After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS Loss of some monthly laboratory sample collection. CONCLUSIONS There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.
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Affiliation(s)
- Rossilene Conceição da Silva Cruz
- Fundação de Dermatologia Tropical e Venereologia
“Alfredo da Matta” (FUAM), Manaus (AM), Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
| | - Samira Bührer-Sékula
- Program of Post-graduation in Tropical Medicine, Instituto de
Patologia Tropical e Saúde Pública da Universidade Federal de
Goiás (UFG), Goiânia (GO), Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
| | - Gerson Oliveira Penna
- Center of Tropical Medicine, Universidade de Brasília (UnB),
Brasília (DF), Brazil
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz
(EFG-Fiocruz), Brasília (DF), Brazil
| | - Maria Elisabete Amaral de Moraes
- Unit of Clinical Pharmacology, Universidade Federal do Ceará
(UNIFAC- UFC), Fortaleza (CE), Brazil
- Program of Post-graduation in Pharmacology, Department of
Physiology and Pharmacology, Faculdade de Medicina, da Universidade Federal do
Ceará (UFC), Fortaleza (CE), Brazil
| | | | - Mariane Martins de Araújo Stefani
- Discipline of Immunology, Instituto de Patologia Tropical e
Saúde Pública, Universidade Federal de Goiás (UFG),
Goiânia (GO), Brazil
| | | | | | - Sinésio Talhari
- Discipline of Dermatology, Universidade Nilton Linsm, Manaus (AM),
Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
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8
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Hungria EM, Bührer-Sékula S, de Oliveira RM, Aderaldo LC, Pontes ADA, Cruz R, Gonçalves HDS, Penna MLF, Penna GO, Stefani MMDA. Leprosy reactions: The predictive value of Mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR). PLoS Negl Trop Dis 2017; 11:e0005396. [PMID: 28222139 PMCID: PMC5336302 DOI: 10.1371/journal.pntd.0005396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/25/2016] [Revised: 03/03/2017] [Accepted: 02/06/2017] [Indexed: 01/13/2023] Open
Abstract
Background Leprosy reactions, reversal reactions/RR and erythema nodosum leprosum/ENL, can cause irreversible nerve damage, handicaps and deformities. The study of Mycobacterium leprae-specific serologic responses at diagnosis in the cohort of patients enrolled at the Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil/U-MDT/CT-BR is suitable to evaluate its prognostic value for the development of reactions. Methodology IgM and IgG antibody responses to PGL-I, LID-1, ND-O-LID were evaluated by ELISA in 452 reaction-free leprosy patients at diagnosis, enrolled and monitored for the development of leprosy reactions during a total person-time of 780,930 person-days, i.e. 2139.5 person-years, with a maximum of 6.66 years follow-up time. Principal findings Among these patients, 36% (160/452) developed reactions during follow-up: 26% (119/452) RR and 10% (41/452) had ENL. At baseline higher anti-PGL-I, anti-LID-1 and anti-ND-O-LID seropositivity rates were seen in patients who developed ENL and RR compared to reaction-free patients (p<0.0001). Seroreactivity in reactional and reaction-free patients was stratified by bacilloscopic index/BI categories. Among BI negative patients, higher anti-PGL-I levels were seen in RR compared to reaction-free patients (p = 0.014). In patients with 0<BI<3, (36 RR, 36 reaction-free), higher antibody levels to PGL-I (p = 0.014) and to LID-1 (p = 0.035) were seen in RR while difference in anti-ND-O-LID positivity was borderline (p = 0.052). Patients with BI≥3 that developed ENL had higher levels of anti-LID-1 antibodies (p = 0.028) compared to reaction-free patients. Anti-PGL-I serology had a limited predictive value for RR according to receiver operating curve/ROC analyses (area-under-the-curve/AUC = 0.7). Anti LID-1 serology at baseline showed the best performance to predict ENL (AUC 0.85). Conclusions Overall, detection of anti-PGL-I, anti-LID-1 and anti-ND-O-LID antibodies at diagnosis, showed low sensitivity and specificity for RR prediction, indicating low applicability of serological tests for RR prognosis. On the other hand, anti-LID-1 serology at diagnosis has shown prognostic value for ENL development in BI positive patients. Trial Registration ClinicalTrials.gov NCT00669643 Leprosy is a debilitating dermato-neurologic disease caused by Mycobacterium leprae. One of the main difficulties in the clinical management of leprosy patients is the development of leprosy reactions which are immune inflammatory episodes that can cause irreversible handicaps, incapacities and deformities. There are two major types of leprosy reactions: reversal reaction (RR) and erythema nodosum leprosum (ENL). Currently, there is no laboratory test able to predict the emergence of leprosy reactions among recently diagnosed patients. In order to investigate laboratory markers for the occurrence of leprosy reactions, we investigated the prognostic value of serologic responses to M. leprae antigens (PGL-I, LID-1, ND-O-LID) in 452 leprosy patients enrolled at the Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil/U-MDT/CT-BR. At diagnosis higher anti-PGL-I, anti-LID-1 and anti-ND-O-LID seropositivity rates were seen in patients who developed ENL and RR compared to reaction-free patients. The anti-PGL-I serology at diagnosis show low sensitivity to predict RR and anti-LID-1 serology at diagnosis has shown prognostic value for ENL development.
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Affiliation(s)
- Emerith Mayra Hungria
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
- * E-mail:
| | | | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Amazonas, Brasil
| | | | - Maria Lúcia Fernandes Penna
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brasil
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Hungria EM, Oliveira RM, Penna GO, Aderaldo LC, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Kerr LRFS, Stefani MMDA, Bührer-Sékula S. Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil. Infect Dis Poverty 2016; 5:110. [PMID: 27919284 PMCID: PMC5139020 DOI: 10.1186/s40249-016-0203-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 10/20/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR). METHODS This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI. RESULTS More than half of the patients (55.5 %) reported leprosy reaction: 18.3 % (138/753) had a RR and 5.4 % (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27 % (205/753) of patients, while 19 % (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9 % were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45). CONCLUSIONS MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.
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Affiliation(s)
- Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás Brazil
| | | | | | | | | | - Rossilene Cruz
- Tropical Medicine Foundation/Foundation “Alfredo da Matta”, Manaus, Amazonas Brazil
| | | | | | | | | | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás Brazil
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Moura RS, Penna GO, Cardoso LPV, de Andrade Pontes MA, Cruz R, de Sá Gonçalves H, Fernandes Penna ML, de Araújo Stefani MM, Bührer-Sékula S. Description of leprosy classification at baseline among patients enrolled at the uniform multidrug therapy clinical trial for leprosy patients in Brazil. Am J Trop Med Hyg 2015; 92:1280-4. [PMID: 25940192 PMCID: PMC4458838 DOI: 10.4269/ajtmh.14-0049] [Citation(s) in RCA: 5] [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: 01/21/2014] [Accepted: 02/18/2015] [Indexed: 11/07/2022] Open
Abstract
The uniform multidrug therapy clinical trial, Brazil (U-MDT/CT-BR), database was used to describe and report the performance of available tools to classify 830 leprosy patients as paucibacillary (PB) and multibacillary (MB) at baseline. In a modified Ridley and Jopling (R&J) classification, considering clinical features, histopathological results of skin biopsies and the slit-skin smear bacterial load results were used as the gold standard method for classification. Anti-phenolic glycolipid-I (PGL-I) serology by ML Flow test, the slit skin smear bacterial load, and the number of skin lesions were evaluated. Considering the R&J classification system as gold standard, ML Flow tests correctly allocated 70% patients in the PB group and 87% in the MB group. The classification based on counting the number of skin lesions correctly allocated 46% PB patients and 99% MB leprosy cases. Slit skin smears properly classified 91% and 97% of PB and MB patients, respectively. Based on U-MDT/CT-BR results, classification of leprosy patients for treatment purposes is unnecessary because it does not impact clinical and laboratories outcomes. In this context, the identification of new biomarkers to detect patients at a higher risk to develop leprosy reactions or relapse remains an important research challenge.
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Affiliation(s)
- Rodrigo Scaliante Moura
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Gerson Oliveira Penna
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Ludimila Paula Vaz Cardoso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Araci de Andrade Pontes
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rossilene Cruz
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Heitor de Sá Gonçalves
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Lúcia Fernandes Penna
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Mariane Martins de Araújo Stefani
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Samira Bührer-Sékula
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
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Moura MES, da Guarda Reis MN, Lima YAR, Eulálio KD, Cardoso LPV, Stefani MMDA. Low rate of transmitted drug resistance may indicate low access to antiretroviral treatment in Maranhão State, northeast Brazil. AIDS Res Hum Retroviruses 2015; 31:250-4. [PMID: 25411830 DOI: 10.1089/aid.2014.0261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Brazilian AIDS epidemic is characterized by significant geographic contrasts: a reduction in incidence and mortality in the epicenter (southeast) and an increase in the northeast. HIV-1-transmitted drug resistance (TDR) and genetic diversity were investigated among 106 antiretroviral (ARV)-naive patients from Maranhão State, northeast. The HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. TDR to the nucleoside/nonnucleoside reverse transcriptase inhibitor (NRTI/NNRTI) and protease inhibitor (PI) was identified by the Calibrated Population Resistance tool (Stanford). The median age was 31 years (range 18-72), with 54.7% women, 78.3% heterosexual transmission, and 17.9% men who have sex with men (MSM). Around 30% had <350 CD4(+) T cells/μl and 47.2% had plasma viral loads ≤10,000 copies/ml. The TDR rate was 3.8% (4/106; CI 95%, 1.2-8.9%) (three males, two of them MSM). Only single class mutations to NRTI (M184V; T215S) or NNRTI (K103S/N) were detected. Subtype B represented 81.1% (86/106), F1 1.9% (2/106), and C 2.8% (3/106); 14.2% were mosaics: 13 BF1 and 2 BC. Surveillance of TDR and HIV-1 genetic diversity is important to improve control strategies regionally.
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Affiliation(s)
| | | | - Yanna Andressa Ramos Lima
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia City/Goiás State, Brazil
| | | | - Ludimila Paula Vaz Cardoso
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia City/Goiás State, Brazil
- Faculty of Medicine, Federal University of Goiás, Jataí/Goiás State, Brazil
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Moura RS, Penna GO, Fujiwara T, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Cardoso LPV, Stefani MMDA, Bührer-Sékula S. Evaluation of a rapid serological test for leprosy classification using human serum albumin as the antigen carrier. J Immunol Methods 2014; 412:35-41. [PMID: 24983877 DOI: 10.1016/j.jim.2014.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 12/25/2022]
Abstract
The presence of anti-BSA antibodies may interfere in serological tests, as ELISA or immunochromatographic assays. BSA is frequently used as a blocking agent or as "inert" carrier of antigens, such as the NT-P-BSA, the semi-synthetic trisaccharide analogue of the PGL-I (phenolic glycolipid-I) antigen from the cell wall of the Mycobacterium leprae. PGL-I was prepared and linked to human serum albumin based in the hypothesis that replacing BSA by a human protein carrier would enhance the performance of leprosy serological tests. A total of 1162 serum samples were tested by ELISA and by the ML Flow rapid test using NT-P-BSA or NT-P-HSA antigens. When grouping leprosy patients as paucibacillary (PB) or multibacillary (MB) according to the Ridley & Jopling classification, ML Flow BSA and ML Flow HSA tests correctly allocated 70.9% and 68.6% of patients in the PB group, and 87% and 81% of patients in the MB group, respectively. Concordant results were found in 82.0% (953/1162) (kappa value=0.637; sd=0.023) of samples between ML Flow tests and 85.7% (996/1162) (kappa value=0.703; sd=0.021) between ELISA tests. ML Flow results were statistically similar and the same was true for ELISA tests using HSA or BSA. However, we noticed a tendency to decreased capacity to detect MB patients and an increased positivity among PB patients, HHC, TB patients and healthy controls by the HSA carrier in both ML Flow and ELISA. The PGL-I serology performed by the ML Flow test with BSA or HSA as antigen carriers can be a useful, friendly auxiliary tool to identify patients with higher bacterial load.
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Affiliation(s)
- Rodrigo Scaliante Moura
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | | | | | | | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil.
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Stefani MMDA, Grassi AB, Sampaio LH, Sousa ALOMD, Costa MB, Scheelbeek P, Neupane KD, Hagge DA, Macdonald M, Cho SN, Oskam L, Bührer-Sékula S. Comparison of two rapid tests for anti-phenolic glycolipid-I serology in Brazil and Nepal. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:124-31. [PMID: 23283463 DOI: 10.1590/s0074-02762012000900019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of leprosy continues to be based on clinical symptoms and early diagnosis and treatment are critical to preventing disability and transmission. Sensitive and specific laboratory tests are not available for diagnosing leprosy. Despite the limited applicability of anti-phenolic glycolipid-I (PGL-I) serology for diagnosis, it has been suggested as an additional tool to classify leprosy patients (LPs) for treatment purposes. Two formats of rapid tests to detect anti-PGL-I antibodies [ML immunochromatography assay (ICA) and ML Flow] were compared in different groups, multibacillary patients, paucibacillary patients, household contacts and healthy controls in Brazil and Nepal. High ML Flow intra-test concordance was observed and low to moderate agreement between the results of ML ICA and ML Flow tests on the serum of LPs was observed. LPs were "seroclassified" according to the results of these tests and the seroclassification was compared to other currently used classification systems: the World Health Organization operational classification, the bacilloscopic index and the Ridley-Jopling classification. When analysing the usefulness of these tests in the operational classification of PB and MB leprosy for treatment and follow-up purposes, the ML Flow test was the best point-of-care test for subjects in Nepal and despite the need for sample dilution, the ML ICA test yielded better performance among Brazilian subjects. Our results identified possible ways to improve the performance of both tests.
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da Costa ZB, de Lima YAR, Martelli CMT, Stefani MMDA. Transmitted HIV resistance among pregnant young women infected with HIV-1 in Brazil. AIDS Patient Care STDS 2013; 27:439-41. [PMID: 23968204 DOI: 10.1089/apc.2012.0448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Zelma Bernades da Costa
- Department of Dermatology, Tropical Medicine and Public Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Yanna Andressa Ramos de Lima
- Department of Microbiology, Immunology, Parasitology and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Celina Maria Turchi Martelli
- Department of Dermatology, Tropical Medicine and Public Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
| | - Mariane Martins de Araújo Stefani
- Department of Microbiology, Immunology, Parasitology and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil
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Caetano KAA, França DDDS, Carneiro MADS, Martins RMB, Stefani MMDA, Kerr LRFS, de Matos MA, Moraes LC, Teles SA. Prevalence and virologic profile of HIV infections among female sex workers in Goiânia City, central Brazil. AIDS Patient Care STDS 2013; 27:1-4. [PMID: 23066700 DOI: 10.1089/apc.2012.0268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hungria EM, Oliveira RMD, Souza ALOMD, Costa MB, Souza VNBD, Silva EA, Moreno FRV, Nogueira MES, Costa MRSN, Silva SMUR, Bührer-Sékula S, Reed SG, Duthie MS, Stefani MMDA. Seroreactivity to new Mycobacterium leprae protein antigens in different leprosy-endemic regions in Brazil. Mem Inst Oswaldo Cruz 2012; 107 Suppl 1:104-11. [DOI: 10.1590/s0074-02762012000900017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/25/2012] [Indexed: 11/22/2022] Open
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da Silveira AA, Cardoso LPV, Francisco RBL, de Araújo Stefani MM. HIV type 1 molecular epidemiology in pol and gp41 genes among naive patients from Mato Grosso do Sul State, central western Brazil. AIDS Res Hum Retroviruses 2012; 28:304-7. [PMID: 21790471 DOI: 10.1089/aid.2011.0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antiretroviral naive patients (n=49) were recruited in central western Brazil (Campo Grande City/Mato Grosso do Sul State, located across the Bolivia and Paraguay borders). HIV-1 protease (PR), reverse transcriptase (RT), and env gp41 HR1 fragments were sequenced. Genetic diversity was analyzed by REGA/phylogenetic analyses. Intersubtype recombinants were identified by SimPlot/phylogenetic trees. PR/RT resistance was analyzed by Calibrated Population Resistance/Stanford databases. T-20 resistance in gp41 was assessed by Stanford, Los Alamos, and other sources. Of HIV-1 subtypes 65.3% were B(PR)B(RT), 10.2% were C(PR)C(RT), and 8.2% were F1(PR)F1(RT). Intersubtype recombinants were 16.3%: four B/F1 and four B/C (two were "CRF31_BC-like"). The Pol-RT V75M mutation was detected in two homosexual partners; one patient had the T215S revertant mutation. T-20/gp41 resistance mutations were L44M (n=2) and V38A (n=1). The high percentage of non-B isolates (∼35%) highlights the importance of molecular surveillance studies in settings distant from the origin of the epidemic. Our data help elaborate the molecular epidemiological map of HIV-1 in Brazil.
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Affiliation(s)
| | - Ludimila Paula Vaz Cardoso
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia City/Goiás State, Brazil
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Cardoso LPV, da Silveira AA, Francisco RBL, da Guarda Reis MN, de Araújo Stefani MM. Molecular characteristics of HIV type 1 infection among prisoners from Central Western Brazil. AIDS Res Hum Retroviruses 2011; 27:1349-53. [PMID: 21732793 DOI: 10.1089/aid.2011.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract This study among antiretroviral-experienced prisoners from central western Brazil investigated mutations associated with secondary resistance to nucleoside/nonnucleoside reverse transcriptase inhibitors (NRTI/NNRTI), protease inhibitors (Stanford HIV-1 Resistance/International Aids Society Databases), and HIV-1 subtypes (REGA/phylogenetic analyses/SimPlot). Twenty-seven prisoners from three prisons (16 males and four females from Mato Grosso do Sul State and seven males from Goiás State) had HIV-1 protease and reverse transcriptase fragments sequenced after nested PCR. Median age was 35 years. Seven males and two females were intravenous drug users, three males referred homosexual practice. Resistance mutations were present in 37% (10/27): NRTI+NNRTI mutations (n=5), NRTI mutations (n=3), multidrug-resistant mutations (n=2). Subtype B (48%), subtype C (11%), B/F1, B/C, and F1/B/C recombinants (40.7%) were detected. Possible intraprison transmissions were identified: two intravenous drug user females (subtype C); two clusters among homosexual males (subtype B and B/F1). High resistance rate and possible intraprison transmission highlight the need for improved prevention, counseling, and treatment strategies for prisoners.
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Affiliation(s)
- Ludimila Paula Vaz Cardoso
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia City/Goiás State, Brazil
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Carvalho BC, Cardoso LPV, Damasceno S, Stefani MMDA. Moderate prevalence of transmitted drug resistance and interiorization of HIV type 1 subtype C in the inland North State of Tocantins, Brazil. AIDS Res Hum Retroviruses 2011; 27:1081-7. [PMID: 21417758 DOI: 10.1089/aid.2010.0334] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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: 11/12/2022] Open
Abstract
The diverse Brazilian AIDS epidemic has reached small cities and scant molecular information is available about the epidemic in Northern Brazil, where the incidence is growing. This study describes transmitted drug resistance and subtypes in the protease (PR) and reverse transcriptase (RT) regions among naive patients recruited in Palmas, the capital of Tocantins State, a newly built city in Northern Brazil. PR/RT regions were retrotranscribed from plasma HIV-1 RNA and 52 were sequenced after direct nested PCR. HIV-1 subtypes were assigned by phylogenetic analysis. Transmitted drug resistance was analyzed by the Calibrated Population Resistance tool Stanford Surveillance Drug Resistance Mutation. Most patients included (59.6%) were males, the median age was 30 years and were mainly referred because of heterosexual or homosexual unprotected sex. One male patient was from the Karajás indigenous tribe. The prevalence of transmitted resistance was 11.5% (CI 95%, 4.4-23.4%): nonnucleoside RT inhibitor mutations (n=3), nucleoside RT inhibitor mutations (n=2), and protease inhibitor mutations (n=1). Dual or triple class resistance was not observed. HIV-1 subtype B(PR)/B(RT) represented 78.8%, 5.8% were subtype C(PR)/C(RT), and 1.9% were subtype F1(PR)/F1(RT). Recombinant viruses represented 13.5% (07/52): B(PR)/F1(RT) (n=1), B(PR)/BF1(RT) (n=4), and C(PR)/CF1(RT) (n=2). This study about the AIDS epidemic in the recently founded city of Palmas/Tocantins in inland Northern Brazil shows moderate levels of transmitted drug resistance and the circulation of diverse recombinant viruses. This pattern is similar to what has been described in major metropolitan cities, suggesting the influence of imported cases from the south/southeast. Moreover these results indicate that patients from this setting should be monitored regarding transmitted drug resistance mutations.
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Costa NMX, Albuquerque MD, Lins JBA, Alvares-Junior JT, Stefani MMDA. Resposta de testes de hipersensibilidade tardia utilizando PPD e outros antígenos em crianças e adolescentes saudáveis e infectados pelo HIV-1 e vacinados com BCG. Rev Soc Bras Med Trop 2011; 44:542-5. [DOI: 10.1590/s0037-86822011005000054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/21/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A contagem de células CD4+ representa marcador da resposta imune celular em pacientes infectados pelo HIV-1. Testes cutâneos de hipersensibilidade tardia (DTH) podem ser empregados para avaliar in vivo respostas celulares a antígenos comuns. MÉTODOS: DTH para derivado proteico purificado de tuberculina (PPD), esporotriquina, tricofitina, candidina e estreptoquinase/estreptodornase foram realizados. Foram testados crianças/adolescentes infectados pelo HIV-1 (n=36) e indivíduos saudáveis (n=56), soronegativos para HIV-1/HIV-2 pareados por sexo-idade, todos com cicatriz vacinal por BCG. Teste exato de Fisher foi aplicado (p<0,05). RESULTADOS: Entre as crianças/adolescentes infectados pelo HIV-1, mediana de idade=8,1 anos; 20/36 eram do sexo masculino; 35 casos de transmissão vertical; 34 casos de AIDS sob terapia antirretroviral; mediana de carga viral = 3.04lc10 cópias/ml; mediana de contagem de células CD4+ = 701 células/μl. Entre os infectados e saudáveis a reatividade DTH a pelo menos um dos antígenos foi, respectivamente, 25% (9/36) e 87,5% (49/56) (p<0,001). Reatividade à candidina predominou nos infectados (8/36, 22%) e ao PPD nos indivíduos saudáveis (40/56, 71,4%). A reatividade ao PPD entre infectados foi de 8,3% (p<0,01). A mediana da induração ao PPD foi 2,5mm (variação: 2-5mm) entre infectados e 6,0mm (variação: 3-15mm) entre os saudáveis. Não observamos correlação entre positividade ao PPD e idade. No grupo de infectados, não observamos correlação entre contagens de células CD4+ e reatividade ao DTH. CONCLUSÕES: Respostas DTH significativamente diminuídas, incluindo a reatividade ao PPD foram observadas em crianças/adolescentes infectados pelo HIV-1 comparadas com controles saudáveis, provavelmente refletindo doença avançada e supressão da imunidade mediada por células T.
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Ferreira AS, Cardoso LPV, Stefani MMDA. Moderate prevalence of transmitted drug resistance and high HIV-1 genetic diversity in patients from Mato Grosso State, Central Western Brazil. J Med Virol 2011; 83:1301-7. [DOI: 10.1002/jmv.22128] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cardoso LPV, Pereira GAS, Viegas ÂA, Schmaltz LEPR, Stefani MMDA. HIV-1 primary and secondary antiretroviral drug resistance and genetic diversity among pregnant women from central Brazil. J Med Virol 2010; 82:351-7. [DOI: 10.1002/jmv.21722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Leprosy diagnosis is based mainly on clinical manifestations and no laboratory test is available to diagnose asymptomatic disease or to predict disease progression among exposed individuals. Novel comparative genomic in silico analyses and molecular biology tools have discovered unique Mycobacterium leprae proteins with potential diagnostic application. Tuberculoid paucibacillary leprosy (PB) shows low antibodies titers and strong Th1 type/ IFN-gamma specific cell mediated immunity (CMI), while lepromatous multibacillary patients (MB) show high antibody titers and low CMI. Therefore, laboratory tests for PB and MB leprosy diagnosis will require CMI and antibody based assays. Serologically reactive recombinant Mycobacterium leprae proteins were identified and may be used in conjunction with PGL-I to improve MB patient diagnosis. Mycobacterium leprae recombinant proteins and synthetic peptides have been tested for CMI-interferon gamma based assays for PB diagnosis. Modified PGL-I serology incorporating new Mycobacterium leprae antigens and CMI tests based on IFN-gamma gamma production may permit the detection of leprosy PB and MB forms in endemic countries.
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Cardoso LPV, de Araújo Stefani MM. High level of multidrug resistance mutations in HIV type 1 pol gene and resistance-associated mutations to enfuvirtide (T-20) among antiretroviral-experienced patients from central Brazil. AIDS Res Hum Retroviruses 2009; 25:943-50. [PMID: 19792869 DOI: 10.1089/aid.2009.0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
HIV-1 resistance mutations to antiretroviral (ARV) drugs (nucleoside reverse transcriptase inhibitors, NRTI; nonnucleoside reverse transcriptase inhibitors, NNRTI; and protease inhibitors, PI) represent a challenge for sustainable virologic and immunologic responses. HIV-1 phylogenetic diversity and ARV resistance mutations associated with protease (PR) and reverse transcriptase (RT) were assessed among 48 ARV-experienced patients from Goiania/Goias, central west Brazil. The gp41 resistance mutations to the fusion inhibitor (T-20) were analyzed among multidrug-resistant (MDR) patients. PR, partial RT, and gp41 genes were amplified and sequenced from plasma RNA. HIV-1 subtype was assigned by phylogenetic analysis. ARV mutations in PR/RT were analyzed by the Stanford Database. T-20 resistance mutations in gp41 were identified by Stanford, the Los Alamos Database, and other sources. Subtype B represented 79.2% (38/48), subtype F1 4.2% (2/48), subtype C 2.1% (1/48), F1(PR)/B(RT) 8.3% (4/48), and B(PR)/F1(RT) 6.3% (3/48). Secondary drug resistance was observed in 79% (38/48): NRTI resistance (n = 1), NNRTI resistance (n = 1), PI + NRTI or NRTI + NNRTI resistance (n = 20), and PI + NRTI +NNRTI resistance, considered MDR (n = 16). Almost half of the MDR patients had viral loads below 10,000 copies/ml. The gp41 sequences from 14 MDR revealed one F1(PR)/B(RT)/F1(ENV) recombinant and 13 subtype B(PR)/B(RT)/B(ENV) isolates. G36E, N42T, and N43S T-20 resistance mutations were observed in three MDR patients, two of them previously treated with T-20 and the other who had never used T-20. Our data among ARV-experienced patients showed a high proportion of drug-resistance mutations and MDR. T-20 resistance mutations were detected among MDR patients corroborating the importance of T-20 genotyping for clinical management and salvage therapy.
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de Araújo Stefani MM, Bevilacqua Vieira RB, de Souza Pereira GA, Teixeira Junior J, Ordália Ferro M. ENTENDENDO COMO O HIV INFECTA CÉLULAS HUMANAS: QUIMIOCINAS E SEUS RECEPTORES. Rev Patol Trop 2007. [DOI: 10.5216/rpt.v27i1.17192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Souza LCS, Turchi Martelli CM, Almeida Netto JCD, de Araújo Stefani MM, de Araújo Pereira LI. POTENCIAIS IMPLICAÇÕES DA CO-INFECÇÂO HIV E Mycobacteríum lepras EM SAÚDE PÚBLICA. Rev Patol Trop 2007. [DOI: 10.5216/rpt.v28i2.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martelli CMT, Stefani MMDA, Penna GO, Andrade ALSSD. Endemias e epidemias brasileiras, desafios e perspectivas de investigação científica: hanseníase. Rev bras epidemiol 2002. [DOI: 10.1590/s1415-790x2002000300006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A endemia hansênica apresenta-se, na virada do milênio, no limiar da sua eliminação como problema global de saúde pública. O Brasil é o único país da América Latina onde a doença não foi eliminada, tendo sido a meta de eliminação postergada para 2005. Neste artigo discute-se o declínio da prevalência após a introdução da poliquimioterapia (PQT) para o tratamento da hanseníase, não acompanhada pela redução da incidência no mesmo período. Os progressos na área de imunologia, biologia molecular e seqüenciamento genômico do M. leprae são apresentados enquanto perspectivas de pesquisa e de aplicação potencial para diagnóstico, prognóstico e vigilância na hanseníase. Apesar do êxito das atuais estratégias de controle tem-se observado com preocupação a redução do interesse e do apoio financeiro em pesquisa na hanseníase e na desestruturação dos serviços de saúde frente ao atual cenário de eliminação. A exclusão da hanseníase da lista de doenças prioritárias é prematura, representando um perigo concreto de não se eliminar a doença, mas a pesquisa em hanseníase. Fica evidente a necessidade de investir na produção de conhecimentos de áreas básica e aplicada que viabilizem uma maior compreensão dos mecanismos de transmissão da infecção, da efetividade dos métodos de prevenção e controle, serão essenciais na "erradicação" da infecção pelo M. leprae.
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