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Cota Queiroz EJ, Nunes da Rocha I, Valentim LDA, Quaresma TJC, de Souza Filho ZA, de Oliveira SMS, de Paula Fernandes F, Macedo CG, Quaresma TC, Moraes WP. Epidemiological, clinical, and geographical characterization of Leprosy in the County of Santarém-Pará: Insights for effective control and targeted intervention. PLoS Negl Trop Dis 2024; 18:e0012063. [PMID: 38507427 PMCID: PMC10984465 DOI: 10.1371/journal.pntd.0012063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/01/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
Leprosy is an infectious disease characterized by slow and chronic evolution, caused by Mycobacterium leprae and or Mycobacterium lepromatosis, an intracellular alcohol-acid-resistant (BAAR) bacillus. The objective of this study was to provide an epidemiological, clinical, and geographic characterization of leprosy in the city of Santarém-Pará during the period 2011-2020. A cross-sectional, descriptive, and quantitative approach was used, employing maps and tables to illustrate clinical and epidemiological variables, including: sex, age, race, area of residence, operational classification, clinical form, number of skin lesions, number of affected nerves, and health units. During the analyzed period, 581 cases of leprosy were diagnosed, resulting in the following cumulative incidence rates: male (60%); age over 15 years (94%); urban area (73%); multibacillary (74%); borderline form (46%); skin lesions greater than 5 (34%); and no nerves affected (68%). In the urban perimeter, a higher cumulative incidence of cases was observed in the central area with 133 cases. However, the health unit reporting the largest number of cases belonged to the southern area, specifically the Basic Health Unit of Nova República, with 48 cases. This study highlights the need to characterize the nuances of leprosy and its variability within the urban environment, according to different areas. Further research is essential to inform the implementation of public policies aimed at addressing the population with the highest vulnerability index, thereby reducing leprosy rates in Santarém.
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Bouth RC, Gobbo AR, Barreto JG, do Carmo Pinto PD, Bittencourt MS, Frade MAC, Nascimento AC, Bandeira SS, da Costa PF, Conde GAB, Avanzi C, Ribeiro-dos-Santos Â, Spencer JS, da Silva MB, Salgado CG. Specialized active leprosy search strategies in an endemic area of the Brazilian Amazon identifies a hypermutated Mycobacterium leprae strain causing primary drug resistance. Front Med (Lausanne) 2023; 10:1243571. [PMID: 37780551 PMCID: PMC10534026 DOI: 10.3389/fmed.2023.1243571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Leprosy, an infectious disease caused by Mycobacterium leprae, remains a public health concern in endemic countries, particularly in Brazil. In this study, we conducted an active surveillance campaign in the hyperendemic city of Castanhal in the northeastern part of the state of Pará using clinical signs and symptoms combined with serological and molecular tools to diagnose new cases and to identify drug resistance of circulating M. leprae strains and their distribution in the community. Methods During an active surveillance of one week, we enrolled 318 individuals using three different strategies to enroll subjects for this study: (i) an active survey of previously treated cases from 2006 to 2016 found in the Brazil National Notifiable Disease Information System database (n = 23) and their healthy household contacts (HHC) (n = 57); (ii) an active survey of school children (SC) from two primary public schools in low-income neighborhoods (n = 178), followed by visits to the houses of these newly diagnosed SC (n = 7) to examine their HHC (n = 34) where we diagnosed additional new cases (n = 6); (iii) and those people who spontaneously presented themselves to our team or the local health center with clinical signs and/or symptoms of leprosy (n = 6) with subsequent follow-up of their HHC when the case was confirmed (n = 20) where we diagnosed two additional cases (n = 2). Individuals received a dermato-neurological examination, 5 ml of peripheral blood was collected to assess the anti-PGL-I titer by ELISA and intradermal earlobe skin scrapings were taken from HHC and cases for amplification of the M. leprae RLEP region by qPCR. Results Anti-PGL-I positivity was highest in the new leprosy case group (52%) followed by the treated group (40.9%), HHC (40%) and lowest in SC (24.6%). RLEP qPCR from SSS was performed on 124 individuals, 22 in treated cases, 24 in newly diagnosed leprosy cases, and 78 in HHC. We detected 29.0% (36/124) positivity overall in this sample set. The positivity in treated cases was 31.8% (7/22), while in newly diagnosed leprosy cases the number of positives were higher, 45.8% (11/23) and lower in HHC at 23.7% (18/76). Whole genome sequencing of M. leprae from biopsies of three infected individuals from one extended family revealed a hypermutated M. leprae strain in an unusual case of primary drug resistance while the other two strains were drug sensitive. Discussion This study represents the extent of leprosy in an active surveillance campaign during a single week in the city of Castanhal, a city that we have previously surveyed several times during the past ten years. Our results indicate the continuing high transmission of leprosy that includes fairly high rates of new cases detected in children indicating recent spread by multiple foci of infection in the community. An unusual case of a hypermutated M. leprae strain in a case of primary drug resistance was discovered. It also revealed a high hidden prevalence of overt disease and subclinical infection that remains a challenge for correct clinical diagnosis by signs and symptoms that may be aided using adjunct laboratory tests, such as RLEP qPCR and anti-PGL-I serology.
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Affiliation(s)
- Raquel Carvalho Bouth
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Spatial Epidemiology Laboratory, Federal University of Pará, Castanhal, Brazil
| | | | | | - Marco Andrey Cipriani Frade
- Divisão de Dermatologia, Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
| | - Apolônio Carvalho Nascimento
- Unidade de Referência Especializada em Dermatologia Sanitária do Estado do Pará – URE Dr. Marcelo Candia, Marituba, Pará, Brazil
| | - Sabrina Sampaio Bandeira
- Unidade de Referência Especializada em Dermatologia Sanitária do Estado do Pará – URE Dr. Marcelo Candia, Marituba, Pará, Brazil
| | | | | | - Charlotte Avanzi
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
| | | | - John Stewart Spencer
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
| | | | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Coordenação de Atenção às Doenças Transmissíveis na Atenção Primária à Saúde, Departamento de Gestão do Cuidado Integral, Secretaria de Atenção Primária à Saúde, Ministério da Saúde, Brasília, Brazil
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Klever AM, Alexander KA, Almeida D, Anderson MZ, Ball RL, Beamer G, Boggiatto P, Buikstra JE, Chandler B, Claeys TA, Concha AE, Converse PJ, Derbyshire KM, Dobos KM, Dupnik KM, Endsley JJ, Endsley MA, Fennelly K, Franco-Paredes C, Hagge DA, Hall-Stoodley L, Hayes D, Hirschfeld K, Hofman CA, Honda JR, Hull NM, Kramnik I, Lacourciere K, Lahiri R, Lamont EA, Larsen MH, Lemaire T, Lesellier S, Lee NR, Lowry CA, Mahfooz NS, McMichael TM, Merling MR, Miller MA, Nagajyothi JF, Nelson E, Nuermberger EL, Pena MT, Perea C, Podell BK, Pyle CJ, Quinn FD, Rajaram MVS, Mejia OR, Rothoff M, Sago SA, Salvador LCM, Simonson AW, Spencer JS, Sreevatsan S, Subbian S, Sunstrum J, Tobin DM, Vijayan KKV, Wright CTO, Robinson RT. The Many Hosts of Mycobacteria 9 (MHM9): A conference report. Tuberculosis (Edinb) 2023; 142:102377. [PMID: 37531864 PMCID: PMC10529179 DOI: 10.1016/j.tube.2023.102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
The Many Hosts of Mycobacteria (MHM) meeting series brings together basic scientists, clinicians and veterinarians to promote robust discussion and dissemination of recent advances in our knowledge of numerous mycobacterial diseases, including human and bovine tuberculosis (TB), nontuberculous mycobacteria (NTM) infection, Hansen's disease (leprosy), Buruli ulcer and Johne's disease. The 9th MHM conference (MHM9) was held in July 2022 at The Ohio State University (OSU) and centered around the theme of "Confounders of Mycobacterial Disease." Confounders can and often do drive the transmission of mycobacterial diseases, as well as impact surveillance and treatment outcomes. Various confounders were presented and discussed at MHM9 including those that originate from the host (comorbidities and coinfections) as well as those arising from the environment (e.g., zoonotic exposures), economic inequality (e.g. healthcare disparities), stigma (a confounder of leprosy and TB for millennia), and historical neglect (a confounder in Native American Nations). This conference report summarizes select talks given at MHM9 highlighting recent research advances, as well as talks regarding the historic and ongoing impact of TB and other infectious diseases on Native American Nations, including those in Southwestern Alaska where the regional TB incidence rate is among the highest in the Western hemisphere.
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Affiliation(s)
- Abigail Marie Klever
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Kathleen A Alexander
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, USA; CARACAL/Chobe Research Institute Kasane, Botswana
| | - Deepak Almeida
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Z Anderson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA; Department of Microbiology, The Ohio State University, Columbus, OH, USA
| | | | - Gillian Beamer
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Paola Boggiatto
- Agricultural Research Service, United States Department of Agriculture, Ames, IA, USA
| | - Jane E Buikstra
- Center for Bioarchaeological Research, Arizona State University, Tempe, AZ, USA
| | - Bruce Chandler
- Division of Public Health, Alaska Department of Health, AK, USA
| | - Tiffany A Claeys
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Aislinn E Concha
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Paul J Converse
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Keith M Derbyshire
- Division of Genetics, The Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, University at Albany, Albany, NY, USA
| | - Karen M Dobos
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Kathryn M Dupnik
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Janice J Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mark A Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, MD, USA
| | - Carlos Franco-Paredes
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA; Hospital Infantil de México Federico Gómez, México, USA
| | | | - Luanne Hall-Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Don Hayes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Courtney A Hofman
- Department of Anthropology, University of Oklahoma, Norman, OK, USA; Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Jennifer R Honda
- Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Natalie M Hull
- Department of Civil, Environmental, and Geodetic Engineering, The Ohio State University, Columbus, OH, USA
| | - Igor Kramnik
- Pulmonary Center, The Department of Medicine, Boston University Chobanian & Aveedisian School of Medicine, National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Karen Lacourciere
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Ramanuj Lahiri
- United States Department of Health and Human Services, Health Resources and Services Administration, Health Systems Bureau, National Hansen's Disease Program, Baton Rouge, LA, USA
| | - Elise A Lamont
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Michelle H Larsen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sandrine Lesellier
- French Agency for Food, Environmental & Occupational Health & Safety (ANSES), Laboratory for Rabies and Wildlife,Nancy, France
| | - Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Najmus S Mahfooz
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Temet M McMichael
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Marlena R Merling
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Michele A Miller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jyothi F Nagajyothi
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Elizabeth Nelson
- Microbial Paleogenomics Unit, Dept of Genomes and Genetics, Institut Pasteur, Paris, France
| | - Eric L Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Maria T Pena
- United States Department of Health and Human Services, Health Resources and Services Administration, Health Systems Bureau, National Hansen's Disease Program, Baton Rouge, LA, USA
| | - Claudia Perea
- Animal & Plant Health Inspection Service, United States Department of Agriculture, Ames, IA, USA
| | - Brendan K Podell
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Charlie J Pyle
- Department of Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, NC, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Fred D Quinn
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Murugesan V S Rajaram
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Oscar Rosas Mejia
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | | | - Saydie A Sago
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Liliana C M Salvador
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Andrew W Simonson
- Department of Microbiology and Molecular Genetics and the Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John S Spencer
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Srinand Sreevatsan
- Pathobiology & Diagnostic Investigation Department, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Selvakumar Subbian
- Public Health Research Institute (PHRI), New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | | | - David M Tobin
- Department of Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, NC, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - K K Vidya Vijayan
- Department of Microbiology and Immunology, Center for AIDS Research, and Children's Research Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caelan T O Wright
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Richard T Robinson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA.
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Costa ILV, da Costa PF, da Silva SM, Gobbo AR, Pinto PDDC, Spencer JS, da Silva MB, Salgado CG. Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon. Front Med (Lausanne) 2023; 10:1218388. [PMID: 37425318 PMCID: PMC10323681 DOI: 10.3389/fmed.2023.1218388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community's early exposure to Mycobacterium leprae and active transmission of the infection. Methods In order to detect new cases among children by combining clinical evaluation and laboratory tests, we conducted an active case finding among individuals under 15 years old on Caratateua Island, located in the city of Belém, in the Pará state, an endemic region in the Amazon. Dermato-neurological examination, collection of 5 mL of peripheral blood for IgM anti-PGL-I antibody titration, and intradermal scraping for bacilloscopy and amplification of the specific RLEP region by qPCR were performed. Results Out of the 56 examined children, 28/56 (50%) new cases were identified. At the time of evaluation, 38/56 (67.8%) children presented one or more clinical alterations. Seropositivity was detected in 7/27 (25.9%) new cases and 5/24 (20.8%) undiagnosed children. DNA amplification of Mycobacterium leprae was observed in 23/28 (82.1%) of new cases and in 5/26 (19.2%) of non-cases. Out of the total cases, 11/28 (39.2%) were exclusively diagnosed by clinical evaluation performed during the active case finding. Seventeen new cases (60.8%) were detected considering the clinical alterations found in addition to positive results for qPCR. In this group, 3/17 (17.6%) qPCR-positive children presented significant clinical changes 5.5 months after the first evaluation. Discussion Our research detected a number of cases 5.6 times higher compared to the total number of pediatric cases recorded throughout the year 2021 in the municipality of Belém, which shows a critical scenario of underdiagnosing of leprosy among children under 15 years old in the region. We propose the use of qPCR technique to identify new cases among children with oligosymptomatic or early disease in endemic areas, in addition to the training of Primary Health Care professionals and the implementation of the Family Health Strategy coverage in the visited area.
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Affiliation(s)
| | | | | | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Pablo Diego do Carmo Pinto
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Laboratório de Genética Humana e Médica, Instituto de Ciência Biológicas, UFPA, Belém, Brazil
- Faculdade de Medicina, Instituto de Ciências Médicas, UFPA, Belém, Pará, Brazil
| | - John Stewart Spencer
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | | | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil
- Coordenação de Atenção às Doenças Transmissíveis na Atenção Primária à Saúde, Departamento de Gestão do Cuidado Integral, Secretaria de Atenção Primária à Saúde, Ministério da Saúde, Brasília, Distrito Federal, Brazil
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Albuquerque AA, dos Santos Mateus C, de Oliveira Rodrigues R, Lima ÉS, Lima LO, da Silva RL, Fernandes MAM, de Macedo AC, Tavares CM, Nogueira PSF, Nagao-Dias AT. Can anti-PGL-I antibody isotypes differentiate leprosy contacts and leprosy patients? Pathog Glob Health 2022; 116:477-484. [PMID: 34974816 PMCID: PMC9639540 DOI: 10.1080/20477724.2021.2021045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Serological tests for antibody measurement in leprosy have a series of limitations in discriminating contacts and patients. The present paper intends to evaluate if association of more than one antibody isotype in serum samples may be a useful tool in leprosy diagnosis. METHODS This study evaluated 395 leprosy contacts and 71 leprosy index cases living in endemic municipalities in Northeastern Brazil. The participants were evaluated according to their anti-phenolic glycolipid antigen-I isotype (PGL-I) profile. Serum anti-PGL-I IgM, IgG, and IgA were measured by indirect ELISA. RESULTS A strong association was found for antibody positivity in MB leprosy index cases. The odds ratios were 6.11 (95% CI 3.08 - 12.16) for IgM, 3.31 (1.66 - 6.61) for IgG, and 16.97 (8.39 - 34.2) for IgA. For IgM associated with one or more isotypes, the OR was 21.0 (95% CI 10.11 - 43.64), and for IgG + IgA, the OR was 17.58 (6.23 - 49.54). The highest diagnostic sensitivity of 76.0% (95% CI 61.8 - 86.9) was observed for IgM, and the lowest value was 24.1% (13.0 - 38.2), which was observed for IgG + IgA isotypes. Regarding presumptive positive predictive values, the lowest value was obtained for IgM at 24.7% (95% CI 18.1 - 32.3), and the highest values were observed for IgM+ one or more isotypes and for IgG + IgA isotype at 60.0% (44.3 - 74.3) and 66.7% (41.0 - 86.7), respectively. CONCLUSIONS The present work demonstrated that by associating two or more positive antibody isotypes, the risk of facing a real case of leprosy may increase.
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Affiliation(s)
- Andressa Almeida Albuquerque
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Camilla dos Santos Mateus
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Raphael de Oliveira Rodrigues
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil,CONTACT Raphael de Oliveira Rodrigues Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1210, Fortaleza, Ceará60430-372, Brazil
| | - Évely Sampaio Lima
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Lucas Oliveira Lima
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Rayane Lima da Silva
- Department of Nursing, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Alexandre Casimiro de Macedo
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Clódis Maria Tavares
- Faculty of Nursing and Pharmacy (ESENFAR), Universidade Federal de Alagoas, Maceió, Brazil
| | - Paula Sacha Frota Nogueira
- Department of Nursing, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Aparecida Tiemi Nagao-Dias
- Department of Clinical and Toxicology Analysis, Faculty of Pharmacy, Nursing and Odontology, Universidade Federal do Ceará, Fortaleza, Brazil
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de Bruijne ND, Urgesa K, Aseffa A, Bobosha K, Schoenmakers A, van Wijk R, Hambridge T, Waltz MM, Kasang C, Mieras L. Development of a questionnaire to determine the case detection delay of leprosy: A mixed-methods cultural validation study. PLoS Negl Trop Dis 2022; 16:e0010038. [PMID: 35025894 PMCID: PMC8758092 DOI: 10.1371/journal.pntd.0010038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Delay in case detection is a risk factor for developing leprosy-related impairments, leading to disability and stigma. The objective of this study was to develop a questionnaire to determine the leprosy case detection delay, defined as the period between the first signs of the disease and the moment of diagnosis, calculated in total number of months. The instrument was developed as part of the PEP4LEP project, a large-scale intervention study which determines the most effective way to implement integrated skin screening and leprosy post-exposure prophylaxis with a single-dose of rifampicin (SDR-PEP) administration in Ethiopia, Mozambique and Tanzania. METHODOLOGY/PRINCIPAL FINDINGS A literature review was conducted and leprosy experts were consulted. The first draft of the questionnaire was developed in Ethiopia by exploring conceptual understanding, item relevance and operational suitability. Then, the first draft of the tool was piloted in Ethiopia, Mozambique and Tanzania. The outcome is a questionnaire comprising nine questions to determine the case detection delay and two annexes for ease of administration: a local calendar to translate the patient's indication of time to number of months and a set of pictures of the signs of leprosy. In addition, a body map was included to locate the signs. A 'Question-by-Question Guide' was added to the package, to provide support in the administration of the questionnaire. The materials will be made available in English, Oromiffa (Afaan Oromo), Portuguese and Swahili via https://www.infolep.org. CONCLUSIONS/SIGNIFICANCE It was concluded that the developed case detection delay questionnaire can be administered quickly and easily by health workers, while not inconveniencing the patient. The instrument has promising potential for use in future leprosy research. It is recommended that the tool is further validated, also in other regions or countries, to ensure cultural validity and to examine psychometric properties like test-retest reliability and interrater reliability.
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Affiliation(s)
- Naomi D. de Bruijne
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
- NLR, Amsterdam, Netherlands
| | - Kedir Urgesa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | | | - Mitzi M. Waltz
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association (DAHW), Wurzburg, Germany
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Rumbaut Castillo R, Hurtado Gascón LC, Ruiz-Fuentes JL, Pastrana Fundora FM, Ramírez Albajés CR, Henao-Martínez AF, Franco-Paredes C, Escobedo ÁA. Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012-2019. PLoS Negl Trop Dis 2021; 15:e0009910. [PMID: 34710091 PMCID: PMC8577780 DOI: 10.1371/journal.pntd.0009910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/09/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In 1993, Cuba achieved leprosy elimination according to the World Health Organization's (WHO) indicator of less than one case per 10,000 population. Despite this achievement, detection of new cases occurs every year among all age groups including children. Detection of new cases in children reveals persistent transmission of the infection. OBJECTIVE To describe the clinical and epidemiological features of leprosy in individuals younger than 15 years (childhood leprosy) reported to the Cuban National Leprosy Control Program (NLCP) between 2012 and 2019. METHODS We conducted a retrospective descriptive study between 2012 and 2019 to assess the clinical and epidemiologic features of individuals under the age of 15 years with a confirmed diagnosis of leprosy reported to the NLCP. We reviewed the NLCP database and collected data to better define the total number of cases of leprosy in adults, children (younger than 15 years). We assessed socio-demographic variables (age, gender, and province of residence) as well as variables of clinical interest including operational classification and staging at diagnosis, bacillary index, grade of disability by WHO staging. Additionally, we evaluated epidemiological variables including passive versus active surveillance of cases, contact investigation focusing specifically in household transmission, and the degree of kinship as well as standing of the child within the focus of transmission when there were additional cases. RESULTS We identified fifty children during the study period corresponding to 3% of the overall cases of leprosy comprising all age groups in Cuba. In the age group younger than 15 years, the majorities of cases was from the Granma province and most were between the ages of 10 and 14 years. Clinically, multibacillary/lepromatous forms were the most common type identified with positive bacillary index. The majority of children diagnosed with leprosy during our study period had a history of a relative with a confirmed diagnosis of leprosy. CONCLUSIONS Detection of cases of leprosy in individuals younger than 15 years of age in Cuba demonstrates ongoing transmission of M. leprae in specific geographic hotspots. Its frequency in the early adolescence, the predominant clinical forms, and the mode of detection associated with sources of suspected familiar infection demonstrated that there is a need for further efforts by the NLCP to conduct active surveillance activities among affected communities to identify cases of leprosy earlier with the goal of preventing further household and community transmission.
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Affiliation(s)
| | | | - Jenny Laura Ruiz-Fuentes
- Laboratorio Nacional de Referencia e Investigaciones en Tuberculosis, Lepra y otras Micobacterias, Instituto de Medicina Tropical Pedro Kourí, La Habana, Cuba
| | | | | | - Andres F. Henao-Martínez
- University of Colorado, Anschutz Medical Center, Division of Infectious Diseases, Aurora, Colorado, United States of America
| | - Carlos Franco-Paredes
- University of Colorado, Anschutz Medical Center, Division of Infectious Diseases, Aurora, Colorado, United States of America
- Hospital Infantil de México, Federico Gómez, México City, México
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Urgesa K, Bobosha K, Seyoum B, Weldegebreal F, Mihret A, Howe R, Geda B, Kaba M, Aseffa A. Evidence for hidden leprosy in a high leprosy-endemic setting, Eastern Ethiopia: The application of active case-finding and contact screening. PLoS Negl Trop Dis 2021; 15:e0009640. [PMID: 34473696 PMCID: PMC8454944 DOI: 10.1371/journal.pntd.0009640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 09/21/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Leprosy or Hansen’s disease is a disabling infectious disease caused by Mycobacterium leprae. Reliance on the self-presentation of patients to the health services results in many numbers of leprosy cases remaining hidden in the community, which in turn results in a longer delay of presentation and therefore leading to more patients with disabilities. Although studies in Ethiopia show pockets of endemic leprosy, the extent of hidden leprosy in such pockets remains unexplored. This study determined the magnitude of hidden leprosy among the general population in Fedis District, eastern Ethiopia. A community-based cross-sectional study was conducted in six randomly selected leprosy-endemic villages in 2019. Health extension workers identified study participants from the selected villages through active case findings and household contact screening. All consenting individuals were enrolled and underwent a standardized physical examination for diagnosis of leprosy. Overall, 262 individuals (214 with skin lesions suspected for leprosy and 48 household contacts of newly diagnosed leprosy cases) were identified for confirmatory investigation. The slit skin smear technique was employed to perform a bacteriological examination. Data on socio-demographic characteristics and clinical profiles were obtained through a structured questionnaire. Descriptive statistics and binary logistic regression were used to assess the association between the outcome variable and predictor variables, and the P-value was set at 0.05. From the 268 individuals identified in the survey, 6 declined consent and 262 (97.8%) were investigated for leprosy. Fifteen cases were confirmed as leprosy, giving a detection rate of 5.7% (95%, CI: 3%, 9%). The prevalence of hidden leprosy cases was 9.3 per 10,000 of the population (15/16107). The majority (93.3%) of the cases were of the multi-bacillary type, and three cases were under 15 years of age. Three cases presented with grade II disability at initial diagnosis. The extent of hidden leprosy was not statistically different based on their sex and contact history difference (p > 0.05). High numbers of leprosy cases were hidden in the community. Active cases findings, and contact screening strategies, play an important role in discovering hidden leprosy. Therefore, targeting all populations living in leprosy pocket areas is required for achieving the leprosy elimination target. Leprosy, also called Hansen’s disease, is a neglected infectious disease leading to deformity and disability. Late presentation and hidden cases are the major risks of leprosy-associated disability. Although leprosy endemic pocket areas and grade II disability with a high proportion were reported in Ethiopia, studies on the burden of hidden leprosy cases are limited. Therefore, this study determined the extent of hidden leprosy cases among the general population in leprosy endemic settings in eastern Ethiopia through active case findings and contact tracing. In this community-based survey, leprosy-suspected individuals in the general population and household contacts of newly diagnosed patients with leprosy were included. Health extension workers, community-based health workers in Ethiopia, visited 16107 individuals in the selected villages and 214 leprosy suspects were enrolled in the study based on the clinical signs of leprosy suspects. Leprosy experts examined all leprosy suspects clinically and a skin slit sample was taken for bacteriological examination. After the confirmation of new cases, 48 of their households’ contacts were then examined by leprosy experts. Of 262 suspects and household contacts evaluated for leprosy, 15 hidden cases confirmed, giving an overall prevalence of 9.3 per 10, 000 population. Most of them were Multi-bacillary (MB) type, and one-fourth of them were younger than 15 years of age, and three cases presented with grade II disability. Hidden leprosy was not statistically associated with participants’ sex, age category, and contact history.
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Affiliation(s)
- Kedir Urgesa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fitsum Weldegebreal
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Biftu Geda
- Department of Nursing, Madda Walabu University, Shashamene, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Gunawan H, Johan R, Achdiat PA, Suwarsa O. Challenging diagnosis of leprosy in a psychotic homeless patient with atypical clinical manifestations: an interesting case report. BMC Infect Dis 2021; 21:540. [PMID: 34098890 PMCID: PMC8185914 DOI: 10.1186/s12879-021-06242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. Case presentation We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient’s face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. Conclusion In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.
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Affiliation(s)
- Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, Indonesia.
| | - Reyshiani Johan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, Indonesia
| | - Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, Indonesia
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van Dijk JHM, van Hooij A, Groot LM, Geboers J, Moretti R, Verhard‐Seymonsbergen E, de Jong D, van der Marel GA, Corstjens PLAM, Codée JDC, Geluk A. Synthetic Phenolic Glycolipids for Application in Diagnostic Tests for Leprosy. Chembiochem 2021; 22:1487-1493. [PMID: 33332701 PMCID: PMC8248333 DOI: 10.1002/cbic.202000810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/16/2020] [Indexed: 01/06/2023]
Abstract
Point-of-care (POC) diagnostic tests for the rapid detection of individuals infected with Mycobacterium leprae, the causative pathogen of leprosy, represent efficient tools to guide therapeutic and prophylactic treatment strategies in leprosy control programs, thus positively contributing to clinical outcome and reducing transmission of this infectious disease. Levels of antibodies directed against the M. leprae-specific phenolic glycolipid I (PGL-I) closely correlate with an individual's bacterial load and a higher risk of developing leprosy. We describe herein the assembly of a set of PGL glycans carrying the characteristic phenol aglycon and featuring different methylation patterns. The PGL trisaccharides were applied to construct neoglycoproteins that were used to detect anti-PGL IgM antibodies in leprosy patients. ELISAs and quantitative lateral-flow assays based on up-converting nanoparticles (UCP-LFAs) showed that the generated PGL-I and PGL-II trisaccharide neoglycoconjugates can be applied for the detection of anti M. leprae IgM antibodies in POC tests.
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Affiliation(s)
- J. Hessel M. van Dijk
- Leiden Institute for ChemistryLeiden UniversityEinsteinweg 552333 CCLeiden (TheNetherlands
| | - Anouk van Hooij
- Department of Infectious DiseasesLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - L. Melanie Groot
- Leiden Institute for ChemistryLeiden UniversityEinsteinweg 552333 CCLeiden (TheNetherlands
| | - Jolijn Geboers
- Department of Infectious DiseasesLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - Rosita Moretti
- Department of Infectious DiseasesLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - Els Verhard‐Seymonsbergen
- Department of Infectious DiseasesLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - Danielle de Jong
- Department Cell and Chemical BiologyLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - Gijs A. van der Marel
- Leiden Institute for ChemistryLeiden UniversityEinsteinweg 552333 CCLeiden (TheNetherlands
| | - Paul L. A. M. Corstjens
- Department Cell and Chemical BiologyLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
| | - Jeroen D. C. Codée
- Leiden Institute for ChemistryLeiden UniversityEinsteinweg 552333 CCLeiden (TheNetherlands
| | - Annemieke Geluk
- Department of Infectious DiseasesLeiden University Medical CenterAlbinusdreef 22333 ZALeiden (TheNetherlands
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Basso MEDM, Andrade RFD, Silva RLFD. Trend of epidemiological indicators of leprosy in an endemic state of the Amazon region. Rev Gaucha Enferm 2021; 42:e20190520. [PMID: 33787762 DOI: 10.1590/1983-1447.2021.20190520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize the temporal trend of epidemiological indicators of leprosy in the State of Amapá. METHOD Time series study, carried out in the Notifiable Diseases Information System. The indicators analyzed were: annual detection rate of new cases, detection rate of new cases in the population from 0 to 14 years old, rate of new cases with grade 2 of disability, proportion of new cases with grade 2 and proportion of new multibacillary cases, between 2005 and 2018. The analysis of the temporal evolution was made by linear regression. RESULTS The detection rate of new cases and the rate of children under 15 years showed a decreasing trend. The rate of new cases with grade 2 of disability and the proportion of cases with grade 2 showed oscillation. The proportions of multibacillary remained constant. CONCLUSION The epidemiological indicators analyzed suggest active transmission and late diagnosis, signaling a possible hidden endemic disease.
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Lima MHGM, Nascimento JP, Souza MLD, Paraizo VA, Nunes PS, Guimarães RA. Magnitude and temporal trend of leprosy indicators in Goiás, Brazil: an ecological study 2001-2017. ACTA ACUST UNITED AC 2020; 29:e2019575. [PMID: 33175008 DOI: 10.1590/s1679-49742020000500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the trend of leprosy indicators in Goiás between 2001 and 2017. METHODS An ecological time series study was conducted. Leprosy morbidity and operational indicators were calculated using Notifiable Health Conditions Information System data. Prais-Winsten regression was used for trend analysis. RESULTS There was a falling trend in the detection rate in the general population (Annual Percent Change [APC] = -6.8 - 95%CI -8.2;-5.4) and in children under 15 years old (APC = -7.2 - 95%CI -8.5;-5.9); a rising trend in the proportion of grade 2 disability (APC = 3.7 - 95%CI 2.0;5.3) and in the proportion of examined physical disability (APC = 0.6 - 95%CI 0.3;0.8); healing and examined contacts proportions were stable. CONCLUSION Detection rates decreased while the proportions of grade 2 physical disability and examined physical disability increased.
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Affiliation(s)
| | | | | | - Vanessa Alves Paraizo
- Pontifícia Universidade Católica de Goiás, Faculdade de Medicina, Goiânia, GO, Brasil
| | - Patrícia Silva Nunes
- Instituto Federal de Educação, Ciência e Tecnologia de Goiás, Núcleo de Estudos e Pesquisas em Promoção da Saúde, Goiânia, GO, Brasil
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Berzosa-Sánchez A, Soto-Sánchez B, Cacho-Calvo JB, Guillén-Martín S. Lepra tuberculoide, todavía presente en nuestro medio. Enferm Infecc Microbiol Clin 2020; 38:344-345. [DOI: 10.1016/j.eimc.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022]
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Epidemiological Characteristics of Leprosy in China, 2018. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2020. [DOI: 10.1097/jd9.0000000000000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Machado A, Lyon S, Rocha‐Silva F, Assunção C, Hernandez M, Jorge D, Cunha A, Barbosa V, Fernades B, Abreu A, Goulart L, Goulart I, Coelho E, Caligiorne R. Novel PCR primers for improved detection of
Mycobacterium leprae
and diagnosis of leprosy. J Appl Microbiol 2020; 128:1814-1819. [DOI: 10.1111/jam.14592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A.S. Machado
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - S. Lyon
- Hospital Eduardo de Menezes Belo Horizonte Minas Gerais Brazil
| | - F. Rocha‐Silva
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - C.B. Assunção
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - M.N. Hernandez
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
- Hospital Eduardo de Menezes Belo Horizonte Minas Gerais Brazil
| | - D.S. Jorge
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
- Hospital Eduardo de Menezes Belo Horizonte Minas Gerais Brazil
| | - A.C.G. Cunha
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
- Hospital Eduardo de Menezes Belo Horizonte Minas Gerais Brazil
| | - V.G. Barbosa
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - B. Fernades
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - A.G.S. Abreu
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
| | - L.R. Goulart
- Laboratório de Nanobiotecnologia Instituto de Genética e Bioquímica Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - I. Goulart
- Laboratório de Nanobiotecnologia Instituto de Genética e Bioquímica Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - E.A.F. Coelho
- Programa de Pós‐Graduação em Ciências da Saúde: Infectologia e Medicina Tropical Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Minas Gerais Brazil
| | - R.B. Caligiorne
- Hospital Santa Casa de Belo Horizonte Ensino e Pesquisa Programa de Pós‐Graduação Belo Horizonte Minas Gerais Brazil
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Serum Anti-PGL-1 IgG, IgM, and IgA in a 3-Year Follow-up Study of 4-15-Year-old Leprosy Contacts. Pediatr Infect Dis J 2019; 38:e193-e198. [PMID: 31220042 DOI: 10.1097/inf.0000000000002337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In 2015, the detection rate of leprosy in Santana do Ipanema municipality, Alagoas state, Brazil, was 39.3 cases per 100,000 inhabitants, and among young people below 15 years of age, it was 32.8 cases per 100,000 inhabitants. MATERIAL AND METHODS A prospective study was carried out from 2015 to 2017, in Santana do Ipanema city, with 69 leprosy contacts in the age group of 4-15 years. Measurement of serum IgM, IgG, and IgA against phenolic glycolipid antigen-1 (PGL-1) was done by an indirect enzyme-linked immunosorbent assay. RESULTS A high frequency of positive anti-PGL-1 IgM was found in both paucibacillary and multibacillary contacts. Twenty-three participants presented suspected lesions and 45 did not. In both groups a high frequency of positive IgM was found. In regard to anti-PGL-1 IgG, it was found a strong association between its positivity and the presence of lesions (relative risk of 3.25). Eight new cases of leprosy were diagnosed, five of which were seropositive for anti-PGL-1. Again, a striking association was found between positive IgG and leprosy (relative risk of 8.5). No significant association was found between IgM isotype and disease, nor between IgA and disease. CONCLUSIONS The present study reinforces the importance of measuring the three anti-PGL-1 isotypes in follow-up studies of leprosy contacts. Moreover, positive anti-PGL-1 IgG is associated with a high associated risk of disease.
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Serrano-Coll H, Mora HR, Beltrán JC, Duthie MS, Cardona-Castro N. Social and environmental conditions related to Mycobacterium leprae infection in children and adolescents from three leprosy endemic regions of Colombia. BMC Infect Dis 2019; 19:520. [PMID: 31196008 PMCID: PMC6567403 DOI: 10.1186/s12879-019-4120-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Leprosy is is still considered a public health issue and in Colombia 7–10% of new cases are found in children, indicating both active transmission and social inequality. We hypothesized that circulating antibodies against Natural Octyl Disaccharide-Leprosy IDRI Diagnostic (NDO-LID) (a combination of Mycobacterium leprae antigens) could reveal the social and environmental aspects associated with higher frequencies of M. leprae infection among children and adolescents in Colombia. Methods An observational cross-sectional study was conducted involving sampling from 82 children and adolescents (younger than 18 years of age) who had household contact with index leprosy patients diagnosed in the last 5 years. Data were analyzed through bivariate analysis made by applying a Pearson x2 test for qualitative variables, while quantitative variables, depending on their distribution, were analyzed using either a Student’s t-test or Mann-Whitney U test. Multivariate analysis was performed using a multiple regression and binomial logistic approach. Results A bivariate analysis demonstrated that antibody titers against NDO-LID were significantly greater in children and adolescents with a low socioeconomic status that had: lived in vulnerable areas of the UAChR shared region; eaten armadillo meat; exposure of over 10 years to an index case and; not received BCG immunization. Moreover, a multivariate analysis showed that residing in the UAChR region has a strong association with a greater possibility of M. leprae infection. Conclusions M. leprae transmission persists among young Colombians, and this is associated with social and environmental conditions. An intensification of efforts to identify new leprosy cases in vulnerable and forgotten populations where M. leprae transmission continues therefore appears necessary. Electronic supplementary material The online version of this article (10.1186/s12879-019-4120-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hugo Rene Mora
- Instituto Colombiano de Medicina Tropical-Universidad CES, Sabaneta, Colombia
| | - Juan Camilo Beltrán
- Instituto Colombiano de Medicina Tropical-Universidad CES, Sabaneta, Colombia
| | | | - Nora Cardona-Castro
- Instituto Colombiano de Medicina Tropical, Faculty of Medicine, Escuela de Graduados - Universidad CES, Cra 43 A # 52 Sur 99., Sabaneta, Colombia.
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Corstjens PLAM, van Hooij A, Tjon Kon Fat EM, Alam K, Vrolijk LB, Dlamini S, da Silva MB, Spencer JS, Salgado CG, Richardus JH, van Hees CLM, Geluk A. Fingerstick test quantifying humoral and cellular biomarkers indicative for M. leprae infection. Clin Biochem 2019; 66:76-82. [PMID: 30695682 DOI: 10.1016/j.clinbiochem.2019.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES New user-friendly diagnostic tests for detection of individuals infected by Mycobacterium leprae (M. leprae), the causative pathogen of leprosy, can help guide therapeutic and prophylactic treatment, thus positively contributing to clinical outcome and reduction of transmission. To facilitate point-of-care testing without the presence of phlebotomists, the use of fingerstick blood (FSB) rather than whole blood-derived serum is preferred. This study is a first proof-of-principle validating that previously described rapid serum tests detecting antibodies and cytokines can also be used with FSB. METHODS Quantitative detection of previously identified biomarkers for leprosy and M. leprae infection, anti-M. leprae PGL-I IgM antibodies (αPGL-I), IP-10 and CRP, was performed with lateral flow (LF) strips utilizing luminescent up-converting reporter particles (UCP) and a portable reader generating unbiased read-outs. Precise amounts of FSB samples were collected using disposable heparinized capillaries. Biomarker levels in paired FSB and serum samples were determined using UCP-LF test strips for leprosy patients and controls in Bangladesh, Brazil, South-Africa and the Netherlands. RESULTS Correlations between serum and FSB from the same individuals for αPGL-I, CRP and IP-10 were highly significant (p < .0001) even after FSB samples had been frozen. The αPGL-I FSB test was able to correctly identify all multibacillary leprosy patients presenting a good quantitative correlation with the bacterial index. CONCLUSIONS Reader-assisted, quantitative UCP-LF tests for the detection of humoral and cellular biomarkers for M. leprae infection, are compatible with FSB. This allows near-patient testing for M. leprae infection and immunomonitoring of treatment without highly trained staff. On site availability of test-result concedes immediate initiation of appropriate counselling and treatment. Alternatively, the UCP-LF format allows frozen storage of FSB samples compatible with deferred testing in central laboratories.
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Affiliation(s)
- Paul L A M Corstjens
- Dept. Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - Anouk van Hooij
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Elisa M Tjon Kon Fat
- Dept. Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - Korshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Loes B Vrolijk
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands; Division of Dermatology, New Groote Schuur Hospital, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Dermatology, New Groote Schuur Hospital, Cape Town, South Africa
| | - Moises Batista da Silva
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - John S Spencer
- Dept. of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, USA
| | - Claudio G Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Jan Hendrik Richardus
- Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Colette L M van Hees
- Dept. of Dermatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Annemieke Geluk
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands.
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19
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Zanella LF, de Sousa IBA, Barbosa MDS, Faccenda O, Simionatto S, Marchioro SB. High detection rate of new cases of multibacillary leprosy in Mato Grosso do Sul, Brazil: an observational study from 2001-2015. Rev Inst Med Trop Sao Paulo 2018; 60:e67. [PMID: 30427402 PMCID: PMC6223305 DOI: 10.1590/s1678-9946201860067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/03/2018] [Indexed: 12/03/2022] Open
Abstract
Leprosy remains a public health problem in Brazil, and the Mato Grosso do Sul State (MS) had the seventh highest rate of detection of new cases in the country in 2015 (26.59 per 100,000 inhabitants) which was classified as very high. This work aimed to determine the epidemiological characteristics of leprosy in MS. Descriptive statistics were performed with data from the Information System on Diseases of Compulsory Declaration (SINAN) between 2001 and 2015, with all patients included in the system serving as the sample. Clinical forms of multibacillary (MB) leprosy predominated in MS during the study period, with a clear positive trend from 2009 to 2015 and a peak in the detection rate of new cases (NCDR) in 2014 corresponding to 40.39 per 100,000 population (p<0.001). The most affected groups were men (56.7%) aged 20-59 years (70.52%), an economically active population. We observed that Northern MS had the highest overall NCDR in the State. In cities bordering other countries, NCDRs were significantly lower than in those of other analyzed cities. There was no dependency ratio correlating NCDRs in cities with higher or lower indexes with basic care coverage (p=0.799) and human development index (p=0.887). In conclusion, the large number of patients with MB leprosy indicates that the diagnosis of leprosy is delayed in MS, perhaps due to difficulties related to diagnostic methods. This situation contributes to the continuing prevalence of leprosy in MS.
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Affiliation(s)
- Leticia Ferrigolo Zanella
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Iara Beatriz Andrade de Sousa
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Marcelo dos Santos Barbosa
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Odival Faccenda
- Universidade Estadual do Mato Grosso do Sul, Programa de Pós-Graduação Stricto Sensu em Ensino em Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Simone Simionatto
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Silvana Beutinger Marchioro
- Universidade Federal da Grande Dourados, Faculdade de Ciências da Saúde, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
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20
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Field-friendly serological tests for determination of M. leprae-specific antibodies. Sci Rep 2017; 7:8868. [PMID: 28827673 PMCID: PMC5566372 DOI: 10.1038/s41598-017-07803-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/29/2017] [Indexed: 11/09/2022] Open
Abstract
Early detection of leprosy is key to reduce the ongoing transmission. Antibodies directed against M. leprae PGL-I represent a useful biomarker for detecting multibacillary (MB) patients. Since efficient leprosy diagnosis requires field-friendly test conditions, we evaluated two rapid lateral flow assays (LFA) for detection of Mycobacterium leprae-specific antibodies: the visual immunogold OnSite Leprosy Ab Rapid test [Gold-LFA] and the quantitative, luminescent up-converting phosphor anti-PGL-I test [UCP-LFA]. Test performance was assessed in independent cohorts originating from three endemic areas. In the Philippine cohort comprising patients with high bacillary indices (BI; average:4,9), 94%(n = 161) of MB patients were identified by UCP-LFA and 78%(n = 133) by Gold-LFA. In the Bangladeshi cohort, including mainly MB patients with low BI (average:1), 41%(n = 14) and 44%(n = 15) were detected by UCP-LFA and Gold-LFA, respectively. In the third cohort of schoolchildren from a leprosy hyperendemic region in Brazil, both tests detected 28%(n = 17) seropositivity. Both rapid tests corresponded well with BI(p < 0.0001), with a fairly higher sensitivity obtained with the UCP-LFA assay. However, due to the spectral character of leprosy, additional, cellular biomarkers are required to detect patients with low BIs. Therefore, the UCP-LFA platform, which allows multiplexing with differential biomarkers, offers more cutting-edge potential for diagnosis across the whole leprosy spectrum.
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