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Gama MEF, Pereira ADPC. Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008-2018. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:401-405. [PMID: 37919202 DOI: 10.1016/j.eimce.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae. OBJECTIVES To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality. METHODS A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil. RESULTS Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions. CONCLUSIONS The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.
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Affiliation(s)
- Maria Eugênia Farias Gama
- Municipal Health Secretariat in Recife, Health District VI, Recife, Brazil; Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil.
| | - Aline de Paula Caetano Pereira
- Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil; Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
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Stuetzle SCW, Bonkass AK, van Brakel WH, Schoenmakers A, Fastenau A. Self-healing in leprosy: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012434. [PMID: 39264863 PMCID: PMC11392240 DOI: 10.1371/journal.pntd.0012434] [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: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Leprosy, caused by Mycobacterium leprae, affects multiple body systems and can lead to preventable disability if untreated. While multidrug therapy (MDT) has been available since 1982, historical evidence suggests that untreated leprosy can resolve spontaneously. Nevertheless, the prevalence of self-healing worldwide, as well as factors determining self-healing, remain unclear. METHODS A systematic review was conducted in 2023 with data from PubMed, Infolep, and Web of Sciences data bases, along with a google search. Data extraction and analysis followed PRISMA guidelines and were summarized in a separate Excel sheet. Included were English-language studies on self-healing in leprosy, regardless the year of publication. RESULTS We included six studies spanning from 1938 to 1978 exploring the incidence of self-healing in different countries and continents. Children, paucibacillary (PB) cases, and possibly males showed a higher probability of self-healing with an average healing time of two years. DISCUSSION/CONCLUSION Recent research on self-healing in leprosy is scarce and evidence limited. This is primarily due to ethical concerns regarding withholding effective treatment of diagnosed patients, and because of the absence of an agreed definition of self-healing. Nevertheless, self-healing appears to be a plausible phenomenon influenced by geographic and demographic factors, and the type of leprosy. We recommend further research on self-healing in leprosy, as it provides insight into the human immune system and the determinants of this phenomenon. More insight could help adapt clinical practices and public health strategies, thereby contributing to an effective management and control of this disease.
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Affiliation(s)
- Sophie C W Stuetzle
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Marie Adelaide Leprosy Center, Karachi, Pakistan
| | | | | | - Anne Schoenmakers
- NLR international, Amsterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anil Fastenau
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Marie Adelaide Leprosy Center, Karachi, Pakistan
- German Leprosy and Tuberculosis Relief Association (DAHW), Wuerzburg, Germany
- Department of Health, Ethics & Society, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Daccach V, Tomaselli PJ, Algemiro JS, Toscano P, Dos Santos ACJ, Frade MAC, Marques W. Focal slowing of nerve conduction velocity in leprosy patients unveiled through multisegmented nerve analysis. J Peripher Nerv Syst 2024; 29:356-362. [PMID: 39165030 DOI: 10.1111/jns.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND AND AIMS Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an intracellular bacillus that systematically invades the peripheral nerves. Diagnosing leprosy neuropathy is still a defying skill, and late diagnosis and treatment are still a reality. Based on the biological characteristics of M. leprae, particularly its preference for invading the Schwann cells localized at the coldest areas of human body, we hypothesized that these areas have focal demyelination that may escape detection through standard nerve conduction studies (NCSs) protocols. METHODS Twenty-five patients with confirmed multibacillary leprosy and 14 controls were accessed. A multisegmented NCS protocol (MP) was performed, targeting short segments through the coldest areas, to identify focal areas of slowed conduction velocity. The effectiveness of this multisegmented protocol was compared to the standard protocol (SP) to detect abnormalities. RESULTS All leprosy patients presented an abnormal study with the MP, contrasting to 19 with the SP. The most frequent NCS pattern was an asymmetric neuropathy with focal slowing of conduction velocity, found in 23 out of 25 leprosy patients. Significant differences favoring the proposed method were observed when comparing the MP with the SP. Notably, the MP increased the sensitivity to detect abnormalities by 122%, 133%, and 257% for the median, peroneal, and tibial nerves, respectively. MP also increases sensitivity to detect focal abnormalities in the ulnar nerve. INTERPRETATION The MP protocol significantly increases the sensitivity of NCSs to detect neurophysiological abnormalities in leprosy neuropathy.
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Affiliation(s)
- Vanessa Daccach
- Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pedro José Tomaselli
- Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Juliana Secchin Algemiro
- Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Patricia Toscano
- Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Marco Andrey Cipriano Frade
- Dermatology, Clinical Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques
- Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Sciences and Technology-INCT-Translational Medicine-CNPq/FAPESP, São Paulo, Brazil
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Jockers D, Bakoubayi AW, Bärnighausen K, Bando PP, Pechar S, Maina TW, Wachinger J, Vetter M, Djakpa Y, Saka B, Gnossike P, Schröder NM, Liu S, Gadah DAY, Kasang C, Bärnighausen T. Effectiveness of Sensitization Campaigns in Reducing Leprosy-Related Stigma in Rural Togo: Protocol for a Mixed Methods Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52106. [PMID: 38635983 PMCID: PMC11066741 DOI: 10.2196/52106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. OBJECTIVE The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. METHODS We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. RESULTS This paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. CONCLUSIONS This trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. TRIAL REGISTRATION German Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52106.
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Affiliation(s)
- Dominik Jockers
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Kate Bärnighausen
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Stefanie Pechar
- Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Teresia Wamuyu Maina
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Jonas Wachinger
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Mark Vetter
- Geovisualization, Technical University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Yawovi Djakpa
- German Leprosy and Tuberculosis Relief Association, Lomé, Togo
| | - Bayaki Saka
- Department of Dermatology, Tsévié Hospital, University of Lomé, Lomé, Togo
| | - Piham Gnossike
- National Programme for Neglected Tropical Diseases, Lomé, Togo
| | - Nora Maike Schröder
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Shuyan Liu
- Department of Psychiatry and Psychotherapy (Campus Charité Mitte), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Till Bärnighausen
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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Li X, Ma Y, Li G, Jin G, Xu L, Li Y, Wei P, Zhang L. Leprosy: treatment, prevention, immune response and gene function. Front Immunol 2024; 15:1298749. [PMID: 38440733 PMCID: PMC10909994 DOI: 10.3389/fimmu.2024.1298749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Since the leprosy cases have fallen dramatically, the incidence of leprosy has remained stable over the past years, indicating that multidrug therapy seems unable to eradicate leprosy. More seriously, the emergence of rifampicin-resistant strains also affects the effectiveness of treatment. Immunoprophylaxis was mainly carried out through vaccination with the BCG but also included vaccines such as LepVax and MiP. Meanwhile, it is well known that the infection and pathogenesis largely depend on the host's genetic background and immunity, with the onset of the disease being genetically regulated. The immune process heavily influences the clinical course of the disease. However, the impact of immune processes and genetic regulation of leprosy on pathogenesis and immunological levels is largely unknown. Therefore, we summarize the latest research progress in leprosy treatment, prevention, immunity and gene function. The comprehensive research in these areas will help elucidate the pathogenesis of leprosy and provide a basis for developing leprosy elimination strategies.
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Affiliation(s)
- Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yun Ma
- Chronic Infectious Disease Control Section, Nantong Center for Disease Control and Prevention, Nantong, China
| | - Guoli Li
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Li Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Lianhua Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Driedger M, Teo I, Roth V. Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report. BMC Infect Dis 2023; 23:815. [PMID: 37990293 PMCID: PMC10662535 DOI: 10.1186/s12879-023-08811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Leprosy is rare within non-endemic countries such as Canada, where cases are almost exclusively imported from endemic regions, often presenting after an incubation period of as many as 20 years. Due to its rarity and prolonged incubation period, diagnosis is often delayed, which may result in neurologic impairment prior to the initiation of treatment. In this report we describe a case that is novel in its incubation period, which is the longest reported to-date and may have contributed to diagnostic delay. The case also uniquely demonstrates the challenges of distinguishing leprosy reactions from new rheumatologic manifestations in a patient with established autoimmune disease. CASE PRESENTATION We describe an 84-year-old male patient with rheumatoid arthritis on methotrexate and hydroxychloroquine, with no travel history outside Canada for 56 years, who presented in 2019 with new-onset paresthesias and rash. His paresthesias persisted despite a short course of prednisone, and his rash recurred after initial improvement. He underwent skin biopsy in May 2021, which eventually led to the diagnosis of leprosy. He was diagnosed with type 1 reaction and was started on rifampin, dapsone, clofazimine and prednisone, with which his rash resolved but his neurologic impairment remained. CONCLUSION This case report serves to highlight the potential for leprosy to present after markedly prolonged incubation periods. This is especially relevant in non-endemic countries that is home to an aging demographic of individuals who migrated decades ago from endemic countries. The importance of this concept is emphasized by the persistent neurologic impairment suffered by our case due to untreated type 1 reaction. We also demonstrate the necessity of skin biopsy in distinguishing this diagnosis from other autoimmune mimics in a patient with known autoimmune disease.
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Affiliation(s)
| | - Iris Teo
- University of Ottawa, Ottawa, ON, Canada
- Division of Anatomical Pathology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Virginia Roth
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Argentina F, Suwarsa O, Gunawan H, Berbudi A. Gene Expression of Human Beta-Defensin-3 and Cathelicidin in the Skin of Leprosy Patients, Household Contacts, and Healthy Individuals from Indonesia. Clin Cosmet Investig Dermatol 2023; 16:1485-1492. [PMID: 37333516 PMCID: PMC10275412 DOI: 10.2147/ccid.s405932] [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: 01/25/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
Background Leprosy, a chronic infectious peripheral neuropathy, is caused by Mycobacterium leprae. This bacterium produces triacylated lipopeptides that can induce the immune system via the Toll-like receptor 2/1 (TLR 2/1) complex. Activation of TLR 2/1 produces proinflammatory cytokines and antimicrobial peptides (AMPs), including human beta-defensin-3 (HBD-3) and cathelicidin. Purpose To analyze differences in gene expression of HBD-3 and cathelicidin in the skin of leprosy patients, household contacts, and healthy individuals. Patients and Methods An analytic observational study was conducted at the Outpatient Clinic of Dermatology and Venereology of Dr Mohammad Hoesin General Hospital, Palembang, Indonesia, from January 2021 to June 2022. In each group of 18 subjects, 72 samples were collected, including skin lesion in leprosy patients, normal skin in leprosy patients, household contacts, and healthy individuals. A comparison of HBD-3 and cathelicidin gene expression between the four groups was analyzed using Pearson Chi Square, Kruskal-Wallis, and Mann-Whitney Test. Results The median value of HBD-3 gene expression on skin lesion in leprosy patients was 260.61 (0.19-3734.10); normal skin in leprosy patients was 1.91 (0.01-151.17); household contacts skin was 7.93 (0.27-121.10); and healthy individuals' skin was 1.00 (1.00-1.00) is highly significant difference (p < 0.0001). The median value of cathelicidin gene expression on skin lesion in leprosy patients was 38.72 (0.28-1852.17); normal skin in leprosy patients was 0.48 (0.01-15.83); household contacts skin was 9.8 (0.04-128.0); and healthy individual skin was 1.00 (1.00-1.00), also highly significant difference (p < 0.0001). Conclusion Gene expression of HBD-3 and cathelicidin increased in skin lesions of leprosy patients and household contacts.
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Affiliation(s)
- Fifa Argentina
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sriwijaya/Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Afiat Berbudi
- Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Hambridge T, Coffeng LE, de Vlas SJ, Richardus JH. Establishing a standard method for analysing case detection delay in leprosy using a Bayesian modelling approach. Infect Dis Poverty 2023; 12:12. [PMID: 36800979 PMCID: PMC9940321 DOI: 10.1186/s40249-023-01065-4] [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: 10/06/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Leprosy is an infectious disease caused by Mycobacterium leprae and remains a source of preventable disability if left undetected. Case detection delay is an important epidemiological indicator for progress in interrupting transmission and preventing disability in a community. However, no standard method exists to effectively analyse and interpret this type of data. In this study, we aim to evaluate the characteristics of leprosy case detection delay data and select an appropriate model for the variability of detection delays based on the best fitting distribution type. METHODS Two sets of leprosy case detection delay data were evaluated: a cohort of 181 patients from the post exposure prophylaxis for leprosy (PEP4LEP) study in high endemic districts of Ethiopia, Mozambique, and Tanzania; and self-reported delays from 87 individuals in 8 low endemic countries collected as part of a systematic literature review. Bayesian models were fit to each dataset to assess which probability distribution (log-normal, gamma or Weibull) best describes variation in observed case detection delays using leave-one-out cross-validation, and to estimate the effects of individual factors. RESULTS For both datasets, detection delays were best described with a log-normal distribution combined with covariates age, sex and leprosy subtype [expected log predictive density (ELPD) for the joint model: -1123.9]. Patients with multibacillary (MB) leprosy experienced longer delays compared to paucibacillary (PB) leprosy, with a relative difference of 1.57 [95% Bayesian credible interval (BCI): 1.14-2.15]. Those in the PEP4LEP cohort had 1.51 (95% BCI: 1.08-2.13) times longer case detection delay compared to the self-reported patient delays in the systematic review. CONCLUSIONS The log-normal model presented here could be used to compare leprosy case detection delay datasets, including PEP4LEP where the primary outcome measure is reduction in case detection delay. We recommend the application of this modelling approach to test different probability distributions and covariate effects in studies with similar outcomes in the field of leprosy and other skin-NTDs.
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Affiliation(s)
- Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Luc E. Coffeng
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J. de Vlas
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sadhu S, Kumar S, Mitra DK, Joshi B. Activated TLR2/4-positive T cells boost cell exhaustion during lepromatous leprosy infection via PD-1 upregulation. Heliyon 2022; 8:e11633. [DOI: 10.1016/j.heliyon.2022.e11633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/03/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
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Mulugeta SS, Maseresha BM, Wassihun SG, Moyehodie YA. Risk Factors for Disability Upgrading Among Leprosy Patients During Treatment: Multilevel Modeling Analysis. SAGE Open Nurs 2022; 8:23779608221129936. [PMID: 36238938 PMCID: PMC9551338 DOI: 10.1177/23779608221129936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Leprosy not only brings about bodily incapacity but also creates a nasty image of affected individuals, triggering discrimination and social stigma. The purpose of this study was to evaluate the status of leprosy disability in patients registered at the All African TB and Leprosy Rehabilitation and Training Center. Methods The study consists of 205 leprosy patients who were undergoing treatment at the All African TB and Leprosy Rehabilitation and Training Center from January 2015 to December 2019. Regional states of the patients were used as a clustering effect in the multilevel logistic regression model. Results In total, 205 (66.3%) completed records revealed patients with leprosy were disabled. Among these, 64.88% of them were males. In multilevel binary logistic regression analysis, the individual-level variables, such as median age (AOR = 1.1; 95% CI: 1.043, 1.13) of patients, patients with duration of symptom [7-12 months (AOR = 2.26; 95% CI: 1.50, 3.39), 13-24 months (AOR = 2.13; 95% CI: 1.44, 3.15), and more than 24 months (AOR = 2.67; 95% CI: 1.8, 4.02)], the absence of sensory loss (AOR = 0.84; 95% CI: 0.72, 0.96), and patients with asymmetry lesion distribution (AOR = 0.74; 95% CI: 0.65, 0.85), were the most significant determinant factors of disability. The default leprosy patient (AOR = 15.53; 95% CI: 1.82, 134.96) and new leprosy patient (AOR = 0.51; 95% CI: 0.33, 1.68) were the significant determinant factors of disability due to leprosy patients. Conclusion An individual-level factor on the risk of disability was higher as age increased and for patients with a longer duration of symptoms. The risk of disability was lower for patients who do not lose their sensation and for patients whose lesion distribution is asymmetrical. The community-level factor, patient categories, was also a significant factor in disability due to leprosy. Furthermore, programs should emphasize raising community awareness, focusing on key messages and early case detection campaigns, such as active surveys, as well as the availability of leprosy care in a public health facility.
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Affiliation(s)
- Solomon Sisay Mulugeta
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia,Solomon Sisay Mulugeta, Department of
Statistics, College of Natural and Computational Sciences, Debre Tabor
university, P.O. BOX. 272, Debre Tabor, Amhara, Ethiopia. E.mail:
| | - Bezanesh Melese Maseresha
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia
| | - Selamawit Getachew Wassihun
- Department of Statistics, College of Natural and Computational
Sciences, Mekdela Amba University, Debre Tabor, Amhara, Ethiopia
| | - Yikeber Abebaw Moyehodie
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia
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Dharmawan Y, Fuady A, Korfage IJ, Richardus JH. Delayed detection of leprosy cases: A systematic review of healthcare-related factors. PLoS Negl Trop Dis 2022; 16:e0010756. [PMID: 36067195 PMCID: PMC9481154 DOI: 10.1371/journal.pntd.0010756] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/16/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. Methods PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. Conclusions Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services. New leprosy patients diagnosed with visible physical deformities represent a significant disease burden that also poses an important public health challenge. The physical deformities often result from long delays in case detection. Greater insight into the healthcare factors that contribute to such delays will support the development of effective prevention programs. We therefore reviewed all studies on the healthcare factors related to case-detection delay that had been published between January 1, 2000, and January 31, 2021. Twenty studies were included in our analysis. We found that misdiagnosis was a core healthcare factor related to delays. Other common factors included inappropriate health services, a high number of consultations before diagnosis; and a lack of referral centers, healthcare personnel, and case-detection methods. Detection delay was further influenced by geographical circumstances, financial and logistic issues, and health-service organization and management including the level of the decentralization of healthcare programs. Because delays in leprosy case detection are due mainly to misdiagnosis, we recommend to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.
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Affiliation(s)
- Yudhy Dharmawan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
- * E-mail: ,
| | - Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Yang J, Li X, Sun Y, Zhang L, Jin G, Li G, Zhang S, Hou K, Li Y. Global epidemiology of leprosy from 2010 to 2020: A systematic review and meta-analysis of the proportion of sex, type, grade 2 deformity and age. Pathog Glob Health 2022; 116:467-476. [PMID: 35510339 PMCID: PMC9639561 DOI: 10.1080/20477724.2022.2057722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The objectives of this study were to explore global epidemiological characteristics of leprosy, and to provide reference for the construction of prevention strategies for leprosy. Computer retrieval of the study on the epidemiology of leprosy from 2010 to 2020 in Web of Science, PubMed, and SCOPUS databases were summarized. The included studies were assessed for the quality of the AHRQ; the proportions of the study indices were meta-analyzed with Stata 16.0. A random effects model was adopted to merge categories, including sex, type, grade 2 deformity (G2D) and age group for meta-analysis. The subgroup analysis used region as a stratification factor to analyze whether there were differences in the indicators. The meta-analysis included 30 studies totaling 11,353 cases. The global pooled proportion of male to female subjects with leprosy was 63% (95% CI 59%, 66%) to 37% (95% CI 34%, 41%), respectively. The pooled multibacillary proportion and paucibacillary proportion were 69% (95% CI 62%, 76%) and 31% (95% CI 24%, 38%), respectively. The pooled grade 2 deformity (G2D) proportion was 22% (95% CI 15%, 30%). Among age groups, the pooled children proportion was 11% (95% CI 8%, 13%), and the pooled adult proportion was 89% (95% CI 87%, 92%). The subgroup analysis indicated that epidemiological indicators varied from country to country. This study suggested that disparities existed between sex, type, grade 2 deformity (G2D) and age group characteristics of leprosy from country to country.
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Affiliation(s)
- Jing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Yanqi Sun
- Department of Prevention and Health Care, Rizhao People's Hospital, Jiangxi Provincial, Rizhao, China
| | - Lianhua Zhang
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Guoli Li
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Shunyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Kunchi Hou
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
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Ebenezer GJ, Pena MT, Daniel AS, Truman RW, Adams L, Duthie MS, Wagner K, Zampino S, Tolf E, Tsottles D, Polydefkis M. Mycobacterium leprae induces Schwann cell proliferation and migration in a denervated milieu following intracutaneous excision axotomy in nine-banded armadillos. Exp Neurol 2022; 352:114053. [PMID: 35341747 DOI: 10.1016/j.expneurol.2022.114053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 01/23/2023]
Abstract
Nine-banded armadillos develop peripheral neuropathy after experimental Mycobacterium leprae infection that recapitulates human disease. We used an intracutaneous excision axotomy model to assess the effect of infection duration by M. leprae on axonal sprouting and Schwan cell density. 34 armadillos (17 naïve and 17 M. leprae-infected) underwent 3 mm skin biopsies to create an intracutaneous excision axotomy followed by a concentric 4-mm overlapping biopsy 3 and 12-months post M. leprae inoculation. A traditional distal leg biopsy was obtained at 15mo for intraepidermal nerve fiber (IENF) density. Serial skin sections were immunostained against a axons (PGP9.5, GAP43), and Schwann cells (p75, s100) to visualize regenerating nerves. Regenerative axons and proliferation of Schwann cells was measured and the rate of growth at each time point was assessed. Increasing anti-PGL antibody titers and intraneural M. leprae confirmed infection. 15mo following infection, there was evidence of axon loss with reduced distal leg IENF versus naïve armadillos, p < 0.05. This was associated with an increase in Schwann cell density (11,062 ± 2905 vs. 7561 ± 2715 cells/mm3, p < 0.01). Following excisional biopsy epidermal reinnervation increased monotonically at 30, 60 and 90 days; the regeneration rate was highest at 30 days, and decreased at 60 and 90 days. The reinnervation rate was highest among animals infected for 3mo vs those infected for 12mo or naïve animals (mean ± SD, 27.8 ± 7.2 vs.16.2 ± 5.8vs. 15.3 ± 6.5 mm/mm3, p < 0.05). The infected armadillos displayed a sustained Schwann cell proliferation across axotomy time points and duration of infection (3mo:182 ± 26, 12mo: 256 ± 126, naive: 139 ± 49 cells/day, p < 0.05). M. leprae infection is associated with sustained Schwann cell proliferation and distal limb nerve fiber loss. Rates of epidermal reinnervation were highest 3mo after infection and normalized by 12 mo of infection. We postulate that excess Schwann cell proliferation is the main pathogenic process and is deleterious to sensory axons. There is a compensatory initial increase in regeneration rates that may be an attempt to compensate for the injury, but it is not sustained and eventually followed by axon loss. Aberrant Schwann cell proliferation may be a novel therapeutic target to interrupt the pathogenic cascade of M. leprae.
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Affiliation(s)
| | - Maria T Pena
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | | | - Richard W Truman
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | - Linda Adams
- DHHS/HRSA/HSB/National Hansen's Disease Program, Baton Rouge, LA 70816, USA
| | | | - Kelly Wagner
- Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Eleanor Tolf
- Neurology, Johns Hopkins University, Baltimore, MD, USA
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Maciel-Fiuza MF, Costa PDSS, Kowalski TW, Schuler-Faccini L, Bonamigo RR, Vetoratto R, Eidt LM, de Moraes PC, Silveira MIDS, Camargo LMA, Callegari-Jacques SM, Castro SMDJ, Vianna FSL. Evaluation of Polymorphisms in Toll-Like Receptor Genes as Biomarkers of the Response to Treatment of Erythema Nodosum Leprosum. Front Med (Lausanne) 2022; 8:713143. [PMID: 35141236 PMCID: PMC8819000 DOI: 10.3389/fmed.2021.713143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/09/2021] [Indexed: 01/18/2023] Open
Abstract
Erythema nodosum leprosum (ENL) is an inflammatory complication caused by a dysregulated immune response to Mycobacterium leprae. Some Toll-like receptors (TLRs) have been identified as capable of recognizing antigens from M. leprae, triggering a wide antimicrobial and inflammatory response. Genetic polymorphisms in these receptors could influence in the appearance of ENL as well as in its treatment. Thus, the objective of this work was to evaluate the association of genetic variants of TLRs genes with the response to treatment of ENL with thalidomide and prednisone. A total of 162 ENL patients were recruited from different regions of Brazil and clinical information was collected from their medical records. Genomic DNA was isolated from blood and saliva samples and genetic variants in TLR1 (rs4833095), TLR2 (rs3804099), TLR4 (rs1927914), and TLR6 (rs5743810) genes were genotyped by TaqMan real-time PCR system. In order to evaluate the variants' association with the dose of the medications used during the treatment, we applied the Generalized Estimating Equations (GEE) analysis. In the present sample, 123 (75.9%) patients were men and 86 (53.1%) were in treatment for leprosy during the ENL episode. We found an association between polymorphisms in TLR1/rs4833095, TLR2/rs3804099, TLR4/rs1927914, and TLR6/rs5783810 with the dose variation of thalidomide in a time-dependent manner, i.e., the association with the genetic variant and the dose of the drug was different depending on the moment of the treatment evaluated. In addition, we identified that the association of polymorphisms in TLR1/rs4833095, TLR2/rs3804099, and TLR6/rs5783810 with the dose variation of prednisone also were time-dependent. Despite these associations, in all the interactions found, the influence of genetic variants on dose variation was not clinically relevant for therapeutic changes. The results obtained in this study show that TLRs polymorphism might play a role in the response to ENL treatment, however, in this context, they could not be considered as useful biomarkers in the clinical setting due small differences in medication doses. A larger sample size with patients with a more genetic profile is fundamental in order to estimate the association of genetic variants with the treatment of ENL and their clinical significance.
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Affiliation(s)
- Miriãn Ferrão Maciel-Fiuza
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Thayne Woycinck Kowalski
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Lavínia Schuler-Faccini
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Renan Rangel Bonamigo
- Post-graduate Program in Pathology, Universidade Federal De Ciências Da Saúde de Porto Alegre, Porto Alegre, Brazil
- Dermatology Service of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Rodrigo Vetoratto
- Dermatology Service of Santa Casa Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Letícia Maria Eidt
- Sanitary Dermatology Clinic, Secretaria De Saúde Do Estado Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Paulo Cezar de Moraes
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Sanitary Dermatology Clinic, Secretaria De Saúde Do Estado Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Luis Marcelo Aranha Camargo
- National Reference Center for Health Dermatology Dona Libania, Fortaleza, Brazil
- Center for Research in Tropical Medicine, Porto Velho, Rondonia, Brazil
- National Institute of Science and Technology-EpiAmo, Rondonia, Brazil
- Department of Medicine, Centro Universitario São Lucas, Porto Velho, Rondônia, Brazil
- National Institute of Science and Technology/CNPq-EpiAmo, Rondonia, Brazil
| | - Sidia Maria Callegari-Jacques
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Department of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Stela Maris de Jezus Castro
- Department of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Fernanda Sales Luiz Vianna
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
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Calheira MC, Trindade SC, Falcão MML, Barbosa LSC, Carvalho GRB, Machado PRL, Gomes-Filho IS, de Jesus Campos E, de Carvalho-Filho PC, Xavier MT, de Farias APF, Filho JTRR, de Santana Passos-Soares J. Immunoassay standardization for the detection of immunoglobulin A (IgA) against Porphyromonas gingivalis antigens in saliva of individuals with and without leprosy. AMB Express 2021; 11:152. [PMID: 34792664 PMCID: PMC8602710 DOI: 10.1186/s13568-021-01312-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/04/2021] [Indexed: 01/14/2023] Open
Abstract
Leprosy reactions are immune processes that cause neural damage in individuals with leprosy. As periodontitis is an infectious disease related to its development, specific antibodies to periodontal pathogens must be evaluated to better understand the humoral mechanisms underlying this relationship. Therefore, the objective of this study was to standardize an immunoassay to measure IgA specific to P. gingivalis antigens in the saliva of individuals with leprosy. An ELISA checkerboard titration was performed. A validation test involving 53 individuals with leprosy, 24 with and 19 without periodontitis, was conducted and a ROC curve constructed to calculate sensitivity and specificity. The coefficient of the optical densities was 2.21 and 2.66 for P. gingivalis crude extract and the recombinant protein HmuY, respectively. Sensitivity and specificity for the P. gingivalis crude extract were 66.7% and 73.7%, respectively, and for HmuY, were 62.5% and 52.6%, respectively. Specific recognition of P. gingivalis occurred predominantly in individuals with periodontitis, which validates the use of this test for studying periodontitis in individuals with leprosy. Trial registration CAEE 64476117.3.0000.0049, 21/07/2017, retrospectively registered
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Bulstra CA, Blok DJ, Alam K, Butlin CR, Roy JC, Bowers B, Nicholls P, de Vlas SJ, Richardus JH. Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study. Infect Dis Poverty 2021; 10:36. [PMID: 33752751 PMCID: PMC7986508 DOI: 10.1186/s40249-021-00817-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally. Methods We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots. Results New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00817-4.
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Affiliation(s)
- Caroline A Bulstra
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khorshed Alam
- Rural Health Programme, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - C Ruth Butlin
- The Leprosy Mission England and Wales, Goldhay Way, Orton Goldhay, Peterborough, England
| | - Johan Chandra Roy
- Rural Health Programme, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Bob Bowers
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Comparison of IL-17 and FOXP3+ Levels in Maternal and Children Leprosy Patients in Endemic and Nonendemic Areas. Interdiscip Perspect Infect Dis 2021; 2021:8879809. [PMID: 33708252 PMCID: PMC7932766 DOI: 10.1155/2021/8879809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Leprosy, a chronic infection caused by M. leprae, has a complex transmission problem that makes eradication programs difficult. New cases and ongoing transmission of leprosy in endemic areas make individuals living in endemic environments vulnerable to leprosy. This can be caused by the dysregulation of immune system in individuals living in leprosy-endemic areas. Although the number of male leprosy patients is higher, female leprosy patients have more impact on the family health status due to close contact with family members, roles in the household, and parenting. This could cause the increased number of children leprosy patients. We investigated the dysregulation of immune system by comparing IL-17 and FOXP3+ levels occurring in maternal and child leprosy patients in endemic and nonendemic areas. The results of the study found a statistically significant difference in IL-17 levels between the MB leprosy patient group and the control group (p=0.048), where higher levels of IL-17 are observed in the control group. A significant difference also was found in FOXP3+ levels between the group of healthy children living in endemic and those living in nonendemic areas (p=0.047), where higher FOXP3+ is observed in the healthy children living in endemic areas group.
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Bao Y, Wang L, Sun J. Post-translational knockdown and post-secretional modification of EsxA determine contribution of EsxA membrane permeabilizing activity for mycobacterial intracellular survival. Virulence 2021; 12:312-328. [PMID: 33356823 PMCID: PMC7808419 DOI: 10.1080/21505594.2020.1867438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Current genetic studies (e.g. gene knockout) have suggested that EsxA and EsxB function as secreted virulence factors that are essential for Mycobaterium tuberculosis (Mtb) intracellular survival, specifically in mediating phagosome rupture and translocation of Mtb to the cytosol of host cells, which further facilitates Mtb intracellular replicating and cell-to-cell spreading. The EsxA-mediated intracellular survival is presumably achieved by its pH-dependent membrane-permeabilizing activity (MPA). However, the data from other studies have generated a discrepancy regarding the role of EsxA MPA in mycobacterial intracellular survival, which has raised a concern that genetic manipulations, such as deletion of esxB-esxA operon or RD-1 locus, may affect other codependently secreted factors that could be also directly involved cytosolic translocation, or stimulate extended disturbance on other genes’ expression. To avoid the drawbacks of gene knockout, we first engineered a Mycobacterium marinum (Mm) strain, in which a DAS4+ tag was fused to the C-terminus of EsxB to allow inducible knockdown of EsxB (also EsxA) at the post-translational level. We also engineered an Mm strain by fusing a SpyTag (ST) to the C-terminus of EsxA, which allowed inhibition of EsxA-ST MPA at the post-secretional level through a covalent linkage to SpyCatcher-GFP. Both post-translational knockdown and functional inhibition of EsxA resulted in attenuation of Mm intracellular survival in lung epithelial cells or macrophages, which unambiguously confirms the direct role of EsxA MPA in mycobacterial intracellular survival.
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Affiliation(s)
- Yanqing Bao
- Department of Biological Sciences and Border Biomedical Research Center, University of Texas at El Paso , El Paso, Texas, USA
| | - Lin Wang
- Department of Biological Sciences and Border Biomedical Research Center, University of Texas at El Paso , El Paso, Texas, USA
| | - Jianjun Sun
- Department of Biological Sciences and Border Biomedical Research Center, University of Texas at El Paso , El Paso, Texas, USA
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Polymorphisms in mitochondrial ribosomal protein S5 (MRPS5) are associated with leprosy risk in Chinese. PLoS Negl Trop Dis 2020; 14:e0008883. [PMID: 33362202 PMCID: PMC7757804 DOI: 10.1371/journal.pntd.0008883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae), with about 210,000 new cases per year worldwide. Although numerous risk loci have been uncovered by genome-wide association studies, the effects of common genetic variants are relatively modest. To identify possible new genetic locus involved in susceptibility to leprosy, whole exome sequencing was performed for 28 subjects including 14 patients and 12 unaffected members from 8 leprosy-affected families as well as another case and an unrelated control, and then the follow-up SNP genotyping of the candidate variants was studied in case-control sample sets. A rare missense variant in mitochondrial ribosomal protein S5 (MRPS5), rs200730619 (c. 95108402T>C [p. Tyr137Cys]) was identified and validated in 369 cases and 270 controls of Chinese descent (Padjusted = 0.006, odds ratio [OR] = 2.74) as a contributing factor to leprosy risk. Moreover, the mRNA level of MRPS5 was downregulated in M. leprae sonicate-stimulated peripheral blood mononuclear cells. Our results indicated that MRPS5 may be involved in leprosy pathogenesis. Further studies are needed to determine if defective MRPS5 could lead to impairment of energy metabolism of host immune cells, which could further cause defect in clearing M. leprae and increase susceptibility to infection.
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Riccò M, Vezzosi L, Ranzieri S, Balzarini F, Mezzoiuso AG, Vaccaro FG. Understanding leprosy in a nonendemic area: a pilot study on knowledge, attitudes, beliefs of medical professionals from North-Western Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020187. [PMID: 33525280 PMCID: PMC7927465 DOI: 10.23750/abm.v91i4.8810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022]
Abstract
Background: Describing knowledge, attitudes and beliefs about leprosy amongst Medical Professionals in a nonendemic area (Parma Province, North-Western Italy). Methods: A cross-sectional study was carried among a sample of Medical Professionals (MP; No. 242) during June and July 2019 as an on-line self-administered questionnaire including 21 true/false items about epidemiology, diagnosis, and clinical characteristics of leprosy. Effectors of better knowledge status (KS) and higher risk perception (RP) were assessed through calculation of respective multivariate odds ratios (OR) and 95% confidence intervals (95%CI) in two logistic regression analysis models. Results: A total of 102 questionnaires were retrieved (participation rate 42.1%; 67.6% of respondents <50 year-old). Of them, 10.8% had previously interacted with at least one leprosy case. Knowledge status (KS) was unsatisfying (59.7% correct answers), and also RP was relatively low, as 91.2% of them acknowledged leprosy as a severe disease, but only 42.2% identified leprosy as highly communicable. Knowledge gaps affected particularly understanding of epidemiology and non-dermatological issues. Moreover, 30.4% of respondents ignored that a treated leprosy case may remain in the community before disease eradication. The main effector of KS was having interacted with a leprosy case (OR 4.881 95%CI 1.245-36.905), while RP was negatively associated with a better KS (OR 0.094 95%CI 0.027-0.334), and working as general practitioner (OR 0.133 95%CI 0.031-0.562). Conclusions: While individual expertise of European MP on leprosy slowly disappears, significant knowledge gaps and the high share of misconceptions collectively stress that refresher training may improve early diagnosis and management of incident cases. (www.actabiomedica.it)
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Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio EmiliaV.le Amendola n.2 - 42122 REServizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL)Dip. di Prevenzione.
| | - Luigi Vezzosi
- Azienda Socio Sanitaria Territoriale di Cremona, Direzione Medica Ospedale di Cremona.
| | - Silvia Ranzieri
- School of Occupational Medicine, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43123 Parma, Italy .
| | - Federica Balzarini
- Università "Vita e Salute" San Raffaele, School of Public Health - Milano.
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Patients with skin smear positive leprosy in Bangladesh are the main risk factor for leprosy development: 21-year follow-up in the household contact study (COCOA). PLoS Negl Trop Dis 2020; 14:e0008687. [PMID: 33125403 PMCID: PMC7598483 DOI: 10.1371/journal.pntd.0008687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
Background Leprosy transmission is ongoing; globally and within Bangladesh. Household contacts of leprosy cases are at increased risk of leprosy development. Identification of household contacts at highest risk would optimize this process. Methods The temporal pattern of new case presentation amongst household contacts was documented in the COCOA (Contact Cohort Analysis) study. The COCOA study actively examined household contacts of confirmed leprosy index cases identified in 1995, and 2000–2014, to provide evidence for timings of contact examination policies. Data was available on 9527 index cases and 38303 household contacts. 666 household contacts were diagnosed with leprosy throughout the follow-up (maximum follow-up of 21 years). Risk factors for leprosy development within the data analysed, were identified using Cox proportional hazard regression. Findings The dominant risk factor for household contacts developing leprosy was having a highly skin smear positive index case in the household. As the grading of initial slit skin smear of the index case increased from negative to high positive (4–6), the hazard of their associated household contacts developing leprosy increases by 3.14 times (p<0.001). Being a blood relative was not a risk factor, no gender differences in susceptibility were found. Interpretation We found a dominance of a single variable predicting risk for leprosy transmission–skin smear positive index cases. A small number of cases are maintaining transmission in the household setting. Focus should be performing contact examinations on these households and detecting new skin smear positive index cases. Conducting slit-skin smears on new cases is needed for predicting risk; such services need supporting. If skin smear positive cases are sustaining leprosy infection within the household setting, the administration of single-dose rifampicin (SDR) to household contacts as the sole intervention in Bangladesh will not be effective. The number of newly detected leprosy cases worldwide has remained stable over the last ten years. Household contacts of leprosy cases are at increased risk of leprosy development. Household contact examinations and case detection are critical aspects of control. Specific risk factors (recognizable by field staff) for leprosy development need to be identified to aid these control efforts. Targeted household examinations could increase early case detection: this is important because untreated leprosy cases are sustaining transmission. This is the largest, most comprehensive study of development of leprosy in household contacts conducted recently with a maximum follow-up of 21 years. We found a single dominant risk factor for the development of leprosy in the household setting, namely slit skin smear positivity in the index case. This is important for leprosy control because household contact examinations can be focused on contacts at highest risk. Implementation would be simple as the risk factor is identified by leprosy staff in the field. Prioritising households known to be at highest risk of leprosy development would allow efficient allocation of resources. Our results cast doubt on the success of administering the recommended prophylactic intervention for contacts; the use of this intervention needs to be re-evaluated.
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Characteristics of Oral Lesions in Patients With Hansen Disease. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moronta Castellano G, Villarroel-Dorrego M, Crespo Lessmann L. Caracterización de lesiones bucales de pacientes con enfermedad de Hansen. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:671-677. [DOI: 10.1016/j.ad.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
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Croker C, Phommasith J, Jerskey R, Marutani A, Ochoa MT. Hansen’s Disease: differences in clinical presentation among Latin American and South East Asian born patients identified in Los Angeles County, California (1995–2016). LEPROSY REV 2020. [DOI: 10.47276/lr.91.3.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramos ACV, Gomes D, Santos Neto M, Berra TZ, de Assis IS, Yamamura M, Crispim JDA, Martoreli Júnior JF, Bruce ATI, dos Santos FL, Souza LLL, Alves YM, de Andrade HLP, Arcoverde MAM, Pieri FM, Arcêncio RA. Trends and forecasts of leprosy for a hyperendemic city from Brazil's northeast: Evidence from an eleven-year time-series analysis. PLoS One 2020; 15:e0237165. [PMID: 32764785 PMCID: PMC7413479 DOI: 10.1371/journal.pone.0237165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
This study’s objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017–2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017–2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Dulce Gomes
- Department of Mathematics, University of Évora, Évora, Portugal
| | - Marcelino Santos Neto
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Imperatriz, Maranhão, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Mellina Yamamura
- Nursing Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Tadashi Inomata Bruce
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ludmilla Leidianne Limirio Souza
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Hamilton Leandro Pinto de Andrade
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marcos Augusto Moraes Arcoverde
- Center for Education, Letters and Health, Western Paraná State University, Campus Foz do Iguaçu, Foz do Iguaçu, Paraná, Brazil
| | | | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Souza CDFD, Magalhães MAFM, Luna CF. Hanseníase e carência social: definição de áreas prioritárias em estado endêmico do Nordeste brasileiro. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200007. [PMID: 32130396 DOI: 10.1590/1980-549720200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Introdução: A hanseníase é uma doença que guarda estreita relação com as condições sociais e econômicas. O Brasil é o único país que ainda não alcançou a meta de eliminação da doença como problema de saúde pública. Objetivo: Este trabalho teve como objetivo analisar a associação entre a carência social dos municípios baianos e a detecção de casos novos de hanseníase na população, como instrumento para a definição de áreas prioritárias para intervenção. Metodologia: Trata-se de um estudo ecológico realizado no estado da Bahia, no período de 2001 a 2015. Variáveis analisadas: coeficiente de detecção casos novos, índice de carência social (ICS) e hanseníase em menores de 15 anos. O ICS foi construído com base em quatro variáveis: índice de performance socioeconômica, renda per capita, proporção de extremamente pobres e densidade domiciliar. Na análise espacial, foram utilizadas modelagem bayesiana empírica local e estatística de Moran global e local. Na análise estatística, foram empregados regressão multivariada, espacial e logística, cálculo do odds ratio e análise de variância. Resultados: A hanseníase apresentou distribuição heterogênea no estado, com concentração no eixo norte-oeste e sul. Dos municípios, 60,4% (n = 252) apresentaram muito baixa condição de vida. Observou-se associação entre as condições de vida e a detecção da hanseníase, com maiores coeficientes no grupo de município com melhor condição de vida (p < 0,001). Conclusão: As piores condições atuaram como um impeditivo ao diagnóstico, ao mesmo tempo que ampliaram o risco de adoecimento. As boas condições possuem efeito inverso.
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Santosa C, Rusyati LMM, Adiguna MS, Praharsini IGAA, Wiraguna AAGP, Wardhana M. Correlation of Plasma Level of Insulin-Like Growth Factor-1 (IGF-1) with Bacterial Index on Leprosy Patients in Bali. Ann Dermatol 2020; 32:370-374. [PMID: 33911770 PMCID: PMC7992574 DOI: 10.5021/ad.2020.32.5.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022] Open
Abstract
Background Leprosy is an infection by Mycobacterium leprae, which influenced by cellular immunity. Leprosy tends to occur in low socio-economic and nutrition groups. Researchers try to prove the role of nutrition in the pathogenesis of leprosy. Insulin-like growth factor-1 (IGF-1) as a marker of nutritional status shown to play a role in cellular immunity. Objective To evaluate the correlation between IGF-1 with bacterial index (BI) on leprosy patients in Bali. Methods Cross-sectional study in Sanglah Public General Hospital, Denpasar of patients with paucibacillary (PB) and multibacillary (MB) leprosy were assessed for BI using slit-skin smear. All patients were tested for plasma IGF-1 using chemiluminescent immunometric assay Immulite. All data were analyzed using IBM SPSS ver. 24.0. The study has been approved by local Institutional Review Board with ethical clearance number 2017.02.1.0356. Results Our study involved 44 MB and 2 PB leprosy. The common age group affected was between 31~40 years old (23.9%), male (60.9%), and normal body mass index (BMI) (65.2%). Mean plasma IGF-1 level in PB leprosy was higher (91.07±0.74 ng/ml) than MB (82.74±6.44 ng/ml). The mean IGF-1 level decreases as BI increases in both groups (CI 95%=81.16~85.04; p<0.001). Pearson correlation test shows strong negative correlation (Pearson r=−0.976; p<0.001) with determinant coefficient (R2) showing 95.2% (p<0.001). Conclusion In Balinese leprosy patients, severity of disease status measured by BI were found to be strongly correlated with the plasma IGF-1 level which may help preventing transmission in household contacts by improving nutritional status.
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Affiliation(s)
- Calvin Santosa
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
| | - Luh Made Mas Rusyati
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
| | - Made Swastika Adiguna
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
| | - IGAA Praharsini
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
| | - AAGP Wiraguna
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
| | - Made Wardhana
- Department of Dermatovenereology, Sanglah General Public Hospital, Udayana University, Bali, Indonesia
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Riccò M, Vezzosi L, Balzarini F, Mezzoiuso AG, Ranzieri S, Vaccaro FG, Odone A, Signorelli C. Epidemiology of leprosy in Italy (1920 - 2019): a comprehensive review on existing data. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:7-14. [PMID: 31517884 PMCID: PMC7233659 DOI: 10.23750/abm.v90i9-s.8695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. METHODS The following keywords were used to explore PubMed and Embase: leprosy, Hansen's disease, (Mycobacterium) leprae, Italy, without any chronological restriction. RESULTS We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. CONCLUSION Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.
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Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio EmiliaV.le Amendola n.2 - 42122 REServizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL)Dip. di Prevenzione.
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Guerra MG, Videira TMFC, Morais HAG, Santos TCRN, Taipa RJF, Abreu MA, Vieira RCC, da Fonseca DMGG, Dos Santos JPAA, Pinto SPAM. Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome - a case report. BMC Infect Dis 2019; 19:455. [PMID: 31117984 PMCID: PMC6530132 DOI: 10.1186/s12879-019-4098-9] [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: 10/22/2018] [Accepted: 05/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. Case report A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. Conclusion This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.
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Affiliation(s)
- Miguel Gomes Guerra
- Department of Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | | | - Hugo Alexandre Gomes Morais
- Department of Neurology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | | | - Ricardo Jorge Ferreira Taipa
- Neuropathology Unit, Department of Neuroscience, Centro Hospitalar Universitário do Porto, 4099-001, Porto, Portugal
| | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, 4099-001, Porto, Portugal
| | - Romana Carisa Carvalho Vieira
- Department of Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
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Santos KCBD, Corrêa RDGCF, Rolim ILTP, Pascoal LM, Ferreira AGN. Estratégias de controle e vigilância de contatos de hanseníase: revisão integrativa. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-1104201912122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
RESUMO A pesquisa objetivou analisar as evidências científicas disponíveis sobre controle e vigilância epidemiológica de contatos de hanseníase. Trata-se de uma revisão integrativa norteada pela pergunta: qual a produção científica sobre controle e vigilância epidemiológica de contatos de hanseníase? Incluíram-se estudos primários, publicados em inglês, português ou espanhol nas bases de dados PubMed, Lilacs e Cinahl, entre 2008 e 2018, disponíveis na íntegra. A amostra foi composta por 19 estudos. Identificaram-se três categorias temáticas: fatores de risco para infecção e adoecimento entre os contatos de hanseníase, vigilância ativa de contatos de hanseníase e novas estratégias de controle e vigilância de contatos de hanseníase. Os resultados mostraram estudos voltados à prevenção e controle da hanseníase entre os contatos, entretanto, as evidências apontam novas estratégias que podem ser incorporadas à prática clínica visando à eliminação da hanseníase como problema de saúde pública no País.
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Romanholo HSB, Souza EAD, Ramos Júnior AN, Kaiser ACGCB, Silva IOD, Brito AL, Vasconcellos C. Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality. Rev Bras Enferm 2018; 71:163-169. [PMID: 29324959 DOI: 10.1590/0034-7167-2016-0607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize approach methods for intradomiciliary contacts (IdC) of leprosy cases resident in Northern Brazil, during 2001-2012. METHOD A cross-sectional and descriptive study in the state of Rondônia. Included IdC of leprosy cases diagnosed/reported in SINAN-Ministry of Health (MS), 2001-2012. A semi-structured instrument was applied to the IdCs, with six interventions: complete dermatological examination; complete neurological examination; BCG vaccination; instructions for return to the health unit; BCG guidance; and guidance to mobilize other contacts.Results: From a total of 459 IdCs included, failure to perform the dermatological examination was reported by 191 people (41.6%) and the neurological examination, by 252 (54.9%); 138 (30.1%) did not have BCG indicated and 122 (26.6%) did not receive guidelines; 257 (56.0%) were not advised to return for a new evaluation/follow-up and 186 (40.5%) were not asked to mobilize other contacts. CONCLUSION Despite the favorable indicators of IdC examination coverage in the state, the evaluation process presents patterns that indicate operational quality failures.
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Affiliation(s)
- Helizandra Simoneti Bianchini Romanholo
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo / Universidade Cidade de São Paulo, Postgraduate Program in Health Sciences. São Paulo, Brazil
| | - Eliana Amorim de Souza
- Universidade Federal do Ceará, Medical school, Postgraduate Program in Public Health. Fortaleza, Ceará, Brazil.,Universidade Federal da Bahia, Interdisciplinary Institute of Health Anísio Teixeira, Medicine Course. Vitória da Conquista, Bahia, Brazil
| | - Alberto Novaes Ramos Júnior
- Universidade Federal do Ceará, Medical school, Postgraduate Program in Public Health. Fortaleza, Ceará, Brazil
| | | | | | - Aline Lima Brito
- Universidade Federal do Ceará, Medical school, Postgraduate Program in Public Health. Fortaleza, Ceará, Brazil
| | - Cídia Vasconcellos
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo / Universidade Cidade de São Paulo, Postgraduate Program in Health Sciences. São Paulo, Brazil.,Universidade São Paulo, Medical school. São Paulo, Brazil
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Martinez JD, Cardenas JA. Treatment of Leprosy and Leprosy Reactions. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Multidrug therapy for leprosy: a game changer on the path to elimination. THE LANCET. INFECTIOUS DISEASES 2017; 17:e293-e297. [DOI: 10.1016/s1473-3099(17)30418-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/30/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022]
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Odriozola EPD, Quintana AM, González V, Pasetto RA, Utgés ME, Bruzzone OA, Arnaiz MR. Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination. Mem Inst Oswaldo Cruz 2017; 112:419-427. [PMID: 28591402 PMCID: PMC5446231 DOI: 10.1590/0074-02760160490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/04/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.
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Affiliation(s)
| | | | - Victor González
- Programa Nacional para el Control de Tuberculosis y Lepra, Argentina
| | | | - María Eugenia Utgés
- Centro de Diagnóstico e Investigación en Endemo-Epidemias, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - María Rosa Arnaiz
- Centro de Diagnóstico e Investigación en Endemo-Epidemias, Ciudad Autónoma de Buenos Aires, Argentina
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Phillips DA, Ferreira JA, Ansah D, Teixeira HSA, Kitron U, de Filippis T, de Alcântara MH, Fairley JK. A tale of two neglected tropical infections: using GIS to assess the spatial and temporal overlap of schistosomiasis and leprosy in a region of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2017; 112:275-280. [PMID: 28327791 PMCID: PMC5354614 DOI: 10.1590/0074-02760160395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite public health efforts to reduce the global burden of leprosy, gaps remain in the knowledge surrounding transmission of infection. Helminth co-infections have been associated with a shift towards the lepromatous end of the disease spectrum, potentially increasing transmission in co-endemic areas. OBJECTIVES Using this biologically plausible association, we conducted a geographic information systems (GIS) study to investigate the spatial associations of schistosomiasis and leprosy in an endemic area of Minas Gerais (MG), Brazil. METHODS Data on new cases of Mycobacterium leprae and Schistosoma mansoni infections from 2007-2014 were retrieved from the Brazilian national notifiable diseases information system for seven municipalities in and surrounding Vespasiano, MG. A total of 139 cases of leprosy and 200 cases of schistosomiasis were mapped to a municipality level. For one municipality, cases were mapped to a neighborhood level and a stratified analysis was conducted to identify spatial associations. FINDINGS A relative risk of 6.80 [95% confidence interval (CI) 1.46 - 31.64] of leprosy was found in neighborhoods with schistosomiasis. Incidence rates of leprosy increased with corresponding incidence rates of schistosomiasis, and the temporal trends of both infections were similar. CONCLUSIONS The associations found in this project support the hypothesis that helminth infections may influence the transmission of leprosy in co-endemic areas.
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Affiliation(s)
| | | | - Deidra Ansah
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, United States
| | - Herica SA Teixeira
- Escola de Medicina, Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brasil
- Secretaria Municipal de Saúde, Vespasiano, MG, Brasil
| | - Uriel Kitron
- Emory University, Department of Environmental Science, Atlanta, GA, United States
| | - Thelma de Filippis
- Escola de Medicina, Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brasil
| | | | - Jessica K Fairley
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
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Grzybowski A, Virmond M. Leprosy: Between biblical descriptions to advances in immunology and diagnostic techniques. Clin Dermatol 2016; 34:1-2. [DOI: 10.1016/j.clindermatol.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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