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Prakoeswa FRS, Haningtyas N, Dewi LM, Handoko EJ, Azenta MT, Ilyas MF. The role of CXCL10 as a biomarker for immunological response among patients with leprosy: a systematic literature review. PeerJ 2024; 12:e17170. [PMID: 38590701 PMCID: PMC11000641 DOI: 10.7717/peerj.17170] [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: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Involvement of a chemokine known as C-X-C motif chemokine ligand 10 or CXCL10 in the immunopathology of leprosy has emerged as a possible immunological marker for leprosy diagnosis and needed to be investigate further. The purpose of this systematic review is to assess CXCL10's potential utility as a leprosy diagnostic tool and evaluation of therapy. Methods This systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. A thorough search was carried out to find relevant studies only in English and limited in humans published up until September 2023 using PubMed, Scopus, Science Direct, and Wiley Online Library database with keywords based on medical subject headings (MeSH) and no exclusion criteria. The Newcastle-Ottawa Scale (NOS) was utilized for quality assessment, while the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was utilized for assessing the risk of bias. Additionally, a narrative synthesis was conducted to provide a comprehensive review of the results. Results We collected a total of 115 studies using defined keywords and 82 studies were eliminated after titles and abstracts were screened. We assessed the eligibility of the remaining 26 reports in full text and excluded four studies due to inappropriate study design and two studies with incomplete outcome data. There were twenty included studies in total with total of 2.525 samples. The included studies received NOS quality evaluation scores ranging from 6 to 8. The majority of items in the risk bias assessment, using RoBANS, across all included studies yielded low scores. However, certain items related to the selection of participants and confounding variables showed variations. Most of studies indicate that CXCL10 may be a helpful immunological marker for leprosy diagnosis, particularly in leprosy reactions as stated in seven studies. The results are better when paired with other immunological markers. Its effectiveness in field-friendly diagnostic tools makes it one of the potential biomarkers used in diagnosing leprosy patients. Additionally, CXCL10 may be utilized to assess the efficacy of multidrug therapy (MDT) in leprosy patients as stated in three studies. Conclusion The results presented in this systematic review supports the importance of CXCL10 in leprosy diagnosis, particularly in leprosy responses and in tracking the efficacy of MDT therapy. Using CXCL10 in clinical settings might help with leprosy early diagnosis. Yet the findings are heterogenous, thus more investigation is required to determine the roles of CXCL10 in leprosy while taking into account for additional confounding variables.
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Affiliation(s)
- Flora Ramona Sigit Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
- Department of Dermatology and Venereology, PKU Muhammadiyah Surakarta Hospital, Surakarta, Central Java, Indonesia
| | - Nabila Haningtyas
- Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
| | - Listiana Masyita Dewi
- Department of Microbiology, Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
| | | | - Moch. Tabriz Azenta
- Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
| | - Muhana Fawwazy Ilyas
- Department of Neurology, Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
- Department of Anatomy and Embryology, Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
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Hinders DC, Taal AT, Lisam S, da Rocha AM, Banstola NL, Bhandari P, Saha A, Kishore J, Fernandes VO, Chowdhury AS, van 't Noordende AT, Mieras L, Richardus JH, van Brakel WH. The PEP++ study protocol: a cluster-randomised controlled trial on the effectiveness of an enhanced regimen of post-exposure prophylaxis for close contacts of persons affected by leprosy to prevent disease transmission. BMC Infect Dis 2024; 24:226. [PMID: 38378497 PMCID: PMC10877766 DOI: 10.1186/s12879-024-09125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. METHODS The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 - 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 - 600 mg) and clarithromycin (150 - 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox' proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. DISCUSSION Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. TRIAL REGISTRATION NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060.
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Affiliation(s)
| | | | | | | | | | | | | | - Jugal Kishore
- Vardhman Mahavir Medical College/Safdarjung Hospital, Delhi, India
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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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Radtke KK, Hill J, Schoenmakers A, Mulder C, van der Grinten E, Overbeek F, Salazar-Austin N, de Medeiros Cordeiro Nascimento W, van Brakel W, Weld E. Predicted Pharmacokinetic Interactions Between Hormonal Contraception and Single or Intermittently Dosed Rifampicin. J Clin Pharmacol 2023; 63:1283-1289. [PMID: 37409982 DOI: 10.1002/jcph.2303] [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: 04/06/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
The scale-up of rifampicin-based prevention regimens is an essential part of the global leprosy strategy. Daily rifampicin may reduce the effectiveness of the oral contraceptive pill (OCP), but little is known about the effects of rifampicin at the less frequent dosing intervals used for leprosy prophylaxis. As many women of reproductive age rely on OCP for family planning, evaluating the interaction with less-than-daily rifampicin regimens would enhance the scalability and acceptability of leprosy prophylaxis. Using a semi-mechanistic pharmacokinetic model of rifampicin induction, we simulated predicted changes in OCP clearance when coadministered with varying rifampicin dosing schedules. Rifampicin given as a single dose (600 or 1200 mg) or 600 mg every 4 weeks was not predicted to result in a clinically relevant interaction with OCP, defined as a >25% increase in clearance. Simulations of daily rifampicin were predicted to increase OCP clearance within the range of observed changes previously reported in the literature. Therefore, our findings suggest that OCP efficacy will be maintained when coadministered with rifampicin-based leprosy prophylaxis regimens of 600 mg once, 1200 mg once, and 600 mg every 4 weeks. This work provides reassurance to stakeholders that leprosy prophylaxis can be used with OCP without any additional recommendations for contraception prevention.
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Affiliation(s)
- Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy Hill
- KNCV Tuberculosis Foundation, Technical Division, The Hague, The Netherlands
- Centenary Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - Christiaan Mulder
- KNCV Tuberculosis Foundation, Technical Division, The Hague, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Floor Overbeek
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Nicole Salazar-Austin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Wim van Brakel
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Ethel Weld
- Department of Medicine, Divisions of Infectious Diseases and Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pierneef L, Malaviya P, van Hooij A, Sundar S, Singh AK, Kumar R, de Jong D, Meuldijk M, Kumar A, Zhou Z, Cloots K, Corstjens P, Hasker E, Geluk A. Field-friendly anti-PGL-I serosurvey in children to monitor Mycobacterium leprae transmission in Bihar, India. Front Med (Lausanne) 2023; 10:1260375. [PMID: 37828950 PMCID: PMC10565223 DOI: 10.3389/fmed.2023.1260375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Background It has been amply described that levels of IgM antibodies against Mycobacterium leprae (M. leprae) phenolic glycolipid I (PGL-I) correlate strongly with the bacterial load in an infected individual. These findings have generated the concept of using seropositivity for antibodies against M. leprae PGL-I as an indicator of the proportion of the population that has been infected. Although anti-PGL-I IgM levels provide information on whether an individual has ever been infected, their presence cannot discriminate between recent and past infections. Since infection in (young) children by definition indicates recent transmission, we piloted the feasibility of assessment of anti-PGL-I IgM seroprevalence among children in a leprosy endemic area in India as a proxy for recent M. leprae transmission. Material and methods A serosurvey for anti-PGL-I IgM antibodies among children in highly leprosy endemic villages in Bihar, India, was performed, applying the quantitative anti-PGL-I UCP-LFA cassette combined with low-invasive, small-volume fingerstick blood (FSB). Results Local staff obtained FSB of 1,857 children (age 3-11 years) living in 12 leprosy endemic villages in Bihar; of these, 215 children (11.58%) were seropositive for anti-PGL-I IgM. Conclusion The anti-PGL-I seroprevalence level of 11.58% among children corresponds with the seroprevalence levels described in studies in other leprosy endemic areas over the past decades where no prophylactic interventions have taken place. The anti-PGL-I UCP-LFA was found to be a low-complexity tool that could be practically combined with serosurveys and was well-accepted by both healthcare staff and the population. On route to leprosy elimination, quantitative anti-PGL-I serology in young children holds promise as a strategy to monitor recent M. leprae transmission in an area.
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Affiliation(s)
- Louise Pierneef
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Paritosh Malaviya
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anouk van Hooij
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Abhishek Kumar Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Danielle de Jong
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike Meuldijk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Awnish Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Zijie Zhou
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Taal AT, Garg A, Lisam S, Agarwal A, Barreto JG, van Brakel WH, Richardus JH, Blok DJ. Identifying clusters of leprosy patients in India: A comparison of methods. PLoS Negl Trop Dis 2022; 16:e0010972. [PMID: 36525390 PMCID: PMC9757546 DOI: 10.1371/journal.pntd.0010972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Preventive interventions with post-exposure prophylaxis (PEP) are needed in leprosy high-endemic areas to interrupt the transmission of Mycobacterium leprae. Program managers intend to use Geographic Information Systems (GIS) to target preventive interventions considering efficient use of public health resources. Statistical GIS analyses are commonly used to identify clusters of disease without accounting for the local context. Therefore, we propose a contextualized spatial approach that includes expert consultation to identify clusters and compare it with a standard statistical approach. METHODOLOGY/PRINCIPAL FINDINGS We included all leprosy patients registered from 2014 to 2020 at the Health Centers in Fatehpur and Chandauli districts, Uttar Pradesh State, India (n = 3,855). Our contextualized spatial approach included expert consultation determining criteria and definition for the identification of clusters using Density Based Spatial Clustering Algorithm with Noise, followed by creating cluster maps considering natural boundaries and the local context. We compared this approach with the commonly used Anselin Local Moran's I statistic to identify high-risk villages. In the contextualized approach, 374 clusters were identified in Chandauli and 512 in Fatehpur. In total, 75% and 57% of all cases were captured by the identified clusters in Chandauli and Fatehpur, respectively. If 100 individuals per case were targeted for PEP, 33% and 11% of the total cluster population would receive PEP, respectively. In the statistical approach, more clusters in Chandauli and fewer clusters in Fatehpur (508 and 193) and lower proportions of cases in clusters (66% and 43%) were identified, and lower proportions of population targeted for PEP was calculated compared to the contextualized approach (11% and 11%). CONCLUSION A contextualized spatial approach could identify clusters in high-endemic districts more precisely than a standard statistical approach. Therefore, it can be a useful alternative to detect preventive intervention targets in high-endemic areas.
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Affiliation(s)
- Anneke T. Taal
- NLR, Amsterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | | | | | | | | | | | - David J. Blok
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sugawara-Mikami M, Tanigawa K, Kawashima A, Kiriya M, Nakamura Y, Fujiwara Y, Suzuki K. Pathogenicity and virulence of Mycobacterium leprae. Virulence 2022; 13:1985-2011. [PMID: 36326715 PMCID: PMC9635560 DOI: 10.1080/21505594.2022.2141987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae (M. leprae) and M. lepromatosis, an obligate intracellular organism, and over 200,000 new cases occur every year. M. leprae parasitizes histiocytes (skin macrophages) and Schwann cells in the peripheral nerves. Although leprosy can be treated by multidrug therapy, some patients relapse or have a prolonged clinical course and/or experience leprosy reaction. These varying outcomes depend on host factors such as immune responses against bacterial components that determine a range of symptoms. To understand these host responses, knowledge of the mechanisms by which M. leprae parasitizes host cells is important. This article describes the characteristics of leprosy through bacteriology, genetics, epidemiology, immunology, animal models, routes of infection, and clinical findings. It also discusses recent diagnostic methods, treatment, and measures according to the World Health Organization (WHO), including prevention. Recently, the antibacterial activities of anti-hyperlipidaemia agents against other pathogens, such as M. tuberculosis and Staphylococcus aureus have been investigated. Our laboratory has been focused on the metabolism of lipids which constitute the cell wall of M. leprae. Our findings may be useful for the development of future treatments.
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Affiliation(s)
- Mariko Sugawara-Mikami
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,West Yokohama Sugawara Dermatology Clinic, Yokohama, Japan
| | - Kazunari Tanigawa
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Akira Kawashima
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Yoko Fujiwara
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Heffernan C, Savić RM, Long RG, Raviglione MC, Ferrara G. Responding to the post-pandemic crisis: post-exposure prophylaxis for TB. Int J Tuberc Lung Dis 2022; 26:807-810. [PMID: 35996295 PMCID: PMC9423019 DOI: 10.5588/ijtld.22.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C Heffernan
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - R M Savić
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - R G Long
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada, Alberta Health Services, Edmonton, AB, Canada
| | - M C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - G Ferrara
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada, Alberta Health Services, Edmonton, AB, Canada
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Drug resistance in leprosy: an update following 70 years of chemotherapy. Infect Dis Now 2022; 52:243-251. [DOI: 10.1016/j.idnow.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
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10
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Boodman C, Keystone J, Bogoch II. Leprosy chemoprophylaxis of household contacts: A survey of Canadian infectious disease and tropical medicine specialists. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:8-13. [PMID: 36340847 PMCID: PMC9603017 DOI: 10.3138/jammi-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Leprosy is uncommon in Canada. However, immigration from leprosy-endemic areas has introduced the infection to a Canadian context, in which most doctors have little knowledge of the disease. Although post-exposure chemoprophylaxis (PEP) is reported to decrease leprosy transmission, no Canadian guidelines advise clinical decision making about leprosy PEP. Here, we characterize the practice patterns of Canadian infectious disease specialists with respect to leprosy PEP and screening of household contacts by yearly physical examinations. METHODS Canadian infectious disease specialists with known experience treating leprosy were identified using university faculty lists. An online anonymous survey was distributed. Certain questions allowed more than one response. RESULTS The survey response rate was 46.5% (20/43). Thirty-five percent responded that PEP is needed for household contacts, 40.0% responded that PEP is not needed for household contacts, and 25.0% did not know whether PEP is needed (multinomial test p = 0.79). Twenty-five percent responded that PEP should be given to all household contacts, 62.5% responded that PEP should be given to contacts of multibacillary cases, and 25.0% responded that PEP should be given to contacts who are genetically related to the index case. For specialists who prescribe PEP, 57.1% use rifampicin, ofloxacin (levofloxacin), and minocycline; 14.3% prescribe single-dose rifampicin; and 28.6% prescribe multiple doses of rifampicin (multinomial test p = 0.11). In addition, 68.4% recommend yearly screening of household contacts, whereas 31.6% do not (multinomial test p = 0.17). CONCLUSION Consensus among Canadian infectious diseases specialists is lacking regarding leprosy PEP and screening of household contacts.
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Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jay Keystone
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Deceased 3 September 2019
| | - Isaac I Bogoch
- Division of Infectious diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Shingda SR, Ali PS, Gandhare NV, Pathan NB, Ansari NH. Investigation of mechanistic interactions between Rifampicin and bovine serum albumin in the presence of different surfactants. J DISPER SCI TECHNOL 2021. [DOI: 10.1080/01932691.2021.1997759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sampat R. Shingda
- Department of Chemistry, Arvindbabu Deshmukh Mahavidyalaya, Bharsinghi, RTM, Nagpur University, Nagpur, India
| | - Parvez S. Ali
- Center for Health Studies, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Nilesh V. Gandhare
- Department of Chemistry, Nabira Mahavidyalaya, RTM, Nagpur University, Katol, India
| | - Naziyanaz B. Pathan
- Department of Chemistry, Institute of Science, RTM, Nagpur University, Nagpur, India
| | - Nizamul H. Ansari
- Department of Physical Sciences (Chemistry), Sant Baba Bhag Singh University, Jalandhar, Punjab, India
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12
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BCG-induced immunity profiles in household contacts of leprosy patients differentiate between protection and disease. Vaccine 2021; 39:7230-7237. [PMID: 34688497 DOI: 10.1016/j.vaccine.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
Leprosy is an infectious disease caused by Mycobacterium leprae leading to irreversible disabilities along with social exclusion. Leprosy is a spectral disease for which the clinical outcome after M. leprae infection is determined by host factors. The spectrum spans from anti-inflammatory T helper-2 (Th2) immunity concomitant with large numbers of bacteria as well as antibodies against M. leprae antigens in multibacillary (MB) leprosy, to paucibacillary (PB) leprosy characterised by strong pro-inflammatory, Th1 as well as Th17 immunity. Despite decades of availability of adequate antibiotic treatment, transmission of M. leprae is unabated. Since individuals with close and frequent contact with untreated leprosy patients are particularly at risk to develop the disease themselves, prophylactic strategies currently focus on household contacts of newly diagnosed patients. It has been shown that BCG (re)vaccination can reduce the risk of leprosy. However, BCG immunoprophylaxis in contacts of leprosy patients has also been reported to induce PB leprosy, indicating that BCG (re)vaccination may tip the balance between protective immunity and overactivation immunity causing skin/nerve tissue damage. In order to identify who is at risk of developing PB leprosy after BCG vaccination, amongst individuals who are chronically exposed to M. leprae, we analyzed innate and adaptive immune markers in whole blood of household contacts of newly diagnosed leprosy patients in Bangladesh, some of which received BCG vaccination. As controls, individuals from the same area without known contact with leprosy patients were similarly assessed. Our data show the added effect of BCG vaccination on immune markers on top of the effect already induced by M. leprae exposure. Moreover, we identified BCG-induced markers that differentiate between protective and disease prone immunity in those contacts.
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A 5-year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy. Biomed Rep 2021; 15:88. [PMID: 34589216 DOI: 10.3892/br.2021.1464] [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: 03/16/2020] [Accepted: 06/02/2021] [Indexed: 11/05/2022] Open
Abstract
Subclinical leprosy is an infectious disease in which the immune system remains infected with Mycobacterium leprae (M. leprae). The progress of subclinical leprosy to clinical cases within 1 year of infection is 1.5%, with an increase to 6% in the following 4 years. Rifampicin is frequently used for prevention of leprosy, and clarithromycin has a bactericidal effect on M. leprae. Thus, the combination of both is expected to improve disease control in patients with subclinical leprosy. The aim of the present study was to evaluate the efficacy of a chemoprophylactic treatment involving rifampicin and clarithromycin against subclinical leprosy in elementary school children from endemic areas of East Java over a 5-year period. The study was performed between 2011 and 2015. Samples were collected from 2,548 healthy elementary school children in Nguling (Pasuruan) and Raas (Sumenep), and analysed using ELISA for anti-PGL (phenolic glycolipid)-1 IgM antibodies. Children who were seropositive for anti-PGL-1 IgM antibodies received a chemoprophylactic regimen consisting of rifampicin (300 mg/day) and clarithromycin (250 mg/day) daily for the initial 10 days, followed by the same regimen every 2 weeks for 3 months. Clinical and serological evaluations were performed annually for 5 years. Amongst the 2,548 healthy elementary school children, 200 were seropositive. The anti-PGL-1 IgM antibody levels significantly decreased between 2011 and 2015 in Nguling (from 1,066.7 to 137.4 U/ml) and Raas (from 773.1 to 563.4 U/ml), the levels decreased every year. In addition, the proportion of patients with decreased anti-PGL-1 IgM antibody levels was consistently higher than patients with increased anti-PGL-1 IgM antibody levels in all periods, except during 2013-2014, in Nguling and Raas. Chemoprophylactic treatment involving rifampicin and clarithromycin may thus be effective against subclinical leprosy amongst elementary school children.
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Abstract
Neuropathy and related disabilities are the major medical consequences of leprosy, which remains a global medical concern. Despite major advances in understanding the mechanisms of M. leprae entry into peripheral nerves, most aspects of the pathogenesis of leprosy neuropathy remain poorly understood. Sensory loss is characteristic of leprosy, but neuropathic pain is sometimes observed. Effective anti-microbial therapy is available, but neuropathy remains a problem especially if diagnosis and treatment are delayed. Currently there is intense interest in post-exposure prophylaxis with single-dose rifampin in endemic areas, as well as with enhanced prophylactic regimens in some situations. Some degree of nerve involvement is seen in all cases and neuritis may occur in the absence of leprosy reactions, but acute neuritis commonly accompanies both Type 1 and Type 2 leprosy reactions and may be difficult to manage. A variety of established as well as new methods for the early diagnosis and assessment of leprosy neuropathy are reviewed. Corticosteroids offer the primary treatment for neuritis and for subclinical neuropathy in leprosy, but success is limited if nerve function impairment is present at the time of diagnosis. A candidate vaccine has shown apparent benefit in preventing nerve injury in the armadillo model. The development of new therapeutics for leprosy neuropathy is greatly needed.
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Affiliation(s)
- Gigi J Ebenezer
- Neurology/Cutaneous Nerve Laboratory, Johns Hopkins University, The John G Rangos Bldg, room: 440, 855 North Wolfe Street, Baltimore, MD, 21205, USA.
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Pierneef L, van Hooij A, Taal A, Rumbaut R, Nobre ML, van Brakel W, Geluk A. Detection of anti-M. leprae antibodies in children in leprosy-endemic areas: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009667. [PMID: 34449763 PMCID: PMC8428563 DOI: 10.1371/journal.pntd.0009667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/09/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy elimination primarily targets transmission of Mycobacterium leprae which is not restricted to patients' households. As interruption of transmission is imminent in many countries, a test to detect infected asymptomatic individuals who can perpetuate transmission is required. Antibodies directed against M. leprae antigens are indicative of M. leprae infection but cannot discriminate between active and past infection. Seroprevalence in young children, however, reflects recent M. leprae infection and may thus be used to monitor transmission in an area. Therefore, this literature review aimed to evaluate what has been reported on serological tests measuring anti-M. leprae antibodies in children without leprosy below the age of 15 in leprosy-endemic areas. METHODS AND FINDINGS A literature search was performed in the databases Pubmed, Infolep, Web of Science and The Virtual Health Library. From the 724 articles identified through the search criteria, 28 full-text articles fulfilled all inclusion criteria. Two additional papers were identified through snowballing, resulting in a total of 30 articles reporting data from ten countries. All serological tests measured antibodies against phenolic glycolipid-I or synthetic derivatives thereof, either quantitatively (ELISA or UCP-LFA) or qualitatively (ML-flow or NDO-LID rapid test). The median seroprevalence in children in endemic areas was 14.9% and was stable over time if disease incidence remained unchanged. Importantly, seroprevalence decreased with age, indicating that children are a suitable group for sensitive assessment of recent M. leprae infection. However, direct comparison between areas, solely based on the data reported in these studies, was impeded by the use of different tests and variable cut-off levels. CONCLUSIONS Quantitative anti-PGL-I serology in young children holds promise as a screening test to assess M. leprae infection and may be applied as a proxy for transmission and thereby as a means to monitor the effect of (prophylactic) interventions on the route to leprosy elimination.
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Affiliation(s)
- Louise Pierneef
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Anouk van Hooij
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Raisa Rumbaut
- National Leprosy Program, Ministry of Public Health of Cuba, Havana, Cuba
| | - Mauricio Lisboa Nobre
- Giselda Trigueiro Hospital and Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Annemieke Geluk
- Dept. Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Tawfik GM, Biala M, Yousef YM, Tiwari R, Dobs M, Lotfy CI, Farrag DA, Hue AT, Yotsu RR, Huy NT. Efficacy of chemoprophylaxis and immunoprophylaxis in leprosy prevention: a systematic review and network meta-analysis of randomized controlled trials. Clin Microbiol Infect 2021; 27:1754-1761. [PMID: 34332107 DOI: 10.1016/j.cmi.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vaccination and single-dose rifampin are the main proven effective intervention types for preventing leprosy among contacts of Mycobacterium leprae endemic areas. Currently, no high-quality evidence is available regarding the best prophylactic intervention. OBJECTIVES Our primary study aim is to detect the most effective prophylactic intervention for the prevention of leprosy. METHODS In May 2019, 12 databases were searched systematically. Updated search terms were developed in March 2020 to complete an updated search. All randomized controlled trials (RCTs) comparing the different types of chemoprophylactic and immunoprophylactic interventions in leprosy prevention were included. Our participants were contacts of patients with leprosy or people residing in leprosy endemic communities. We searched for different types of chemoprophylactic and immunoprophylactic interventions used in leprosy prevention. We used network meta-analysis and meta-analysis. Quality assessment was performed using Cochrane Risk of Bias for included RCTs, in which all included RCTs were rated to be low to moderate risk. We registered our protocol in Prospero with ID CRD42019143207. RESULTS Among 11 included studies (326 264 patients) from original and updated search terms, eight were eligible for network meta-analysis (NMA) while four were eligible for MA. Findings suggest that Bacillus Calmette-Guérin (BCG) vaccination was the most effective intervention compared to placebo (risk ratios (RRs) 0.49 (0.30, 0.80), p 0.77), followed by combined BCG vaccination and single-dose rifampicin (SDR) with similarly low values (RR 48%, p 0.77). BCG revaccination was the least effective intervention compared to placebo (RR 1.08 (0.36, 3.22), p 0.26). CONCLUSION Compared to placebo, the BCG vaccine was the most effective prophylactic intervention. The combination of BCG vaccination + SDR had nearly the same efficacy as BCG vaccination alone, while BCG revaccination was the least effective. Thus, vaccination proved to be a more effective treatment than SDR alone. A well-designed multicenter RCT is warranted to evaluate the safety of these vaccines.
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Affiliation(s)
- Gehad Mohamed Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan.
| | - Marwa Biala
- Faculty of Medicine, Tripoli University, Tripoli, Libya.
| | - Yomna Mahmoud Yousef
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
| | - Ranjit Tiwari
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, 44600, Nepal.
| | - Monica Dobs
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Assuit University, Assuit, Egypt.
| | - Caroline Ibrahim Lotfy
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Pharmacy, Assuit University, Assuit, Egypt.
| | - Doha Ahmed Farrag
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Anh Tran Hue
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; School of Medicine, International University of Health and Welfare, Tochigi, Japan.
| | - Rie Roselyne Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Nguyen Tien Huy
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
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Leprosy postexposure prophylaxis with single-dose rifampicin: Nepalese dermatologist's dilemma. PLoS Negl Trop Dis 2021; 15:e0009039. [PMID: 33830989 PMCID: PMC8031444 DOI: 10.1371/journal.pntd.0009039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Leprosy post-exposure prophylaxis: innovation and precision public health. LANCET GLOBAL HEALTH 2021; 9:e8-e9. [DOI: 10.1016/s2214-109x(20)30512-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022]
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van Hooij A, Tjon Kon Fat EM, de Jong D, Khatun M, Soren S, Chowdhury AS, Chandra Roy J, Alam K, Kim JP, Richardus JH, Geluk A, Corstjens PLAM. Prototype multi-biomarker test for point-of-care leprosy diagnostics. iScience 2020; 24:102006. [PMID: 33490914 PMCID: PMC7807156 DOI: 10.1016/j.isci.2020.102006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 12/23/2020] [Indexed: 12/27/2022] Open
Abstract
To end the decade-long, obstinately stagnant number of new leprosy cases, there is an urgent need for field-applicable diagnostic tools that detect infection with Mycobacterium leprae, leprosy's etiologic agent. Since immunity against M. leprae is characterized by humoral and cellular markers, we developed a lateral flow test measuring multiple host proteins based on six previously identified biomarkers for various leprosy phenotypes. This multi-biomarker test (MBT) demonstrated feasibility of quantitative detection of six host serum proteins simultaneously, jointly allowing discrimination of patients with multibacillary and paucibacillary leprosy from control individuals in high and low leprosy endemic areas. Pilot testing of fingerstick blood showed similar MBT performance in point-of-care (POC) settings as observed for plasma and serum. Thus, this newly developed prototype MBT measures six biomarkers covering immunity against M. leprae across the leprosy spectrum. The MBT thereby provides the basis for immunodiagnostic POC tests for leprosy with potential for other (infectious) diseases as well. Prototype MBT that quantitatively detects six host-derived biomarkers is developed The immunopathological spectrum of leprosy is ideally suited to evaluate the MBT MBT discriminated patients with leprosy from controls in a high and non-endemic area Application of the MBT using low invasive fingerstick blood is technically feasible
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Affiliation(s)
- Anouk van Hooij
- Department of Infectious Diseases Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Elisa M Tjon Kon Fat
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Danielle de Jong
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Marufa Khatun
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Santosh Soren
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Abu Sufian Chowdhury
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Johan Chandra Roy
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Khorshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Jong-Pill Kim
- Institute for Leprosy Research, Korean Hansen Welfare Association, Gyeonggi-do, South Korea
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
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Steinmann P, Dusenbury C, Addiss D, Mirza F, Smith WCS. A comprehensive research agenda for zero leprosy. Infect Dis Poverty 2020; 9:156. [PMID: 33183339 PMCID: PMC7658911 DOI: 10.1186/s40249-020-00774-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leprosy control achieved dramatic success in the 1980s-1990s with the implementation of short course multidrug therapy, which reduced the global prevalence of leprosy to less than 1 in 10 000 population. However, a period of relative stagnation in leprosy control followed this achievement, and only limited further declines in the global number of new cases reported have been achieved over the past decade. MAIN TEXT In 2016, major stakeholders called for the development of an innovative and comprehensive leprosy strategy aimed at reducing the incidence of leprosy, lowering the burden of disability and discrimination, and interrupting transmission. This led to the establishment of the Global Partnership for Zero Leprosy (GPZL) in 2018, with partners aligned around a shared Action Framework committed to achieving the WHO targets by 2030 through national leprosy program capacity-building, resource mobilisation and an enabling research agenda. GPZL convened over 140 experts from more than 20 countries to develop a research agenda to achieve zero leprosy. The result is a detailed research agenda focusing on diagnostics, mapping, digital technology and innovation, disability, epidemiological modelling and investment case, implementation research, stigma, post exposure prophylaxis and transmission, and vaccines. This research agenda is aligned with the research priorities identified by other stakeholders. CONCLUSIONS Developing and achieving consensus on the research agenda for zero leprosy is a significant step forward for the leprosy community. In a next step, research programmes must be developed, with individual components of the research agenda requiring distinct expertise, varying in resource needs, and operating over different timescales. Moving toward zero leprosy now requires partner alignment and new investments at all stages of the research process, from discovery to implementation.
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Affiliation(s)
- Peter Steinmann
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Courtenay Dusenbury
- Global Partnership for Zero Leprosy, Task Force for Global Health, Decatur, GA, USA
| | - David Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
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Abstract
Nepal has long been known as a leprosy endemic country. However, in 2010, the application of World Health Organization guidelines in Nepal led to the misleading determination that leprosy had been 'eliminated' there. This misnomer has contributed to the current situation in which leprosy is on the increase. A national active case finding program is urgently required.
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Schoenmakers A, Mieras L, Budiawan T, van Brakel WH. The State of Affairs in Post-Exposure Leprosy Prevention: A Descriptive Meta-Analysis on Immuno- and Chemo-Prophylaxis. Res Rep Trop Med 2020; 11:97-117. [PMID: 33117053 PMCID: PMC7573302 DOI: 10.2147/rrtm.s190300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Annually, over 200,000 people are diagnosed with leprosy, also called Hansen’s disease. This number has been relatively stable over the past years. Progress has been made in the fields of chemoprophylaxis and immunoprophylaxis to prevent leprosy, with a primary focus on close contacts of patients. In this descriptive meta-analysis, we summarize the evidence and identify knowledge gaps regarding post-exposure prophylaxis against leprosy. Methods A systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted by searching the medical scientific databases Cochrane, Embase, Pubmed/MEDLINE, Research Gate, Scopus and Web of Science on Jan. 22, 2020, using a combination of synonyms for index terms in four languages: “leprosy” and “population” or “contacts” and “prevention” or “prophylaxis.” Subsequently, Infolep.org and Google Scholar were searched and the "snowball method" was used to retrieve other potentially relevant literature. The found articles were screened for eligibility using predetermined inclusion and exclusion criteria. Results After deduplication, 1,515 articles were screened, and 125 articles were included in this descriptive meta-analysis. Immunoprophylaxis by bacillus Calmette-Guérin (BCG) vaccination is known to provide protection against leprosy. The protection it offers is higher in household contacts of leprosy patients compared with the general population and is seen to decline over time. Contact follow-up screening is important in the first period after BCG administration, as a substantial number of new leprosy patients presents three months post-vaccination. Evidence for the benefit of re-vaccination is conflicting. The World Health Organization (WHO) included BCG in its Guidelines for the Diagnosis, Treatment and Prevention of Leprosy by stating that BCG at birth should be maintained in at least all leprosy high-burden regions. Literature shows that several vaccination interventions with other immunoprophylactic agents demonstrate similar or slightly less efficacy in leprosy risk reduction compared with BCG. However, most of these studies do not exclusively focus on post-exposure prophylaxis. Two vaccines are considered future candidates for leprosy prophylaxis: Mycobacterium indicus pranii (MiP) and LepVax. For chemoprophylaxis, trials were performed with dapsone/acedapsone, rifampicin, and ROM, a combination of rifampicin, ofloxacin, and minocycline. Single-dose rifampicin is favored as post-exposure prophylaxis, abbreviated as SDR-PEP. It demonstrated a protective effect of 57% in the first two years after administration to contacts of leprosy patients. It is inexpensive, and adverse events are rare. The risk of SDR-PEP inducing rifampicin resistance is considered negligible, but continuous monitoring in accordance with WHO policies should be encouraged. The integration of contact screening and SDR-PEP administration into different leprosy control programs was found to be feasible and well accepted. Since 2018, SDR-PEP is included in the WHO Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. Conclusion Progress has been made in the areas of chemoprophylaxis and immunoprophylaxis to prevent leprosy in contacts of patients. Investing in vaccine studies, like LepVax and MiP, and increasing harmonization between tuberculosis (TB) and leprosy research groups is important. SDR-PEP is promising as a chemoprophylactic agent, and further implementation should be promoted. More chemoprophylaxis research is needed on: enhanced medication regimens; interventions in varying (epidemiological) settings, including focal mass drug administration (fMDA); specific approaches per contact type; combinations with screening variations and field-friendly rapid tests, if available in the future; community and health staff education; ongoing antibiotic resistance surveillance; and administering chemoprophylaxis with SDR-PEP prior to BCG administration. Additionally, both leprosy prophylactic drug registration nationally and prophylactic drug availability globally at low or no cost are important for the implementation and further upscaling of preventive measures against leprosy, such as SDR-PEP and new vaccines.
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Lenz SM, Collins JH, Ray NA, Hagge DA, Lahiri R, Adams LB. Post-exposure prophylaxis (PEP) efficacy of rifampin, rifapentine, moxifloxacin, minocycline, and clarithromycin in a susceptible-subclinical model of leprosy. PLoS Negl Trop Dis 2020; 14:e0008583. [PMID: 32936818 PMCID: PMC7494095 DOI: 10.1371/journal.pntd.0008583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials. METHODOLOGY/PRINCIPAL FINDINGS Athymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation. CONCLUSIONS/SIGNIFICANCE The delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3-4 months) and late (8-9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.
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Affiliation(s)
| | - Jaymes H. Collins
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Nashone A. Ray
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Deanna A. Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Ramanuj Lahiri
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Linda B. Adams
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
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Shu Kurizky P, Dos Santos Neto LL, Barbosa Aires R, Henrique da Mota LM, Martins Gomes C. Opportunistic tropical infections in immunosuppressed patients. Best Pract Res Clin Rheumatol 2020; 34:101509. [PMID: 32299676 DOI: 10.1016/j.berh.2020.101509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmune and autoinflammatory diseases are associated with severe morbidity, and represent an impactful health and economic burden worldwide. The treatment of these diseases can include a course with detrimental side effects. Immunosuppression increases the risk of opportunistic infections, but in some cases, the abrupt discontinuation of these medications can result in immune reconstitution inflammatory syndrome. Special attention must be directed to endemic tropical infections, such as leishmaniasis, Chagas disease, malaria, arbovirosis, yellow fever, leprosy, paracoccidioidomycosis, disseminated strongyloidiasis, and ectoparasitosis. These endemic diseases of developing countries can be considered as possible emerging diseases in developed regions partially because of environmental factors and migration. In the present article, we aim to review the evidence-based aspects of the most important opportunistic tropical infections in immunosuppressed patients. We also aim to review the important aspects of vaccination, chemical prophylaxis, and treatment for these infections in people with medication-induced immunosuppression.
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Affiliation(s)
- Patrícia Shu Kurizky
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Leopoldo Luiz Dos Santos Neto
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Rodrigo Barbosa Aires
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Licia Maria Henrique da Mota
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Ciro Martins Gomes
- Programa de Pós-graduação em Ciências Médicas, Programa de Pós-Graduação em Medicina Tropical, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
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Tió-Coma M, Avanzi C, Verhard EM, Pierneef L, van Hooij A, Benjak A, Roy JC, Khatun M, Alam K, Corstjens P, Cole ST, Richardus JH, Geluk A. Genomic Characterization of Mycobacterium leprae to Explore Transmission Patterns Identifies New Subtype in Bangladesh. Front Microbiol 2020; 11:1220. [PMID: 32612587 PMCID: PMC7308449 DOI: 10.3389/fmicb.2020.01220] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/13/2020] [Indexed: 01/06/2023] Open
Abstract
Mycobacterium leprae, the causative agent of leprosy, is an unculturable bacterium with a considerably reduced genome (3.27 Mb) compared to homologues mycobacteria from the same ancestry. In 2001, the genome of M. leprae was first described and subsequently four genotypes (1-4) and 16 subtypes (A-P) were identified providing means to study global transmission patterns for leprosy. In order to understand the role of asymptomatic carriers we investigated M. leprae carriage as well as infection in leprosy patients (n = 60) and healthy household contacts (HHC; n = 250) from Bangladesh using molecular detection of the bacterial element RLEP in nasal swabs (NS) and slit skin smears (SSS). In parallel, to study M. leprae genotype distribution in Bangladesh we explored strain diversity by whole genome sequencing (WGS) and Sanger sequencing. In the studied cohort in Bangladesh, M. leprae DNA was detected in 33.3% of NS and 22.2% of SSS of patients with bacillary index of 0 whilst in HHC 18.0% of NS and 12.3% of SSS were positive. The majority of the M. leprae strains detected in this study belonged to genotype 1D (55%), followed by 1A (31%). Importantly, WGS allowed the identification of a new M. leprae genotype, designated 1B-Bangladesh (14%), which clustered separately between the 1A and 1B strains. Moreover, we established that the genotype previously designated 1C, is not an independent subtype but clusters within the 1D genotype. Intraindividual differences were present between the M. leprae strains obtained including mutations in hypermutated genes, suggesting mixed colonization/infection or in-host evolution. In summary, we observed that M. leprae is present in asymptomatic contacts of leprosy patients fueling the concept that these individuals contribute to the current intensity of transmission. Our data therefore emphasize the importance of sensitive and specific tools allowing post-exposure prophylaxis targeted at M. leprae-infected or -colonized individuals.
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Affiliation(s)
- Maria Tió-Coma
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Charlotte Avanzi
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Els M. Verhard
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Louise Pierneef
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Anouk van Hooij
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Andrej Benjak
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Johan Chandra Roy
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Marufa Khatun
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Khorshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Stewart T. Cole
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Krismawati H, Oktavian A, Maladan Y, Wahyuni T. Risk factor for <em>Mycobacterium leprae</em> detection in household contacts with leprosy patients: a study in Papua, East Indonesia. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.192962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND In the era of leprosy eradication, Jayapura is still one of the biggest leprosy pockets in Papua, Indonesia. The trend for leprosy case detection rate has remained relatively stable over recent years. This study was aimed to detect Mycobacterium leprae in household contacts and to evaluate the associated factors with the detection. METHODS This cross-sectional study recruited household contacts of leprosy patients who were diagnosed consecutively from March to August 2015 in Hamadi Point of Care, Jayapura. The leprosy patients were diagnosed using polymerase chain reaction (PCR). For each leprosy patient, up to four household contacts that had no symptom were included. Every household contact received screening through DNA detection of M. leprae extracted from nasal swab specimens and examined using PCR. Factors for bacteria detection included intensity, time duration and number of contacts living together in the same house, and random blood glucose levels were evaluated. Bivariate analysis was used to associate them with M. leprae detection in household contacts. RESULTS From 107 household contacts of 35 patients who had leprosy, M. leprae was detected in 19.6%. Household contacts with leprosy patients for >1 year was a risk factor for detection (OR = 12.45; 95% CI = 1.595–97.20; p = 0.002). Blood glucose (p = 0.444), ethnic (p = 0.456), sleeping proximity to leprosy case (p = 0.468) and relatives (p = 0.518) give no effect to M. leprae detection in household contacts. CONCLUSIONS Among the various risk factors studied, duration of living together with the patient significantly increased the risk of M. leprae transmission.
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Palit A, Kar H. Prevention of transmission of leprosy: The current scenario. Indian J Dermatol Venereol Leprol 2020; 86:115-123. [DOI: 10.4103/ijdvl.ijdvl_326_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ortuno-Gutierrez N, Younoussa A, Randrianantoandro A, Braet S, Cauchoix B, Ramboarina S, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Richardus JH, de Jong BC, Hasker E. Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts. BMC Infect Dis 2019; 19:1033. [PMID: 31805862 PMCID: PMC6896699 DOI: 10.1186/s12879-019-4649-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar. Methods PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome. Discussion Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP. Trial registration Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.
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Affiliation(s)
- Nimer Ortuno-Gutierrez
- Projects Department, Damien Foundation, Boulevard Leopold II, 263, PO B-1081, Brussels, Belgium.
| | - Assoumani Younoussa
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | | | - Sofie Braet
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Aboubacar Mzembaba
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Zahara Salim
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Mohamed Amidy
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | | | | | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
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Alemu Belachew W, Naafs B. Position statement:LEPROSY: Diagnosis, treatment and follow‐up. J Eur Acad Dermatol Venereol 2019; 33:1205-1213. [DOI: 10.1111/jdv.15569] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- W. Alemu Belachew
- Department of Dermatovenereology Ayder Referral Hospital Mekelle University Mekelle, Tigray Ethiopia
| | - B. Naafs
- Department of Dermatovenereology Ayder Referral Hospital Mekelle University Mekelle, Tigray Ethiopia
- Regional Dermatology Training Centre (RDTC) Moshi Tanzania
- Instituto Lauro de Souza Lima (ILSL) Bauru SP Brazil
- Foundation Global Dermatology Munnekeburen the Netherlands
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30
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Corstjens PLAM, van Hooij A, Tjon Kon Fat EM, Alam K, Vrolijk LB, Dlamini S, da Silva MB, Spencer JS, Salgado CG, Richardus JH, van Hees CLM, Geluk A. Fingerstick test quantifying humoral and cellular biomarkers indicative for M. leprae infection. Clin Biochem 2019; 66:76-82. [PMID: 30695682 DOI: 10.1016/j.clinbiochem.2019.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES New user-friendly diagnostic tests for detection of individuals infected by Mycobacterium leprae (M. leprae), the causative pathogen of leprosy, can help guide therapeutic and prophylactic treatment, thus positively contributing to clinical outcome and reduction of transmission. To facilitate point-of-care testing without the presence of phlebotomists, the use of fingerstick blood (FSB) rather than whole blood-derived serum is preferred. This study is a first proof-of-principle validating that previously described rapid serum tests detecting antibodies and cytokines can also be used with FSB. METHODS Quantitative detection of previously identified biomarkers for leprosy and M. leprae infection, anti-M. leprae PGL-I IgM antibodies (αPGL-I), IP-10 and CRP, was performed with lateral flow (LF) strips utilizing luminescent up-converting reporter particles (UCP) and a portable reader generating unbiased read-outs. Precise amounts of FSB samples were collected using disposable heparinized capillaries. Biomarker levels in paired FSB and serum samples were determined using UCP-LF test strips for leprosy patients and controls in Bangladesh, Brazil, South-Africa and the Netherlands. RESULTS Correlations between serum and FSB from the same individuals for αPGL-I, CRP and IP-10 were highly significant (p < .0001) even after FSB samples had been frozen. The αPGL-I FSB test was able to correctly identify all multibacillary leprosy patients presenting a good quantitative correlation with the bacterial index. CONCLUSIONS Reader-assisted, quantitative UCP-LF tests for the detection of humoral and cellular biomarkers for M. leprae infection, are compatible with FSB. This allows near-patient testing for M. leprae infection and immunomonitoring of treatment without highly trained staff. On site availability of test-result concedes immediate initiation of appropriate counselling and treatment. Alternatively, the UCP-LF format allows frozen storage of FSB samples compatible with deferred testing in central laboratories.
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Affiliation(s)
- Paul L A M Corstjens
- Dept. Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - Anouk van Hooij
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Elisa M Tjon Kon Fat
- Dept. Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - Korshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Loes B Vrolijk
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands; Division of Dermatology, New Groote Schuur Hospital, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Dermatology, New Groote Schuur Hospital, Cape Town, South Africa
| | - Moises Batista da Silva
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - John S Spencer
- Dept. of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, USA
| | - Claudio G Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, Pará, Brazil
| | - Jan Hendrik Richardus
- Dept. of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Colette L M van Hees
- Dept. of Dermatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Annemieke Geluk
- Dept. of Infectious Diseases, Leiden University Medical Center, The Netherlands.
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