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Chen L, Zheng D, Li M, Zeng M, Yang B, Wang X. Epidemiology and grade 2 disability of leprosy among migrant and resident patients in Guangdong: an unignorable continued transmission of leprosy. Front Public Health 2023; 11:1275010. [PMID: 38074749 PMCID: PMC10710308 DOI: 10.3389/fpubh.2023.1275010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Leprosy remains a major public health concern worldwide and one of the leading causes of disability. New cases of leprosy with grade 2 disability (G2D) often reflect delayed detection due to the limited capacity of the health system to recognize leprosy early. This study aimed to describe the epidemiology and G2D of leprosy among migrant and resident patients with leprosy in Guangdong province, China. Methods Data on newly diagnosed cases of leprosy were collected from the leprosy management information system in China. Descriptive statistical analysis was used to describe the status of G2D. Joinpoint regression model and logistic regression were performed to analyze the temporal trends and influencing factors for G2D. Results The G2D rate among migrant, resident, and total patients with leprosy was 17.5%, 18.7%, and 18.4%, respectively. The total G2D rate increased significantly from 18.0% in 2001 to 25.7% in 2021 (average annual per cent change: 2.5%). Multivariate analysis revealed that factors that negatively influence G2D between migrant and resident patients included delayed discovery time (migrants: OR = 2.57; residents: OR = 4.99) and nerve damage when diagnosed (migrants: OR = 9.40; residents: OR = 21.28). Discussion Our findings indicate that the targeted intervention measures implemented by our health system are urgently needed to improve the current situation, such as programs to promote early detection, strengthen awareness and skills of healthcare workers, and rehabilitation for disabled patients to improve their quality of life.
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Affiliation(s)
| | | | | | | | | | - Xiaohua Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
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2
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Dewi DAR, Djatmiko CBP, Rachmawati I, Arkania N, Wiliantari NM, Nadhira F. Immunopathogenesis of Type 1 and Type 2 Leprosy Reaction: An Update Review. Cureus 2023; 15:e49155. [PMID: 38130570 PMCID: PMC10733783 DOI: 10.7759/cureus.49155] [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] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Leprosy reactions are acute exacerbations of the signs and symptoms of leprosy occurring during the natural course of the disease and during or after treatment. Left untreated or improperly managed, reactions can lead to severe nerve function impairment and subsequently to disabilities. In the present context of leprosy eradication efforts, leprosy reactions continue to pose a significant and enduring challenge. Type 1 leprosy reaction and type 2 leprosy reaction are substantial contributors to nerve impairment and the subsequent development of enduring impairments. The study of immunopathogenesis of leprosy reactions has emerged as a significant area of research due to its potential to identify critical targets for the early detection and management of these episodes. This study aims to reveal the pathogenesis of type 1 and 2 leprosy reactions so that they can form the basis for their treatment. The study used scientific journals from reputable platforms such as PubMed, Scopus, and Google Scholar to evaluate the pathogenesis of leprosy reaction type 1 and 2 in leprosy patients. This review indicates that the progression of leprosy nerve damage and sensitivity to reactions may be predicted using genetic and serum markers in the human host. A more profound comprehension of the molecular processes underlying leprosy reactions may offer a logical plan for early detection and leprosy reaction complication prevention.
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Affiliation(s)
- Dian Andriani Ratna Dewi
- Department of Dermatovenereology, Faculty of Military Medicine, The Republic of Indonesia Defense University, Bogor, IDN
- Department of Dermatovenereology, Gatot Soebroto Central Army Hospital, Central Jakarta, IDN
| | - Christine Bella Putri Djatmiko
- Department of Dermatovenereology, Faculty of Military Medicine, The Republic of Indonesia Defense University, Bogor, IDN
| | - Indy Rachmawati
- Department of Dermatovenereology, Faculty of Military Medicine, The Republic of Indonesia Defense University, Bogor, IDN
| | - Nabila Arkania
- Department of Dermatovenereology, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, IDN
| | - Ni M Wiliantari
- Department of Dermatovenereology, Ratna Dewi Principal Clinic, Bekasi, IDN
| | - Farrasila Nadhira
- Department of Dermatovenereology, Ratna Dewi Principal Clinic, Bekasi, IDN
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Falcão IWS, Souza DS, Cardoso DL, Costa FAR, Leite KTF, de M. HD, Salgado CG, da Silva MB, Barreto JG, da Costa PF, dos Santos AM, Conde GAB, Seruffo MCDR. A study about management of drugs for leprosy patients under medical monitoring: A solution based on AHP-Electre decision-making methods. PLoS One 2023; 18:e0276508. [PMID: 36780451 PMCID: PMC9924998 DOI: 10.1371/journal.pone.0276508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/07/2022] [Indexed: 02/15/2023] Open
Abstract
Leprosy, also known as Hansen's, is one of the listed neglected tropical diseases as a major health problem global. Treatment is one of the main alternatives, however, the scarcity of medication and its poor distribution are important factors that have driven the spread of the disease, leading to irreversible and multi-resistant complications. This paper uses a distribution methodology to optimize medication administration, taking into account the most relevant attributes for the epidemiological profile of patients and the deficit in treatment via Polychemotherapy. Multi-criteria Decision Methods were applied based on AHP-Electre model in a database with information from patients in the state of Para between 2015 and 2020. The results pointed out that 84% of individuals did not receive any treatment and, among these, the method obtained a gain in the distribution of 68% in patients with positive diagnosis for leprosy.
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Affiliation(s)
- Igor W. S. Falcão
- Technology Institute, Federal University of Para, Belém, PA, Brazil
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
- * E-mail:
| | - Daniel S. Souza
- Technology Institute, Federal University of Para, Belém, PA, Brazil
| | - Diego L. Cardoso
- Technology Institute, Federal University of Para, Belém, PA, Brazil
| | | | - Karla T. F. Leite
- Computer Science, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Harold D. de M.
- Electrical Engineering Department, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Claudio G. Salgado
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | - Moisés B. da Silva
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | - Josafá G. Barreto
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | | | | | - Guilherme A. B. Conde
- Institute of Engineering and Geosciences - IEG, Federal University of Western Para, Belém, PA, Brazil
| | - Marcos C. da R. Seruffo
- Technology Institute, Federal University of Para, Belém, PA, Brazil
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
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Wang Y, Xiao D, Wu M, Qing L, Yang T, Xiao P, Deng D. Epidemiological Characteristics and Factors Associated with Cure of Leprosy in Chongqing, China, from 1949 to 2019. Am J Trop Med Hyg 2023; 108:165-173. [PMID: 36410327 PMCID: PMC9833069 DOI: 10.4269/ajtmh.22-0474] [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: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Chongqing is one of the focuses of leprosy control in China. Although leprosy control in Chongqing has achieved remarkable results over the years, there are also some problems, such as recurrent epidemics and insufficient early detection in some areas. The aim of this study was to analyze the epidemiological characteristics of leprosy in Chongqing, from 1949 to 2019 and explore the potential factors sociated with cure of leprosy to provide a basis for improving leprosy prevention and treatment strategies in Chongqing. Epidemiological indicators such as incidence and prevalence rates were used to evaluate the prevalence of leprosy. The epidemiological characteristics and control situation of leprosy in patients were analyzed using demographic characteristics, diagnosis, and treatment. Survival analysis was conducted to explore factors associated with the cure of leprosy. From 1949 to 2019, 3,703 cases of leprosy were registered in Chongqing. The incidence of leprosy in the city peaked at 0.853/105 in 1960 and remained below 0.100/105 after 2003. The number of high incidence areas decreased significantly, but they were mainly concentrated in the northeast and southeast regions. The early detection rate increased yearly from 1949 to 2019, and the rate of grade 2 disability ranged from 38.2% to 21.7%, with a fluctuating downward trend after 1960. Male, young age, employment as a farmer, delayed diagnosis, and multibacillary leprosy were risk factors for leprosy cure. Chongqing should continue to strengthen leprosy monitoring to improve the early detection of leprosy and focus on sociated risk factors to carry out multiple strategies.
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Affiliation(s)
- Yunna Wang
- School of Public Health, Chongqing Medical University, Chongqing City, China
| | - Dayong Xiao
- Chongqing Center for Disease Control and Prevention, Chongqing City, China
| | - Mingyue Wu
- Information Center of West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Qing
- School of Public Health, Chongqing Medical University, Chongqing City, China
| | - Tong Yang
- School of Public Health, Chongqing Medical University, Chongqing City, China
| | - Peng Xiao
- Chongqing Center for Disease Control and Prevention, Chongqing City, China
| | - Dan Deng
- School of Public Health, Chongqing Medical University, Chongqing City, China
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The burden of physical disability among patients with newly detected leprosy in Yunnan, China, 1990-2020: A population-based, cross-sectional survey. PLoS Negl Trop Dis 2022; 16:e0010719. [PMID: 36219605 PMCID: PMC9553049 DOI: 10.1371/journal.pntd.0010719] [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: 10/14/2021] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical disability is the main complication of leprosy. Although understanding the leprosy rate, prevalence, spatiotemporal distribution, and physical nerve characteristic trends is crucial for the implementation of leprosy control programs and identification of remaining challenges, these data are still unclear. We assessed physical disability trends among newly detected leprosy cases over the past 31 years in 129 counties and territories in Yunnan, China. METHODOLOGY/PRINCIPAL FINDINGS We analyzed the data of newly detected leprosy cases from the Leprosy Management Information System in Yunnan, China, from 1990-2020. All available data related to physical disability were analyzed, including demographic characteristics (sex, age, ethnicity, education level); clinical characteristics (diagnosis duration, detection mode, contact history, leprosy reaction, skin lesions, nerve lesions, disability classification); World Health Organization (WHO) leprosy physical disability indicators; and nerve and eyes, hands and feet (EHF) involvement. A total of 10758 newly diagnosed leprosy cases were identified, and 7328 (65.60%), 1179 (10.55%) and 2251 (20.15%) were associated with grade 0, 1, and 2 disability (G0D, G1D, and G2D), respectively. Male sex, older age, Han ethnicity, urban employment, a longer diagnosis duration, a contact history, greater nerve involvement, and tuberculoid-related forms of leprosy were associated with increased prevalence rates of physical disability. The rates of physical disability in newly detected leprosy cases per 1 million population decreased from 5.41, 2.83, and 8.24 in 1990 to 0.29, 0.25, and 0.54 per 1 million population in 2020, with decreases of 94.64%, 91.17%, and 93.44% in G2D, G1D and total physical disability (G1D + G2D) rates, respectively. In the same period, the proportions of G2D, G1D and total physical disability decreased from 28.02%, 14.65%, and 42.67% in 1990 to 10.08%, 11.76%, and 21.85% in 2020, with decreases of 64.03%, 19.73%, and 48.79%, respectively. Nerve thickening was more common than nerve tenderness, and claw hand, plantar insensitivity, and lagophthalmos were the most frequently reported EHF-related disabilities. CONCLUSIONS Despite general progress in reducing the prevalence of leprosy-related physical disability, the proportion of physical disability among leprosy disease remains high, especially in specific counties. This implies that leprosy cases are being detected at a later stage and that transmission in the community still exists. Further efforts focusing on early detection are crucial for leprosy control and the elimination of the disease burden.
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Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study. PLoS Negl Trop Dis 2021; 15:e0009923. [PMID: 34758025 PMCID: PMC8580233 DOI: 10.1371/journal.pntd.0009923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. METHODOLOGY/PRINCIPAL FINDINGS We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516-7.073, 3.714-5.212, and 2.063-2.509; for ≥ 10, 5-10 y, and 2-5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843-4.244, and 1.959-3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341-2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052-2.079, 1.075-1.923, 1.261-1.838, and 1.072-1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106-1.960 and 1.498-2.814; for 15-59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522-2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195-1.952), rural occupation (OR: 1.364; 95% CI: 1.128-1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159-1.386), and male sex (OR: 1.128; 95% CI: 1.024-1.243). CONCLUSIONS Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.
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Bandeira SS, Pires CA, Quaresma JAS. Leprosy Reactions In Childhood: A Prospective Cohort Study In The Brazilian Amazon. Infect Drug Resist 2019; 12:3249-3257. [PMID: 31802916 PMCID: PMC6802621 DOI: 10.2147/idr.s217181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background and objective In highly endemic areas, severe multibacillary forms of leprosy and reactional episodes are not rare in children. The objective of the present study was to describe the clinical and epidemiological aspects of leprosy reactions in children from the Brazilian Amazon. Methods This was a prospective cohort study of 34 leprosy patients aged under 15 years diagnosed at a health referral unit in northern Brazil between April 2014 and June 2015. Follow-up medical consultations were performed during multidrug therapy (MDT) and one year after the end of treatment. Participants underwent a simple neurologic examination and answered a structured questionnaire. Results Of the 34 recruited patients, 18 (52.9%) had leprosy reactions and/or neuritis. Among these, 10 (55.6%) had reactions at diagnosis, 13 (72.2%) had reactions after MDT, and 14 (77.8%) had two or more reactional episodes. Type I reactions occurred in 14 (77.8%) cases. Complications, such as disabilities, necrotizing erythema nodosum, or Cushing’s syndrome, occurred in six (33.3%) patients. The following variables showed significant associations (p ≤ 0.05) with leprosy reactions: age 8–14 years, number of doctors seen (≥3), multibacillary classification, number of skin lesions (≥10), or borderline and lepromatous clinical forms. The high frequency of type I reactions resulted in prolonged corticosteroid therapy, which may cause deficient bone maturation in childhood. Conclusion Older age in children, consulting many physicians for diagnosis, severe clinical forms, and numerous skin lesions were positively associated with reaction development. Reactions after MDT highlight the need for continuity in healthcare of children with leprosy.
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Affiliation(s)
- Sabrina Sampaio Bandeira
- Sanitary Dermatology Referral Unit "Dr. Marcello Cândia", Secretary of State for Public Health, Marituba, PA, Brazil.,Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil
| | - Carla Avelar Pires
- Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil.,Center of Health and Biological Sciences, State University of Para, Belem, PA, Brazil
| | - Juarez Antonio Simões Quaresma
- Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil.,Center of Health and Biological Sciences, State University of Para, Belem, PA, Brazil
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de Paula HL, de Souza CDF, Silva SR, Martins-Filho PRS, Barreto JG, Gurgel RQ, Cuevas LE, Santos VS. Risk Factors for Physical Disability in Patients With Leprosy: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1120-1128. [PMID: 31389998 DOI: 10.1001/jamadermatol.2019.1768] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The World Health Organization (WHO) 2016-2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than 1 per million population. Objective To systematically identify clinical factors associated with physical disability in patients with leprosy. Data Source Searches were conducted in Scopus, PubMed, and Web of Science databases to identify studies published from January 23, 1988, to May 23, 2018, using the keywords leprosy and physical disability and related terms. Study Selection Studies that evaluated patients using the WHO leprosy disability grading system and reported the number of patients with and without disability by clinical characteristics were included. Data Extraction and Synthesis The odds ratio (OR) was used as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models. Main Outcomes and Measures The primary outcome was physical disability according to the WHO disability classification. The association between clinical features and physical disability was evaluated. Results The search identified 2447 reports. After screening titles and abstracts, 177 full-text articles were assessed for eligibility, and 32 studies were included in the systematic review; 24 of the 32 studies included sex information (39 571 patients), of whom 24 218 (61.2%) were male. Male patients with leprosy were more likely to have physical disability than female patients with leprosy (pooled OR, 1.66; 95% CI, 1.43-1.93; I2, 81.3%; P < .001). Persons with multibacillary leprosy were 4-fold more likely to have physical disability than those with paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I2, 88.9%, P < .001). Patients having leprosy reactions were more likely to have disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I2, 92.1%; P < .001). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability. Conclusions and Relevance This systematic review and meta-analysis confirms the association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation. These findings can guide the development of targeted interventions for early identification of individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and prevent physical disability.
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Affiliation(s)
- Hidyanara L de Paula
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Carlos D F de Souza
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Sara R Silva
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Paulo R S Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil.,Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Josafá G Barreto
- Spatial Epidemiology Laboratory, Federal University of Pará, Castanhal, Pará, Brazil
| | - Ricardo Q Gurgel
- Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Victor S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
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Silva Rezende da Silva J, Proença Palmeira I, Margareth Moita Sá A, Vidal Nogueira LM, Rodrigues Ferreira AM. Variáveis clínicas associadas ao grau de incapacidade física na hanseníase. REVISTA CUIDARTE 2018. [DOI: 10.15649/cuidarte.v10i1.618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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de Santana JF, da Silva MR, Picheth GF, Yamanaka IB, Fogaça RL, Thomaz-Soccol V, Machado-de-Avila RA, Chávez-Olórtegui C, Sierakowski MR, de Freitas RA, Alvarenga LM, de Moura J. Engineered biomarkers for leprosy diagnosis using labeled and label-free analysis. Talanta 2018; 187:165-171. [DOI: 10.1016/j.talanta.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/12/2022]
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Sales-Marques C, Cardoso CC, Alvarado-Arnez LE, Illaramendi X, Sales AM, Hacker MDA, Barbosa MGDM, Nery JADC, Pinheiro RO, Sarno EN, Pacheco AG, Moraes MO. Genetic polymorphisms of the IL6 and NOD2 genes are risk factors for inflammatory reactions in leprosy. PLoS Negl Trop Dis 2017; 11:e0005754. [PMID: 28715406 PMCID: PMC5531687 DOI: 10.1371/journal.pntd.0005754] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 07/27/2017] [Accepted: 06/28/2017] [Indexed: 01/18/2023] Open
Abstract
The pathways that trigger exacerbated immune reactions in leprosy could be determined by genetic variations. Here, in a prospective approach, both genetic and non-genetic variables influencing the amount of time before the development of reactional episodes were studied using Kaplan-Meier survival curves, and the genetic effect was estimated by the Cox proportional-hazards regression model. In a sample including 447 leprosy patients, we confirmed that gender (male), and high bacillary clinical forms are risk factors for leprosy reactions. From the 15 single nucleotide polymorphisms (SNPs) at the 8 candidate genes genotyped (TNF/LTA, IFNG, IL10, TLR1, NOD2, SOD2, and IL6) we observed statistically different survival curves for rs751271 at the NOD2 and rs2069845 at the IL6 genes (log-rank p-values = 0.002 and 0.023, respectively), suggesting an influence on the amount of time before developing leprosy reactions. Cox models showed associations between the SNPs rs751271 at NOD2 and rs2069845 at IL6 with leprosy reactions (HRGT = 0.45, p = 0.002; HRAG = 1.88, p = 0.0008, respectively). Finally, IL-6 and IFN-γ levels were confirmed as high, while IL-10 titers were low in the sera of reactional patients. Rs751271-GT genotype-bearing individuals correlated (p = 0.05) with lower levels of IL-6 in sera samples, corroborating the genetic results. Although the experimental size may be considered a limitation of the study, the findings confirm the association of classical variables such as sex and clinical forms with leprosy, demonstrating the consistency of the results. From the results, we conclude that SNPs at the NOD2 and IL6 genes are associated with leprosy reactions as an outcome. NOD2 also has a clear functional pro-inflammatory link that is coherent with the exacerbated responses observed in these patients.
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Affiliation(s)
| | | | | | - Ximena Illaramendi
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Anna Maria Sales
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Roberta Olmo Pinheiro
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Euzenir Nunes Sarno
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Milton Ozório Moraes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- * E-mail:
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12
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Silva RLL, Santos MB, Almeida PLS, Barros TS, Magalhães L, Cazzaniga RA, Souza PRM, Luz NF, França-Costa J, Borges VM, Lima-Junior DS, Lipscomb MW, Duthie MS, Reed SG, Almeida RP, Jesus AR. sCD163 levels as a biomarker of disease severity in leprosy and visceral leishmaniasis. PLoS Negl Trop Dis 2017; 11:e0005486. [PMID: 28355218 PMCID: PMC5386291 DOI: 10.1371/journal.pntd.0005486] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 04/10/2017] [Accepted: 03/13/2017] [Indexed: 01/10/2023] Open
Abstract
Background CD163, receptor for the haptoglobin–hemoglobin complex, is expressed on monocytes/macrophages and neutrophils. A soluble form of CD163 (sCD163) has been associated with the M2 macrophage phenotype, and M2 macrophages have been shown to down-modulate inflammatory responses. In particular, previous studies have shown that M2 is closely associated with the most severe clinical presentation of leprosy (i.e. lepromatous leprosy (LL)), as well as tuberculosis. We hypothesized that sCD163 correlates with severity of diseases caused by intracellular pathogens. Methodology/Principal findings To assess this hypothesis, sCD163 levels were measured in the serum of leprosy and visceral leishmaniasis (VL) patients stratified by severity of the clinical presentation. sCD163 levels were significantly higher in patients with these diseases than those observed in healthy control individuals. Further analyses on infection and disease status of leprosy and VL patients revealed a clear association of sCD163 levels with clinical parameters of disease severity. In vitro culture assays revealed that Leishmania infection induced CD163 expression on the surface of both monocyte/macrophages and neutrophils, suggesting these cells as possible sources of sCD163. FACS analyses shows that the cells expressing CD163 produces both TNF-α and IL-4. Conclusions/Significance Taken together, our results reveal sCD163 as a potential biomarker of severity of diseases caused by intracellular pathogens M. leprae and Leishmania spp. and have a modulatory role, with a mix of an inflammatory property induced by TNF-α release, but that potentially induces an anti-inflammatory T cell response, related to IL-4 release. Visceral leishmaniasis (VL) is a systemic, and most severe form of leishmaniasis. Soluble CD163 (sCD163) levels can serve as biomarker for disease severity in several inflammatory disorders. However, no linkage has been reported for its relationship with Leishmania infections. We now demonstrate, for the first time, that sCD163 is increased in VL patients, and its presence is directly correlated to clinical parameters of disease severity. In vitro infection of monocyte-derived macrophages and neutrophils with L. infantum and L. amazonensis induces, while BCG reduce the expression of CD163 on macrophage surface Furthermore, presence of sCD163 is reduced during clinical improvements. Taken together, results reveal an important role for sCD163 in immune modulation during disease progression, and suggest a potential role as biomarker for determining disease severity and clearance.
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Affiliation(s)
- Ricardo Luís Louzada Silva
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
- Departamento de Educação em Saúde de Lagarto–Universidade Federal de Sergipe–Lagarto–Brazil
| | - Marcio B. Santos
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
- Departamento de Educação em Saúde de Lagarto–Universidade Federal de Sergipe–Lagarto–Brazil
| | - Priscila L. S. Almeida
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
- Departamento de Educação em Saúde de Lagarto–Universidade Federal de Sergipe–Lagarto–Brazil
| | - Thayse S. Barros
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
| | - Lucas Magalhães
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
| | - Rodrigo A. Cazzaniga
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
| | - Patrícia R. M. Souza
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
- Departamento de Educação em Saúde de Lagarto–Universidade Federal de Sergipe–Lagarto–Brazil
| | - Nívea F. Luz
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Jaqueline França-Costa
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Valeria M. Borges
- Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Djalma S. Lima-Junior
- Departamento de Bioquímica e Imunologia–Faculdade de Medicina de Ribeirão Preto–Universidade de São Paulo–Ribeirão Preto–Brazil
| | - Michael W. Lipscomb
- Department of Biology, Howard University, Washington–DC–United States of America
| | - Malcolm S. Duthie
- Infectious Diseases Research Institute (IDRI)–Seattle–WA–United States of America
| | - Steven G. Reed
- Infectious Diseases Research Institute (IDRI)–Seattle–WA–United States of America
| | - Roque Pacheco Almeida
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
| | - Amélia Ribeiro Jesus
- Laboratório de Biologia Molecular–Hospital Universitário–Universidade Federal de Sergipe–Aracaju—Brazil
- * E-mail:
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Abstract
BACKGROUND Leprosy in children is still a frequent but sometimes unrecognized public health problem and an important cause of disability. Establishing the risk factors that lead to the development of disability is important for the development of suitable prevention programs. We describe the incidence of leprosy and the prevalence and degree of associated disabilities in children<15 years of age at the time of first presentation to the health services in Aracaju, Sergipe, Northeast Brazil. METHODS A retrospective case series of 266 cases of leprosy in children under 15 years old of Aracaju from 2001 to 2012. Logistic regressions were performed to identify factors for disability. RESULTS The average detection rate was 16.5/100,000 children under 15 years old per year over the study period. Physical disability was associated with the presence of affected nerves and multibacillary leprosy. CONCLUSIONS The detection rate of leprosy in children is still high in Aracaju, Northeast Brazil. Having affected nerves and multibacillary leprosy are associated with the development of disability in children.
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IL-10 and NOS2 modulate antigen-specific reactivity and nerve infiltration by T cells in experimental leprosy. PLoS Negl Trop Dis 2014; 8:e3149. [PMID: 25210773 PMCID: PMC4161319 DOI: 10.1371/journal.pntd.0003149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/28/2014] [Indexed: 12/18/2022] Open
Abstract
Background Although immunopathology dictates clinical outcome in leprosy, the dynamics of early and chronic infection are poorly defined. In the tuberculoid region of the spectrum, Mycobacterium leprae growth is restricted yet a severe granulomatous lesion can occur. The evolution and maintenance of chronic inflammatory processes like those observed in the leprosy granuloma involve an ongoing network of communications via cytokines. IL-10 has immunosuppressive properties and IL-10 genetic variants have been associated with leprosy development and reactions. Methodology/Principal Findings The role of IL-10 in resistance and inflammation in leprosy was investigated using Mycobacterium leprae infection of mice deficient in IL-10 (IL-10−/−), as well as mice deficient in both inducible nitric oxide synthase (NOS2−/−) and IL-10 (10NOS2−/−). Although a lack of IL-10 did not affect M. leprae multiplication in the footpads (FP), inflammation increased from C57Bl/6 (B6)<IL-10−/−<NOS2−/−<10NOS2−/−. While IL-10−/− mice exhibited modest FP induration compared to B6, NOS2−/− and 10NOS2−/− mice developed markedly enlarged FP marking distinct phases: early (1 month), peak (3–4 months), and chronic (8 months). IFN-γ-producing CD4+CD44+ cells responding to M. leprae cell wall, membrane, and cytosol antigens and ML2028 (Ag85B) were significantly increased in the evolved granuloma in NOS2−/− FP compared to B6 and IL-10−/− during early and peak phases. In 10NOS2−/− FP, CD4+CD44+ and especially CD8+CD44+ responses were augmented even further to these antigens as well as to ML0380 (GroES), ML2038 (bacterioferritin), and ML1877 (EF-Tu). Moreover, fragmented nerves containing CD4+ cells were present in 10NOS2−/− FP. Conclusions/Significance The 10NOS2−/− strain offers insight on the regulation of granuloma formation and maintenance by immune modulators in the resistant forms of leprosy and presents a new model for investigating the pathogenesis of neurological involvement. Despite effective antimicrobial therapy, 30–50% of leprosy patients develop immunological complications called leprosy reactions before, during or even years after being cured. Leprosy reactions are a major risk for neuritis that leads to peripheral nerve damage, disfigurement and disability. Unfortunately, why and how leprosy reactions occur is not well understood. Based on the latest human genetic leprosy susceptibility research and mouse infection models, we generated a double knockout mouse strain (10NOS2−/−) which has deficiencies in two key immune factors, interleukin-10 (IL-10) and inducible nitric oxide synthase (NOS2). We investigated the dynamics of the immune response to Mycobacterium leprae infection and chronicled the types of immune cells recruited to the site of infection. 10NOS2−/− mice developed a substantial induration in response to infection, as well as an increased interferon-gamma response to components of the leprosy bacillus. Interestingly, these animals also exhibited CD4+ T cell infiltration into the nerves, a phenomenon which has not been previously reported in leprosy mouse models. This new model provides insight into potential mechanisms whereby immune modulators may regulate leprosy reactions and neuritis and could aid the development of tests for monitoring and treatment of leprosy patients.
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