1
|
Wasson MK, Whitson C, Miller B, Abebe W, Tessema B, Emerson LE, Anantharam P, Tesfaye AB, Fairley JK. Potential drivers of leprosy infection: A case–control study of parasitic coinfection and water, sanitation, and hygiene in North Gondar, Ethiopia. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.934030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite extensive control measures and a declining number of human reservoirs, the incidence of leprosy in excess of 200,000 new cases each year suggests that alternative pathways of transmission may play a role in continued endemicity. Parasitic coinfection and limited water, sanitation, and hygiene (WASH) have been suggested to predispose individuals to Mycobacterium leprae infection and were further explored in this study.MethodsLeprosy cases and uninfected controls were recruited from areas around North Gondar, Ethiopia throughout 2019. Participants completed dietary and WASH surveys in addition to providing stool for helminth microscopic diagnosis and urine for Schistosoma mansoni Point-of-care circulating cathodic antigen (POC-CCA)™ rapid diagnostic testing. A similar methodology was employed for a case–control study of leprosy previously conducted by our research team in North Gondar from May to October of 2018. To more comprehensively evaluate associations between the above exposures and leprosy, data from the present 2019 study and the previous 2018 study were combined in select multivariate logistic regression analyses.ResultsA total of 47 men (59%) and 33 women (41%) participated in this study with an average age of 40 (SD 15.0 years). Most leprosy cases were multibacillary (93%). There was a high prevalence of parasitic coinfection among both cases (71%) and controls (60%). WASH insecurities were also widespread. On multivariate analysis, lack of soap for handwashing [aOR= 2.53, 95% CI (1.17, 5.47)] and the lack of toilet facilities [Adjusted odds ratio (aOR)= 2.32, 95% CI (1.05, 5.12)] were significantly associated with leprosy. Positive directionality was identified for a number of other inputs, including helminth infection [aOR= 3.23, 95% CI (0.85, 12.35)].ConclusionsTaken together, these findings strengthen previous research conducted in 2018 implicating poor WASH conditions as a driver of leprosy infection. Leprosy remains the leading infectious cause of disability in the world. As such, future research should explore the above susceptibilities in more depth to curtail the global burden of disease.
Collapse
|
2
|
Tomaselli PJ, Dos Santos DF, Dos Santos ACJ, Antunes DE, Marques VD, Foss NT, Moreira CL, Nogueira PTB, Nascimento OJM, Neder L, Barreira AA, Frade MA, Goulart IMB, Marques W. Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression. Brain 2021; 145:1499-1506. [PMID: 34664630 DOI: 10.1093/brain/awab396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/25/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤ 12 months) and long (> 12 months) disease duration. Positive and negative symptoms mediated by small-fibre were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (p < 0,001), as well as motor deficits (p = 0,002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (p < 0,001). Primary neural leprosy progress over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes.
Collapse
Affiliation(s)
- Pedro J Tomaselli
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD
| | - Diogo F Dos Santos
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - André C J Dos Santos
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Douglas E Antunes
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Vanessa D Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Norma T Foss
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Carolina L Moreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Patrícia T B Nogueira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Osvaldo J M Nascimento
- Antonio Pedro University Hospital (HUAP), Fluminense Federal University, Niterói, 24033-900, Brazil
| | - Luciano Neder
- Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos, 14784-400, Brazil
| | - Amilton A Barreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Marco A Frade
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Isabela M B Goulart
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Wilson Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD.,National Institute for Science and Technology for Translational Medicine, INCT, Brazil
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Teles SF, Silva EA, Souza RMD, Tomimori J, Florian MC, Souza RO, Marcos EVC, Souza-Santana FCD, Gamba MA. Association between NDO-LID and PGL-1 for leprosy and class I and II human leukocyte antigen alleles in an indigenous community in Southwest Amazon. Braz J Infect Dis 2020; 24:296-303. [PMID: 32589879 PMCID: PMC9392080 DOI: 10.1016/j.bjid.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022] Open
Abstract
The frequencies of the Human leukocyte antigen (HLA) alleles in the Puyanawa indigenous reserve population and their association with the NDO-LID and ELISA PGL-1 rapid serological test was assessed. This was a cross-sectional study with an epidemiological clinical design conducted in two indigenous communities in the state of Acre, Brazil. Blood was collected in a tube with EDTA to identify HLA alleles and perform serological tests. DNA was obtained using the salting out procedure. The LabType™ technique (One-Lambda-USA) was used for HLA class I (loci A*, B* and C*) and II (loci DRB1*, DQA1* and DQB1*) typing. Allele frequency was obtained by direct count, and the chi-square test was used to assess the association with the NDO-LID and PGL-1 tests. The most frequent alleles in the two communities were: HLA-A*02:01, HLA-B*40:02, HLA-DRB1*16:02, HLA-DQA1*05:05 and HLA-DQB1*03:01. The allele HLA-C*04:01 was the most common in the Barão community, and the allele HLA-C*07:01 in Ipiranga. Among individuals who presented seropositivity to the NDO-LID test, the association with alleles HLA-A*02 (43.18% vs 24.8%, p = 0.03, OR = 2.35) and HLA-B*53 (6.83% vs 0.0%, p = 0.03, OR = 8.95) was observed in the Barão community. HLA-B*15 was associated with non-seroconversion to the NDO-LID test in Ipiranga. In both communities, HLA-B*40 and HLA-C*03 were associated with positive serological response to ELISA PGL-1. The HLA class I and II alleles most frequently found in this study have already been described among Terena indigenous groups, and HLA class I contributes to seroconversion to NDO-LID and PGL-1 tests in inhabitants of the Barão and Ipiranga communities.
Collapse
|
5
|
Trindade LC, Martins LC, Marques DM, Mendes MDS, Fonseca FLA, Pereira LAA. Importance of epidemiological surveillance of leprosy: analysis of the occurrence of leprosy in intra-domiciliary contacts in a capital in the Brazilian northeast region. Rev Soc Bras Med Trop 2020; 53:e20190507. [PMID: 32187344 PMCID: PMC7094054 DOI: 10.1590/0037-8682-0507-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found.
Collapse
Affiliation(s)
- Luciana Cavalcante Trindade
- Universidade Católica de Santos, Programa de Pós-Graduação Stricto Sensu em Saúde Coletiva, Santos, SP, Brasil.,Faculdade de Medicina do ABC, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Santo André, SP, Brasil
| | - Lourdes Conceição Martins
- Universidade Católica de Santos, Programa de Pós-Graduação Stricto Sensu em Saúde Coletiva, Santos, SP, Brasil
| | | | | | | | - Luiz Alberto Amador Pereira
- Universidade Católica de Santos, Programa de Pós-Graduação Stricto Sensu em Saúde Coletiva, Santos, SP, Brasil
| |
Collapse
|
6
|
Vidal SL, De Mattos AMM, Menegati LM, Monteiro TBM, Laurindo CR, Carvalho APM, Teixeira HC, Coelho ADCO. Testes sorológicos anti-NDO-HSA, anti-LID-1 e anti- NDO-LID em contatos domiciliares de área não endêmica de hanseníase. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.25750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: Diversos fatores podem interferir no desenvolvimento da hanseníase, entre eles fatores genéticos, convívio com o caso de hanseníase e classificação operacional do caso. Testes sorológicos que avaliam a reatividade de anticorpos IgM e IgG frente a antígenos específicos para o Mycobacterium leprae (M. leprae) podem atuar como auxiliaresna vigilância dos contatos e/ou população de risco. Objetivo: Analisar o comportamento dos testes sorológicos anti-PGL-1 sintético (NDO-HSA), anti-LID-1 e anti-NDO-LID em área não endêmica de hanseníase e sua relação com características do caso de hanseníase. Material e métodos: Trata-se de um estudo transversal, do tipo analítico, realizado com 35 contatos domiciliares (CD) dos casos de hanseníase. A coleta de dados ocorreu no período de agosto/2016 a fevereiro/2017 por meio de visitas domiciliares. A reatividade de anticorpos IgM e IgG frente aos antígenos Natural disaccharide linked to human serum albumin via octyl (NDOHSA), Leprosy IDRI diagnostic 1 (LID-1) e Natural disaccharideoctyl - Leprosy IDRI Diagnostic 1(NDO-LID) foi avaliada por ensaio imunoenzimático (ELISA). Os dados foram exportados e analisados no software StatisticalPackage for the Social Sciences(SPSS) 24 for Windows. Resultados: Foi observada maior proporção de positividade aos testes em CD de casos multibacilares (MB),que residiam com o caso de hanseníase na época do diagnóstico e que tinham parentesco consanguíneo com o caso. Esses casos de hanseníase MB também apresentaram soropositividade frente aos antígenos testados. O valor do índice ELISA foi maior no grupo de CD de casos MB. Houve concordância moderada e significativa (K= 0,53; p< 0,0001) entre os testes anti-NDO-HSA e anti-NDO-LID, mas não foi detectada diferença entre os testes anti-NDO-HSA e anti-LID-1 (K= -0,05; p= 0,678). A correlação foi positiva entre os três antígenos, porém, entre LID-1 e NDO-HSA, não houve significância estatística (p<0,186). Conclusão: Os resultados sugerem que testes sorológicos em conjunto com as características avaliadas nos contatos domiciliares em área não endêmica de hanseníase,podem atuarcomo auxiliares na detecção de indivíduos infectados pelo M. leprae, contribuindo para vigilância dos contatos domiciliares.
Collapse
|