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Igarashi Y, Marques AP, Andrade KFA, Brito AL, Xavier MB, Souza GS, Callegari B. Accelerometer approach for anticipatory postural adjustments assessment during step initiation in patients with leprosy. Sci Rep 2024; 14:17409. [PMID: 39075219 PMCID: PMC11286943 DOI: 10.1038/s41598-024-68224-x] [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: 12/06/2023] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
Anticipatory postural adjustments (APAs) involve a complex coordination of sensorimotor information that can be impaired in diseases that affect nerve conduction. Assessing APAs typically requires costly video recording technology, posing a challenge to the study of postural changes. This hurdle is compounded in impoverished communities affected by diseases such as leprosy, which often receive limited government support. Recent years have seen the validation of inertial sensors in wearable devices and smartphones for APA analysis in diverse populations, including adults, the elderly and people with Parkinson's disease. This progress offers economically efficient alternatives for the study of APA in leprosy. Do patterns of activation of anticipatory postural adjustment differ between leprosy patients and healthy controls? We also investigated the validity and replicability of APAs recorded in leprosy patients using inertial measurements and video capture recordings. Thirty healthy individuals in the control group and 30 individuals with leprosy in the leprosy group performed ten gait initiation trials. To record the APA for gait initiation, the participants stood on a 2 m platform. Each participant was informed that the experimenter would give an signal, after which the participant would initiate a two-step walk on the platform. Inertial recordings (low-cost method) and video capture recordings (gold-standard method) from center of mass displacements were used to extract the APA before gait initiation. The results show that APAs are similar between groups (control and leprosy), but leprosy patients have less consistent APAs. In addition, this study highlights the reproducibility and high correlation between the values of variables obtained from both instruments, the video recording as gold standard method and portable digital inertial sensor as a low-cost alternative method. These promising findings support the use of affordable inertial sensors to track and record APAs in underserved populations that lack easy access to gold standard methods such as video recording. This approach has the potential to improve the therapeutic care and rehabilitation of these patients. Although not currently part of official protocols for leprosy patients, this assessment method could prove particularly valuable in situations where significant sensorimotor impairments are suspected or documented.
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Affiliation(s)
- Yuzo Igarashi
- Laboratório de Estudos da Motricidade Humana, Universidade Federal do Pará, Generalíssimo Deodoro Avenue 92, Umarizal, Belém, Pará, 66055-240, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
| | - Amelia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Karen Flaviane Assis Andrade
- Laboratório de Estudos da Motricidade Humana, Universidade Federal do Pará, Generalíssimo Deodoro Avenue 92, Umarizal, Belém, Pará, 66055-240, Brazil
| | - Aymee Lobato Brito
- Laboratório de Estudos da Motricidade Humana, Universidade Federal do Pará, Generalíssimo Deodoro Avenue 92, Umarizal, Belém, Pará, 66055-240, Brazil
| | - Marília Brasil Xavier
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
- Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Givago Silva Souza
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
| | - Bianca Callegari
- Laboratório de Estudos da Motricidade Humana, Universidade Federal do Pará, Generalíssimo Deodoro Avenue 92, Umarizal, Belém, Pará, 66055-240, Brazil.
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil.
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2
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Assis BPN, Chaves AT, Lage DP, Cardoso MM, Pereira IAG, Câmara RSB, Freitas CS, Martins VT, Ludolf F, de Oliveira ALG, Oliveira-da-Silva JA, Tavares GSV, Galdino AS, Chávez-Fumagalli MA, Machado-de-Ávila RA, Christodoulides M, Gonçalves DU, Bueno LL, Fujiwara RT, Coelho EAF, da Costa Rocha MO. A recombinant chimeric antigen constructed with B-cell epitopes from Mycobacterium leprae hypothetical proteins is effective for the diagnosis of leprosy. Diagn Microbiol Infect Dis 2024; 109:116338. [PMID: 38718661 DOI: 10.1016/j.diagmicrobio.2024.116338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
The diagnosis if leprosy is difficult, as it requires clinical expertise and sensitive laboratory tests. In this study, we develop a serological test for leprosy by using bioinformatics tools to identify specific B-cell epitopes from Mycobacterium leprae hypothetical proteins, which were used to construct a recombinant chimeric protein, M1. The synthetic peptides were obtained and showed good reactivity to detect leprosy patients, although the M1 chimera have showed sensitivity (Se) and specificity (Sp) values higher than 90.0% to diagnose both paucibacillary (PB) and multibacillary (MB) leprosy patients, but not those developing tegumentary or visceral leishmaniasis, tuberculosis, Chagas disease, malaria, histoplasmosis and aspergillosis, in ELISA experiments. Using sera from household contacts, values for Se and Sp were 100% and 65.3%, respectively. In conclusion, our proof-of-concept study has generated data that suggest that a new recombinant protein could be developed into a diagnostic antigen for leprosy.
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Affiliation(s)
- Bárbara P N Assis
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil; Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, 30622-020, Minas Gerais, Brazil
| | - Ana T Chaves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Daniela P Lage
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Mariana M Cardoso
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Isabela A G Pereira
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Raquel S B Câmara
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Camila S Freitas
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Vívian T Martins
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Fernanda Ludolf
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte 30130-110, Minas Gerais, Brazil
| | - Ana Laura G de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - João A Oliveira-da-Silva
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Grasiele S V Tavares
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Alexsandro S Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São João Del-Rei, Divinópolis, 35.501-296, Minas Gerais, Brazil
| | - Miguel A Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Umacollo, Arequipa, 04000, Peru
| | - Ricardo A Machado-de-Ávila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, 88806-000, Santa Catarina, Brazil
| | - Myron Christodoulides
- Neisseria Research Group, Molecular Microbiology, School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, England, UK
| | - Denise U Gonçalves
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Lílian L Bueno
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil; Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Ricardo T Fujiwara
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil; Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Eduardo A F Coelho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, Brazil.
| | - Manoel Otávio da Costa Rocha
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
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Kukkaro P, Vedithi SC, Blok DJ, van Brakel WH, Geluk A, Srikantam A, Scollard D, Adams LB, Duck M, Anand S, Tucker A, Cruz I, Pemmaraju VRR, Dagne DA, Asiedu K, Hanna C. Target product profiles: leprosy diagnostics. Bull World Health Organ 2024; 102:288-295. [PMID: 38562197 PMCID: PMC10976862 DOI: 10.2471/blt.23.290881] [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: 09/18/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 04/04/2024] Open
Abstract
The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention.
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Affiliation(s)
| | | | - David J Blok
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Kingdom of the Netherlands
| | | | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Kingdom of the Netherlands
| | - Aparna Srikantam
- Clinical and Laboratory Research Division, Blue Peter Public Health and Research Centre-LEPRA Society, Hyderabad, India
| | - David Scollard
- National Hansen’s Disease Program, Baton Rouge, United States of America (USA)
| | - Linda B Adams
- National Hansen’s Disease Program, Baton Rouge, United States of America (USA)
| | - Mathias Duck
- The Leprosy Mission International, Brentford, England
| | | | - Andie Tucker
- The Task Force for Global Health, Inc, Decatur, USA
| | - Israel Cruz
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - VRR Pemmaraju
- Global Leprosy Programme, WHO Regional Office for South-East Asia, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Cota Queiroz EJ, Nunes da Rocha I, Valentim LDA, Quaresma TJC, de Souza Filho ZA, de Oliveira SMS, de Paula Fernandes F, Macedo CG, Quaresma TC, Moraes WP. Epidemiological, clinical, and geographical characterization of Leprosy in the County of Santarém-Pará: Insights for effective control and targeted intervention. PLoS Negl Trop Dis 2024; 18:e0012063. [PMID: 38507427 PMCID: PMC10984465 DOI: 10.1371/journal.pntd.0012063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/01/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
Leprosy is an infectious disease characterized by slow and chronic evolution, caused by Mycobacterium leprae and or Mycobacterium lepromatosis, an intracellular alcohol-acid-resistant (BAAR) bacillus. The objective of this study was to provide an epidemiological, clinical, and geographic characterization of leprosy in the city of Santarém-Pará during the period 2011-2020. A cross-sectional, descriptive, and quantitative approach was used, employing maps and tables to illustrate clinical and epidemiological variables, including: sex, age, race, area of residence, operational classification, clinical form, number of skin lesions, number of affected nerves, and health units. During the analyzed period, 581 cases of leprosy were diagnosed, resulting in the following cumulative incidence rates: male (60%); age over 15 years (94%); urban area (73%); multibacillary (74%); borderline form (46%); skin lesions greater than 5 (34%); and no nerves affected (68%). In the urban perimeter, a higher cumulative incidence of cases was observed in the central area with 133 cases. However, the health unit reporting the largest number of cases belonged to the southern area, specifically the Basic Health Unit of Nova República, with 48 cases. This study highlights the need to characterize the nuances of leprosy and its variability within the urban environment, according to different areas. Further research is essential to inform the implementation of public policies aimed at addressing the population with the highest vulnerability index, thereby reducing leprosy rates in Santarém.
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Costa MRD, Magliano CADS, Barros BM, Morais QCD, Braga AA, Senna KMSE, Gomes CM, Macedo ACD, Santos MDS. A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective. CAD SAUDE PUBLICA 2024; 40:e00038723. [PMID: 38198381 PMCID: PMC10775967 DOI: 10.1590/0102-311xen038723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 01/12/2024] Open
Abstract
Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.
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Affiliation(s)
- Milene Rangel da Costa
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Quenia Cristina Dias Morais
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Brasil
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Lopes-Luz L, Saavedra DP, Fogaça MBT, Bührer-Sékula S, Stefani MMDA. Challenges and advances in serological and molecular tests to aid leprosy diagnosis. Exp Biol Med (Maywood) 2023; 248:2083-2094. [PMID: 38059475 PMCID: PMC10800132 DOI: 10.1177/15353702231209422] [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] [Indexed: 12/08/2023] Open
Abstract
Leprosy is a neglected chronic infectious disease caused by obligate intracellular bacilli, Mycobacterium leprae and Mycobacterium lepromatosis. Despite multidrug therapy (MDT) success, leprosy accounts for more than 200,000 new cases yearly. Leprosy diagnosis remains based on the dermato-neurologic examination, but histopathology of skin biopsy and bacilloscopy of intradermal scraping are subsidiary diagnostic tests that require expertise and laboratory infrastructure. This minireview summarizes the state of the art of serologic tests to aid leprosy diagnosis, highlighting enzyme-linked immunosorbent assay (ELISA) and point-of-care tests (POCT) biotechnologies. Also, the impact of the postgenomic era on the description of new recombinantly expressed M. leprae-specific protein antigens, such as leprosy Infectious Disease Research Institute (IDRI) diagnostic (LID)-1 is summarized. Highly specific and sensitive molecular techniques to detect M. leprae DNA as the quantitative polymerase chain reaction (qPCR) and the loop-mediated isothermal amplification (LAMP) are briefly reviewed. Serology studies using phenolic glycolipid-I (PGL-I) semi-synthetic antigens, LID-1 fusion antigen, and the single fusion complex natural disaccharide-octyl (NDO)-LID show high sensitivity in multibacillary (MB) patients. However, serology is not applicable to paucibacillary patients, as they have weak humoral response and robust cell-mediated response, requiring tests for cellular biomarkers. Unlike ELISA-based tests, leprosy-specific POCT based on semi-synthetic PGL-I antigens and NDO-LID 1 antigen is easy to perform, cheaper, equipment-free, and can contribute to early diagnosis avoiding permanent incapacities and helping to interrupt M. leprae transmission. Besides its use to help diagnosis of household contacts or at-risk populations in endemic areas, potential applications of leprosy serology include monitoring MDT efficacy, identification of recent infection, especially in young children, as surrogate markers of disease progression to orient adult chemoprophylaxis and as a predictor of type 2 leprosy reactions. Advances in molecular biology techniques have reduced the complexity and execution time of qPCR confirming its utility to help diagnosis while leprosy-specific LAMP holds promise as an adjunct test to detect M. leprae DNA.
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Affiliation(s)
- Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
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Gama MEF, Pereira ADPC. Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008-2018. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00254-X. [PMID: 37919202 DOI: 10.1016/j.eimce.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae. OBJECTIVES To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality. METHODS A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil. RESULTS Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions. CONCLUSIONS The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.
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Affiliation(s)
- Maria Eugênia Farias Gama
- Municipal Health Secretariat in Recife, Health District VI, Recife, Brazil; Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil.
| | - Aline de Paula Caetano Pereira
- Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil; Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
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Barbosa CC, Bezerra GSN, Xavier AT, de Albuquerque MDFPM, do Bonfim CV, de Medeiros ZM, de Souza WV. Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12155. [PMID: 36231457 PMCID: PMC9566694 DOI: 10.3390/ijerph191912155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Leprosy is a public health problem in South American, African and Oceanian countries. National programs need to be evaluated, and the survival analysis model can aid in the construction of new indicators. The aim of this study was to assess the period of time until the outcomes of interest for patients with or exposed to leprosy by means of survival analysis surveys. This review researched articles using the databases of PubMed, Science Direct, Scopus, Scielo and BVS published in English and Portuguese. Twenty-eight articles from Brazil, India, Bangladesh, the Philippines and Indonesia were included. The Kaplan-Meier method, which derives the log-rank test, and Cox's proportional hazards regression, which obtains the hazard ratio, were applied. The mean follow-up until the following outcomes were: (I) leprosy (2.3 years) in the population who were exposed to it, (II) relapse (5.9 years), (III) clinical manifestations before, during and after treatment-nerve function impairment (5.2 years), leprosy reactions (4.9 years) and physical disability (8.3 years) in the population of patients with leprosy. Therefore, the use of survival analysis will enable the evaluation of national leprosy programs and assist in the decision-making process to face public health problems.
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Affiliation(s)
- Celivane Cavalcanti Barbosa
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Amanda Tavares Xavier
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Cristine Vieira do Bonfim
- Postgraduate Program in Public Health, Federal University of Pernambuco, Recife 50670-901, Brazil
- Social Research Division, Joaquim Nabuco Foundation, Ministry of Education, Recife 52171-010, Brazil
| | - Zulma Maria de Medeiros
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | - Wayner Vieira de Souza
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
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Sharma M, Singh P. Advances in the Diagnosis of Leprosy. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.893653] [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
Leprosy is a public health issue, and early detection is critical to avert disability. Despite the global attempt to eradicate this disease as a public health problem, it remains an important cause of global neurological disability. India, Brazil and Indonesia share more than 70% of the cases. The reduction of new cases is a priority in the WHO global strategy 2021-2030 which aims to reduce disease transmission in the community by diagnosing cases and identifying subclinical infection. The clinical manifestations of leprosy range from a few to several lesions. The identification remains difficult due to the limited sensitivity of traditional approaches based on bacillary counts of skin smears and histology. To aid in the diagnosis of this disease, molecular biology, and biotechnological technologies have been applied, each with its own set of benefits and downsides despite providing an essential tool to validate the clinical diagnosis of leprosy. Because of this, it is strongly recognized that specific, inexpensive point of care technologies should be developed, particularly to identify asymptomatic M. leprae infections or leprosy nearer to the suspected cases seeking medical attention. Thus, this review will provide an overview of the advancements in leprosy diagnosis over the world. The purpose of this review is to improve our understanding of the outcomes of current tests and technologies used in leprosy diagnosis and to emphasize critical aspects concerning the detection of leprosy bacilli.
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