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Barbosa Ladino MC, Jiménez Betancourth C, Vásquez Acevedo L, Haag M, Zirkel J, Schwienhorst-Stich EM, Navarro M, Kasang C, Gágyor I, Parisi S. Body map stories from Colombia: experiences of people affected by leprosy and the influence of peers during diagnosis and treatment. Int J Equity Health 2024; 23:98. [PMID: 38741119 DOI: 10.1186/s12939-024-02152-0] [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: 11/04/2023] [Accepted: 03/15/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. METHODS A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2-3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. RESULTS The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. CONCLUSION People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability.
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Affiliation(s)
- Martha Cecilia Barbosa Ladino
- DAHW Latin America, GLRA German Leprosy and Tuberculosis Relief Association, Bogotá, Colombia
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Camila Jiménez Betancourth
- DAHW Latin America, GLRA German Leprosy and Tuberculosis Relief Association, Bogotá, Colombia
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Lucrecia Vásquez Acevedo
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Melanie Haag
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Janina Zirkel
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
- Internal Medicine, Unit of Infectious Disease, University Hospital Würzburg, Würzburg, Germany
| | | | - Miriam Navarro
- Epidemiology Unit, Public Health Centre of Elche - FISABIO, Alicante, Spain
- Department of Public Health, Science History and Gynaecology, Universidad Miguel Hernández, Alicante, Spain
| | - Christa Kasang
- DAHW HQ, GLRA German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Parisi
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany.
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Dos Santos LS, Souza LB, Goulart IMB, Drummond MR, Velho PENF. Bartonella henselae DNA detection in patients with type 1 leprosy reactions for more than six months. Braz J Infect Dis 2024; 28:103743. [PMID: 38697215 PMCID: PMC11126756 DOI: 10.1016/j.bjid.2024.103743] [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: 11/15/2023] [Revised: 02/28/2024] [Accepted: 04/14/2024] [Indexed: 05/04/2024] Open
Abstract
Leprosy reactions are among the main causes of physical disability resulting from an infectious disease and can culminate in irreversible physical disabilities, therefore they should be considered a clinical emergency, as well as the elucidation of its cause. Co-infections are considered one of the main triggering causes of leprosy reactions, aggravating and maintaining these reactions for longer in these patients. After reporting a high rate of Bartonella henselae infection in patients with chronic type 2 leprosy reaction, 19/47 (40.4 %) compared to the control group, 9/50 (18.0 %), p = 0.0149, we conducted this study to observe the rate of infection by Bartonella sp. in a group of patients with chronic type 1 leprosy reactions. Blood samples from 14 patients with chronic type 1 leprosy reactions were analyzed by molecular and microbiological tests and compared. The results showed that, like patients with chronic type 2 leprosy reactions, this group of patients has a high proportion of B. henselae infection 6/14 (42.9 %), p = 0.88. We conclude that these bacteria can trigger chronic leprosy reactions and should be investigated in all chronic leprosy reactions patients. Summary Line: Our results showed that, like patients with chronic type 2 leprosy reactions, this group of patients has the same proportion of B. henselae DNA detection 6/14 (42.9 %), p = 0.88.
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Affiliation(s)
- Luciene Silva Dos Santos
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil.
| | - Lais Bomediano Souza
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Departamento de Medicina, Campinas, São Paulo, SP, Brasil
| | | | - Marina Rovani Drummond
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
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Sharath S, Sinha S, Sardana K, Ahuja A. Sequential occurrence of upgrading and downgrading type 1 leprosy reactions: A case report. Trop Doct 2024; 54:185-188. [PMID: 38356319 DOI: 10.1177/00494755241229754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Savitha Sharath
- Senior Resident, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Surabhi Sinha
- Assistant Professor, Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College, New Delhi, India
| | - Kabir Sardana
- Director Professor and Head of the Department, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Director Professor and Head of the Department, Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Ahmed G. Pressure Stockings for Edematous Feet in the Lepra Reaction: An Inexpensive Patronage. Cureus 2024; 16:e58893. [PMID: 38800266 PMCID: PMC11116919 DOI: 10.7759/cureus.58893] [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: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Leprosy has been known for its wide range of peripheral nerve and tissue involvement and causing disabilities. Early diagnosis and treatment with multi-drug therapy can save lives and limbs and prevent disabilities. However, management and drug therapy are usually lengthy and full of ups and downs of side effects. Further, the lepra reaction is frequently noted during management, requiring immunosuppression and leading to associated side effects. Limb edema per se due to leprosy is unusual and mostly a symptom of a reactional state. There is no specific management for edema in such cases, and it subsides with improving reactionary states. Nevertheless, the edema may be persistent and bothersome. The present report highlights one such unusual case in a 40-year-old man, diagnosed with borderline-tuberculoid leprosy and experiencing a type-1 reaction. Owing to ocular complications, steroid therapy for the reaction was tapered abruptly, and his limb edema did not subside with the improving lepra reaction. Compression stockings helped to manage edema. This case also makes us ponder the possible use of compression stockings as an opioid-sparing aid in lepra reaction-related edema.
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Affiliation(s)
- Ghazal Ahmed
- Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Serrano-Coll H, Wan EL, Restrepo-Rivera L, Cardona-Castro N. Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients. Pathog Dis 2024; 82:ftae013. [PMID: 38806255 PMCID: PMC11180982 DOI: 10.1093/femspd/ftae013] [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: 02/07/2024] [Revised: 04/21/2024] [Accepted: 05/27/2024] [Indexed: 05/30/2024] Open
Abstract
Leprosy is a chronic granulomatous infectious and disabling disease caused by two mycobacteria, Mycobacterium leprae and Mycobacterium lepromatosis. Acute inflammatory responses, known as leprosy reactions, are significant contributors to disabilities. Three types of leprosy reactions have been identified based on excessive cytokine release (e.g. type 1) or the accumulation of immune complexes in tissues inducing multiorgan damage (e.g. types 2 and 3). The type of leprosy reaction has implications on treatment and management strategies, yet are not well understood by health workers caring for leprosy patients. We attempt to describe the immunologic mechanisms behind the different leprosy reactions and the rationale for tailoring clinical treatment and management to the particular type of leprosy reaction based on the underlying immunologic situation.
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Affiliation(s)
- Héctor Serrano-Coll
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
| | - Eric L Wan
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington DC 200072, United States
| | - Lina Restrepo-Rivera
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
| | - Nora Cardona-Castro
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
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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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Ramasamy S, Galhotra A, Agrawal S. Adverse reactions after Covid-19 vaccination in persons affected by leprosy: A scoping review. J Family Med Prim Care 2023; 12:1771-1774. [PMID: 38024943 PMCID: PMC10657070 DOI: 10.4103/jfmpc.jfmpc_635_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background Leprosy reactions are the main pathway leading to severe nerve damage and disability. These reactions can occur at any time. The coronavirus disease 2019 (Covid-19) pandemic led to a catastrophic loss of human life and has had a devastating impact on persons affected by leprosy. Objective To achieve deep insight into the subject of adverse reactions acquired after Covid vaccinations in persons affected by leprosy through a literature review. Materials and Methods A scoping review was conducted in the studies published between July 2021 and June 2022 using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Results Using the search strategy, a total of 130 articles were found, of which five were relevant to the study. The adverse reactions were acquired mostly in males [9 (81.8%)]; the majority of them belong to borderline tuberculoid [4 (36.4%)], and most of them were released from treatment (multi-drug therapy) [7 (63.6%)]. Conclusion Surveillance and management of adverse events following immunization (AEFI) are essential; even minor AEFI should be reported and documented in a line list.
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Affiliation(s)
| | - Abhiruchi Galhotra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Zhu J, Shi C, Zhao H, He R, Jing Z, Yang D. Case Report: Upper Thoracic Esophageal Paralysis Accompanying a Type 1 Leprosy Reaction. Am J Trop Med Hyg 2023; 109:343-344. [PMID: 37277105 PMCID: PMC10397463 DOI: 10.4269/ajtmh.22-0799] [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: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 06/07/2023] Open
Abstract
Type 1 leprosy reactions (T1LRs) occur mainly in patients with borderline leprosy and an unstable immune status. The main symptoms of T1LRs include aggravated skin lesions and nerve damage. Nerve damage involving the glossopharyngeal and vagus nerves causes dysfunction of the nose, pharynx, larynx, and even the esophagus, which are innervated by these nerves. Here, we report a case of upper thoracic esophageal paralysis caused by vagus nerve involvement in a patient with T1LRs. Although infrequent, this serious emergency merits attention.
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Affiliation(s)
- Jianyu Zhu
- Department of Leprosy, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Chao Shi
- Department of Leprosy, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Huaibo Zhao
- Department of Leprosy, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Rongli He
- Department of Infectious Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zhichun Jing
- Department of Leprosy, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Degang Yang
- Department of Leprosy, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Harikrishna GV, Ca J, Doddapaneni S, Bhat N, Bhanu P. A Case of Borderline Tuberculoid Leprosy With Type One Lepra Reaction. Cureus 2023; 15:e38081. [PMID: 37252606 PMCID: PMC10212743 DOI: 10.7759/cureus.38081] [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: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. The variants that can be identified include tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), and lepromatous forms (LL). Type one lepra reactions are delayed hypersensitivity reactions that are often observed in borderline variants due to an unstable immunological response. They can exacerbate skin lesions and neuritis, leading to a higher risk of disabilities and deformities. Early detection and management would play a major role in limiting morbidity. Here, we present a case of a 46-year-old male diagnosed with borderline tuberculoid leprosy on multidrug therapy who developed features suggestive of type one lepra reaction. Early recognition of this entity helps in mitigating the risk of permanent nerve damage, disability, deformity, and morbidity.
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Affiliation(s)
| | - Jayashankar Ca
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Sravya Doddapaneni
- Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Nuthan Bhat
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Prakash Bhanu
- Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
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Das M, David D, Horo I, Van Hooij A, Tió-Coma M, Geluk A, Vedithi SC. Mycobacterium leprae and host immune transcriptomic signatures for reactional states in leprosy. Front Microbiol 2023; 14:1113318. [PMID: 37051521 PMCID: PMC10083373 DOI: 10.3389/fmicb.2023.1113318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundMycobacterium leprae transcriptomic and human host immune gene expression signatures that demonstrate a plausible association with type I (T1R) and type II reactions (T2R) aid in early diagnosis, prevention of nerve damage and consequent demyelinating neuropathy in leprosy. The aim of the study is to identify M. leprae and host-associated gene-expression signatures that are associated with reactional states in leprosy.MethodsThe differentially expressed genes from the whole transcriptome of M. leprae were determined using genome-wide hybridization arrays with RNA extracted from skin biopsies of 20 T1R, 20 T2R and 20 non reactional controls (NR). Additionally, human immune gene-expressions were profiled using RT2-PCR profiler arrays and real-time qPCRs.ResultsThe RNA quality was optimal in 16 NR, 18 T1R and 19 T2R samples. Whole transcriptome expression array of these samples revealed significant upregulation of the genes that encode integral and intrinsic membrane proteins, hydrolases and oxidoreductases. In T1R lesional skin biopsy specimens, the top 10 significantly upregulated genes are ML2064, ML1271, ML1960, ML1220, ML2498, ML1996, ML2388, ML0429, ML2030 and ML0224 in comparison to NR. In T2R, genes ML2498, ML1526, ML0394, ML1960, ML2388, ML0429, ML0281, ML1847, ML1618 and ML1271 were significantly upregulated. We noted ML2664 was significantly upregulated in T1R and repressed in T2R. Conversely, we have not noted any genes upregulated in T2R and repressed in T1R. In both T1R and T2R, ML2388 was significantly upregulated. This gene encodes a probable membrane protein and epitope prediction using Bepipred-2.0 revealed a distinct B-cell epitope. Overexpression of ML2388 was noted consistently across the reaction samples. From the host immune gene expression profiles, genes for CXCL9, CXCL10, CXCL2, CD40LG, IL17A and CXCL11 were upregulated in T1R when compared to the NR. In T2R, CXCL10, CXCL11, CXCL9, CXCL2 and CD40LG were upregulated when compared to the NR group.ConclusionA gene set signature involving bacterial genes ML2388, ML2664, and host immune genes CXCL10 and IL-17A can be transcriptomic markers for reactional states in leprosy.
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Affiliation(s)
- Madhusmita Das
- Molecular Biology and Immunology Division, Schieffelin Institute of Health Research and Leprosy Centre, Karigiri, Vellore, Tamil Nadu, India
- *Correspondence: Madhusmita Das,
| | - Diana David
- Molecular Biology and Immunology Division, Schieffelin Institute of Health Research and Leprosy Centre, Karigiri, Vellore, Tamil Nadu, India
| | - Ilse Horo
- Molecular Biology and Immunology Division, Schieffelin Institute of Health Research and Leprosy Centre, Karigiri, Vellore, Tamil Nadu, India
| | - Anouk Van Hooij
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Maria Tió-Coma
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
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Muddebihal A, Sardana K, Khurana A, Sachdeva S, Singh I, Ahuja M, Sharma R. A prospective case control study of resistance to rifampicin, dapsone and ofloxacin in Type 1 and Type 2 leprosy reactions and the therapeutic impact of modified treatment regimen on reactions. J Eur Acad Dermatol Venereol 2023; 37:e149-e151. [PMID: 36308057 DOI: 10.1111/jdv.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/25/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Madhvi Ahuja
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
| | - Rahul Sharma
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
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Inyang IE, Bassey IE, Okoroiwu HU. Evaluation of hematological parameters in patients with leprosy in Southern Nigeria. Germs 2022; 12:478-487. [PMID: 38021182 PMCID: PMC10660229 DOI: 10.18683/germs.2022.1354] [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: 07/16/2022] [Revised: 10/23/2022] [Accepted: 12/31/2022] [Indexed: 12/01/2023]
Abstract
Introduction Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae that mostly result in immunological reactions that affect the skin, peripheral nervous system and mucosa of the upper respiratory tract. This study aimed to evaluate hematological parameters among subjects with leprosy and deduce biomarkers for onset of leprosy reaction. Methods This was a cross-sectional study performed from September 1, 2018 to August 1, 2019. Sixty patients with leprosy (30 on multidrug therapy (MDT) and 30 that had completed MDT) and 30 apparently healthy controls were enrolled. Hematology auto-analyzer (Sysmex KX-21N by Sysmex Corporation Kobe, Japan) was used in sample analysis. ANOVA and Kruskal Wallis were used for mean comparison. Eta squared was used to assess effect size. Sensitivity and specificity were assessed using receiver operator characteristic (ROC) curve. Association was checked using bivariate logistics regression. Results The majority (68.3%) of the patients with leprosy were males and a larger proportion were either farmers or unemployed. The prevalence of leprosy reaction in the studied population was 40%. The following parameters were significantly (p<0.05) reduced: red cell count, hemoglobin and hematocrit in patients with leprosy compared to controls. Total white cell count, absolute lymphocyte, neutrophil, monocyte and eosinophil counts were significantly elevated in patients with leprosy compared to controls. The hemoglobin and mean corpuscular volume of patients with leprosy on treatment were significantly higher compared to those who had completed treatment, while the mean corpuscular hemoglobin concentration was significantly reduced. Overall, 65% of patients with leprosy were anemic. Eosinophil count showed good biomarker potential for leprosy reaction onset with AUC 0.709. Sex and absolute eosinophil count were associated with leprosy reaction (OR=11.194; 95%CI: 1.775-70.586). Conclusions This study has shown a high frequency of anemia in patients with leprosy, both those on treatment and those that had completed MDT, necessitating incorporation of post treatment plan in the management of leprosy. This study has reported absolute eosinophil as potential biomarker of leprosy reaction.
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Affiliation(s)
- Inyeneobong Ernest Inyang
- B.MLS, Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
| | - Iya Eze Bassey
- B.MLS, MSc, PhD, Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
| | - Henshaw Uchechi Okoroiwu
- B.MLS, M.Sc, Ph.D, Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Arthur Jarvis University, Brigadier Dan Archibong Drive, Ndon Obori Ikot Effanga, Akpabuyo, Cross River State, Nigeria and Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, PMB 1115, Cross River State, Nigeria
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Gomes de Castro KK, Lopes da Silva PH, Nahar dos Santos L, Leal JMP, de Pinho Pereira MM, Alvim IMP, Esquenazi D. Downmodulation of Regulatory T Cells Producing TGF-β Participates in Pathogenesis of Leprosy Reactions. Front Med (Lausanne) 2022; 9:865330. [PMID: 35924037 PMCID: PMC9341400 DOI: 10.3389/fmed.2022.865330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Leprosy reactions are an acute and systemic manifestation, which occurs suddenly, can be severe and lead leprosy patients to disability. Reactional episodes are observed among half of the multibacillary patients, mainly in borderline lepromatous and lepromatous forms. They may begin at any time during multidrug therapy, and even before the treatment. Physical disabilities, which are the source of extreme suffering and pain for patients, occur in progression of the cellular immune response associated with a reaction and are still poorly understood. Thus, this work aimed to phenotypically and functionally characterize CD4+ and CD8+ Treg cells ex vivo and in response to Mycobacterium leprae (ML). We studied 52 individuals, including 18 newly diagnosed and untreated multibacillary leprosy patients, 19 reactional multibacillary patients (Type I or Type II episodes) and 15 healthy volunteers, included as controls, all residents of the city of Rio de Janeiro. The functional activity and frequencies of these cells were evaluated through multiparametric flow cytometry. In addition, the production of cytokines in supernatant from peripheral blood mononuclear cell cultures was also investigated against ML by enzyme-linked immunosorbent assay. Our results showed a decrease in CD4+TGF-β+ Treg and CD8+ TGF-β+ Treg in leprosy multibacillary patients during both types of reactional episodes. Alterations in the cytokine profile was also observed in Type II reactions, along with upregulation of IL-17 and IL-6 in supernatant. Thus, our study suggests that downregulation of Treg cells is related with both classes of reactional episodes, improving our understanding of immune hyporesponsiveness in multibacillary patients and hyperesponsiveness in both reactions.
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Affiliation(s)
| | | | | | | | | | | | - Danuza Esquenazi
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Pathology and Laboratories, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Danuza Esquenazi
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Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management. J Trop Med 2022; 2022:8652062. [PMID: 35832335 PMCID: PMC9273393 DOI: 10.1155/2022/8652062] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 01/03/2023] Open
Abstract
Leprosy is a neglected infectious disease caused by acid-fast bacillus Mycobacterium leprae. It primarily affects the skin and then progresses to a secondary stage, causing peripheral neuropathy with potential long-term disability along with stigma. Leprosy patients account for a significant proportion of the global disease burden. Previous efforts to improve diagnostic and therapeutic techniques have focused on leprosy in adults, whereas childhood leprosy has been relatively neglected. This review aims to update the diagnostic and therapeutic recommendations for adult and childhood leprosy. This review summarizes the clinical, bacteriological, and immunological approaches used in the diagnosis of leprosy. As strategies for the diagnosis and management of leprosy continue to develop better and more advanced knowledge, control and prevention of leprosy are crucial.
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15
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Orujyan D, Narinyan W, Rangarajan S, Rangchaikul P, Prasad C, Saviola B, Venketaraman V. Protective Efficacy of BCG Vaccine against Mycobacterium leprae and Non-Tuberculous Mycobacterial Infections. Vaccines (Basel) 2022; 10:vaccines10030390. [PMID: 35335022 PMCID: PMC8952781 DOI: 10.3390/vaccines10030390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
The genus mycobacterium includes several species that are known to cause infections in humans. The microorganisms are classified into tuberculous and non-tuberculous based on their morphological characteristics, defined by the dynamic relationship between the host defenses and the infectious agent. Non-tuberculous mycobacteria (NTM) include all the species of mycobacterium other than the ones that cause tuberculosis (TB). The group of NTM contains almost 200 different species and they are found in soil, water, animals—both domestic and wild—milk and food products, and from plumbed water resources such as sewers and showerhead sprays. A systematic review of Medline between 1946 and 2014 showed an 81% decline in TB incidence rates with a simultaneous 94% increase in infections caused by NTM. Prevalence of infections due to NTM has increased relative to infections caused by TB owing to the stringent prevention and control programs in Western countries such as the USA and Canada. While the spread of typical mycobacterial infections such as TB and leprosy involves human contact, NTM seem to spread easily from the environment without the risk of acquiring from a human contact except in the case of M. abscessus in patients with cystic fibrosis, where human transmission as well as transmission through fomites and aerosols has been recorded. NTM are opportunistic in their infectious processes, making immunocompromised individuals such as those with other systemic infections such as HIV, immunodeficiencies, pulmonary disease, or usage of medications such as long-term corticosteroids/TNF-α inhibitors more susceptible. This review provides insight on pathogenesis, treatment, and BCG vaccine efficacy against M. leprae and some important NTM infections.
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Sakral A, Dogra N, Dogra D, Sharma K. Clinical and epidemiological trends in childhood leprosy: A 20-year retrospective analysis from a tertiary care hospital in Jammu, North India. Indian J Dermatol Venereol Leprol 2022; 88:755-760. [PMID: 35146981 DOI: 10.25259/ijdvl_1326_20] [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: 12/01/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Slightly more than half the total number of childhood leprosy cases worldwide are from India. AIM To analyze the clinical and epidemiological trends of childhood leprosy over 20 years in a tertiary care hospital. METHODS We retrieved the medical records of all children less than 15 years of age registered in the leprosy clinic between April 1998 and March 2018. We tabulated and analyzed data pertaining to demographic details along with clinical findings such as cutaneous lesions, nerves involved, sensory loss, deformities, reactions, smear status, histopathology and treatment. RESULTS Out of total 1548 leprosy cases registered during the study period, 55 (3.55%) cases of childhood leprosy were diagnosed. Thirty five (63.6%) children were in the age group of 11-15 years and 83.7% were migrants from other states. Thirteen (23.6%) children reported contact with a diagnosed case of leprosy, mainly in close contacts. Fifty three (96.4%) children presented with cutaneous lesions while 2 (3.6%) had pure neural involvement. Borderline tuberculoid leprosy was the most common clinical presentation in 27 (49.1%) followed by borderline lepromatous leprosy in 11 (18%). Thickened peripheral nerve trunks were detected in 42 (76.4%), most commonly the ulnar nerve. Reactional episodes occurred in 12 (21.8%) cases (Type 1 reaction, 10 (18.2%); Type 2 reaction, 2 (3.6%)). Grade 2 disability was detected in 4 (7.3%). Multidrug therapy was started in all patients, multibacillary (MB) regimen in 42 (76.3%) patients and paucibacillary (PB) regimen in 13 (23.7%). Twenty five (45.4%) children defaulted from the treatment. On comparing the data of 2008-18 with that of the previous decade (1998-2007), there was a higher proportion of migrant cases as compared to local cases (3:1-11:1) and MB cases as compared to PB cases (2:1-6:1). The proportion of treatment defaulters declined from 60% to 36%. LIMITATIONS Relapse rate could not be calculated due to inadequate follow-up period. As it is a hospital-based retrospective study with no active surveys, these findings may not reflect trends in the community. CONCLUSION Childhood leprosy continues to be a significant problem. There is a clear need to strengthen early detection, treatment and regular follow-up of these cases in both high and low endemic settings.
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Affiliation(s)
- Arti Sakral
- Department of Dermatology, Venereology and Leprology, Government Medical College, Jammu, India
| | - Naina Dogra
- Department of Dermatology, Venereology and Leprology, Government Medical College, Jammu, India
| | - Devraj Dogra
- Department of Dermatology, Venereology and Leprology, Government Medical College, Jammu, India
| | - Kamna Sharma
- Department of Community Medicine, Government Medical College, Kathua, Jammu and Kashmir, India
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17
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Luo Y, Kiriya M, Tanigawa K, Kawashima A, Nakamura Y, Ishii N, Suzuki K. Host-Related Laboratory Parameters for Leprosy Reactions. Front Med (Lausanne) 2021; 8:694376. [PMID: 34746168 PMCID: PMC8568883 DOI: 10.3389/fmed.2021.694376] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 12/27/2022] Open
Abstract
Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.
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Affiliation(s)
- Yuqian Luo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,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
| | - 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
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Norihisa Ishii
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,National Sanatorium Tamazenshoen, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Rosdiana B, Astari L, Astindari A, Rosita Sigit Prakoeswa C, Zulkarnain I, Damayanti D, Utomo B, Listiawan MY. Risk Factors of Type 1 Leprosy Reaction in Leprosy Patients attending Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr Soetomo General Hospital in 2017–2019: A Retrospective Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by increased response of cellular-mediated immunity to Mycobacterium leprae. Manifestations include skin and nerve lesions, edema, and permanent disabilities. There are several risk factors that should be recognized to prevent disabilities.
AIM: The aim of this study was to analyze the relationship of risk factors to the occurrence of type 1 leprosy reaction in leprosy patients treated at the Outpatient Clinic of Dr. Soetomo General Hospital.
METHODS: This study was an analytical study with retrospective observational study design. Data were secondary from the medical records of leprosy patients at the Outpatient Clinic of Dr. Soetomo General Hospital from January 2017 to December 2019.
RESULTS: Out of 364 patients in the Outpatient Clinic, 190 (52.2%) had leprosy without a reaction and 65 (17.9%) had type 1 reaction. Analysis showed that age, leprosy type, and treatment regimen were significantly associated with the incidence of type 1 reaction (p = 0.023; 0.003 and 0.004, respectively), with the leprosy type as the most dominant risk factor. Age 15–34 years old; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen are risk factors for the occurrence of type I leprosy reaction.
CONCLUSION: There is a statistically significant correlation between the risk factor and the occurrence of type 1 leprosy reaction in leprosy patient. The risk factor that has significant correlation is age 15–34 years; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen. The most significant risk factor for the occurrence of type 1 leprosy reaction from our study is the type of leprosy (BB, BL, and BT).
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19
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Frade MAC, Coltro PS, Filho FB, Horácio GS, Neto AA, da Silva VZ, Westin AT, Guimarães FR, Innocentini LMAR, Motta ACF, Farina Junior JA. Lucio's phenomenon: A systematic literature review of definition, clinical features, histopathogenesis and management. Indian J Dermatol Venereol Leprol 2021; 88:464-477. [PMID: 34672479 DOI: 10.25259/ijdvl_909_19] [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: 10/01/2019] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility and risk of causing disabilities. Lucio's phenomenon is a rare manifestation among lepromatous patients with a rapid and severe evolution and high mortality. It is difficult to differentiate from ulcerative/necrotic erythema nodosum leprosum and has no consensus on how it should be treated. This article is a qualitative review of the literature after the introduction of multidrug therapy, aiming to bring consensus related to the clinical, laboratory and histopathological diagnostic criteria of the disease and its management.
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Affiliation(s)
- Marco Andrey Cipriani Frade
- Department of Medical Clinics, Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Pedro S Coltro
- Department of Surgery and Anatomy, Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Fred Bernardes Filho
- Department of Medical Clinics, Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Grazielle S Horácio
- Department of Medical Clinics, Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Antônio A Neto
- Department of Surgery and Anatomy, Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Vinicius Z da Silva
- Department of Surgery and Anatomy, Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Andrezza T Westin
- Department of Medical Clinics, Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Francielle R Guimarães
- Department of Medical Clinics, Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Lara M A R Innocentini
- Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana C F Motta
- Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jayme A Farina Junior
- Department of Surgery and Anatomy, Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
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20
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Pathak R, Agrawal S, Paudyal P. Rare occurrence of lepra type 1 reaction in pure neuritic leprosy: A case report. Clin Case Rep 2021; 9:e04324. [PMID: 34194806 PMCID: PMC8223892 DOI: 10.1002/ccr3.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
Type 1 reaction in pure neuritic leprosy usually occurs in the form of neuritis. The development of new skin lesion during reaction is rare. Clinicians should be aware about occurrence of type 1 reaction in pure neuritic leprosy.
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Affiliation(s)
- Raksha Pathak
- Department of Dermatology and VenereologyB.P Koirala Institute of Health SciencesDharanNepal
| | - Sudha Agrawal
- Department of Dermatology and VenereologyB.P Koirala Institute of Health SciencesDharanNepal
| | - Punam Paudyal
- Department of PathologyB.P Koirala Institute of Health SciencesDharanNepal
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21
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Croker C, Phommasith J, Jerskey R, Marutani A, Ochoa MT. Hansen’s Disease: differences in clinical presentation among Latin American and South East Asian born patients identified in Los Angeles County, California (1995–2016). LEPROSY REV 2020. [DOI: 10.47276/lr.91.3.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Chandan N, Ashack KA, Hill C. Ulcers and edema in a patient with leprosy. Int J Dermatol 2020; 59:1073-1075. [DOI: 10.1111/ijd.14845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Neha Chandan
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
| | - Kurt A. Ashack
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
| | - Carlotta Hill
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
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23
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Antunes DE, Goulart IMB, Goulart LR. Will cases of leprosy reaction increase with COVID-19 infection? PLoS Negl Trop Dis 2020; 14:e0008460. [PMID: 32678816 PMCID: PMC7367444 DOI: 10.1371/journal.pntd.0008460] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
- * E-mail:
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil
- Institute of Biochemistry and Genetics, Federal University of Uberlandia, Uberlandia, Brazil
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
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24
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Glucocorticoids in Leprosy Reversal reaction. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2020. [DOI: 10.2478/sjdv-2019-0011] [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
Abstract
Leprosy is a disease that is caused by Mycobacterium leprae which results in lots of disabilities in the patients. Leprosy is treated by multi-drug therapy regimen; however, this therapy might cause leprosy reactions in the patients. There are several types of lepromatous reaction: type 1 reaction, type 2 reaction and neuritis. Type 1 reaction mainly occurs in BB, BL and BT forms of leprosy and is characterized by exacerbation of preexisting lesions. The therapy of this reaction according to the WHO guideline is corticosteroid therapy. This article will explain several key points related to the corticosteroid therapy in leprosy reversal reactions, including the side effects and alternative therapies available.
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25
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Duthie MS, Roferos FO, Abellana JF, Taborada T, Sanchez R, Maghanoy A, Balagon MF. Utility and limitations of serodiagnostic tests in monitoring the response to treatment of leprosy patients. Diagn Microbiol Infect Dis 2020; 96:114984. [PMID: 31954594 DOI: 10.1016/j.diagmicrobio.2019.114984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
Simple measures that can facilitate early recognition of leprosy complications are still lacking. We therefore evaluated a lateral flow-based rapid diagnostic test and fast enzyme-linked immunosorbent assay measuring anti-LID-NDO antibody responses among leprosy cases in Cebu, Philippines. Responses were measured at diagnosis, then during and after the provision of standard multidrug therapy. Our data indicate that both platforms are highly sensitive tools for the primary diagnosis of, in particular, multibacillary leprosy. A gradual, quantifiable decline in both magnitude of response and percent positive responders was observed during and after treatment. As a group, patients that developed erythema nodosum leprosum (ENL) had a significantly higher response at diagnosis than patients that either developed reversal reactions or did not develop reactions. Although higher initial anti-NDO-LID responses were a risk factor for ENL, neither platform, however, could reliably predict the time of emergence of reactional episodes.
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Affiliation(s)
- Malcolm S Duthie
- Infectious Disease Research Institute, 1616 Eastlake Ave E, Seattle, WA 98102, USA; Host Directed Therapeutics (HDT), Suite 280, 1616 Eastlake Ave E, Seattle, WA 98102, USA.
| | | | - Junie F Abellana
- Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines
| | - Tonet Taborada
- Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines
| | - Riza Sanchez
- Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines
| | - Armi Maghanoy
- Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines
| | - Marivic F Balagon
- Leonard Wood Memorial Center for Leprosy Research, Cebu, Philippines
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26
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Differential Expression of IFN- γ, IL-10, TLR1, and TLR2 and Their Potential Effects on Downgrading Leprosy Reaction and Erythema Nodosum Leprosum. J Immunol Res 2019; 2019:3405103. [PMID: 31781675 PMCID: PMC6875386 DOI: 10.1155/2019/3405103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/16/2019] [Indexed: 01/30/2023] Open
Abstract
Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01 ± 0.23, TLR2: 1.22 ± 0.18; p = 0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24 ± 0.17, TLR2: 2.88 ± 0.37; p = 0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93 ± 0.17, TLR2: 2.81 ± 0.15; p = 0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect = 0.503 > residual effect = 0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect = 0.778 > residual effect = 0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.
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27
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Teles RMB, Lu J, Tió-Coma M, Goulart IMB, Banu S, Hagge D, Bobosha K, Ottenhoff THM, Pellegrini M, Geluk A, Modlin RL. Identification of a systemic interferon-γ inducible antimicrobial gene signature in leprosy patients undergoing reversal reaction. PLoS Negl Trop Dis 2019; 13:e0007764. [PMID: 31600201 PMCID: PMC6805014 DOI: 10.1371/journal.pntd.0007764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/22/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
Reversal reactions (RRs) in leprosy are characterized by a reduction in the number of bacilli in lesions associated with an increase in cell-mediated immunity against the intracellular bacterium Mycobacterium leprae, the causative pathogen of leprosy. To identify the mechanisms that contribute to cell-mediated immunity in leprosy, we measured changes in the whole blood-derived transcriptome of patients with leprosy before, during and after RR. We identified an ‘RR signature’ of 1017 genes that were upregulated at the time of the clinical diagnosis of RR. Using weighted gene correlated network analysis (WGCNA), we detected a module of 794 genes, bisque4, that was significantly correlated with RR, of which 434 genes were part of the RR signature. An enrichment for both IFN-γ and IFN-β downstream gene pathways was present in the RR signature as well as the RR upregulated genes in the bisque4 module, including those encoding proteins of the guanylate binding protein (GBP) family that contributes to antimicrobial responses against mycobacteria. Specifically, GBP1, GBP2, GBP3 and GBP5 mRNAs were upregulated in the RR peripheral blood transcriptome, with GBP1, GBP2 and GBP5 mRNAs also upregulated in the RR disease lesion transcriptome. These data indicate that RRs involve a systemic upregulation of IFN-γ downstream genes including GBP family members as part of the host antimicrobial response against mycobacteria. Reversal reaction (RR) is a major cause of tissue injury and disabilities in leprosy, resulting from the rapid onset of cell-mediated immune responses to the intracellular bacterium Mycobacterium leprae. To identify the mechanisms related to the increase in cell-mediated immunity in RR, we measured changes in the whole blood-derived transcriptome of patients with leprosy before, during and after RR. We identified that RRs are associated with an IFN-γ induced inflammatory response including an antimicrobial gene network containing the GBP1, GBP2, GBP3 and GBP5 mRNAs in the peripheral blood. Furthermore, we show that GBP1, GBP2 and GBP5 mRNAs are also upregulated at the site of disease in RR patients. In summary, our study suggests that RR involves a systemic induction of IFN-γ regulated genes that contributes to an antimicrobial response against the pathogen, releasing ligands and antigens that can further amplify the inflammatory response.
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Affiliation(s)
- Rosane M. B. Teles
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California (UCLA), Los Angeles, California, United States of America
| | - Jing Lu
- Department of Molecular, Cell and Developmental Biology, University of California (UCLA), Los Angeles, California, United States of America
| | - Maria Tió-Coma
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Isabela M. B. Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Faculty of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Sayera Banu
- International Center for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Deanna Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, Kathmandu, Nepal
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tom H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Matteo Pellegrini
- Department of Molecular, Cell and Developmental Biology, University of California (UCLA), Los Angeles, California, United States of America
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert L. Modlin
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California (UCLA), Los Angeles, California, United States of America
- Department of Microbiology, Immunology and Molecular Genetics, University of California (UCLA), Los Angeles, California, United States of America
- * E-mail:
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de Macedo CS, de Carvalho FM, Amaral JJ, de Mendonça Ochs S, Assis EF, Sarno EN, Bozza PT, Pessolani MCV. Leprosy and its reactional episodes: Serum levels and possible roles of omega-3 and omega-6-derived lipid mediators. Cytokine 2018; 112:87-94. [DOI: 10.1016/j.cyto.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/27/2023]
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Shi C, Jing ZC, Yang DG, Zhu JY. A rare case of type 1 leprosy reactions following tetanus infection in a borderline tuberculoid leprosy patient and a literature review. Infect Dis Poverty 2018; 7:58. [PMID: 29908564 PMCID: PMC6004287 DOI: 10.1186/s40249-018-0441-4] [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: 12/15/2017] [Accepted: 05/17/2018] [Indexed: 11/29/2022] Open
Abstract
Background Type 1 leprosy reaction, also known as “reversal reaction”, is related to cellular immune responses to Mycobacterium leprae antigens. The risk factors that trigger type 1 leprosy reactions are poorly understood. Leprosy with concurrent tetanus is rare, and there are no publicly available reports of a leprosy patient infected with tetanus that induced type 1 leprosy reactions. Case presentation A 56-year-old Chinese Han female presented to our hospital with symptoms of erythematous plaques and pain over her left upper limb for 2 days and foreign object sensation in her throat for 3 days. The patient had a 6-year history of leprosy. Type 1 leprosy reactions were initially considered, followed by treatment with methylprednisolone. Two days later, the patient’s symptoms were aggravated, with neck muscle tension and difficulty in opening her mouth, and the erythematous plaques had spread over most of her left upper limb. After further careful examinations, we confirmed the diagnosis of tetanus with concurrent type 1 leprosy reactions. The patient was given anti-tetanus treatment for 12 days and anti-leprosy reaction treatment for 4 months; the diseases were eventually controlled. Conclusions This report suggests that tetanus infection may be a trigger for type 1 leprosy reactions. Electronic supplementary material The online version of this article (10.1186/s40249-018-0441-4) contains supplementary material, which is available to authorized users.
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Sandre MK, Poenaru SM, Boggild AK. Erythema Nodosum Leprosum Triggered by Antecedent Influenza Vaccine and Respiratory Tract Infection: A Case Report. J Cutan Med Surg 2018; 23:114-116. [PMID: 30326738 DOI: 10.1177/1203475418808759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a patient with new-onset erythema nodosum leprosum months after successful treatment of her mid-borderline leprosy, which was likely triggered by a combination of antecedent influenza vaccination and upper respiratory tract infection.
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Affiliation(s)
- Matthew K Sandre
- 1 Division of Dermatology, University of Toronto, Toronto, ON, Canada.,2 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonia M Poenaru
- 3 Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrea K Boggild
- 2 Department of Medicine, University of Toronto, Toronto, ON, Canada.,4 Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada.,5 Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, ON, Canada
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31
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Saleem MD, Oussedik E, Picardo M, Schoch JJ. Acquired disorders with hypopigmentation: A clinical approach to diagnosis and treatment. J Am Acad Dermatol 2018; 80:1233-1250.e10. [PMID: 30236514 DOI: 10.1016/j.jaad.2018.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Acquired hypopigmented skin changes are commonly encountered by dermatologists. Although hypopigmentation is often asymptomatic and benign, occasional serious and disabling conditions present with cutaneous hypopigmentation. A thorough history and physical examination, centered on disease distribution and morphologic findings, can aid in delineating the causes of acquired hypopigmented disorders. The second article in this 2-part continuing medical education series focuses on conditions with a hypopigmented phenotype. Early diagnosis and appropriate management of these disorders can improve a patient's quality of life, halt disease progression, and prevent irreversible disability.
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Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida
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Carvalho JCD, Araújo MG, Coelho-Dos-Reis JGA, Peruhype-Magalhães V, Alvares CC, Moreira MDL, Teixeira-Carvalho A, Martins-Filho OA, Araújo MSS. Phenotypic and functional features of innate and adaptive immunity as putative biomarkers for clinical status and leprosy reactions. Microb Pathog 2018; 125:230-239. [PMID: 30195647 DOI: 10.1016/j.micpath.2018.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022]
Abstract
The aim of this study was to identify phenotypic and functional biomarkers associated with distinct clinical status of leprosy or leprosy reactions. The study included tuberculoid/borderline (BB/BT/T) and lepromatous (BL/L) leprosy poles as well as Type-1 and Type-2 leprosy reactions along with healthy controls (NI). A range of peripheral blood biomarkers of innate (neutrophils - NEU and monocytes - MON) and adaptive immunity (CD4+ and CD8+ T-cells) were evaluated ex vivo and upon in vitro stimuli with M. leprae antigen. Data analysis allowed the selection of NEUTLR4+ (ex vivo) and CD4+IL-10+ (in vitro) as universal biomarkers increased in all leprosy patients and those exhibiting leprosy reactions. A range of biomarkers were commonly found in both poles of leprosy patients, including decreased levels of MONTGF-β+ (ex vivo) and increased levels of MONTNF-α+, CD4+TGF-β+, CD8+TLR2+, CD8+TNF-α+, CD8+IL-4+ and CD8+TGF-β+ (in vitro). Noteworthy was that MONHLA-DR+ (ex vivo) and CD8+IL-10+ (in vitro) were particularly found in BL/L patients. Leprosy patients with Type-1 reaction exhibited a larger list of altered biomarkers, mainly involving activation markers (TLR2, TLR4, HLA-DR and DAF-2T) in NEU and MON along with CD4+ and CD8+ cells. In summary, this study provided insights about immunological features of leprosy poles and leprosy reactional episodes with putative applicability, including novel biomarkers for complementary diagnosis and future therapeutic approaches in clinical studies.
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Affiliation(s)
- Jairo Campos de Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil; Fundação Hospitalar do Estado de Minas Gerais, Alameda Vereador Álvaro Celso, 100 - Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.
| | - Marcelo Grossi Araújo
- Serviço de Dermatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Al. Álvaro Celso, 55, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Vanessa Peruhype-Magalhães
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
| | - Cláudio Caetano Alvares
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
| | - Marcela de Lima Moreira
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
| | - Márcio Sobreira Silva Araújo
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/FIOCRUZ - MG, Belo Horizonte, Minas Gerais, Brazil.
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Serrano-Coll H, Salazar-Peláez L, Acevedo-Saenz L, Cardona-Castro N. Mycobacterium leprae-induced nerve damage: direct and indirect mechanisms. Pathog Dis 2018; 76:5057473. [PMID: 30052986 DOI: 10.1093/femspd/fty062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/16/2018] [Indexed: 12/22/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This disease is characterized by skin and peripheral nerve trunk damage. The mechanisms responsible for the observed nerve damage in leprosy could be directly related to the ability of M. leprae to infect Schwann cells, leading to triggering of signaling events. Therefore, we hypothesize that in response to M. leprae infection, activation of the Notch signaling pathway in Schwann cells could play a crucial role in glial cell dedifferentiation. On the other hand, nerve damage evidenced in this disease may be additionally explained by indirect mechanisms such as the immune response and genetic susceptibility of the host. The understanding of the mechanisms leading to nerve damage induced by M. leprae infection will allow us to generate valuable tools for the early detection of leprosy as well as for the mitigation of the effects of this disabling disease.
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Affiliation(s)
- Héctor Serrano-Coll
- Basic Science Research Group, School of Medicine, CES University, Calle 10 A No. 22-04, Medellín, Colombia.,School of Graduate Studies, CES University, Calle 10 A No. 22-04, Medellín, Colombia
| | - Lina Salazar-Peláez
- Basic Science Research Group, School of Medicine, CES University, Calle 10 A No. 22-04, Medellín, Colombia.,School of Graduate Studies, CES University, Calle 10 A No. 22-04, Medellín, Colombia
| | - Liliana Acevedo-Saenz
- Basic Science Research Group, School of Medicine, CES University, Calle 10 A No. 22-04, Medellín, Colombia.,School of Graduate Studies, CES University, Calle 10 A No. 22-04, Medellín, Colombia
| | - Nora Cardona-Castro
- Basic Science Research Group, School of Medicine, CES University, Calle 10 A No. 22-04, Medellín, Colombia.,School of Graduate Studies, CES University, Calle 10 A No. 22-04, Medellín, Colombia.,Colombian Institute of Tropical Medicine (ICMT), Cra 43 A No. 52-99, Sabaneta, Antioquia, Colombia
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34
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de Mattos Barbosa MG, de Andrade Silva BJ, Assis TQ, da Silva Prata RB, Ferreira H, Andrade PR, da Paixão de Oliveira JA, Sperandio da Silva GM, da Costa Nery JA, Sarno EN, Pinheiro RO. Autophagy Impairment Is Associated With Increased Inflammasome Activation and Reversal Reaction Development in Multibacillary Leprosy. Front Immunol 2018; 9:1223. [PMID: 29915584 PMCID: PMC5994478 DOI: 10.3389/fimmu.2018.01223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
Leprosy reactions are responsible for incapacities in leprosy and represent the major cause of permanent neuropathy. The identification of biomarkers able to identify patients more prone to develop reaction could contribute to adequate clinical management and the prevention of disability. Reversal reaction may occur in unstable borderline patients and also in lepromatous patients. To identify biomarker signature profiles related with the reversal reaction onset, multibacillary patients were recruited and classified accordingly the occurrence or not of reversal reaction during or after multidrugtherapy. Analysis of skin lesion cells at diagnosis of multibacillary leprosy demonstrated that in the group that developed reaction (T1R) in the future there was a downregulation of autophagy associated with the overexpression of TLR2 and MLST8. The autophagy impairment in T1R group was associated with increased expression of NLRP3, caspase-1 (p10) and IL-1β production. In addition, analysis of IL-1β production in serum from multibacillary patients demonstrated that patients who developed reversal reaction have significantly increased concentrations of IL-1β at diagnosis, suggesting that the pattern of innate immune responses could predict the reactional episode outcome. In vitro analysis demonstrated that the blockade of autophagy with 3-methyladenine (3-MA) in Mycobacterium leprae-stimulated human primary monocytes increased the assembly of NLRP3 specks assembly, and it was associated with an increase of IL-1β and IL-6 production. Together, our data suggest an important role for autophagy in multibacillary leprosy patients to avoid exacerbated inflammasome activation and the onset of reversal reaction.
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Affiliation(s)
| | | | - Tayná Quintella Assis
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Helen Ferreira
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | | | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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35
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Hanna E, Dany M, Abbas O, Kreidieh F, Kurban M. Updates on the use of vaccines in dermatological conditions. Indian J Dermatol Venereol Leprol 2018; 84:388-402. [PMID: 29794355 DOI: 10.4103/ijdvl.ijdvl_1036_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Numerous vaccines are being actively developed for use in dermatologic diseases. Advances in the fields of immunotherapy, genetics and molecular medicine have allowed for the design of prophylactic and therapeutic vaccines with immense potential in managing infections and malignancies of the skin. This review addresses the different vaccines available for use in dermatological diseases and those under development for future potential use. The major limitation of our review is its complete reliance on published data. Our review is strictly limited to the availability of published research online through available databases. We do not cite any of the authors' previous publications nor have we conducted previous original research studies regarding vaccines in dermatology. Strength would have been added to our paper had we conducted original studies by our research team regarding the candidate vaccines delineated in the paper.
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Affiliation(s)
- Edith Hanna
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Dany
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kreidieh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center; Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon; Department of Dermatology, Columbia University, New York, USA
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36
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Semwal S, Joshi D, Goel G, Mittal N, Majumdar K, Kapoor N. Cytological Diagnosis of Erythema Nodosum Leprosum in Clinically Unsuspected Cases: A Report of Two Cases. J Cytol 2018; 35:63-65. [PMID: 29403176 PMCID: PMC5795734 DOI: 10.4103/0970-9371.223598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The manifestations of this disease varies across the spectrum of tuberculoid (TT) to lepromatous (LL) leprosy. The course of this indolent disease is interrupted by acute exacerbations in the form of leprare actions. Erythema nodosum leprosum (ENL), a type 2 lepra reaction, occurs in lepromatous or borderline lepromatous cases, usually in response to multidrug therapy. Early detection and timely management of these patients is important to reduce the associated morbidity. We report two clinically unusual cases of ENL on fine-needle aspiration cytology. In one case, antileprosy treatment was completed 10 years back, whereas in the other case, ENL was the presenting feature of the disease. Cytological examination of swelling in both the cases showed neutrophils, lymphoid cells, clusters of foamy macrophages, histiocytes, and giant cells. Fite stain was positive, which confirmed the cytological diagnosis of ENL.
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Affiliation(s)
- Shruti Semwal
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Garima Goel
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Neha Mittal
- Tata Memorial hospital, Mumbai, Maharashtra, India
| | | | - Neelkamal Kapoor
- Department of Pathology and Laboratory Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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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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dos Santos LN, da Silva PHL, Alvim IMP, Nery JADC, Lara FA, Sarno EN, Esquenazi D. Role of TEFFECTOR/MEMORY Cells, TBX21 Gene Expression and T-Cell Homing Receptor on Type 1 Reaction in Borderline Lepromatous Leprosy Patients. PLoS One 2016; 11:e0164543. [PMID: 27764137 PMCID: PMC5072666 DOI: 10.1371/journal.pone.0164543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/27/2016] [Indexed: 01/30/2023] Open
Abstract
In spite of hyporesponsivity to Mycobacterium leprae, borderline lepromatous (BL) patients show clinical and immunological instability, and undergo frequent acute inflammatory episodes such as type 1 reaction (T1R), which may cause nerve damages. This work focused on the participation of T cell subsets from blood and skin at T1R onset. We observed a significantly increased ex vivo frequency of both effector and memory CD4+ and CD8+ T cells in T1R group. Besides, ex vivo frequency of T cell homing receptor, the Cutaneous Leukocyte-associated Antigen (CLA) was significantly increased in T cells from T1R patients. M. leprae induced a higher frequency of CD4+ TEM and CD8+ TEF cells, as well as of CD8+/TEMRA (terminally differentiated effector T cells) subset, which expressed high CD69+. The presence of IFN-γ‒producing-CD4+ TEF and naïve and effector CD8+ T lymphocytes was significant in T1R. TBX21 expression was significantly higher in T1R, while BL showed increased GATA3 and FOXP3 expression. In T1R, TBX21 expression was strongly correlated with CD8+/IFN-γ‒ T cells frequency. The number of double positive CD8+/CLA+ and CD45RA+/CLA+ cells was significantly higher in skin lesions from T1R, in comparison with non-reactional BL group. The observed increase of ex vivo T cells at T1R onset suggests intravascular activation at the beginning of reactional episodes. The antigen-specific response in T1R group confirmed the higher number of CD8+/CLA+ and CD45RA+/CLA+ cells in T1R lesions suggests possible migration of these cells activated by M. leprae components inside the vascular compartment to skin and participation in T1R physiopathology.
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Affiliation(s)
| | | | - Iris Maria Peixoto Alvim
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Flávio Alves Lara
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danuza Esquenazi
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Pathology and Laboratories, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Chan MMF, Smoller BR. Overview of the Histopathology and Other Laboratory Investigations in Leprosy. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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40
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Abstract
Leprosy reactions are acute inflammatory episodes that occur in the setting of Mycobacterium leprae infection. Precipitants of reactions can be pharmacologic and nonpharmacologic. Both type 1 and type 2 reactions typically occur before and during leprosy treatment but may also occur after treatment has been completed. Reactions cause morbidity due to nerve damage, and prompt corticosteroid therapy is warranted to minimize nerve damage due to reactions.
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Affiliation(s)
- Jane Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea K Boggild
- Department of Medicine, University of Toronto, Toronto, ON, Canada Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, ON, Canada
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41
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de Oliveira MBB, Diniz LM. Leprosy among children under 15 years of age: literature review. An Bras Dermatol 2016; 91:196-203. [PMID: 27192519 PMCID: PMC4861567 DOI: 10.1590/abd1806-4841.20163661] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.
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Morato-Conceicao YT, Alves-Junior ER, Arruda TA, Lopes JC, Fontes CJF. Serum uric acid levels during leprosy reaction episodes. PeerJ 2016; 4:e1799. [PMID: 26989632 PMCID: PMC4793330 DOI: 10.7717/peerj.1799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background. Leprosy reactions are acute inflammatory episodes that occur mainly in the multibacillary forms of the disease. The reactions are classified as type 1 (reverse reaction) or type 2 (erythema nodosum leprosum). Leprosy-associated oxidative stress has been widely demonstrated. Several recent studies have shown uric acid (UA) to have antioxidative effects under pathologic conditions. The objective of this study was to assess serum levels of UA in patients with leprosy reactions, with the aim of monitoring their levels before and after treatment, compared with levels in leprosy patients without reactions. Methods. The study included patients aged 18–69 years assisted at a leprosy treatment reference center in the Central Region of Brazil. Patients who were pregnant; were using immunosuppressant drugs or immunobiologicals; or had an autoimmune disease, human immunodeficiency virus infection, acquired immune deficiency syndrome, or tuberculosis were excluded. Upon recruitment, all individuals were clinically assessed for skin lesions and neural or systemic impairment. Some patients had already completed treatment for leprosy, while others were still undergoing treatment or had initiated treatment after being admitted. The treatment of the reactional episode was started only after the initial evaluation. Laboratory assessments were performed upon admission (baseline) and at approximately 30 and 60 days (time points 1 and 2, respectively). Results. A total of 123 leprosy patients were recruited between June 2012 and June 2015; among them, 56, 42, and 25 presented with type 1, type 2, and no reactions, respectively. Serum UA levels were significantly reduced in patients with type 2 leprosy reactions compared with patients in the control group and remained lower in the two subsequent assessments, after initiation of anti-reaction treatments, with similar values to those recorded before the treatment. Discussion. The decreased serum UA levels in patients with type 2 leprosy reactions might be due to the consumption of UA to neutralize the enhanced production of oxygen- and nitrogen-reactive species that occurs during type 2 reactions. The maintenance of the reduced levels in the follow-up assessments may indicate persistence of oxidative stress in the initial post-treatment stages, despite improved clinical conditions. The results of this study suggest that serum UA may play an antioxidative role during type 2 leprosy reactions.
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Affiliation(s)
- Yvelise T Morato-Conceicao
- Department of Internal Medicine, Faculty of Medicine, Julio Muller University Hospital, Universidade Federal de Mato Grosso , Cuiaba MT , Brazil
| | | | - Talita A Arruda
- Department of Internal Medicine, Faculty of Medicine, Julio Muller University Hospital, Universidade Federal de Mato Grosso , Cuiaba MT , Brazil
| | - Jose C Lopes
- Department of Internal Medicine, Julio Muller University Hospital, Universidade Federal de Mato Grosso , Cuiaba MT , Brazil
| | - Cor J F Fontes
- Department of Internal Medicine, Faculty of Medicine, Julio Muller University Hospital, Universidade Federal de Mato Grosso , Cuiaba MT , Brazil
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The Essential Role of Cholesterol Metabolism in the Intracellular Survival of Mycobacterium leprae Is Not Coupled to Central Carbon Metabolism and Energy Production. J Bacteriol 2015; 197:3698-707. [PMID: 26391209 PMCID: PMC4626898 DOI: 10.1128/jb.00625-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/05/2015] [Indexed: 01/13/2023] Open
Abstract
Mycobacterium leprae induces the formation of lipid droplets, which are recruited to pathogen-containing phagosomes in infected macrophages and Schwann cells. Cholesterol is among the lipids with increased abundance in M. leprae-infected cells, and intracellular survival relies on cholesterol accumulation. The present study investigated the capacity of M. leprae to acquire and metabolize cholesterol. In silico analyses showed that oxidation of cholesterol to cholest-4-en-3-one (cholestenone), the first step of cholesterol degradation catalyzed by the enzyme 3β-hydroxysteroid dehydrogenase (3β-HSD), is apparently the only portion of the cholesterol catabolic pathway seen in Mycobacterium tuberculosis preserved by M. leprae. Incubation of bacteria with radiolabeled cholesterol confirmed the in silico predictions. Radiorespirometry and lipid analyses performed after incubating M. leprae with [4-14C]cholesterol or [26-14C]cholesterol showed the inability of this pathogen to metabolize the sterol rings or the side chain of cholesterol as a source of energy and carbon. However, the bacteria avidly incorporated cholesterol and, as expected, converted it to cholestenone both in vitro and in vivo. Our data indicate that M. leprae has lost the capacity to degrade and utilize cholesterol as a nutritional source but retains the enzyme responsible for its oxidation to cholestenone. Thus, the essential role of cholesterol metabolism in the intracellular survival of M. leprae is uncoupled from central carbon metabolism and energy production. Further elucidation of cholesterol metabolism in the host cell during M. leprae infection will establish the mechanism by which this lipid supports M. leprae intracellular survival and will open new avenues for novel leprosy therapies. IMPORTANCE Our study focused on the obligate intracellular pathogen Mycobacterium leprae and its capacity to metabolize cholesterol. The data make an important contribution for those interested in understanding the mechanisms of mycobacterial pathogenesis, since they indicate that the essential role of cholesterol for M. leprae intracellular survival does not rely on its utilization as a nutritional source. Our findings reinforce the complexity of cholesterol's role in sustaining M. leprae infection. Further elucidation of cholesterol metabolism in the host cell during M. leprae infection will establish the mechanism by which this lipid supports M. leprae intracellular survival and will open new avenues for novel leprosy therapies.
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Fu X, Liu H, Zhang F. Borderline Lepromatous Leprosy with Type 1 (Reversal) Reactions in a Chinese Man. Am J Trop Med Hyg 2015; 93:207-209. [PMID: 26251526 PMCID: PMC4530734 DOI: 10.4269/ajtmh.14-0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Furen Zhang
- *Address correspondence to Furen Zhang, 27397 Jingshi Lu, Jinan 250022, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Shandong Province, People’s Republic of China. E-mail:
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Andrade PR, Pinheiro RO, Sales AM, Illarramendi X, de Mattos Barbosa MG, Moraes MO, Jardim MR, da Costa Nery JA, Sampaio EP, Sarno EN. Type 1 reaction in leprosy: a model for a better understanding of tissue immunity under an immunopathological condition. Expert Rev Clin Immunol 2015; 11:391-407. [DOI: 10.1586/1744666x.2015.1012501] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Rivoire BL, Groathouse NA, TerLouw S, Neupane KD, Ranjit C, Sapkota BR, Khadge S, Kunwar CB, Macdonald M, Hawksworth R, Thapa MB, Hagge DA, Tibbals M, Smith C, Dube T, She D, Wolff M, Zhou E, Makhene M, Mason R, Sizemore C, Brennan PJ. Safety and efficacy assessment of two new leprosy skin test antigens: randomized double blind clinical study. PLoS Negl Trop Dis 2014; 8:e2811. [PMID: 24874401 PMCID: PMC4038488 DOI: 10.1371/journal.pntd.0002811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/10/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND New tools are required for the diagnosis of pre-symptomatic leprosy towards further reduction of disease burden and its associated reactions. To address this need, two new skin test antigens were developed to assess safety and efficacy in human trials. METHODS A Phase I safety trial was first conducted in a non-endemic region for leprosy (U.S.A.). Healthy non-exposed subjects (n = 10) received three titrated doses (2.5 µg, 1.0 µg and 0.1 µg) of MLSA-LAM (n = 5) or MLCwA (n = 5) and control antigens [Rees MLSA (1.0 µg) and saline]. A randomized double blind Phase II safety and efficacy trial followed in an endemic region for leprosy (Nepal), but involved only the 1.0 µg (high dose) and 0.1 µg (low dose) of each antigen; Tuberculin PPD served as a control antigen. This Phase II safety and efficacy trial consisted of three Stages: Stage A and B studies were an expansion of Phase I involving 10 and 90 subjects respectively, and Stage C was then conducted in two parts (high dose and low dose), each enrolling 80 participants: 20 borderline lepromatous/lepromatous (BL/LL) leprosy patients, 20 borderline tuberculoid/tuberculoid (BT/TT) leprosy patients, 20 household contacts of leprosy patients (HC), and 20 tuberculosis (TB) patients. The primary outcome measure for the skin test was delayed type hypersensitivity induration. FINDINGS In the small Phase I safety trial, reactions were primarily against the 2.5 µg dose of both antigens and Rees control antigen, which were then excluded from subsequent studies. In the Phase II, Stage A/B ramped-up safety study, 26% of subjects (13 of 50) showed induration against the high dose of each antigen, and 4% (2 of 50) reacted to the low dose of MLSA-LAM. Phase II, Stage C safety and initial efficacy trial showed that both antigens at the low dose exhibited low sensitivity at 20% and 25% in BT/TT leprosy patients, but high specificity at 100% and 95% compared to TB patients. The high dose of both antigens showed lower specificity (70% and 60%) and sensitivity (10% and 15%). BL/LL leprosy patients were anergic to the leprosy antigens. INTERPRETATION MLSA-LAM and MLCwA at both high (1.0 µg) and low (0.1 µg) doses were found to be safe for use in humans without known exposure to leprosy and in target populations. At a sensitivity rate of 20-25% these antigens are not suitable as a skin test for the detection of the early stages of leprosy infection; however, the degree of specificity is impressive given the presence of cross-reactive antigens in these complex native M. leprae preparations. TRIAL REGISTRATION ClinicalTrials.gov NCT01920750 (Phase I), NCT00128193 (Phase II).
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Affiliation(s)
- Becky L. Rivoire
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
- * E-mail:
| | - Nathan A. Groathouse
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Stephen TerLouw
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Kapil Dev Neupane
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Chaman Ranjit
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | | | - Saraswoti Khadge
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Chatra B. Kunwar
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Murdo Macdonald
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Rachel Hawksworth
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Min B. Thapa
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Deanna A. Hagge
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Melinda Tibbals
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Carol Smith
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Tina Dube
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Dewei She
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Mark Wolff
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Eric Zhou
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Robin Mason
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Christine Sizemore
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Patrick J. Brennan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
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