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Xavier MB, Pires CAA, Gomes CMDC, Rodrigues GF, Xavier DP, de Brito JAGDSM, Corbett CEP. The expression of FOXP3 in lesions of several forms of leprosy in patients co-infected with HIV. PLoS Negl Trop Dis 2021; 15:e0009887. [PMID: 34748560 PMCID: PMC8601607 DOI: 10.1371/journal.pntd.0009887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/18/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brazil remains endemic for infection by the human immunodeficiency virus (HIV) and leprosy, having a major impact on public health and the life quality of affected patients. Although the relevance of this co-infection is recognized, several aspects, such as the immune response, are not yet fully understood. The objective of this study was to investigate the expression of FOXP3+ Treg cells in leprosy skin lesions and to correlate their clinical forms, laboratory characteristics (CD4, CD8, and CV), and the immune reconstitution syndrome in HIV-leprosy co-infection. METHODOLOGY/PRINCIPAL FINDINGS An observational, cross-sectional, and analytical study was carried out comparing four groups of patients: those with concomitant diagnosis of leprosy and HIV infection without a leprosy reaction, those with leprosy and HIV co-infection patients with a reverse reaction (RR), those with leprosy without HIV and without reaction, and those with leprosywithout HIV and with RR. The patients were diagnosed at a dermatology outpatient clinic located in Belém, Pará, Brazil, from 2003 to 2017. In the sample studied, there was a positive correlation between FOXP3+ cell density and viral load, negative correlation with blood CD4+ (not statistically significant), significant positive correlation in CD8 count in patients with leprosy reaction, and positive relationship in patients with IRIS. The density of cells expressing FOXP3 was higher in the BL/LL forms in patients without HIV, although the difference was not statistically significant. However, the cell mean was higher in the TT/BT forms in patients co-infected with leprosy and HIV, showing contradictory results. CONCLUSIONS/SIGNIFICANCE These findings support that higher activity of the HIV may stimulate or result in a higher expression of FOXP3-Tregs and that they may be involved in active immunosuppression observed at the infection site at the tissue level. This supports the need to expand studies on FOXP3+ Treg cells in co-infected patients.
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Affiliation(s)
- Marília Brasil Xavier
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
- Research Laboratory on Skin diseases of Sanitary Interest, Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Carla Andréa Avelar Pires
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
- Research Laboratory on Skin diseases of Sanitary Interest, Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Cláudia Maria de Castro Gomes
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
| | - Gabriela Fernandes Rodrigues
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
| | - Débora Pinheiro Xavier
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
| | | | - Carlos Eduardo Pereira Corbett
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
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Souza CDFD, Medronho RDA, Santos FGB, Magalhães MDAFM, Luna CF. Modelagem espacial da hanseníase no estado da Bahia, Brasil, (2001-2015) e determinantes sociais da saúde. CIENCIA & SAUDE COLETIVA 2020; 25:2915-2926. [DOI: 10.1590/1413-81232020258.21522018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
Resumo O trabalho analisa a distribuição espacial da hanseníase na Bahia e os determinantes sociais relacionados. Estudo ecológico com dados de hanseníase do período 2001-2015. Três indicadores epidemiológicos foram selecionados: coeficiente de detecção na população geral e em menores de 15 anos e a taxa de casos novos com grau II de incapacidade. Os indicadores foram suavizados pelo Modelo Bayesiano Empírico Local e aplicou-se estatística de Moran Global e Local. As variáveis independentes foram selecionadas a partir do Censo IBGE-2010. Regressões multivariadas foram empregadas, seguidas de regressão espacial. Observou-se distribuição heterogênea no estado, com concentração no eixo norte-oeste e região sul. Para o coeficiente de detecção geral, cinco variáveis compuseram o modelo: densidade demográfica, proporção da população urbana, renda per capita, proporção de extremamente pobres e domicílios com mais de três pessoas por dormitório. A proporção de analfabetismo compôs o modelo final para a taxa de grau II de incapacidade física. Não foram identificados determinantes da ocorrência da doença em menores de 15 anos. A modelagem utilizada contribuiu para demonstrar a heterogeneidade espacial e os determinantes sociais da doença na Bahia, colocando em evidência a complexidade do problema.
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da Silva TP, Bittencourt TL, de Oliveira AL, Prata RBDS, Menezes V, Ferreira H, Nery JADC, de Oliveira EB, Sperandio da Silva GM, Sarno EN, Pinheiro RO. Macrophage Polarization in Leprosy-HIV Co-infected Patients. Front Immunol 2020; 11:1493. [PMID: 32849508 PMCID: PMC7403476 DOI: 10.3389/fimmu.2020.01493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
In HIV-infected individuals, a paradoxical clinical deterioration may occur in preexisting leprosy when highly active antiretroviral therapy (HAART)-associated reversal reaction (RR) develops. Leprosy–HIV co-infected patients during HAART may present a more severe form of the disease (RR/HIV), but the immune mechanisms related to the pathogenesis of leprosy–HIV co-infection remain unknown. Although the adaptive immune responses have been extensively studied in leprosy–HIV co-infected individuals, recent studies have described that innate immune cells may drive the overall immune responses to mycobacterial antigens. Monocytes are critical to the innate immune system and play an important role in several inflammatory conditions associated with chronic infections. In leprosy, different tissue macrophage phenotypes have been associated with the different clinical forms of the disease, but it is not clear how HIV infection modulates the phenotype of innate immune cells (monocytes or macrophages) during leprosy. In the present study, we investigated the phenotype of monocytes and macrophages in leprosy–HIV co-infected individuals, with or without RR. We did not observe differences between the monocyte profiles in the studied groups; however, analysis of gene expression within the skin lesion cells revealed that the RR/HIV group presents a higher expression of macrophage scavenger receptor 1 (MRS1), CD209 molecule (CD209), vascular endothelial growth factor (VEGF), arginase 2 (ARG2), and peroxisome proliferator-activated receptor gamma (PPARG) when compared with the RR group. Our data suggest that different phenotypes of tissue macrophages found in the skin from RR and RR/HIV patients could differentially contribute to the progression of leprosy.
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Affiliation(s)
| | | | | | | | - Vinicius Menezes
- 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
| | | | | | - Gilberto Marcelo Sperandio da Silva
- Chagas Disease Clinic Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, 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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de Souza CDF, Luna CF, Magalhães MDAFM. Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities. An Bras Dermatol 2019; 94:182-191. [PMID: 31090823 PMCID: PMC6486086 DOI: 10.1590/abd1806-4841.20197554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/22/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS The use of synthetic indicators is a limitation of the study. CONCLUSIONS Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.
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Affiliation(s)
- Carlos Dornels Freire de Souza
- Discipline of Collective Health, Curso de Medicina,
Universidade Federal de Alagoas, Arapiraca (AL), Brazil
- Instituto Aggeu Magalhães, Fundação
Oswaldo Cruz, Recife (PE), Brazil
| | - Carlos Feitosa Luna
- Instituto Aggeu Magalhães, Fundação
Oswaldo Cruz, Recife (PE), Brazil
- Program of Post-Graduation in Public Health,
Fundação Oswaldo Cruz, Recife (PE), Brazil
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Lydiawati E, Sirithida C, Vannda S, Vortey H, Ratana H, Listiawan MY, Agusni I. LEPROSY AND HUMAN IMMUNODEFICIENCY VIRUS COINFECTION: A RARE CASE REPORT. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2019. [DOI: 10.20473/ijtid.v7i4.8869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leprosy, or Hansen disease, is a chronic infectious disease caused by Mycobacterium leprae which is associated with inflammation that may damage the skin and the peripheral nerves. Leprosy remains an important public health problem in Southeast Asia, America, and Africa. It has been speculated that, as with TB, HIV infection may exacerbate leprosy lesions and/or lead to increased susceptibility to leprosy. We report the case of leprosy and HIV co-infection and reveals its clinical manifestation. A 34-year-old female came to outpatient clinic complaining of rednessplaque on her face of 2-months duration. It was also accompanied with thick sensation but without itchy or burning sensation. We found thick erythematous plaque with sharp margin and hypoesthesia on her face and body. There were no madarosis, saddle nose, lagophthalmos, nor sign of neuritis. The slit-skin smear revealed BI 1+ globi and MI 2%. From laboratory examination we found CBC was within normal limit, IgM anti PGL-1 titer was 1265 u/mL and IgG anti PGL-1 was 834 u/mL Both histological examination on her ear lobe and extremity revealed that was similar to the lesion of leprosy. The detection of HIV antibody was positive with CD4 count on 325 cells/μL. We treat her with MDT for MB leprosy along with ART (Tenofovir, Lamivudine, and Efavirenz). After 6-months follow-up we observed no progression of the lesions though the slit-skin smear after completing 6 months of therapy become negative. M. leprae does not seem to accelerate the decline of immune function when associated with HIV infection. HIV infection does not seem to affect the clinical classification and progression of leprosy. Treatment of the HIV-leprosy co-infected patient consists of the combination of ARTs and anti-leprosy agents. So that, the treatment of leprosy and HIV co-infection does not differ from that of a seronegative leprosy patient.
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Girma S, Avanzi C, Bobosha K, Desta K, Idriss MH, Busso P, Tsegaye Y, Nigusse S, Hailu T, Cole ST, Aseffa A. Evaluation of Auramine O staining and conventional PCR for leprosy diagnosis: A comparative cross-sectional study from Ethiopia. PLoS Negl Trop Dis 2018; 12:e0006706. [PMID: 30180155 PMCID: PMC6138420 DOI: 10.1371/journal.pntd.0006706] [Citation(s) in RCA: 5] [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: 02/09/2018] [Revised: 09/14/2018] [Accepted: 07/19/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Diagnosis of leprosy mainly relies on clinical examination due to the inconsistent sensitivity and poor reproducibility of the current laboratory tests. Utilisation of alternative methods to the standard Ziehl Neelsen (ZN), Fite-Faraco (FF) and Haematoxylin and Eosin (H&E) staining procedures may eventually improve leprosy diagnosis. METHODOLOGY/PRINCIPAL FINDINGS In this comparative study, the performance of the fluorescent Auramine O (AO) staining and polymerase chain reaction (PCR) was assessed with different skin samples using a combination of ZN, FF and H&E staining as the gold standard. AO, ZN, FF, H&E and PCR tests were performed on slit skin smears (SSS) and/or punch biopsies collected from 141 clinically confirmed leprosy cases and 28 non-leprosy skin samples. DNA was extracted from punch biopsies using two different methods with or without mechanical lysis. Sensitivities were 87.6%, 59.3% and 77% for H&E, ZN and FF, respectively, whereas it reached 65.5% and 77.9% for AO in SSS and tissue sections and 91.1% for PCR in tissue samples. Morover, samples with low bacillary index, sensitivity of AO staining (61.8%) was similar to FF (60%, p>0.05) and lower than PCR (86.6%, p<0.05). Sensitivity of PCR also increased (96.8%, p<0.05) when mechanical lysis was used during DNA extraction compared to enzymatic treatment alone (84.6%). CONCLUSIONS/SIGNIFICANCE Our results showed that for diagnostic purposes, analysis of skin section is more sensitive than SSS, especially for samples with low bacillary load. AO staining on SSS and tissue sections was not significantly better than other routine diagnostic tests but considerably more user friendly. The sensitivity of PCR was higher than current standard methods and increased when combined with more efficient DNA extraction using mechanical and chemical lysis. Therefore, we recommend AO staining for the diagnosis of leprosy in lower health facilities such as health centres and district hospitals and PCR diagnosis at referral level and research centres.
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Affiliation(s)
- Selfu Girma
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Charlotte Avanzi
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Kassu Desta
- Addis Ababa University, CHS, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
| | | | - Philippe Busso
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | | | - Tsegaye Hailu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stewart T. Cole
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Pires CAA, Quaresma JAS, de Souza Aarão TL, de Souza JR, Macedo GMM, Neto FOMJ, Xavier MB. Expression of interleukin-1β and interleukin-6 in leprosy reactions in patients with human immunodeficiency virus coinfection. Acta Trop 2017; 172:213-216. [PMID: 28511777 DOI: 10.1016/j.actatropica.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Previous studies suggest that coinfection of leprosy and human immunodeficiency virus (HIV) does not decrease the frequency and intensity of leprosy reactions. However, the immunological aspects of leprosy reactions in coinfected patients remain obscure, with a limited number of studies showing contradictory results. Observational study using tissue samples collected during leprosy reactions from 15 patients coinfected with leprosy and HIV and from 15 patients with leprosy alone. Patients were part of a prior larger cohort study of leprosy patients with and without HIV coinfection. Specific antibodies were used to detect IL-1β and IL-6 expression in skin biopsy tissue cells. IL-1β and IL-6 expression was similar between leprosy patients with and without HIV coinfection (p>0.05). Coinfected and non-coinfected tissues showed similar levels of IL-1β and IL-6 expression for type 1 reactions. A trend towards increased levels of IL-1β and IL-6 expression was observed in tissue from coinfected patients (p=0.0024). The expression of IL-1β and IL-6 during leprosy reactions did not differ significantly between tissues obtained from leprosy patients with and without HIV coinfection. Therefore, we conclude that HIV coinfection does not affect the immunological pattern of leprosy reactions.
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de Sousa JR, de Sousa RPM, de Souza Aarão TL, Dias LB, Oliveira Carneiro FR, Simões Quaresma JA. Response of iNOS and its relationship with IL-22 and STAT3 in macrophage activity in the polar forms of leprosy. Acta Trop 2017; 171:74-79. [PMID: 28327412 DOI: 10.1016/j.actatropica.2017.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 01/09/2023]
Abstract
Leprosy is a chronic granulomatous infection that manifests as different clinical forms related to the immunological response. The aim of the study was to evaluated the response of IL-22, STAT3, CD68 and iNOS in leprosy skin lesions. The mean number IL-22 positive cells was 12.12±1.90cells/field in the TT form and 31.31±2.91cells/field in the LL form. STAT3 positive cells was 5.29±1.96 cells/field in the TT form, while this number was 11.13±3.48cells/field in the LL form. The mean number of CD68 positive cells was 25.18±6.21cells/field in the TT form and 62.81±8.13cells/field in the LL form. Quantitative analysis of iNOS revealed a significant difference, with the mean number of cells expressing the enzyme being 30.24±2.88cells/field in the TT form compared to 35.44±4.69cells/field in the LL form. Linear correlations in lesions of TT patients showed a moderate positive correlations between CD68 and iNOS, STAT3 and Inos, IL-22 and STAT3, and IL-22 and iNOS. Our results demonstrate that these factors can act synergistically to induce a microbicidal activity in the population of macrophages in the leprosy lesions.
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Affiliation(s)
| | | | - Tinara Leila de Souza Aarão
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Brazil; Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil
| | - Leonidas Braga Dias
- Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil
| | | | - Juarez Antonio Simões Quaresma
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Brazil; Centro de ciências Biológicas e da Saúde, Universidade do Estado do Para, Belem, Brazil.
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