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Muddebihal A, Sardana K, Khurana A, Ahuja A, Singh I. Time to revisit the purported link of leprosy reactions with infective triggers: An unnecessary economic burden for patients. Trop Doct 2024; 54:157-164. [PMID: 37920941 DOI: 10.1177/00494755231210724] [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] [Indexed: 11/04/2023]
Abstract
Existing literature on factors triggering leprosy reactions is based only on case reports and case series, and thus probably gives a biased view. We undertook a case-control study to investigate such purported trigger factors in 42 leprosy reaction patients and 40 non-reactional controls, and the cost of investigations required for the same. Detailed history, clinical evaluation and investigations for triggers were carried out. Infections (typhoid, dental caries) were the most common triggers found, followed by pregnancy. Trigger factors were commoner in the type 2 reaction (T2R) group compared to type 1 (T1R) reaction group. There was however no statistical difference between the two groups. The average estimated cost of investigations was higher in the reactional group and this difference was statistically significant. Hence, except for essential investigations required for initiating steroids, an extensive battery of investigations is unjustified unless the medical history suggests a definitive infective trigger.
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Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India
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Jayashankar CA, Prakash B, Prashanthi SVSR, Bhat N, Joshi A, Narayanaswamy G. A case of lepromatous leprosy in a background of chronic hepatitis B infection. J Family Med Prim Care 2024; 13:1559-1562. [PMID: 38827665 PMCID: PMC11142012 DOI: 10.4103/jfmpc.jfmpc_589_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: 04/03/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 06/04/2024] Open
Abstract
Leprosy is a chronic granulomatous infection that primarily affects developing and underdeveloped countries. Co-infection with the hepatitis B virus can complicate its natural course by altering the host immune system response and thereby the disease outcomes. Early detection and treatment of the disease is thus imperative for preventing debilitating deformities. Several studies have shown positive viral markers for human immunodeficiency virus (HIV) and hepatitis B in patients with leprosy. However, in the Indian subcontinent, we have limited evidence highlighting this correlation. We present a case of a 42-year-old male with chronic hepatitis B infection presenting with new-onset lepromatous leprosy. The patient was successfully managed with a multibacillary multidrug regimen. In patients with hepatitis B co-infection, clinicians must be vigilant about the higher risk of complications and poorer patient outcomes. Extensive longitudinal studies assessing the correlation between leprosy and hepatitis B in India can help tailor future guidelines for management.
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Affiliation(s)
- C. A. Jayashankar
- Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Bhanu Prakash
- Department of Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | | | - Nuthan Bhat
- Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Amey Joshi
- Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Girish Narayanaswamy
- Department of Microbiology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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3
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Fróes LAR, Toma TS, Poderoso RE, Trindade MÂB. Viral co-infections in leprosy: a scoping review. Int J Dermatol 2023; 62:547-557. [PMID: 36738114 DOI: 10.1111/ijd.16613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
CONTEXT The most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research. METHODS The authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews. RESULTS For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, co-infections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part. CONCLUSIONS This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.
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Affiliation(s)
- Luis Alberto Ribeiro Fróes
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 455, São Paulo, 01246-903, SP, Brazil
| | - Tereza Setsuko Toma
- Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | | | - Maria Ângela Bianconcini Trindade
- LIM56, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
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Boldt ABW, Oliveira-Toré CDF, Kretzschmar GC, Weinschutz Mendes H, Stinghen ST, Andrade FA, Bumiller-Bini V, Gonçalves LB, Braga ACDM, Stahlke EVRS, Velavan TP, Thiel S, de Messias-Reason IJT. Hepatitis B Virus Infection Among Leprosy Patients: A Case for Polymorphisms Compromising Activation of the Lectin Pathway and Complement Receptors. Front Immunol 2021; 11:574457. [PMID: 33643280 PMCID: PMC7904891 DOI: 10.3389/fimmu.2020.574457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
Thousands of leprosy patients not only suffer from physical deformities, but also either have or have had hepatitis B virus (HBV) coinfection. Polymorphisms of the complement system modulate susceptibility to leprosy, but genetic susceptibility to past or present HBV infection is unknown. We used sequencing and multiplex sequence-specific PCR to genotype 72 polymorphisms of seven genes (MBL2, FCN1, FCN2, FCN3, MASP1, MASP2, C3) encoding components of the lectin pathway, and two genes encoding complement receptors (CR1, VSIG4) in 190 patients, of which 74 were positive for HBsAg and/or anti-HBc (HBV+, 93.2% with a resolved infection) and 116 lepromatous patients, and 408 HBV-blood donors. In addition, we tested for levels of proteins of the lectin pathway. We found no difference between serum concentrations of mannan-binding lectin (MBL), MBL-associated serine proteins (MASP-1, MASP-2, MASP-3, MAp44), ficolin-3 (FCN-3), soluble complement receptor 1 (sCR1) and MBL mediated C4 activation, measured by ELISA or TRIFMA in up to 167 HBV+ and HBV- patients. Haplotypes lowering protein levels or encoding dysfunctional proteins increased susceptibility to HBV infection: MBL2*LYQC (OR = 3.4, p = 0.02), MASP1*AC_CC (OR = 4.0, p = 0.015) and MASP2*1C2-l (OR = 5.4, p = 0.03). Conversely, FCN1*3C2 haplotype, associated with higher gene expression, was protective (OR = 0.56, P = 0.033). Other haplotypes associated with HBV susceptibility were: MASP2*2B1-i (OR = 19.25, P = 0.003), CR1*3A (OR = 2.65, P = 0.011) and VSIG4*TGGRCG (OR = 12.55, P = 0.014). Some polymorphisms in ficolin genes associated with lower protein levels increased susceptibility to leprosy/HBV infection: FCN*1 (OR = 1.66, P = 0.029), FCN2*GGGCAC (OR = 6.73, P = 0.008), and FCN3*del_del_C (OR = 12.54, P = 0.037), and to lepromatous disease/HBV infection: FCN2*TA (OR = 2.5, P = 0.009), whereas FCN2*MAG was associated with increased FCN-2 expression and resistance against coinfection (OR = 0.29, P = 0.026). These associations were independent of demographic factors and did not increase susceptibility to leprosy per se, except MASP2*1C2-l. Associations for FCN2, FCN3, MASP1, MASP2, and VSIG4 variants were also independent of each other. In conclusion, polymorphisms compromising activation of the lectin pathway of complement increase susceptibility to HBV infection, with ficolin polymorphisms playing a major role in modulating the susceptibility among leprosy patients.
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Affiliation(s)
- Angelica Beate Winter Boldt
- Laboratory of Human Molecular Genetics, Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Camila de Freitas Oliveira-Toré
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Gabriela Canalli Kretzschmar
- Laboratory of Human Molecular Genetics, Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Hellen Weinschutz Mendes
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Sérvio Túlio Stinghen
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Fabiana Antunes Andrade
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Valéria Bumiller-Bini
- Laboratory of Human Molecular Genetics, Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Letícia Boslooper Gonçalves
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Anna Carolina de Moraes Braga
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Thirumalaisamy P. Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Iara José Taborda de Messias-Reason
- Laboratory of Molecular Immunopathology, Postgraduate Program in Internal Medicine and Health Sciences, Department of Clinical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Costa JEF, Morais VMS, Gonçales JP, Medeiros AADP, Barroso H, Compri AP, Fukasawa L, Moreira RC, Coêlho MRCD. Occult hepatitis B virus infection in patients with leprosy. J Med Virol 2018; 91:775-780. [PMID: 30512182 DOI: 10.1002/jmv.25374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022]
Abstract
Leprosy patients may present with immune system impairment and have a higher hepatitis B virus (HBV) seroprevalence, justifying the investigation of occult HBV infection in these individuals. The aim of this study was to verify the frequency and the clinical factors associated with occult HBV infection in leprosy patients. Between 2015 and 2016, leprosy patients from a reference center in Brazil were interviewed to assess clinical data. Blood samples were collected for the screening of HBV serological markers using enzyme-linked immunosorbent assay. Patients with negative hepatitis B surface antigen (HBsAg) that had positive anti-HBc and/or anti-HBs were selected for HBV DNA detection using real-time polymerase chain reaction. SPSS was used for data analysis. Among 114 selected patients, six were identified with occult infection (5.3%) and five of them with multibacillary leprosy. Three patients with occult infection had a history of a type 2 reaction (P = 0.072; OR, 4.97; 95% CI, 0.87-28.52). Only two patients with occult infection had isolated anti-HBc, while three had isolated anti-HBs, including those with the highest HBV DNA titers. In conclusion, in leprosy patients with negative HBsAg and positive anti-HBc and/or anti-HBs, occult HBV infection occurs in 5.3% and can be found even in patients with isolated anti-HBs.
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Affiliation(s)
- Joanne E F Costa
- Sector of Dermatology, Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Viviane M S Morais
- Sector of Virology, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, Brazil
| | - Juliana P Gonçales
- Sector of Virology, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Adriana P Compri
- Laboratory of Viral Hepatitis, Virology Center, Instituto Adolfo Lutz, Pacaembu, Brazil
| | - Lucila Fukasawa
- Laboratory of Viral Hepatitis, Virology Center, Instituto Adolfo Lutz, Pacaembu, Brazil
| | - Regina C Moreira
- Laboratory of Viral Hepatitis, Virology Center, Instituto Adolfo Lutz, Pacaembu, Brazil
| | - Maria Rosângela C D Coêlho
- Sector of Virology, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Physiology and Pharmacology, Center for Biosciences, Universidade Federal de Pernambuco, Recife, Brazil
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6
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Costa JEF, Morais VMS, Gonçales JP, Silva DM, Coêlho MRCD. Prevalence and risk factors for hepatitis B and C viruses in patients with leprosy. Acta Trop 2017; 172:160-163. [PMID: 28457830 DOI: 10.1016/j.actatropica.2017.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/23/2017] [Accepted: 04/23/2017] [Indexed: 01/21/2023]
Abstract
It has been reported a higher seroprevalence of HBV and HCV in leprosy patients than in the general population, but the reasons for these findings are not yet clear. On the other hand, there is evidence that these viruses may influence the onset of leprosy reactional episodes, an important cause of neurological sequelae. This study aimed to determine seroprevalence and risk factors for HBV and HCV in leprosy patients and to investigate its association with leprosy reactions. Patients attended from 2015 to 2016 at a Reference Center in Leprosy in Northeastern region of Brazil, were interviewed, had their records reviewed to investigate biological, clinical, behavioral and socioeconomic factors, and underwent blood sample collection. Biological samples were tested for HBV (HBsAg, anti-HBs and anti-HBs) and HCV (anti-HCV) serological markers by ELISA and, in anti-HCV positive samples, HCV RNA was screened by real time PCR. SPSS program was used to analyze the data. A total of 403 leprosy patients were included. Although anti-HBc was positive in 14.1%, there was no detection of HBsAg, which contradicts the hypothesis that leprosy patients have immune deficit that make them more prone to chronic HBV infection. Multibacillary leprosy (0.057), health-related work (0.011) and lower educational level (0.035) were associated with anti-HBc positivity. Anti-HCV was positive in 0.5%, with no detection of HCV RNA. No association was identified between anti-HCV and the epidemiological analyzed factors. There was also no association of anti-HBc or anti-HCV with type 1 or type 2 leprosy reactions. Thus, the seroprevalence of HBV and HCV in leprosy patients was similar to that of the general population of Northeastern region of Brazil, and no association of HBV or HCV with leprosy reactions was observed.
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Affiliation(s)
- J E F Costa
- Health Sciences Center, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - V M S Morais
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - J P Gonçales
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - D M Silva
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - M R C D Coêlho
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil; Department of Physiology and Pharmacology, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
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Roffey S, Tucker K, Filipek-Ogden K, Montgomery J, Cameron J, O’Connell T, Evans J, Marter P, Taylor GM. Investigation of a Medieval Pilgrim Burial Excavated from the Leprosarium of St Mary Magdalen Winchester, UK. PLoS Negl Trop Dis 2017; 11:e0005186. [PMID: 28125649 PMCID: PMC5268360 DOI: 10.1371/journal.pntd.0005186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
We have examined the remains of a Pilgrim burial from St Mary Magdalen, Winchester. The individual was a young adult male, aged around 18–25 years at the time of death. Radiocarbon dating showed the remains dated to the late 11th–early 12th centuries, a time when pilgrimages were at their height in Europe. Several lines of evidence in connection with the burial suggested this was an individual of some means and prestige. Although buried within the leprosarium cemetery, the skeleton showed only minimal skeletal evidence for leprosy, which was confined to the bones of the feet and legs. Nonetheless, molecular testing of several skeletal elements, including uninvolved bones all showed robust evidence of DNA from Mycobacterium leprae, consistent with the lepromatous or multibacillary form of the disease. We infer that in life, this individual almost certainly suffered with multiple soft tissue lesions. Genotyping of the M.leprae strain showed this belonged to the 2F lineage, today associated with cases from South-Central and Western Asia. During osteological examination it was noted that the cranium and facial features displayed atypical morphology for northern European populations. Subsequently, geochemical isotopic analyses carried out on tooth enamel indicated that this individual was indeed not local to the Winchester region, although it was not possible to be more specific about their geographic origin. This multidisciplinary research article, involving biomolecular analysis, osteology, strontium and oxygen isotopic analyses and archaeology, examines the remains of a Pilgrim burial excavated from the medieval leprosy hospital of St Mary Magdalen, Winchester, UK. Radiocarbon dating showed the remains dated to the late 11th–early 12th centuries, a time when pilgrimages were at their height in Europe. The leprosarium at Winchester is one of the earliest excavated examples from Western Europe and has been the subject of a series of recent academic papers. The site is remarkable for the high number of burials displaying skeletal lesions characteristic of leprosy (86%) and the state of preservation of biomolecular markers of the disease, including mycolipids and DNA. Genotyping of the M.leprae strain showed this belonged to the 2F lineage, today associated with cases from South-Central and Western Asia. Several aspects of the burial and dietary isotope analysis indicated this was an individual of some prestige and means; an unusual cranial morphology pointed to possible origin outside of the British Isles. Strontium and oxygen isotopic analyses confirmed he was not local to the Winchester area but were not able to pinpoint his precise origins. Overall these findings confirm the benefits of a multidisciplinary approach which allows investigation of the wider relationship between leprosy, medieval pilgrimage and M.leprae transmission.
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Affiliation(s)
- Simon Roffey
- Department of Archaeology, University of Winchester, Winchester, United Kingdom
- * E-mail:
| | - Katie Tucker
- Department of Archaeology, University of Winchester, Winchester, United Kingdom
| | | | - Janet Montgomery
- Department of Archaeology, Durham University, Durham United Kingdom
| | - Jamie Cameron
- Research Laboratory for Archaeology and the History of Art, University of Oxford, Dyson Perrins Building, Oxford, United Kingdom
| | - Tamsin O’Connell
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom
| | - Jane Evans
- NERC Isotope Geosciences Laboratory, Keyworth, Notts, United Kingdom
| | - Phil Marter
- Department of Archaeology, University of Winchester, Winchester, United Kingdom
| | - G. Michael Taylor
- Department of Microbial and Cellular Sciences, Faculty of Health and Medical Sciences, AX Building, University of Surrey, Guildford, Surrey, United Kingdom
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Machado PRL, Machado LM, Shibuya M, Rego J, Johnson WD, Glesby MJ. Viral Co-infection and Leprosy Outcomes: A Cohort Study. PLoS Negl Trop Dis 2015; 9:e0003865. [PMID: 26267882 PMCID: PMC4534371 DOI: 10.1371/journal.pntd.0003865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses. Methodology/Principal Findings Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02–18.74. Conclusions/Significance Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients. The clinical and social impact of leprosy, a disease caused by Mycobacterium leprae, is due to the deformities and disabilities that are consequences of skin and peripheral nerve inflammation. We believe that leprosy patients who also have an associated viral infection will have a worse outcome. This can be due to alterations in the immune system triggered by the virus co-infection, leading to an increasing inflammation of the skin or peripheral nerves affected by Mycobacterium leprae, or to a depression of the mechanisms that control the infection. We have verified if the presence of specific viral infections in leprosy subjects is associated with a higher risk of developing a worse outcome like nerve inflammation, impairment in the nerve function or relapse. We have screened the patients for human immunodeficiency virus, human T cell lymphotrophic virus type 1, hepatitis B and hepatitis C virus. These subjects were followed up during all the period of leprosy treatment (at least 6 months) in order to detect the emergence of any complication. We have found that leprosy patients with viral co-infection are at higher risk to develop nerve inflammation and damage, as well as relapse, compared to subjects without viral co-infection.
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Affiliation(s)
- Paulo R. L. Machado
- Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, Salvador, Bahia, Brazil
- * E-mail:
| | - Lídia M. Machado
- Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mayume Shibuya
- Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Jamile Rego
- Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Warren D. Johnson
- Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America
| | - Marshall J. Glesby
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America
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Leitão C, Ueda D, de Moraes Braga AC, Boldt ABW, Messias-Reason IJT. Leprosy and hepatitis B coinfection in southern Brazil. Braz J Infect Dis 2013; 18:8-12. [PMID: 23933408 PMCID: PMC9425193 DOI: 10.1016/j.bjid.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/06/2013] [Accepted: 04/18/2013] [Indexed: 11/28/2022] Open
Abstract
To investigate the association of leprosy with hepatitis B virus (HBV) infection, as yet unknown for South Brazil, we assessed hepatitis B virus coinfection in 199 South Brazilian leprosy patients (119 lepromatous, 15 tuberculoid, 30 borderline, 12 undetermined and 23 unspecified) and in 681 matched blood donors by screening for the hepatitis B virus markers HBSAg and anti-HBc, using ELISA. Positive samples were retested and anti-HBc+ only samples were tested for the hepatitis B surface antibody (anti-HBs). There was a strong association between leprosy and hepatitis B virus infection (OR = 9.8, 95% CI = 6.4–14.7; p = 0.004·E−30), as well as an association between HBV infection and lepromatous leprosy, compared to other forms (OR = 2.4, 95% CI = 1.2–4.8; p = 0.017). We also found that confinement due to leprosy was associated with hepatitis B virus infection (OR = 3.9, 95% CI = 2.1–7.4; p = 0.015·E−3). Leprosy patients are susceptible to develop hepatitis B virus infection, especially lepromatous. Institutionalized patients, who probably present a stronger Th2 response, have higher risk of being exposed to hepatitis B virus. This clearly emphasizes the need for special care to leprosy patients in preventing hepatitis B virus coinfection in South Brazil.
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Affiliation(s)
- Cleverson Leitão
- Laboratório de Imunopatologia Molecular, Department of Medical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Denis Ueda
- Laboratório de Imunopatologia Molecular, Department of Medical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Anna Carolina de Moraes Braga
- Laboratório de Imunopatologia Molecular, Department of Medical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Angelica B W Boldt
- Laboratório de Imunopatologia Molecular, Department of Medical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Iara J T Messias-Reason
- Laboratório de Imunopatologia Molecular, Department of Medical Pathology, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
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Affiliation(s)
- A M Klioze
- Department of Medicine and Division of Dermatology, University of Florida College of Medicine, Gainesville, FL , USA
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