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Affiliation(s)
- David M Scollard
- From Wilbraham, MA. Dr. Scollard (now retired) was director of the National Hansen's Disease Programs in Baton Rouge, LA
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Lenz SM, Ray NA, Lema T, Collins JH, Thapa R, Girma S, Balagon M, Bobosha K, Hagge DA, Williams DL, Scollard DM, Lahiri R, Adams LB. Utility of a Mycobacterium leprae molecular viability assay for clinical leprosy: An analysis of cases from the Philippines, Ethiopia, and Nepal. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.967351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mycobacterium leprae is a slow-growing species of mycobacteria that cannot be cultured in axenic media. This presents a number of challenges for monitoring treatment efficacy and advancing new drugs and regimens for treating leprosy. We previously developed a molecular viability assay (MVA) which measures expression of hsp18 and esxA transcripts to determine viability of M. leprae directly from infected tissue. The objective of the current study was to determine the utility of the MVA for practical use on clinical specimens. Leprosy cases from the Philippines (N = 199), Ethiopia (N = 40), and Nepal (N = 200) were diagnosed by clinical examination, slit-skin smears (SSS) from index sites, and/or histopathology. Biopsy specimens for MVA were collected from an active lesion and stored in 70% ethanol. DNA and RNA were extracted from the tissue, and M. leprae were enumerated on the DNA fraction via RLEP qPCR. Based on this count, DNased RNA was normalized to the equivalent of 3x103M. leprae per reverse transcription reaction, and hsp18 and esxA transcripts were amplified by PCR on the resulting cDNA. There was a strong correlation between RLEP enumeration on the specific biopsy specimen for MVA and the average SSS bacterial index (BI) in all three cohorts (p < 0.001). The MVA could be performed on most biopsies with an average SSS BI ≥ 2 and showed a decrease in M. leprae viability with increasing duration of leprosy multidrug therapy (R2 = 0.81, p < 0.001). The MVA also detected viable M. leprae in relapse patients where it showed significant correlation with the mouse footpad assay (p = 0.018). The MVA is a M. leprae-specific, sensitive, and relatively quick test. Clinically, the MVA would likely be most useful to monitor treatment, confirm suspected relapse cases, and determine efficacy of new leprosy drugs in clinical trials.
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Abstract
Neuropathy and related disabilities are the major medical consequences of leprosy, which remains a global medical concern. Despite major advances in understanding the mechanisms of M. leprae entry into peripheral nerves, most aspects of the pathogenesis of leprosy neuropathy remain poorly understood. Sensory loss is characteristic of leprosy, but neuropathic pain is sometimes observed. Effective anti-microbial therapy is available, but neuropathy remains a problem especially if diagnosis and treatment are delayed. Currently there is intense interest in post-exposure prophylaxis with single-dose rifampin in endemic areas, as well as with enhanced prophylactic regimens in some situations. Some degree of nerve involvement is seen in all cases and neuritis may occur in the absence of leprosy reactions, but acute neuritis commonly accompanies both Type 1 and Type 2 leprosy reactions and may be difficult to manage. A variety of established as well as new methods for the early diagnosis and assessment of leprosy neuropathy are reviewed. Corticosteroids offer the primary treatment for neuritis and for subclinical neuropathy in leprosy, but success is limited if nerve function impairment is present at the time of diagnosis. A candidate vaccine has shown apparent benefit in preventing nerve injury in the armadillo model. The development of new therapeutics for leprosy neuropathy is greatly needed.
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Affiliation(s)
- Gigi J Ebenezer
- Neurology/Cutaneous Nerve Laboratory, Johns Hopkins University, The John G Rangos Bldg, room: 440, 855 North Wolfe Street, Baltimore, MD, 21205, USA.
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Sharma R, Singh P, McCoy RC, Lenz SM, Donovan K, Ochoa MT, Estrada-Garcia I, Silva-Miranda M, Jurado-Santa Cruz F, Balagon MF, Stryjewska B, Scollard DM, Pena MT, Lahiri R, Williams DL, Truman RW, Adams LB. Isolation of Mycobacterium lepromatosis and Development of Molecular Diagnostic Assays to Distinguish Mycobacterium leprae and M. lepromatosis. Clin Infect Dis 2021; 71:e262-e269. [PMID: 31732729 DOI: 10.1093/cid/ciz1121] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycobacterium leprae was thought to be the exclusive causative agent of leprosy until Mycobacterium lepromatosis was identified in a rare form of leprosy known as diffuse lepromatous leprosy (DLL). METHODS We isolated M. lepromatosis from a patient with DLL and propagated it in athymic nude mouse footpads. Genomic analysis of this strain (NHDP-385) identified a unique repetitive element, RLPM, on which a specific real-time quantitative polymerase chain reaction assay was developed. The RLPM assay, and a previously developed RLEP quantitative polymerase chain reaction assay for M. leprae, were validated as clinical diagnostic assays according to Clinical Laboratory Improvement Amendments guidelines. We tested DNA from archived histological sections, patient specimens from the United States, Philippines, and Mexico, and US wild armadillos. RESULTS The limit of detection for the RLEP and RLPM assays is 30 M. leprae per specimen (0.76 bacilli per reaction; coefficient of variation, 0.65%-2.44%) and 122 M. lepromatosis per specimen (3.05 bacilli per reaction; 0.84%-2.9%), respectively. In histological sections (n = 10), 1 lepromatous leprosy (LL), 1 DLL, and 3 Lucio reactions contained M. lepromatosis; 2 LL and 2 Lucio reactions contained M. leprae; and 1 LL reaction contained both species. M. lepromatosis was detected in 3 of 218 US biopsy specimens (1.38%). All Philippines specimens (n = 180) were M. lepromatosis negative and M. leprae positive. Conversely, 15 of 47 Mexican specimens (31.91%) were positive for M. lepromatosis, 19 of 47 (40.43%) were positive for M. leprae, and 2 of 47 (4.26%) contained both organisms. All armadillos were M. lepromatosis negative. CONCLUSIONS The RLPM and RLEP assays will aid healthcare providers in the clinical diagnosis and surveillance of leprosy.
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Affiliation(s)
- Rahul Sharma
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Pushpendra Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA.,National Institute of Research in Tribal Health, Jabalpur, MP India
| | - Rajiv C McCoy
- Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kelly Donovan
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Maria T Ochoa
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Iris Estrada-Garcia
- Departamento Immunologia, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Mayra Silva-Miranda
- Consejo Nacional de Ciencia y Tecnologia (National Council of Science and Technology)-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Fermin Jurado-Santa Cruz
- Centro Dermatológico Dr. Ladislao de la Pascua, Secretaria de Salud de la Ciudad de México, Mexico City, Mexico
| | - Marivic F Balagon
- Leonard Wood Memorial, Center for Leprosy Research, Cebu, Philippines
| | - Barbara Stryjewska
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - David M Scollard
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Maria T Pena
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Ramanuj Lahiri
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Diana L Williams
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Richard W Truman
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
| | - Linda B Adams
- US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Program, Baton Rouge, Louisiana, USA
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Araujo S, Goulart LR, Truman RW, Goulart IMB, Vissa V, Li W, Matsuoka M, Suffys P, Fontes AB, Rosa PS, Scollard DM, Williams DL. qPCR-High resolution melt analysis for drug susceptibility testing of Mycobacterium leprae directly from clinical specimens of leprosy patients. PLoS Negl Trop Dis 2017; 11:e0005506. [PMID: 28570560 PMCID: PMC5453413 DOI: 10.1371/journal.pntd.0005506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Real-Time PCR-High Resolution Melting (qPCR-HRM) analysis has been recently described for rapid drug susceptibility testing (DST) of Mycobacterium leprae. The purpose of the current study was to further evaluate the validity, reliability, and accuracy of this assay for M. leprae DST in clinical specimens. METHODOLOGY/PRINCIPAL FINDINGS The specificity and sensitivity for determining the presence and susceptibility of M. leprae to dapsone based on the folP1 drug resistance determining region (DRDR), rifampin (rpoB DRDR) and ofloxacin (gyrA DRDR) was evaluated using 211 clinical specimens from leprosy patients, including 156 multibacillary (MB) and 55 paucibacillary (PB) cases. When comparing the results of qPCR-HRM DST and PCR/direct DNA sequencing, 100% concordance was obtained. The effects of in-house phenol/chloroform extraction versus column-based DNA purification protocols, and that of storage and fixation protocols of specimens for qPCR-HRM DST, were also evaluated. qPCR-HRM results for all DRDR gene assays (folP1, rpoB, and gyrA) were obtained from both MB (154/156; 98.7%) and PB (35/55; 63.3%) patients. All PCR negative specimens were from patients with low numbers of bacilli enumerated by an M. leprae-specific qPCR. We observed that frozen and formalin-fixed paraffin embedded (FFPE) tissues or archival Fite's stained slides were suitable for HRM analysis. Among 20 mycobacterial and other skin bacterial species tested, only M. lepromatosis, highly related to M. leprae, generated amplicons in the qPCR-HRM DST assay for folP1 and rpoB DRDR targets. Both DNA purification protocols tested were efficient in recovering DNA suitable for HRM analysis. However, 3% of clinical specimens purified using the phenol/chloroform DNA purification protocol gave false drug resistant data. DNA obtained from freshly frozen (n = 172), formalin-fixed paraffin embedded (FFPE) tissues (n = 36) or archival Fite's stained slides (n = 3) were suitable for qPCR-HRM DST analysis. The HRM-based assay was also able to identify mixed infections of susceptible and resistant M. leprae. However, to avoid false positives we recommend that clinical specimens be tested for the presence of the M. leprae using the qPCR-RLEP assay prior to being tested in the qPCR-HRM DST and that all specimens demonstrating drug resistant profiles in this assay be subjected to DNA sequencing. CONCLUSION/SIGNIFICANCE Taken together these results further demonstrate the utility of qPCR-HRM DST as an inexpensive screening tool for large-scale drug resistance surveillance in leprosy.
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Affiliation(s)
- Sergio Araujo
- National Reference Center for Sanitary Dermatology and Leprosy, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- Division National Hansen's Disease Programs (NHDP), Healthcare Systems Bureau (HSB), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (DHHS), Baton Rouge, Louisiana, United States of America
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- Institute of Genetics and Biochemistry, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Richard W. Truman
- Division National Hansen's Disease Programs (NHDP), Healthcare Systems Bureau (HSB), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (DHHS), Baton Rouge, Louisiana, United States of America
| | - Isabela Maria B. Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Varalakshmi Vissa
- Good Samaritan Society, Fort Collins, Colorado, United States of America
| | - Wei Li
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Masanori Matsuoka
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Philip Suffys
- Fundação Oswaldo Cruz, Laboratory of Molecular Biology applied to Mycobacteria, Rio de Janeiro, Rio de Janeiro, Brazil
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Amanda B. Fontes
- Fundação Oswaldo Cruz, Laboratory of Molecular Biology applied to Mycobacteria, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia S. Rosa
- Instituto Lauro de Souza Lima, Department of Biology, Bauru, São Paulo, Brazil
| | - David M. Scollard
- Division National Hansen's Disease Programs (NHDP), Healthcare Systems Bureau (HSB), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (DHHS), Baton Rouge, Louisiana, United States of America
| | - Diana L. Williams
- Division National Hansen's Disease Programs (NHDP), Healthcare Systems Bureau (HSB), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (DHHS), Baton Rouge, Louisiana, United States of America
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Elston DM, Liranzo MO, Scollard DM. Comparing the sensitivity of auramine-rhodamine fluorescence to polymerase chain reaction in the detection of Mycobacterium leprae in Fite-negative tissue sections. J Am Acad Dermatol 2017; 76:992-993. [DOI: 10.1016/j.jaad.2016.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 10/19/2022]
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Sharma R, Singh P, Loughry WJ, Lockhart JM, Inman WB, Duthie MS, Pena MT, Marcos LA, Scollard DM, Cole ST, Truman RW. Zoonotic Leprosy in the Southeastern United States. Emerg Infect Dis 2016; 21:2127-34. [PMID: 26583204 PMCID: PMC4672434 DOI: 10.3201/eid2112.150501] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The geographic range and complexity of this disease are increasing. Nine-banded armadillos (Dasypus novemcinctus) are naturally infected
with Mycobacterium leprae and have been implicated in zoonotic
transmission of leprosy. Early studies found this disease mainly in Texas and
Louisiana, but armadillos in the southeastern United States appeared to be free of
infection. We screened 645 armadillos from 8 locations in the southeastern United
States not known to harbor enzootic leprosy for M. leprae DNA and
antibodies. We found M. leprae–infected armadillos at each
location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using
single-nucleotide polymorphism variable number tandem repeat genotyping/genome
sequencing, we detected M. leprae genotype 3I-2-v1 among 35
armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In
comparison, 52 human patients from the same region were infected with 31 M.
leprae types. However, 42.3% (22/52) of patients were infected with 1 of
the 2 M. leprae genotype strains associated with armadillos. The
geographic range and complexity of zoonotic leprosy is expanding.
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Abstract
Leprosy and tuberculosis are chronic mycobacterial infections that elicit granulomatous inflammation. Both infections are curable, but granulomatous injury to cutaneous structures, including cutaneous nerves in leprosy, may cause permanent damage. Both diseases are major global concerns: tuberculosis for its high prevalence and mortality, and leprosy for its persistent global presence and high rate of neuropathic disability. Cutaneous manifestations of both leprosy and tuberculosis are frequently subtle and challenging in dermatologic practice and often require a careful travel and social history and a high index of suspicion.
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Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, 1770 Physician Park Drive, Baton Rouge, LA 70816, USA.
| | - Mara M Dacso
- Center for Dermatology and Cosmetic Laser Surgery, 5026 Tennyson Parkway, Plano, TX 75024, USA; Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Ma Luisa Abad-Venida
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Rizal Avenue, Manila 1008, Philippines
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Truman RW, Ebenezer GJ, Pena MT, Sharma R, Balamayooran G, Gillingwater TH, Scollard DM, McArthur JC, Rambukkana A. The armadillo as a model for peripheral neuropathy in leprosy. ILAR J 2015; 54:304-14. [PMID: 24615444 DOI: 10.1093/ilar/ilt050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Leprosy (also known as Hansen's Disease) is a chronic infectious disease caused by Mycobacterium leprae that primarily targets the peripheral nervous system; skin, muscle, and other tissues are also affected. Other than humans, nine-banded armadillos (Dasypus novemcinctus) are the only natural hosts of M. leprae, and they are the only laboratory animals that develop extensive neurological involvement with this bacterium. Infection in the armadillo closely recapitulates many of the structural, physiological, and functional aspects of leprosy seen in humans. Armadillos can be useful models of leprosy for basic scientific investigations into the pathogenesis of leprosy neuropathy and its associated myopathies, as well as for translational research studies in piloting new diagnostic methods or therapeutic interventions. Practical and ethical constraints often limit investigation into human neuropathies, but armadillos are an abundant source of leprotic neurologic fibers. Studies with these animals may provide new insights into the mechanisms involved in leprosy that also might benefit the understanding of other demyelinating neuropathies. Although there is only a limited supply of armadillo-specific reagents, the armadillo whole genomic sequence has been completed, and gene expression studies can be employed. Clinical procedures, such as electrophysiological nerve conduction testing, provide a functional assessment of armadillo nerves. A variety of standard histopathological and immunopathological procedures including Epidermal Nerve Fiber Density (ENFD) analysis, Schwann Cell Density, and analysis for other conserved cellular markers can be used effectively with armadillos and will be briefly reviewed in this text.
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Scollard DM, Martelli CMT, Stefani MMA, Maroja MDF, Villahermosa L, Pardillo F, Tamang KB. Risk factors for leprosy reactions in three endemic countries. Am J Trop Med Hyg 2015; 92:108-14. [PMID: 25448239 PMCID: PMC4347363 DOI: 10.4269/ajtmh.13-0221] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/21/2014] [Indexed: 11/07/2022] Open
Abstract
The objective of this study was to ascertain risk factors for complications (reactions or neuritis) in leprosy patients at the time of diagnosis in three leprosy-endemic countries. Newly diagnosed patients were enrolled in Brazil, the Philippines, and Nepal, and risk factors for reactions and neuritis were assessed using a case-control approach: "cases" were patients with these complications, and controls were patients without complications. Of 1,972 patients enrolled in this study, 22% had complications before treatment. Type 1 reaction was diagnosed in 13.7% of patients, neuritis alone in 6.9.%, and type 2 reaction in 1.4%. The frequency of these complications was higher in Nepal, in lepromatous patients, in males, and in adults versus children. Reactions and neuritis were seen in patients at diagnosis, before treatment was started. Reactions were seen in adults and children, even in patients with only a single lesion. Neuritis was often present without other signs of reaction. Reactions and neuritis were more likely to occur in lepromatous patients, and were more likely to be seen in adults than in children.
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Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Celina M T Martelli
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Mariane M A Stefani
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Maria de Fatima Maroja
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Laarni Villahermosa
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Fe Pardillo
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
| | - Krishna B Tamang
- National Hansen's Disease Programs, Baton Rouge, Louisiana; Federal University of Goias, Institute of Tropical Pathology and Public Health, Goias, Brazil; Federal University of Pernambuco, Tropical Medicine Department, Recife, Pernambuco, Brazil; Fundação de Dermatologia Tropical Alfredo da Matta, Manaus, Amazonas, Brazil; Leonard Wood Memorial Center for Leprosy Research, Cebu, Republic of The Philippines; Lalgadh Leprosy Hospital and Services Center, Dhanusha District, Nepal
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Williams DL, Lewis C, Sandoval FG, Robbins N, Keas S, Gillis TP, Scollard DM. Drug resistance in patients with leprosy in the United States. Clin Infect Dis 2013; 58:72-3. [PMID: 24065328 DOI: 10.1093/cid/cit628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Molecular drug susceptibility testing was performed on 39 US patients with leprosy. Of these, 2 had dapsone-resistant Mycobacterium leprae and 1 of these patients also had rifampin-resistant M. leprae. Even though antileprosy drug resistance occurs in this leprosy population, resistance does not appear to be a major problem.
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Sharma R, Lahiri R, Scollard DM, Pena M, Williams DL, Adams LB, Figarola J, Truman RW. The armadillo: a model for the neuropathy of leprosy and potentially other neurodegenerative diseases. Dis Model Mech 2012; 6:19-24. [PMID: 23223615 PMCID: PMC3529335 DOI: 10.1242/dmm.010215] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Leprosy (also known as Hansen’s disease) is an infectious peripheral neurological disorder caused by Mycobacterium leprae that even today leaves millions of individuals worldwide with life-long disabilities. The specific mechanisms by which this bacterium induces nerve injury remain largely unknown, mainly owing to ethical and practical limitations in obtaining affected human nerve samples. In addition to humans, nine-banded armadillos (Dasypus novemcinctus) are the only other natural host of M. leprae, and they develop a systemically disseminated disease with extensive neurological involvement. M. leprae is an obligate intracellular parasite that cannot be cultivated in vitro. Because of the heavy burdens of bacilli they harbor, nine-banded armadillos have become the organism of choice for propagating large quantities of M. leprae, and they are now advancing as models of leprosy pathogenesis and nerve damage. Although armadillos are exotic laboratory animals, the recently completed whole genome sequence for this animal is enabling researchers to undertake more sophisticated molecular studies and to develop armadillo-specific reagents. These advances will facilitate the use of armadillos in piloting new therapies and diagnostic regimens, and will provide new insights into the oldest known infectious neurodegenerative disorder.
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Affiliation(s)
- Rahul Sharma
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
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Scollard DM. Chemotherapy of leprosy has changed (almost) everything. LEPROSY REV 2012; 83:245-246. [PMID: 23356025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, 1770 Physician Park Dr., Baton Rouge, LA 70816, USA.
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Gillis TP, Scollard DM, Lockwood DNJ. What is the evidence that the putative Mycobacterium lepromatosis species causes diffuse lepromatous leprosy? LEPROSY REV 2011. [DOI: 10.47276/lr.82.3.205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gillis TP, Scollard DM, Lockwood DNJ. What is the evidence that the putative Mycobacterium lepromatosis species causes diffuse lepromatous leprosy? LEPROSY REV 2011; 82:205-209. [PMID: 22125927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Han et al. have made a retrospective isolation of DNA from two patients with fatal Lucio's phenomenon. This DNA does have some molecular differences to M. leprae and may constitute a variant of M. leprae. However the experiments and data needed to confirm that this is a new leprosy-causing species have not yet been done. We have outlined the work that does need to be done. For the moment the assertion that 'M. lepromatosis' is a new leprosy-causing species is not proven.
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Truman RW, Singh P, Sharma R, Busso P, Rougemont J, Paniz-Mondolfi A, Kapopoulou A, Brisse S, Scollard DM, Gillis TP, Cole ST. Probable zoonotic leprosy in the southern United States. N Engl J Med 2011; 364:1626-33. [PMID: 21524213 PMCID: PMC3138484 DOI: 10.1056/nejmoa1010536] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the southern region of the United States, such as in Louisiana and Texas, there are autochthonous cases of leprosy among native-born Americans with no history of foreign exposure. In the same region, as well as in Mexico, wild armadillos are infected with Mycobacterium leprae. METHODS Whole-genome resequencing of M. leprae from one wild armadillo and three U.S. patients with leprosy revealed that the infective strains were essentially identical. Comparative genomic analysis of these strains and M. leprae strains from Asia and Brazil identified 51 single-nucleotide polymorphisms and an 11-bp insertion-deletion. We genotyped these polymorphic sites, in combination with 10 variable-number tandem repeats, in M. leprae strains obtained from 33 wild armadillos from five southern states, 50 U.S. outpatients seen at a clinic in Louisiana, and 64 Venezuelan patients, as well as in four foreign reference strains. RESULTS The M. leprae genotype of patients with foreign exposure generally reflected their country of origin or travel history. However, a unique M. leprae genotype (3I-2-v1) was found in 28 of the 33 wild armadillos and 25 of the 39 U.S. patients who resided in areas where exposure to armadillo-borne M. leprae was possible. This genotype has not been reported elsewhere in the world. CONCLUSIONS Wild armadillos and many patients with leprosy in the southern United States are infected with the same strain of M. leprae. Armadillos are a large natural reservoir for M. leprae, and leprosy may be a zoonosis in the region. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- Richard W Truman
- Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services, National Hansen's Disease Program, Louisiana State University, Baton Rouge, USA.
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Stefani MM, Guerra JG, Sousa ALM, Costa MB, Oliveira MLW, Martelli CT, Scollard DM. Potential plasma markers of Type 1 and Type 2 leprosy reactions: a preliminary report. BMC Infect Dis 2009; 9:75. [PMID: 19473542 PMCID: PMC2696458 DOI: 10.1186/1471-2334-9-75] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 05/27/2009] [Indexed: 01/20/2023] Open
Abstract
Background The clinical management of leprosy Type 1 (T1R) and Type 2 (T2R) reactions pose challenges mainly because they can cause severe nerve injury and disability. No laboratory test or marker is available for the diagnosis or prognosis of leprosy reactions. This study simultaneously screened plasma factors to identify circulating biomarkers associated with leprosy T1R and T2R among patients recruited in Goiania, Central Brazil. Methods A nested case-control study evaluated T1R (n = 10) and TR2 (n = 10) compared to leprosy patients without reactions (n = 29), matched by sex and age-group (+/- 5 years) and histopathological classification. Multiplex bead based technique provided profiles of 27 plasma factors including 16 pro inflammatory cytokines: tumor necrosis factor-α (TNF-α), Interferon-γ (IFN-γ), interleukin (IL)- IL12p70, IL2, IL17, IL1 β, IL6, IL15, IL5, IL8, macrophage inflammatory protein (MIP)-1 alpha (MIP1α), 1 beta (MIP1β), regulated upon activation normal T-cell expressed and secreted (RANTES), monocyte chemoattractrant protein 1 (MCP1), CC-chemokine 11 (CCL11/Eotaxin), CXC-chemokine 10 (CXCL10/IP10); 4 anti inflammatory interleukins: IL4, IL10, IL13, IL1Rα and 7 growth factors: IL7, IL9, granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), platelet-derived growth factor BB (PDGF BB), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF). Results Elevations of plasma CXCL10 (P = 0.004) and IL6 (p = 0.013) were observed in T1R patients compared to controls without reaction. IL6 (p = 0.05), IL7 (p = 0.039), and PDGF-BB (p = 0.041) were elevated in T2R. RANTES and GMCSF were excluded due to values above and below detection limit respectively in all samples. Conclusion Potential biomarkers of T1R identified were CXCL10 and IL6 whereas IL7, PDGF-BB and IL6, may be laboratory markers of TR2. Additional studies on these biomarkers may help understand the immunopathologic mechanisms of leprosy reactions and indicate their usefulness for the diagnosis and for the clinical management of these events.
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Affiliation(s)
- Mariane M Stefani
- Tropical Pathology and Public Health Institute, Federal University of Goias, GO, Brazil.
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Scollard DM, Fowlkes N, Martinez A, Chaduvula M, Nath I, Stryjewska B, Williams D. Reversal Reaction in Leprosy Is Associated with Increased CXCL10 Production. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.1003.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Natalie Fowlkes
- School of Veterinary MedicineLouisiana State UniversityBaton RougeLA
| | | | | | - Indira Nath
- LEPRA‐Blue Peter Research CenterHyderabadIndia
| | | | - Diana Williams
- Laboratory Research BranchNational Hansen's Disease ProgramsBaton RougeLA
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Scollard DM. The biology of nerve injury in leprosy. LEPROSY REV 2008; 79:242-253. [PMID: 19009974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The steps in the pathogenesis of nerve injury in leprosy are depicted in Figure 1. Localisation of M. leprae to nerve, Schwann cell infection & responses, as yet unknown mechanisms of injury, axonal atrophy, and finally demyelination. These steps, and the mechanisms responsible for them, occur quickly in the course of this disease (as noted, even the earliest diagnostic lesions have sensory abnormalities), but they are also chronic processes that may contribute to progressive nerve injury over a period of many years unless interrupted by treatment, and even after cure of the infection in some patients. A common feature throughout this pathogenesis is inflammation--within and around the nerve. Inflammation is not only defined by its chemical mediators such as cytokines and chemokines, but by one of the most basic phenomena of inflammation--edema. The extent to which edema might contribute to nerve injury in leprosy has not been reviewed because it has not been studied in nerves affected by leprosy, although clinically, surgeons who perform neurolysis are convinced that they are decompressing nerves sustaining injury due to increased (edematous?) pressure. Inflammation in and around nerves is undoubtedly driven, in part, by the immunological responses in each of the portions of the immunologic spectrum of leprosy, but some inflammatory phenomena may be non-specific inflammation related to infection and foreign material (i.e., mycobacterial components). Few if any fixed associations can be made between the steps outlined in this conceptual framework of events; even the depicted sequence of these events is uncertain. Considerable additional data is needed to determine the connections between these processes and their underlying mechanisms. Additionally, although much emphasis is given to myelinated fibres (and demyelination) in studies of the biology of leprosy neuropathy, the small, sensory fibres in the skin are not myelinated. Additional studies of mechanisms of injury to these nerves is required. The results of all of these studies can be reasonably expected to identify new points for clinical intervention in--and possibly the prevention of--nerve injury in leprosy.
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Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, LSU-SVM, Skip Bertman Dr. Baton Rouge, LA 70803, USA.
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Scollard DM. Treatment Gets Better, but Leprosy Remains a Global Problem. Ann Acad Med Singap 2008. [DOI: 10.47102/annals-acadmedsg.v37n1p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Scollard DM. Treatment gets better, but leprosy remains a global problem. Ann Acad Med Singap 2008; 37:1-2. [PMID: 18265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Hagge DA, Marks VT, Ray NA, Dietrich MA, Kearney MT, Scollard DM, Krahenbuhl JL, Adams LB. Emergence of an effective adaptive cell mediated immune response to Mycobacterium leprae is not impaired in reactive oxygen intermediate-deficient mice. ACTA ACUST UNITED AC 2007; 51:92-101. [PMID: 17645529 DOI: 10.1111/j.1574-695x.2007.00282.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cytokine-activated macrophages (MPhi) employ reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI) to combat pathogens. The requirement for ROI for an effective host response to experimental leprosy using mice which have a disruption in the 91-kD subunit of the NAPDH oxidase cytochrome b (phox91-/-) was examined. Mycobacterium leprae multiplication in phox91-/- foot pads (FP) was elevated early in infection but subsequently arrested similarly to control mice within a noninvasive granuloma. Using a modified lepromin test model, a similar cellular composition in the M. leprae-induced FP granuloma in both strains with lymphocyte infiltration consisting primarily of CD4+CD44(hi)CD62L(lo) effector cells was found. Of great interest was the disparity in the T cell population between the granuloma and the draining lymph node which contained predominantly naïve CD4+CD44(lo)CD62L(hi) cells and was, therefore, not representative of the infection site. TH1 cytokines, chemokines and inducible nitric oxide synthase were comparably expressed in the FP of both strains. When infected in vitro, normal MPhi from B6 and phox91-/- mice supported bacterial viability, whereas IFNgamma-activated MPhi killed M. leprae in a RNI-dependent manner, emphasizing that ROI was dispensable. These data show that phox91-/- mice generate a strong adaptive immune response and control long-term infection with M. leprae.
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Affiliation(s)
- Deanna A Hagge
- Immunology Research Department, National Hansen's Disease Programs, Laboratory Research Branch, Baton Rouge, LA 70803, USA
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Scollard DM, Joyce MP, Gillis TP. Development of Leprosy and Type 1 Leprosy Reactions after Treatment with Infliximab: A Report of 2 Cases. Clin Infect Dis 2006; 43:e19-22. [PMID: 16779736 DOI: 10.1086/505222] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 03/22/2006] [Indexed: 11/03/2022] Open
Abstract
Humanized monoclonal antibodies to tumor necrosis factor- alpha are valuable for the treatment of rheumatologic conditions, but they have been associated with the development of serious infections. We report the first 2 cases of leprosy developing after treatment with infliximab. After discontinuation of infliximab, both patients developed type 1 ("reversal") leprosy reactions.
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Affiliation(s)
- D M Scollard
- National Hansen's Disease Programs, Louisiana State University, Baton Rouge, LA 70803, USA.
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Abstract
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.
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Affiliation(s)
- D M Scollard
- Laboratory Research Branch, National Hansen's Disease Programs, LSU-SVM, Skip Bertman Dr., Baton Rouge, LA 70803, USA.
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Williams DL, Oby-Robinson S, Pittman TL, Scollard DM. Purification of Mycobacterium leprae RNA for gene expression analysis from leprosy biopsy specimens. Biotechniques 2004; 35:534-6, 538, 540-1. [PMID: 14513559 DOI: 10.2144/03353st07] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gene expression analysis in Mycobacterium leprae, an obligate intracellular pathogen and the etiologic agent of leprosy, has been hampered by the lack of an efficient method to purify RNA from leprosy lesions. Therefore to date, transcripts for only a few genes have been identified. We report the use of a single-tube homogenization/RNA extraction method that produces enough RNA to study the expression of 30 genes from a single skin biopsy specimen of a multibacillary leprosy patient and demonstrate that RNA can be purified after fixation of biopsies in 70% ethanol for up to a year. This represents a major advancement in the ability to study M. leprae gene expression directly from biopsy material and should help to define genes that are associated with intracellular survival of this human pathogen.
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Affiliation(s)
- Diana L Williams
- Molecular Biology Research Department, Laboratory Research Branch, National Hansen's Disease Programs at LSU-SVM, Rm. 3517W, Skip Bertman Drive, Baton Rouge, LA 70803, USA.
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Abstract
Footpad lesions of 3 nude mice infected by Mycobacterium leprae were studied at 9, 12, and 14 months after inoculation with light and electron microscope. The lesions were somewhat similar to those found in nodules in polar lepromatous leprosy. Striated muscles rather than nerves were the preferred site of the growth of M. leprae. Yet, M. leprae were identified in Schwann cells and endothelial cells, singly and in clumps. M. leprae filled macrophages, and free M. leprae were found in large numbers in the endoneurium without producing any significant demyelination.
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Affiliation(s)
- Charles K Job
- Pathology Research Department, National Hansen's Disease Programs, L.S.U.-S.V.M., Skip Bertman Drive, Baton Rouge, Louisiana, USA
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Scollard DM. The social dimensions of leprosy. Int J Lepr Other Mycobact Dis 2003; 71:246-7. [PMID: 14608822 DOI: 10.1489/1544-581x(2003)71<246:tsdol>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Scollard DM. Changes at the journal. Int J Lepr Other Mycobact Dis 2003; 71:113-4. [PMID: 12914134 DOI: 10.1489/1544-581x(2003)71<113:catj>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Adams LB, Scollard DM, Ray NA, Cooper AM, Frank AA, Orme IM, Krahenbuhl JL. The study of Mycobacterium leprae infection in interferon-gamma gene--disrupted mice as a model to explore the immunopathologic spectrum of leprosy. J Infect Dis 2002; 185 Suppl 1:S1-8. [PMID: 11865434 DOI: 10.1086/338002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium leprae infection was evaluated in interferon-gamma knockout (GKO) mice. At 4 months, growth of the bacilli in the footpads of GKO mice plateaued a log(10) higher than that in control mice. Control mice exhibited mild lymphocytic and histiocytic infiltrates, whereas GKO mice developed large, unorganized infiltrates of epithelioid macrophages and scattered CD4 and CD8 T cells. Flow cytometric analysis of popliteal lymph node cells demonstrated similar profiles of T cells; however, GKO cells exhibited an elevated proliferative response to M. leprae antigen. Expression of inducible nitric oxide synthase mRNA was decreased in GKO mice, whereas macrophage inflammatory protein-1alpha and interleukin-4 and -10 mRNA expression were augmented. Control and GKO activated macrophages inhibited bacterial metabolism and produced nitrite. Thus, although deficient in an important Th1 cytokine, GKO mice possess compensatory mechanisms to control M. leprae growth and feature elements resembling mid-borderline leprosy in humans.
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Affiliation(s)
- Linda B Adams
- National Hansen's Disease Programs, Laboratory Research Branch, Louisiana State University, Baton Rouge, Louisiana 70803, USA
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Costa MB, Cavalcanti Neto PF, Martelli CM, Stefani MM, Maceira JP, Gomes MK, Schettini AP, Rebello PF, Pignataro PE, Ueda ES, Narahashi K, Scollard DM. Distinct histopathological patterns in single lesion leprosy patients treated with single dose therapy (ROM) in the Brazilian Multicentric Study. Int J Lepr Other Mycobact Dis 2001; 69:177-86. [PMID: 11875761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This paper aims to describe the histomorphologic features of skin biopsies of single lesion leprosy patients recruited at outpatient clinics in four Brazilian states in the Northeast (Amazonas and Rondonia), Southeast (Rio de Janeiro) and Center-West (Goiás) between October 1997 and December 1998. Patients clinically diagnosed as single skin lesion paucibacillary (SSL-PB) leprosy had a standard 4-mm punch biopsy taken from the lesion before rifampin, ofloxacin, minocycline (ROM) therapy. The features of the cellular inflammatory infiltrates, the presence of nerve involvement and acid-fast bacilli (AFB) were used to categorize SSL-PB biopsies into different histopathological groups. Two-hundred-seventy-eight (93.0%) out of 299 patients had a skin biopsy available. Seven single lesion patients were diagnosed as BL or LL leprosy types (MB) by the histopathological exams and 12 cases were excluded due to other skin diseases. Therefore, 259 patients had skin lesions with histomorphological features compatible with PB leprosy categorized as follows: 33.6% (N = 87) of the biopsies represented well-circumscribed epithelioid cell granuloma (Group 1); 21.6% (N = 56) less-circumscribed epithelioid cell granuloma (Group 2); 12.0% (N = 31) were described as mononuclear inflammatory infiltrate permeated with epithelioid cells (Group 3), and 29.7% (N = 77) had perivascular/periadnexal mononuclear inflammatory infiltrate (Group 4). Minimal/no morphological alteration in the skin was detected in only 8 (3.1%) SSL-PB patients categorized as Group 5, who were considered to have leprosy by clinical parameters. SSL-PB leprosy patients recruited in a multicentric study presented histomorphology readings comprising the whole PB leprosy spectrum but also a few MB cases. These results indicate heterogeneity among SSL-PB patients, with a predominance of well-circumscribed and less-circumscribed epithelioid cell granulomas (Groups 1 and 2) in the sites studied and the heterogeneity of local cellular immune response.
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Affiliation(s)
- M B Costa
- Federal University of Goias, Rua 1141, Brazil.
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Abstract
Selective infection of peripheral nerves is a unique property of Mycobacterium leprae that results in serious injury, but its basis is unexplained. Recent evidence from infected armadillos suggests that endothelial cells of peripheral nerve vasculature may be the gatekeepers by which M. leprae infects nerves. The pathogenesis of neuropathy in leprosy may thus entail a dynamic sequence of adhesion, immunologic, and inflammatory processes involving peripheral nerve endothelial cells.
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Affiliation(s)
- D M Scollard
- Research Pathology Department, National Hansen's Disease Program at LSU, Baton Rouge, LA 70894, USA.
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Burdick AE, Hendi A, Elgart GW, Barquin L, Scollard DM. Hansen's disease in a patient with a history of sarcoidosis. Int J Lepr Other Mycobact Dis 2000; 68:307-11. [PMID: 11221094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We report a rare case of concomitant Hansen's disease (HD) and sarcoidosis. Reticulin staining may be a helpful diagnostic tool in establishing the diagnosis of sarcoidosis in skin lesions. The diagnosis of HD can be established despite negative polymerase chain reaction results for the detection of Mycobacterium leprae DNA. Finally, a well-established diagnosis of sarcoidosis does not preclude the development of another granulomatous disorder. Hence, when new lesions developed in a patient with sarcoidosis despite appropriate therapy, other concurrent diagnoses should be pursued.
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Affiliation(s)
- A E Burdick
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Jackson Memorial Hospital, P.O. Box 016250 (R-250), Miami, Florida 33101, USA.
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Abstract
Endothelial cell infection by Mycobacterium leprae has long been described histologically in all types of leprosy and in some of the acute reactions occurring in this disease. Recent evidence from experimental lepromatous neuritis indicates that M. leprae colonizes endothelial cells of epineural blood vessels even in sites of minimal infection, suggesting that interaction between these cells and M. leprae may play an important role in the selective localization of this organism to peripheral nerve. To begin to study the mechanisms involved, we have examined the interaction between M. leprae and human umbilical vein endothelial cells (HUVEC) in vitro using light microscopy, scanning and transmission electron microscopy, and confocal laser scanning microscopy. When M. leprae were added to confluent monolayers of HUVEC, uptake increased slowly to a maximum at 24 hours. Maximal percentages of infected cells were similar at ratios of organisms:cell over a range of 25:1 to 100:1. The bacilli appeared to lie within membrane-bound vacuoles at all time points. The kinetics of association of M. leprae with HUVEC are much slower than has previously been observed with macrophages, possibly due to differences in the binding of M. leprae. Compared with other pathogens that infect endothelial cells, M. leprae also appear to be ingested more slowly, and to a more limited degree. The receptors involved in M. leprae binding to endothelial cells and the impact of intracellular infection by M. leprae on these cells remain to be determined.
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Affiliation(s)
- D M Scollard
- Department of Research Pathology, GWL Hansen's Disease Center, LSU School of Medicine, New Orleans, Louisiana, USA.
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Scollard DM. M. leprae infection of vascular and lymphatic endothelial cells of the epineurium and perineurium in experimental lepromatous neuritis. Nihon Hansenbyo Gakkai Zasshi 1999; 68:147-55. [PMID: 10659610 DOI: 10.5025/hansen.68.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infection of peripheral nerve by M. leprae, the histopathologic hallmark of leprosy, is a major factor in this disease, but the route and mechanisms by which bacilli localize to peripheral nerve are unknown. Experimentally infected armadillos have recently been recognized as a model of lepromatous neuritis; the major site of early accumulation of M. leprae is epineurial. To determine the epineurial cells involved, 1 cm. segments of 44 nerves from armadillos were screened for acid-fast bacilli (AFB), and thin sections were examined ultrastructurally. Of 596 blocks containing nerve, 36% contained AFB. Overall, M. leprae were found in endothelial cells in 40% of epineurial blood vessels and 75% of lymphatics, and in 25% of endoneurial vessels. Comparison of epineurial and endoneurial findings suggested that colonization of epineurial vessels preceded endoneurial infection. Such colonization of epineurial nutrient vessels may greatly increase the risk of endoneurial M. leprae bacteremia, and also enhance the risk of ischemia following even mild increases in inflammation or mechanical stress. These findings also raise the possibility that early, specific mechanisms in the localization of M. leprae to peripheral nerve may involve adhesion events between M. leprae (or M. leprae-parasitized macrophages) and the endothelial cells of the vasa nervorum.
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Affiliation(s)
- D M Scollard
- Department of Research Pathology, GWL Hansen's Disease Center, LSU, Baton Rouge, USA.
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Scollard DM, McCormick G, Allen JL. Localization of Mycobacterium leprae to endothelial cells of epineurial and perineurial blood vessels and lymphatics. Am J Pathol 1999; 154:1611-20. [PMID: 10329613 PMCID: PMC1866584 DOI: 10.1016/s0002-9440(10)65414-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Infection of peripheral nerve by Mycobacterium leprae, the histopathological hallmark of leprosy, is a major factor in this disease, but the route and mechanisms by which bacilli localize to peripheral nerve are unknown. Experimentally infected armadillos have recently been recognized as a model of lepromatous neuritis; the major site of early accumulation of M. leprae is epineurial. To determine the epineurial cells involved, 1-cm segments of 44 nerves from armadillos were screened for acid-fast bacilli and thin sections were examined ultrastructurally. Of 596 blocks containing nerve, 36% contained acid-fast bacilli. Overall, M. leprae were found in endothelial cells in 40% of epineurial blood vessels and 75% of lymphatics, and in 25% of vessels intraneurally. Comparison of epineurial and endoneurial findings suggested that colonization of epineurial vessels preceded endoneurial infection. Such colonization of epineurial nutrient vessels may greatly increase the risk of endoneurial M. leprae bacteremia, and also enhance the risk of ischemia following even mild increases in inflammation or mechanical stress. These findings also raise the possibility that early, specific mechanisms in the localization of M. leprae to peripheral nerve may involve adhesion events between M. leprae (or M. leprae-parasitized macrophages) and the endothelial cells of the vasa nervorum.
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Affiliation(s)
- David M. Scollard
- G. W. L. Hansen’s Disease Center at Louisiana State University, Baton Rouge, and the Departments of Pathology,†
| | - Gregory McCormick
- G. W. L. Hansen’s Disease Center at Louisiana State University, Baton Rouge, and the Departments of Pathology,†
| | - Joe L. Allen
- G. W. L. Hansen’s Disease Center at Louisiana State University, Baton Rouge, and the Departments of Pathology,†
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Abstract
Advanced lesions of the face, nasopharynx, and oropharynx have played an important role in the medical and social history of Hansen's disease. Renaissance artists included detailed portrayals of these lesions in some of their paintings, a testimony not only to their artistic skill and powers of observation but also to the common presence of these patients in European cities and towns of the period. The disease is now understood as a broad immunologic spectrum of host responses to Mycobacterium leprae, with a variety of clinical and pathologic manifestations in nerve, soft tissues, and bone. This review incorporates the findings of 2 extraordinary studies (one from Europe and the other from Japan) of pharyngeal and facial lesions. In the 1950s, studies of skeletal remains from the churchyard of a Danish leprosarium revealed a triad of maxillofacial lesions unique to leprosy and designated facies leprosa. In pre-World War II Japan, before effective treatment had been discovered, a prominent otorhinolaryngologist studying oropharyngeal and nasopharyngeal lesions prepared watercolor illustrations of the natural progression of untreated Hansen's disease. As a result of effective antimicrobial therapy, such advanced lesions are now rarely seen, but the presenting signs and symptoms of leprosy still occasionally arise in the nasal and oral mucosa. The nasopharynx and oropharynx may be important early sites of inoculation and infection by M leprae, and they require additional emphasis in worldwide efforts toward early diagnosis and treatment of Hansen's disease.
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Affiliation(s)
- D M Scollard
- Research Pathology, Gillis W. Long Hansen's Disease Center at LSU, Baton Rouge, LA 70894, USA
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Lockwood D, Scollard DM. Report of workshop on nerve damage and reactions. Int J Lepr Other Mycobact Dis 1998; 66:598-9. [PMID: 10347590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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47
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Scollard DM, Gillis TP, Williams DL. Polymerase chain reaction assay for the detection and identification of Mycobacterium leprae in patients in the United States. Am J Clin Pathol 1998; 109:642-6. [PMID: 9576586 DOI: 10.1093/ajcp/109.5.642] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The differentiation of leprosy from other cutaneous granulomatous diseases is routinely based on characteristic histopathologic features and the demonstration of Mycobacterium leprae by acid-fast staining. Increased ascertainment of other mycobacterial infections in the skin has made this task more difficult, but the distinction remains fundamental for the selection of appropriate treatment. Experience with formalin-fixed, paraffin-embedded tissues, frozen tissues, and tissue lysates referred for detection of M. leprae DNA by a polymerase chain reaction (PCR) assay during the past 4 years was reviewed. This assay was done by using primers and probes previously developed in our laboratory to amplify a 360-base-pair fragment of the gene for an 18-kD protein of M. leprae. Among biopsy samples obtained from 37 patients, PCR results were positive for 10 of 20 samples diagnosed as leprosy by histopathologic criteria and in 0 of 17 not diagnosed as leprosy. The specificity of the assay was 100% in this clinical referral material; sensitivity ranged from 50% to 83%. The PCR assay also identified M. leprae in one third of samples in which acid-fast organisms were seen and the histopathologic features were consistent with but not definitive of leprosy. In a nonendemic population, the sensitivity and specificity of PCR assay recommend its use primarily to identify M. leprae when acid-fast organisms are discernible but atypical clinical or histopathologic features obscure the diagnosis. The assay is not highly informative when acid-fast bacilli are not detectable by light microscopy.
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Affiliation(s)
- D M Scollard
- Department of Pathology and Molecular Biology, GWL Hansen's Disease Center at Louisiana State University, Baton Rouge 70894, USA
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48
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Gormus BJ, Murphey-Corb M, Martin LN, Baskin GB, Mack PA, Xu K, Ratteree MS, Gerone PJ, Scollard DM, Gillis TP. Impaired responses to Mycobacterium leprae antigens in rhesus monkeys experimentally inoculated with simian immunodeficiency virus and M. leprae. LEPROSY REV 1998; 69:24-39. [PMID: 9628093 DOI: 10.5935/0305-7518.19980004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seven of eight rhesus monkeys (RM) coinfected with simian immunodeficiency virus (SIV) and Mycobacterium leprae harboured acid-fast bacilli (AFB) at sites of dermal inoculation and/or at disseminated sites at times of humane sacrifice (up to 270 days post-M. leprae inoculation) due to SIV-induced debilitation or, in one long term survivor's case, to date over 3 years post-M. leprae inoculation. Detectable AFB were cleared in biopsies of inoculation sites of RM inoculated with M. leprae alone after 63 days postinoculation; these sites have, so far, remained AFB-negative, thereafter. Compared to animals infected with M. leprae alone, RM coinfected with SIV plus M. leprae showed: 1, completely suppressed serum antibody responses to M. leprae-specific PGL-I antigen, but strong anti-SIV Gp120 antibody responses; 2, impaired sensitization of blood mononuclear cells (MNC) to in vitro recognition of M. leprae-specific antigens in blastogenic stimulation assays; 3, impaired in vitro responses of blood MNC to nonspecific (ConA) blastogenic stimuli; and 4, early post-M. leprae inoculation, there was a significant incremental diminution of percentages of blood CD4+CD29+ T-cells in addition to the existing SIV-induced diminished percentages of CD4+CD29+ T-cells. The results indicate that humoral and cellular immune responses to M. leprae antigens are compromised in M. leprae-inoculated RM previously infected with SIV. These results provide an immunologic basis for the demonstration of enhanced M. leprae persistence or leprosy susceptibility in SIV-M. leprae coinfected RM.
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Affiliation(s)
- B J Gormus
- Department of Microbiology, Tulane Regional Primate Research Center, Covington, LA 70433, USA
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Lathrop G, Scollard DM, Dietrich M. Reactivity of a population of armadillo lymphocytes with an antibody to human gamma,delta T-cells. Clin Immunol Immunopathol 1997; 82:68-72. [PMID: 9000044 DOI: 10.1006/clin.1996.4285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reactivity of lymphocytes from the nine-banded armadillo (Dasypus novemcinctus) was examined by flow cytometry using a panel of 16 commercially available fluorochrome-conjugated monoclonal antibodies raised against human or murine leukocyte antigens. The only reactivity observed was with antibody TCRdelta1, directed against a common determinant on the delta chain of the human gamma,delta T-cell receptor. Using this antibody, a distinct, bright population of lymphocytes was seen in the peripheral blood in all of 47 animals examined, accounting for 2.0-47.1% of lymphocytes (median, 10.6%). The gamma,delta-reactive lymphocyte population comprised a greater percentage of intraepithelial lymphocytes in the small intestine than in the blood; variable percentages of gamma,delta-reactive cells were also observed in the spleen, thymus, lymph nodes, and bone marrow, and in cutaneous lepromas. In armadillos with disseminated Mycobacterium leprae infection, a significantly greater percentage of circulating lymphocytes reacted with the anti-gamma,delta antibody. This is the first described reactivity of armadillo lymphocytes with a monoclonal antibody to a lymphocyte antigen, and it may offer a useful tool in disease models involving the armadillo.
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Affiliation(s)
- G Lathrop
- Department of Research Pathology, GWL Hansen's Disease Center at LSU, LSU School of Veterinary Medicine, Baton Rouge, Louisiana 70894, USA
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Scollard DM, Lathrop GW, Truman RW. Infection of distal peripheral nerves by M. leprae in infected armadillos; an experimental model of nerve involvement in leprosy. Int J Lepr Other Mycobact Dis 1996; 64:146-151. [PMID: 8690974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Mechanisms of localization of Mycobacterium leprae to the peripheral nerves and of subsequent nerve injury are not understood. No experimental animal model has been available for use in examining the pathogenesis of M. leprae-induced nerve injury. A detailed dissection was, therefore, done of the major peripheral nerves in the extremities of six M. leprae-inoculated armadillos, three of which had developed characteristic disseminated infection. All of the animals with disseminated infection had extensive involvement of the peripheral nerves, increasing in intensity as the nerve was followed distally. No M. leprae were found in the animals without disseminated infection. The degree of infection was greater in epineural tissues than in the intraneural compartment (i.e., Schwann cells) at all levels. The infection of nerves by M. leprae was associated with focal interstitial, mononuclear cell infiltration of involved nerves. These results suggest that: 1) armadillos offer a model for the study of neural involvement in leprosy, since the pattern of neural distribution in susceptible armadillos is comparable to the pattern of nerve involvement in man; 2) early localization of M. leprae may be to the epineural tissues, including lymphatic and vascular structures and extracellular matrix; 3) Schwann cell involvement may be a late event; and 4) mechanisms involving the endothelium of epineural and perineural tissues may be important in the selective localization of M. leprae to peripheral nerves.
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Affiliation(s)
- D M Scollard
- Department of Research Pathology, GWL Hansen's Disease Center, Louisiana State University, Baton Rouge 70894, USA
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