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Fairley JK, Ferreira JA, Fraga LAO, Lyon S, Valadão Cardoso TM, Boson VC, Madureira Nunes AC, Medeiros Cinha EH, de Oliveira LBP, Magueta Silva EB, Marçal PHF, Branco AC, Grossi MAF, Jones DP, Ziegler TR, Collins JM. High-Resolution Plasma Metabolomics Identifies Alterations in Fatty Acid, Energy, and Micronutrient Metabolism in Adults Across the Leprosy Spectrum. J Infect Dis 2024; 229:1189-1199. [PMID: 37740551 PMCID: PMC11011203 DOI: 10.1093/infdis/jiad410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND High-resolution metabolomics (HRM) is an innovative tool to study challenging infectious diseases like leprosy, where the pathogen cannot be grown with standard methods. Here, we use HRM to better understand associations between disease manifestations, nutrition, and host metabolism. METHODS From 2018 to 2019, adults with leprosy and controls were recruited in Minas Gerais, Brazil. Plasma metabolites were detected using an established HRM workflow and characterized by accurate mass, mass to charge ratio m/z and retention time. The mummichog informatics package compared metabolic pathways between cases and controls and between multibacillary (MB) and paucibacillary (PB) leprosy. Additionally, select individual metabolites were quantified and compared. RESULTS Thirty-nine cases (62% MB and 38% PB) and 25 controls were enrolled. We found differences (P < .05) in several metabolic pathways, including fatty acid metabolism, carnitine shuttle, retinol, vitamin D3, and C-21 steroid metabolism, between cases and controls with lower retinol and associated metabolites in cases. Between MB and PB, leukotrienes, prostaglandins, tryptophan, and cortisol were all found to be lower in MB (P < .05). DISCUSSION Metabolites associated with several nutrient-related metabolic pathways appeared differentially regulated in leprosy, especially MB versus PB. This pilot study demonstrates the metabolic interdependency of these pathways, which may play a role in the pathophysiology of disease.
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Affiliation(s)
- Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - José A Ferreira
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
| | - Lucia A O Fraga
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Sandra Lyon
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Victor Campos Boson
- Faculdade da Saúde e Écologia Humana, FASEH, Vespasiano, Minas Gerais, Brazil
| | | | - Eloisa H Medeiros Cinha
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Lorena B P de Oliveira
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Erica B Magueta Silva
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Pedro H F Marçal
- Department of Health Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Alexandre C Branco
- Centro de Referência em Doenças Endêmicas e Programs Especiais, Governador Valadares, Minas Gerais, Brazil
| | | | - Dean P Jones
- Division of Pulmonary, Critical Care, and Allergy, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeffrey M Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Mwageni N, van Wijk R, Daba F, Mamo E, Debelo K, Jansen B, Schoenmakers A, van Hees CLM, Kasang C, Mieras L, Mshana SE. The NLR SkinApp: Testing a Supporting mHealth Tool for Frontline Health Workers Performing Skin Screening in Ethiopia and Tanzania. Trop Med Infect Dis 2024; 9:18. [PMID: 38251215 PMCID: PMC10819267 DOI: 10.3390/tropicalmed9010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background: The prevalence of skin diseases such as leprosy, and limited dermatological knowledge among frontline health workers (FHWs) in rural areas of Sub-Saharan Africa, led to the development of the NLR SkinApp: a mobile application (app) that supports FHWs to promptly diagnose and treat, or suspect and refer patients with skin diseases. The app includes common skin diseases, neglected tropical skin diseases (skin NTDs) such as leprosy, and HIV/AIDS-related skin conditions. This study aimed to test the supporting role of the NLR SkinApp by examining the diagnostic accuracy of its third edition. Methods: A cross-sectional study was conducted in East Hararghe, Ethiopia, as well as the Mwanza and Morogoro region, Tanzania, in 2018-2019. Diagnostic accuracy was measured against a diagnosis confirmed by two dermatologists/dermatological medical experts (reference standard) in terms of sensitivity, specificity, positive predictive value, and negative predictive value. The potential negative effect of an incorrect management recommendation was expressed on a scale of one to four. Results: A total of 443 patients with suspected skin conditions were included. The FHWs using the NLR SkinApp diagnosed 45% of the patients accurately. The values of the sensitivity of the FHWs using the NLR SkinApp in determining the correct diagnosis ranged from 23% for HIV/AIDS-related skin conditions to 76.9% for eczema, and the specificity from 69.6% for eczema to 99.3% for tinea capitis/corporis. The inter-rater reliability among the FHWs for the diagnoses made, expressed as the percent agreement, was 58% compared to 96% among the dermatologists. Of the management recommendations given on the basis of incorrect diagnoses, around one-third could have a potential negative effect. Conclusions: The results for diagnosing eczema are encouraging, demonstrating the potential contribution of the NLR SkinApp to dermatological and leprosy care by FHWs. Further studies with a bigger sample size and comparing FHWs with and without using the NLR SkinApp are needed to obtain a better understanding of the added value of the NLR SkinApp as a mobile health (mHealth) tool in supporting FHWs to diagnose and treat skin diseases.
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Affiliation(s)
- Nelly Mwageni
- Department of Microbiology, Catholic University of Health and Allied Sciences, Mwanza 33102, Tanzania; (N.M.)
| | - Robin van Wijk
- NLR/Leprastichting, 1097 DN Amsterdam, The Netherlands (A.S.); (L.M.)
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Fufa Daba
- Deutsche Lepra-und Tuberkulosehilfe, Addis Ababa 1165, Ethiopia; (F.D.); (K.D.)
| | - Ephrem Mamo
- Armauer Hansen Research Institute, Addis Ababa 1005, Ethiopia;
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia
| | - Kitesa Debelo
- Deutsche Lepra-und Tuberkulosehilfe, Addis Ababa 1165, Ethiopia; (F.D.); (K.D.)
| | - Benita Jansen
- NLR/Leprastichting, 1097 DN Amsterdam, The Netherlands (A.S.); (L.M.)
| | - Anne Schoenmakers
- NLR/Leprastichting, 1097 DN Amsterdam, The Netherlands (A.S.); (L.M.)
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Colette L. M. van Hees
- Department of Dermatology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Christa Kasang
- Deutsche Lepra-und Tuberkulosehilfe, 97080 Würzburg, Germany;
| | - Liesbeth Mieras
- NLR/Leprastichting, 1097 DN Amsterdam, The Netherlands (A.S.); (L.M.)
| | - Stephen E. Mshana
- Department of Microbiology, Catholic University of Health and Allied Sciences, Mwanza 33102, Tanzania; (N.M.)
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Aycheh MW, van’t Noordende AT, Moges NA, Schippers AP. The cross-cultural validation of the Beach Center Family Quality of Life Scale among persons affected by leprosy or podoconiosis in Northwest Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011235. [PMID: 37801432 PMCID: PMC10584103 DOI: 10.1371/journal.pntd.0011235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/18/2023] [Accepted: 07/17/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The Beach Center Family Quality of Life Scale has been developed and validated in different languages in different countries. However, this scale has not been validated in the Ethiopian Amharic language context. Therefore, this study aimed to investigate the cross-cultural validity of the Beach Center Family Quality of Life Scale, among Ethiopian families of persons affected by leprosy and podoconiosis. METHODOLOGY We explored the semantic equivalence, internal consistency, reproducibility, floor and ceiling effects, and interpretability of the Beach Center Family Quality of Life Scale in Amharic. A cross-sectional study was conducted after the translation and back-translation of the instrument. A total of 302 adult persons affected by leprosy or podoconiosis was asked about their level of satisfaction with their family life, using the Beach Center Family Quality of Life Scale. In addition, 50 participants were re-interviewed two weeks after the initial assessment to test the reproducibility of the scale. Participants were recruited in the East Gojjam zone of Northwest Ethiopia. RESULTS The findings of this study showed that the Beach Center Family Quality of Life Scale had high internal consistency (Cronbach's alpha of 0.913) and reproducibility (intra-class correlation coefficient of 0.857). The standard error of measurement was 3.01, which is 2.4% of the total score range. The smallest detectable change was 8.34. Confirmatory factor analysis showed adequate factor loadings and model fit indices like the original scale. The composite reliability and average variance extracted from the scale were acceptable. No floor and ceiling effects were found. CONCLUSIONS Our findings indicate that the Amharic version of the Beach Center Family Quality of Life Scale has adequate cultural validity to assess the family quality of life in Ethiopian families of persons affected by leprosy and podoconiosis.
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Affiliation(s)
- Moges Wubie Aycheh
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Anna T. van’t Noordende
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nurilign Abebe Moges
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alice P. Schippers
- Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
- Disability Studies in the Netherlands, Utrecht, The Netherlands
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Yotsu RR, Ding Z, Hamm J, Blanton RE. Deep learning for AI-based diagnosis of skin-related neglected tropical diseases: A pilot study. PLoS Negl Trop Dis 2023; 17:e0011230. [PMID: 37578966 PMCID: PMC10449179 DOI: 10.1371/journal.pntd.0011230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 03/13/2023] [Revised: 08/24/2023] [Accepted: 06/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Deep learning, which is a part of a broader concept of artificial intelligence (AI) and/or machine learning has achieved remarkable success in vision tasks. While there is growing interest in the use of this technology in diagnostic support for skin-related neglected tropical diseases (skin NTDs), there have been limited studies in this area and fewer focused on dark skin. In this study, we aimed to develop deep learning based AI models with clinical images we collected for five skin NTDs, namely, Buruli ulcer, leprosy, mycetoma, scabies, and yaws, to understand how diagnostic accuracy can or cannot be improved using different models and training patterns. METHODOLOGY This study used photographs collected prospectively in Côte d'Ivoire and Ghana through our ongoing studies with use of digital health tools for clinical data documentation and for teledermatology. Our dataset included a total of 1,709 images from 506 patients. Two convolutional neural networks, ResNet-50 and VGG-16 models were adopted to examine the performance of different deep learning architectures and validate their feasibility in diagnosis of the targeted skin NTDs. PRINCIPAL FINDINGS The two models were able to correctly predict over 70% of the diagnoses, and there was a consistent performance improvement with more training samples. The ResNet-50 model performed better than the VGG-16 model. A model trained with PCR confirmed cases of Buruli ulcer yielded 1-3% increase in prediction accuracy across all diseases, except, for mycetoma, over a model which training sets included unconfirmed cases. CONCLUSIONS Our approach was to have the deep learning model distinguish between multiple pathologies simultaneously-which is close to real-world practice. The more images used for training, the more accurate the diagnosis became. The percentages of correct diagnosis increased with PCR-positive cases of Buruli ulcer. This demonstrated that it may be better to input images from the more accurately diagnosed cases in the training models also for achieving better accuracy in the generated AI models. However, the increase was marginal which may be an indication that the accuracy of clinical diagnosis alone is reliable to an extent for Buruli ulcer. Diagnostic tests also have their flaws, and they are not always reliable. One hope for AI is that it will objectively resolve this gap between diagnostic tests and clinical diagnoses with the addition of another tool. While there are still challenges to be overcome, there is a potential for AI to address the unmet needs where access to medical care is limited, like for those affected by skin NTDs.
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Affiliation(s)
- Rie R. Yotsu
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, Louisiana, United States of America
| | - Zhengming Ding
- Department of Computer Science, Tulane University School of Science and Engineering, 201 Lindy Claiborne Boggs Center, 6823 St. Charles Avenue, New Orleans, Louisiana, United States of America
| | - Jihun Hamm
- Department of Computer Science, Tulane University School of Science and Engineering, 201 Lindy Claiborne Boggs Center, 6823 St. Charles Avenue, New Orleans, Louisiana, United States of America
| | - Ronald E. Blanton
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, Louisiana, United States of America
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Coleman M, Hill J, Timeon E, Rimon E, Bauro T, Ioteba N, Cunanan A, Douglas NM, Islam T, Tomlinson J, Campbell PO, Williman J, Priest P, Marais BJ, Britton WJ, Chambers ST. Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol. BMJ Open 2023; 13:e065369. [PMID: 37385746 PMCID: PMC10314446 DOI: 10.1136/bmjopen-2022-065369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Progress towards leprosy elimination is threatened by increasing incidence in 'hot-spot' areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in 'hot-spot' areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap. METHODS AND ANALYSIS This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022-2025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before-after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a 'hot-spot' sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme. ETHICS AND DISSEMINATION Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22/111) and the University of Sydney (2021/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.
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Affiliation(s)
- Mikaela Coleman
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy Hill
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Eretii Timeon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Erei Rimon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Temea Bauro
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Nabura Ioteba
- Pasifika Futures Ltd, Christchurch, New Zealand
- Pacific Leprosy Foundation, Christchurch, New Zealand
| | - Arturo Cunanan
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Health, Culion Sanatorium and General Hospital, Culion, Philippines
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tauhid Islam
- Division of Programmes for Disease Control, Manila, Philippines
| | | | - Patrick O Campbell
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Jonathan Williman
- Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand
| | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Warwick J Britton
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Stephen T Chambers
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Dallmann-Sauer M, Xu YZ, da Costa ALF, Tao S, Gomes TA, Prata RBDS, Correa-Macedo W, Manry J, Alcaïs A, Abel L, Cobat A, Fava VM, Pinheiro RO, Lara FA, Probst CM, Mira MT, Schurr E. Allele-dependent interaction of LRRK2 and NOD2 in leprosy. PLoS Pathog 2023; 19:e1011260. [PMID: 36972292 PMCID: PMC10079233 DOI: 10.1371/journal.ppat.1011260] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/06/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
Leprosy, caused by Mycobacterium leprae, rarely affects children younger than 5 years. Here, we studied a multiplex leprosy family that included monozygotic twins aged 22 months suffering from paucibacillary leprosy. Whole genome sequencing identified three amino acid mutations previously associated with Crohn’s disease and Parkinson’s disease as candidate variants for early onset leprosy: LRRK2 N551K, R1398H and NOD2 R702W. In genome-edited macrophages, we demonstrated that cells expressing the LRRK2 mutations displayed reduced apoptosis activity following mycobacterial challenge independently of NOD2. However, employing co-immunoprecipitation and confocal microscopy we showed that LRRK2 and NOD2 proteins interacted in RAW cells and monocyte-derived macrophages, and that this interaction was substantially reduced for the NOD2 R702W mutation. Moreover, we observed a joint effect of LRRK2 and NOD2 variants on Bacillus Calmette-Guérin (BCG)-induced respiratory burst, NF-κB activation and cytokine/chemokine secretion with a strong impact for the genotypes found in the twins consistent with a role of the identified mutations in the development of early onset leprosy.
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Affiliation(s)
- Monica Dallmann-Sauer
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
- Departments of Human Genetics and Medicine, Faculty of Medicine and Health Science, McGill University; Montreal, Canada
- Graduate Program in Health Sciences, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná; Curitiba, Brazil
| | - Yong Zhong Xu
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
| | - Ana Lúcia França da Costa
- Department of Specialized Medicine, Health Sciences Center, Federal University of Piauí; Teresina, Brazil
| | - Shao Tao
- Division of Experimental Medicine, Faculty of Medicine, McGill University; Montreal, Canada
- The Translational Research in Respiratory Diseases Program, The Research Institute of the McGill University Health Centre; Montreal, Canada
| | - Tiago Araujo Gomes
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation; Rio de Janeiro, Brazil
| | | | - Wilian Correa-Macedo
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
- Department of Biochemistry, Faculty of Medicine and Health Science, McGill University; Montreal, Canada
| | - Jérémy Manry
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
| | - Alexandre Alcaïs
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U.1163, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U.1163, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, United States of America
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U.1163, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, United States of America
| | - Vinicius M. Fava
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation; Rio de Janeiro, Brazil
| | - Flavio Alves Lara
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation; Rio de Janeiro, Brazil
| | - Christian M. Probst
- Laboratory of Systems and Molecular Biology of Trypanosomatids, Instituto Carlos Chagas; FIOCRUZ, Curitiba, Brazil
| | - Marcelo T. Mira
- Graduate Program in Health Sciences, School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná; Curitiba, Brazil
- * E-mail: (M.T.M); (E.S.)
| | - Erwin Schurr
- Program in Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Centre; Montreal, Canada
- McGill International TB Centre, McGill University; Montreal, Canada
- Departments of Human Genetics and Medicine, Faculty of Medicine and Health Science, McGill University; Montreal, Canada
- Department of Biochemistry, Faculty of Medicine and Health Science, McGill University; Montreal, Canada
- * E-mail: (M.T.M); (E.S.)
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Putri AI, de Sabbata K, Agusni RI, Alinda MD, Darlong J, de Barros B, Walker SL, Zweekhorst MBM, Peters RMH. Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries. PLoS Negl Trop Dis 2022; 16:e0010476. [PMID: 35696438 PMCID: PMC9191760 DOI: 10.1371/journal.pntd.0010476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/22/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Leprosy reactions, Type-1 and erythema nodosum leprosum, are immune-mediated complications of leprosy, which play a significant role in the morbidity associated with the disease. A considerable amount of literature has been published on the impact of leprosy in general but few studies focus specifically on leprosy reactions. This study aimed to investigate the impact of leprosy reactions on physical, psychological, and social aspects of the lives of people affected by analysing their life experiences and perspectives about leprosy reactions.
Methods/Principal findings
This qualitative study involved people affected by leprosy reactions and their family members in two leprosy endemic countries. The data were collected through 66 interviews and 9 focus group discussions (4–6 participants each) in Surabaya, Indonesia, and Purulia, India. Content analysis and conversational analysis were performed. This study found that both types of leprosy reactions were perceived as an unpredictable and painful condition. Leprosy reactions restricted physical activities of the participants, such as going to bathroom, sleeping, eating, and cooking. In the interviews, the respondents expressed a range of emotions and feelings including confusion, sadness, anxiety, and anger. Some recounted that they felt stigmatized and lost opportunities to socialise and earn money. Differences between the two settings were identified. The majority of Indonesian participants preferred to stay at home, and some concealed the diagnosis of leprosy, while most of the Indian respondents continued working up to the time of hospitalization.
Conclusion
Leprosy reactions are a distressing complication of leprosy and adversely affect the lives of those affected. Individuals reported physical discomfort, distress, anxiety, stigma, and financial hardship and these negative impacts in the physical, psychological, and social spheres reinforced each other. These findings provide important information about a need for early detection and sustained commitment to follow-up care for people with a history of leprosy reactions. More research on new drugs for reactional episodes, tools to measure knowledge, attitude, and practice, and costing study on leprosy reactions treatment are needed. We recommend the development and testing of holistic strategies to improve the management of leprosy reactions.
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Affiliation(s)
- Annisa Ika Putri
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
- * E-mail:
| | - Kevin de Sabbata
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
- School of Law, Keele University, Keele, Newcastle, United Kingdom
| | - Regitta I. Agusni
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Medhi Denisa Alinda
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | | | - Barbara de Barros
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen L. Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ruth M. H. Peters
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
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van 't Noordende AT, Aycheh MW, Moges NA, Tadesse T, Schippers AP. Family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis versus usual care in Ethiopia: study protocol for a cluster-randomised controlled trial. BMJ Open 2022; 12:e056620. [PMID: 35354636 PMCID: PMC8968636 DOI: 10.1136/bmjopen-2021-056620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Leprosy, podoconiosis and lymphatic filariasis (LF) are three skin-related neglected tropical diseases. All three conditions can lead to temporary and permanent impairments. These impairments progressively worsen and are major determinants of stigma, discrimination and participation restrictions. Self-care is essential to prevent disabilities and chronic disease complications. Many persons with leprosy-related, LF-related and podoconiosis-related disabilities need to practice self-management routines their entire life. This is difficult without support and encouragement of others. The objective of this study was to assess the effectiveness of a family-based intervention in terms of physical outcomes related to prevention and self-management of disabilities due to leprosy, podoconiosis and LF and family quality of life and well-being compared with usual practice and care. METHODS AND ANALYSIS The study will use a cluster-randomised controlled trial design with two study arms. The project will be carried out in endemic districts in East and West Gojjam zones in the Amhara region in Ethiopia. Clusters consist of kebeles (lower administrative structures in the district) that have been merged, based on their geographical proximity and the number of cases in each kebele. A total of 630 participants will be included in the study. The intervention group will consist of 105 persons affected by leprosy, 105 persons affected by LF or podoconiosis, and 210 family members. The control group will consist of 105 persons affected by leprosy and 105 persons affected by LF or podoconiosis. The family-based intervention comprises an essential care package that consists of the following three main components: (1) self-management of disabilities, (2) economic empowerment and (3) psychosocial support. Participants in the control areas will receive usual practice and care. Data analysis includes, but is not limited to, calculating the percentage of change and corresponding 95% CI of physical impairment outcomes in each group, before and after the intervention is implemented, effect sizes, intention to treat and difference in difference analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Debre Markos University Health Sciences Institutional Research Ethics Review Committee. Results will be disseminated through peer-reviewed publications, conference presentations and workshops. TRIAL REGISTRATION NUMBER PACTR202108907851342.
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Affiliation(s)
- Anna Tiny van 't Noordende
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Technical Department, NLR, Amsterdam, The Netherlands
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nurilign Abebe Moges
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Tadesse
- Programme, Ethiopian National Association of Persons Affected by Leprosy (ENAPAL), Addis Ababa, Ethiopia
| | - Alice P Schippers
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Care ethics, University of Humanistic Studies, Utrecht, The Netherlands
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Schoenmakers A, Hambridge T, van Wijk R, Kasang C, Richardus JH, Bobosha K, Mitano F, Mshana SE, Mamo E, Marega A, Mwageni N, Letta T, Muloliwa AM, Kamara DV, Eman AM, Raimundo L, Njako B, Mieras L. PEP4LEP study protocol: integrated skin screening and SDR-PEP administration for leprosy prevention: comparing the effectiveness and feasibility of a community-based intervention to a health centre-based intervention in Ethiopia, Mozambique and Tanzania. BMJ Open 2021; 11:e046125. [PMID: 34446483 PMCID: PMC8395349 DOI: 10.1136/bmjopen-2020-046125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER NL7294 (NTR7503).
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Affiliation(s)
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin van Wijk
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Christa Kasang
- Deutsche Lepra- und Tuberkulosehilfe e.V, Wuerzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fernando Mitano
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Ephrem Mamo
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Nelly Mwageni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Taye Letta
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | - Artur Manuel Muloliwa
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | | | | | | | - Blasdus Njako
- Deutsche Lepra- und Tuberkulosehilfe e.V. Tanzania, Dar es Salaam, United Republic of Tanzania
| | - Liesbeth Mieras
- Medical Technical Department, NLR, Amsterdam, The Netherlands
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van’t Noordende AT, Bakirtzief da Silva Pereira Z, Biswas P, Ilyas M, Krishnan V, Parasa J, Kuipers P. Strengthening individual and family resilience against leprosy-related discrimination: A pilot intervention study. PLoS Negl Trop Dis 2021; 15:e0009329. [PMID: 33798199 PMCID: PMC8046345 DOI: 10.1371/journal.pntd.0009329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/28/2020] [Revised: 04/14/2021] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy and leprosy-related stigma can have a major impact on psychosocial wellbeing of persons affected and their family members. Resilience is a process that incorporates many of the core skills and abilities which may enable people to address stigma and discrimination. The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination. Methodology We used a quasi-experimental, before-after study design with a mixed methods approach. The 10-week family-based intervention was designed to strengthen the resilience of individuals and families by enhancing their protective abilities and capacity to overcome adversity. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. Persons affected and their family members were included using purposive sampling. Two questionnaires were used pre-and post-intervention: the Connor-Davidson Resilience Scale (CD-RISC, maximum score 100, with high scores reflecting greater resilience) and the WHOQOL-BREF (maximum score of 130, with higher scores reflecting higher quality of life). In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in the Odisha cohort again at six months after completion. Paired t-tests measured differences pre- and post- intervention. Qualitative data were thematically analysed. Findings Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in CD-RISC scores for persons affected and family members from Odisha state (baseline 46.5, first follow-up 77.0, second follow-up 70.0), this improvement was maintained at six-month follow-up. There was no increase in CD-RISC scores post-intervention among participants from Telangana state. WHOQOL-BREF scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. No families dropped out of the study. In the qualitative feedback, all participants described drawing benefit from the programme. Participants especially appreciated the social dimensions of the intervention. Conclusion This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life. A large-scale efficacy trial is necessary to determine the effectiveness and long-term sustainability of the intervention. The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. We assessed resilience and quality of life with two questionnaires (the CD-RISC and WHOQOL-BREF) pre-and post-intervention. In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in Odisha state again at six months after completion. Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in resilience scores for persons affected and family members from Odisha state, this improvement was maintained at six-month follow-up. There was no increase in resilience scores post-intervention among participants from Telangana state. Quality of life scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. Participants especially appreciated the social dimensions of the intervention. This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life.
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Affiliation(s)
- Anna T. van’t Noordende
- NLR, Amsterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | | | - Mohammed Ilyas
- Hyderabad Leprosy Control & Health Society, Hyderabad, India
| | | | | | - Pim Kuipers
- The Hopkins Centre, Griffith University, Queensland, Australia
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de Barros B, Lambert SM, Shah M, Pai VV, Darlong J, Rozario BJ, Alinda MD, Sales AM, Doni S, Hagge DA, Shrestha D, Listiawan MY, Yitaye AM, Nery JAC, Neupane KD, Dias VLA, Butlin CR, Nicholls PG, Lockwood D, Walker SL. Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial. BMJ Open 2020; 10:e037700. [PMID: 33203627 PMCID: PMC7674097 DOI: 10.1136/bmjopen-2020-037700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Erythema nodosum leprosum (ENL) is an immunological complication of leprosy. ENL results in morbidity and disability and if it is not treated can lead to death. The current treatment consists of thalidomide or high doses of oral corticosteroids for prolonged periods. Thalidomide is not available in many leprosy endemic countries. The use of corticosteroids is associated with morbidity and mortality. Identifying treatment regimens that reduce the use of corticosteroids in ENL is essential. Methotrexate (MTX) is used to treat many inflammatory diseases and has been used successfully to treat patients with ENL not controlled by other drugs, including prednisolone and thalidomide. We present the protocol of the 'MTX and prednisolone study in ENL' (MaPs in ENL) a randomised controlled trial (RCT) designed to test the efficacy of MTX in the management of ENL. METHODS AND ANALYSIS MaPs in ENL is an international multicentre RCT, which will be conducted in leprosy referral centres in Bangladesh, Brazil, Ethiopia, India, Indonesia and Nepal. Patients diagnosed with ENL who consent to participate will be randomly allocated to receive 48 weeks of weekly oral MTX plus 20 weeks of prednisolone or 48 weeks of placebo plus 20 weeks of prednisolone. Participants will be stratified by type of ENL into those with acute ENL and those with chronic and recurrent ENL. The primary objective is to determine whether MTX reduces the requirement for additional prednisolone. Patients' reported outcome measures will be used to assess the efficacy of MTX. Participants will be closely monitored for adverse events. ETHICS AND DISSEMINATION Results will be submitted for publication in peer-reviewed journals. Ethical approval was obtained from the Observational/Interventions Research Ethics Committee of the London School of Hygiene & Tropical Medicine (15762); The Leprosy Mission International Bangladesh Institutional Research Board (in process); AHRI-ALERT Ethical Review Committee, Ethiopia; Ethics Committee of the Managing Committee of the Bombay Leprosy Project; and The Leprosy Mission Trust India Ethics Committee; the Nepal Health and Research Council and Health Research Ethics Committee Dr. Soetomo, Indonesia. This study is registered at www.clinicaltrials.gov. This is the first RCT of MTX for ENL and will contribute to the evidence for the management of ENL.Trial registration numberNCT 03775460.
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Affiliation(s)
- Barbara de Barros
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Saba M Lambert
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Mahesh Shah
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | | | | | | | - Medhi Denisa Alinda
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo General Hospital, Surabaya, Jawa Timur, Indonesia
| | - Anna M Sales
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Shimelis Doni
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Deanna A Hagge
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Dilip Shrestha
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - M Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, Dr Soetomo General Hospital, Surabaya, Jawa Timur, Indonesia
| | - Abeba M Yitaye
- Clinical Research Department, ALERT Center, Addis Ababa, London, Ethiopia
| | - Jose A C Nery
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Kapil D Neupane
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Vivianne L A Dias
- Leprosy Laboratory, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - C Ruth Butlin
- DBLM Hospital, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Peter G Nicholls
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Lockwood
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen L Walker
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Barbieri RR, Manta FSN, Moreira SJM, Sales AM, Nery JAC, Nascimento LPR, Hacker MA, Pacheco AG, Machado AM, Sarno EM, Moraes MO. Quantitative polymerase chain reaction in paucibacillary leprosy diagnosis: A follow-up study. PLoS Negl Trop Dis 2019; 13:e0007147. [PMID: 30835722 PMCID: PMC6428338 DOI: 10.1371/journal.pntd.0007147] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 10/24/2018] [Revised: 03/21/2019] [Accepted: 01/09/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The diagnosis of paucibacillary (PB) leprosy cases remains a challenge because of the absence of a confirmatory laboratory method. While quantitative polymerase chain reaction (qPCR) has been shown to provide reliable sensitivity and specificity in PB diagnoses, a thorough investigation of its efficacy in clinical practice has not yet been published. The present study evaluated patients with suspected leprosy skin lesions by using qPCR to identify PB individuals in the Leprosy Outpatient clinic at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. METHODS One hundred seventy-two suspected PB cases were included in the study. The patients were evaluated by a dermatologist at three different times. The clinical dermato-neurological examination and collected samples were performed on the first visit. On the second visit, the results of the histopathological analysis and PCR assay (DNA-based Mycobacterium leprae qPCR-targeting 16S gene) results were analyzed, and a decision regarding multi-drug therapy was made. A year later, the patients were re-examined, and the consensus diagnosis was established. RESULTS In 58% (100/172) of cases, a conclusive diagnosis via histopathological analysis was not possible; however, 30% (30/100) of these cases had a positive PCR. One hundred ten patients (110/172) attended the third visit. The analysis showed that while the sensitivity of the histopathological test was very low (35%), a qPCR alone was more effective for identifying leprosy, with 57% sensitivity. CONCLUSION The use of qPCR in suspected PB cases with an inconclusive histology improved the sensitivity of leprosy diagnoses.
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Affiliation(s)
- Raquel R. Barbieri
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Fernanda S. N. Manta
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Suelen J. M. Moreira
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna M. Sales
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José A. C. Nery
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mariana A. Hacker
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antônio G. Pacheco
- PROCC—Programa de Computação Científica—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alice M. Machado
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Euzenir M. Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milton O. Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute—Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
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