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Fogaça MBT, Crispim GJB, Saavedra DP, Lopes-Luz L, da Silva LA, de Camargo BR, Guimarães RA, Nagata T, Ribeiro BM, Bührer-Sékula S. An indirect ELISA for detecting anti-SARS-CoV-2 antibodies in human sera using a baculovirus-expressed recombinant nucleocapsid antigen. Biologicals 2024; 86:101769. [PMID: 38759304 DOI: 10.1016/j.biologicals.2024.101769] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/20/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
This study focuses on the development and initial assessment of an indirect IgG enzyme-linked immunosorbent assay (ELISA) specifically designed to detect of anti-SARS-CoV-2 antibodies. The unique aspect of this ELISA method lies in its utilization of a recombinant nucleocapsid (N) antigen, produced through baculovirus expression in insect cells. Our analysis involved 292 RT-qPCR confirmed positive serum samples and 54 pre-pandemic healthy controls. The process encompassed cloning, expression, and purification of the SARS-CoV-2 N gene in insect cells, with the resulted purified protein employed in our ELISA tests. Statistical analysis yielded an Area Under the Curve of 0.979, and the optimized cut-off exhibited 92 % sensitivity and 94 % specificity. These results highlight the ELISA's potential for robust and reliable serological detection of SARS-CoV-2 antibodies. Further assessments, including a larger panel size, reproducibility tests, and application in diverse populations, could enhance its utility as a valuable biotechnological solution for diseases surveillance.
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Affiliation(s)
- Matheus Bernardes Torres Fogaça
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | | | - Djairo Pastor Saavedra
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Leonardo Assis da Silva
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Brenda Rabello de Camargo
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Rafael Alves Guimarães
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil.
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Penna GO, Pontes MADA, Talhari S, Gonçalves HDS, Cortez CCT, Pessoa ADS, Pedroza V, Bührer-Sékula S, Stefani MMDA, Penna MLF. Late relapses in leprosy patients in Brazil: 10-year post-trial of uniform multidrug therapy (U-MDT/CT-BR). Braz J Infect Dis 2024; 28:103745. [PMID: 38697216 PMCID: PMC11078633 DOI: 10.1016/j.bjid.2024.103745] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Leprosy is a neglected dermato-neurologic, infectious disease caused by Mycobacterium leprae or M. lepromatosis. Leprosy is treatable and curable by multidrug therapy/MDT, consisting of 12 months rifampicin, dapsone and clofazimine for multibacillary/MB patients and for 6 months for paucibacillary/PB patients. The relapse rate is considered a crucial treatment outcome. A randomized Controlled Trial (U-MDT/CT-BR) conducted from 2007‒2012 compared clinical outcomes in MB patients after 12 months regular MDT/R-MDT and 6 months uniform MDT/U-MDT in two highly endemic Brazilian areas. OBJECTIVES To estimate the 10 years relapse rate of MB patients treated with 6 months U-MDT. METHODS The statistical analyses treated the data as a case-control study, sampled from the cohort generated for the randomized trial. Analyses estimated univariate odds ratio and applied logistic regression for multivariate analysis, controlling the confounding variables. RESULTS The overall relapse rate was 4.08 %: 4.95 % (16 out of 323) in the U-MDT group and 3.10 % (9 out of 290) in the regular/R-MDT group. The difference in relapse proportion between U-MDT and R-MDT groups was 1.85 %, not statistically significant (Odds Ratio = 1.63, 95 % CI 0.71 to 3.74). However, misdiagnosis of relapses, may have introduced bias, underestimating the force of the association represented by the odds ratio. CONCLUSIONS The relapse estimate of 10 years follow-up study of the first randomized, controlled study on U-MDT/CT-BR was similar to the R-MDT group supporting strong evidence that 6 months U-MDT for MB patients is an acceptable option to be adopted by leprosy endemic countries worldwide. TRIAL REGISTRATION ClinicalTrials.gov: NCT00669643.
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Affiliation(s)
- Gerson Oliveira Penna
- Universidade de Brasília, Núcleo de Medicina Tropical, Brasília, DF, Brazil; Fundação Oswaldo Cruz, Escola de Governo Fiocruz Brasília, Brasília, DF, Brazil.
| | | | - Sinésio Talhari
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | | | | | - Allen de Souza Pessoa
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Ciências Aplicadas à Dermatologia, Manaus, AM, Brazil
| | - Valderiza Pedroza
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | - Samira Bührer-Sékula
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brazil
| | | | - Maria Lucia Fernandes Penna
- Universidade Federal Fluminense, Departamento de Epidemiologia e Bioestatística, Rio de Janeiro, RJ, Brazil.
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Moreira NS, Baldo TA, Duarte LC, Lopes-Luz L, Oliveira KA, Estrela PFN, Simões AM, Bührer-Sékula S, Duarte GRM, Coltro WKT. Direct immunoassay on a polyester microwell plate for colorimetric detection of the spike protein in swab and saliva samples. Anal Methods 2023; 16:74-82. [PMID: 38073521 DOI: 10.1039/d3ay01755a] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
This study presents the development of a polyester microplate for detecting the S-protein of the SARS-CoV-2 virus in saliva and nasopharyngeal swab samples using direct enzyme-linked immunosorbent assay (ELISA) technology. The polyester microplate was designed to contain 96 zones with a 3 mm diameter each, and a volume of 2-3 μL. The experimental conditions including reagent concentration and reaction time were optimized. The microplate image was digitized and analyzed using graphical software. The linear range obtained between protein S concentrations and pixel intensity was 0-10 μg mL-1, with a correlation coefficient of 0.99 and a limit of detection of 0.44 μg mL-1. The developed methodology showed satisfactory intraplate and interplate repeatability with RSD values lower than 7.8%. The results achieved through immunoassay performed on polyester microplates were consistent with those of the RT-PCR method and showed a sensitivity of 100% and 90% and specificity of 85.71% and 100% for saliva and nasopharyngeal samples, respectively. The proposed direct immunoassay on polyester microplates emerges as an alternative to conventional immunoassays performed on commercial polystyrene plates, given the low cost of the device, low consumption of samples and reagents, lower waste generation, and shorter analysis time. Moreover, the immunoassay has shown great potential for diagnosing COVID-19 with precision and accuracy.
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Affiliation(s)
- Nikaele S Moreira
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Thaisa A Baldo
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Lucas C Duarte
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia de Goiás - Campus Inhumas, 75402-556, Inhumas, GO, Brazil
| | - Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Centro Multiusuário de Bioinsumos e Tecnologias em Saúde, Universidade Federal de Goiás, 74605-050, Goiânia, GO, Brazil
- Innovation Hub in Point-of-Care Technologies, 74690-900, Goiânia, GO, Brazil
| | - Karoliny A Oliveira
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Paulo F N Estrela
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Amanda M Simões
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Centro Multiusuário de Bioinsumos e Tecnologias em Saúde, Universidade Federal de Goiás, 74605-050, Goiânia, GO, Brazil
- Innovation Hub in Point-of-Care Technologies, 74690-900, Goiânia, GO, Brazil
| | - Gabriela R M Duarte
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
- Innovation Hub in Point-of-Care Technologies, 74690-900, Goiânia, GO, Brazil
| | - Wendell K T Coltro
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
- Innovation Hub in Point-of-Care Technologies, 74690-900, Goiânia, GO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Bioanalítica, 13084-971, Campinas, SP, Brazil
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Lopes-Luz L, Fogaça MBT, Bentivoglio-Silva BG, Saavedra DP, Alves LM, Franca LV, Crispim GJB, de Andrade IA, Ribeiro BM, Nagata T, Bührer-Sékula S. A novel highly specific biotinylated MAC-ELISA for detection of anti-SARS-CoV-2 nucleocapsid antigen IgM antibodies during the acute phase of COVID-19. Braz J Microbiol 2023; 54:2893-2901. [PMID: 37930615 PMCID: PMC10689632 DOI: 10.1007/s42770-023-01160-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
The gold standard for diagnosing COVID-19 in the acute phase is RT-qPCR. However, this molecular technique can yield false-negative results when nasopharyngeal swab collection is not conducted during viremia. To mitigate this challenge, the enzyme-linked immunosorbent assay (ELISA) identifies anti-SARS-CoV-2 IgM antibodies in the initial weeks after symptom onset, facilitating early COVID-19 diagnosis. This study introduces a novel and highly specific IgM antibody capture ELISA (MAC-ELISA), which utilizes biotinylated recombinant SARS-CoV-2 nucleocapsid (N) antigen produced in plants. Our biotinylated approach streamlines the procedure by eliminating the requirement for an anti-N-conjugated antibody, circumventing the need for peroxidase-labeled antigens, and preventing cross-reactivity with IgM autoantibodies such as rheumatoid factor. Performance evaluation of the assay involved assessing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy using 682 RT-qPCR-positive samples, categorized by weeks relative to symptoms onset. Negative controls included 205 pre-pandemic serum samples and 46 serum samples from patients diagnosed with other diseases. Based on a cut-off of 0.087 and ROC curve analysis, the highest sensitivity of 81.2% was observed in the 8-14 days post-symptom (dps) group (2nd week), followed by sensitivities of 73.8% and 68.37% for the 1-7 dps (1st week) and 15-21 dps groups (3rd week), respectively. Specificity was consistently 100% across all groups. This newly developed biotinylated N-MAC-ELISA offers a more streamlined and cost-effective alternative to molecular diagnostics. It enables simultaneous testing of multiple samples and effectively identifies individuals with false-negative results.
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Affiliation(s)
- Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A Alliance, Goiânia, GO, 74605-050, Brazil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A Alliance, Goiânia, GO, 74605-050, Brazil
| | | | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A Alliance, Goiânia, GO, 74605-050, Brazil
| | - Luana Michele Alves
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A Alliance, Goiânia, GO, 74605-050, Brazil
| | - Luísa Valério Franca
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | | | - Ikaro Alves de Andrade
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Centro Multiusuário de Pesquisa de Bioinsumos e Tecnologias em Saúde, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil.
- Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A Alliance, Goiânia, GO, 74605-050, Brazil.
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Lopes-Luz L, Saavedra DP, Fogaça MBT, Bührer-Sékula S, Stefani MMDA. Challenges and advances in serological and molecular tests to aid leprosy diagnosis. Exp Biol Med (Maywood) 2023; 248:2083-2094. [PMID: 38059475 PMCID: PMC10800132 DOI: 10.1177/15353702231209422] [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] [Indexed: 12/08/2023] Open
Abstract
Leprosy is a neglected chronic infectious disease caused by obligate intracellular bacilli, Mycobacterium leprae and Mycobacterium lepromatosis. Despite multidrug therapy (MDT) success, leprosy accounts for more than 200,000 new cases yearly. Leprosy diagnosis remains based on the dermato-neurologic examination, but histopathology of skin biopsy and bacilloscopy of intradermal scraping are subsidiary diagnostic tests that require expertise and laboratory infrastructure. This minireview summarizes the state of the art of serologic tests to aid leprosy diagnosis, highlighting enzyme-linked immunosorbent assay (ELISA) and point-of-care tests (POCT) biotechnologies. Also, the impact of the postgenomic era on the description of new recombinantly expressed M. leprae-specific protein antigens, such as leprosy Infectious Disease Research Institute (IDRI) diagnostic (LID)-1 is summarized. Highly specific and sensitive molecular techniques to detect M. leprae DNA as the quantitative polymerase chain reaction (qPCR) and the loop-mediated isothermal amplification (LAMP) are briefly reviewed. Serology studies using phenolic glycolipid-I (PGL-I) semi-synthetic antigens, LID-1 fusion antigen, and the single fusion complex natural disaccharide-octyl (NDO)-LID show high sensitivity in multibacillary (MB) patients. However, serology is not applicable to paucibacillary patients, as they have weak humoral response and robust cell-mediated response, requiring tests for cellular biomarkers. Unlike ELISA-based tests, leprosy-specific POCT based on semi-synthetic PGL-I antigens and NDO-LID 1 antigen is easy to perform, cheaper, equipment-free, and can contribute to early diagnosis avoiding permanent incapacities and helping to interrupt M. leprae transmission. Besides its use to help diagnosis of household contacts or at-risk populations in endemic areas, potential applications of leprosy serology include monitoring MDT efficacy, identification of recent infection, especially in young children, as surrogate markers of disease progression to orient adult chemoprophylaxis and as a predictor of type 2 leprosy reactions. Advances in molecular biology techniques have reduced the complexity and execution time of qPCR confirming its utility to help diagnosis while leprosy-specific LAMP holds promise as an adjunct test to detect M. leprae DNA.
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Affiliation(s)
- Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
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de Andrade Rodrigues RS, Heise EFJ, Hartmann LF, Rocha GE, Olandoski M, de Araújo Stefani MM, Latini ACP, Soares CT, Belone A, Rosa PS, de Andrade Pontes MA, de Sá Gonçalves H, Cruz R, Penna MLF, Carvalho DR, Fava VM, Bührer-Sékula S, Penna GO, Moro CMC, Nievola JC, Mira MT. Prediction of the occurrence of leprosy reactions based on Bayesian networks. Front Med (Lausanne) 2023; 10:1233220. [PMID: 37564037 PMCID: PMC10411956 DOI: 10.3389/fmed.2023.1233220] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Leprosy reactions (LR) are severe episodes of intense activation of the host inflammatory response of uncertain etiology, today the leading cause of permanent nerve damage in leprosy patients. Several genetic and non-genetic risk factors for LR have been described; however, there are limited attempts to combine this information to estimate the risk of a leprosy patient developing LR. Here we present an artificial intelligence (AI)-based system that can assess LR risk using clinical, demographic, and genetic data. Methods The study includes four datasets from different regions of Brazil, totalizing 1,450 leprosy patients followed prospectively for at least 2 years to assess the occurrence of LR. Data mining using WEKA software was performed following a two-step protocol to select the variables included in the AI system, based on Bayesian Networks, and developed using the NETICA software. Results Analysis of the complete database resulted in a system able to estimate LR risk with 82.7% accuracy, 79.3% sensitivity, and 86.2% specificity. When using only databases for which host genetic information associated with LR was included, the performance increased to 87.7% accuracy, 85.7% sensitivity, and 89.4% specificity. Conclusion We produced an easy-to-use, online, free-access system that identifies leprosy patients at risk of developing LR. Risk assessment of LR for individual patients may detect candidates for close monitoring, with a potentially positive impact on the prevention of permanent disabilities, the quality of life of the patients, and upon leprosy control programs.
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Affiliation(s)
- Rafael Saraiva de Andrade Rodrigues
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | - Eduardo Ferreira José Heise
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | | | | | - Marcia Olandoski
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
| | | | | | | | - Andrea Belone
- Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil
| | | | | | | | - Rossilene Cruz
- Tropical Dermatology and Venerology Alfredo da Matta Foundation, Amazonas, Brazil
| | | | | | - Vinicius Medeiros Fava
- Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, and The McGill International TB Centre, Departments of Human Genetics and Medicine, McGill University, Montreal, QC, Canada
| | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Brazil
| | - Gerson Oliveira Penna
- Tropical Medicine Centre, University of Brasília, and Fiocruz School of Government – Brasilia, Brasília, Brazil
| | | | | | - Marcelo Távora Mira
- School of Medicine and Life Sciences, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná – PUCPR, Curitiba, Paraná, Brazil
- Pharmacy Program, School of Health and Biosciences, PUCPR, Curitiba, Paraná, Brazil
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de Andrade IA, Franca LV, Kauffmann CM, Maeda MHK, Koyama LHH, Hamann PRV, Lopes-Luz L, Fogaça MBT, de Camargo BR, Ribeiro BM, Bührer-Sékula S, Nagata T. Practical use of tobravirus-based vector to produce SARS-CoV-2 antigens in plants. J Virol Methods 2023; 315:114710. [PMID: 36914098 PMCID: PMC10008036 DOI: 10.1016/j.jviromet.2023.114710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/14/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023]
Abstract
A plant-based heterologous expression system is an attractive option for recombinant protein production because it is based on a eukaryotic system of high feasibility, and low biological risks. Frequently, binary vector systems are used for transient gene-expression in plants. However, plant virus vector-based systems offer advantages for higher protein yields due to their self-replicating machinery. In the present study, we show an efficient protocol using a plant virus vector based on a tobravirus, pepper ringspot virus, that was employed for transient expression of severe acute respiratory syndrome coronavirus 2 partial gene fragments of the spike (named S1-N) and the nucleocapsid (named N) proteins in Nicotiana benthamiana plants. Purified proteins yield of 40~60µg/g of fresh leaves were obtained. Both proteins, S1-N and N, showed high and specific reactivities against convalescent patients' sera by the enzyme-linked immunosorbent assay format. The advantages and critical points in using this plant virus vector are discussed. DATA AVAILABILITY: All data generated and analyzed during this study are included in this published article and supporting materials.
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Affiliation(s)
- Ikaro Alves de Andrade
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil; Pós-graduação em Biologia Microbiana, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Luísa Valério Franca
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Caterynne Melo Kauffmann
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil; Pós-graduação em Fitopatologia, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Matheus Hideki Kihara Maeda
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Lucas Hideo Hataka Koyama
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Pedro Ricardo Vieira Hamann
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74690-900, Brazil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74690-900, Brazil
| | - Brenda Rabello de Camargo
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74690-900, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, 70910-900, Brazil; Pós-graduação em Biologia Microbiana, Universidade de Brasília, Brasília, DF, 70910-900, Brazil; Pós-graduação em Fitopatologia, Universidade de Brasília, Brasília, DF, 70910-900, Brazil.
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8
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Lopes-Luz L, Silva-Filho E, Mendonça M, Moreira ÂN, Venceslau A, de Sousa DR, Sánchez TG, de Moura RS, Conceição FR, Kipnis A, Stefani MMDA, Bührer-Sékula S. Combined antibodies against internalins A and B proteins have potential application in immunoassay for detection of Listeria monocytogenes. J Food Sci Technol 2023; 60:123-131. [PMID: 36618043 PMCID: PMC9813296 DOI: 10.1007/s13197-022-05597-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022]
Abstract
Listeria monocytogenes is a food-borne bacterium that causes listeriosis upon the ingestion of contaminated food. Traditional methods to detect L. monocytogenes require pre-enrichment broths to increase its concentration. To improve the screening of contaminated food and prevent listeriosis outbreaks, rapid, specific and sensitive assays are needed to detect L. monocytogenes. This study developed a prototype lateral flow immunochromatographic assay (LFIA) employing antibodies against L. monocytogenes Internalin A (InlA) and Internalin B (InlB) proteins, that are involved in non-phagocytic cell invasion. The following antibodies were used to capture L. monocytogenes antigenic targets: mouse anti-Internalin A monoclonal antibody (MAb-2D12) conjugated to colloidal gold nanoparticles and a mouse anti-Internalin B polyclonal antibody. This test was able to detect pure L. monocytogenes from culture with a limit of detection (LOD) ranging from 5.9 × 103 to 1.5 × 104 CFU/mL. In milk artificially contaminated with L. monocytogenes, the LOD was 1 × 105 CFU/mL. This prototype test discriminated L. monocytogenes from other bacterial species (Listeria innocua, Enterobacter cloacae, Bacillus cereus). Results indicate that this LFIA developed using antibodies against L. monocytogenes InlA and InlB proteins is a sensitive and specific tool that can be potentially useful to rapidly detect L. monocytogenes in contaminated food. Supplementary Information The online version contains supplementary material available at 10.1007/s13197-022-05597-9.
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Affiliation(s)
- Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Ernandes Silva-Filho
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Marcelo Mendonça
- Universidade Federal Do Agreste Pernambuco, Curso de Medicina Veterinária, Garanhuns, Pernambuco 55292-270 Brasil
| | - Ângela Nunes Moreira
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia Aplicada, Universidade Federal de Pelotas, Pelotas, RS 96010-610 Brasil
| | - Andressa Venceslau
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Dienny Rodrigues de Sousa
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | - Tatiana Galvez Sánchez
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | | | - Fabricio Rochedo Conceição
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Laboratório de Imunologia Aplicada, Universidade Federal de Pelotas, Pelotas, RS 96010-610 Brasil
| | - André Kipnis
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
| | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO 74605-050 Brasil
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9
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Kendall C, Kerr LRFS, Miranda JGV, Rubin de Pinho ST, Silva Andrade RF, Rodrigues LC, Frota CC, Mota RMS, Freitas de Almeida RL, Moreira FB, Gomes RBC, Alves de Almeida N, França L, Pontes MADA, Gonçalves H, Penna GO, Bührer-Sékula S, Klovdahl A, Barreto ML. A social network approach for the study of leprosy transmission beyond the household. Trans R Soc Trop Med Hyg 2021; 116:100-107. [PMID: 34015825 DOI: 10.1093/trstmh/trab071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2020] [Revised: 02/18/2021] [Accepted: 05/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycobacterium leprae was the first microorganism directly associated with a disease, however, there are still important gaps in our understanding of transmission. Although household contacts are prioritized, there is evidence of the importance of extrahousehold contacts. The goal of this article is to contribute to our understanding of the transmission of leprosy ex-household. METHODS We compare co-location data of 397 leprosy cases and 211 controls drawn from the Centro de Dermatologia Sanitária D. Libânia in Fortaleza, Brazil. We collected lifetime geolocation data related to residence, school attendance and workplace and developed novel methods to establish a critical distance (Rc) for exposure and evaluated the potential for transmission for residence, school and workplace. RESULTS Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an Rc of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases. CONCLUSIONS Our novel network approach offers a promising opportunity to explore leprosy transmission. Our networks confirm the importance of coresidence, provide a boundary and suggest a role for transmission in workplaces. Schools, on the other hand, do not demonstrate a clustering of cases. Our findings may have programmatic relevance.
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Affiliation(s)
- Carl Kendall
- Tulane School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, R: Prof. Costa Mendes, 1608 - 5o. andar - Rodolfo Teófilo - CEP: 60.430-971 - Fortaleza - CE - Brazil
| | - Ligia Regina Franco Sansigolo Kerr
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, R: Prof. Costa Mendes, 1608 - 5o. andar - Rodolfo Teófilo - CEP: 60.430-971 - Fortaleza - CE - Brazil
| | | | | | | | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, UK
| | - Cristiane Cunha Frota
- Universidade Federal do Ceará, Departamento de Patologia e Medicine Legal, Fortaleza, CE, Brazil
| | - Rosa Maria Salani Mota
- Universidade Federal do Ceará, Departamento de Estatística e Matemática Aplicada, Fortaleza, CE, Brazil
| | | | | | | | - Naíla Alves de Almeida
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Lucas França
- University College London, Institute of Neurology, London, UK
| | | | | | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Alden Klovdahl
- School of Public Health, University of Texas, Houston, TX, USA
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10
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Lopes-Luz L, Mendonça M, Bernardes Fogaça M, Kipnis A, Bhunia AK, Bührer-Sékula S. Listeria monocytogenes: review of pathogenesis and virulence determinants-targeted immunological assays. Crit Rev Microbiol 2021; 47:647-666. [PMID: 33896354 DOI: 10.1080/1040841x.2021.1911930] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/17/2022]
Abstract
Listeria monocytogenes is one of the most invasive foodborne pathogens and is responsible for numerous outbreaks worldwide. Most of the methods to detect this bacterium in food require selective enrichment using traditional bacterial culture techniques that can be time-consuming and labour-intensive. Moreover, molecular methods are expensive and need specific technical knowledge. In contrast, immunological approaches are faster, simpler, and user-friendly alternatives and have been developed for the detection of L. monocytogenes in food, environmental, and clinical samples. These techniques are dependent on the constitutive expression of L. monocytogenes antigens and the specificity of the antibodies used. Here, updated knowledge on pathogenesis and the key immunogenic virulence determinants of L. monocytogenes that are used for the generation of monoclonal and polyclonal antibodies for the serological assay development are summarised. In addition, immunological approaches based on enzyme-linked immunosorbent assay, immunofluorescence, lateral flow immunochromatographic assays, and immunosensors with relevant improvements are highlighted. Though the sensitivity and specificity of the assays were improved significantly, methods still face many challenges that require further validation before use.
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Affiliation(s)
- Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil
| | - Marcelo Mendonça
- Curso de Medicina Veterinária, Universidade Federal do Agreste de Pernambuco, Garanhuns, Brasil
| | | | - André Kipnis
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil
| | - Arun K Bhunia
- Department of Food Science, Purdue University, West Lafayette, IN, USA.,Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA.,Purdue Institute of Inflammation, Immunology and Infectious Disease, Purdue University, West Lafayette, IN, USA
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil
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11
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Uaska Sartori PV, Penna GO, Bührer-Sékula S, Pontes MAA, Gonçalves HS, Cruz R, Virmond MCL, Dias-Baptista IMF, Rosa PS, Penna MLF, Medeiros Fava V, Stefani MMA, Távora Mira M. Human Genetic Susceptibility of Leprosy Recurrence. Sci Rep 2020; 10:1284. [PMID: 31992776 PMCID: PMC6987179 DOI: 10.1038/s41598-020-58079-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/30/2019] [Indexed: 12/30/2022] Open
Abstract
Host genetic susceptibility to leprosy has been intensively investigated over the last decades; however, there are no studies on the role of genetic variants in disease recurrence. A previous initiative identified three recurrent cases of leprosy for which none of the M. leprae strains, as obtained in the first and the second diagnosis, had any known genomic variants associated to resistance to Multidrug therapy; in addition, whole genome sequencing indicated that the same M. leprae was causing two out of the three recurrences. Thus, these individuals were suspected of being particularly susceptible to M. leprae infection, either as relapse or reinfection. To verify this hypothesis, 19 genetic markers distributed across 11 loci (14 genes) classically associated with leprosy were genotyped in the recurrent and in three matching non-recurrent leprosy cases. An enrichment of risk alleles was observed in the recurrent cases, suggesting the existence of a particularly high susceptibility genetic profile among leprosy patients predisposing to disease recurrence.
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Affiliation(s)
- Priscila Verchai Uaska Sartori
- Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155 - Prado Velho, Curitiba, Paraná, Brazil
| | - Gerson O Penna
- Tropical Medicine Centre, University of Brasília, UnB - Brasília, DF, Brazil
- Campus Universitário Darcy Ribeiro, S/N, Asa Norte, Brasília - DF, CEP, 70.904.970, Brasil
- Escola Fiocruz de Governo, Fiocruz Brasília, Avenida L3 Norte, s/n, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Brazil
| | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Rua 235 - s/n - Setor Universitário - Goiania, Goiania, Goiás, Brazil
| | - Maria A A Pontes
- Dona Libânia Dermatology Centre, R. Pedro I, 1033 - Centro, Fortaleza, Ceará, Brazil
| | - Heitor S Gonçalves
- Dona Libânia Dermatology Centre, R. Pedro I, 1033 - Centro, Fortaleza, Ceará, Brazil
| | - Rossilene Cruz
- Tropical Dermatology and Venerology, Fundação Alfredo da Matta, Av. Codajás, 24 - Cachoeirinha, Manaus, Amazonas, Brazil
| | - Marcos C L Virmond
- Lauro Souza Lima Institute, Rodovia Comandante João Ribeiro de Barros, km 225/226, s/n - Distrito Industrial Marcus Vinícius Feliz Machado, Bauru, São Paulo, Brazil
| | - Ida M F Dias-Baptista
- Lauro Souza Lima Institute, Rodovia Comandante João Ribeiro de Barros, km 225/226, s/n - Distrito Industrial Marcus Vinícius Feliz Machado, Bauru, São Paulo, Brazil
| | - Patricia S Rosa
- Lauro Souza Lima Institute, Rodovia Comandante João Ribeiro de Barros, km 225/226, s/n - Distrito Industrial Marcus Vinícius Feliz Machado, Bauru, São Paulo, Brazil
| | - Maria L F Penna
- Epidemiology and Biostatistics Department, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Centro, Niterói, Rio de Janeiro, Brazil
| | - Vinicius Medeiros Fava
- Infectious Diseases and Immunity in Global Health (IDIGH) Program at the Research Institute of the McGill University Health Centre (RI-MUHC), 1001 Boulevard Décarie, Bioinformatics suite ES1.5561, H4A 3J1., Montreal, Quebec, Canada
| | - Mariane M A Stefani
- Escola Fiocruz de Governo, Fiocruz Brasília, Avenida L3 Norte, s/n, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Brazil.
| | - Marcelo Távora Mira
- Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155 - Prado Velho, Curitiba, Paraná, Brazil.
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12
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Santos JHA, Bührer-Sékula S, Melo GC, Cordeiro-Santos M, Pimentel JPD, Gomes-Silva A, Costa AG, Saraceni V, Da-Cruz AM, Lacerda MVG. Ascaris lumbricoides coinfection reduces tissue damage by decreasing IL-6 levels without altering clinical evolution of pulmonary tuberculosis or Th1/Th2/Th17 cytokine profile. Rev Soc Bras Med Trop 2019; 52:e20190315. [PMID: 31800922 DOI: 10.1590/0037-8682-0315-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Immunological control of Mycobacterium tuberculosis infection is dependent on the cellular immune response, mediated predominantly by Th1 type CD4+ T cells. Polarization of the immune response to Th2 can inhibit the host immune protection against pathogens. Patients with tuberculosis coinfected with helminths demonstrate more severe pulmonary symptoms, a deficiency in the immune response against tuberculosis, and an impaired response to anti-tuberculosis therapy. METHODS We evaluated the cellular immune response and the impact of the presence of Ascaris lumbricoides on the immune and clinical response in pulmonary tuberculosis patients. Ninety-one individuals were included in the study: 38 tuberculosis patients, 11 tuberculosis patients coinfected with Ascaris lumbricoides and other helminths, 10 Ascaris lumbricoides patients, and 34 non-infected control individuals. Clinical evolution of pulmonary tuberculosis was studied on 0, 30, 60, and 90 days post-diagnosis of Mycobacterium tuberculosis and Ascaris lumbricoides. Furthermore, immune cells and plasma cytokine profiles were examined in mono/coinfection by Mycobacterium tuberculosis and Ascaris lumbricoides using flow cytometry. RESULTS There were no statistical differences in any of the evaluated parameters and the results indicated that Ascaris lumbricoides infection does not lead to significant clinical repercussions in the presentation and evolution of pulmonary tuberculosis. CONCLUSIONS The association with Ascaris lumbricoides did not influence the Th1, Th2, and Th17 type responses, or the proportions of T lymphocyte subpopulations. However, higher serum levels of IL-6 in tuberculosis patients may explain the pulmonary parenchymal damage.
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Affiliation(s)
- João Hugo Abdalla Santos
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil
| | - Samira Bührer-Sékula
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Gisely Cardoso Melo
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil
| | - Marcelo Cordeiro-Santos
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil
| | - João Paulo Diniz Pimentel
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Diretora de Ensino e Pesquisa, Manaus, AM, Brasil
| | - Adriano Gomes-Silva
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brasil
| | - Allyson Guimarães Costa
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Diretora de Ensino e Pesquisa, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Manaus, AM, Brasil
| | - Valeria Saraceni
- Prefeitura da Cidade do Rio de Janeiro, Secretaria Municipal de Saúde, Rio de Janeiro, RJ, Brasil
| | - Alda Maria Da-Cruz
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Guimarães Lacerda
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Fundação Oswaldo Cruz, Instituto de Pesquisas Leônidas & Maria Deane, Manaus, AM, Brasil
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13
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Cruz RC, Bührer-Sékula S, Penna MLF, Penna GDO, Talhari S. Reply of the authors of the Continuing Medical Education article to Dr. Jaison Barreto and Dr. Laila Laguiche. An Bras Dermatol 2018; 93:625-626. [PMID: 30066790 PMCID: PMC6063105 DOI: 10.1590/abd1806-4841.201893404] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Samira Bührer-Sékula
- Post-Graduation Program in Tropical Medicine, Instituto de
Patologia Tropical e Saúde Pública, Universidade Federal de
Goiás, Goiânia (GO), Brazil
| | - Maria Lúcia F. Penna
- Department of Epidemiology and Statistics, Universidade Federal
Fluminense– Niterói (RJ), Brazil
| | - Gerson de Oliveira Penna
- Tropical Medicine Center, Universidade de Brasília,
Brasília (DF), Brazil
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz,
Brasília (DF), Brazil
| | - Sinésio Talhari
- Discipline of Dermatology, Universidade Nilton Lins, Manaus (AM),
Brazil
- Post-Graduation Program of the Fundação de Medicina
Tropical and Universidade do Estado do Amazonas, Manaus (AM), Brazil
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14
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Cruz RCDS, Bührer-Sékula S, Penna GO, de Moraes MEA, Gonçalves HDS, Stefani MMDA, Penna MLF, Pontes MADA, Talhari S. Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach. An Bras Dermatol 2018; 93:377-384. [PMID: 29924240 PMCID: PMC6001105 DOI: 10.1590/abd1806-4841.20186709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). PATIENTS AND METHODS After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS Loss of some monthly laboratory sample collection. CONCLUSIONS There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.
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Affiliation(s)
- Rossilene Conceição da Silva Cruz
- Fundação de Dermatologia Tropical e Venereologia
“Alfredo da Matta” (FUAM), Manaus (AM), Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
| | - Samira Bührer-Sékula
- Program of Post-graduation in Tropical Medicine, Instituto de
Patologia Tropical e Saúde Pública da Universidade Federal de
Goiás (UFG), Goiânia (GO), Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
| | - Gerson Oliveira Penna
- Center of Tropical Medicine, Universidade de Brasília (UnB),
Brasília (DF), Brazil
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz
(EFG-Fiocruz), Brasília (DF), Brazil
| | - Maria Elisabete Amaral de Moraes
- Unit of Clinical Pharmacology, Universidade Federal do Ceará
(UNIFAC- UFC), Fortaleza (CE), Brazil
- Program of Post-graduation in Pharmacology, Department of
Physiology and Pharmacology, Faculdade de Medicina, da Universidade Federal do
Ceará (UFC), Fortaleza (CE), Brazil
| | | | - Mariane Martins de Araújo Stefani
- Discipline of Immunology, Instituto de Patologia Tropical e
Saúde Pública, Universidade Federal de Goiás (UFG),
Goiânia (GO), Brazil
| | | | | | - Sinésio Talhari
- Discipline of Dermatology, Universidade Nilton Linsm, Manaus (AM),
Brazil
- Program of Post-graduation, Fundação de Medicina
Tropical e Universidade do Estado do Amazonas (UEA/FMT-HVD), Manaus (AM), Brazil
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15
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Hungria EM, Bührer-Sékula S, Oliveira RM, Aderaldo LC, Pontes MAA, Cruz R, de Gonçalves HS, Penna MLF, Penna GO, Stefani MMA. Mycobacterium leprae-Specific Antibodies in Multibacillary Leprosy Patients Decrease During and After Treatment With Either the Regular 12 Doses Multidrug Therapy (MDT) or the Uniform 6 Doses MDT. Front Immunol 2018; 9:915. [PMID: 29867930 PMCID: PMC5960669 DOI: 10.3389/fimmu.2018.00915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/12/2018] [Indexed: 12/15/2022] Open
Abstract
Leprosy serology reflects the bacillary load of patients and multidrug therapy (MDT) reduces Mycobacterium leprae-specific antibody titers of multibacillary (MB) patients. The Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil (U-MDT/CT-BR) compared outcomes of regular 12 doses MDT/R-MDT and the uniform 6 doses MDT/U-MDT for MB leprosy, both of regimens including rifampicin, clofazimine, and dapsone. This study investigated the impact of R-MDT and U-MDT and the kinetic of antibody responses to M. leprae-specific antigens in MB patients from the U-MDT/CT-BR. We tested 3,400 serum samples from 263 MB patients (R-MDT:121; U-MDT:142) recruited at two Brazilian reference centers (Dona Libânia, Fortaleza, Ceará; Alfredo da Matta Foundation, Manaus, Amazonas). Enzyme-linked immunosorbent assays with three M. leprae antigens [NT-P-BSA: trisaccharide-phenyl of phenollic glycolipid-I antigen (PGL-I); LID-1: Leprosy Infectious Disease Research Institute Diagnostic 1 di-fusion recombinant protein; and ND-O-LID: fusion complex of disaccharide-octyl of PGL-I and LID-1] were performed using around 13 samples per patient. Samples were collected at baseline/M0, during MDT (R-MDT:M1–M12 months, U-MDT:M1–M6 months) and after MDT discontinuation (first, second year). Statistical significance was assessed by the Mann–Whitney U test for comparison between groups (p values < 0.05). Mixed effect multilevel regression analyses were used to investigate intraindividual serological changes overtime. In R-MDT and U-MDT groups, males predominated, median age was 41 and 40.5 years, most patients were borderline lepromatous and lepromatous leprosy (R-MDT:88%, U-MDT: 90%). The bacilloscopic index at diagnosis was similar (medians: 3.6 in the R-MDT and 3.8 in the U-MDT group). In R-MDT and U-MDT groups, a significant decline in anti-PGL-I positivity was observed from M0 to M5 (p = 0.035, p = 0.04, respectively), from M6 to M12 and at the first and second year posttreatment (p < 0.05). Anti-LID-1 antibodies declined from M0 to M6 (p = 0.024), M7 to M12 in the R-MDT; from M0 to M4 (p = 0.003), M5 to M12 in the U-MDT and posttreatment in both groups (p > 0.0001). Anti-ND-O-LID antibodies decreased during and after treatment in both groups, similarly to anti-PGL-I antibodies. Intraindividual serology results in R-MDT and U-MDT patients showed that the difference in serology decay to all three antigens was dependent upon time only. Our serology findings in MB leprosy show that regardless of the duration of the U-MDT and R-MDT, both of them reduce M. leprae-specific antibodies during and after treatment. In leprosy, antibody levels are considered a surrogate marker of the bacillary load; therefore, our serological results suggest that shorter U-MDT is also effective in reducing the patients’ bacillary burden similarly to R-MDT.
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Affiliation(s)
- Emerith M Hungria
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Regiane M Oliveira
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
| | | | - Maria L F Penna
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, e FIOCRUZ Brasília, Brasília, Brazil
| | - Mariane M A Stefani
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
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Cruz RCDS, Bührer-Sékula S, Penna MLF, Penna GO, Talhari S. Leprosy: current situation, clinical and laboratory aspects, treatment history and perspective of the uniform multidrug therapy for all patients. An Bras Dermatol 2017; 92:761-773. [PMID: 29364430 PMCID: PMC5786388 DOI: 10.1590/abd1806-4841.20176724] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/23/2017] [Indexed: 11/25/2022] Open
Abstract
In this review, the most relevant and current epidemiological data, the main clinical, laboratory and therapeutical aspects of leprosy are presented. Detailed discussion of the main drugs used for leprosy treatment, their most relevant adverse effects, evolution of the therapeutic regimen, from dapsone as a monotherapy to the proposed polychemotherapy by World Health Organization (WHO) can be found in this CME. We specifically highlight the drug acceptability, reduction in treatment duration and the most recent proposal of a single therapeutic regimen, with a fixed six months duration, for all clinical presentations, regardless of their classification.
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Affiliation(s)
| | - Samira Bührer-Sékula
- Post-Graduation Program in Tropical Medicine, Instituto de Patologia
Tropical e Saúde Pública, Universidade Federal de Goiás (UFG) -
Goiânia (GO), Brazil
| | - Maria Lúcia F. Penna
- Department of Epidemiology and Statistics, Universidade Federal
Fluminense (UFF) - Niterói (RJ), Brazil
| | - Gerson Oliveira Penna
- Tropical Medicine Center, Universidade de Brasília (UnB) -
Brasília (DF), Brazil
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz
(EFG-Fiocruz) - Brasília (DF), Brazil
| | - Sinésio Talhari
- Discipline of Dermatology, Universidade Nilton Lins - Manaus (AM),
Brazil
- Post-Graduation Program of the Fundação de Medicina
Tropical and Universidade do Estado do Amazonas (UEA/FMT-HVD) - Manaus (AM),
Brazil
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Stefani MMA, Avanzi C, Bührer-Sékula S, Benjak A, Loiseau C, Singh P, Pontes MAA, Gonçalves HS, Hungria EM, Busso P, Piton J, Silveira MIS, Cruz R, Schetinni A, Costa MB, Virmond MCL, Diorio SM, Dias-Baptista IMF, Rosa PS, Matsuoka M, Penna MLF, Cole ST, Penna GO. Whole genome sequencing distinguishes between relapse and reinfection in recurrent leprosy cases. PLoS Negl Trop Dis 2017; 11:e0005598. [PMID: 28617800 PMCID: PMC5498066 DOI: 10.1371/journal.pntd.0005598] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 02/14/2017] [Revised: 07/05/2017] [Accepted: 04/26/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Since leprosy is both treated and controlled by multidrug therapy (MDT) it is important to monitor recurrent cases for drug resistance and to distinguish between relapse and reinfection as a means of assessing therapeutic efficacy. All three objectives can be reached with single nucleotide resolution using next generation sequencing and bioinformatics analysis of Mycobacterium leprae DNA present in human skin. METHODOLOGY DNA was isolated by means of optimized extraction and enrichment methods from samples from three recurrent cases in leprosy patients participating in an open-label, randomized, controlled clinical trial of uniform MDT in Brazil (U-MDT/CT-BR). Genome-wide sequencing of M. leprae was performed and the resultant sequence assemblies analyzed in silico. PRINCIPAL FINDINGS In all three cases, no mutations responsible for resistance to rifampicin, dapsone and ofloxacin were found, thus eliminating drug resistance as a possible cause of disease recurrence. However, sequence differences were detected between the strains from the first and second disease episodes in all three patients. In one case, clear evidence was obtained for reinfection with an unrelated strain whereas in the other two cases, relapse appeared more probable. CONCLUSIONS/SIGNIFICANCE This is the first report of using M. leprae whole genome sequencing to reveal that treated and cured leprosy patients who remain in endemic areas can be reinfected by another strain. Next generation sequencing can be applied reliably to M. leprae DNA extracted from biopsies to discriminate between cases of relapse and reinfection, thereby providing a powerful tool for evaluating different outcomes of therapeutic regimens and for following disease transmission.
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Affiliation(s)
- Mariane M. A. Stefani
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás, Brazil
- * E-mail: (MMAS); (STC); (GOP)
| | - Charlotte Avanzi
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás, Brazil
- University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Andrej Benjak
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Chloé Loiseau
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Switzerland
| | - Pushpendra Singh
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
- Department of Microbiology and Biotechnology Centre, Maharaja Sayajirao University of Baroda, Vadodara, India
| | | | | | - Emerith M. Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Philippe Busso
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Jérémie Piton
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
| | | | - Rossilene Cruz
- University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Dermatology and Venerology, Alfredo da Matta Foundation, Manaus, Amazonas, Brazil
| | - Antônio Schetinni
- Tropical Dermatology and Venerology, Alfredo da Matta Foundation, Manaus, Amazonas, Brazil
| | - Maurício B. Costa
- Faculty of Medicine, Federal University of Goiás, Goiania, Goiás, Brazil
| | | | | | | | | | - Masanori Matsuoka
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
- Jyu-kanbo National Museum, Kusatsu, Gunma, Japan
| | - Maria L. F. Penna
- Epidemiology and Biostatistics Department, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Stewart T. Cole
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Switzerland
- * E-mail: (MMAS); (STC); (GOP)
| | - Gerson O. Penna
- Tropical Medicine Centre, University of Brasília, Brasília DF, Brazil
- Fiocruz, Brasilia, Brazil
- * E-mail: (MMAS); (STC); (GOP)
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Magno EDS, Saraceni V, Souza ABD, Magno RDS, Saraiva MDGG, Bührer-Sékula S. [Factors associated with TB/HIV coinfection: evidence from notification data in the State of Amazonas, Brazil, 2001-2012]. CAD SAUDE PUBLICA 2017; 33:e00019315. [PMID: 28614446 DOI: 10.1590/0102-311x00019315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/20/2016] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis (TB) in persons living with HIV (PLHIV) is the leading infectious cause of AIDS-related death. The aim of this study was to estimate the prevalence of TB/HIV coinfection, evaluate notification of the two diseases over time by probabilistic database linkage, and identify factors associated with AIDS and TB notifications. Prevalence of TB/HIV coinfection was 7.7%. The group of PLHIV with subsequent TB diagnosis was the most representative, despite available preventive measures. Underreporting of TB among AIDS cases was 35%, and 19.6% of TB cases could have been reported as AIDS. For AIDS cases with mention of TB, living in the state capital showed 75% greater odds of being reported to the Tuberculosis Notification System (SINAN-TB), and having died increased the odds of reporting by 40%. Of TB cases with mention of HIV, brown skin color, age 25 to 39 years, living in the state capital, and having evolved to death were associated with higher odds of reporting to the AIDS Notification System. Periodic linkage of these databases can be a powerful tool for programs to decrease underreporting.
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Affiliation(s)
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | | - Samira Bührer-Sékula
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brasil.,Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil
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19
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Hungria EM, Bührer-Sékula S, de Oliveira RM, Aderaldo LC, Pontes ADA, Cruz R, Gonçalves HDS, Penna MLF, Penna GO, Stefani MMDA. Leprosy reactions: The predictive value of Mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR). PLoS Negl Trop Dis 2017; 11:e0005396. [PMID: 28222139 PMCID: PMC5336302 DOI: 10.1371/journal.pntd.0005396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/25/2016] [Revised: 03/03/2017] [Accepted: 02/06/2017] [Indexed: 01/13/2023] Open
Abstract
Background Leprosy reactions, reversal reactions/RR and erythema nodosum leprosum/ENL, can cause irreversible nerve damage, handicaps and deformities. The study of Mycobacterium leprae-specific serologic responses at diagnosis in the cohort of patients enrolled at the Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil/U-MDT/CT-BR is suitable to evaluate its prognostic value for the development of reactions. Methodology IgM and IgG antibody responses to PGL-I, LID-1, ND-O-LID were evaluated by ELISA in 452 reaction-free leprosy patients at diagnosis, enrolled and monitored for the development of leprosy reactions during a total person-time of 780,930 person-days, i.e. 2139.5 person-years, with a maximum of 6.66 years follow-up time. Principal findings Among these patients, 36% (160/452) developed reactions during follow-up: 26% (119/452) RR and 10% (41/452) had ENL. At baseline higher anti-PGL-I, anti-LID-1 and anti-ND-O-LID seropositivity rates were seen in patients who developed ENL and RR compared to reaction-free patients (p<0.0001). Seroreactivity in reactional and reaction-free patients was stratified by bacilloscopic index/BI categories. Among BI negative patients, higher anti-PGL-I levels were seen in RR compared to reaction-free patients (p = 0.014). In patients with 0<BI<3, (36 RR, 36 reaction-free), higher antibody levels to PGL-I (p = 0.014) and to LID-1 (p = 0.035) were seen in RR while difference in anti-ND-O-LID positivity was borderline (p = 0.052). Patients with BI≥3 that developed ENL had higher levels of anti-LID-1 antibodies (p = 0.028) compared to reaction-free patients. Anti-PGL-I serology had a limited predictive value for RR according to receiver operating curve/ROC analyses (area-under-the-curve/AUC = 0.7). Anti LID-1 serology at baseline showed the best performance to predict ENL (AUC 0.85). Conclusions Overall, detection of anti-PGL-I, anti-LID-1 and anti-ND-O-LID antibodies at diagnosis, showed low sensitivity and specificity for RR prediction, indicating low applicability of serological tests for RR prognosis. On the other hand, anti-LID-1 serology at diagnosis has shown prognostic value for ENL development in BI positive patients. Trial Registration ClinicalTrials.gov NCT00669643 Leprosy is a debilitating dermato-neurologic disease caused by Mycobacterium leprae. One of the main difficulties in the clinical management of leprosy patients is the development of leprosy reactions which are immune inflammatory episodes that can cause irreversible handicaps, incapacities and deformities. There are two major types of leprosy reactions: reversal reaction (RR) and erythema nodosum leprosum (ENL). Currently, there is no laboratory test able to predict the emergence of leprosy reactions among recently diagnosed patients. In order to investigate laboratory markers for the occurrence of leprosy reactions, we investigated the prognostic value of serologic responses to M. leprae antigens (PGL-I, LID-1, ND-O-LID) in 452 leprosy patients enrolled at the Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil/U-MDT/CT-BR. At diagnosis higher anti-PGL-I, anti-LID-1 and anti-ND-O-LID seropositivity rates were seen in patients who developed ENL and RR compared to reaction-free patients. The anti-PGL-I serology at diagnosis show low sensitivity to predict RR and anti-LID-1 serology at diagnosis has shown prognostic value for ENL development.
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Affiliation(s)
- Emerith Mayra Hungria
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil
- * E-mail:
| | | | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Amazonas, Brasil
| | | | - Maria Lúcia Fernandes Penna
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brasil
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Hungria EM, Oliveira RM, Penna GO, Aderaldo LC, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Kerr LRFS, Stefani MMDA, Bührer-Sékula S. Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil. Infect Dis Poverty 2016; 5:110. [PMID: 27919284 PMCID: PMC5139020 DOI: 10.1186/s40249-016-0203-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 10/20/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR). METHODS This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI. RESULTS More than half of the patients (55.5 %) reported leprosy reaction: 18.3 % (138/753) had a RR and 5.4 % (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27 % (205/753) of patients, while 19 % (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9 % were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45). CONCLUSIONS MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.
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Affiliation(s)
- Emerith Mayra Hungria
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás Brazil
| | | | | | | | | | - Rossilene Cruz
- Tropical Medicine Foundation/Foundation “Alfredo da Matta”, Manaus, Amazonas Brazil
| | | | | | | | | | - Samira Bührer-Sékula
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiania, Goiás Brazil
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Cordeiro-Santos M, Trajman A, Cobelens F, Durovni B, Gonçalves M, Bührer-Sékula S, Saraceni V. Tuberculosis Infection Control: Potential Benefit of a New Rapid Tuberculosis Test in a Human Immunodeficiency Virus/AIDS Reference Hospital. Infect Control Hosp Epidemiol 2016; 35:1206-7. [DOI: 10.1086/677643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Garrido MDS, Bührer-Sékula S, Souza AB, de Oliveira GP, Antunes IA, Mendes JM, Saraceni V, Martinez-Espinosa FE, Ramasawmy R. Multidrug-resistant tuberculosis in the Amazonas State, Brazil, 2000-2011. Int J Tuberc Lung Dis 2016; 19:531-6. [PMID: 25868020 DOI: 10.5588/ijtld.14.0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Amazonas is facing increasing challenges in tuberculosis (TB) control, with nearly 3000 cases per year, and multidrug-resistant TB (MDR-TB) may jeopardise the TB control programme. OBJECTIVE To assess the number of MDR-TB cases in the Amazonas and to improve estimates of the burden of TB. DESIGNS The Brazilian National Mandatory Disease Reporting System (SINAN) and the Brazilian Epidemiological Surveillance System of Multidrug Resistance (TBMR) were searched for MDR-TB cases in the State of Amazonas from 2000 to 2011. RESULTS Eighty-one MDR-TB cases were notified. The rates of primary MDR-TB, initial MDR-TB during the first treatment regimen and acquired MDR-TB were respectively 3.8%, 13.7% and 82.7%; 26.9% of previously treated patients had ⩾ 4 treatment cycles. The MDR-TB cases reported 263 contacts, only 35.0% of whom were examined. The cure and death rates among the 81 patients with MDR-TB were respectively 45.7% and 25.9%. CONCLUSIONS The number of MDR-TB cases seems incompatible with the high TB prevalence in the Amazonas. Most patients were unaware of contact with TB patients. TB is endemic in the Amazonas. This highlights the need for improving resistance investigation among all TB cases.
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Affiliation(s)
- M da S Garrido
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Vigilância em Saúde do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde de Manaus, Manaus, Amazonas, Brazil
| | - S Bührer-Sékula
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Patologia e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - A B Souza
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - G P de Oliveira
- Programa Nacional de Tuberculose, Ministério da Saúde, Brasília, Brazil
| | - I A Antunes
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil, Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil
| | - J M Mendes
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil
| | - V Saraceni
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - F E Martinez-Espinosa
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, Amazonas, Brazil
| | - R Ramasawmy
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil; Programa de Pós-graduação em Imunologia Básica e Aplicada, Universidade Federal de Amazonas, Manaus, Amazonas, Brazil
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Moura RS, Penna GO, Cardoso LPV, de Andrade Pontes MA, Cruz R, de Sá Gonçalves H, Fernandes Penna ML, de Araújo Stefani MM, Bührer-Sékula S. Description of leprosy classification at baseline among patients enrolled at the uniform multidrug therapy clinical trial for leprosy patients in Brazil. Am J Trop Med Hyg 2015; 92:1280-4. [PMID: 25940192 PMCID: PMC4458838 DOI: 10.4269/ajtmh.14-0049] [Citation(s) in RCA: 5] [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] [Received: 01/21/2014] [Accepted: 02/18/2015] [Indexed: 11/07/2022] Open
Abstract
The uniform multidrug therapy clinical trial, Brazil (U-MDT/CT-BR), database was used to describe and report the performance of available tools to classify 830 leprosy patients as paucibacillary (PB) and multibacillary (MB) at baseline. In a modified Ridley and Jopling (R&J) classification, considering clinical features, histopathological results of skin biopsies and the slit-skin smear bacterial load results were used as the gold standard method for classification. Anti-phenolic glycolipid-I (PGL-I) serology by ML Flow test, the slit skin smear bacterial load, and the number of skin lesions were evaluated. Considering the R&J classification system as gold standard, ML Flow tests correctly allocated 70% patients in the PB group and 87% in the MB group. The classification based on counting the number of skin lesions correctly allocated 46% PB patients and 99% MB leprosy cases. Slit skin smears properly classified 91% and 97% of PB and MB patients, respectively. Based on U-MDT/CT-BR results, classification of leprosy patients for treatment purposes is unnecessary because it does not impact clinical and laboratories outcomes. In this context, the identification of new biomarkers to detect patients at a higher risk to develop leprosy reactions or relapse remains an important research challenge.
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Affiliation(s)
- Rodrigo Scaliante Moura
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Gerson Oliveira Penna
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Ludimila Paula Vaz Cardoso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Araci de Andrade Pontes
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rossilene Cruz
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Heitor de Sá Gonçalves
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Lúcia Fernandes Penna
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Mariane Martins de Araújo Stefani
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Samira Bührer-Sékula
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; Centre for Tropical Medicine, University of Brasília, Brasília DF, Brazil; Dona Libânia Dermatology Centre, Fortaleza, Ceará, Brazil; Alfredo da Matta Tropical Dermatology and Venereology Foundation, Manaus, Amazonas, Brazil; Epidemiology and Biostatistics Department, Fluminense Federal University, Rio de Janeiro, Brazil
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Garrido MDS, Bührer-Sékula S, Souza ABD, Ramasawmy R, Quincó PDL, Monte RL, Santos LO, Perez-Porcuna TM, Martinez-Espínosa FE, Saraceni V, Cordeiro-Santos M. Temporal distribution of tuberculosis in the State of Amazonas, Brazil. Rev Soc Bras Med Trop 2015; 48 Suppl 1:63-9. [PMID: 26061372 DOI: 10.1590/0037-8682-0055-2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis (TB) is one of the infectious diseases that contributes most to the morbidity and mortality of millions of people worldwide. Brazil is one of 22 countries that accounts for 80% of the tuberculosis global burden. The highest incidence rates in Brazil occur in the States of Amazonas and Rio de Janeiro. The aim of this study was to describe the temporal distribution of TB in the State of Amazonas. Between 2001 and 2011, 28,198 cases of tuberculosis were reported in Amazonas, distributed among 62 municipalities, with the capital Manaus reporting the highest (68.7%) concentration of cases. Tuberculosis was more prevalent among males (59.3%) aged 15 to 34 years old (45.5%), whose race/color was predominantly pardo (64.7%) and who had pulmonary TB (84.3%). During this period, 81 cases of multidrug-resistant TB were registered, of which the highest concentration was reported from 2008 onward (p = 0.002). The municipalities with the largest numbers of indigenous individuals affected were São Gabriel da Cachoeira (93%), Itamarati (78.1%), and Santa Isabel do Rio Negro (70.1%). The future outlook for this region includes strengthening the TB control at the primary care level, by expanding diagnostic capabilities, access to treatment, research projects developed in collaboration with the Dr. Heitor Vieira Dourado Tropical Medicine Foundation .;Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD).; and financing institutions, such as the project for the expansion of the Clinical Research Center and the creation of a hospital ward for individuals with transmissible respiratory diseases, including TB.
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Affiliation(s)
- Marlucia da Silva Garrido
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Samira Bührer-Sékula
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Alexandra Brito de Souza
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Rajendranath Ramasawmy
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Patrícia de Lima Quincó
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Rossicleia Lins Monte
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Lucilaide Oliveira Santos
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Tomás Maria Perez-Porcuna
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Valéria Saraceni
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Marcelo Cordeiro-Santos
- Departamento de Ensino e Pós-Graduação, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
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da Silva Garrido M, Ramasawmy R, Perez-Porcuna TM, Zaranza E, Chrusciak Talhari A, Martinez-Espinosa FE, Bührer-Sékula S. Primary drug resistance among pulmonary treatment-naïve tuberculosis patients in Amazonas State, Brazil. Int J Tuberc Lung Dis 2015; 18:559-63. [PMID: 24903793 DOI: 10.5588/ijtld.13.0191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is the main indicator of previous treatment in tuberculosis (TB) patients. MDR-TB among treatment-naïve patients indicates infection with drug-resistant Mycobacterium tuberculosis strains, and such cases are considered primary drug-resistant cases. OBJECTIVE To estimate the prevalence of drug resistance in pulmonary TB (PTB) treatment-naïve patients and to identify the socio-demographic and clinical characteristics of the resistant population. METHODS A total of 205 treatment-naïve PTB patients from Manaus, Amazonas State, Brazil, were enrolled. Drug susceptibility testing (DST) was performed on all positive mycobacterial cultures using the 1% proportion method. RESULTS Positive M. tuberculosis cultures were obtained from only 175 patients for DST. The prevalence of primary MDR-TB was 1.7% (3/175); 14.3% (25/175) of the cultures presented resistance to at least one of the drugs. Resistance to streptomycin, isoniazid, rifampicin and ethambutol was respectively 8.6%, 6.9%, 3.4% and 2.3%. An association between TB patients with resistance to more than one drug and known previous household contact with a TB patient was observed (P= 0.008, OR 6.7, 95%CI 1.2-67.3). CONCLUSIONS Although the prevalence of primary MDR-TB currently is relatively low, it may become a major public health problem if tailored treatment is not provided, as resistance to more than one drug is significantly associated with household contact.
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Affiliation(s)
- M da Silva Garrido
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - R Ramasawmy
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - T M Perez-Porcuna
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - E Zaranza
- Laboratório Central de Saúde Pública do Amazonas, Manaus, Amazonas, Brazil
| | - A Chrusciak Talhari
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - F E Martinez-Espinosa
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - S Bührer-Sékula
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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26
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Moura RS, Penna GO, Fujiwara T, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Cardoso LPV, Stefani MMDA, Bührer-Sékula S. Evaluation of a rapid serological test for leprosy classification using human serum albumin as the antigen carrier. J Immunol Methods 2014; 412:35-41. [PMID: 24983877 DOI: 10.1016/j.jim.2014.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 03/13/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 12/25/2022]
Abstract
The presence of anti-BSA antibodies may interfere in serological tests, as ELISA or immunochromatographic assays. BSA is frequently used as a blocking agent or as "inert" carrier of antigens, such as the NT-P-BSA, the semi-synthetic trisaccharide analogue of the PGL-I (phenolic glycolipid-I) antigen from the cell wall of the Mycobacterium leprae. PGL-I was prepared and linked to human serum albumin based in the hypothesis that replacing BSA by a human protein carrier would enhance the performance of leprosy serological tests. A total of 1162 serum samples were tested by ELISA and by the ML Flow rapid test using NT-P-BSA or NT-P-HSA antigens. When grouping leprosy patients as paucibacillary (PB) or multibacillary (MB) according to the Ridley & Jopling classification, ML Flow BSA and ML Flow HSA tests correctly allocated 70.9% and 68.6% of patients in the PB group, and 87% and 81% of patients in the MB group, respectively. Concordant results were found in 82.0% (953/1162) (kappa value=0.637; sd=0.023) of samples between ML Flow tests and 85.7% (996/1162) (kappa value=0.703; sd=0.021) between ELISA tests. ML Flow results were statistically similar and the same was true for ELISA tests using HSA or BSA. However, we noticed a tendency to decreased capacity to detect MB patients and an increased positivity among PB patients, HHC, TB patients and healthy controls by the HSA carrier in both ML Flow and ELISA. The PGL-I serology performed by the ML Flow test with BSA or HSA as antigen carriers can be a useful, friendly auxiliary tool to identify patients with higher bacterial load.
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Affiliation(s)
- Rodrigo Scaliante Moura
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | | | | | - Rossilene Cruz
- Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | | | | | | | | | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil.
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27
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Calado KLS, Magnanini MMF, Moura RSD, Gallo MEN, Bührer-Sékula S, Oliveira MLWDRD. Serology with ML Flow test in health professionals from three different states of Brazil. An Bras Dermatol 2014; 88:918-23. [PMID: 24474100 PMCID: PMC3900342 DOI: 10.1590/abd1806-4841.20132139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/11/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In highly endemic countries, transmission and sub-clinical infection of leprosy
are likely and the disease manifests itself in individuals without any known close
contact with a leprosy patient. Health workers are social contacts belonging to
the same network (the Health System) and some of them share the same social
environment (nursing assistants) as patients with known patients and / or
carriers. OBJECTIVE To identify ML Flow seropositivity among health professionals. METHODS We conducted a cross-sectional study using a serological survey with the ML Flow
test in 450 health professionals (doctors, nurses and nursing assistants), in
order to detect seropositivity in areas of high and low endemicity in
municipalities from three Brazilian states (RJ, MS and RS). RESULTS The results showed general 16% seropositivity, higher in low endemic areas,
regardless of whether there was direct care for leprosy patients. Paradoxically, a
statistical association was observed between the area studied and seropositivity,
as the place with the lowest endemicity (CA) had the highest seropositivity rate
(p = 0.033). CONCLUSION The authors suggest these results are associated with a presence of an
unspecified link to bovine serum albumin (BSA), carrier of PGL-1 in the ML Flow
test, and recommend expanded seroepidemiological research utilizing tests with
human and bovine albumin.
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Affiliation(s)
- Karla Lucena Sampaio Calado
- Federal University of Rio de Janeiro, Rio de JaneiroRJ, Brazil, Master's in Dermatology, Federal University of Rio de Janeiro (UFRJ) - Assistant Professor of Dermatology, Federal University of Grande Dourados (UFGD). PhD in Tropical Medicine from the Oswaldo Cruz Foundation (FIOCRUZ) - Rio de Janeiro (RJ), Brazil
| | - Mônica Maria Ferreira Magnanini
- Oswaldo Cruz Foundation, Rio de JaneiroRJ, Brazil, PhD in Public Health from the Oswaldo Cruz Foundation (FIOCRUZ). Statistics, Federal University of Rio de Janeiro (UFRJ) - Rio de Janeiro (RJ), Brazil
| | - Rodrigo Scaliante de Moura
- Federal University of Goiás, GoiâniaGO, Brazil, Biomedical doctor. Master's in Tropical Medicine, Federal University of Goiás (UFG) - Goiânia (GO), Brazil
| | - Maria Eugenia Noviski Gallo
- Oswaldo Cruz Foundation, Rio de JaneiroRJ, Brazil, PhD in Tropical Medicine from the Oswaldo Cruz Foundation (FIOCRUZ). Professor at the Oswaldo Cruz Foundation (FIOCRUZ) - Rio de Janeiro (RJ), Brazil
| | - Samira Bührer-Sékula
- Universiteit van Amsterdam, Netherlands, Netherlands, PhD in Immunology from the Universiteit van Amsterdam, Netherlands - Collaborating Professor at the Federal University of Goiás (UFG) - Goiânia (GO), Brazil
| | - Maria Leide Wand-Del-Rey de Oliveira
- Federal University of Rio de Janeiro, Rio de JaneiroRJ, Brazil, PhD in Dermatology from the Federal University of Rio de Janeiro (UFRJ)-Federal Adjuct Professor, University of Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil
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Stefani MMDA, Grassi AB, Sampaio LH, Sousa ALOMD, Costa MB, Scheelbeek P, Neupane KD, Hagge DA, Macdonald M, Cho SN, Oskam L, Bührer-Sékula S. Comparison of two rapid tests for anti-phenolic glycolipid-I serology in Brazil and Nepal. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:124-31. [PMID: 23283463 DOI: 10.1590/s0074-02762012000900019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of leprosy continues to be based on clinical symptoms and early diagnosis and treatment are critical to preventing disability and transmission. Sensitive and specific laboratory tests are not available for diagnosing leprosy. Despite the limited applicability of anti-phenolic glycolipid-I (PGL-I) serology for diagnosis, it has been suggested as an additional tool to classify leprosy patients (LPs) for treatment purposes. Two formats of rapid tests to detect anti-PGL-I antibodies [ML immunochromatography assay (ICA) and ML Flow] were compared in different groups, multibacillary patients, paucibacillary patients, household contacts and healthy controls in Brazil and Nepal. High ML Flow intra-test concordance was observed and low to moderate agreement between the results of ML ICA and ML Flow tests on the serum of LPs was observed. LPs were "seroclassified" according to the results of these tests and the seroclassification was compared to other currently used classification systems: the World Health Organization operational classification, the bacilloscopic index and the Ridley-Jopling classification. When analysing the usefulness of these tests in the operational classification of PB and MB leprosy for treatment and follow-up purposes, the ML Flow test was the best point-of-care test for subjects in Nepal and despite the need for sample dilution, the ML ICA test yielded better performance among Brazilian subjects. Our results identified possible ways to improve the performance of both tests.
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Gonçalves HDS, Pontes MADA, Bührer-Sékula S, Cruz R, Almeida PC, Moraes MEAD, Penna GO. Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:74-8. [PMID: 23283457 DOI: 10.1590/s0074-02762012000900013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022] Open
Abstract
This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.
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Penna GO, Pontes MADA, Cruz R, Gonçalves HDS, Penna MLF, Bührer-Sékula S. A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:22-7. [PMID: 23283449 DOI: 10.1590/s0074-02762012000900005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022] Open
Abstract
Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.
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Saraiva MDGG, Amorim RDS, Moura MAS, Santos ECSD, Sampaio LS, Barbosa MDGV, Bührer-Sékula S. Historical analysis of the records of sylvan yellow fever in the State of Amazonas, Brazil, from 1996 to 2009. Rev Soc Bras Med Trop 2013; 46:223-6. [PMID: 23740065 DOI: 10.1590/0037-8682-1573-2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/05/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Yellow fever is a non-contagious infectious disease, highly lethal, transmitted by the Aedes, Haemagogus and Sabethes. METHODS Descriptive retrospective study of the yellow fever cases in Amazonas, between 1996 and 2009. RESULTS Forty two cases of yellow fever were confirmed, with 30 deaths, 10% of which were foreigners. CONCLUSIONS The presence of Aedes aegypti and Aedes albopictus in both rural Amazonas and its capital demonstrates the dispersion of these vectors and underscores the need for better and continuous epidemiological and entomological control.
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Affiliation(s)
- Maria das Graças Gomes Saraiva
- Departamento de Epidemiologia e Saúde Pública, Fundação de Medicina Tropical "Doutor Heitor Vieira Dourado", Manaus, AM, Brasil.
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Hungria EM, Oliveira RMD, Souza ALOMD, Costa MB, Souza VNBD, Silva EA, Moreno FRV, Nogueira MES, Costa MRSN, Silva SMUR, Bührer-Sékula S, Reed SG, Duthie MS, Stefani MMDA. Seroreactivity to new Mycobacterium leprae protein antigens in different leprosy-endemic regions in Brazil. Mem Inst Oswaldo Cruz 2012; 107 Suppl 1:104-11. [DOI: 10.1590/s0074-02762012000900017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/25/2012] [Indexed: 11/22/2022] Open
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Pérez-Porcuna TM, Ascaso C, Ogusku MM, Abellana R, Malheiro A, Quinco P, Antunes I, Monte R, Tavares M, Garrido M, Bührer-Sékula S, Martinez-Espinosa FE. Evaluation of new strategies for the diagnosis of tuberculosis among pediatric contacts of tuberculosis patients. Pediatr Infect Dis J 2012; 31:e141-6. [PMID: 22572746 DOI: 10.1097/inf.0b013e31825cbb3b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In young children, underdiagnosis and diagnostic delay have an adverse effect on morbidity and mortality of tuberculosis (TB). This study evaluated new strategies for early TB diagnosis using an outpatient protocol in children between 0 and 5 years of age, with a recent household TB contact. METHODS Case recruitment was performed in Manaus, Amazonas, Brazil, from 2008 to 2009. Epidemiologic and clinical data, tuberculin test, chest radiograph and 2 induced sputum respiratory samples from each participant were obtained. Laboratory diagnosis was based on Lowenstein-Jensen (LJ) culture, mycobacteria growth indicator tube (MGIT) and polymerase chain reaction. We conducted a study of comparison of diagnostic tests and a study of cases and controls to identify the clinical characteristics of the population with positive culture and polymerase chain reaction results. RESULTS A total of 102 children were evaluated. Thirty-two fulfilled criteria of suspicion of TB. MGIT was more sensitive (P = 0.035) and faster (P < 0.001) than LJ. Clinical score, MGIT, LJ and polymerase chain reaction presented no concordance or slight concordance. A positive MGIT culture was only associated with a strong tuberculin test reaction (P = 0.026). The combination of MGIT with the clinical score allowed the diagnosis of 33% more cases with little or no symptomatology compared with the exclusive use of the clinical classification. CONCLUSIONS The sensitivity and speed of MGIT demonstrate the utility of liquid cultures for the diagnosis in children. Furthermore, these results suggest that the use of MGIT in children presenting recent household TB contact and a strong tuberculin test reaction may be a strategy to improve early TB diagnosis.
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Affiliation(s)
- Tomàs M Pérez-Porcuna
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil.
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Garrido MS, Talhari AC, Antunes IA, Matsuda JDS, Zaranza EDG, Martinez-Espinosa FE, Bührer-Sékula S. Primary multidrug-resistant tuberculosis and its control implications in the State of Amazonas, Brazil: report of 3 cases. Rev Soc Bras Med Trop 2012; 45:530-2. [PMID: 22930053 DOI: 10.1590/s0037-86822012000400024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/14/2011] [Indexed: 11/21/2022] Open
Abstract
The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.
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Affiliation(s)
- Marlucia Silva Garrido
- Programa de Pós-Graduação em Medicina Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, AM, Brasil.
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Garrido MDS, Penna ML, Perez-Porcuna TM, de Souza AB, Marreiro LDS, Albuquerque BC, Martínez-Espinosa FE, Bührer-Sékula S. Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study. PLoS One 2012; 7:e39134. [PMID: 22720052 PMCID: PMC3373579 DOI: 10.1371/journal.pone.0039134] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/16/2012] [Indexed: 11/18/2022] Open
Abstract
Setting Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. Objective This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. Design Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as ‘cases’ and those completing treatment as ‘controls’. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. Results Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. Conclusions Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs.
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Affiliation(s)
- Marlucia da Silva Garrido
- Tropical Medicine Post-Graduate Program - Amazonas State University/Dr Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil.
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Martins ACDC, Miranda A, Oliveira MLWDRD, Bührer-Sékula S, Martinez A. Estudo da mucosa nasal de contatos de hanseníase, com positividade para o antígeno glicolipídio fenólico 1. Braz J Otorhinolaryngol 2010. [PMID: 20963340 PMCID: PMC9450795 DOI: 10.1590/s1808-86942010000500008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The disease more frequently affects the nasal mucosa and can occur independently of its clinical form or even before lesions on the skin or on other parts of the body. It is necessary to employ epidemiological surveillance of household contacts with new leprosy cases for early disease diagnosis. Aim identify specific and early leprosy lesions through endoscopic, baciloscopy, histopathology exams, and real time polymerase chain reaction of the nasal cavity mucosa on household and peridomiciliary contacts with positive serology for the phenolic glycolipid 1 antigen. Methodology Between 2003 at 2006 there was a prospective cross-sectional clinical study with 31 contacts with patients with leprosy with positive serology against PGL-1, 05 negative controls and 01 positive control. Results Between seropositive contacts, real-time PCR was positive for M. leprae DNA in 06 (19.35%) of them and the higher number of genome copies were found in contacts who became sick. Conclusion Nasal mucosa tests alone did not enable the early diagnosis of Leprosy. However, through the combination of various methods, tests on the contacts can help identify subclinical infection and monitor the contacts that could be responsible for spreading the disease.
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Bührer-Sékula S, van Beers S, Oskam L, Lecco R, Madeira ES, Dutra MAL, Luis MC, Faber WR, Klatser PR. The relation between seroprevalence of antibodies against phenolic glycolipid-I among school children and leprosy endemicity in Brazil. Rev Soc Bras Med Trop 2009; 41 Suppl 2:81-8. [PMID: 19618082 DOI: 10.1590/s0037-86822008000700017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Leprosy control programs would benefit expressively from an easy method to estimate disease prevalence and to assess the effect of leprosy control measures on disease prevalence. Determination of the seroprevalence of antibodies to PGL-I through school children surveys might be a useful indicator of leprosy prevalence at the district level. To investigate whether seropositivity rates could be related to leprosy detection rates and whether seropositivity could be used as a proximal indicator to predict the leprosy incidence in other areas, 7,073 school children in three different leprosy-endemic states in Brazil were tested. The results show a widely varying distribution of seropositivity in the communities independent of the number of leprosy cases detected. Seroprevalence was significantly lower at private schools. No differences in the patterns of seropositivity between ELISA and dipstick were observed. No correlation between leprosy detection rate and seropositivity rates could be established.
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Grossi MADF, Leboeuf MAA, Andrade ARCD, Lyon S, Antunes CMDF, Bührer-Sékula S. The influence of ML Flow test in leprosy classification. Rev Soc Bras Med Trop 2009; 41 Suppl 2:34-8. [PMID: 19618073 DOI: 10.1590/s0037-86822008000700008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This is a descriptive, exploratory study correlating ML Flow, bacilloscopy and classification of paucibacillary (PB) and multibacillary (MB), involving 1,041 new leprosy cases in 13 municipalities of Minas Gerais State, from October 2002 to March 2004. Agreement between ML Flow and the classification of the number of skin lesions and bacilloscopy was moderate (K:0.51 and K:0.48, respectively); and substantial for final classification (K:0.77). From January 2000 to March 2004, the proportion of new MB cases in Minas Gerais decreased from 78.1 to 65.8%. The reduction in the percentage of MB cases was higher in health centers that participated in the ML Flow study (73.1% to 53.3%). The difference between PB and MB in the participating and non-participating health centers from January to March 2004 was statistically significant. Implementation of the ML Flow test influenced the classification of patients, suggesting a direct and beneficial impact on patient treatment and the control of the leprosy endemic in Minas Gerais, Brazil.
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Affiliation(s)
- Maria Aparecida de Faria Grossi
- Post-graduate Program in Health Sciences: Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, MG, Brazil.
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Oliveira MLW, Cavaliére FAM, Maceira JMP, Bührer-Sékula S. The use of serology as an additional tool to support diagnosis of difficult multibacillary leprosy cases: lessons from clinical care. Rev Soc Bras Med Trop 2009; 41 Suppl 2:27-33. [PMID: 19618072 DOI: 10.1590/s0037-86822008000700007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Seven multibacillary leprosy and two suspected cases assisted in different situations during clinical care activities at the university in Rio de Janeiro city are described. All cases presented some difficulties for diagnosis, since they evolved with few or no cardinal signs or symptoms of leprosy. A serological test used as an auxiliary tool was helpful in the diagnosis or exclusion procedure of each case, facilitating academic discussions at the time of case examination. Considering serology and bacilloscopy (skin smear) as the only rapid and relatively cheap available tests for confirmation of atypical MB leprosy, the advantages and disadvantages of their use were discussed. Both tests support the diagnostic procedure and the classification of cases for treatment purposes. The advantage of bacilloscopy is its capacity for diagnosis confirmation. The advantages of serology are: (a) its applicability for direct use by health workers, providing immediate results; (b) the potential for patient participation in the process; and (c) it provides a learning opportunity, allowing for improved teaching of leprosy pathogenesis.
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Affiliation(s)
- Maria Leide W Oliveira
- Dermatology Department, Medical School, Federal University of Rio de Janeiro, RJ, Rio de Janeiro, Brazil.
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Deps PD, Antunes JMAP, Faria C, Bührer-Sékula S, Camargo ZP, Opromola DV, Tomimori J. Research regarding anti-PGL-I antibodies by ELISA in wild armadillos from Brazil. Rev Soc Bras Med Trop 2009; 41 Suppl 2:73-6. [PMID: 19618080 DOI: 10.1590/s0037-86822008000700015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Armadillos have been involved in leprosy transmission and are considered a source of Mycobacterium leprae in numerous reports. Clinicians from certain areas of the USA consider contact with armadillos a risk factor for leprosy. However, there is a challenge associated with the role of wild armadillos perpetuating human leprosy in the American Continent. The presence of anti-PGL-I antibodies was investigated in wild nine-banded armadillos from leprosy-endemic areas in State of Espirito Santo, Brazil, by ELISA performed on serum samples from 47 armadillos. Positive ELISA was obtained from 5 (10.6%) armadillos. Infected armadillos may play some role in leprosy transmission, disseminating bacilli in the environment, perhaps making it more difficult to interrupt transmission and reduce the number of new leprosy cases. ELISA is an efficient tool for seroepidemiological investigations of Mycobacterium leprae in armadillos.
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Affiliation(s)
- Patrícia D Deps
- Department of Social Medicine, Federal University of Espirito Santo, Vitória, Brazil.
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Abstract
Serology using a species-specific antigen for Mycobacterium leprae, PGL-I, could be a marker for the bacterial load of patients with leprosy. Various studies have identified the potential use of serology in the classification of patients for treatment purposes, case monitoring, identification of the risk of relapse and selection of household contacts with a higher risk of contracting the disease. A systematic review of the literature was conducted and 26 articles were included in this comparative analysis. The results of the use of PGL-I serology in different situations, its limitations and possible applications were evaluated. Studies show the efficacy of PGL-I serology in the classification of patients, treatment monitoring and as a predictive test for leprosy reactions. To improve early diagnosis and follow-up of the population at greatest risk of developing leprosy, the methodologies used in the past have yet to show a favorable cost-benefit ratio, although studies indicate that the use of the test might positively influence leprosy control programs. With simple and robust techniques, the use of PGL-I serology is viable.
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Teixeira AC, Cruvinel DL, Roma FRD, Luppino LF, Resende LHP, Sousa TD, Bührer-Sékula S, Goulart IMB. Evaluation of the agreement between clinical and laboratorial exams in the diagnosis of leprosy. Rev Soc Bras Med Trop 2009; 41 Suppl 2:48-55. [PMID: 19618076 DOI: 10.1590/s0037-86822008000700011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the correlation between the clinical and laboratory diagnosis of leprosy, using biopsy results from laboratories 'A' and 'B' and the ML Flow test. Clinical and histopathological diagnoses presented 67.6% agreement. The laboratories showed 73.7% agreement in the bacterial index and laboratory 'B' detected 25.4% more positives. The highest agreement was in the LL form and lowest, in the I form. The highest diagnostic discrepancy was for the BB form. Clinical diagnosis agreement was 41.3% for laboratory 'A' and 54% for 'B'. The ML Flow test reclassified 10.7% of the patients. The spectrum of leprosy classification is important for a clearer understanding of the disease and its proper treatment, but is not used in health services, which use the simplified WHO criteria. This could be complemented by ML Flow testing. Such simplification is unacceptable for Leprosy Reference Centers regarding patient attendance, teaching and research, for which the standardization of the Ridley-Jopling classification is recommended.
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Affiliation(s)
- André Costa Teixeira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinical Hospital, Faculty of Medicine, Federal University of Uberlândia, MG, Brazil
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Brito MDFDM, Ximenes RAA, Gallo MEN, Bührer-Sékula S. Association between leprosy reactions after treatment and bacterial load evaluated using anti PGL-I serology and bacilloscopy. Rev Soc Bras Med Trop 2009; 41 Suppl 2:67-72. [PMID: 19618079 DOI: 10.1590/s0037-86822008000700014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Leprosy (Hansen's disease, HD) reactions are immune-inflammatory phenomena that occur during the evolution of the disease. Given the current criteria for treatment of the disease, this event is often observed after the patient has been released from treatment (RFT) from multi-drug therapy (MDT). A case-control study was conducted comparing laboratory results of cases of leprosy reactions after RFT from multibacillary MDT (MDT/MB) with a control group to analyze the possible association between posttreatment reactions and bacterial load using the ML Flow serological test for detection of antibodies to Mycobacterium leprae and the results of bacilloscopic skin smears. The study was conducted in two reference centers in Recife, Pernambuco State, Brazil, involving 208 patients. The results obtained indicate that posttreatment reaction is statistically associated with bacterial load through positive serology post-RFT. In conclusion, common risk factors exist between relapses and post-RFT reactions.
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Bührer-Sékula S, Illarramendi X, Teles RB, Penna MLF, Nery JAC, Sales AM, Oskam L, Sampaio EP, Sarno EN. The additional benefit of the ML Flow test to classify leprosy patients. Acta Trop 2009; 111:172-6. [PMID: 19393609 DOI: 10.1016/j.actatropica.2009.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 04/17/2008] [Revised: 02/24/2009] [Accepted: 04/15/2009] [Indexed: 11/28/2022]
Abstract
The use of the skin lesion counting classification leads to both under and over diagnosis of leprosy in many instances. Thus, there is a need to complement this classification with another simple and robust test for use in the field. Data of 202 untreated leprosy patients diagnosed at FIOCRUZ, Rio de Janeiro, Brazil, was analyzed. There were 90 patients classified as PB and 112 classified as MB according to the reference standard. The BI was positive in 111 (55%) patients and the ML Flow test in 116 (57.4%) patients. The ML Flow test was positive in 95 (86%) of the patients with a positive BI. The lesion counting classification was confirmed by both BI and ML Flow tests in 65% of the 92 patients with 5 or fewer lesions, and in 76% of the 110 patients with 6 or more lesions. The combination of skin lesion counting and the ML Flow test results yielded a sensitivity of 85% and a specificity of 87% for MB classification, and correctly classified 86% of the patients when compared to the standard reference. A considerable proportion of the patients (43.5%) with discordant test results in relation to standard classification was in reaction. The use of any classification system has limitations, especially those that oversimplify a complex disease such as leprosy. In the absence of an experienced dermatologist and slit skin smear, the ML Flow test could be used to improve treatment decisions in field conditions.
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Lyon S, Lyon AC, Da Silva RC, Grossi MADF, Lyon SH, Bührer-Sékula S, Rocha MOC. A comparison of ML Flow serology and slit skin smears to assess the bacterial load in newly diagnosed leprosy patients in Brazil. LEPROSY REV 2008; 79:162-170. [PMID: 18711938] [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: 05/26/2023]
Abstract
INTRODUCTION The ML Flow test is an immunochromatographic assay that detects IgM antibodies against M. leprae-specific anti-phenolic glycolipid I (PGL-I). In addition to slit skin smears stained by the Ziehl-Neelsen technique, it can be helpful in the operational classification of leprosy patients for treatment purposes. OBJECTIVE This work studied the relationship between antibody levels as detected by semi-quantitative ML Flow serologic test and bacterial load as quantified by slit skin smear. PATIENTS AND METHODS 135 patients with newly detected leprosy at the reference service in Sanitary Dermatology in Brazil had slit skin smears (registered as bacillary index - BI) and an ML Flow test (registered qualitatively and semi-quantitatively) performed at admission. A logistic regression and agreement measures (kappa index) were calculated. RESULTS Slit skin smears were positive in 35.9% of patients and 57% of patients were seropositive for PGL-1 antibodies. Among the seropositive patients, 416% had five or fewer skin lesions, and 65.8% had more than one peripheral nerve involved. Slit skin smears were positive in only three seronegative patients (5.6%), and negative in 41.9% of seropositive patients. Patients with a BI of 4 + had an OR of 33 for being seropositive in comparison to those with a low BI. CONCLUSIONS There is a correlation between serologic test and slit skin smear results. Therefore, an ML Flow test may become a useful tool in the clinical classification of leprosy, besides slit skin smears, which require a proper laboratory infrastructure and experienced personnel.
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Affiliation(s)
- Sandra Lyon
- Sanitary Dermatology Service, Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil.
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Lyon S, Lyon AC, da Silva RC, de Faria Grossi MA, Lyon SH, Bührer-Sékula S, Rocha MOC. A comparison of ML Flow serology and slit skin smears to assess the bacterial load in newly diagnosed leprosy patients in Brazil. LEPROSY REV 2008. [DOI: 10.47276/lr.79.2.162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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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Grossi MADF, Leboeuf MAA, Andrade ARCD, Bührer-Sékula S, Antunes CMDF. Risk factors for ML Flow seropositivity in leprosy patients. Rev Soc Bras Med Trop 2008; 41 Suppl 2:39-44. [PMID: 19618074 DOI: 10.1590/s0037-86822008000700009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The early diagnosis of leprosy, its correct classification and the risk factors related to seropositivity have become important for patient treatment and disease control, especially where the responsibility for treatment has been transferred to basic health care centers. This descriptive, exploratory study using logistic regression was undertaken to evaluate the association between the variables of sex, age, mode of detection, number of skin lesions and affected nerves, disability grade and bacilloscopy with the results of the ML Flow serological test in 1,072 new leprosy cases in 13 municipalities in Minas Gerais State. Seropositivity (50.7%) was statistically associated with patients 15 years-old or over (OR:2.6) and those with more than five skin lesions (OR:7.5), more than one affected nerve (OR:2.4) and a positive bacilloscopic index (OR:5.5 for 0<BI<2 and OR:191.2 for BI>or=2), thus contributing to the appropriate classification and treatment of patients.
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Affiliation(s)
- Maria Aparecida de Faria Grossi
- Post-graduate Program in Health Sciences: Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Lyon S, Castorina da Silva R, Lyon AC, Grossi MADF, Lyon SH, Azevedo MDL, Bührer-Sékula S, Rocha MODC. Association of the ML Flow serologic test to slit skin smear. Rev Soc Bras Med Trop 2008; 41 Suppl 2:23-6. [PMID: 19618071 DOI: 10.1590/s0037-86822008000700006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A descriptive, exploratory study was conducted analyzing the association of covariables in the results of the ML Flow serological test and slit skin smear. A total of 60 leprosy cases diagnosed at the state Sanitary Dermatology Referral Center were investigated. Slit skin smear samples were collected from four sites and the results were expressed by the bacillary index. ML Flow was registered in both qualitative and semi-quantitative terms. Cohen's kappa coefficient was used to study the agreement with Landis and Koch's observer criteria for interpretation. For statistical analysis, the logistic regression model and Kruskal-Wallis test were used. ML Flow showed a strong association with slit skin smear results, since a gradual increase in BI was accompanied by a semi-quantitative rise in antibody levels measured by ML Flow, with 100% positivity in cases presenting a positive slit skin smear. Given its strong correlation to slit skin smear, the results of this study provide evidence that the ML Flow test could be a valuable auxiliary tool in the classification and treatment of leprosy patients.
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Affiliation(s)
- Sandra Lyon
- Department of Sanitary Dermatology, Eduardo de Menezes Hospital, Hospital Foundation of Minas Gerais State, MG, Brazil.
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Barreto JA, Nogueira MES, Diorio SM, Bührer-Sékula S. Leprosy serology (ML Flow test) in borderline leprosy patients classified as paucibacillary by counting cutaneous lesions: an useful tool. Rev Soc Bras Med Trop 2008; 41 Suppl 2:45-7. [PMID: 19618075 DOI: 10.1590/s0037-86822008000700010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Leprosy remains an endemic disease in Brazil, with almost 40,000 new cases diagnosed each year. As it is difficult to perform laboratory procedures in the field, operational classification is determined by counting lesions, which can cause underdiagnosis of multibacillary cases and failures in treatment. To evaluate a new tool to diagnose MB cases, the ML Flow test, 21/77 (27.3%) patients with untreated borderline leprosy (6 BL and 15 BT) with 1 to 5 cutaneous lesions were evaluated according to the R&J Classification. The ML Flow test was positive in 14/21 (66.6%) patients; 7/21 (33.3%) cases, 5 BT and 2 BL, showed negative results. Classification of leprosy based only on the number of lesions can fail to diagnose MB leprosy. The ML Flow test is a useful tool to diagnose borderline leprosy in patients with 1 to 5 cutaneous lesions.
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