High-Resolution Plasma Metabolomics Identifies Alterations in Fatty Acid, Energy, and Micronutrient Metabolism in Adults Across the Leprosy Spectrum.

BACKGROUND: High-resolution metabolomics (HRM) is an innovative tool to study challenging infectious diseases like leprosy, where the pathogen cannot be grown with standard methods. Here, we use HRM to better understand associations between disease manifestations, nutrition, and host metabolism. METHODS: From 2018 to 2019, adults with leprosy and controls were recruited in Minas Gerais, Brazil. Plasma metabolites were detected using an established HRM workflow and characterized by accurate mass, mass to charge ratio m/z and retention time. The mummichog informatics package compared metabolic pathways between cases and controls and between multibacillary (MB) and paucibacillary (PB) leprosy. Additionally, select individual metabolites were quantified and compared. RESULTS: Thirty-nine cases (62% MB and 38% PB) and 25 controls were enrolled. We found differences (P < .05) in several metabolic pathways, including fatty acid metabolism, carnitine shuttle, retinol, vitamin D3, and C-21 steroid metabolism, between cases and controls with lower retinol and associated metabolites in cases. Between MB and PB, leukotrienes, prostaglandins, tryptophan, and cortisol were all found to be lower in MB (P < .05). DISCUSSION: Metabolites associated with several nutrient-related metabolic pathways appeared differentially regulated in leprosy, especially MB versus PB. This pilot study demonstrates the metabolic interdependency of these pathways, which may play a role in the pathophysiology of disease.

Impaired warm and cold perception thresholds in leprosy skin lesions.

The aim of the present study was to determine the frequency of alteration in warm perception thresholds (WPT), cold perception thresholds (CPT) and the warm and cold perception interval (WCPI) in leprosy-suspected skin lesions, and to determine if these tests could assist in the diagnosis of leprosy. Tests were conducted using a thermal sensory analyser TSA-2001 (Medoc Ltd, Israel) and the method of levels. A cross-sectional study of 112 patients presenting leprosy-suspected skin lesions ('patch'), with no clinical evidence of peripheral nerve damage, was conducted. Leprosy diagnosis was based on clinical dermato-neurological examinations and complementary tests. One hundred and eight subjects (45 males, 63 females; average age 37.7 years) completed the tests: 82 were positively diagnosed with leprosy and 26 with diseases of different etiologies. The mean values of WPT (45-63 +/- 5.59), CPT (9.64 +/- 11.34) and WCPI 36.01 +/- 15.58) registered in leprosy-skin lesions were significantly different (P < 0.001) from lesions of diverse aetiologies and skin area without lesions. The cut-off point for WPT as determined from the ROC curve (receiver operating characteristic) was 35-10 degrees C, with a sensitivity of 90.2% and a specificity of 100%, and the corresponding cut-off point for CPT was 28.95 degrees C, with a sensitivity of 92.7% and a specificity of 100%. Nevertheless, all patients with leprosy presented a WCPI greater than 6.10 degrees C (ROC curve) in skin lesions. Increase in the thermal thresholds indicated warm hypoaesthesia, cold hypoaesthesia or both. The WCPI, which embraces both warm and cold perception thresholds, was the best indicator of thermal sensation, a term used in literature as a non-specific expression that does not describe warm and cold stimuli explicitly in terms of units of temperature.

The ML flow test as a point of care test for leprosy control programmes: potential effects on classification of leprosy patients.

OBJECTIVE: To evaluate the use of the ML Flow test as an additional, serological, tool for the classification of new leprosy patients. DESIGN: In Brazil, Nepal and Nigeria, 2632 leprosy patients were classified by three METHODS: : (1) as multibacillary (MB) or paucibacillary (PB) according to the number of skin lesions (WHO classification), (2) by slit skin smear examination, and (3) by serology using the ML Flow test detecting IgM antibodies to Mycobacterium leprae-specific phenolic glycolipid-I. RESULTS: The proportion of MB leprosy patients was 39.5, 35.6 and 19.4% in Brazil, Nepal and Nigeria, respectively. The highest seropositivity in patients was observed in Nigeria (62.9%), followed by Brazil (50.8%) and Nepal (35.6%). ML Flow test results and smears were negative in 69.1 and 82.7% of PB patients, while smears were positive in 58.6% of MB patients in Brazil and 28.3% in Nepal. In MB patients, both smears and ML Flow tests were negative in 15.6% in Brazil and 38.3%, in Nepal. Testing all PB patients with the ML Flow test to prevent under-treatment would increase the MB group by 18, 11 and 46.2% for Brazil, Nepal and Nigeria, respectively. Using the ML Flow test as the sole criterion for classification would result in an increase of 11.3 and 43.5% of patients requiring treatment for MB leprosy in Brazil and Nigeria, respectively, and a decrease of 3.7% for Nepal. CONCLUSIONS: The ML Flow test could be used to strengthen classification, reduce the risk of under-treatment and minimize the need for slit skin smears.

Estudo das alteraçöes oculares em hansenianos de controle ambulatorial / Study of ocular lesions in leprous outpatients

Foram examinados 997 pacientes hansenianos de controle ambulatorial, sendo que 528 (53%) eram da forma Virchowiana, 199 (20%) da forma Dimorfa, 167 (16,8%) da forma Tuberculoide e 103 (10,3%) da forma Indeterminada. 314 pacientes (31,5%) apresentavam alteraçöes do bulbo ocular, e essas manifestaçöes foram mais frequentes na forma Virchowiana e aumentaram de acordo com a idade do paciente e duraçäo da doença. Lesöes oculares severas foram achados raros e essa baixa incidência foi atribuída, em parte, ao tratamento sistêmico precoce