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1.
Open Forum Infect Dis ; 9(3): ofac036, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35169594

RESUMO

BACKGROUND: Immunological biomarkers have often been used as a complementary approach to support clinical diagnosis in several infectious diseases. The lack of commercially available laboratory tests for conclusive early diagnosis of leprosy has motivated the search for novel methods for accurate diagnosis. In the present study, we describe an integrated analysis of a cytokine release assay using a machine learning approach to create a decision tree algorithm. This algorithm was used to classify leprosy clinical forms and monitor household contacts. METHODS: A model of Mycobacterium leprae antigen-specific in vitro assay with subsequent cytokine measurements by enzyme-linked immunosorbent assay was employed to measure the levels of tumor necrosis factor (TNF), interferon-γ, interleukin 4, and interleukin 10 (IL-10) in culture supernatants of peripheral blood mononuclear cells from patients with leprosy, healthy controls, and household contacts. Receiver operating characteristic curve analysis was carried out to define each cytokine's global accuracy and performance indices to identify clinical subgroups. RESULTS: Data demonstrated that TNF (control culture [CC]: AUC = 0.72; antigen-stimulated culture [Ml]: AUC = 0.80) and IL-10 (CC: AUC = 0.77; Ml: AUC = 0.71) were the most accurate biomarkers to classify subgroups of household contacts and patients with leprosy, respectively. Decision tree classifier algorithms for TNF analysis categorized subgroups of household contacts according to the operational classification with moderate accuracy (CC: 79% [48/61]; Ml: 84% [51/61]). Additionally, IL-10 analysis categorized leprosy patients' subgroups with moderate accuracy (CC: 73% [22/30] and Ml: 70% [21/30]). CONCLUSIONS: Together, our findings demonstrated that a cytokine release assay is a promising method to complement clinical diagnosis, ultimately contributing to effective control of the disease.

2.
In. Soares, Cleverson Teixeira. Histopathological diagnosis of leprosy. Sharjah, Bentham Science Publishers;Bentham Books, 2021. p.151-179, graf, tab, ilus.
Monografia em Inglês | SES-SP, SES-SP, HANSEN, HANSENIASE, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1292182

RESUMO

Type 2 reaction (t2R), also called erythema nodosum leprosum (ENL), is a reactional phenomenon that occurs in response to Mycobacterium leprae antigens in patients with borderline lepromatous our lepromatous forms of leprosy. T2R usually occurs after starting treatment and can affect any parasitic tissue in the body, causing neuritis, arthritis, painful lymphadenitis, buccopharyngeal lesions, laryngitis, hepatomegaly, splenomegaly, bone injuries, iridocyclitis, uveitis, orchitis, glomerulitis with proteinuria, and hematuria. Recognition of the histopathological characteristics of T2R is important for guiding early treatmen tof the reaction process, decreasing the likelihood of developing serious sequelae, especially when T2R affects the nerves, and to exclude different diseases that can simulate T2R over leprosy lesions during the T2R diagnosis are described, and some of its differential clinicopathological diagnoses and their possible pathophysiological mechanisms are discussed.


Assuntos
Hanseníase Virchowiana , Eritema Nodoso , Hanseníase/complicações , Sinais e Sintomas
3.
Artigo em Inglês | MEDLINE | ID: mdl-33037158

RESUMO

BACKGROUND: The biophysical and ultrasonographic properties of the skin change in papulosquamous diseases. AIMS: : To identify biophysical and ultrasonographic properties for the differentiation of five main groups of papulosquamous skin diseases. METHODS: Fifteen biophysical and ultrasonographic parameters were measured by multiprobe adapter system and high-frequency ultrasonography in active lesions and normal control skin in patients with chronic eczema, psoriasis, lichen planus, pityriasis rosea and parapsoriasis/mycosis fungoides. Using histological diagnosis as a gold standard, a decision tree analysis was performed based on the mean percentage changes of these parameters [(lesion-control/control) ×100] for differentiation of the diseases. RESULTS: The accuracy of the decision tree model for differentiation of five diseases was 67% which developed based on changes in stratum corneum hydration, epidermal thickness, skin pH, melanin index, R0 (reciprocal of firmness) and erythema. Among the flowcharts for pairs of diseases, three models for differentiation had high accuracy (> 95%): those of psoriasis from lichen planus, pityriasis rosea, and parapsoriasis/mycosis fungoides. LIMITATIONS: Validation studies on a larger sample size in situations where the diagnosis is unclear are needed to confirm the accuracy and applicability of decision trees. CONCLUSION: Skin biophysical and ultrasonographic properties may help in the differentiation of papulosquamous diseases as simple and non-invasive tools.


Assuntos
Árvores de Decisões , Dermatopatias Papuloescamosas/diagnóstico por imagem , Dermatopatias Papuloescamosas/patologia , Adulto , Biometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Dermatopatias Papuloescamosas/fisiopatologia , Fenômenos Fisiológicos da Pele , Ultrassonografia , Adulto Jovem
4.
J Am Acad Dermatol ; 83(1): 1-14, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32229279

RESUMO

Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.


Assuntos
Hanseníase/diagnóstico , Diagnóstico Diferencial , Doenças Endêmicas , Saúde Global , Humanos , Incidência , Hanseníase/classificação , Hanseníase/epidemiologia , Hanseníase/microbiologia , Prevalência
5.
Dermatol Clin ; 36(4): 369-375, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30201146

RESUMO

Although diagnosis of cutaneous granulomatous disorders (CGDs) is usually suspected based on morphologic findings, localization, and anamnestic data, clinical differentiation from each other and from similar dermatoses may be challenging. Recently, dermatoscopy has been demonstrated to be a useful tool for assisting the recognition of several CGDs. This article provides a current overview of the dermatoscopic features of the main noninfectious and infectious CGDs, including sarcoidosis, necrobiosis lipoidica, granuloma annulare, rheumatoid nodules, and leishmaniasis. Other, less common, CGDs are briefly addressed, including granulomatous rosacea, acne agminata, and leprosy.


Assuntos
Dermoscopia , Sarcoidose/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem , Granuloma Anular/diagnóstico por imagem , Humanos , Leishmaniose Cutânea/diagnóstico por imagem , Hanseníase Dimorfa/diagnóstico por imagem , Lúpus Vulgar/diagnóstico por imagem , Necrobiose Lipoídica/diagnóstico por imagem , Nódulo Reumatoide/diagnóstico por imagem
6.
Dermatol Clin ; 35(2): 135-144, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28317523

RESUMO

Vitiligo has a variety of presentations, including focal, acrofacial, segmental, and generalized forms. Thorough knowledge of these presentations is important to make the correct diagnosis. Signs of activity are important to recognize so that treatment is optimized. Clinical findings of confettilike depigmentation, trichrome and inflammatory vitiligo, and the Koebner phenomenon should alert the clinician that a patient's disease is likely to worsen. These patients may require systemic treatment to stabilize their disease. Many other skin disorders present with hypopigmentation or depigmentation and must be distinguished to determine the right diagnosis, advise the patient on prognosis, and prescribe the correct treatment.


Assuntos
Hipopigmentação/diagnóstico , Vitiligo/diagnóstico , Diagnóstico Diferencial , Doença Enxerto-Hospedeiro/complicações , Humanos , Hipopigmentação/etiologia , Hanseníase Tuberculoide/complicações , Líquen Escleroso e Atrófico/complicações , Lúpus Eritematoso Discoide/complicações , Piebaldismo/diagnóstico , Pitiríase/complicações , Tinha Versicolor/complicações
7.
Diagn Microbiol Infect Dis ; 86(2): 163-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27506457

RESUMO

Mycobacterium leprae-specific serological and cell-mediated-immunity/CMI test were evaluated for the differential diagnosis of multibacillary/MB, and paucibacillary/PB leprosy from other dermatoses. Whole-blood assay/WBA/IFNγ stimulated with LID-1 antigen and ELISA tests for IgG to LID-1 and IgM to PGL-I were performed. WBA/LID-1/IFNγ production was observed in 72% PB, 11% MB leprosy, 38% dermatoses, 40% healthy endemic controls/EC. The receiver operating curve/ROC for WBA/LID-1 in PB versus other dermatoses showed 72.5% sensitivity, 61.5% specificity and an area-under-the-curve/AUC=0.75; 74% positive predictive value/PPV, 59% negative predictive value/NPV. Anti PGL-I serology was positive in 67% MB, 8% PB leprosy, 6% of other dermatoses; its sensitivity for MB=66%, specificity=93%, AUC=0.89; PPV=91%, NPV=72%. Anti-LID-1 serology was positive in 87% MB, 7% PB leprosy, all other participants were seronegative; 87.5% sensitivity for MB, 100% specificity, AUC=0.97; PPV=100%, NPV=88%. In highly endemic areas anti-LID-1/PGL-I serology and WBA/LID-1-represent useful tools for the differential diagnosis of leprosy from other confounding dermatoses.


Assuntos
Testes Diagnósticos de Rotina/métodos , Imunoensaio/métodos , Hanseníase/diagnóstico , Mycobacterium leprae/imunologia , Dermatopatias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Adulto Jovem
8.
Int J Paleopathol ; 4: 17-24, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29539498

RESUMO

An early 15th-century burial from a basilica at Polis Chrysochous provides the first archaeological evidence of leprosy in Cyprus, extending the temporal depth and illuminating the biological and social history of this disease on the island. The skeletal remains of a young adult female (age 20-34 years) display pathognomonic features of lepromatous leprosy including maxillary alveolar resorption with antemortem loss of all but one incisor, remodeling of the margin of the nasal sill and resorption of the anterior nasal spine, with diaphyseal remodeling of hand and foot phalanges and the distal third through fifth metatarsals of both feet. Periosteal reaction on distal tibiae and the majority of both fibulae demonstrates tracking of inflammation from the feet to lower legs. Use wear on the remaining maxillary incisor signals participation in common occupational activities in life. Although disfigured and debilitated, burial inside the narthex of the basilica indicates that the community did not ostracize this woman in death. This contextualized analysis provides insight into the biological and social consequences of living with leprosy and illustrates the changing attitudes toward those afflicted with this disease in Cyprus.

9.
Rev. AMRIGS ; 54(2): 182-185, abr.-jun. 2010. ilus
Artigo em Português | LILACS | ID: lil-685605

RESUMO

A hanseníase é uma doença infectocontagiosa com várias apresentações clínicas, a depender da resposta imunológica do paciente. Os autores relatam o caso de uma paciente com o diagnóstico clínico e histopatológico iniciais de dermatomiosite que obteve melhora após o uso de corticosteróide sistêmico. Entretanto, uma reavaliação da paciente, com um exame físico minucioso, reorientou o diagnóstico para o correto: hanseníase


Leprosy is an infectious disease with various clinical presentations, depending on the patient’s immune response. The authors report a case of a patient with initial clinical and histopathological diagnosis of dermatomyositis which improved after therapy with systemic corticosteroid. However, a reassessment of the patient, with a careful physical examination, redirected to the correct diagnosis: leprosy


Assuntos
Dermatomiosite/diagnóstico , Hanseníase Virchowiana/diagnóstico , Exame Físico
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