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1.
Int J Mycobacteriol ; 8(2): 208-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31210170

RESUMEN

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/microbiología , Lepra Lepromatosa/microbiología , Lepra Multibacilar/diagnóstico , Adulto , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Masculino , Piel/microbiología , Piel/patología
2.
J Clin Invest ; 129(5): 1926-1939, 2019 04 02.
Artículo en Inglés | MEDLINE | ID: mdl-30939123

RESUMEN

IL-26 is an antimicrobial protein secreted by Th17 cells that has the ability to directly kill extracellular bacteria. To ascertain whether IL-26 contributes to host defense against intracellular bacteria, we studied leprosy, caused by the obligate intracellular pathogen Mycobacterium leprae, as a model. Analysis of leprosy skin lesions by gene expression profiling and immunohistology revealed that IL-26 was more strongly expressed in lesions from the self-limited tuberculoid compared with expression in progressive lepromatous patients. IL-26 directly bound to M. leprae in axenic culture and reduced bacteria viability. Furthermore, IL-26, when added to human monocyte-derived macrophages infected with M. leprae, entered the infected cell, colocalized with the bacterium, and reduced bacteria viability. In addition, IL-26 induced autophagy via the cytoplasmic DNA receptor stimulator of IFN genes (STING), as well as fusion of phagosomes containing bacilli with lysosomal compartments. Altogether, our data suggest that the Th17 cytokine IL-26 contributes to host defense against intracellular bacteria.


Asunto(s)
Interleucinas/inmunología , Lepra Lepromatosa/microbiología , Lepra Tuberculoide/microbiología , Células Th17/inmunología , Autofagia , Citocinas/inmunología , Perfilación de la Expresión Génica , Humanos , Lisosomas/inmunología , Lisosomas/microbiología , Macrófagos/inmunología , Monocitos/citología , Mycobacterium leprae , Mycobacterium tuberculosis , Fagosomas/inmunología , Proteínas Recombinantes/inmunología , Transducción de Señal
3.
PLoS Negl Trop Dis ; 12(12): e0007035, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30592714

RESUMEN

BACKGROUND: Erythema nodosum leprosum (ENL) is a systemic inflammatory complication occurring mainly in patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL). Prednisolone is widely used for treatment of ENL reactions. However, it has been reported that prolonged treatment with prednisolone increases the risk for prednisolone-induced complications such as osteoporosis, diabetes, cataract and arteriosclerosis. It has been speculated that perhaps these complications result from lipid profile alterations by prednisolone. The effects of extended prednisolone treatment on lipid profiles in ENL patients have not been studied in leprosy patients with ENL reactions. Therefore, in this study we conducted a case-control study to investigate the changes in lipid profiles and serological responses in Ethiopian patients with ENL reaction after prednisolone treatment. METHODS: A prospective matched case-control study was employed to recruit 30 patients with ENL and 30 non-reactional LL patient controls at ALERT Hospital, Ethiopia. Blood samples were obtained from each patient with ENL reaction before and after prednisolone treatment as well as from LL controls. The serological host responses to PGL-1, LAM and Ag85 M. leprae antigens were measured by ELISA. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured by spectrophotometric method. RESULTS: The host antibody response to M. leprae PGL-1, LAM and Ag85 antigens were significantly reduced in patients with ENL reactions compared to LL controls after treatment. Comparison between patients with acute and chronic ENL showed that host-response to PGL-1 was significantly reduced in chronic ENL after prednisolone treatment. Untreated patients with ENL reactions had low lipid concentration compared to LL controls. However, after treatment, both groups had comparable lipid profiles except for LDL, which was significantly higher in patients with ENL reaction. Comparison within the ENL group before and after treatment showed that prednisolone significantly increased LDL and HDL levels in ENL patients and this was more prominent in chronic ENL than in acute patients with ENL. CONCLUSION: The significantly increased prednisolone-induced LDL and TG levels, particularly in patients with chronic ENL reactions, is a concern in the use of prednisolone for extended periods in ENL patients. The findings highlight the importance of monitoring lipid profiles during treatment of patients to minimize the long-term risk of prednisolone-induced complications.


Asunto(s)
Eritema Nudoso/sangre , Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Prednisolona/administración & dosificación , Adolescente , Adulto , Estudios de Casos y Controles , Colesterol/sangre , Eritema Nudoso/etiología , Eritema Nudoso/inmunología , Femenino , Humanos , Lepra Lepromatosa/microbiología , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Mycobacterium leprae/fisiología , Prednisolona/efectos adversos , Estudios Prospectivos , Triglicéridos/sangre , Adulto Joven
6.
Int J Mycobacteriol ; 7(2): 191-194, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29900900

RESUMEN

Erythema nodosum leprosum (ENL) is characterized by tender erythematous nodules, accompanied by fever, malaise, arthralgia, and systemic complications. Atypical clinical manifestations have been reported such as pustular, bullous, ulceration; livedo reticularis; erythema multiforme-like reaction; and Sweet's syndrome (SS)-like presentation. We reported a case of ENL reaction presenting as SS-like reaction in a borderline lepromatous leprosy patient.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Síndrome de Sweet/diagnóstico , Adulto , Eritema Nudoso/microbiología , Eritema Nudoso/patología , Humanos , Lepra Dimorfa/microbiología , Lepra Dimorfa/patología , Lepra Lepromatosa/microbiología , Lepra Lepromatosa/patología , Masculino , Mycobacterium leprae/genética , Mycobacterium leprae/aislamiento & purificación , Síndrome de Sweet/microbiología , Síndrome de Sweet/patología
7.
An Bras Dermatol ; 93(2): 181-184, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29723371

RESUMEN

BACKGROUND: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. OBJECTIVE: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. METHOD: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. RESULTS: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. STUDY LIMITATIONS: Small number of patients.. CONCLUSION: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/microbiología , Masculino , Neuritis/microbiología , Recurrencia , Retratamiento , Factores de Tiempo , Resultado del Tratamiento
8.
PLoS Negl Trop Dis ; 12(3): e0006341, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29522533

RESUMEN

BACKGROUND: Facial deformation as a sequela of leprosy is caused not only by a saddle nose but also by regression of the maxilla, as well documented in paleopathological observations of excavated skeletal remains of patients with leprosy. However, maxillary changes in living patients have been evaluated only by the subjective visual grading. Here, we attempted to evaluate maxillary bone deformation in patients with leprosy using three-dimensional computed tomography (3D-CT). METHODS: Three-dimensional images centered on the maxilla were reconstructed using multiplanar reconstruction methods in former patients with leprosy (n = 10) and control subjects (n = 5); the anterior-posterior length of the maxilla (MA-P) was then measured. The difference between the MA-P of the patients and those of controls was evaluated after compensating for individual skull size. These findings were also compared with those from previous paleopathological studies. FINDINGS: Three former patients with lepromatous leprosy showed marked atrophy of the maxilla at the prosthion (-8.6, -11.1 and -17.9 mm) which corresponded with the visual appearance of the maxillary deformity, and these results were consistent with paleopathological findings of excavated skeletal remains. Additionally, the precise bone defects of the maxilla could be individually calculated for accurate reconstructive surgery. INTERPRETATION: We have successfully illustrated maxillary bone deformities in living patients with leprosy. This study also confirmed the maxillary regression described in paleopathological studies.


Asunto(s)
Lepra Lepromatosa/patología , Maxilar/diagnóstico por imagen , Maxilar/patología , Anciano , Anciano de 80 o más Años , Atrofia , Anomalías Congénitas/diagnóstico por imagen , Cara , Femenino , Humanos , Imagenología Tridimensional , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/microbiología , Masculino , Maxilar/microbiología , Nariz/diagnóstico por imagen , Paleopatología , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X
9.
An. bras. dermatol ; 93(2): 181-184, Mar.-Apr. 2018. graf
Artículo en Inglés | LILACS | ID: biblio-887190

RESUMEN

Abstract: Background: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. Objective: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. Method: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. Results: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. Study limitations: Small number of patients.. Conclusion: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Humanos , Masculino , Femenino , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Recurrencia , Factores de Tiempo , Lepra Lepromatosa/microbiología , Resultado del Tratamiento , Retratamiento , Eritema Nudoso/microbiología , Lepra Multibacilar/microbiología , Leprostáticos/uso terapéutico , Neuritis/microbiología
11.
Microb Pathog ; 113: 427-431, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29170041

RESUMEN

Leprosy caused by Mycobacterium leprae is characterized by a spectrum of clinical manifestations that are determined by the predominant immunological profile of the host. The recruitment of leukocytes to the sites of injury can influence the development of these profiles. Cell adhesion molecules such as ICAM-1, VCAM-1 and CD62E participate in this process and their expression is regulated by transcriptions factors such as NFκB. To correlate the expression of cell adhesion molecules and NFκB (p65) in leprosy lesions, 30 skin biopsies of patients with leprosy [16 with the tuberculoid (TT) or borderline tuberculoid (BT) forms and 14 with the lepromatous (LL) or borderline lepromatous (BL) forms] were analyzed by immunohistochemistry. A larger mean number of cells expressing VCAM-1 (BT/TT: 18.28 ± 1.4; BL/LL: 10.67 ± 1.2; p = 0.0002), ICAM-1 (BT/TT: 9.92 ± 1.1; BL/LL: 5.87 ± 1.0; p = 0.0084) and CD62E (BT/TT: 13.0 ± 1.5; BL/LL: 2.58 ± 0.3; p = 0.0001) were observed in BT and TT lesions. The mean number of cells expressing NFκB was similar in the two clinical forms (BT/TT: 2.21 ± 2.7; BL/LL: 2.35 ± 3.1;p = 0.9285). No significant correlation was observed between expression of the transcription factor and adhesion molecules analyzed. The synthesis of ICAM-1, VCAM-1 and CD62E depends on the activation of NFκB, which acts synergistically with other transcription factors. Adequate activation of intracellular signaling pathways results in the production of endothelial adhesion molecules, contributing to the recruitment of cells to the site of injury and thus eliciting an effective inflammatory response in the elimination of the bacillus.


Asunto(s)
Inmunohistoquímica , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/patología , Factor de Transcripción ReIA/metabolismo , Factores de Transcripción/metabolismo , Biopsia , Selectina E/biosíntesis , Endotelio/patología , Humanos , Molécula 1 de Adhesión Intercelular/biosíntesis , Lepra Lepromatosa/microbiología , Leucocitos/inmunología , Leucocitos/microbiología , Microvasos , Mycobacterium leprae/patogenicidad , FN-kappa B/metabolismo , Piel/patología , Molécula 1 de Adhesión Celular Vascular/biosíntesis
12.
PLoS Negl Trop Dis ; 11(10): e0006011, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29028793

RESUMEN

BACKGROUND: Leprosy reactions are a significant cause of morbidity in leprosy population. Erythema nodosum leprosum (ENL) is an immunological complication affecting approximately 50% of patients with lepromatous leprosy (LL) and 10% of borderline lepromatous (BL) leprosy. ENL is associated with clinical features such as skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. ENL is treated mainly with corticosteroids and corticosteroids are often required for extended periods of time which may lead to serious adverse effects. High mortality rate and increased morbidity associated with corticosteroid treatment of ENL has been reported. For improved and evidence-based treatment of ENL, documenting the systems affected by ENL is important. We report here the clinical features of ENL in a cohort of patients with acute ENL who were recruited for a clinico-pathological study before and after prednisolone treatment. MATERIALS AND METHODS: A case-control study was performed at ALERT hospital, Ethiopia. Forty-six LL patients with ENL and 31 non-reactional LL matched controls were enrolled to the study and followed for 28 weeks. Clinical features were systematically documented at three visits (before, during and after predinsolone treatment of ENL cases) using a specifically designed form. Skin biopsy samples were obtained from each patient before and after treatment and used for histopathological investigations to supplement the clinical data. RESULTS: Pain was the most common symptom reported (98%) by patients with ENL. Eighty percent of them had reported skin pain and more than 70% had nerve and joint pain at enrolment. About 40% of the patients developed chronic ENL. Most individuals 95.7% had nodular skin lesions. Over half of patients with ENL had old nerve function impairment (NFI) while 13% had new NFI at enrolment. Facial and limb oedema were present in 60% patients. Regarding pathological findings before treatment, dermal neutrophilic infiltration was noted in 58.8% of patients with ENL compared to 14.3% in LL controls. Only 14.7% patients with ENL had evidence of vasculitis at enrolment. CONCLUSION: In our study, painful nodular skin lesions were present in all ENL patients. Only 58% patients had dermal polymorphonuclear cell infiltration showing that not all clinically confirmed ENL cases have neutrophilic infiltration in lesions. Very few patients had histological evidence of vasculitis. Many patients developed chronic ENL and these patients require inpatient corticosteroid treatment for extended periods which challenges the health service facility in resource poor settings, as well as the patient's quality of life.


Asunto(s)
Eritema Nudoso/patología , Eritema Nudoso/fisiopatología , Lepra Lepromatosa/patología , Lepra Lepromatosa/fisiopatología , Piel/patología , Adolescente , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Adulto , Biopsia , Estudios de Casos y Controles , Edema/etiología , Eritema Nudoso/tratamiento farmacológico , Etiopía/epidemiología , Extremidades , Femenino , Hospitales , Humanos , Lepra Dimorfa/complicaciones , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Infiltración Neutrófila , Dolor , Calidad de Vida , Piel/efectos de los fármacos , Piel/inmunología , Piel/microbiología , Vasculitis/etiología , Vasculitis/patología , Adulto Joven
13.
J Med Microbiol ; 66(11): 1640-1649, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28984227

RESUMEN

PURPOSE: A woman's skull, exhibiting features of lepromatous leprosy (LL), was recovered from a garden in Hoxne, Suffolk. The absence of post crania and lack of formal excavation meant that diagnosis and dating was uncertain. The aim of this research was to confirm the diagnosis using biomolecular means and second, to place it in context with other British leprosy cases using SNP genotyping and radiocarbon dating. METHODOLOGY: Bone from the skull was analysed by ancient DNA (aDNA) methods and subjected to radiocarbon dating. As a result, stable carbon and nitrogen isotope values were produced, both useful for assessing aspects of the woman's diet.Results/Key findings. aDNA confirmed the presence of mycobacterium leprae and genotyping demonstrated an ancestral variant of subtype 3I, the same lineage recently identified in living squirrels in the south of England. Radiocarbon dating revealed the woman lived approximately between 885-1015 AD, providing evidence for endurance of this subtype in East Anglia, having been previously identified as early as the fifth-sixth century (Great Chesterford) and as late as the thirteenth century (Ipswich). CONCLUSIONS: The confirmation of a new pre-Norman leprosy case in East Anglia is of interest as this is where a high proportion of cases are located. Possible factors for this may include preservation and excavation biases, population density, but also connection and trade, possibly of fur, with the continent. Future research on other British LL cases should focus on exploring these aspects to advance understanding of the disease's history, here and on the continent.


Asunto(s)
Lepra Lepromatosa/epidemiología , Mycobacterium leprae/genética , Mycobacterium leprae/aislamiento & purificación , Adulto , Femenino , Genotipo , Historia Medieval , Humanos , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/historia , Lepra Lepromatosa/microbiología , Mycobacterium leprae/clasificación , Osteología , Cráneo/microbiología , Reino Unido
14.
Emerg Infect Dis ; 23(11): 1864-1866, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-29048278

RESUMEN

We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Clinicians should consider this pathogen in the diagnosis of patients with symptoms of leprosy who have traveled to endemic areas.


Asunto(s)
Eritema/diagnóstico , Lepra Lepromatosa/diagnóstico , Mycobacterium/aislamiento & purificación , Eritema/microbiología , Eritema/patología , Cara/patología , Humanos , Lepra Lepromatosa/microbiología , Lepra Lepromatosa/patología , Masculino , Persona de Mediana Edad , Mycobacterium/genética , Viaje
15.
Am J Dermatopathol ; 39(11): 857-859, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28763338

RESUMEN

Erythema nodosum leprosum (ENL) may uncommonly present before treatment in patients with multibacillary leprosy. Atypical manifestations are known in ENL and may be clinically misleading. Such wide variations in the clinical presentation of leprosy in reaction make histopathology an important tool for supporting clinical diagnosis. We report bullous ENL presenting as the first manifestation of leprosy in a 30-year-old Indian man diagnosed using histopathology.


Asunto(s)
Eritema Nudoso/patología , Lepra Lepromatosa/patología , Lepra Multibacilar/patología , Piel/patología , Adulto , Antibacterianos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/microbiología , Humanos , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/microbiología , Masculino , Valor Predictivo de las Pruebas , Piel/efectos de los fármacos , Piel/microbiología
16.
Microbes Infect ; 19(11): 505-514, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28684130

RESUMEN

Our previous study has demonstrated that IL-10 may modulate both indoleamine 2,3-dioxygenase (IDO) and CD163 expression in lepromatous leprosy (LL) cells, favoring Mycobacterium leprae persistence through induction of regulatory pathways and iron storage. Here, we observed that in LL lesion cells there is an increase in the expression of proteins involved in iron metabolism such as hemoglobin (Hb), haptoglobin, heme oxygenase 1 and transferrin receptor 1 (TfR1) when compared to tuberculoid leprosy (BT) cells. We also found increased iron deposits and diminished expression of the iron exporter ferroportin 1 in LL lesion cells. Hemin, but not FeSO4 stimulation, was able to enhance M. leprae viability by a mechanism that involves IDO. Analysis of cell phenotype in lesions demonstrated a predominance of M2 markers in LL when compared with BT lesion cells. A positive correlation between CD163 and PPARG with the bacillary index (BI) was observed. In contrast, TNF, STAT1 and CSF2 presented a negative correlation with the BI. In summary, this study demonstrates that iron may regulate IDO expression by a mechanism that involves IL-10, which may contribute for the predominance of M2-like phenotype in LL lesions that favors the phagocytosis and maintenance of M. leprae in host cells.


Asunto(s)
Indolamina-Pirrol 2,3,-Dioxigenasa/fisiología , Hierro/fisiología , Mycobacterium leprae/fisiología , Adulto , Femenino , Humanos , Immunoblotting , Técnicas para Inmunoenzimas , Indolamina-Pirrol 2,3,-Dioxigenasa/metabolismo , Hierro/metabolismo , Lepra Lepromatosa/metabolismo , Lepra Lepromatosa/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
18.
Infect Disord Drug Targets ; 17(3): 223-226, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28558644

RESUMEN

BACKGROUND: Subcutaneous phaeohyphomycosis is an infection caused by melanized fungi and is increasingly reported among immunosuppressive patients. The most commonly cited etiologic agent is Exophiala jeanselmei, followed by Alternaria spp. We present a case of subcutaneous phaeohyphomycosis in a 48-yearold woman, with a history of lepromatous leprosy, using corticosteroid in immunosuppressive doses due to a type 2 repetitive reaction leprosy outbreak. RESULT AND DISCUSSION: The diagnosis was confirmed by fine-needle aspiration of the secretion, with subsequent direct mycological observations, culture and molecular analysis. The species agent was identified by culture and nucleotide sequences of ribosomal DNA as Exophiala dermatitidis.


Asunto(s)
Exophiala/aislamiento & purificación , Lepra Lepromatosa/complicaciones , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Corticoesteroides/uso terapéutico , Biopsia con Aguja Fina , ADN Ribosómico , Exophiala/genética , Femenino , Humanos , Huésped Inmunocomprometido , Lepra Lepromatosa/microbiología , Persona de Mediana Edad , Feohifomicosis/diagnóstico
20.
Int J Mycobacteriol ; 6(1): 1-8, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28317797

RESUMEN

OBJECTIVE/BACKGROUND: Clinical diagnosis of indeterminate and tuberculoid leprosy is often difficult due to limited and confounding signs and symptoms. In the current study, we evaluated the utility of new multiplex polymerase chain reaction (PCR) using Mycobacterium leprae-specific DNA sequences in the pseudogene regions of ML1545, ML2180, and ML2179 for PCR-based diagnosis of indeterminate leprosy (IND) and leprosy cases across the immunological spectrum. The sensitivity was compared with that of RLEP PCR. METHODS: DNA was extracted from paraffin-embedded skin biopsy specimens of 220 leprosy cases, which were divided into IND (41), tuberculoid form (3), borderline tuberculoid (42), midborderline (3), borderline lepromatous (n=59), and lepromatous leprosy (72) cases. PCR positivity of both multiplex and RLEP PCR were compared in all the samples. A decision tree was constructed using the classification and regression trees algorithm to predict the probability of PCR positivity with the new multiplex PCR scheme in various clinical groups of leprosy. Sensitivity of each pseudogene target was determined using real-time PCR assays, and specificity was confirmed by PCR amplification of DNA extracted from three other mycobacterial species and skin biopsies of 44 non-leprosy cases. RESULTS: A multiplex PCR positivity of 75.61% was noted in IND cases when compared to that of 58.54% using RLEP PCR (P < 0.05). Enhanced multiplex PCR positivity was noted across various clinical groups in comparison to RLEP PCR. The decision tree classifier has predicted statistically significant probability for multiplex PCR positivity among RLEP-PCR negative group and clinical groups with a low bacillary load. CONCLUSION: This new multiplex PCR scheme can support the diagnosis of indeterminate and tuberculoid forms of leprosy with limited clinical manifestations and can be implemented in basic clinical/diagnostic setting that possess conventional PCR facilities.


Asunto(s)
Lepra Lepromatosa/diagnóstico , Lepra Paucibacilar/diagnóstico , Lepra Tuberculoide/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Mycobacterium leprae/genética , Adolescente , Adulto , Biopsia , Niño , Preescolar , ADN Bacteriano , Árboles de Decisión , Femenino , Humanos , Lactante , Lepra Lepromatosa/microbiología , Lepra Paucibacilar/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Seudogenes/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Sensibilidad y Especificidad , Piel/microbiología , Piel/patología , Adulto Joven
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