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1.
Int J Dermatol ; 58(12): 1415-1422, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31148144

RESUMEN

BACKGROUND: Dermatological diseases have a negative impact on quality of life (QoL), affecting mental and physical health. Leprosy patients usually present with a worse QoL compared with those affected by other conditions. Reactions, neural damage, and pain are some of the consequences that contribute to the lower QoL. However, due to the wide spectrum of the disease, symptoms vary according to leprosy's subtype. This study aimed to compare the QoL between paucibacillary and multibacillary leprosy patients. Individuals were also compared considering the presence of reactions and a correlation between questionnaires was performed. METHODS: A total of 104 patients with leprosy aged 18 years old and over were selected. QoL was assessed by the Brazilian-Portuguese validated versions of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the Dermatology Life Quality Life Index (DLQI). RESULTS: Multibacillary patients showed a more impaired physical function, worse bodily pain, lower score of SF-36, and higher interference of skin on the performance of daily activities when compared to the paucibacillary group. Individuals without reactions presented lower bodily pain and less effect of the skin on clothing choices compared to those with reactions. The SF-36 domains exhibited weak correlations with most DLQI questions, and the linear regression model showed that 32% of changes in QoL were related to the skin aspect. CONCLUSIONS: Multibacillary leprosy patients have a worse QoL when compared to paucibacillary patients. Reactions played a small role in the QoL of our cohort of patients.


Asunto(s)
Lepra Multibacilar/psicología , Lepra Paucibacilar/psicología , Dolor/psicología , Calidad de Vida , Adulto , Brasil , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Lepra Multibacilar/complicaciones , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/microbiología , Lepra Paucibacilar/complicaciones , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Dolor/diagnóstico , Dolor/etiología , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Piel/microbiología , Piel/patología
2.
PLoS Negl Trop Dis ; 13(4): e0007318, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31017900

RESUMEN

BACKGROUND: Leprosy, caused by Mycobacterium leprae, affects over 200,000 people annually worldwide and remains endemic in the ethnically diverse, mountainous and underdeveloped southwestern provinces of China. Delayed diagnosis of leprosy persists in China, thus, additional knowledge to support early diagnosis, especially early diagnosis of paucibacillary (PB) patients, based on the host immune responses induced by specific M. leprae antigens is needed. The current study aimed to investigate leprosy patients and controls in Southwest China by comparing supernatants after stimulation with specific M. leprae antigens in an overnight whole-blood assay (WBA) to determine whether host markers induced by specific M. leprae antigens improve the diagnosis or discrimination of PB patients with leprosy. METHODOLOGY/PRINCIPAL FINDINGS: Leprosy patients [13 multibacillary (MB) patients and 7 PB patients] and nonleprosy controls [21 healthy household contacts (HHCs), 20 endemic controls (ECs) and 19 tuberculosis (TB) patients] were enrolled in this study. The supernatant levels of ten host markers stimulated by specific M. leprae antigens were evaluated by overnight WBA and multiplex Luminex assays. The diagnostic value in PB patients and ECs and the discriminatory value between PB patients and HHCs or TB patients were evaluated by receiver operator characteristics (ROC) analysis. ML2044-stimulated CXCL8/IL-8 achieved the highest sensitivity of 100%, with a specificity of 73.68%, for PB diagnosis. Compared to single markers, a 3-marker combination model that included ML2044-induced CXCL8/IL-8, CCL4/MIP-1 beta, and IL-6 improved the diagnostic specificity to 94.7% for PB patients. ML2044-stimulated IL-4 and CXCL8/IL-8 achieved the highest sensitivity (85.71% and 100%) and the highest specificity (95.24% and 84.21%) for discriminating PB patients from HHCs and TB patients, respectively. CONCLUSIONS: Our findings suggest that the host markers induced by specific M. leprae antigens in an overnight WBA increase diagnostic and discriminatory value in PB patients with leprosy, with a particularly strong association with interleukin 8.


Asunto(s)
Antígenos Bacterianos/inmunología , Sangre/inmunología , Inmunidad Innata , Inmunoensayo/métodos , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/inmunología , Mycobacterium leprae/inmunología , Adulto , China , Citocinas/análisis , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Masculino , Curva ROC , Sensibilidad y Especificidad , Adulto Joven
3.
PLoS Negl Trop Dis ; 13(3): e0007284, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30883558

RESUMEN

BACKGROUND: The reduced amounts of Mycobacterium leprae (M. leprae) among paucibacillary (PB) patients reflect the need to further optimize methods for leprosy diagnosis. An increasing number of reports have shown that droplet digital polymerase chain reaction (ddPCR) is a promising tool for diagnosis of infectious disease among samples with low copy number. To date, no publications have investigated the utility of ddPCR in the detection of M. leprae. The aim of this study was to develop and evaluate a ddPCR assay for the diagnosis of PB leprosy. METHODOLOGY: The two most sensitive DNA targets for detection of M. leprae were selected from electronic databases for assessment of sensitivity and specificity by quantitative polymerase chain reaction (qPCR) and ddPCR. Control patients (n = 59) suffering from other dermatological diseases were used to define the cut-off of the duplex ddPCR assay. For comparative evaluation, qPCR and ddPCR assays were performed in 44 PB patients and 68 multibacillary (MB) patients. PRINCIPAL FINDINGS: M. leprae-specific repetitive element (RLEP) and groEL (encoding the 65 kDa molecular chaperone GroEL) were used to develop the ddPCR assay by systematically analyzing specificity and sensitivity. Based on the defined cut-off value, the ddPCR assay showed greater sensitivity in detecting M. leprae DNA in PB patients compared with qPCR (79.5% vs 36.4%), while both assays have a 100% sensitivity in MB patients. CONCLUSIONS/SIGNIFICANCE: We developed and evaluated a duplex ddPCR assay for leprosy diagnosis in skin biopsy samples from leprosy patients. While still costly, ddPCR might be a promising diagnostic tool for detection of PB leprosy.


Asunto(s)
Lepra Paucibacilar/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium leprae/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Piel/microbiología , Adolescente , Adulto , Anciano , Biopsia , Chaperonina 60/genética , Femenino , Humanos , Secuencias Repetitivas Esparcidas , Masculino , Persona de Mediana Edad , Mycobacterium leprae/genética , Sensibilidad y Especificidad , Adulto Joven
4.
PLoS Negl Trop Dis ; 13(3): e0007147, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30835722

RESUMEN

OBJECTIVE: The diagnosis of paucibacillary (PB) leprosy cases remains a challenge because of the absence of a confirmatory laboratory method. While quantitative polymerase chain reaction (qPCR) has been shown to provide reliable sensitivity and specificity in PB diagnoses, a thorough investigation of its efficacy in clinical practice has not yet been published. The present study evaluated patients with suspected leprosy skin lesions by using qPCR to identify PB individuals in the Leprosy Outpatient clinic at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. METHODS: One hundred seventy-two suspected PB cases were included in the study. The patients were evaluated by a dermatologist at three different times. The clinical dermato-neurological examination and collected samples were performed on the first visit. On the second visit, the results of the histopathological analysis and PCR assay (DNA-based Mycobacterium leprae qPCR-targeting 16S gene) results were analyzed, and a decision regarding multi-drug therapy was made. A year later, the patients were re-examined, and the consensus diagnosis was established. RESULTS: In 58% (100/172) of cases, a conclusive diagnosis via histopathological analysis was not possible; however, 30% (30/100) of these cases had a positive PCR. One hundred ten patients (110/172) attended the third visit. The analysis showed that while the sensitivity of the histopathological test was very low (35%), a qPCR alone was more effective for identifying leprosy, with 57% sensitivity. CONCLUSION: The use of qPCR in suspected PB cases with an inconclusive histology improved the sensitivity of leprosy diagnoses.


Asunto(s)
Lepra Paucibacilar/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium leprae/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Adolescente , Adulto , Anciano , Brasil , ADN Bacteriano/genética , ADN Ribosómico/genética , Femenino , Histocitoquímica , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium leprae/genética , Pacientes Ambulatorios , ARN Ribosómico 16S/genética , Sensibilidad y Especificidad , Adulto Joven
5.
BMC Infect Dis ; 19(1): 22, 2019 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-30616580

RESUMEN

BACKGROUND: Early detection of leprosy and multidrug therapy are crucial to achieve zero transmission and zero grade II incapacities goals of World Health Organization. Leprosy is difficult to diagnose because clinical forms vary and there are no gold standard methods to guide clinicians. The serological rapid tests aid the clinical diagnosis and are available for field use. They are easy to perform, do not require special equipment or refrigeration and are cheaper than the molecular tests. METHODS: We evaluated the performance of two rapid serological tests (PGL1 and NDO-LID) in the discrimination of leprosy cases from healthy individuals at the Alfredo da Matta Foundation, a reference center for the disease in Manaus, Amazonas, Brazil. PGL1 and NDO-LID rapid tests are capable of detecting specific antibodies of M. leprae, IgM and IgM/IgG, respectively. A total of 530 healthy subjects and 171 patients (50 with paucibacillary and 121 multibacillary leprosy) were included in the study. RESULTS: Among the paucibacillary leprosy patients, the sensitivity was 34.0 and 32.0% for the NDO-LID and PGL1, respectively. In multibacillary leprosy patients, the NDO-LID sensitivity was 73.6% and the PGL1 was 81.0%. Serological tests demonstrated specificities of 75.9% for PGL-1 and 81.7% for NDO-LID. The positive predictive value (PPV), negative predictive value (NPV) and accuracy in multibacillary patients were 47.9, 93.1, and 80.2% respectively for the NDO-LID, and 43.4, 94.6 76.8% for PGL1. CONCLUSIONS: The tests showed limited capacity in the diagnosis of the disease, however, the high negative predictive value of the tests indicates a greater chance of true negatives in this group favoring exclusion of leprosy. This characteristic of the ML flow test is important in aiding clinical Diagnosis, especially in a region endemic to the disease and with other confounding skin conditions.


Asunto(s)
Antígenos Bacterianos/inmunología , Glucolípidos/inmunología , Lepra/diagnóstico , Pruebas Serológicas/métodos , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Brasil , Estudios de Casos y Controles , Niño , Diagnóstico Precoz , Femenino , Humanos , Lepra/sangre , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Sensibilidad y Especificidad
8.
Medicine (Baltimore) ; 97(32): e11616, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30095620

RESUMEN

INTRODUCTION: Leprosy is a chronic infectious granulomas disease caused by Mycobacterium leprae that can manifest as a wide variety of immunological and clinical features. CASE SUMMARY: Here, we describe the case of a woman with clinical characteristics of borderline tuberculoid (BT) leprosy that manifested as 3 asymmetric skin lesions involving her hip and lower limbs. This unusual presentation was initially misdiagnosed as sarcoidosis because noncaseating granulomas are a histopathological feature of both diseases. Differentiation and the diagnosis of BT leprosy was achieved using real-time polymerase chain reaction (PCR) to amplify an M leprae specific DNA sequence and to detect serum antibodies specific to M leprae antigens. Accordingly, a 6-month course of multidrug therapy led to a marked improvement in the skin lesions. CONCLUSION: The use of auxiliary tests including real-time PCR to amplify an M leprae-specific DNA sequence, enzyme-linked immunosorbent assay, and dipstick detection of serum antibodies specific to M leprae antigens are good methods to obtain a correct diagnosis of BT leprosy.


Asunto(s)
Lepra Paucibacilar/diagnóstico , Enfermedades Cutáneas Bacterianas/diagnóstico , Adulto , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Antígenos Bacterianos/inmunología , Diagnóstico Diferencial , Femenino , Humanos , Mycobacterium leprae/inmunología , Reacción en Cadena en Tiempo Real de la Polimerasa , Sarcoidosis/diagnóstico
9.
Int J Dermatol ; 57(9): 1107-1113, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29809278

RESUMEN

BACKGROUND: Various clinical criteria are used to categorize leprosy patients into paucibacillary (PB) and multibacillary (MB), thus aiding in appropriate treatment. However, comprehensive studies validating these criteria are minimal. AIMS: To assess sensitivity and specificity of different clinical criteria individually and in combination for classifying leprosy into PB/MB spectrum. METHOD: A prospective study was conducted wherein 50 newly diagnosed, untreated leprosy cases were recruited and classified into PB and MB using the following clinical criteria: number of skin lesions (NSL), number of body areas affected (NBAA), and size of largest skin lesion (SLSL). Patients with pure neuritic leprosy, diffuse macular type of lepromatous leprosy, and with reactions were excluded. Sensitivity and specificity of these clinical criteria in classification was calculated taking histopathological findings as gold standard. RESULTS: Among 50 patients, 37 were males and 13 were females with a mean age of 32.08 ± 16.55 years. The sensitivity and specificity of NSL, NBAA, and SLSL was 94.74 and 87.1%, 94.74 and 61.29%, and 73.68 and 16.13%, respectively. Combining all three criteria, the sensitivity increased to 100%, but specificity decreased drastically to 12.9%. The ROC curve for NSL, NBAA, and SLSL showed a cutoff of ≥6 skin lesions, ≥3 body areas affected, and ≤2 cm lesion to classify as MB. CONCLUSION: The current WHO system of leprosy classification based on NSL seems to be best among available clinical criteria. Uniform and sensible application of this criteria itself assures appropriate categorizing and leprosy treatment with reasonable sensitivity and specificity.


Asunto(s)
Lepra Multibacilar/clasificación , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/clasificación , Lepra Paucibacilar/diagnóstico , Adolescente , Adulto , Femenino , Humanos , India , Lepra Multibacilar/patología , Lepra Paucibacilar/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Centros de Atención Terciaria , Adulto Joven
10.
Mem Inst Oswaldo Cruz ; 113(5): e170467, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29513821

RESUMEN

BACKGROUND Leprosy remains a health problem in many countries, with difficulties in diagnosis resulting in delayed treatment and more severe disabilities. Antibodies against several Mycobacterium leprae antigens have, however, shown value as diagnostic and/or prognostic markers. OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM and IgG subclass reactivity against three M. leprae specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide bound to human serum albumin; LID-1, the fusion protein product of the ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO. METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB) leprosy patients, and their respective household contacts, were evaluated for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies by enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of each ELISA were evaluated by receiver operating characteristic (ROC) curve analysis. FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are markedly increased in MB patients. For the first time, our data reveal a selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in MB patients, demonstrating that these antibody isotypes are suitable for differentiation between MB and PB patients. ROC curve analysis indicates an improved capacity for diagnosing MB leprosy patients using the detection of IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID over the performance levels attained with NDO-HSA. CONCLUSIONS Our findings indicate that serological tests based on the detection of antigen-specific IgG1 antibodies are a useful tool to differentiate MB from PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID antigens in the serodiagnosis of leprosy.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Estudios de Casos y Controles , Trazado de Contacto , Ensayo de Inmunoadsorción Enzimática , Humanos , Lepra Multibacilar/inmunología , Lepra Paucibacilar/inmunología , Mycobacterium leprae/inmunología , Curva ROC , Sensibilidad y Especificidad
11.
PLoS Negl Trop Dis ; 12(2): e0006261, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29481570

RESUMEN

BACKGROUND: The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing. METHODOLOGY/PRINCIPAL FINDINGS: This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children's cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate. CONCLUSIONS/SIGNIFICANCE: This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization's goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease's transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.


Asunto(s)
Trazado de Contacto , Lepra Paucibacilar/epidemiología , Lepra Paucibacilar/transmisión , Lepra/epidemiología , Lepra/transmisión , Adolescente , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Familia , Femenino , Humanos , Lepra/diagnóstico , Lepra/microbiología , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/microbiología , Masculino , Mycobacterium leprae , Prevalencia , Instituciones Académicas
12.
Mem. Inst. Oswaldo Cruz ; 113(5): e170467, 2018. tab, graf
Artículo en Inglés | LILACS | ID: biblio-894925

RESUMEN

BACKGROUND Leprosy remains a health problem in many countries, with difficulties in diagnosis resulting in delayed treatment and more severe disabilities. Antibodies against several Mycobacterium leprae antigens have, however, shown value as diagnostic and/or prognostic markers. OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM and IgG subclass reactivity against three M. leprae specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide bound to human serum albumin; LID-1, the fusion protein product of the ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO. METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB) leprosy patients, and their respective household contacts, were evaluated for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies by enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of each ELISA were evaluated by receiver operating characteristic (ROC) curve analysis. FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are markedly increased in MB patients. For the first time, our data reveal a selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in MB patients, demonstrating that these antibody isotypes are suitable for differentiation between MB and PB patients. ROC curve analysis indicates an improved capacity for diagnosing MB leprosy patients using the detection of IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID over the performance levels attained with NDO-HSA. CONCLUSIONS Our findings indicate that serological tests based on the detection of antigen-specific IgG1 antibodies are a useful tool to differentiate MB from PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID antigens in the serodiagnosis of leprosy.


Asunto(s)
Inmunoglobulina G/sangre , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/inmunología , Curva ROC , Sensibilidad y Especificidad
13.
Clin. biomed. res ; 38(4): 348-355, 2018.
Artículo en Portugués | LILACS | ID: biblio-1023937

RESUMEN

Introdução: A hanseníase é de grande importância para a saúde pública, devido à sua epidemiologia e a seu poder incapacitante. A eficiência no diagnóstico desta doença é limitada. O objetivo deste estudo foi o de analisar o desempenho de um teste rápido imunocromatográfico para hanseníase multibacilar (MB) e paucibacilar (PB), em amostras positivas e negativas pela baciloscopia de raspado dérmico em pacientes diagnosticados com hanseníase, comparando analiticamente com os critérios da Organização Mundial da Saúde (OMS). Métodos: O estudo foi realizado no município de Ji-Paraná/RO, entre 2015 e 2016, sendo avaliados 140 indivíduos. A análise comparativa entre os métodos foi realizada pelo cálculo de sensibilidade e especificidade utilizando o software SPSS®. Foi estimado o índice de Kappa (k) para avaliação da concordância entre os métodos. Valores de p <0,05 foram considerados significativos. Resultados: O índice de concordância entre o teste rápido e a classificação da OMS foi de k= 0,94 (p <0,01). Quando comparado a baciloscopia de indivíduos com hanseníase PB e o teste rápido, foi verificada concordância não significante (k= 0,01; p= 0,59). Comparando a concordância entre a baciloscopia de indivíduos com hanseníase MB e o teste rápido, foi detectado um índice de k= 0,64 (p <0,01). Além disso, sensibilidade de 94% e especificidade de 98% foram detectadas para hanseníase PB. Para hanseníase MB a sensibilidade foi de 95% e a especificidade de 98%. Conclusão: O teste rápido avaliado é uma ferramenta útil, rápida e eficaz no auxílio do diagnóstico da hanseníase. (AU)


Introduction: Leprosy is of great importance for public health because of its epidemiology and disabling power. Efficiency in the diagnosis of this disease is limited. The objective of this study was to evaluate the performance of a rapid immunochromatographic test for multibacillary (MB) and paucibacillary (BP) leprosy, in positive and negative samples by skin smear examination in patients with leprosy, and to compare the rapid test analytically with World Health Organization (WHO) criteria. Methods: The study was conducted in the municipality of Ji-Paraná/RO, Brazil, between 2015 and 2016. In total, 140 individuals were evaluated. For a comparative analysis of the methods, sensitivity and specificity were calculated using SPSS® software. The Kappa (k) index was used to evaluate agreement between the methods. A p-value < 0.05 was considered significant. Results: Regarding agreement between the rapid test and WHO classification, k index was 0.94 (p < 0.01). When skin smear of individuals with BP leprosy was compared to the rapid test, agreement was non-significant (k = 0.01; p = 0.59). For agreement between skin smear of individuals with MB leprosy and the rapid test, a k index of 0.64 (p < 0.01) was detected. In addition, for PB leprosy sensitivity was 94% and specificity was 98%, while for MB leprosy sensitivity was 95% and specificity was 98%. Conclusion: The rapid test is a useful tool, fast and effective in aiding the diagnosis of leprosy. (AU)


Asunto(s)
Humanos , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/epidemiología , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/epidemiología , Brasil/epidemiología
14.
Braz J Infect Dis ; 21(5): 557-561, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28602616

RESUMEN

Considering that the main route of Mycobacterium leprae transmission is the upper respiratory tract, detection of salivary antibodies can be a useful tool for diagnosing early infection. The study aimed to analyze salivary anti-PGL-1 IgA and IgM antibodies in 169 children aged 4-16 years old, who lived nearby or inside the house of multibacillary or paucibacillary leprosy patients in two endemic cities in Alagoas State - Brazil. Salivary anti-PGL-1 antibodies were quantified by modified ELISA method. The frequency of contact and clinical form of the index case were significantly associated with salivary antibody levels. High frequency of IgM positivity strongly suggests active transmission of M. leprae in these communities. We suggest in the present work that salivary anti-PGL IgA and IgM are important biomarkers to be used for identifying communities with probable active transmission of M. leprae.


Asunto(s)
Anticuerpos Antibacterianos/administración & dosificación , Antígenos Bacterianos/análisis , Trazado de Contacto , Familia , Glucolípidos/análisis , Lepra Multibacilar/diagnóstico , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/inmunología , Saliva/química , Adolescente , Antígenos Bacterianos/inmunología , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Glucolípidos/inmunología , Humanos , Masculino , Saliva/inmunología
15.
Rev Soc Bras Med Trop ; 50(2): 208-215, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28562757

RESUMEN

INTRODUCTION: : Currently, there are no laboratory tests or sensitive and specific molecular markers for the early diagnosis of leprosy. The aim of this study was to analyze the clinical characteristics of patients with leprosy and investigate their immunological profile, comparing this with the type of lesion and the presence or absence of a Bacillus Calmette-Guérin (BCG) vaccination scar. METHODS:: Statistical analyzes were performed by employing comparative tests (Pearson´s chi-square) to evaluate the variables in different clinical forms, considering significance at the 5% level. RESULTS: : The study identified a predominance of lepromatous leprosy (26.9%) in patients aged between 34-53 years. Caucasians predominantly had borderline tuberculoid (BT) clinical forms (42%); a predominance of males with borderline lepromatous (19%) and lepromatous leprosy (26.9%) forms was observed; and the presence of BCG vaccination scars (27.5%) and lower limb nerves were more affected (38%) predominantly in the BT clinical form. Significant differences were identified, which included hypochromic lesions predominantly in the BT clinical form (24%); diffuse-type lesions predominantly in the tuberculoid (TT) clinical form (28%); ill-defined lesion border dominance in lepromatous leprosy (LL) clinical forms (30%); an irregular lesion limit predominantly in LL clinical forms (32%); and a predominant Th1 immune response in the BT clinical form (41.7%). CONCLUSIONS: : The evaluation of the immunological profile in leprosy patients may contribute to the more detailed diagnosis and possibly better characterization of the prognosis for these individuals.


Asunto(s)
Lepra Multibacilar/diagnóstico , Lepra Multibacilar/inmunología , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/inmunología , Células TH1/inmunología , Células Th2/inmunología , Adolescente , Adulto , Biopsia , Estudios Transversales , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Lepra Multibacilar/clasificación , Lepra Paucibacilar/clasificación , Masculino , Persona de Mediana Edad , Células TH1/metabolismo , Adulto Joven
16.
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
17.
Diagn Microbiol Infect Dis ; 87(4): 328-334, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28126361

RESUMEN

To advance toward a whole blood assay (WBA)-based test capable of facilitating the diagnosis of paucibacillary (PB) leprosy, we evaluated a prototype in-tube WBA using combinations of Mycobacterium leprae antigens. Blood was collected from newly diagnosed untreated PB (n=38), multibacillary (MB) (n=30), healthy household contacts (HHC) of MB (n=27), and endemic controls (n=61) residing in Goiânia and Fortaleza, Brazil. Blood was incubated with M. leprae cell sonicate, recombinant proteins (46f+LID-1; ML0276+LID-1), or controls (phosphate-buffered saline, phytohemagglutinin, M. tuberculosis purified protein derivative). Antigen-specific IFNγ production was observed in 71-84% and 55% of PB and HHC, respectively. Antigen-specific CXCL10 levels were similarly assessed to determine if, unlike IFNγ, CXCL10 could differentiate PB from HHC with repeated exposure/asymptomatic M. leprae infection. The CXCL10 levels induced in response to M. leprae antigens could not, however, differentiate PB from HHC. Despite these limitations, the WBAs reported here still represent important tools for assessing M. leprae infection rates and evaluating the impact of control measures.


Asunto(s)
Antígenos Bacterianos/inmunología , Infecciones Asintomáticas/epidemiología , Quimiocina CXCL10/inmunología , Interferón gamma/inmunología , Lepra Paucibacilar/inmunología , Lepra Paucibacilar/microbiología , Mycobacterium leprae/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/inmunología , Bioensayo/métodos , Brasil , Femenino , Humanos , Lepra Paucibacilar/sangre , Lepra Paucibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Proteínas Recombinantes/inmunología , Adulto Joven
18.
Fontilles, Rev. leprol ; 30(5): 471-478, mayo-ago. 2016. ilus
Artículo en Español | IBECS | ID: ibc-156066

RESUMEN

La lepra es una enfermedad común y aunque ya no constituye un problema de salud en el país ni en la provincia, sí se notifican casos todos los años. Este año notificamos casos con características clínicas inusuales, pues la lepra de Lucio es una forma de lepra lepromatosa que se observa fundamentalmente en México, siendo excepcional su presentación en nuestro medio. Es la denominada lepra difusa o moteada, no tiene nódulos sino que se caracteriza por presentar zonas de vasculitis múltiples en la que se produce necrosis dermoepidérmica y la aparición de úlceras planas que se unen entre sí y curan dejando cicatriz. Se caracteriza por presentar una infiltración difusa generalizada de la piel. Además, se presentó un segundo caso con lepra tuberculoide de lesión única, con engrosamiento de nervios cubitales de 10 años de evolución, sin tratamiento y sin ningún tipo de discapacidad. El tercer caso se presentó con manifestaciones clínicas muy floridas de una lepra dimorfa sin anestesia táctil, térmica ni dolorosa con un año de evolución sin tratamiento


Leprosy is a common illness in our area and although it no longer represents a public health problem in the state or at country level new cases are notified every year. This year we have diagnosed cases with unusual clinical characteristics, one with Lucio’s Leprosy is a form of lepromatous leprosy that is observed fundamentally in Mexico and unusual in our area. It is also defined as diffuse or spotted leprosy and the patient doesn’t have nodules but presents areas of multiple vasculitis in which dermoepidermal necrosis together with the appearance of plane ulcers that unite takes place and it cures leaving a scar. This type of leprosy is mainly characterized by a disseminated diffuse infiltration of the skin. We also had a second case with single lesion tuberculoid leprosy, presenting affectation of the ulnar nerve, without treatment, no visible deformities and diagnosed 10 years ago of the disease. And a third case with very florid clinical manifestations of dimorphous leprosy without tactile, thermal nor pain anesthesia with a year of evolution and without treatment is also presented


Asunto(s)
Humanos , Masculino , Anciano , Anciano de 80 o más Años , Lepra Dimorfa/diagnóstico , Lepra Paucibacilar/diagnóstico , Lepra Lepromatosa/diagnóstico , Lepra Dimorfa/terapia , Lepra Paucibacilar/terapia , Lepra Lepromatosa/terapia , Cuba
19.
Lepr Rev ; 86(3): 288-91, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26665366

RESUMEN

A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed.


Asunto(s)
Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/patología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/patología , Anciano , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Paucibacilar/tratamiento farmacológico , Hechicería/psicología
20.
Lupus ; 24(13): 1448-51, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26113359

RESUMEN

Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15 mg/day, hydroxychloroquine 200 mg/day and mycophenolate mofetil 3 g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.


Asunto(s)
Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/microbiología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/microbiología , Adolescente , Autoanticuerpos/análisis , Niño , Dapsona/uso terapéutico , Humanos , Leprostáticos/uso terapéutico , Lepra Paucibacilar/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Mycobacterium leprae/aislamiento & purificación , Enfermedades Raras , Rifampin/uso terapéutico
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