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2.
PLoS One ; 15(12): e0244451, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33373997

RESUMEN

Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013-2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.


Asunto(s)
Coinfección/tratamiento farmacológico , Atención a la Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Implementación de Plan de Salud , Lepra/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Cuidados Posteriores/organización & administración , Cuidados Posteriores/estadística & datos numéricos , Antirretrovirales/uso terapéutico , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Quimioprevención/métodos , Estudios de Cohortes , Coinfección/microbiología , Atención a la Salud/métodos , Atención a la Salud/estadística & datos numéricos , Farmacorresistencia Bacteriana Múltiple , Femenino , Infecciones por VIH/virología , Humanos , Lepra/microbiología , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Mycobacterium leprae/aislamiento & purificación , Mycobacterium tuberculosis/aislamiento & purificación , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Uganda , Adulto Joven
3.
PLoS Negl Trop Dis ; 14(9): e0008611, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32936805

RESUMEN

BACKGROUND: The aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases. METHODOLOGY: Data on new cases reported to the National Leprosy Registry between the years 2003-2018 were extracted. In absence of detailed travel history, cases were considered "autochthonous" or "imported" based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification. PRINCIPAL FINDINGS: Data were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast. CONCLUSIONS: Autochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of M. leprae is likely to have now effectively stopped in Spain.


Asunto(s)
Lepra/epidemiología , Lepra/transmisión , Adulto , Factores de Edad , Anciano , Femenino , Geografía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Factores Sexuales , España/epidemiología , Viaje
5.
Galicia clin ; 81(3): 80-82, jul. 2020. ilus
Artículo en Español | IBECS | ID: ibc-199179

RESUMEN

La lepra o enfermedad de Hansen, es una entidad nosológica infecciosa producida por Mycobacterium leprae. No se conoce exactamente su mecanismo de transmisión. Es más frecuente en hombres y aparece habitualmente entre la segunda y tercera década de la vida. El diagnóstico de lepra es clínico, sin embargo la presencia de los bacilos en frotis y biopsias cutáneas y la detección de su ADN permiten su confirmación. El tratamiento es largo y la curación se consigue tras varios años sin enfermedad. Presentamos un caso de lepra autóctono atendido en nuestro centro. Mujer de 41 años de edad, española, agricultora que consulta por presentar lesiones cutáneas redondeadas, con centro deprimido, eritematodescamativas en el borde y acompañadas de unas lesiones cutáneas nodulares en miembros inferiores. Se decidió biopsiar las lesiones nodulares que confirmaron el diagnóstico de lepra. Se inició tratamiento y las lesiones cutáneas evolucionaron favorablemente hasta su resolución. Actualmente existen dos casos de lepra activos y tres en vigilancia tras el tratamiento. En Galicia es poco habitual, y casi siempre está en relación con población inmigrante


Leprosy or Hansen's disease is an infectious nosological entity produced by Mycobacterium leprae. Its transmission mechanism is not known exactly. It is more common in men and usually appears between the second and third decade of life. The diagnosis of leprosy is clinical, however the presence of bacilli in smears and skin biopsies and the detection of their DNA allow their confirmation. The treatment is long and the cure is achieved after several years without disease. We present a case of autochthonous leprosy attended in our center. A 41-year-old Spanish woman, a farmer who consulted due to rounded skin lesions, with a depressed center, erythematodescampathetic on the edge and accompanied by nodular skin lesions on the lower limbs. It was decided to biopsy the nodular lesions that confirmed the diagnosis of leprosy. Treatment was started and the skin lesions evolved favorably until their resolution. Currently there are two cases of active leprosy and three in surveillance after treatment. In Galicia it is unusual, and it is almost always related to the immigrant population


Asunto(s)
Humanos , Femenino , Adulto , Úlcera Cutánea/patología , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Biopsia/métodos , Mycobacterium leprae/patogenicidad , España/epidemiología
6.
Int J Infect Dis ; 98: 6-13, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32553715

RESUMEN

OBJECTIVES: Understanding the nature of Mycobacterium leprae transmission is vital to implement better control strategies for leprosy elimination. The present study expands the knowledge of county-level strain diversity, distribution, and transmission patterns of leprosy in endemic provinces of China. METHODS: We genetically characterized 290 clinical isolates of M. leprae from four endemic provinces using variable number tandem repeats (VNTR) and single nucleotide polymorphisms (SNPs). Attained genetic profiles and cluster consequences were contrasted with geographical and migration features of leprosy at county levels. RESULTS: Considering the allelic variability of 17 VNTR loci by the discriminatory index, (GTA)9, (AT)17, (AT)15, (TA)18, (TTC)21, and (TA)10 are reported to be more highly polymorphic than other loci. The VNTR profile generated the low-density clustering pattern in the counties of Sichuan and Yunnan, whereas clusters have been observed from the isolates from Huayuan (N = 6), Yongding (N = 3), Zixing (N = 3), Chenxi (N = 2) and Zhongfang (N = 2) counties of Hunan, and Zhijin (N = 3), Anlong (N = 2), Zhenning (N = 2), and Xixiu (N = 2) counties of Guizhou. In some clusters, people's social relations have been observed between villages. From the 290 clinical isolates, the most predominantly reported SNP was 3K (278, 95.8%), followed by SNP 1D (10, 3.4%), which are typically observed to be predominant in China. We also detected the novel SNP 3J (2, 0.8%), which has not yet been reported in China. CONCLUSION: The clustering pattern of M. leprae indicates the transmission of leprosy still persists at county levels, suggesting that there is a need to implement better approaches for tracing the close contacts of leprosy patients.


Asunto(s)
Lepra/microbiología , Mycobacterium leprae/aislamiento & purificación , Alelos , China/epidemiología , Análisis por Conglomerados , ADN Bacteriano/genética , Genotipo , Geografía , Humanos , Lepra/epidemiología , Lepra/transmisión , Repeticiones de Minisatélite , Epidemiología Molecular , Mycobacterium leprae/clasificación , Mycobacterium leprae/genética , Filogenia , Polimorfismo de Nucleótido Simple
7.
Int J Infect Dis ; 96: 172-179, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32371193

RESUMEN

BACKGROUND: Human-to-human transmission of Mycobacterium leprae among household contacts of active leprosy cases is significant, and surveillance of household contacts is vital to interrupting the transmission chain for this disease. This study was conducted to identify similarities in M. leprae strains, based on genomic single nucleotide polymorphisms (SNPs), among cases and their household contacts and in multicase families in order to decipher possible associations, transmission links, various clinical conditions of index cases that enhance person-to-person transmission, and timelines for transmission patterns. METHODS: PCR for M. leprae DNA detection (amplification of the Rlep gene) and SNP subtyping of M. leprae strains was performed for 61 index cases and one of their household contacts. Additionally, we studied six families with multiple cases of leprosy, to understand timelines of infectivity and its relation to severity of the disease in the index cases. RESULTS: Index cases with lepromatous (LL) and borderline lepromatous (BL) leprosy, together with a positive bacteriological index (BI) for M. leprae, result in a higher percentage of their contacts subclinically infected with M. leprae, with odds ratios (OR) of 6.6 (95% confidence interval (CI) 1.6-27.6) for BL and LL, and 7.07 (CI 1.41-35.41) for BI-positive index cases. 75% of the case-contact pairs had a similar SNP subtype of M. leprae. The timeline of infection in multicase families revealed that contacts were infected during the BI-positive period of the index case. CONCLUSION: Using molecular methods, we determined that positivity for M. leprae DNA in contacts of index leprosy cases was attributed to clinical characteristics of leprosy in the index cases. LL and BL forms of leprosy, together with positive BI, contributed to dissemination of infection to household contacts. In conclusion, we found a relationship between SNP subtypes within index case-contact pairs. This method can help decipher the transmission patterns and identify individuals at risk of contracting leprosy.


Asunto(s)
Lepra/epidemiología , Mycobacterium leprae/genética , Adolescente , Adulto , Composición Familiar , Femenino , Humanos , Lepra/microbiología , Lepra/transmisión , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Mycobacterium leprae/clasificación , Mycobacterium leprae/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo de Nucleótido Simple , Adulto Joven
8.
PLoS Negl Trop Dis ; 14(5): e0008325, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32453754

RESUMEN

Leprosy urgently needs a precise and early diagnostic tool. The sensitivity of the direct (bacilli staining, Mycobacterium leprae DNA) and indirect (antibody levels, T cell assays) diagnostics methods vary based on the clinical form. Recently, PCR-based M. leprae DNA detection has been shown to differentially diagnose leprosy from other dermatological conditions. However, accuracy can still be improved, especially for use with less invasive clinical samples. We tested different commercial DNA extraction kits: DNeasy Blood & Tissue, QIAamp DNA Microbiome, Maxwell 16 DNA Purification, PowerSoil DNA Isolation; as well as in-house phenol-chloroform and Trizol/FastPrep methods. Extraction was performed on M. leprae-infected mouse footpads and different clinical samples of leprosy patients (skin biopsies and scrapings, lesion, oral and nasal swabs, body hair, blood on FTA cards, peripheral whole blood). We observed that the Microbiome kit was able to enrich for mycobacterial DNA, most likely due the enzymatic digestion cocktail along with mechanical disruption involved in this method. Consequently, we had a significant increase in sensitivity in skin biopsies from paucibacillary leprosy patients using a duplex qPCR targeting 16S rRNA (M. leprae) and 18S rRNA (mammal) in the StepOnePlus system. Our data showed that the presence of M. leprae DNA was best detected in skin biopsies and skin scrapings, independent of the extraction method or the clinical form. For multibacillary patients, detection of M. leprae DNA in nasal swabs indicates the possibility of having a much less invasive sample that can be used for the purposes of DNA sequencing for relapse analysis and drug resistance monitoring. Overall, DNA extracted with the Microbiome kit presented the best bacilli detection rate for paucibacillary cases, indicating that investments in extraction methods with mechanical and DNA digestion should be made.


Asunto(s)
ADN Bacteriano/aislamiento & purificación , Mycobacterium leprae/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Animales , ADN Bacteriano/genética , Humanos , Ratones , Mycobacterium leprae/genética , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , Sensibilidad y Especificidad
10.
PLoS Negl Trop Dis ; 14(4): e0008276, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32339201

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar pathologic conditions. They primarily target the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease, being endemic in specific locations within countries of the Americas, Asia, and Africa, while in Europe it is only rarely reported. The reason for a spatial inequality in the prevalence of leprosy in so-called endemic pockets within a country is still largely unexplained. A systematic review was conducted targeting leprosy transmission research data, using PubMed and Scopus as sources. Publications between January 1, 1945 and July 1, 2019 were included. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. The transmission of this disease is probably much more complicated than was thought before. In the Americas, the nine-banded armadillo (Dasypus novemcinctus) has been established as another natural host and reservoir of M. leprae. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. More recently, in red squirrels (Sciurus vulgaris) with leprosy-like lesions in the British Isles M. leprae and M. lepromatosis DNA was detected. This finding was unexpected, because leprosy is considered a disease of humans (with the exception of the armadillo), and because it was thought that leprosy (and M. leprae) had disappeared from the United Kingdom. Furthermore, animals can be affected by other leprosy-like diseases, caused by pathogens phylogenetically closely related to M. leprae. These mycobacteria have been proposed to be grouped as a M. leprae-complex. We argue that insights from the transmission and reservoirs of members of the M. leprae-complex might be relevant for leprosy research. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. A reduction in transmission cannot be expected to be accomplished by actions or interventions from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, to increase our understanding of the intricate picture of leprosy transmission, we propose a One Health transdisciplinary research approach.


Asunto(s)
Reservorios de Enfermedades , Transmisión de Enfermedad Infecciosa , Lepra/transmisión , Lepra/veterinaria , Animales , Armadillos/microbiología , Salud Global , Humanos , Incidencia , Lepra/epidemiología , Mycobacterium/aislamiento & purificación , Mycobacterium leprae/aislamiento & purificación , Prevalencia , Sciuridae/microbiología
11.
PLoS Negl Trop Dis ; 14(3): e0008127, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32203502

RESUMEN

Understanding the prevalence of M. leprae infection in armadillos is important because of evidence from Brazil and other countries of an association between contact with armadillos and the development of Hansen's Disease (leprosy). Our aim was to characterize studies which have investigated natural M. leprae infection in wild armadillos in Brazil, and to quantify and explore variability in the reported prevalence of infection. We conducted a systematic review (PROSPERO CRD42019155277) of publications in MEDLINE, EMBASE, Global Health, Scopus, LILACS, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses e Dissertações de CAPES, and Biblioteca Virtual em Saúde up to 10/2019 using Mesh and text search terms (in English, Portuguese, Spanish, and French). The 10 included studies represented a total sample of 302 armadillos comprising 207 (69%) Dasypus novemcinctus, 67 (22%) Euphractus sexcinctus, 16 (5%) Priodontes maximus, 10 (3%) Cabassous unicinctus, and 2 (1%) Cabassous tatouay from 7 different states. Methods used included histopathology (4 studies), PGL-1 and LID-1 antigen detection (4 studies) and examination for clinical signs of disease (4 studies). Eight studies used PCR of which 7 targeted the RLEP repetitive element and 3 tested for inhibitory substances. M. leprae prevalence by PCR ranged from 0% (in 3 studies) to 100% in one study, with a summary estimate of 9.4% (95% CI 0.4% to 73.1%) and a predictive interval of 0-100%. The average prevalence is equivalent to 1 in 10 armadillos in Brazil being infected with M. leprae, but wide variation in sample estimates means that the prevalence in any similar study would be entirely unpredictable. We propose instead that future studies aim to investigate transmission and persistence of M. leprae within and between armadillo populations, meanwhile adopting the precautionary principle to protect human health and an endangered species in Brazil.


Asunto(s)
Armadillos/microbiología , Lepra/epidemiología , Lepra/veterinaria , Mycobacterium leprae/aislamiento & purificación , Animales , Animales Salvajes/microbiología , Brasil/epidemiología , ADN Bacteriano/análisis , Bases de Datos Factuales , Mapeo Geográfico , Mycobacterium leprae/genética , Reacción en Cadena de la Polimerasa , Prevalencia , Secuencias Repetitivas de Ácidos Nucleicos , Zoonosis/epidemiología , Zoonosis/microbiología
12.
BMC Infect Dis ; 20(1): 62, 2020 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-31959113

RESUMEN

BACKGROUND: To evaluate the effectiveness and safety of the World Health Organization antibiotic regimen for the treatment of paucibacillary (PB) and multibacillary (MB) leprosy compared to other available regimens. METHODS: We performed a search from 1982 to July 2018 without language restriction. We included randomized controlled trials, quasi-randomized trials, and comparative observational studies (cohorts and case-control studies) that enrolled patients of any age with PB or MB leprosy that were treated with any of the leprosy antibiotic regimens established by the WHO in 1982 and used any other antimicrobial regimen as a controller. Primary efficacy outcomes included: complete clinical cure, clinical improvement of the lesions, relapse rate, treatment failure. Data were pooled using a random effects model to estimate the treatment effects reported as relative risk (RR) with 95% confidence intervals (CI). RESULTS: We found 25 eligible studies, 11 evaluated patients with paucibacillary leprosy, while 13 evaluated patients with MB leprosy and 1 evaluated patients of both groups. Diverse regimen treatments and outcomes were studied. Complete cure at 6 months of multidrug therapy (MDT) in comparison to rifampin-ofloxacin-minocycline (ROM) found RR of 1.06 (95% CI 0.88-1.27) in five studies. Whereas six studies compare the same outcome at different follow up periods between 6 months and 5 years, according to the analysis ROM was not better than MDT (RR of 1.01 (95% CI 0.78-1.31)) in PB leprosy. CONCLUSION: Not better treatment than the implemented by the WHO was found. Diverse outcome and treatment regimens were studied, more statements to standardized the measurements of outcomes are needed.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra Multibacilar/tratamiento farmacológico , Lepra Paucibacilar/tratamiento farmacológico , Minociclina/uso terapéutico , Ofloxacino/uso terapéutico , Rifampin/uso terapéutico , Organización Mundial de la Salud , Adolescente , Adulto , Anciano , Niño , Protocolos Clínicos , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Leprostáticos/efectos adversos , Masculino , Persona de Mediana Edad , Minociclina/efectos adversos , Mycobacterium leprae/efectos de los fármacos , Mycobacterium leprae/aislamiento & purificación , Enfermedades Desatendidas/tratamiento farmacológico , Ofloxacino/efectos adversos , Recurrencia , Rifampin/efectos adversos , Insuficiencia del Tratamiento , Adulto Joven
13.
Indian J Dermatol Venereol Leprol ; 86(2): 115-123, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31975697

RESUMEN

With the worldwide implementation of WHO multidrug therapy in the 1980s, the global burden of leprosy has decreased. However, the annual new case detection rate around the world has remained nearly static over the past decade with India, Brazil, and Indonesia contributing the majority of these new cases. This has been attributed to the ongoing transmission of Mycobacterium leprae from existing untreated cases and partly to the intensive new case detection programs operative in endemic areas. The WHO has called for a "global interruption of transmission of leprosy by 2020". Targeted chemoprophylaxis of contacts may help bring down the number of new cases. The single-dose rifampicin currently in use for post-exposure prophylaxis (PEP) has limitations and so newer antileprosy drugs and regimens have been trialed for chemoprophylaxis. BCG re-vaccination in combination with chemoprophylaxis for the prevention of leprosy transmission has not been very encouraging. The use of the anti-phenolic glycolipid-1 (PGL-1) antibody test to detect subclinical cases and administer targeted chemoprophylaxis was unsuccessful owing to its low sensitivity and technical difficulties in a field setup. There is a pressing need for newer multidrug chemoprophylactic regimens using second-line antileprosy drugs. The Netherlands Leprosy Relief has proposed an enhanced PEP++ regimen. A simple but highly sensitive and specific serological test to detect subclinical cases at the field level needs to be developed. Although there are a number of challenges in the large-scale implementation of strategies to halt leprosy transmission, it is important to overcome these in order to move towards a "leprosy-free world."


Asunto(s)
Inmunoterapia/métodos , Leprostáticos/administración & dosificación , Lepra/prevención & control , Lepra/transmisión , Ensayos Clínicos como Asunto/métodos , Quimioterapia Combinada , Humanos , Inmunoterapia/tendencias , Lepra/epidemiología , Mycobacterium leprae/efectos de los fármacos , Mycobacterium leprae/aislamiento & purificación
14.
J Appl Microbiol ; 128(6): 1814-1819, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31981442

RESUMEN

AIMS: Diagnosis of leprosy, a chronic infection caused by Mycobacterium leprae, predominantly depends on clinical manifestations and histopathological analysis, hampering rapid and accurate diagnostics. Our aim was to increase accuracy of leprosy diagnosis by improving M. leprae's DNA detection based on polymerase chain reaction (PCR) technique using new specific primers for the RLEP repetitive sequence. METHODS AND RESULTS: The specific target region, RLEP, of M. leprae's genome was selected based on comparative genomics. After confirming the specificity of this region, using blastn analysis, primers were designed and tested for their in silico specificity. To evaluate the specificity and sensitivity of these primers in vitro, 184 blood samples from patients were used in qPCR. The new primer pair LYON1/LYON2 produced 91% positive samples, whereas the current primer pair LP1/LP2 produced 46%. Specificity and DNA detection limit test were carried out to compare the efficiency of the developed primer pair. The LYON1/LYON2 primer showed 100% specificity, whereas LP1/LP2 showed 64%. The DNA detection limit of LYON1/LYON2 was 10 copies of bacterial genomes per millilitre, whereas LP1/LP2 was 1000 copies of bacterial genomes per millilitre. CONCLUSIONS: In conclusion, the developed LYON1/LYON2 primer pair presented to be a specific and sensitive new molecular marker for the diagnosis of leprosy. SIGNIFICANCE AND IMPACT OF THE STUDY: The development of a specific primer pair for the detection of the M. leprae genome through qPCR technique contributes to a fast, sensitive and specific diagnosis, which is essential to prevent spreading and progression of this disease.


Asunto(s)
Lepra/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium leprae/aislamiento & purificación , ADN Bacteriano/genética , Femenino , Genoma Bacteriano/genética , Humanos , Secuencias Repetitivas Esparcidas/genética , Lepra/sangre , Lepra/microbiología , Mycobacterium leprae/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Sensibilidad y Especificidad
15.
Dis Mon ; 66(7): 100899, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31806242

RESUMEN

Leprosy is a bacterial infection causing severe disfigurement of the affected individual. It is considered as an ancient disease affecting humanity since thousands of years and also has tremendous stigma associated with it. It is known as a neglected tropical disease. In spite of all the efforts, the disease remains a major healthcare distress in many underdeveloped and developing countries like India and Brazil. Thus, to understand the disease and implement various strategies successfully, one need to understand the epidemiological aspect of the disease along with various operational factors influencing the epidemiological data. Thus, the present paper describes the various epidemiological facts and figures of leprosy along with the suggestions and measures to tackle this global ailment.


Asunto(s)
Lepra/epidemiología , Lepra/microbiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades Cutáneas Bacterianas/patología , Brasil/epidemiología , Niño , Femenino , Historia del Siglo XIX , Humanos , Incidencia , India/epidemiología , Lepra/historia , Lepra/transmisión , Masculino , Mycobacterium leprae/aislamiento & purificación , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/microbiología , Prevalencia , Enfermedades Cutáneas Bacterianas/etiología , Enfermedades Cutáneas Bacterianas/microbiología , Estigma Social
16.
Transbound Emerg Dis ; 67(2): 1032-1034, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31733134

RESUMEN

Leprosy is a human infectious disease caused by Mycobacterium leprae or Mycobacterium lepromatosis that can also occur in animals and even manifest as zoonosis. Recently, both mycobacteria were detected in red squirrels (Sciurus vulgaris) from the British Isles. To further explore the presence of leprosy bacilli in North-West Europe, we screened Belgian and Dutch squirrels. Tissue samples from 115 animals tested by qPCR were negative for both pathogens. No molecular or pathological evidence was found of the presence of these zoonotic pathogens in North-West Europe.


Asunto(s)
Lepra/veterinaria , Mycobacterium leprae/aislamiento & purificación , Mycobacterium/aislamiento & purificación , Sciuridae/microbiología , Animales , Bélgica/epidemiología , Humanos , Lepra/microbiología , Mycobacterium/genética , Mycobacterium leprae/genética , Países Bajos/epidemiología , Reino Unido/epidemiología , Zoonosis
18.
Dis Mon ; 66(7): 100918, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31813526

RESUMEN

The present review summarizes the current updates on dental perspectives on leprosy and the affording factors that are responsible for the prevalence of caries and periodontal diseases in leprosy. It also highlights immunopathological phenomena and reactional episodes of leprosy that occur due to daedal interactions between the perio-odontopathic bacteria and M. leprae. In addition, a brief introduction, historiography, classification and clinicopathological aspects are also been covered.


Asunto(s)
Caries Dental/epidemiología , Lepra/patología , Mycobacterium leprae/aislamiento & purificación , Periodoncio/microbiología , Carga Bacteriana/tendencias , Historia del Siglo XIX , Humanos , Inmunidad Celular/fisiología , Lepra/clasificación , Lepra/historia , Lepra/microbiología , Mycobacterium leprae/metabolismo , Enfermedades Periodontales/complicaciones , Periodoncio/patología , Prevalencia
19.
s.l; s.n; 2020. 15 p. ilus, graf, tab.
No convencional en Inglés | Sec. Est. Saúde SP, CONASS, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1146399

RESUMEN

Leprosy is difficult to diagnose since it is caused by a bacterium that does not grow in vitro. Bacilli direct detection or the presence of specific antibodies can vary greatly depending on the clinical form. M. leprae direct DNA detection can aid clinical diagnosis, although invasive skin biopsies are still necessary to detect the pathogen or histological features consistent with leprosy. Here we show that a kit combining mechanical and chemical lysis efficiently removes host DNA and enriches for M. leprae DNA, allowing better detection of paucibacillary cases. We believe our findings can contribute to improving disease diagnosis, as well as early detection and that could help monitoring strategies(AU).


Asunto(s)
Humanos , Animales , Ratones , ADN Bacteriano/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Mycobacterium leprae/aislamiento & purificación , ADN Bacteriano/genética , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , Sensibilidad y Especificidad , Mycobacterium leprae/genética
20.
BMC Infect Dis ; 19(1): 1013, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783808

RESUMEN

BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. CASES PRESENTATION: We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. CONCLUSIONS: This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.


Asunto(s)
Lepra Multibacilar/diagnóstico , Úlcera Cutánea/diagnóstico , Adolescente , Adulto , Anciano , Errores Diagnósticos , Humanos , Leprostáticos , Lepra Multibacilar/complicaciones , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Piel/patología , Úlcera Cutánea/complicaciones
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