Differential immunoglobulin and complement levels in leprosy prior to development of reversal reaction and erythema nodosum leprosum

Background Leprosy is a treatable infectious disease caused by Mycobacterium leprae. However, there is additional morbidity from leprosy-associated pathologic immune reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL), which occur in 1 in 3 people with leprosy, even with effective treatment of M. leprae. There is currently no predictive marker in use to indicate which people with leprosy will develop these debilitating immune reactions. Our peripheral blood mononuclear cell (PBMC) transcriptome analysis revealed that activation of the classical complement pathway is common to both RR and ENL. Additionally, differential expression of immunoglobulin receptors and B cell receptors during RR and ENL support a role for the antibody-mediated immune response during both RR and ENL. In this study, we investigated B-cell immunophenotypes, total and M. leprae-specific antibodies, and complement levels in leprosy patients with and without RR or ENL. The objective was to determine the role of these immune mediators in pathogenesis and assess their potential as biomarkers of risk for immune reactions in people with leprosy. Methodology/findings We followed newly diagnosed multibacillary leprosy cases (n = 96) for two years for development of RR or ENL. They were compared with active RR (n = 35), active ENL (n = 29), and healthy household contacts (n = 14). People with leprosy who subsequently developed ENL had increased IgM, IgG1, and C3d-associated immune complexes with decreased complement 4 (C4) at leprosy diagnosis. People who developed RR also had decreased C4 at leprosy diagnosis. Additionally, elevated anti-M. leprae antibody levels were associated with subsequent RR or ENL. Conclusions Differential co-receptor expression and immunoglobulin levels before and during immune reactions intimate a central role for humoral immunity in RR and ENL. Decreased C4 and elevated anti-M. leprae antibodies in people with new diagnosis of leprosy may be risk factors for subsequent development of leprosy immune reactions

Prevalence and intensity of infection by intestinal parasites in school-aged children in the City of Salvador (Bahia State, Brazil)

Submitted by Ana Lucia Teixeira ([email protected]) on 2019-09-12T14:37:38Z No. of bitstreams: 1 Prevalência e intensidade da infecção por parasitasintestinais em crianças na idade escolar na Cidade de Salvador.pdf: 24881 bytes, checksum: a4efd883baa2dd8c24d70a0f30b6749e (MD5)Approved for entry into archive by Ana Lucia Teixeira ([email protected]) on 2019-09-12T17:20:48Z (GMT) No. of bitstreams: 1 Prevalência e intensidade da infecção por parasitasintestinais em crianças na idade escolar na Cidade de Salvador.pdf: 24881 bytes, checksum: a4efd883baa2dd8c24d70a0f30b6749e (MD5)Made available in DSpace on 2019-09-12T17:20:48Z (GMT). No. of bitstreams: 1 Prevalência e intensidade da infecção por parasitasintestinais em crianças na idade escolar na Cidade de Salvador.pdf: 24881 bytes, checksum: a4efd883baa2dd8c24d70a0f30b6749e (MD5) Previous issue date: 2001Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto das Ciências da Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Como parte de um estudo para avaliar as relações entre mudanças ambientais e ocorrência de infecções, estudou-se a prevalência e intensidade de parasitas intestinais em uma amostra de crianças em idade escolar, residentes em Salvador. A prevalência de infectados por pelo menos um protozoário/helminto foi 66,1%. A prevalência da infecção por helmintos, se eleva com o aumento da idade das crianças, sendo os meninos mais intensamente infectados.As part of a major study to evaluate the relationship between environmental changes and occurrence of the infection, prevalence and intensity of infection by intestinal parasites was studied in a sample of school children aged 7 to 14 years living in the City of Salvador. The prevalence of infection by at least one species of protozoa or helminth was 66.1%. Prevalence of infection by helminths increased with age. For all helminth species male children presented the highest prevalence

Ocular sporotrichosis: A frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas

Purpose: Sporotrichosis is a subcutaneous mycosis caused by Sporothrix sp., a dimorphic fungus. Although the cutaneous form is the most frequent form, the ocular presentation has been increasingly diagnosed in epidemic areas. We describe three cases of ocular sporotrichosis with the involvement of the ocular adnexa due to autoinoculation without trauma with successful antifungal treatment. Observations: Patient 1: A 68-year-old woman presented with granulomatous conjunctivitis of the right eye with an ulcerated nodule on the right temporal region for 5 months. Patient 2: A 46-year-old woman with conjunctival hyperemia of the left eye with associated periorbital edema and erythema for the past 4 months was referred to the Dermatology Department due to an ulcerated nodule on the left malar region. Patient 3: A 14-year-old boy presented to the emergency department with inferior palpebral edema with a 5-day evolution. Specimens were obtained from the lesions of the three patients, and the cultures were positive for Sporothrix sp. The three cases were diagnosed as ocular sporotrichosis and were successfully treated with itraconazole (200–400 mg/d). Two of the three patients developed sequelae such as conjunctival fibrosis and symblepharon. Conclusions and importance: We emphasize the importance of the ophthalmologist being familiar with the diagnosis and management of this rare and frequently misdiagnosed form of sporotrichosis

Identifying Leprosy and Those at Risk of Developing Leprosy by Detection of Antibodies against LID-1 and LID-NDO

<div><p>Leprosy is caused by <i>Mycobacterium leprae</i> infection and remains a major public health problem in many areas of the world. Challenges to its timely diagnosis result in delay in treatment, which is usually associated with severe disability. Although phenolic glycolipid (PGL)-I has been reported as auxiliary diagnostic tool, currently there is no serological assay routinely used in leprosy diagnosis. The aim of this study was to evaluate the effectiveness of two related reagents, LID-1 and LID-NDO, for the detection of <i>M</i>. <i>leprae</i> infection. Sera from 98 leprosy patients, 365 household contacts (HHC) and 98 endemic controls from Rio Grande do Norte, Brazil, were evaluated. A subgroup of the HHC living in a hyperendemic area was followed for 7–10 years. Antigen-specific antibody responses were highest in multibacillary (MB) at the lepromatous pole (LL/BL) and lowest in paucibacillary (PB) at the tuberculoid pole (TT/BT). A positive correlation for both anti-LID-1 and anti-LID-NDO antibodies was found with bacterial burden (LID-1, r = 0.84, <i>p</i><0.001; LID-NDO, r = 0.82, <i>p</i><0.001), with higher sensitivity than bacilloscopy. According to <i>Receiver Operating Curve</i>, LID-1 and LID-NDO performed similarly. The sensitivity for MB cases was 89% for LID-1 and 95% for LID-NDO; the specificity was 96% for LID-1 and 88% for LID-NDO. Of the 332 HHC that were followed, 12 (3.6%) were diagnosed with leprosy in a median time of 31 (3–79) months after recruitment. A linear generalized model using LID-1 or LID-NDO as a predictor estimated that 8.3% and 10.4% of the HHC would become a leprosy case, respectively. Together, our findings support a role for the LID-1 and LID-NDO antigens in diagnosing MB leprosy and identifying people at greater risk of developing clinical disease. These assays have the potential to improve the diagnostic capacity at local health centers and aid development of strategies for the eventual control and elimination of leprosy from endemic areas.</p></div

Active Surveillance of Hansen's Disease (Leprosy): Importance for Case Finding among Extra-domiciliary Contacts

<div><p>Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of <i>Mycobacterium leprae</i>.</p> </div

Estruturas de variância residual para estimação de funções de covariância para o peso de bovinos da raça Canchim Residual variance structures to estimate covariance functions for weight of Canchim beef cattle

Este trabalho foi realizado com o objetivo de avaliar a utilização de diferentes estruturas de variância residual para estimação de funções de covariância para o peso de bovinos da raça Canchim. As funções de covariância foram estimadas pelo método da Máxima Verossimilhança Restrita em um modelo animal com os efeitos fixos de grupo de contemporâneos (ano e mês de nascimento e sexo), idade da vaca ao parto como covariável (efeitos linear e quadrático) e da trajetória média de crescimento, enquanto os efeitos aleatórios considerados foram os efeitos genéticos aditivos direto e materno, de ambiente permanente individual e materno e residual. Foram utilizadas diversas estruturas para a variância residual: funções de variâncias de ordem linear até quíntica e 1, 5, 10, 15 ou 20 classes de idades. A utilização de variância residual homogênea não foi adequada. A utilização da função de variância residual quártica e a divisão da variância residual em 20 classes proporcionaram os melhores ajustes, e a divisão em classes foi mais eficiente que a utilização de funções. As estimativas de herdabilidade direta se situaram entre 0,16 e 0,25 na maioria das idades consideradas e as maiores estimativas foram obtidas próximo aos 360 dias de idade e no final do período estudado. Em geral, as estimativas de herdabilidade direta foram semelhantes para os modelos com variância residual homogênea, função de variância residual quártica ou com 20 classes de idade. A melhor descrição das variâncias residuais para o peso em diversas idades de bovinos da raça Canchim foi a que considerou 20 classes heterogêneas. Entretanto, como existem classes com variâncias semelhantes, é possível agrupar algumas delas e reduzir o número de parâmetros estimados.<br>This study was carried out to evaluate the use of different residual variance structures to estimate covariance functions for weight of Canchim beef cattle. The covariance functions were estimated by the Restricted Maximum Likelihood method, in an animal model with fixed effect of contemporary group (year and month of birth and sex), age of dam at calving as covariable (linear and quadratic effects) and mean growth trajectory while the random effects considered were the direct additive genetic and maternal effects, permanent individual environment and maternal and residual effects. Different structures were used for residual variance: ordinary polynomials of different orders (linear to fifth) and step functions with 1, 5, 10, 15 and 20 classes. Homogeneous residual variance was not adequate. The four-ordered variance function and the step function with 20 classes presented the best fit and the class division was more efficient than residual functions. The estimated heritabilities were between 0.16 and 0.25, and the greatest ones were obtained close to 360 days and at the end of the study period. The estimated heritabilities were similar for models with homogeneous residual variance, four-ordered residual function and step model with 20 classes of heterogeneous variances. The best description of residual variance, for weights at different ages of Canchim beef cattle, was by step function with 20 classes of heterogeneous variances. However, as existing classes with the same variances, they can be grouped to reduce the number of parameters to be estimated

Parameters estimated through ROC analysis with regard to three distinct scenarios.

<p>Parameters estimated through ROC analysis with regard to three distinct scenarios.</p