Serodiagnosis of leprosy and follow-up of household contacts using a commercial rapid test containing ND-O/LID-1 antigens

Introduction: Early diagnosis of leprosy, including the diagnosis of sub-clinical disease in contacts of known cases, would be a major advance. The signs of early leprosy are often difficult to assess and a reliable diagnostic test could play an important role in identifying cases and thus reducing transmission. Methods: Subjects were recruited at Centro de Saude Jardim Guanabara, Rondonopolis, Mato Grosso State, Brazil. Sera were obtained from 174 recently diagnosed leprosy patients, 409 household contacts, 53 endemic controls and 12 patients with active TB. 186 of the household contacts were re-tested on subsequent visits. Both the NDO-LID rapid test (Orange Life, Rio de Janeiro, Brazil) and an anti-PGL-1 ELISA test were used on all samples for comparison. Results: LID-1 was positive in 25 of 125 PB cases (20%), but in 41 of 49 MB cases (83.7%), while the anti-PGL-1 ELISA was positive in 8 (6.4%) and 35 (71.4%) cases, respectively. Specificity for LID-1 was 85% and for the anti-PGL-1 ELISA, 97%. Amongst household contacts, 9 of 409 (2.2%) were positive on the LID-1 test, and a further 51 (115%) were weakly positivealthough 9 cases of leprosy were subsequently identified amongst these contacts, 6 had tested negative, 2 were weakly positive and only 1 had been positive. Conclusion: The ND-O-LID-1 assay can be easily performed by the addition of serum to the assay device, and thus can be applied in resource-poor settings. The test was found to be useful for the detection of multibacillary cases, which in the long term will help to reduce transmission of the disease. This is a specific test, but it is not very sensitive for early detection of leprosy in household contacts and paucibacillary forms.Inst Lauro Souza Lime, Bauru, SP, BrazilHlth Ctr Rondonopolis MT, Rondonopolis, BrazilFed Univ Sao Paulo Unifesp, Dept Dermatol, Sao Paulo, BrazilUniv Fed Sao Paulo Unifesp, Dept Dermatol, Sao Paulo, BrazilWeb of Scienc

Increased hepcidin expression in multibacillary leprosy

Iron is essential for all organisms and its availability can control the growth of microorganisms; therefore, we examined the role of iron metabolism in multibacillary (MB) leprosy, focusing on the involvement of hepcidin. Erythrograms, iron metabolism parameters, pro-inflammatory cytokines and urinary hepcidin levels were evaluated in patients with MB and matched control subjects. Hepcidin expression in MB lesions was evaluated by quantitative polymerase chain reaction. The expression of ferroportin and hepcidin was evaluated by immunofluorescence in paucibacillary and MB lesions. Analysis of hepcidin protein levels in urine and of hepcidin mRNA and protein levels in leprosy lesions and skin biopsies from healthy control subjects showed elevated hepcidin levels in MB patients. Decreases in haematologic parameters and total iron binding capacity were observed in patients with MB leprosy. Moreover, interleukin-1 beta, ferritin, soluble transferrin receptor and soluble transferrin receptor/log ferritin index values were increased in leprosy patients. Hepcidin was elevated in lepromatous lesions, whereas ferroportin was more abundant in tuberculoid lesions. In addition, hepcidin and ferroportin were not colocalised in the biopsies from leprosy lesions. Anaemia was not commonly observed in patients with MB; however, the observed changes in haematologic parameters indicating altered iron metabolism appeared to result from a mixture of anaemia of inflammation and iron deficiency. Thus, iron sequestration inside host cells might play a role in leprosy by providing an optimal environment for the bacillus.CNPq [401012/2005-0]CNPqFundacao Paulista contra a HanseniaseFundacao Paulista contra a Hanseniase [095

Accidental Jorge Lobo's disease in a worker dealing with Lacazia loboi infected mice: a case report

<p>Abstract</p> <p>Introduction</p> <p>Jorge Lobo's disease (Lacaziosis) is a subcutaneous infection of humans living in the Amazon region of Latin America, and in dolphins inhabiting the east coastal areas of the United States. The disease mainly affects people from rural areas living or working in close contact with vegetation and aquatic environments. Most patients refer having developed lesions after accidental trauma with plant thorns or insect bites. Inter-human transmission has never been confirmed suggesting that <it>Lacazia loboi </it>is acquired from environmental propagules.</p> <p>Case presentation</p> <p>We report the case of a 41-year-old woman from São Paulo, Brazil, a non-endemic area of Jorge Lobo's disease, with <it>L. loboi </it>skin infection most likely accidentally acquired while manipulating experimentally infected mice in the laboratory.</p> <p>Conclusion</p> <p>Because many patients with Jorge Lobo's disease do not recall accidental skin trauma before their infections, the possibility of accidentally acquired Jorge Lobo's disease through unnoticed broken skin should be considered during the clinical investigation of nodular skin diseases in people who have contact with the fungus or who live in endemic areas. This is the second report of animal to human transmission of this disease.</p

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Leprosy is a serious infectious disease whose treatment still poses some challenges. Patients are usually treated with a combination of antimicrobial drugs called multidrug therapy. Although this treatment is effective against Mycobacterium leprae, the bacillus that causes leprosy, patients may develop severe inflammatory reactions during treatment. These reactions may be either attributed to an improvement in the immunological reactivity of the patient along with the treatment, or to relapse of the disease due to the proliferation of remaining bacilli. In certain patients these two conditions may be difficult to differentiate. The present study addresses the histopathology picture of and the M. leprae bacilli in sequential biopsies taken from lesions of patients who presented such reactions aiming to improve the differentiation of the two conditions. This is important because these reactions are one of the major causes of the disabilities of the patients with leprosy, and should be treated early and appropriately. Our results show that the histopathology picture alone is not sufficient, and that bacilli's counting is necessary

Estudo terapêntico comparando a associação de rifampicina, ofloxacina e minociclina com a associação rifampicina, clofazimina e dapsona em pacientes multibacilar

O presente trabalho comparou dois esquemas terapêuticos em pacientes com hanseníase multibacilar. O grupo 1, que recebeu o tratamento convencional (PQT-MB), foi denominado grupo controle. O grupo 2, denominado de grupo teste, recebeu a associação de rifampicina 600 mg, mais ofloxacina 400 mg, mais minociclina 100 mg (ROM), administrado sob supervisão, uma vez por mês. A duração total do tratamento nos dois grupos foi de dois anos. Na avaliação inicial foram realizados: exame clínico, baciloscópico e histológico. A baciloscopia e a biópsia foram repetidas no final do primeiro ano e novamente no final do segundo ano de tratamento. A avaliação clínica foi realizada mensalmente por ocasião da administração da dose supervisionada. No grupo 1 foram avaliados 14 pacientes. O índice baciloscópico (IB) antes do tratamento variou de 2 a 4,8. No grupo 2 foram estudados 12 pacientes. O IB antes do tratamento nesse grupo variou de 1,6 a 4,8. Ambos os grupos apresentavam lesões cutâneas que os caracterizavam como pertencentes ao pólo virchoviano. Histologicamente apresentavam quadro de hanseníase virchoviana ativa, exceto um paciente do grupo 2. Ao final do primeiro ano de tratamento estavam todos clinicamente melhorados, o índice baciloscópico diminuído e com quadro histológico em regressão. Essa tendência de melhora se mantinha e na avaliação do final do segundo ano todos estavam clinicamente, baciloscopicamente e histologicamente ainda melhores. A análise estatística dos parâmetros, baciloscópico e histológico, mostrou que não houve diferença estatisticamente significativa entre os grupos estudados, sendo, portanto os dois esquemas equivalentes. A ocorrência de reação tipo 2 (eritema nodoso hansênico - ENH) foi igual nos dois grupos. No grupo 1, todos apresentaram pigmentação cutânea devido a clofazimina...The present study compared two therapeutic schemes in multibacillary leprosy patients. Group 1 was the control group that received the conventional (MDT-MB) treatment. Group 2 was the test group that received the association of rifampin 600 mg, ofloxacin 400 mg and minocyclin 100 mg (ROM), administrated once a month under supervision. Both groups were treated for two years. Initial evaluation of patients included: clinical examination, bacilloscopy and histology. Bacilloscopy and skin biopsy were repeated at the end of the first and second years of treatment. Clinical evaluation was performed monthly concomitant to administration of drugs. Fourteen patients were evaluated in group 1. Bacilloscopic index (BI) before treatment varied from 2 to 4.8. Twelve patients were evaluated in group 2. The BI before treatment in this group varied from 1.6 to 4.8. Both groups presented cutaneous lesions characteristic of the lepromatous type. The histological picture resembled active lepromatous leprosy, except for one patient of group 2. At the end of the first year of treatment all patients showed clinical improvement, the BI decreased and they presented regressive histological picture. This tendency to improvement was maintained and at the final evaluation in the second year all patient showed even better clinical, bacilloscopic and histological improvement. The statistical analysis of bacilloscopic and histological parameters showed there weren't significant differences between the groups studied, therefore, treatments were equally efficacious. Occurrence of type 2 (erythema leprosum nodosum ENL) reactional episodes was similar in both groups. In group 1 all patients presented skin pigmentation due to clofazimine. These results demonstrate that monthly administration of rifampin, plus ofloxacin plus minocyclin are as efficacious and secure as the conventional scheme... (Complete abstract, click eletronic address below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Hanseníase tuberculóide em paciente com Aids Tuberculoid leprosy in aids patient

Relata-se o caso de uma criança de oito anos, portadora de Aids, que desenvolveu hanseníase tuberculóide antes do início da terapia anti-retroviral. Apresentava lesões ulceradas nos membros, Mitsuda de 8,5mm, hipoestesia em perna esquerda, e o diagnóstico de hanseníase foi definido pela imuno-histoquímica antiproteína S-100, que mostrou fragmentos de ramos nervosos no interior dos granulomas. A incidência da hanseníase não aumentou com o advento da Aids, e não há modificações na apresentação clínica ou na resposta terapêutica nos casos de hanseníase associados à Aids. Também não se observou neste caso o desenvolvimento da reação tipo 1 como resultado da reconstituição imunológica devido ao tratamento anti-retroviral.<br>The authors present a 8 year-old child with AIDS who developed tuberculoid leprosy prior the beginning of the anti-retroviral treatment. The pacient presented ulcered lesions in arms and legs, the Mitsuda reaction was 8,5 mm, there was hypostesia of the left leg and the leprosy diagnosis was reached mainly supported by the anti-S100 protein immunohistochemistry staining that showed fragments of nerve branches inside granulomas. The incidence of leprosy has not increased because of AIDS. There haven’t been changes in the clinical presentation and in the response to therapy in cases of leprosy associated with AIDS. We haven’t also observed development of type 1 reaction in this patient resulting from restoring of the immune response after the anti-retroviral treatment

Localized cutaneous leishmaniasis of the plantar region: A 40-year outcome

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-08-14T18:50:11Z No. of bitstreams: 1 Barral AMP Localized cutaneous....pdf: 168027 bytes, checksum: 58df8e3206c22c6658f822a378d41880 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-08-14T19:10:00Z (GMT) No. of bitstreams: 1 Barral AMP Localized cutaneous....pdf: 168027 bytes, checksum: 58df8e3206c22c6658f822a378d41880 (MD5)Made available in DSpace on 2017-08-14T19:10:00Z (GMT). No. of bitstreams: 1 Barral AMP Localized cutaneous....pdf: 168027 bytes, checksum: 58df8e3206c22c6658f822a378d41880 (MD5) Previous issue date: 2017Federal University of Rio Grande do Sul. Porto Alegre, RGS, BrazilLauro de Souza Lima Institute. Bauru, SP, BrasilLauro de Souza Lima Institute. Bauru, SP, BrasilFederal and Catholic University of Pelotas. Pelotas, RGS, BrazilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilWe report the case of a 78-year-old male Brazilian farmer, who presented with an extensive ulcer on the right foot that had an erythematous and raised border. This ulcer involved most of the right plantar region and had persisted for more than 40 years. Satellite erythematous papules and tumor-like growths were also seen on the right ankle. Extracutaneous involvement was not found. Light microscopy showed epithelial hyperplasia and diffuse histiocyte infiltration with intense plasmocytosis. Cultures for fungi and Leishmania were negative. The polymerase chain reaction with specific primers for Leishmania was performed using DNA extracted from the lesions; it showed an amplification of 120 pB. The patient had an excellent response after two 20-day cycles of intravenous N-methylglucamine antimonate (15mg/Kg/day). Leishmaniasis should be highly considered in the differential diagnosis of chronic ulcers in endemic areas

Association between neuropathic pain and A-Waves in Leprosy patients with type 1 and 2 reactions

Summary: Neuropathic pain (NP) is a well-recognized feature of leprosy neuropathy. However, the diagnosis of NP is difficult using only clinical criteria. In the study reported here, by means of conventional nerve conduction studies, the authors sought for an association between long-latency responses and NP complaints in leprosy patients with type 1 and 2 reactions. Of the 27 ulnar nerves of leprosy patients, 18 with type 1 reaction (T1R) and 9 with type 2 reaction (T2R) were followed-up for 6 months before and after steroid treatment. Clinical characteristics of pain complaints and clinical function were assessed, as well as the presence of F- and A-waves of the ulnar nerve using nerve conduction studies. The clinical and the neurophysiologic findings were compared to note positive concordances (presence of NP and A-waves together) and negative concordances (absence of NP and A-waves together) before and after treatment. Both reactions presented a high frequency of A-waves (61.1% in T1R and 66.7% in T2R, P < 0.05) and prolonged F-waves (69.4% in T1R and 65.8% in T2R, P = 0.4). No concordances were seen between pain complaints and F-waves. However, significant concordances between NP and A-waves were observed, although restricted to the T2R group ([chi]2 = 5.65, P = 0.04). After treatment, there was a significant reduction in pain complaints, as well as the presence of F- and A-waves in both groups (P < 0.05 for all comparisons). In conclusion, the presence of A-waves correlates well with pain complaints of neuropathic characteristics in leprosy patients, especially in those with type 2 reaction. Probably, such response shares similar mechanisms with the small-fiber dysfunction seen in these patients with NP, such as demyelination, intraneural edema, and axonal sprouting. Further studies using specific tools for small-fiber assessment are warranted to confirm our findings