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Tropical Medicine and Infectious Disease Oct 2018Leprosy is an infectious disease caused by and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are... (Review)
Review
Leprosy is an infectious disease caused by and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health care levels for the effective control of leprosy. This paper presents a systematic review analysis in order to investigate the performance of polymerase chain reaction (PCR) vis-à-vis slit skin smears (SSS) in various clinical settings and its potential usefulness as a routine lab test for leprosy diagnosis. Records of published journal articles were identified through PubMed database search. Twenty-seven articles were included for the analysis. The evidence from this review analysis suggests that PCR on skin biopsy is the ideal diagnostic test. Nevertheless, PCR on SSS samples also seems to be useful with its practical value for application, even at primary care levels. The review findings also indicated the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic leprosy. The -specific repetitive element (RLEP) was the most frequently-used marker although its variable performance across the clinical sites and samples are a matter of concern. Undertaking further research studies with large sample numbers and uniform protocols studied simultaneously across multiple clinical sites is recommended to address these issues.
PubMed: 30275432
DOI: 10.3390/tropicalmed3040107 -
Revista Da Sociedade Brasileira de... 2008Serology using a species-specific antigen for Mycobacterium leprae, PGL-I, could be a marker for the bacterial load of patients with leprosy. Various studies have... (Review)
Review
Serology using a species-specific antigen for Mycobacterium leprae, PGL-I, could be a marker for the bacterial load of patients with leprosy. Various studies have identified the potential use of serology in the classification of patients for treatment purposes, case monitoring, identification of the risk of relapse and selection of household contacts with a higher risk of contracting the disease. A systematic review of the literature was conducted and 26 articles were included in this comparative analysis. The results of the use of PGL-I serology in different situations, its limitations and possible applications were evaluated. Studies show the efficacy of PGL-I serology in the classification of patients, treatment monitoring and as a predictive test for leprosy reactions. To improve early diagnosis and follow-up of the population at greatest risk of developing leprosy, the methodologies used in the past have yet to show a favorable cost-benefit ratio, although studies indicate that the use of the test might positively influence leprosy control programs. With simple and robust techniques, the use of PGL-I serology is viable.
Topics: Antibodies, Bacterial; Antigens, Bacterial; Glycolipids; Humans; Immunoglobulin M; Leprosy; Mycobacterium leprae; Predictive Value of Tests; Serologic Tests
PubMed: 19618069
DOI: 10.1590/s0037-86822008000700004 -
PLoS Neglected Tropical Diseases May 2016There is no point of care diagnostic test for infection with M. Leprae or for leprosy, although ELISA anti PGL-1 has been considered and sometimes used as a means to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is no point of care diagnostic test for infection with M. Leprae or for leprosy, although ELISA anti PGL-1 has been considered and sometimes used as a means to identify infection.
METHODS
A systematic review of all cohort studies, which classified healthy leprosy contacts, at entry, according to anti-PGL1 positivity, and had at least one year follow up. The outcome was clinical diagnosis of leprosy by an experienced physician. The meta-analysis used a fixed model to estimated OR for the association of PGL-1 positivity and clinical leprosy. A fixed model also estimated the sensibility of PGL-1 positivity and positive predictive value.
RESULTS
Contacts who were anti PGL-1 positive at baseline were 3 times as likely to develop leprosy; the proportion of cases of leprosy that were PGL-1 positive at baseline varied but was always under 50%.
CONCLUSIONS
Although there is a clear and consistent association between positivity to anti PGL-1 and development of leprosy in healthy contacts, selection of contacts for prophylaxis based on anti PGL1 response would miss more than half future leprosy cases. Should chemoprophylaxis of controls be incorporated into leprosy control programmes, PGL1 appears not to be a useful test in the decision of which contacts should receive chemoprophylaxis.
Topics: Antibodies, Bacterial; Antigens, Bacterial; Cohort Studies; Enzyme-Linked Immunosorbent Assay; Female; Glycolipids; Humans; Immunoglobulin G; Leprosy; Male; Mycobacterium leprae; Predictive Value of Tests; Risk Factors
PubMed: 27192199
DOI: 10.1371/journal.pntd.0004703 -
Indian Journal of Dermatology,... 2022Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility... (Review)
Review
Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility and risk of causing disabilities. Lucio's phenomenon is a rare manifestation among lepromatous patients with a rapid and severe evolution and high mortality. It is difficult to differentiate from ulcerative/necrotic erythema nodosum leprosum and has no consensus on how it should be treated. This article is a qualitative review of the literature after the introduction of multidrug therapy, aiming to bring consensus related to the clinical, laboratory and histopathological diagnostic criteria of the disease and its management.
Topics: Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy; Leprosy, Lepromatous; Leprosy, Multibacillary
PubMed: 34672479
DOI: 10.25259/IJDVL_909_19 -
Infectious Diseases of Poverty Feb 2023Leprosy is an infectious disease caused by Mycobacterium leprae and remains a source of preventable disability if left undetected. Case detection delay is an important...
BACKGROUND
Leprosy is an infectious disease caused by Mycobacterium leprae and remains a source of preventable disability if left undetected. Case detection delay is an important epidemiological indicator for progress in interrupting transmission and preventing disability in a community. However, no standard method exists to effectively analyse and interpret this type of data. In this study, we aim to evaluate the characteristics of leprosy case detection delay data and select an appropriate model for the variability of detection delays based on the best fitting distribution type.
METHODS
Two sets of leprosy case detection delay data were evaluated: a cohort of 181 patients from the post exposure prophylaxis for leprosy (PEP4LEP) study in high endemic districts of Ethiopia, Mozambique, and Tanzania; and self-reported delays from 87 individuals in 8 low endemic countries collected as part of a systematic literature review. Bayesian models were fit to each dataset to assess which probability distribution (log-normal, gamma or Weibull) best describes variation in observed case detection delays using leave-one-out cross-validation, and to estimate the effects of individual factors.
RESULTS
For both datasets, detection delays were best described with a log-normal distribution combined with covariates age, sex and leprosy subtype [expected log predictive density (ELPD) for the joint model: -1123.9]. Patients with multibacillary (MB) leprosy experienced longer delays compared to paucibacillary (PB) leprosy, with a relative difference of 1.57 [95% Bayesian credible interval (BCI): 1.14-2.15]. Those in the PEP4LEP cohort had 1.51 (95% BCI: 1.08-2.13) times longer case detection delay compared to the self-reported patient delays in the systematic review.
CONCLUSIONS
The log-normal model presented here could be used to compare leprosy case detection delay datasets, including PEP4LEP where the primary outcome measure is reduction in case detection delay. We recommend the application of this modelling approach to test different probability distributions and covariate effects in studies with similar outcomes in the field of leprosy and other skin-NTDs.
Topics: Humans; Bayes Theorem; Leprosy; Mycobacterium leprae; Leprosy, Multibacillary; Leprosy, Paucibacillary
PubMed: 36800979
DOI: 10.1186/s40249-023-01065-4 -
Revista Do Instituto de Medicina... 2022People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review...
People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.
Topics: Antibodies, Bacterial; Antigens, Bacterial; BCG Vaccine; Brazil; Glycolipids; Humans; Leprosy; Mycobacterium leprae; Risk Factors
PubMed: 36197417
DOI: 10.1590/S1678-9946202264055 -
PLoS Neglected Tropical Diseases Oct 2018Leprosy is a chronic infectious disease neglected, caused by Mycobacterium leprae, considered a public health problem because may cause permanent physical disabilities...
BACKGROUND
Leprosy is a chronic infectious disease neglected, caused by Mycobacterium leprae, considered a public health problem because may cause permanent physical disabilities and deformities, leading to severe limitations. This review presents an overview of the results of epidemiological studies on leprosy occurrence in childhood in Brazil, aiming to alert health planners and managers to the actual need to institute special control strategies.
METHODOLOGY/PRINCIPAL FINDINGS
Data collection consisted of an electronic search for publications in eight databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), PuBMed, Biblioteca Virtual em Saúde (BVS), SciVerse Scopus (Scopus), CAPES theses database, CAPES journals database and Web of Science of papers published up to 2016. After apply selection criteria, twenty-two papers of studies conducted in four different regions of Brazil and published between 2001 and 2016 were included in the review. The leprosy detection rate ranged from 10.9 to 78.4 per 100,000 inhabitants. Despite affecting both sexes, leprosy was more common in boys and in 10-14-year-olds. Although the authors reported a high cure proportion (82-90%), between 1.7% and 5.5% of the individuals developed a disability resulting from the disease.
CONCLUSIONS/SIGNIFICANCE
The findings of this review shows that leprosy situation in Brazilian children under 15 years is extremely adverse in that the leprosy detection rate remains high in the majority of studies. The proportion of cases involving disability is also high and reflects the difficulties and the poor effectiveness of actions aimed at controlling the disease. The authors suggest the development of studies in spatial clusters of leprosy, where beyond the routine actions established, are included news strategies of active search and campaigns and actions of educations inside the clusters of this disease. The new agenda needs to involve the precepts of ethical, humane and supportive care, in order to achieve a new level of leprosy control in Brazil.
Topics: Adolescent; Age Factors; Brazil; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Leprosy; Male; Prevalence; Sex Factors
PubMed: 30278054
DOI: 10.1371/journal.pntd.0006788 -
Acta Bio-medica : Atenei Parmensis Sep 2019Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the...
BACKGROUND AND AIMS
Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy.
METHODS
The following keywords were used to explore PubMed and Embase: leprosy, Hansen's disease, (Mycobacterium) leprae, Italy, without any chronological restriction.
RESULTS
We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases.
CONCLUSION
Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.
Topics: Adolescent; Adult; Aged; Demography; Female; Humans; Incidence; Italy; Leprosy; Male; Middle Aged; Prevalence; Young Adult
PubMed: 31517884
DOI: 10.23750/abm.v90i9-S.8695 -
PLoS Neglected Tropical Diseases Mar 2021Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. The current figures of the disease burden in the 2017 global burden of disease study, however, are considered to be under-estimated. In this study, we aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data.
METHODOLOGY/PRINCIPAL FINDINGS
The search strategy included all major databases with no restriction on language, setting, study design, or year of publication. Studies on human populations that have been affected by leprosy and recorded the HRQOL with the Short form tool, were included. A consortium was formed with authors who could share the anonymous individual-level data of their study. Mean disability weight estimates, sorted by the grade of leprosy disability as defined by WHO, were estimated for individual participant data and pooled using multivariate random-effects meta-analysis. Eight out of 14 studies from the review were included in the meta-analysis due to the availability of individual-level data (667 individuals). The overall estimated disability weight for grade 2 disability was 0.26 (95%CI: 0.18-0.34). For grade 1 disability the estimated weight was 0.19 (95%CI: 0.13-0.26) and for grade 0 disability it was 0.13 (95%CI: 0.06-0.19). The revised disability weight for grade 2 leprosy disability is four times higher than the published GBD 2017 weights for leprosy and the grade 1 disability weight is nearly twenty times higher.
CONCLUSIONS/SIGNIFICANCE
The global burden of leprosy is grossly underestimated. Revision of the current disability weights and inclusion of disability caused in individuals with grade 0 leprosy disability will contribute towards a more precise estimation of the global burden of leprosy.
Topics: Disabled Persons; Global Burden of Disease; Humans; Leprosy; Quality of Life
PubMed: 33651814
DOI: 10.1371/journal.pntd.0009209 -
BMC Infectious Diseases Jan 2020To evaluate the effectiveness and safety of the World Health Organization antibiotic regimen for the treatment of paucibacillary (PB) and multibacillary (MB) leprosy... (Meta-Analysis)
Meta-Analysis
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.
Topics: Adolescent; Adult; Aged; Child; Clinical Protocols; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Multibacillary; Leprosy, Paucibacillary; Male; Middle Aged; Minocycline; Mycobacterium leprae; Neglected Diseases; Ofloxacin; Recurrence; Rifampin; Treatment Failure; World Health Organization; Young Adult
PubMed: 31959113
DOI: 10.1186/s12879-019-4665-0