Estudo sorológico da co-infecção de leishmania infantum e mycobacterium leprae em área de alta endemicidade / Sorological sutdy of coinfection leishmania infantum e mmycobacterium leprae in area of endemicity high

Introdução: A região Nordeste é responsável por 55% dos casos de hanseníase e por quase 50% dos casos de Leishmaniose visceral no Brasil. O Ceará, em especial a capital Fortaleza, é responsável por um grande número de casos novos dessas doenças. Este fato é reforçado pela correlação na distribuição de casos dessas patologias por municípios do estado do Ceará,onde de acordo com os dados da Secretaria de Saúde do Estado (2013), observa-se forte correlação epidemiológica entre os casos de hanseníase e do Leishmaniose visceral nos 184 municípios principalmente em Fortaleza. Objetivos: Nosso objetivo foi analisar a produção de anticorpos IgM anti-PGL1 em pacientes com Calazar sem tratamento. Material e métodos: 28 pacientes com confirmação clínico-laboratorial para Leishmaniose visceral acompanhados no Hospital São José de Doenças Infecciosas. Resultados: Quanto ao gênero, 21 foram do sexo masculino e 7 do sexo feminino, com mediana de idade de 20,5 anos (var. 3 a 76 anos), dos quais 15 pacientes não necessitaram internamento e 13 foram internados por um período médio de 28 dias (var. 5 a 28 dias). A média e desvio-padrão do índice de IgM anti-PGL1 foi de 1,91 + 0,69, sendo 78,6% considerados soropositivos. Conclusão: Não foi observada qualquer diferença entre gênero,idade, necessidade ou não de internamento, ou tempo de tratamento. A alta frequência de IgM anti-PGL1 positiva pode ser secundária à ativiação policlonal que ocorre na Leishmaniose visceral, dificultando a possibilidade de detecção da infecção pelo M. leprae por avaliação sorológica em região de alta endemicidade para Leishmaniose visceral.

Introduction: The Northeast region accounts for 55% of leprosy cases and nearly 50% of cases of visceral leishmaniasis in Brazil. Ceará, in particular the Fortaleza capital is responsible for a large number of new cases of these diseases. This fact is reinforced by the correlation in the distribution of cases of these diseases in the state of Ceará counties where according to the data of the State Health Departament (2013), we observed strong epidemiological correlation between cases of leprosy and visceral leishmaniasis in 184 counties mostly in Fortaleza. Objectives: Our objective was to analyze the production of anti-PGL1 IgM antibodies in patients with visceral leishmaniasis untreated. Materials and Methods: 28 patients with clinical and laboratory confirmation for visceral leishmaniasis followed at SãoJosé Hospital for Infectious Diseases. Results: As togender, 21 were males and 7 females, with a median age of 20,5 years (var 3-76 years.), Of which 15 patients did not require hospitalization and 13 were hospitalized for an average 28 days (var. 5 to 28 days). The mean and standard deviation of the anti-IgM PGL1 index was 1.91 ± 0.69, and 78.6% considered seropositive. Conclusion: It was not observed any difference between gender, age, necessity or not hospitalization, or time treatment. The high frequency of positive IgM anti-PGL1,can be secondary to polyclonal activation occurring in kala-azar, hindering the possibility of detection of M. leprae infection by serologic evaluation in high endemicity area for visceral leishmaniasis.

Clinico-histopathological correlation and detection of anti PGL-1 antibodies in leprosy patients.

Background: Leprosy (Hansen’s disease) is one of the major health problems of the world especially in developing countries. In India, it was first described in “Sushruta Samhita ” & treated by Chaulmoogra oil and caused by Mycobacterium Leprae. Early diagnosis of leprosy, an absolute necessity for control as well as effective therapy. For this, clinical diagnosis, skin smear examination is adequate coupled with histo-pathological examination of skin and nerve lesions with modified Fite Faraco stain for demonstration of acid fast bacilli. Moreover, bacillary index is required for adequate combined chemotherapy regimen. Detection of anti PGL-1 antibodies in serum gives an added advantage for detection and monitoring treatment. Materials & Methods : A total of 85 cases of leprosy who attended outpatient department of Skin & VD, Shri Sayaji General Hospital Baroda chosen for study during '07-08' period with 75 cases from leprosy hospital, Baroda which included 50 detected patients and 25 child contacts with 25 healthy voluntary blood donors from blood bank, SSGH selected.Clinical, past and family history taken with slit skin smears stained with Z-N stain,graded and histopathological evaluation done. Serological study done from serumof leprosy patients and healthy blood donors; tested by serodia kitsand interpretation made. Results : Most cases were in 2nd to 4th decade and males dominated. Clinically most cases were of indeterminate and tuberculoid type and histologically indeterminate and borderline tuberculoid. Clinico-histopathological correlation was found most in indeterminate followed by histoid type. Voluntary blood donors were seronegative. 21 out of 48 multibacillary cases and 6 out of 28 paucibacillary showed seropositivity for anti PGL-1 antibodies (p<0.001). Conclusion : . All suspected leprosy cases clinically should be subjected to slit skin smear examination with histopathological evaluation; bacillary study which helps in diagnosis and adequate treatment of patients. Detection of antibodies to PGL-1 in patients indicate pres-ence of leprosy bacilli and useful in preclinical diagnosis and determining progress of therapy.

Correlation of zinc plasma and IgM anti-PGL-1 levels among close contact of leprosy.

Background: Previous study showed leprosy patients have low zinc status. Yet the status of zinc in close-contact, which indicated by IgM anti-PGL1 level, have not determined. The aim of the study was to determine the association of zinc plasma and IgM anti-PGL-1 levels among close contact of leprosy patients in Indonesia. Methods: This was an observational study. Subjects were 186 close-contact leprosy patients. Measurement of zinc plasma status used atomic absorption spectrophotometer while examination of IgM anti-PGL1 level used ELISA (Polyclonal rabbit anti human IgM/HRP/(Dako®). Results: The average level of IgM anti-PGL1 and zinc plasma were 804 unit/mL (± 439.4) and 16.6 μmol/L (± 3.5) consecutively. There was significant correlation between zinc plasma and IgM anti-PGL1 (r = - 0.230; p = 0.002). Conclusion: There is a significant correlation between zinc plasma and IgM anti-PGL1 in close contact of leprosy

Early detection of leprosy by examination of household contacts, determination of serum anti-PGL-1 antibodies and consanguinity

A cross-sectional clinical trial in which the serum anti-phenolic glycolipid (anti-PGL-1) antibodies were analysed in household contacts (HHC) of patients with leprosy as an adjunct early leprosy diagnostic marker was conducted. The families of 83 patients underwent clinical examination and serum anti-PGL1 measurement using enzyme-linked immunosorbent assay. Of 320 HHC, 98 were contacts of lepromatous leprosy (LL), 80 were contacts of borderline lepromatous (BL), 28 were contacts of borderline (BB) leprosy, 54 were contacts of borderline tuberculoid (BT), 40 were contacts of tuberculoid (TT) and 20 were contacts of indeterminate (I) leprosy. Consanguinity with the patients was determined for 232 (72.5 percent) HHC. Of those 232 contacts, 183 had linear consanguinity. Forty-nine HHC had collateral consanguinity. Fifty-eight contacts (18.1 percent) tested positive for anti-PGL1 antibodies. The number of seropositive contacts based on the clinical forms of the index case was 17 (29.3 percent) for LL, 15 (25.9 percent) for BL, one (1.7 percent) for BB, 14 (24.1 percent) for BT, three (5.2 percent) for TT and eight (13.7 percent) for I. At the one year follow-up, two (3.4 percent) of these seropositive contacts had developed BT leprosy. The results of the present study indicate that the serum anti-PGL-1 IgM antibody may be useful for evaluating antigen exposure and as a tool for an early leprosy diagnosis in HHC.

Use of anti-PGL-1 antibodies to monitor therapy regimes in leprosy patients

The suitability of IgM antibodies to PGL-1 for monitoring the response to multidrug therapy (MDT) was sequentially tested by ELISA in 105 leprosy patients, and bacterial indexes (BI) were also determined. Patients were divided into 3 groups: group 1, 34 multibacillary (MB) patients treated for 12 months with MDT-MB; group 2, 33 MB patients treated for 24 months with MDT-MB, and group 3, 38 paucibacillary (PB) patients treated for 6 months with MDT-PB. Untreated MB patients exhibited higher antibody levels (mean ± SEM): group 1 (6.95 ± 1.35) and group 2 (12.53 ± 2.02) than untreated PB patients (1.28 ± 0.35). There was a significant difference (P < 0.01) in anti-PGL-1 levels in group 1 patients: untreated (6.95 ± 1.35) and treated for 12 months (2.78 ± 0.69) and in group 2 patients: untreated (12.53 ± 2.02) and treated for 24 months (2.62 ± 0.79). There was no significant difference between untreated (1.28 ± 0.35) and treated (0.62 ± 0.12) PB patients. Antibody levels correlated with BI. The correlation coefficient (Pearson’s r) was 0.72 before and 0.23 (P < 0.05) after treatment in group 1 and 0.67 before and 0.96 (P < 0.05) after treatment in group 2. BI was significantly reduced (P < 0.01) after 12 and 24 months on MDT (group 1: 1.26-0.26; group 2: 1.66-0.36). Our data indicate that monitoring anti-PGL-1 levels during MDT may be a sensitive tool for evaluating treatment efficacy. These data also indicate that the control of leprosy infection can be obtained with 12 months of MDT in MB patients.

Survey to identify Mycobacterium leprae-infected household contacts of patients from prevalent regions of leprosy in Colombia

Leprosy in Colombia is in the post-elimination phase; nevertheless, there are regions of this country where the incidence is still around 3-4/100,000. Early detection of leprosy patients is a priority for achieving control and elimination of leprosy; however, the clinical exam is not very sensitive and thus, the majority of patients are diagnosed only when they demonstrate lesions, and damage to the nerves and skin has already occurred. The goal of the present study was to identify Mycobacterium leprae infection and immune responses in household contacts (HHC) of leprosy patients from three prevalent regions of Colombia. Clinical examination, the Mitsuda test, evaluation of IgM anti-PGL-I in the serum, the bacillar index (BI), and polymerase chain reaction (PCR) from nasal swabs (NS) were performed for 402 HHC of 104 leprosy patients during a cross-sectional survey. Positive titers for IgM anti-PGL1 were found for 54 HHC, and PCR-positive NS for 22. The Mitsuda reaction was negative for 38 HHC, although three were positive for IgM anti-PGL-1 titers. The data document that leprosy transmission among HHC is still occurring in a non-endemic country.

The different levels of interferron gamma capacity production on several stages of leprosy.

Informations concerning imunological activity in subclinical leprosy is still lacking. Therefore, the objective of this study was to find out the prevalence of subclinical leprosy and interferon- (IFN-) production at several stages of leprosy. This observational study using a cross sectional approach was conducted in Semarang, Central Java, Indonesia. Twenty-six leprosy patients and 62 relatives who lived together with the leprosy patients were included in the study. The venous blood samples were taken from all (88) of the subjects. All of the venous blood samples were measured for IFN- levels by Elisa method. Sixty two blood samples from the relatives who lived together with the leprosy patients were measured for IgM anti PGL-1 to determine the subclinical stage of leprosy. Thus, there were three groups in this study: leprosy patients (LP), subclinical leprosy (SL) and sero-negative subjects (SN). Thirty three of the 62 relatives (53.2%) were in subclinical stage of leprosy, while 29 others were not (sero-negative). There was a significant difference (P= 0.001) in IFN- production capacity among the three groups (LP,SL and SN). Among the three groups, the LP group had the lowest, while SL group had the highest IFN- production capacity.