Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients

Abstract: INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS : Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.

Avaliação de pacientes com hanseníase na faixa virchowiana diagnosticados entre 1990 e 2000 e tratados com poliquimioterapia 24 doses e seus comunicantes na fase pós-eliminação em municípios de Santa Catarina / Assessment of lepromatous leprosy patients diagnosed among 1990 and 2000 and treated with multidrugtherapy 24 doses and their household contacts in the post-elimination phase in Santa Catarina municipalities

INTRODUÇÃO: A poliquimioterapia (PQT-OMS) para tratamento da hanseníase resultou em drástica redução da sua prevalência, mas em limitado impacto na detecção de casos novos (CN), que se manteve estável em Santa Catarina, estado na fase de pós-eliminação. Casos com altos índices baciloscópicos apresentam risco de recidiva tardia e podem consistir em focos persistentes de transmissão da doença. OBJETIVOS: Avaliar a recidiva da doença em amostra de pacientes virchowianos regularmente tratados com PQT-OMS 24 doses; ensaios de resistência terapêutica em camundongos para os casos suspeitos; resposta imune específica (celular e humoral) e detecção do DNA do M. leprae nos casos-índices (CI) e seus contatos indradomiciliares (CID); e os achados frente aos indicadores epidemiológicos e operacionais de Santa Catarina. CASUÍSTICA E MÉTODOS: A partir da busca no Sistema de Informação de Agravos de Notificação (SINAN), foram selecionados 46 CI, tratados entre 1990-2000, e 187 CID, dos municípios de Itajaí e Joinville. A avaliação constituiu de: exames dermatoneurológico e anatomopatológico da pele; baciloscopia do esfregaço cutâneo; reação de Mitsuda; sorologia para glicolipídeo fenólico-I (IgM-anti-PGL-I); ensaios de resistência terapêutica em camundongos e de detecção do DNA bacilar no muco nasal por reação em cadeia da polimerase (PCR) para as seqüências repetitivas específicas RLEP-130 e RLEP-372. RESULTADOS: Entre os CI após alta por cura (m=11,2 ± 3 anos), a idade média (57,3±14,5 anos) foi superior (p<0,05) comparada aos CID, com predomínio de homens (p=0,001) e Mitsuda-negativos (78,6%). Em quatro casos (8,7%) considerados recidivados, o valor sérico médio (0,365) e as freqüências da positividade do anti-PGL-I e a da RLEP-130 (75%; p=0,03) foram consistentemente elevados, e os testes em camundongos, negativos. Dentre os 187 CID, 22 (11,8%) adoeceram (CIDd), a maioria (10 casos; 45,4%) foi diagnosticada entre 2 a 19 anos; 6 casos (27,3%), no mesmo período do seu...

Introduction: Multidrugtherapy (MDT-WHO) resulted in marked reduction of leprosy prevalence in Brazil, without impact on detection of new cases in Santa Catarina (SC) state in the post-elimination phase. Lepromatous cases with high bacilloscopic index have late relapse risk and can consist in the disease transmission focus. Objectives: The aim of this study was to evaluate the disease recurrence and microbiological resistance in lepromatous leprosy patients regularly treated with MDT-WHO/24 doses; specific immune response (cellular and humoral) and M. leprae DNA detection in index cases (IC) and their household contacts (HHC); and the findings face to the epidemiological and operational indicators of Santa Catarina state. Casuistic and methods: After consulting the Brazilian Information System of Notification (SINAN) database, 46 IC successfully diagnosed and treated between 1990 and 2000, and their 187 HHC from Joinville and Itajaí (SC) municipalities were selected. A dermatoneurological examination was performed, as well as the skin biopsies for histopathology and therapy resistance assay in mouse pads, skin smears for bacilloscopy, anti-PGL-I IgM serology, Mitsuda reaction, polymerase chain reaction for M. leprae DNA detection in nasal secretion based on 130bp and 372bp specific repetitive sequences (RLEP). Results: Cured IC (m=11.2±3 years) had mean age higher ((57.3±14.5 years old; p<0.05) than HHC, most of them were males (p=0.001) and Mitsuda negative (78.6%). In 4 relapsed cases (8.7%) the average anti-PGL-I serum levels (0.365), as well as frequency of positive antibody and RLEP-130 (75%; p=0.03) were consistently high and the mouse footpads assays resulted negative. Among 187 HHC, 22 (11.8%) became sick (sHHC), 10 cases (45.4%) were diagnosed between 2 and 19 years, being 6 cases (27.3%) in the same year of their IC; 6 new cases (3 borderline-tuberculoid and 3 tuberculoid) were detected during the study, with high RLEP-130 positive frequency...

Identificação dos alelos HLA-DQB1*01 em pacientes hansenianos mitsuda negativos / Identification of HLA-DQB1*01 alleles in mitsuda negative leprosy patients

A proposta deste estudo foi identificar os alelos que codificam o HLA-DQ1 envolvidos na ausência de resposta imune celular em 60 pacientes hansenianos (50LL e 10BL) Mitsuda negativos. Os resultados obtidos mostraram a presença do alelo HLA-DQB1*0501 em 48.30% dos pacientes, seguido do HLA-DQB1*0602 em 31.66%, ambos subtipos do fenótipo HLA-DQB1*01. Apesar do predomínio destes alelos, não se pode afirmar que eles sejam os responsáveis pela ausência de resposta ao teste de Mitsuda. Sugerimos mais estudos neste segmento para a confirmação dos resultados.

The purpose of this study was to identify the gene encoding HLA-DQ1 involved in the absence of cellular immune response in 60 Mitsuda negative leprosy patients (50LL and 10BL). The results showed the presence of HLA-DQB1*0501 in 48.30% of patients, followed by HLA-DQB1*0602 in 31.66%, both subtypes of the phenotype HLA-DQB1*01. Despite the prevalence of these alleles, we can not say that they are responsible for the lack of response to the Mitsuda antigen. We suggest further studies to confirm the results.

Intradermorreacciones y su aplicación: revisión bibliográfica / Skin and its application: literature review

Las intradermorreacciones consisten en la aplicación intradérmica de una sustancia conocida con la finalidad de evaluar la hipersensibilidad retardada (HSR). Se utilizan con fines diagnósticos y pronósticos en algunas enfermedades. En esta revision se identifican las características relevantes de estas pruebas

The summary of recent new & relapse Hansen' disease cases (2004 - 2008) / 나학회지

Hansen's disease, chronic infectious disease caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. The bacteria have affinity for the skin and peripheral nerves and are likely the cause of neuropathy, a cardinal manifestation of the disease. WHO recommends a protocol of multidrug therapy(MDT), which effectively controls the disease, hence contributing to the global elimination program. Early detection of leprosy and treatment by MDT are the most important steps in preventing deformity and disability. For the understanding of recent characteristics of the new & relapse Hansen' disease in Institute for Leprosy Research Korea, we are summarized and reported the epidemiological factors. During recent 5 years(2004-2008), we were experienced 26 new cases and 12 relapse cases of Hansen's disease in our institute, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. 1. In 26 new cases, the mean age is 64.11 in 18 Koreans and 27.75 in 8 foreigners(Indonesia, Nepal, Philippines, Sri Lanka, Thailand), the types of Hansen's disease are 19 lepromatous, 2 borderline and 5 tuberculoid, mean BI is 3.7+, mean O.D. of PGL-I antibody is 0.697, numbers of TTC repeat are 12(7 cases), 11(6 cases), 13(5 cases), 10(4 cases), 16(2 cases), and 31(1 case) and of GACATC repeats are 4(all 18 Koreans) and 3(all 8 foreigners). Among 26 new cases, 1 case(53ACC/GCC) has the mutation of folP1 gene and all new cases have no mutation of rpoB gene. 2. In 12 relapse cases(all Koreans), the mean age is 61.08, the types of Hansen's disease are all 12 lepromatous, mean BI is 4.8+,and mean O.D. of PGL-I antibody is 0.960, and numbers of TTC repeat are 11(6 cases), 12(4 cases), and 13(1 case), and of GACATC repeats are 4(all 12 Koreans). Among 12 relapse cases, 3 cases(55CCC/CGC) and 1 case(53ACC/ GCC) have the mutation of folP1 gene and 3 cases(425TCG/TTG) and 1 case(420CAC/GAC) have the mutation of rpoB gene. 2 relapse cases have the mutation of folP1 & rpoB gene.

12 Cases of Hansen's Disease(New case & Relapse) / 나학회지

Between 2008 and 2009, We found 9 new cases and 3 relapse cases, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The obtained results were summarized as follows: 1. In 9 new cases, the mean age was 56.2 in 5 Koreans and 28.2 in 4 foreigners(Nepal, Thailand, Sri Lanka, Philippines), the types of Hansen's disease were 5 lepromatous(2 Koreans and 3 foreigners), 1 borderline(1 foreigner) and 2 tuberculoid(2 Koreans), mean BI was 3.4+, mean O.D. of PGL-I antibody was 0.445, numbers of TTC repeat are 16(2 Korean and 2 foreigners), 11(2 Koreans), 12(1 Koreans) and 13(1 Koreans), and of GACATC repeats are 4(4 Koreans) and 3(1 Korean and 4 foreigners). Among 9 new cases, 1 case has the mutation offolP1 gene. 2. All new cases had no mutation of & rpoB gene. 3. In 3 relapse cases, the mean age was 63.7, the types of Hansen's disease were 3 lepromatous(3 Koreans), mean BI was 4.0+,and mean O.D. of PGL-I antibody was 0.846, and numbers of TTC repeat were 12(2 cases), 11(1 case), and of GACATC repeats are 4(all 3 Koreans). Among 3 relapse cases, 1 case has the mutation ofrpoB gene.

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.

6 Cases of Hansen's Disease(New case & Relapse) / 나학회지

In 2007, we find 3 new cases and 3 relapse cases, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The results obtained were summarized as follows: 1. In 3 new cases, 2 Koreans are 70 and 79 years old, one foreigner (Filipino) is 38 years old, mean BI is 2.8, and mean O.D. of PGL-I antibody is 0.22, and numbers of TTC repeat are 10(Korean), 11(Korean), and 12(Filipino), and of GACATC repeats are 4(2 Koreans) and 3(1 foreigner/ Filipino). All new cases have no mutation of folP1 & rpoB gene. 2. In 3 relapse cases, the mean age is 56.8, mean BI is 5.6+, and mean O.D. of PGL-I antibody is 0.70, and numbers of TTC repeat are 11(2 cases), and 12(1 case), and of GACATC repeats are 4(all 3 Koreans). Among 3 relapse cases, 2 cases have the mutation of folP1 gene and 2cases have the mutationo frpoB gene, especially one case have the mutation of both folP1 & rpoB gene.

8 Cases of Hansen's Disease(New case & Relapse) / 나학회지

In 2006, we find 7 new cases and one relapse case, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. In new cases, the mean age is 59.3, mean BI is 3.3+, mean O.D. of PGL-I antibody is 0.941, numbers of TTC repeat are 13(3 cases), 11(2 case), 12(1 cases), and 31(1 case), and of GACATC repeats are 4(5 Koreans) and 3(2 foreigners). In relapse case, a 45 years-old male patient is revealed that BI is 5+, O.D. of PGL-I antibody is 1.096, numbers of TTC repeat are 12 and GACATC repeats are 4.

12 Cases of Hansen's Disease(New case & Relapse) / 나학회지

In 2005, we find 7 new cases and 5 relapse cases, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The results obtained were summarized as follows: 1. In new cases, the mean age is 54.6, mean BI is 4.1+,and mean O.D. of PGL-I antibody is 0.866, and numbers of TTC repeat are 10(3 cases), 12(3 cases), and 11(1 case), and of GACATC repeats are 4(all Korean 5 cases) and 3(all foreigners 2cases). 2. In relapse case, the mean age is 65.0, mean BI is 4.6+,and mean O.D. of PGL-I antibody is 1.19, and numbers of TTC repeat are 11(2 cases), 12(1 cases), 13(1 case) and unknown(1 case), and of GACATC repeats are 4(all Korean 4 cases) and unknown(1 case).

A reação de mitsuda em tatus Dasypus novemcinctus utilizando antigeno humano e antigeno derivado de tatus / Mitsuda reaction in armadillos Dasypus novemcinctus using human and armadillo derived antigens

O tatu foi um modelo experimental importante para o estudo da hanseniase, alem de ser ainda uma importante fonte para coleta de bacilos. Apesar dos inumeros relatos de estudos em tatus de especie Dasypus novemcinctus, pouco se sabe sobre a real susceptibilidade desta especie ao bacilo de Hansen apos inoculaçao experimental com M. leprae. Alguns autores relatam que cerca de 80 por cento dos animais desenvolveriam a doença quando infectados. No Brasil, a inoculaçao experimental desta especie resultou em inoculaçoes positiva em apenas dois momento, tendo ate sido levantada a hipotese de estes animais serem mais resistentes a infecçao experimental. No presente estudo, utilizou-se a resposta ao nantigeno de Mitsuda como um indicador de resposta imune celular de tatus ao M. leprae...

Mitsuda reaction in armadillos Dasypus novemcinctus using human and armadillo derived antigens

The armadillo has been an important experimental model for leprosy, besides it is still an important resource for bacilli. Despite the innumerous studies about armadillos of the Genus Dasypus, little is known about the real susceptibility of this species to the Hansen’s bacillus after experimental infection with M. leprae. Many authors have reported that 80 per cent of the inoculated animal will develop the disease. In Brazil, positive inoculation of this species was obtained only twice, being raised the hypothesis that these animals are more resistant to experimental infection. In the present study the response to the Mitsuda antigen was used as an indicative of cellular immune response to M. leprae in armadillos. Twenty one animals were tested with two Mitsuda antigen preparations, human derived (4,2 x 109 bacilli/ml) and armadillo derived (1,6 x 108 bacilli/ml) antigens. Response after 28 days of intradermal testing showed that most of the animals presented an infiltrate composed by grouped macrophages with vacuolated cytoplasm and rare lymphocytes. This response resembles lepromatous leprosy in humans and suggests that these animals would be susceptible to development of disseminated leprosy when successfully inoculated. Bacilloscopy in these animals varied from 3+ to 4+ according to Ridley’s scale (1966). Two animals developed a granulomatous reaction with borderline pattern and bacilloscopy varying from 1+ to 3+.

Infection by Mycobacterium leprae of household contacts of lepromatous leprosy patients from a post-elimination leprosy region of Colombia

The Leprosy Control Program of Antioquia, (post-elimination leprosy state of Colombia), had registered by 1999, 56 lepromatous leprosy patients and their household contacts (HHC). Our interest was to detect Mycobacterium leprae infection in these HHC. Clinical examination, acid-fast bacillary staining (AFB) in nasal secretions, and slit skin samples, IgM anti-PGL-I in serum and Lepromine A (Mitsuda) reactivity were tested. Two hundred forty eight HHC were studied, 49 percent were male. After clinical examination, two HHC were diagnosed as multi bacillary patients; 13 percent showed positive IgM anti-PGL-I titers; Mitsuda reaction (> 4 mm) was positive in 59 percent; AFB was negative in all samples, except in the two new patients. HHC were classified according to test results.Group 1: two new multi bacillary patients. Group 2: 15 HHC seropositive, Mitsuda-negative. Group 3: 13 HHC seropositive, Mitsuda-positive. Group 4: 130 HHC seronegative, Mitsuda-positive. Group 5: 88 HHC seronegative, Mitsuda-negative. These results are an indication that the transmission of the infection is still happening in a region considered in the post elimination phase. The two new patients represent an infection source for others contacts, and groups 2 and 3 are infected HHC that could develop the disease in future. Follow up of high risk population is necessary to achieve real elimination of leprosy.

Desenvolvimento de preparado antigênico Mitsuda-símile e sua avaliação em pacientes multibacilares Mitsuda-negativos / Development of a Mitsuda-like antigen and its evaluation in multibacillary, Mitsuda-negative leprosy patients

FUNDAMENTOS: A hanseníase, causada pelo Mycobacterium leprae, manifesta-se por forma clínica denominada paucibacilar, benigna, Mitsuda-positiva, imunocompetente, e por outra forma, denominada multibacilar, grave, Mitsuda-negativa, imunodeficiente. Doentes multibacilares, eliminadores de bacilos, são considerados os mantenedores da endemia hansênica. OBJETIVOS: Os autores testaram cultura de micobactérias, obtida em laboratório, em pacientes Mitsuda-negativos, em busca de possível viragem imunológica. MÉTODOS:Com a cultura de micobactérias, foi preparado antígeno mitsudina-símile, que foi testado em 28 hansenianos Mitsuda-negativos, os quais, após avaliação desse teste, foram submetidos a novo teste de Mitsuda. Outros 28 Mitsuda-negativos receberam a inoculação de placebo e, posteriormente, foram avaliados por meio de novo teste de Mitsuda. RESULTADOS: Nos pacientes inoculados com a mitsudina experimental houve respostas favoráveis: em 25 deles reações macroscópicas positivas, em quatro das quais, com granuloma tuberculóide. Avaliados por meio de novo teste de Mitsuda, quatro deles responderam com típicas reações Mitsuda-positivas, com granuloma tuberculóide. Nos pacientes testados com placebo, as respostas foram negativas; a um novo teste de Mitsuda, houve uma resposta positiva. CONCLUSÕES: Em hansenianos Mitsuda-negativos, testados com mitsudina experimental, foram constatadas 14,29 por cento de respostas favoráveis, com reações de Mitsuda-símiles provocadas por essa mitsudina; testados os pacientes, novamente, com o antígeno de Mitsuda, foram constatadas 14,81 por cento de respostas favoráveis, com reações positivas.

6 Cases of Hansen's Disease(New case & Relapse) / 나학회지

In 2003, we find 5 new cases and one relapse case, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The results obtained were summarized as follows: 1. In new cases, the mean age is 52.5, mean BI is 3.4+,and mean O.D. of PGL-I antibody is 0.531, and numbers of TTC repeat are 12(2 cases), 13(2 cases), and 11(1 case), and of GACATC repeats are 4(all 6 cases). 2. In relapse case, a 58 years-old male patient is revealed that BI is 6+,and O.D. of PGL-I antibody is 0.873, numbers of TTC repeat are 11 GACATC repeats are 4.

Estudo comparativo entre reacao de Mitsuda e fenotipagem HLA em pacientes hansenianos / ?

Neste estudo propos-se comparar o teste intradermico de Mitsuda e os alelos HLA-DR2/HLA-DR3 e HLA-DQ1 relacionados com as formas clinicas da hanseniase, visando contribuir para o delineamento de nova metodologia no auxilio prognostico desta doenca. Foram estudados 176 pacientes hansenianos (50 HT, 50 HV e 76 HD). A tipificacao do HLA-DR e HLA-DQ foi determinada pela tecnica de PCR/SSP e reacao de Mitsuda pela intradermorreacao com leitura em 28 dias. Na forma HT os resultados demonstraram que a reacao de Mitsuda foi positiva em todos os pacientes, sendo 16 por cento positivo1+ 68 por cento positivo2+ e 16 por cento positivo3+. O diametro de induracao variou entre 4,0 a 18,0mm, com valor medio de 7,5mm. A especificidade HLA-DR2 esteve presente em 28 por cento dos pacientes deste grupo (24 por cento HLA-DRB1*15 e 4 porcento HLA-DRB1*16). A especificidade HLA-DR3 esteve presente 16 por cento dos pacientes (8 por cento HLA-DRB1*17 e 8 por cento HLA-DRB1*18), 2 por cento apresentaram os alelos HLA-DR2 e HLA-DR3 simultaneamente, totalizando 46 por cento da amostra estudada com o marcador. A forma HV apresentou a reacao de Mitsuda negativa em todos os pacientes estudados. A especificidade do HLA-DQ1 esteve presente em 74 por cento dos pacientes (34 por cento HLA-DQB1*05, 28 por cento HLA-DQB1*06 e 12 por cento HLA-DQB1*05 e HLA-DQB1*06). No grupo HD, o padrao de leitura da reacao de Mitsuda resultou em negativo em 48,7 por cento duvidoso 5,2 por cento positivo 1+ 30,3 por cento e positivo 2+ 15,8 por cento. O diametro da iduracao variou entre negativo a 7,5mm com valor medio de 2,4mm...

Estudo Comparativo entre reação de mitsuda e fenotipagem HLA em pacientes hansenianos

Neste estudo propôs-se comparar o teste intradérmico de Mitsuda e os alelos HLA-DR2 /HLA -DR3 e HLA-DQ1 relacionados com as formas clínicas da hanseníase, visando contribuir para o delineamento de nova metodologia no auxílio prognóstico desta doença. Foram estudados 176 pacientes hansenianos (50 HT, 50 HV e 76 HD). A tipificação do HLA-DR e HLA -DQ foi determinada pela técnica de PCR/SSP e a reação de Mitsuda pela intradermorreação com leitura em 28 dias. Na forma HT os resultados demonstraram que a reação de Mitsuda foi positiva em todos os pacientes, sendo 16% positivo1+, 68% positivo2+ e 16% positivo3+. O diâmetro de induração variou entre 4,0 a 18,0mm, com valor médio de 7,5mm. A especificidade HLA-DR2 esteve presente em 28% dos pacientes deste grupo (24% HLA-DRB1*15 e 4% HLA-DRB1*16). A especificidade HLA-DR3 esteve presente em 16% dos pacientes (8% HLA-DRB1*17 e 8% HLA-DRB1*18), 2% apresentaram os alelos HLA-DR2 e HLA-DR3 simultâneamente, totalizando 46% da amostra estudada com o marcador. A forma HV apresentou a reação de Mitsuda negativa em todos os pacientes estudados. A especificidade do HLA-DQ1 esteve presente em 74% dos pacientes (34% HLA-DQB1*05, 28% HLA-DQB1*06 e 12% HLA-DQB1*05 e HLA-DQB1*06). No grupo HD, o padrão de leitura da reação de Mitsuda resultou em negativo em 48,7%, duvidoso 5,2%, positivo 1+ 30,3% e positivo 2+ 15,8%. O diâmentro da induração variou entre negativo a 7,5mm com valor médio de 2,4mm. Com relação aos alelos HLA, não foi possível realizar a comparação, por não se ter verificado após estudo de associação, nenhum alelo relacionado ao grupo HD. Realizou-se também análise não estratificada dos pacientes de acordo com a resposta ao teste de Mitsuda. Oitenta e cinco pacientes foram positivos para o teste de Mitsuda e destes, 43,5% possuíam o alelo HLA-DR2 ou HLA-DR3. Noventa e um pacientes tiveram reação de Mitsuda negativa, destes 65,9% apresentaram o alelo HLA-DQ1. Os dados obtidos neste estudo permitiram ...

Estudo Comparativo entre reação de mitsuda e fenotipagem HLA em pacientes hansenianos / Comparative study between the mitsuda test and the HLA phenotype in leprosy patients

Neste estudo propôs-se comparar o teste intradérmico de Mitsuda e os alelos HLA-DR2 /HLA -DR3 e HLA-DQ1 relacionados com as formas clínicas da hanseníase, visando contribuir para o delineamento de nova metodologia no auxílio prognóstico desta doença. Foram estudados 176 pacientes hansenianos (50 HT, 50 HV e 76 HD). A tipificação do HLA-DR e HLA -DQ foi determinada pela técnica de PCR/SSP e a reação de Mitsuda pela intradermorreação com leitura em 28 dias. Na forma HT os resultados demonstraram que a reação de Mitsuda foi positiva em todos os pacientes, sendo 16% positivo1+, 68% positivo2+ e 16% positivo3+. O diâmetro de induração variou entre 4,0 a 18,0mm, com valor médio de 7,5mm. A especificidade HLA-DR2 esteve presente em 28% dos pacientes deste grupo (24% HLA-DRB1*15 e 4% HLA-DRB1*16). A especificidade HLA-DR3 esteve presente em 16% dos pacientes (8% HLA-DRB1*17 e 8% HLA-DRB1*18), 2% apresentaram os alelos HLA-DR2 e HLA-DR3 simultâneamente, totalizando 46% da amostra estudada com o marcador. A forma HV apresentou a reação de Mitsuda negativa em todos os pacientes estudados. A especificidade do HLA-DQ1 esteve presente em 74% dos pacientes (34% HLA-DQB1*05, 28% HLA-DQB1*06 e 12% HLA-DQB1*05 e HLA-DQB1*06). No grupo HD, o padrão de leitura da reação de Mitsuda resultou em negativo em 48,7%, duvidoso 5,2%, positivo 1+ 30,3% e positivo 2+ 15,8%. O diâmentro da induração variou entre negativo a 7,5mm com valor médio de 2,4mm. Com relação aos alelos HLA, não foi possível realizar a comparação, por não se ter verificado após estudo de associação, nenhum alelo relacionado ao grupo HD. Realizou-se também análise não estratificada dos pacientes de acordo com a resposta ao teste de Mitsuda. Oitenta e cinco pacientes foram positivos para o teste de Mitsuda e destes, 43,5% possuíam o alelo HLA-DR2 ou HLA-DR3. Noventa e um pacientes tiveram reação de Mitsuda negativa, destes 65,9% apresentaram o alelo HLA-DQ1. Os dados obtidos neste estudo permitiram concluir que a utilização isolada da tipificação HLA não constitui uma ferramenta adequada para auxílio no prognóstico da doença, embora o emprego em conjunto das duas metodologias poderão complementar o diagnóstico da hanseníase

11 Cases of Hansens Disease(New case & Relapse) / 나학회지

In 2003, we found 6 new cases and 5 relapse cases, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The results obtained were summarized as follows: 1. In new cases, the mean age was 62.5, mean BI is 4+,and mean O.D. of PGL-I antibody was 0.678, and numbers of TTC repeat was 12(4 cases), 18(1 case), and 20(1 case), and of GACATC repeats are 4(5 cases, Koreans)and 3(1 case, Filipino). 2. In relapse cases, the mean age was 59.4, mean BI is 4.6+,and mean O.D. of PGL-I antibody was 0.772, and numbers of TTC repeat was 11(4 cases), 15(1 case), and of GACATC repeats are 4(4 case, Koreans)and 3(1 case, Korean).