Latent leprosy infection identified by dual RLEP and anti-PGL-I positivity: Implications for new control strategies.

Autor: da Silva MB; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Li W; Colorado State University, Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Fort Collins, CO, Unites States of America., Bouth RC; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Gobbo AR; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Messias ACC; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Moraes TMP; Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará (UFOPA), Santarém, Pará, Brazil., Jorge EVO; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Barreto JG; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil.; Spatial Epidemiology Laboratory, Universidade Federal do Pará-Campus Castanhal, Castanhal, Pará, Brazil., Filho FB; Division of Dermatology, Department of Internal Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil., Conde GAB; Laboratório de Suporte a Decisões, Universidade Federal do Oeste do Pará (UFOPA), Santarém, Pará, Brazil., Frade MAC; Division of Dermatology, Department of Internal Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil., Salgado CG; Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belem, Pará, Brazil., Spencer JS; Colorado State University, Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Fort Collins, CO, Unites States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 May 13; Vol. 16 (5), pp. e0251631. Date of Electronic Publication: 2021 May 13 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0251631
Abstrakt: The number of new cases of leprosy reported worldwide has remained essentially unchanged for the last decade despite continued global use of free multidrug therapy (MDT) provided to any diagnosed leprosy patient. In order to more effectively interrupt the chain of transmission, new strategies will be required to detect those with latent disease who contribute to furthering transmission. To improve the ability to diagnose leprosy earlier in asymptomatic infected individuals, we examined the combined use of two well-known biomarkers of M. leprae infection, namely the presence of M. leprae DNA by PCR from earlobe slit skin smears (SSS) and positive antibody titers to the M. leprae-specific antigen, Phenolic Glycolipid I (anti-PGL-I) from leprosy patients and household contacts living in seven hyperendemic cities in the northern state of Pará, Brazilian Amazon. Combining both tests increased sensitivity, specificity and accuracy over either test alone. A total of 466 individuals were evaluated, including 87 newly diagnosed leprosy patients, 52 post-treated patients, 296 household contacts and 31 healthy endemic controls. The highest frequency of double positives (PGL-I+/RLEP+) were detected in the new case group (40/87, 46%) with lower numbers for treated (12/52, 23.1%), household contacts (46/296, 15.5%) and healthy endemic controls (0/31, 0%). The frequencies in these groups were reversed for double negatives (PGL-I-/RLEP-) for new cases (6/87, 6.9%), treated leprosy cases (15/52, 28.8%) and the highest in household contacts (108/296, 36.5%) and healthy endemic controls (24/31, 77.4%). The data strongly suggest that household contacts that are double positive have latent disease, are likely contributing to shedding and transmission of disease to their close contacts and are at the highest risk of progressing to clinical disease. Proposed strategies to reduce leprosy transmission in highly endemic areas may include chemoprophylactic treatment of this group of individuals to stop the spread of bacilli to eventually lower new case detection rates in these areas.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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