Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy.

Autor: de Carvalho Dornelas B; Pathology Unit, Hospital of Clinics, Federal University of Uberlândia, Brazilian Company for Hospital Services (HC-UFU/EBSERH), Uberlândia, MG, Brazil. dornelasbruno@gmail.com.; Post-Graduation Program in Health Science, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil. dornelasbruno@gmail.com.; Unidade de Anatomia Patológica. Hospital de Clínicas de Uberlândia, Av. Pará, 1720 - Umuarama, Uberlândia, MG, 38405-320, Brazil. dornelasbruno@gmail.com., da Costa WVT; School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil., de Abreu JPF; Pathology Unit, Hospital of Clinics, Federal University of Uberlândia, Brazilian Company for Hospital Services (HC-UFU/EBSERH), Uberlândia, MG, Brazil., Daud JS; Pathology Unit, Hospital of Clinics, Federal University of Uberlândia, Brazilian Company for Hospital Services (HC-UFU/EBSERH), Uberlândia, MG, Brazil., Campos FDAR; School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil., de Oliveira Campos DR; Pathology Unit, Hospital of Clinics, Federal University of Uberlândia, Brazilian Company for Hospital Services (HC-UFU/EBSERH), Uberlândia, MG, Brazil., Antunes DE; National Reference Center for Leprosy/Dermatological Health (CREDESH), HC- UFU/EBSERH, Uberlândia, MG, Brazil., de Araújo LB; School of Mathematics, Federal University of Uberlândia, Uberlândia, MG, Brazil., Dos Santos DF; Post-Graduation Program in Health Science, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil.; National Reference Center for Leprosy/Dermatological Health (CREDESH), HC- UFU/EBSERH, Uberlândia, MG, Brazil., Soares CT; Lauro de Souza Lima Institute (ILSL), Bauru, SP, Brazil., Goulart IMB; Post-Graduation Program in Health Science, School of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil.; National Reference Center for Leprosy/Dermatological Health (CREDESH), HC- UFU/EBSERH, Uberlândia, MG, Brazil.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2024 Oct 01; Vol. 24 (1), pp. 1085. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1186/s12879-024-09937-2
Abstrakt: Background: Treatment failure (TF) in leprosy following multidrug therapy (MDT) presents a significant challenge. The current World Health Organization (WHO) fixed-duration MDT regimen, based on lesion count, might not be adequate. Leprosy lacks clear-cut objective cure criteria, and the predictive value of post-MDT histopathological findings remains uncertain. This study aims to identify predictive factors for TF among leprosy patients who have completed the WHO-recommended MDT.
Methods: An analysis was conducted on 80 individuals from a national leprosy reference center, comprising 40 TF cases (with a mean relapse at 13.0 months) and 40 controls (with a mean of 113.1 months without disease signs). Various epidemiological and clinical-laboratory parameters were assessed post-MDT.
Results: In skin samples, the presence of foamy granuloma (OR = 7.36; 95%CI2.20-24.60; p = 0.0012) and histological bacillary index (hBI) ≥ 1+ (OR = 1.55; 95%CI1. 22-1.99; p = 0.0004) were significantly associated with TF, with odds ratios of 7.36 and 1.55, respectively. Individuals who experienced TF had a mean hBI of 3.02+ (SD ± 2.02), while the control group exhibited a mean hBI of 1.8+ (SD ± 1.88). An hBI ≥ 3 + showed a sensitivity of 73% and a specificity of 78% for TF detection (AUC: 0.75; p = 0.0001). Other histopathological features like epithelioid granulomas, and skin changes did not show significant associations (p > 0.05). Additionally, higher anti-phenolic glycolipid-I (anti-PGL-I) ELISA index (EI) levels were linked to a 1.4-fold increased likelihood for TF (OR = 1.4; 95%CI1.13-1.74; p = 0.0019). A mean EI of 4.48 (SD ± 2.80) was observed, with an EI ≥ 3.95 showing a sensitivity of 79% and a specificity of 59% for TF detection (AUC: 0.74; p = 0.0001). Moreover, the presence of Mycobacterium leprae (M. leprae) DNA in real-time polymerase chain reaction (qPCR) was associated with a 3.43-fold higher likelihood of TF. Multivariate regression analysis indicated that concurrent presentation of neural/perineural lymphocytic infiltrate, foamy granuloma, hBI ≥ 1+, and EI ≥ 1 markedly increased the likelihood of TF by up to 95.41%.
Conclusion: Persistence of nerve-selective lymphocytic infiltrate, foamy granulomas, and bacilli in skin biopsies, and elevated EI post-MDT, may serve as predictive factors for identifying individuals at higher probability of TF.
(© 2024. The Author(s).)
Databáze: MEDLINE
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