The importance of greater control over environmental risk and educational factors needs to be emphasized in attempts to reduce the prevalence of these parasitic diseases.
Introduction: Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. Methods: We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classifi cation, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. Results: We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. Conclusions: Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.
Leprosy is an important cause of disability in the developing world. Early diagnosis is essential to allow for cure and to interrupt transmission of this infection. MicroRNAs (miRNAs) are important factors for host-pathogen interaction and they have been identified as biomarkers for various infectious diseases. The expression profile of 377 microRNAs were analyzed by TaqMan low-density array (TLDA) in skin lesions of tuberculoid and lepromatous leprosy patients as well as skin specimens from healthy controls. In a second step, 16 microRNAs were selected for validation experiments with reverse transcription-quantitative PCR (qRT-PCR) in skin samples from new individuals. Principal-component analysis followed by logistic regression model and receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic potential of selected miRNAs. Four patterns of differential expression were identified in the TLDA experiment, suggesting a diagnostic potential of miRNAs in leprosy. After validation experiments, a combination of four miRNAs (miR-101, miR-196b, miR-27b, and miR-29c) was revealed as able to discriminate between healthy control and leprosy patients with 80% sensitivity and 91% specificity. This set of miRNAs was also able to discriminate between lepromatous and tuberculoid patients with a sensitivity of 83% and 80% specificity. In this work, it was possible to identify a set of miRNAs with good diagnostic potential for leprosy.KEYWORDS biomarker, leprosy, miRNA L eprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. The infection affects primarily the skin and can cause damage to peripheral nerves, mucosa, and other organs, including liver and eyes. Leprosy is classified as a neglected tropical disease and remains one of the main causes of disability in the world (1-3). According to a World Health Organization (WHO) report including data from 138 countries, 211,974 newly diagnosed patients were notified in the year 2015 and 96% of them were reported from 22 countries, including Brazil (4).Leprosy presents a spectrum of clinical manifestations depending on the host immune response against M. leprae. It can be classified according to histopathological (Ridley-Jopling) criteria into different forms across two opposing poles: a so-called resistance pole responsible for a localized form of the disease (tuberculoid tuberculoid [TT]) and a susceptibility pole that is a disseminated form, which leads to the development of more severe clinical manifestations (lepromatous leprosy [LL]). There are also three intermediate and unstable forms: borderline tuberculoid (BT), borderline
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