Diagnostic challenges of single plaque-like lesion paucibacillary leprosy

Barbieri, Raquel Rodrigues; Sales, Anna Maria; Illarramendi, Ximena; Moraes, Milton Ozório; Nery, José Augusto da Costa; Moreira, Suelen Justo Maria; Sarno, Euzenir Nunes; Machado, Adriana Rodrigues; Bozza, Fernando A.

doi:10.1590/0074-0276140212

Cited by 10 publications

(12 citation statements)

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“…Only the involvement of experienced physicians, government, population of hyperendemic area [27], along with novel technologies such as qPCR to diagnose [28] and large-scale public policies clinically screening household contacts with chemo- and immunoprophylaxis of healthy ones could halt M. leprae transmission in the community and reduce the number of cases of visible disability [29].…”

Section: Discussionmentioning

confidence: 99%

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil

et al. 2019

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BackgroundEarly detection of leprosy and multidrug therapy are crucial to achieve zero transmission and zero grade II incapacities goals of World Health Organization. Leprosy is difficult to diagnose because clinical forms vary and there are no gold standard methods to guide clinicians. The serological rapid tests aid the clinical diagnosis and are available for field use. They are easy to perform, do not require special equipment or refrigeration and are cheaper than the molecular tests.MethodsWe evaluated the performance of two rapid serological tests (PGL1 and NDO-LID) in the discrimination of leprosy cases from healthy individuals at the Alfredo da Matta Foundation, a reference center for the disease in Manaus, Amazonas, Brazil. PGL1 and NDO-LID rapid tests are capable of detecting specific antibodies of M. leprae, IgM and IgM/IgG, respectively. A total of 530 healthy subjects and 171 patients (50 with paucibacillary and 121 multibacillary leprosy) were included in the study.ResultsAmong the paucibacillary leprosy patients, the sensitivity was 34.0 and 32.0% for the NDO-LID and PGL1, respectively. In multibacillary leprosy patients, the NDO-LID sensitivity was 73.6% and the PGL1 was 81.0%. Serological tests demonstrated specificities of 75.9% for PGL-1 and 81.7% for NDO-LID. The positive predictive value (PPV), negative predictive value (NPV) and accuracy in multibacillary patients were 47.9, 93.1, and 80.2% respectively for the NDO-LID, and 43.4, 94.6 76.8% for PGL1.ConclusionsThe tests showed limited capacity in the diagnosis of the disease, however, the high negative predictive value of the tests indicates a greater chance of true negatives in this group favoring exclusion of leprosy. This characteristic of the ML flow test is important in aiding clinical Diagnosis, especially in a region endemic to the disease and with other confounding skin conditions.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3653-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil

et al. 2019

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“…Current leprosy diagnosis relies upon clinical examination of the patient, recognition of skin lesions and peripheral neuropathy, in addition to identification of acid fast bacilli and histopathology typical of the active lesion. However, the identification of a true leprosy case when disabilities are not yet visible, especially for PB patients, is a challenge for clinician [ 38 , 39 ]. Therefore, histopathology is still mostly used as the gold standard for the diagnosis, with some limitations [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Auramine O staining and conventional PCR for leprosy diagnosis: A comparative cross-sectional study from Ethiopia

et al. 2018

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BackgroundDiagnosis of leprosy mainly relies on clinical examination due to the inconsistent sensitivity and poor reproducibility of the current laboratory tests. Utilisation of alternative methods to the standard Ziehl Neelsen (ZN), Fite-Faraco (FF) and Haematoxylin and Eosin (H&E) staining procedures may eventually improve leprosy diagnosis.Methodology/Principal findingsIn this comparative study, the performance of the fluorescent Auramine O (AO) staining and polymerase chain reaction (PCR) was assessed with different skin samples using a combination of ZN, FF and H&E staining as the gold standard. AO, ZN, FF, H&E and PCR tests were performed on slit skin smears (SSS) and/or punch biopsies collected from 141 clinically confirmed leprosy cases and 28 non-leprosy skin samples. DNA was extracted from punch biopsies using two different methods with or without mechanical lysis.Sensitivities were 87.6%, 59.3% and 77% for H&E, ZN and FF, respectively, whereas it reached 65.5% and 77.9% for AO in SSS and tissue sections and 91.1% for PCR in tissue samples. Morover, samples with low bacillary index, sensitivity of AO staining (61.8%) was similar to FF (60%, p>0.05) and lower than PCR (86.6%, p<0.05). Sensitivity of PCR also increased (96.8%, p<0.05) when mechanical lysis was used during DNA extraction compared to enzymatic treatment alone (84.6%).Conclusions/SignificanceOur results showed that for diagnostic purposes, analysis of skin section is more sensitive than SSS, especially for samples with low bacillary load. AO staining on SSS and tissue sections was not significantly better than other routine diagnostic tests but considerably more user friendly. The sensitivity of PCR was higher than current standard methods and increased when combined with more efficient DNA extraction using mechanical and chemical lysis. Therefore, we recommend AO staining for the diagnosis of leprosy in lower health facilities such as health centres and district hospitals and PCR diagnosis at referral level and research centres.

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“…For that purpose, serological test using anti-PGL1 has been performed among leprosy household contacts [ 30 ]. In recent years, studies carried out at the Fiocruz Leprosy Laboratory have demonstrated the great value of qPCR in the clinical management of suspected cases of paucibacillary leprosy [ 10 ] as well as pure neural leprosy [ 31 ]. But, to develop new diagnostic methods, that could be used in a variety of field conditions, to augment diagnostic accuracy, a greater commitment on the part of the health care system regarding research is urgently needed.…”

Section: Discussionmentioning

confidence: 99%

“…For diagnostic purposes, patients are routinely undergo dermato-neurological evaluation, skin smears, skin biopsies for histopathological analysis [ 9 ] and, if necessary, polymerase chain reaction is performed [ 10 ]. Those diagnosed with leprosy are treated and followed up at the Fiocruz Clinic or referred to the original service for treatment.…”

Section: Methodsmentioning

confidence: 99%

Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil

et al. 2016

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Reorientation of the public health policies in Brazil over the last 20 years in association with a stable rate of new-case detection prompted the establishment of a decentralized leprosy control strategy. The aim was to move from a vertical model associated with general dermatological services to one in which the diagnosis and treatment of the disease would be integrated into the primary care level of the national health care facilities. Once patients demand for leprosy reference centers began to be affected by the process of integrating leprosy diagnosis into the basic health care services, it was necessary to determine the profile of all our referrals in light of the new decentralization policy.ObjectiveWe evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals.MethodsThis is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy.ResultOur data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis.ConclusionThe results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

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Diagnostic challenges of single plaque-like lesion paucibacillary leprosy

Cited by 10 publications

References 9 publications

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil

Evaluation of Auramine O staining and conventional PCR for leprosy diagnosis: A comparative cross-sectional study from Ethiopia

Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil

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