Associação entre reação hansênica após alta e a carga bacilar avaliada utilizando sorologia anti PGL-I e baciloscopia

Brito, Maria de Fátima de Medeiros; Ximenes, Ricardo Arraes Alencar; Gallo, Maria Eugênia Noviski; Bührer-Sékula, Samira

doi:10.1590/s0037-86822008000700014

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…The difference between men and women has been shown to be similar to other studies, which also point to this higher prevalence in men [11,12,13]. The predominance of reactional states among men may be associated with a greater delay in the search for health services, which hampers the development of preventive and early diagnosis actions [14].…”

Section: Discussionsupporting

confidence: 76%

Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

Sousa¹,

Oliveira²,

Centeno³

et al. 2017

int arch med

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Introduction: During the course of leprosy, 10 to 50% of individuals can be surprised by reaction states, which are immune system reactions of the patient to Mycobacterium leprae. Leprosy reactions constitute the main cause of nerve damage and disability caused by leprosy.Objective: To analyze the clinical and therapeutic profile of patients with leprosy reactions registered in a Dermatology Service in the city of Belém-PA.Methods: This is a cross-seccional, descriptive study. It was investigated through analysis of medical records, 52 patients who fit the established inclusion criteria. Data were collected in July and August 2016.Results: It was found a predominance of men, from the metropolitan region. The clinical form most common of Leprosy was Borderline, and the leprosy reaction type 1. The most of reactions occurred right after the introduction of multidrug therapy,and more than a half of patients with type 1 reaction showed edema of limbs. Regarding the type 2, fever and general symptoms were the most common, present in all cases. The frequency of neural damage was evident, showing reduction of motor force level andloss of protective sensation. Conclusion:Early diagnosis and appropriate therapeutic management of reactive events is critical to the prevention of disabilities.

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Section: Discussionsupporting

confidence: 76%

Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

Sousa¹,

Oliveira²,

Centeno³

et al. 2017

int arch med

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“…Bacillary load is known to directly correlate with antibody levels and with the development of leprosy reactions [2, 16, 27, 28]. Moreover, antibodies, which are abundant in MB patients, probably play a role in the pathophysiology of ENL [15–17, 39].…”

Section: Discussionmentioning

confidence: 99%

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

et al. 2016

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BackgroundThe predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR).MethodsThis was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI.ResultsMore than half of the patients (55.5 %) reported leprosy reaction: 18.3 % (138/753) had a RR and 5.4 % (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27 % (205/753) of patients, while 19 % (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9 % were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45).ConclusionsMB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0203-0) contains supplementary material, which is available to authorized users.

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“…However, patients with high concentrations of anti-PGL-I IgM at the onset of treatment presented a higher risk of developing type 1 reactions, thus identifying patients for monitoring and early treatment may reduce nerve damage and disability 65 . In posttreatment reactions, patients with a positive PGL-I serology when released from treatment showed a 10.4-fold greater chance of developing reactions compared to those with negative serology 7 . Research using serology is necessary to identify the patients at higher risk of developing reactions in order to define the best approach to case holding and patient monitoring.…”

Section: Pgl-i As a Predictor Of Reactions And Relapsementioning

confidence: 93%

Sorologia da hanseníase utilizando PGL-I: revisão sistemática

Moura

Calado

Oliveira

et al. 2008

Rev. Soc. Bras. Med. Trop.

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Serology using a species-specific antigen for Mycobacterium leprae, PGL-I, could be a marker for the bacterial load of patients with leprosy. Various studies have identified the potential use of serology in the classification of patients for treatment purposes, case monitoring, identification of the risk of relapse and selection of household contacts with a higher risk of contracting the disease. A systematic review of the literature was conducted and 26 articles were included in this comparative analysis. The results of the use of PGL-I serology in different situations, its limitations and possible applications were evaluated. Studies show the efficacy of PGL-I serology in the classification of patients, treatment monitoring and as a predictive test for leprosy reactions. To improve early diagnosis and follow-up of the population at greatest risk of developing leprosy, the methodologies used in the past have yet to show a favorable cost-benefit ratio, although studies indicate that the use of the test might positively influence leprosy control programs. With simple and robust techniques, the use of PGL-I serology is viable.

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Associação entre reação hansênica após alta e a carga bacilar avaliada utilizando sorologia anti PGL-I e baciloscopia

Cited by 29 publications

References 7 publications

Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

Sorologia da hanseníase utilizando PGL-I: revisão sistemática

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