A Case of Recurrent Rash and Leg Numbness Mimicking Systemic Rheumatic Disease

Flower, Cindy; Gaskin, David A.; Marquez, Sean

doi:10.1097/rhu.0b013e318064e7a0

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…Confounding WHO's implementation of a global leprosy eradication strategy is that the number of trained leprologists has diminished. This is inadvertently increasing the likelihood that a clinical diagnosis is delayed or even missed, especially in regions where leprosy has been controlled (1,13,16,25). The presence of serum immunoglobulin M (IgM) antibody to phenolic glycolipid I (PGL-I) correlates with BI in leprosy patients and has been used to support disease symptoms as a means to categorize leprosy patients.…”

mentioning

confidence: 99%

Use of Protein Antigens for Early Serological Diagnosis of Leprosy

Duthie

Goto

Ireton

et al. 2007

Clin Vaccine Immunol

128

139

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Leprosy is a chronic and debilitating human disease caused by infection with the Mycobacterium leprae bacillus. Despite the marked reduction in the number of registered worldwide leprosy cases as a result of the widespread use of multidrug therapy, the number of new cases detected each year remains relatively stable. This indicates that M. leprae is still being transmitted and that, without earlier diagnosis, M. leprae infection will continue to pose a health problem. Current diagnostic techniques, based on the appearance of clinical symptoms or of immunoglobulin M (IgM) antibodies that recognize the bacterial phenolic glycolipid I, are unable to reliably identify early-stage leprosy. In this study we examine the ability of IgG within leprosy patient sera to bind several M. leprae protein antigens. As expected, multibacillary leprosy patients provided stronger responses than paucibacillary leprosy patients. We demonstrate that the geographic locations of the patients can influence the antigens they recognize but that ML0405 and ML2331 are recognized by sera from diverse regions (the Philippines, coastal and central Brazil, and Japan). A fusion construct of these two proteins (designated leprosy IDRI diagnostic 1 [LID-1]) retained the diagnostic activity of the component antigens. Upon testing against a panel of prospective sera from individuals who developed leprosy, we determined that LID-1 was capable of diagnosing leprosy 6 to 8 months before the onset of clinical symptoms. A serological diagnostic test capable of identifying and allowing treatment of early-stage leprosy could reduce transmission, prevent functional disabilities and stigmatizing deformities, and facilitate leprosy eradication.Cases in which Mycobacterium leprae infection manifests to cause leprosy present as a bacteriologic, clinical, immunologic, and pathological spectrum ranging from the extremes observed in paucibacillary (PB) and multibacillary (MB) patients (21,24). PB patients have one or a few skin lesions and a low or absent bacterial index (BI; a measure of the number of acidfast bacilli in the dermis, expressed on a logarithmic scale) and demonstrate specific cell-mediated immunity against M. leprae, but they have low or absent titers of M. leprae-specific antibodies and a granulomatous dermatopathology. In marked contrast, MB patients have multiple symmetric skin lesions and a high BI and demonstrate high titers of anti-M. leprae antibodies but an absence of specific cell-mediated immunity and a dermatopathology largely devoid of functional lymphocytes (21). Despite the implementation of a WHO-directed eradication program over the last 20 years, the worldwide annual rate of new case detection for leprosy remains stable at approxi-

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mentioning

confidence: 99%

Use of Protein Antigens for Early Serological Diagnosis of Leprosy

Duthie

Goto

Ireton

et al. 2007

Clin Vaccine Immunol

128

139

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“…WHO experts have listed diagnostic criteria as one or more of the following: hypopigmented or reddish skin patches with definite loss of sensation, thickened peripheral nerves, and acid-fast bacilli on skin smears or biopsies (WHO Expert Committee on Leprosy, 1998). While there are field-based tests, these are not widely used to provide point-of-care leprosy diagnosis, and reductions in the number of trained leprologists has increased the likelihood that clinical diagnosis is delayed or even missed, especially in regions where leprosy has been "controlled" (1,11,14,23).…”

mentioning

confidence: 99%

Selection of Antigens and Development of Prototype Tests for Point-of-Care Leprosy Diagnosis

Duthie

Ireton

Kanaujia

et al. 2008

Clin Vaccine Immunol

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Leprosy can be a devastating chronic infection that causes nerve function impairment and associated disfigurement. Despite the recent reduction in the number of registered worldwide leprosy cases as a result of the widespread use of multidrug therapy, the number of new cases detected each year remains relatively stable. The diagnosis of leprosy is currently based on the appearance of clinical signs and requires expert clinical, as well as labor-intensive and time-consuming laboratory or histological, evaluation. For the purpose of developing an effective, simple, rapid, and low-cost diagnostic alternative, we have analyzed the serologic antibody response to identify Mycobacterium leprae proteins that are recognized by leprosy patients. More than 100 recombinant antigens were analyzed in a protein array format to select those with discriminatory properties for leprosy diagnosis. As expected, multibacillary leprosy patients recognized more antigens with stronger antibody responses than paucibacillary leprosy patients. Our data indicate, however, that multibacillary patients can be distinguished from paucibacillary patients, and both of these groups can be segregated from endemic control groups. We went on to confirm the diagnostic properties of antigens ML0405 and ML2331 and the LID-1 fusion construct of these two proteins by enzyme-linked immunosorbent assay. We then demonstrated the performance of these antigens in rapid test formats with a goal of developing a point-of-care diagnostic test. A serological diagnostic test capable of identifying and allowing treatment of leprosy could reduce transmission, prevent functional disabilities and stigmatizing deformities, and facilitate leprosy eradication.

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“…2 The literature describes leprosy patients who were initially diagnosed with and treated for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatopolymyositis, and systemic vasculitis. [3][4][5][6][7][8] Those systemic manifestations are seen mainly in multibacillary leprosy, especially during reactional states, and are secondary to the direct infiltration and proliferation of the bacillus in the affected organ. [2][3][4][5][6][7][8][9] Systemic manifestations include malar erythema, subcutaneous nodules, ulcerations, purpuras, ischemic necrosis, Raynaud's phenomenon, polyneuropathy, multiple mononeuritis, muscle weakness, generalized lymphadenopathy, hepatosplenomegaly, and glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Systemic manifestations include malar erythema, subcutaneous nodules, ulcerations, purpuras, ischemic necrosis, Raynaud's phenomenon, polyneuropathy, multiple mononeuritis, muscle weakness, generalized lymphadenopathy, hepatosplenomegaly, and glomerulonephritis. 2,[8][9][10] The presence of rheumatoid factor, anti-cyclic citrullinated antibodies, ANF, anticardiolipin antibodies, antineutrophil cytoplasmic antibodies, and others are among the serologic changes observed.…”

Section: Discussionmentioning

confidence: 99%

Manifestações sistêmicas e ulcerações cutâneas da hanseníase: diagnóstico diferencial com outras doenças reumáticas

Ribeiro¹,

Guedes²,

Pereira³

et al. 2009

Rev. Bras. Reumatol.

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Leprosy is a systemic disease with predominant involvement of skin and nerves; articular manifestations are common and, in some cases, represent the initial complaint. We describe the case of a female patient with borderline leprosy, which manifested, initially, with symmetric polyarthritis, cutaneous ulcerative lesions on the lower limbs, and systemic manifestations mimicking rheumatic disease. The authors emphasize the importance of the differential diagnosis of the systemic, joint and, cutaneous involvement of leprosy with rheumatic diseases.

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A Case of Recurrent Rash and Leg Numbness Mimicking Systemic Rheumatic Disease

Cited by 10 publications

References 12 publications

Use of Protein Antigens for Early Serological Diagnosis of Leprosy

Use of Protein Antigens for Early Serological Diagnosis of Leprosy

Selection of Antigens and Development of Prototype Tests for Point-of-Care Leprosy Diagnosis

Manifestações sistêmicas e ulcerações cutâneas da hanseníase: diagnóstico diferencial com outras doenças reumáticas

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