An Attempt to Improve Pure Neural Leprosy Diagnosis Using Immunohistochemistry Tests in Peripheral Nerve Biopsy Specimens

Medeiros, Mildred Ferreira; Jardim, Márcia Rodrigues; Vital, Robson Teixeira; Nery, José Augusto da Costa; Sales, Anna Maria; Moraes, Milton Ozório; Chimelli, Leila; Pessolani, Maria Cristina Vidal; Ferreira, Helen; Sarno, Euzenir Nunes; Antunes, Sérgio Luiz Gomes

doi:10.1097/pai.0b013e31828dc70c

Cited by 7 publications

(2 citation statements)

References 14 publications

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“…Although there have been previous Brazilian studies about LAM in leprosy [20,21] this is the first study using Determine TB LAM Ag conducted in Brazil using the national algorithm in established clinical sites demonstrating that LAM should be used in sites with high burden of HIV to improve the rapid diagnosis of TB.…”

Section: Discussionmentioning

confidence: 96%

Accuracy of Determine TB-LAM Ag to detect TB in HIV infected patients associated with diagnostic methods used in Brazilian public health units

et al. 2019

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BackgroundDetermine TB-LAM Ag (LAM) is a point of care test developed to diagnose tuberculosis (TB). The aim of this study was to evaluate the diagnostic performance of LAM in people living with HIV using Brazilian public health network algorithm for TB diagnosis.Methods and findingsA cross-sectional study design was used to enroll 199 adult patients in two sites in Rio de Janeiro and two in São Paulo. The study enrolled HIV-infected patients with CD4 counts ≤200 cells/mm3 (in the Alere PIMA CD4 assay at study screening), patients coughing for at least 2 weeks or presenting a chest radiography suggestive of TB. LAM, in conjunction with sputum smear microscopy or Xpert MTB/RIF (Xpert) as compared to Mycobacterium tuberculosis culture, which was used as a reference standard. TB prevalence was 24.6%. Overall accuracy of LAM was 79.9% (73.8%-84.9%), positive and negative predictive values were 62.2% (46.1%-75.9%) and 84% (77.5%-88.8%), respectively. The overall LAM sensitivity was 46.9% (33.7%-60.6%) and specificity was 90.7% (84.9%-94.4%). The best performance of LAM was observed among patients with CD4 counts ≤50 cells/mm3 (sensitivity = 70.4% and specificity = 85.9%). When 2 respiratory smears were used in conjunction with LAM, sensitivity increased 22%, as compared to just 2 smears. Furthermore, LAM when used in conjunction with two respiratory smears, was as sensitive as compared to a single one. However, no improvement in TB diagnosis occurred when LAM was used with Xpert as compared to Xpert alone. Among 14 LAM false positive tests, Non-Tuberculosis Mycobacteria were isolated in three cases.ConclusionLAM is a point of care test that increased TB diagnosis in immunosuppressed HIV-infected patients when used in conjunction with smear microscopy, but not when used with Xpert in Brazilian public health network sites. Use of LAM test should be considered in settings where immunosuppressed HIV patients need rapid TB diagnosis.

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Section: Discussionmentioning

confidence: 96%

Accuracy of Determine TB-LAM Ag to detect TB in HIV infected patients associated with diagnostic methods used in Brazilian public health units

et al. 2019

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“…Differential diagnosis may be even more difficult when only neurological symptoms are present -as in pure neural leprosy 5 . Often, the diagnosis of pure neural leprosy depends on careful clinical evaluation associated with complementary exams, laboratory analyses, electroneuromyography, and molecular methods to confirm the diagnosis 6 . However, these technologies are largely scarce in primary health care, which can lead to false diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brzil, 2016-2019

et al. 2023

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This study aimed to analyze the self-reported clinical history of patients misdiagnosed with leprosy in the State of Mato Grosso, Brazil. This is a cross-sectional study of new leprosy cases diagnosed in the State of Mato Grosso from 2016 to 2019, with individuals who were released from multidrug therapy due to misdiagnosis after starting treatment. Data were collected via telephone interviews. Over the study period, 354 leprosy cases were released from treatment due to misdiagnosis, of which 162 (45.8%) could be interviewed. All interviewees expressed dissatisfaction with their treatment, which prompted them to seek a reevaluation of their diagnosis before they were released due to “misdiagnosis”. Among them, 35.8% received a final diagnosis of a musculoskeletal or connective tissue disease - mainly fibromyalgia and degenerative changes in the spine - followed by 13.6% with diagnoses of skin and subcutaneous tissue diseases. For 23.5% of the respondents, no alternative diagnosis was established, whereas 7.4% were later re-diagnosed with leprosy. Fibromyalgia and spinal problems were the most common alternative diagnoses for erroneous leprosy. Although the diagnosis of leprosy is usually clinical and does not require access to technical infrastructure in most cases, some more complex situations require diagnostic support via complementary tests, as well as close collaboration between primary care and reference services.

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Infectious Diseases

Elston¹,

Gibson²,

Kutzner³

2015

Handbook of Practical Immunohistochemistry

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An Attempt to Improve Pure Neural Leprosy Diagnosis Using Immunohistochemistry Tests in Peripheral Nerve Biopsy Specimens

Cited by 7 publications

References 14 publications

Accuracy of Determine TB-LAM Ag to detect TB in HIV infected patients associated with diagnostic methods used in Brazilian public health units

Accuracy of Determine TB-LAM Ag to detect TB in HIV infected patients associated with diagnostic methods used in Brazilian public health units

Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brzil, 2016-2019

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