Leprosy: clinical and immunopathological characteristics

Fróes, Luis Alberto Ribeiro; Sotto, Mírian Nacagami; Trindade, Maria Ângela Bianconcini

doi:10.1016/j.abd.2021.08.006

Cited by 35 publications

(36 citation statements)

References 39 publications

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“…Classically, it is characterized with a Th1/Th2 paradigm, presenting a cytokine profile that varies according to the type of Th response. However, studies have also shown differences across the disease spectrum for Th9, Th17, Th25 and Treg lymphocytes ( de Sousa et al, 2017 ; Froes et al, 2022 ).…”

Section: The Gut Microbiota and Mycobacteria Infectionsmentioning

confidence: 99%

“…The reverse reaction is an acute inflammatory episode in the skin and nerves characterized by an accentuated of the cellular immune response against M. leprae. ENL is a systemic inflammatory process characterized by an increase in the levels of pro-inflammatory cytokines, such as TNF-alpha, IL-6, and IL-1B, derived from Th17 lymphocytes ( Costa et al, 2018 ; Froes et al, 2022 ). Taking into account that the gut microbiota influences the homeostasis of various populations of T cells in the gut, including Tregs, Th1 and Th17 ( Gaboriau-Routhiau et al, 2009 ), directing the pattern of local and systemic immune response ( Schirmer et al, 2016 ; Thursby and Juge, 2017 ), it is plausible to assume that the host’s gut microbiota may be associated to the variety of clinical responses present in leprosy and to the inflammatory state in leprosy reactions.…”

Section: The Gut Microbiota and Mycobacteria Infectionsmentioning

confidence: 99%

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Role of gut microbiota in infectious and inflammatory diseases

et al. 2023

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Thousands of microorganisms compose the human gut microbiota, fighting pathogens in infectious diseases and inhibiting or inducing inflammation in different immunological contexts. The gut microbiome is a dynamic and complex ecosystem that helps in the proliferation, growth, and differentiation of epithelial and immune cells to maintain intestinal homeostasis. Disorders that cause alteration of this microbiota lead to an imbalance in the host’s immune regulation. Growing evidence supports that the gut microbial community is associated with the development and progression of different infectious and inflammatory diseases. Therefore, understanding the interaction between intestinal microbiota and the modulation of the host’s immune system is fundamental to understanding the mechanisms involved in different pathologies, as well as for the search of new treatments. Here we review the main gut bacteria capable of impacting the immune response in different pathologies and we discuss the mechanisms by which this interaction between the immune system and the microbiota can alter disease outcomes.

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Section: The Gut Microbiota and Mycobacteria Infectionsmentioning

confidence: 99%

Section: The Gut Microbiota and Mycobacteria Infectionsmentioning

confidence: 99%

Role of gut microbiota in infectious and inflammatory diseases

et al. 2023

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“…Leprosy is a neglected tropical disease caused by Mycobacterium leprae and Mycobacterium lepromatosis . The global incidence of the disease has decreased from more than 5 million cases in the 1980s to 133,802 cases in 2020, persisting, however, as a major cause of permanent physical disability in the world 1 . In 2021, 140,594 new cases of the disease were reported worldwide, an increase of 10.2% over the previous year.…”

Section: Introductionmentioning

confidence: 99%

“…The global incidence of the disease has decreased from more than 5 million cases in the 1980s to 133,802 cases in 2020, persisting, however, as a major cause of permanent physical disability in the world. 1 In 2021, 140,594 new cases of the disease were reported worldwide, an increase of 10.2% over the previous year. The 23 countries with the highest leprosy incidence are all developing countries, concentrating 94.6% of the new cases.…”

Section: Introductionmentioning

confidence: 99%

Viral co‐infections in leprosy: a scoping review

et al. 2023

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ContextThe most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research. MethodsThe authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews.Results For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, coinfections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part.Conclusions This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.

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“…Thus, the need to intensify the development and improvement of current laboratory methodologies for the early and satisfactory diagnosis of the disease is evident ( 4 , 5 ). However, different clinical, bacteriological, and immunopathological characteristics constitute the spectrum of the disease and express the relationship between the pathogenicity of the bacilli and the host’s immune response, which makes it difficult and unfeasible to control the disease ( 6 ). Additionally and focusing on strategies to break the chains of HD transmission, WHO included a recommendation to implement HD post-exposure prophylaxis with single-dose rifampicin (SDR) for healthy close contacts of patients with HD aged 2 years or older, after excluding HD and tuberculosis diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Bacilloscopy and polymerase chain reaction of slit-skin smears and anti-phenolic glycolipid-I serology for Hansen’s disease diagnosis

et al. 2022

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The bacilloscopy of the slit-skin smear (SSS) is the exclusive laboratory test associated with dermato-neurological evaluation for Hansen’s disease (HD) diagnosis; however, it is negative in the majority of PB or primary neural forms. Thus, a PCR technique involving different sequences and target genes has been performed with an aim to increase the sensitivity and specificity of M. leprae identification, especially in patients with low bacillary loads. Additionally, serological assays based on antibody response reflect infection levels and indicate that this could be a simpler, less invasive technique for estimating M. leprae exposure. Serological tests and PCR have been shown to be more sensitive and accurate than the SSS. Our study aimed to measure accuracy and performance among the SSS and PCR of dermal scrapings stored on filter paper and APGL-I serology for diagnosis in HD. A cross-sectional study analyzing the medical records (n = 345) of an HD outpatient-dermatology clinic from 2014 to 2021 was conducted. Accuracy performance parameters, correlation, and concordance were used to assess the value among the SSS, PCR, and APGL-I exams in HD. The SSS presented 24.5% sensitivity, 100% specificity, 37.4% accuracy, and the lowest negative predictive value (21.5%). The PCR assay had 41, 100, and 51% sensitivity, specificity, and accuracy, respectively. PCR and APGL-I serology increased the detection of HD cases by 16 and 20.6%, respectively. PCR was positive in 51.3% of patients when the SSS was negative. The SSS obtained moderate concordance with PCR [k-value: 0.43 (CI: 0.33–0.55)] and APGL-I [k-value: 0.41 (CI: 0.31–0.53)]. A moderate positive correlation was found between the APGL-I index and the bacillary index (r = 0.53; P < 0.0001). Thus, the use of the SSS is a low sensitivity and accuracy method due to its low performance in HD detection. The use of PCR and serological tests allows for a more sensitive and accurate diagnosis of patients.

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Leprosy: clinical and immunopathological characteristics

Cited by 35 publications

References 39 publications

Role of gut microbiota in infectious and inflammatory diseases

Role of gut microbiota in infectious and inflammatory diseases

Viral co‐infections in leprosy: a scoping review

Bacilloscopy and polymerase chain reaction of slit-skin smears and anti-phenolic glycolipid-I serology for Hansen’s disease diagnosis

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