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LEPROSY REACTIONS: THE PREDICTIVE VALUE OF MYCOBACTERIUM LEPRAE-SPECIFIC SEROLOGY EVALUATED IN A BRAZILIAN COHORT OF LEPROSY PATIENTS (U-MDT/CT-BR)
Mycobacterium leprae
Imunoglobulina G
Imunoglobulina M
Testes Sorológicos
Diagnóstico da Situação de Saúde
Malcolm Duthie, Greg Ireton, Jeff Guderian, Raodoh Mohamath and Ayesha Misquith (IDRI, USA) e Tsuyoshi Fujiwara (Nara University, Japan) ajudaram no fornecimento de materiais para a pesquisa.
Autor(es)
Afiliação
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta. Manaus, AM, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Universidade Federal Fluminense. Departamento de Epidemiologia e Bioestatística. Niterói, RJ, Brasil.
Universidade de Brasília. Faculdade de Medicina. Núcleo de Medicina Tropical. Brasília, DF, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta. Manaus, AM, Brasil.
Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brasil.
Universidade Federal Fluminense. Departamento de Epidemiologia e Bioestatística. Niterói, RJ, Brasil.
Universidade de Brasília. Faculdade de Medicina. Núcleo de Medicina Tropical. Brasília, DF, Brasil.
Universidade Federal de Goiás. Instituto de Patologia Tropical e Saúde Pública. Goiânia, GO, Brasil.
Resumo em Inglês
Background: Leprosy reactions, reversal reactions/RR and erythema nodosum leprosum/ENL, can cause irreversible nerve damage, handicaps and deformities. The study of Mycobacterium leprae-specific serologic responses at diagnosis in the cohort of patients enrolled at the Clinical Trial for Uniform Multidrug Therapy Regimen for Leprosy Patients in Brazil/U-MDT/CT-BR is suitable to evaluate its prognostic value for the development of reactions. Methodology: IgM and IgG antibody responses to PGL-I, LID-1, ND-O-LID were evaluated by ELISA in 452 reaction-free leprosy patients at diagnosis, enrolled and monitored for the development of leprosy reactions during a total person-time of 780,930 person-days, i.e. 2139.5 person-years, with a maximum of 6.66 years follow-up time. Principal findings: Among these patients, 36% (160/452) developed reactions during follow-up: 26% (119/452) RR and 10% (41/452) had ENL. At baseline higher anti-PGL-I, anti-LID-1 and anti-ND-O-LID seropositivity rates were seen in patients who developed ENL and RR compared to reaction-free patients (p<0.0001). Seroreactivity in reactional and reaction-free patients was stratified by bacilloscopic index/BI categories. Among BI negative patients, higher anti-PGL-I levels were seen in RR compared to reaction-free patients (p = 0.014). In patients with 0<BI<3, (36 RR, 36 reaction-free), higher antibody levels to PGL-I (p = 0.014) and to LID-1 (p = 0.035) were seen in RR while difference in anti-ND-O-LID positivity was borderline (p = 0.052). Patients with BI≥3 that developed ENL had higher levels of anti-LID-1 antibodies (p = 0.028) compared to reaction-free patients. Anti-PGL-I serology had a limited predictive value for RR according to receiver operating curve/ROC analyses (area-under-the-curve/AUC = 0.7). Anti LID-1 serology at baseline showed the best performance to predict ENL (AUC 0.85). Conclusions: Overall, detection of anti-PGL-I, anti-LID-1 and anti-ND-O-LID antibodies at diagnosis, showed low sensitivity and specificity for RR prediction, indicating low applicability of serological tests for RR prognosis. On the other hand, anti-LID-1 serology at diagnosis has shown prognostic value for ENL development in BI positive patients.
DeCS
HanseníaseMycobacterium leprae
Imunoglobulina G
Imunoglobulina M
Testes Sorológicos
Diagnóstico da Situação de Saúde
Editor
Public Library of Science
Referência
HUNGRI, Emerith Mayra et al. Leprosy reactions: the predictive value of Mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR). Plos Neglected Tropical Diseases, [San Francisco], v. 11, n. 2, p. 1-17, feb. 2017.DOI
10.1371/journal.pntd.0005396ISSN
1935-2727Notas
Gerson Oliveira Penna - Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento.Malcolm Duthie, Greg Ireton, Jeff Guderian, Raodoh Mohamath and Ayesha Misquith (IDRI, USA) e Tsuyoshi Fujiwara (Nara University, Japan) ajudaram no fornecimento de materiais para a pesquisa.
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