Detection of &lt;em&gt;Mycobacterium leprae&lt;/em&gt; using real-time PCR in paucibacillary leprosy patients with negative acid-fast bacilli smears

Devita, Arleen; Ibrahim, Fera; Menaldi, Sri Linuwih; Budianti, Angky; Yasmon, Andi

doi:10.13181/mji.v28i4.2643

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…The role of new diagnostics needs consideration for both leprosy and scabies ACD. Molecular detection using nucleic acid amplification techniques such as polymerase chain reaction (PCR) to detect M. leprae has been used on skin and nasal swabs [ 47 ] and also shows promise for diagnosis of scabies [ 48 ]. Point of care diagnostics for scabies are currently under development [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Active case detection methods for crusted scabies and leprosy: A systematic review

et al. 2021

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Background Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.

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Section: Discussionmentioning

confidence: 99%

Active case detection methods for crusted scabies and leprosy: A systematic review

et al. 2021

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Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy

de Carvalho Dornelas,

da Costa,

de Abreu

et al. 2024

BMC Infect Dis

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Background Treatment failure (TF) in leprosy following multidrug therapy (MDT) presents a significant challenge. The current World Health Organization (WHO) fixed-duration MDT regimen, based on lesion count, might not be adequate. Leprosy lacks clear-cut objective cure criteria, and the predictive value of post-MDT histopathological findings remains uncertain. This study aims to identify predictive factors for TF among leprosy patients who have completed the WHO-recommended MDT. Methods An analysis was conducted on 80 individuals from a national leprosy reference center, comprising 40 TF cases (with a mean relapse at 13.0 months) and 40 controls (with a mean of 113.1 months without disease signs). Various epidemiological and clinical-laboratory parameters were assessed post-MDT. Results In skin samples, the presence of foamy granuloma (OR = 7.36; 95%CI2.20-24.60; p = 0.0012) and histological bacillary index (hBI) ≥ 1+ (OR = 1.55; 95%CI1. 22-1.99; p = 0.0004) were significantly associated with TF, with odds ratios of 7.36 and 1.55, respectively. Individuals who experienced TF had a mean hBI of 3.02+ (SD ± 2.02), while the control group exhibited a mean hBI of 1.8+ (SD ± 1.88). An hBI ≥ 3 + showed a sensitivity of 73% and a specificity of 78% for TF detection (AUC: 0.75; p = 0.0001). Other histopathological features like epithelioid granulomas, and skin changes did not show significant associations ( p > 0.05). Additionally, higher anti-phenolic glycolipid-I (anti-PGL-I) ELISA index (EI) levels were linked to a 1.4-fold increased likelihood for TF (OR = 1.4; 95%CI1.13-1.74; p = 0.0019). A mean EI of 4.48 (SD ± 2.80) was observed, with an EI ≥ 3.95 showing a sensitivity of 79% and a specificity of 59% for TF detection (AUC: 0.74; p = 0.0001). Moreover, the presence of Mycobacterium leprae ( M. leprae ) DNA in real-time polymerase chain reaction (qPCR) was associated with a 3.43-fold higher likelihood of TF. Multivariate regression analysis indicated that concurrent presentation of neural/perineural lymphocytic infiltrate, foamy granuloma, hBI ≥ 1+, and EI ≥ 1 markedly increased the likelihood of TF by up to 95.41%. Conclusion Persistence of nerve-selective lymphocytic infiltrate, foamy granulomas, and bacilli in skin biopsies, and elevated EI post-MDT, may serve as predictive factors for identifying individuals at higher probability of TF. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-024-09937-2.

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Detection of <em>Mycobacterium leprae</em> using real-time PCR in paucibacillary leprosy patients with negative acid-fast bacilli smears

Cited by 2 publications

References 16 publications

Active case detection methods for crusted scabies and leprosy: A systematic review

Active case detection methods for crusted scabies and leprosy: A systematic review

Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy

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