Paucibacillary Leprosy Patients Research Articles

A recombinant chimeric antigen constructed with B-cell epitopes from Mycobacterium leprae hypothetical proteins is effective for the diagnosis of leprosy

The diagnosis if leprosy is difficult, as it requires clinical expertise and sensitive laboratory tests. In this study, we develop a serological test for leprosy by using bioinformatics tools to identify specific B-cell epitopes from Mycobacterium leprae hypothetical proteins, which were used to construct a recombinant chimeric protein, M1. The synthetic peptides were obtained and showed good reactivity to detect leprosy patients, although the M1 chimera have showed sensitivity (Se) and specificity (Sp) values higher than 90.0% to diagnose both paucibacillary (PB) and multibacillary (MB) leprosy patients, but not those developing tegumentary or visceral leishmaniasis, tuberculosis, Chagas disease, malaria, histoplasmosis and aspergillosis, in ELISA experiments. Using sera from household contacts, values for Se and Sp were 100% and 65.3%, respectively. In conclusion, our proof-of-concept study has generated data that suggest that a new recombinant protein could be developed into a diagnostic antigen for leprosy.

Serodiagnosis of paucibacillary and multibacillary leprosy using a recombinant chimeric protein composed of specific B-cell epitopes derived from Mycobacterium leprae proteins

Leprosy diagnosis is difficult due to the clinical similarity with other infectious diseases, and laboratory tests presents problems related to sensitivity and/or specificity. In this study, we used bioinformatics to assess Mycobacterium leprae proteins and formulated a chimeric protein that was tested as a diagnostic marker for the disease. The amino acid sequences from ML0008, ML0126, ML0308, ML1057, ML2028, ML2038, ML2498 proteins were evaluated, and the B-cell epitopes QASVAYPATSYADFRAHNHWWNGP, SLQRSISPNSYNTARVDP and QLLGQTADVAGAAKSGPVQPMGDRGSVSPVGQ were considered M. leprae-specific and used to construct the gene encoding the recombinant antigen. The gene was constructed, the recombinant protein was expressed, purified and tested in ELISA using 252 sera, which contained samples from multibacillary (MB) or paucibacillary (PB) leprosy patients, from their household contacts and healthy individuals, as well as from patients with Chagas disease, visceral and tegumentary leishmaniases (VL/TL), malaria, tuberculosis, and HIV. Sensitivity (Se) and specificity (Sp) for MB and PB samples compared to sera from both healthy subjects and individuals with cross-reactive diseases were 100%. The Se value for MB and PB samples compared to sera from household contacts was 100%, but Sp was 64%. In conclusion, data suggest that this protein could be considered in future studies for leprosy diagnosis.

Standardization of SYBR Green-Based Real-Time PCR Through the Evaluation of Different Thresholds for Different Skin Layers: An Accuracy Study and Track of the Transmission Potential of Multibacillary and Paucibacillary Leprosy Patients.

The development of new molecular techniques is essential for the early diagnosis of leprosy. Studies in the field have failed to elucidate the performance of these tests in clinical practice. We aimed to design a new primer pair for the repetitive element (RLEP) target of Mycobacterium leprae and to test the accuracy of SYBR green-based real-time PCR through the evaluation of different thresholds for different skin layers. We also aimed to track the transmission potential of multibacillary and paucibacillary leprosy patients. The in vitro validation of our reaction resulted in a quantification limit of 0.03 bacilli. We then conducted a cross-sectional/cohort-based study of diagnostic accuracy. Patients were included, and skin samples were divided into four layers: epidermis, superior dermis, inferior dermis, and hypodermis. We also quantified M. leprae in nasal swabs of the included patients and compared the results to the number of household contacts also diagnosed with leprosy. One hundred patients with a clinical presentation compatible with leprosy were allocated to the leprosy or control group. Although the parasite load was greater in the superior and inferior dermis, M. leprae DNA was found in all skin layers. The best sensitivity was observed for the superior dermis using the presence of any quantifiable bacillus DNA as the threshold [sensitivity=59.26% (95% CI=45.97–71.32)]. In the epidermis, setting 1 quantifiable bacillus as the threshold resulted in 100% specificity (95% CI=92.29–100). The number of bacilli found in nasal swabs was not significantly related to the number of household contacts also diagnosed with leprosy. Paucibacillary patients tested positive only for bacillus fragments in nasal swabs but not for the entire bacilli. We can conclude that superficial biopsies might result in sensitivity loss, although different skin sample types will have little influence on the final accuracy. In contrast, threshold changes greatly influence these properties. Paucibacillary patients may not be a relevant source of disease transmission.

Hubungan Asupan Vitamin D Dan Selenium Dengan Indeks Bakteriologi Penderita Kusta Tipe MB (Multibacillary) : Systematic Literature Review

Background : As one of the infectious diseases that have a high prevalence until now, leprosy is a chronic transmission disease caused by infection with Mycobacterium Leprae. Apart from the standard MDT (Multidrug Therapy), nutritional support is a crucial component to restrict further infection severity. Vitamin D and selenium play essential roles as the primary defence against susceptibility. Methods : The systematic literature review was conducted using three international databases : PubMed, ResearchGate, and DOAJ, which were published between 2010 – 2020 using English or Indonesian. A total of 8 articles (2 articles identifying the correlation of selenium with leprosy, and 6 articles identifying the correlation of vitamin D with leprosy) using cross- sectional analytic and case-control analytic studies were included in this review. Results : The average serum levels of vitamin D and selenium in leprosy patients were lower than in healthy controls. This case was also found in Multibacillary leprosy patients compared to Paucibacillary leprosy patients. This serum levels can affect the bacteriological index, which is the higher the serum levels, the lower the bacteriological index. Disscusion : Serum vitamin D and selenium levels are affected by vitamin D and selenium intake, which can lead to a reduction in bacteriological index across all multibacillary leprosy patients. There is a negative correlation between vitamin D, selenium, and bacteriological index in patients with MB (Multibacillary) leprosy.Keywords:Leprosy, Vitamin D, Selenium, Bacteriological Index

Effect of Relationship between Protein Oxidation and Total Thiols in Progression of Leprosy

Objective: In several countries including India, leprosy is an older disease & until now continuous to be an important health issue. Leprosy is a chronic granulomatous disease, the causative agent for which is mycobacterium leprae. Due to imbalance between natural antioxidants and oxidative stress is significant event occurs that influences the pathogenesis of leprosy. Considering this the study was carried out to find, what type of relationship between MDA, Protein carbonyl and thiols as disease advances.
 Methods: 50 diagnosed leprosy patients & 50 healthy controls were included in this study. In leprosy group, 16 were Paucibacillary (PB) and 34 were Multibacillary (MB) type leprosy patients.
 Results: Serum Protein carbonyl and serum Malondialdehyde increased in leprosy patients than controlling. Further analysis reveals that the serum malondialdehyde was significantly increased in MB leprosy patients than PB leprosy patients. On the other hand, our proposed system significantly lowers the total thiols in leprosy patients when compared with controls. Serum total thiols were lower in MB leprosy than PB leprosy patients. Among leprosy patients the negative correlation of Malondialdehyde with total thiol and Protein carbonyl with total thiols was observed.
 Conclusion: Thus, as protein oxidation and lipid per oxidation in leprosy increases, the total thiols decreases which may lead to modifications of protein and lipids that are responsible for severity of disease hence therapy aimed at reducing generation of free radicals that can result in oxidative stress and as a result a modification of proteins and lipids.

Study of Effect of Nitrosamine Stress in Progression of Leprosy

Objective: In several countries, including India, leprosy is an older disease & till now continues to be an important health issue. Leprosy is a chronic granulomatous disease, the contributing agent for this is mycobacterium leprae. Nitric oxide (NO) plays a significant role in immunity to fight against bacteria. But increased NO can harm host tissue by causing altered structure of thiol-containing compounds, which is a significant event that influences the pathogenesis of leprosy. Considering this, the study was planned to determine the type of relationship between NO, nitrothiols, and thiols as disease advances.
 Methods: 50 newly diagnosed leprosy patients & 50 healthy controls were included in the study. In the leprosy group,16 were Paucibacillary (PB), and 34 were Multibacillary (MB) type, leprosy patients.
 Results: Serum NO and serum nitrothiol significantly increased (p<0.01) in leprosy patients than controls. Further, Serum NO and serum nitrothiol significantly increased (p<0.01) in MB leprosy patients than PB leprosy patients. On the other hand, we found a significantly decreased (p<0.01) level of total thiols in leprosy patients compared with controls. Serum thiols significantly decreased (p<0.01) in MB leprosy patients than PB leprosy patients. Among Both leprosy patients, the negative correlation of NO with thiol and nitrothiol with thiols was observed.
 Conclusion: Thus, in leprosy, increased nitric oxide causes modification of thiol groups of proteins and impaired their activity which may be responsible for the severity of disease; hence therapy aimed to reduce nitrosative modification of proteins leprosy.

Ultra-sensitive detection of Mycobacterium leprae: DNA extraction and PCR assays.

Leprosy urgently needs a precise and early diagnostic tool. The sensitivity of the direct (bacilli staining, Mycobacterium leprae DNA) and indirect (antibody levels, T cell assays) diagnostics methods vary based on the clinical form. Recently, PCR-based M. leprae DNA detection has been shown to differentially diagnose leprosy from other dermatological conditions. However, accuracy can still be improved, especially for use with less invasive clinical samples. We tested different commercial DNA extraction kits: DNeasy Blood & Tissue, QIAamp DNA Microbiome, Maxwell 16 DNA Purification, PowerSoil DNA Isolation; as well as in-house phenol-chloroform and Trizol/FastPrep methods. Extraction was performed on M. leprae-infected mouse footpads and different clinical samples of leprosy patients (skin biopsies and scrapings, lesion, oral and nasal swabs, body hair, blood on FTA cards, peripheral whole blood). We observed that the Microbiome kit was able to enrich for mycobacterial DNA, most likely due the enzymatic digestion cocktail along with mechanical disruption involved in this method. Consequently, we had a significant increase in sensitivity in skin biopsies from paucibacillary leprosy patients using a duplex qPCR targeting 16S rRNA (M. leprae) and 18S rRNA (mammal) in the StepOnePlus system. Our data showed that the presence of M. leprae DNA was best detected in skin biopsies and skin scrapings, independent of the extraction method or the clinical form. For multibacillary patients, detection of M. leprae DNA in nasal swabs indicates the possibility of having a much less invasive sample that can be used for the purposes of DNA sequencing for relapse analysis and drug resistance monitoring. Overall, DNA extracted with the Microbiome kit presented the best bacilli detection rate for paucibacillary cases, indicating that investments in extraction methods with mechanical and DNA digestion should be made.

Application of new host biomarker profiles in quantitative point-of-care tests facilitates leprosy diagnosis in the field.

BackgroundTransmission of Mycobacterium leprae, the pathogen causing leprosy, is still persistent. To facilitate timely (prophylactic) treatment and reduce transmission it is vital to both early diagnose leprosy, and identify infected individuals lacking clinical symptoms. However, leprosy-specific biomarkers are limited, particularly for paucibacillary disease. Therefore, our objective was to identify new biomarkers for leprosy and assess their applicability in point-of-care (POC) tests.MethodsUsing multiplex-bead-arrays, 60 host-proteins were measured in a cross-sectional approach in 24-h whole blood assays (WBAs) collected in Bangladesh (79 patients; 54 contacts; 51 endemic controls (EC)). Next, 17 promising biomarkers were validated in WBAs of a separate cohort (55 patients; 27 EC). Finally, in a third cohort (36 patients; 20 EC), five candidate markers detectable in plasma were assessed for application in POC tests.FindingsThis study identified three new biomarkers for leprosy (ApoA1, IL-1Ra, S100A12), and confirmed five previously described biomarkers (CCL4, CRP, IL-10, IP-10, αPGL-I IgM). Overnight stimulation in WBAs provided increased specificity for leprosy and was required for IL-10, IL-1Ra and CCL4. The remaining five biomarkers were directly detectable in plasma, hence suitable for rapid POC tests. Indeed, lateral flow assays (LFAs) utilizing this five-marker profile detected both multi- and paucibacillary leprosy patients with variable immune responses.InterpretationApplication of novel host-biomarker profiles to rapid, quantitative LFAs improves leprosy diagnosis and allows POC testing in low-resource settings. This platform can thus aid diagnosis and classification of leprosy and also provides a tool to detect M.leprae infection in large-scale contact screening in the field.

Potential for serodiagnosis of Indonesian leprosy patients by detecting antibodies against LID-1

Leprosy is caused by Mycobacterium leprae infection and remains a major public health problem in many areas of the world. The Leprosy IDRI Diagnostic (LID)-1 antigen has demonstrated potential to improve the diagnostic capacity of local health centers and aid the development of strategies for the eventual control and elimination of leprosy from endemic areas. The diagnostic capacity of LID-1 has not yet, however, been studied in Indonesia. Objective: To determine the proportion of Indonesian leprosy patients that have circulating antibodies against LID-1. Sera from thirtyfive leprosy patients from Surabaya, Indonesia were evaluated using an Enzyme Linked Immunosorbent Assay (ELISA) detecting IgG antibodies against the LID-1 antigen. Anti-LID-1 antibody levels correlated with both the clinical form of leprosy and the bacterial index (BI). LID-1-specific IgG responses were higher in multibacillary (MB) than in paucibacillary (PB) leprosy patients. Our data indicate that the detection and measurement of serum IgG against LID-1 could be an effective tool for use in control programs in various states and municipalities in Indonesia.

Effect of clofazimine on nerve function impairment in pauci-bacillary leprosy patients

<p class="abstract"><strong>Background:</strong> Clofazimine is a riminophenazine derivative which is useful both for treating the leprosy and managing reactive episodes. Previous studies demonstrated that clofazimine may have a useful prophylactic role against neuritis/type 1 reaction and nerve damage. The WHO Technical Advisory Group (TAG), in its Third meeting in 2002, proposed that uniform MDT regimen (U-MDT) of 6 months duration should be considered to treat all types of leprosy. This study was aimed to determine any additional beneficial effects of clofazimine as part of UMDT in the prevention of nerve function impairment (NFI) in paucibacillary (PB) leprosy patients.</p><p class="abstract"><strong>Methods:</strong> Sixty paucibacillary leprosy patients were randomized into two groups, A and B consisting of 30 patients each. Group A received U-MDT for 6 months and group B received MDT-PB for 6 months. Nerve function assessment (NFA) using various modalities was done at the beginning (0 month) and at the completion of MDT (6 months) and results were compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> No statistically significant difference in improvement or deterioration of NFI was found in two groups.</p><p class="abstract"><strong>Conclusions:</strong> On the basis of present study, we found that addition of clofazimine in standard dose as part of U-MDT has no beneficial role in prevention or improvement of NFI in PB leprosy patients. However, a larger longitudinal study taking substantial number of population in both groups might be helpful to derive any conclusion.</p>

Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil

BackgroundEarly detection of leprosy and multidrug therapy are crucial to achieve zero transmission and zero grade II incapacities goals of World Health Organization. Leprosy is difficult to diagnose because clinical forms vary and there are no gold standard methods to guide clinicians. The serological rapid tests aid the clinical diagnosis and are available for field use. They are easy to perform, do not require special equipment or refrigeration and are cheaper than the molecular tests.MethodsWe evaluated the performance of two rapid serological tests (PGL1 and NDO-LID) in the discrimination of leprosy cases from healthy individuals at the Alfredo da Matta Foundation, a reference center for the disease in Manaus, Amazonas, Brazil. PGL1 and NDO-LID rapid tests are capable of detecting specific antibodies of M. leprae, IgM and IgM/IgG, respectively. A total of 530 healthy subjects and 171 patients (50 with paucibacillary and 121 multibacillary leprosy) were included in the study.ResultsAmong the paucibacillary leprosy patients, the sensitivity was 34.0 and 32.0% for the NDO-LID and PGL1, respectively. In multibacillary leprosy patients, the NDO-LID sensitivity was 73.6% and the PGL1 was 81.0%. Serological tests demonstrated specificities of 75.9% for PGL-1 and 81.7% for NDO-LID. The positive predictive value (PPV), negative predictive value (NPV) and accuracy in multibacillary patients were 47.9, 93.1, and 80.2% respectively for the NDO-LID, and 43.4, 94.6 76.8% for PGL1.ConclusionsThe tests showed limited capacity in the diagnosis of the disease, however, the high negative predictive value of the tests indicates a greater chance of true negatives in this group favoring exclusion of leprosy. This characteristic of the ML flow test is important in aiding clinical Diagnosis, especially in a region endemic to the disease and with other confounding skin conditions.

Utility of immunoglobulin isotypes against LID-1 and NDO-LID for, particularly IgG1, confirming the diagnosis of multibacillary leprosy.

BACKGROUND Leprosy remains a health problem in many countries, with difficulties in diagnosis resulting in delayed treatment and more severe disabilities. Antibodies against several Mycobacterium leprae antigens have, however, shown value as diagnostic and/or prognostic markers.OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM and IgG subclass reactivity against three M. leprae specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide bound to human serum albumin; LID-1, the fusion protein product of the ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO.METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB) leprosy patients, and their respective household contacts, were evaluated for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies by enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of each ELISA were evaluated by receiver operating characteristic (ROC) curve analysis.FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are markedly increased in MB patients. For the first time, our data reveal a selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in MB patients, demonstrating that these antibody isotypes are suitable for differentiation between MB and PB patients. ROC curve analysis indicates an improved capacity for diagnosing MB leprosy patients using the detection of IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID over the performance levels attained with NDO-HSA.CONCLUSIONS Our findings indicate that serological tests based on the detection of antigen-specific IgG1 antibodies are a useful tool to differentiate MB from PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID antigens in the serodiagnosis of leprosy.

Lesional levels of superoxide dismutase and malondialdehyde in paucibacillary and multibacillary leprosy patients

BackgroundLeprosy or Hansen’s disease (HD) is a chronic infectious disease caused by Mycobacterium leprae. The ratio of malondialdehyde (MDA)/superoxide dismutase (SOD) may be considered as an index of oxidative stress (OS).ObjectiveTo assess the OS by estimating the levels of antioxidant enzyme (SO

Salivary anti-PGL-1 IgM may indicate active transmission of Mycobacterium leprae among young people under 16 years of age

Considering that the main route of Mycobacterium leprae transmission is the upper respiratory tract, detection of salivary antibodies can be a useful tool for diagnosing early infection. The study aimed to analyze salivary anti-PGL-1 IgA and IgM antibodies in 169 children aged 4–16 years old, who lived nearby or inside the house of multibacillary or paucibacillary leprosy patients in two endemic cities in Alagoas State – Brazil. Salivary anti-PGL-1 antibodies were quantified by modified ELISA method. The frequency of contact and clinical form of the index case were significantly associated with salivary antibody levels. High frequency of IgM positivity strongly suggests active transmission of M. leprae in these communities. We suggest in the present work that salivary anti-PGL IgA and IgM are important biomarkers to be used for identifying communities with probable active transmission of M. leprae.

Serum anti-phenolic glycolipid-1 IgA correlates to IgM isotype in leprosy patients: a possible candidate for seroepidemiological surveys?

The aim of this study was to compare serum anti-phenolic glycolipid-1 IgA, IgG, and IgM levels in leprosy patients and controls. Analysis of anti-PGL-1 IgA, IgG, or IgM in serum samples from multibacillary (MB, n=32) and paucibacillary (PB, n=22) leprosy patients, and in non-endemic controls (n=17), using an indirect enzyme-linked immunosorbent assay. A strong correlation between serum IgM and IgA isotypes was found (r=.745, P<.0001) in MB patients. A moderate correlation was found in all analyses in PB patients. A moderate agreement was found between anti-PGL1 IgA and IgM tests. Based on the ROC curves, the cut-off values were selected and the parameters of validation were calculated. Considering the clinical forms altogether, the diagnostic sensitivities were 50.0% for IgA, 22.2% for IgG, and 74.1% for IgM. The positive (VPP) and negative (VPN) predictive values were estimated for each isotype. For IgA, the VPP and VPN were, respectively, 100.0% (87.0%-100.0%; 95% confidence interval) and 38.7% (24.4%-54.5%); for IgG, 100% (87.0%-100.0%) and 28.8% (17.8%-42.1%), respectively; and for IgM, 95.2% (83.8%-99.4%) and 51.7% (32.5%-70.6%), respectively. Despite the limiting factors, anti-PGL1 IgA correlates to IgM levels and it could be considered as a possible laboratorial tool to be also used, for instance, in serological follow-up studies.

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil.

BackgroundThe predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR).MethodsThis was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI.ResultsMore than half of the patients (55.5 %) reported leprosy reaction: 18.3 % (138/753) had a RR and 5.4 % (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27 % (205/753) of patients, while 19 % (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9 % were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45).ConclusionsMB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0203-0) contains supplementary material, which is available to authorized users.

Detection of Mycobacterium leprae in Formalin-Fixed Paraffin-Embedded Sample by Fite-Faraco Staining and Polymerase Chain Reaction

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The identification of mycobacteria in tissue sections can be made through a microscopic examination with fite-faraco staining or PCR method. Paraffin blocks from four patients with leprosy were retrieved from The Pathologic Department of Dr.Soetomo Hospital, Surabaya. Two cases were from paucibacillary leprosy patients with no mycobacteria stained by fite-faraco. PCR assay showed a negative result. The other two cases were multibacillary leprosy with many bacteria stained by fite-faraco. PCR assay showed a positive result.

Role of Polymerase Chain Reaction (PCR) in the Diagnosis of Paucibacillary Leprosy

Leprosy caused by Mycobacterium leprae, is still considered a major health problem in many developing countries. The routine bacteriological test on the demonstration of acid-fast bacilli in skin smears is not sufficiently sensitive or specific in the paucibacillary leprosy patients. To detect DNA of Mycobacterium leprae by Polymerase Chain Reaction (PCR) from skin biopsy specimen as a means of diagnosis of paucibacillary leprosy. It was a cross-sectional study of clinically diagnosed 33 cases of Paucibacillary leprosy patients. Laboratory works were performed in the Department of Microbiology and Immunology and Department of pathology; Bangabandhu Sheikh Mujib Medical University (BSMMU) and Leprosy Control Institute and Hospital, Mohakhali, Dhaka from November 2013 to June 2015. It was observed that the mean age of patients was found 30.9±13.7 years, 19(57.6%) patients had two to five skin lesions, all (100%) patients had tuberculoid type of leprosy, all (100%) patients had loss of sensation and 18(54.5%) patients had nerve thickening. Regarding slit skin smear test, it was observed that all (100%) patients were slit skin smear negative for leprosy bacilli, 8(24.2%) patients had positive skin biopsy for histopathology and 15(45.5%) patients had positive skin biopsy for PCR. The validity of PCR for identification of paucibacillary leprosy correlated with sensitivity 100%, specificity 72%, accuracy 78.8%, positive predictive value 53.3% and negative predictive value 100%. Polymerase chain reaction (PCR) has definite value in the diagnosis of paucibacillary leprosy and can be regarded as a sensitive and specific diagnostic modality.&#x0D; CBMJ 2015 July: Vol. 04 No. 02 P: 41-48

Quantiferon-Gold Tuberculosis Test Cannot Detect Latent Tuberculosis in Patients With Leprosy.

Five of 10 paucibacillary leprosy patients were Quantiferon Gold (Q-G) positive with negative chest X-rays. Forty multibacillary leprosy patients were negative. Reports have shown 100% cross-reactivity of ESAT6 and CFP10 between Mycobacterium leprae and Mycobacterium tuberculosis. The Q-G test cannot detect latent tuberculosis in patients with leprosy.

Detection of antibodies to both M. leprae PGL-I and MMP-II to recognize leprosy patients at an early stage of disease progression

Antibodies to phenolic glycolipid (PGL)-I and major membrane protein (MMP)-II were evaluated for serodiagnosis of leprosy in Southwest China, and the role in predicting the occurrence of the disease in household contacts (HHCs) of leprosy was examined. Using PGL-I (natural disaccharide-octyl-bovine serum albumin) antigen–based diagnosis (IgM antibodies), we could detect 94.9% of multibacillary (MB) leprosy and 38.9% paucibacillary (PB) leprosy patients, whereas using MMP-II (IgG antibody), 88.1% of MB and 61.1% of PB patients were positive. By combining the 2 tests and considering either test positive as positive, 100% of MB patients and 72.2% of PB patients were found to test positive. Of the HHCs of leprosy, 28.3% and 30% had positive levels of PGL-I and MMP-II Abs, respectively. Seven out of 21 HHCs, who had high Ab titer to either antigen, developed leprosy during the follow-up period of 3years. These data suggest that the measurement of both anti-PGL-I as well as anti-MMP-II antibodies could facilitate early detection of leprosy.