Leprosy reactions: the predictive value of Mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR)
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2017
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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 Clin ical 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 antibod ies (p = 0.028) compared to reaction-free patients. Anti-PGL-I serology had a limited predic tive 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 sero logical 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.
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HUNGRIA, 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, e0005396, 2017. DOI: 10.1371/journal.pntd.0005396. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC5336302/. Acesso em: 12 fev. 205.