Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil.
Hospital de Doenças Tropicais Anuar Auad, Goiânia, Goiás, Brazil.
Eur J Clin Microbiol Infect Dis. 2020 Dec;39(12):2345-2360. doi: 10.1007/s10096-020-03979-5. Epub 2020 Jul 14.
This surveillance study evaluated leprosy-serologic tests and the IFNγ whole-blood-assay/WBA as adjunct diagnostic tools. Previously diagnosed leprosy index cases, intradomiciliary, peridomiciliary contacts from a Brazilian endemic area were enrolled during domiciliary visits. Physical evaluation was performed by trained nurses and leprosy diagnosis confirmed by expert dermatologist. ELISA detected IgM anti-PGL-I, IgG anti-LID-1, and IgM/IgG anti-ND-O-LID antibodies. Heparinized WBA plasma stimulated with LID-1, 46f + LID-1, ML0276 + LID-1 (24 h, 37 °C, 5% CO was tested for human IFNγ (QuantiFERON®-TB Gold/QFT-G; Qiagen). The survey included 1731 participants: 44 leprosy index cases, 64 intradomiciliary, 1623 peridomiciliary contacts. Women represented 57.7%, median age was 32 years, 72.2% had BCG scar. Leprosy prevalence was higher in intradomiciliary (8.57%) versus peridomiciliary contacts (0.67%), p < 0.001. Among 23 suspects, five leprosy cases were confirmed: 4 multibacillary/MB and 1 paucibacillary/PB. Leprosy incidence was 0.30%: 1.56% in intradomiciliary versus 0.25% in peridomiciliary (p = 0.028). Seropositivity rates were 1.9% to PGL-I, 4.9% to LID-1, and 1.0% to ND-O-LID. LID-1 positivity was higher in all groups; incident cases were LID-1 seropositive. ND-O-LID positivity was higher in intra- versus peridomiciliary contacts (p = 0.022). IFNγ WBA (40 index cases, 19 suspects, 35 intradomiciliary, 74 peridomiciliary contacts) showed higher LID-1/WBA positivity in peridomiciliary contacts (p > 0.05); significant differences among groups were seen with 46f + LID-1 but 0276 + LID-1 induced higher IFNγ levels. Incident cases were LID-1 seropositive, while IFNγ-WBA had marginal diagnostic application. As seropositivity indicates exposed individuals at higher risk of disease development, the utility of serologic screening for surveillance and prophylactic measures remains to be demonstrated.
本监测研究评估了麻风病血清学检测和 IFNγ 全血检测/全血分析作为辅助诊断工具。在上门探访期间,从巴西地方性流行地区招募了先前诊断的麻风病索引病例和家庭内、家庭周围的接触者。由经过培训的护士进行体格检查,由皮肤科专家确诊麻风病。ELISA 检测 IgM 抗 PGL-I、IgG 抗 LID-1 和 IgM/IgG 抗 ND-O-LID 抗体。用 LID-1、46f+LID-1、ML0276+LID-1 刺激肝素化全血分析血浆(24 小时,37°C,5%CO2),检测人类 IFNγ(QuantiFERON®-TB Gold/QFT-G;Qiagen)。该调查包括 1731 名参与者:44 名麻风病索引病例、64 名家庭内接触者、1623 名家庭周围接触者。女性占 57.7%,中位年龄为 32 岁,72.2%有卡介苗疤痕。家庭内接触者(8.57%)的麻风病患病率高于家庭周围接触者(0.67%),p<0.001。在 23 名疑似病例中,确诊了 5 例麻风病病例:4 例多菌型/MB 和 1 例少菌型/PB。麻风病发病率为 0.30%:家庭内接触者为 1.56%,家庭周围接触者为 0.25%(p=0.028)。血清阳性率为 PGL-I 为 1.9%,LID-1 为 4.9%,ND-O-LID 为 1.0%。LID-1 阳性率在所有组中均较高;发病病例均为 LID-1 血清阳性。家庭周围接触者的 ND-O-LID 阳性率高于家庭内接触者(p=0.022)。IFNγ 全血分析(40 名索引病例、19 名疑似病例、35 名家庭内接触者、74 名家庭周围接触者)显示,家庭周围接触者的 LID-1/WBA 阳性率较高(p>0.05);46f+LID-1 和 0276+LID-1 组之间有显著差异,但 0276+LID-1 诱导的 IFNγ 水平更高。发病病例为 LID-1 血清阳性,而 IFNγ-WBA 仅具有边缘诊断应用。由于血清阳性表明处于疾病发展风险较高的暴露个体,因此血清学筛查用于监测和预防性措施的效用仍有待证明。