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巴西亚马逊地区卡拉塔图阿岛一个没有初级卫生保健覆盖的区域内儿童中的麻风病情况。

Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon.

作者信息

Costa Izabelle Laissa Viana, da Costa Patrícia Fagundes, da Silva Sâmela Miranda, Gobbo Angélica Rita, Pinto Pablo Diego do Carmo, Spencer John Stewart, da Silva Moises Batista, Salgado Claudio Guedes

机构信息

Laboratório de Dermato-Imunologia, Universidade Federal do Pará, Marituba, Pará, Brazil.

Laboratório de Genética Humana e Médica, Instituto de Ciência Biológicas, UFPA, Belém, Brazil.

出版信息

Front Med (Lausanne). 2023 Jun 22;10:1218388. doi: 10.3389/fmed.2023.1218388. eCollection 2023.

Abstract

INTRODUCTION

The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community's early exposure to and active transmission of the infection.

METHODS

In order to detect new cases among children by combining clinical evaluation and laboratory tests, we conducted an active case finding among individuals under 15 years old on Caratateua Island, located in the city of Belém, in the Pará state, an endemic region in the Amazon. Dermato-neurological examination, collection of 5 mL of peripheral blood for IgM anti-PGL-I antibody titration, and intradermal scraping for bacilloscopy and amplification of the specific RLEP region by qPCR were performed.

RESULTS

Out of the 56 examined children, 28/56 (50%) new cases were identified. At the time of evaluation, 38/56 (67.8%) children presented one or more clinical alterations. Seropositivity was detected in 7/27 (25.9%) new cases and 5/24 (20.8%) undiagnosed children. DNA amplification of was observed in 23/28 (82.1%) of new cases and in 5/26 (19.2%) of non-cases. Out of the total cases, 11/28 (39.2%) were exclusively diagnosed by clinical evaluation performed during the active case finding. Seventeen new cases (60.8%) were detected considering the clinical alterations found in addition to positive results for qPCR. In this group, 3/17 (17.6%) qPCR-positive children presented significant clinical changes 5.5 months after the first evaluation.

DISCUSSION

Our research detected a number of cases 5.6 times higher compared to the total number of pediatric cases recorded throughout the year 2021 in the municipality of Belém, which shows a critical scenario of underdiagnosing of leprosy among children under 15 years old in the region. We propose the use of qPCR technique to identify new cases among children with oligosymptomatic or early disease in endemic areas, in addition to the training of Primary Health Care professionals and the implementation of the Family Health Strategy coverage in the visited area.

摘要

引言

儿童麻风病的检测是该疾病的一项重要流行病学指标,表明社区早期接触该感染并存在感染的活跃传播。

方法

为了通过结合临床评估和实验室检测来发现儿童中的新病例,我们在位于帕拉州贝伦市的卡拉塔图阿岛对15岁以下个体开展了主动病例发现工作,该岛是亚马逊地区的一个流行区。进行了皮肤神经学检查、采集5毫升外周血用于IgM抗PGL - I抗体滴定,以及进行皮内刮片用于细菌学检查和通过qPCR扩增特定的RLEP区域。

结果

在56名接受检查的儿童中,确定了28/56(50%)例新病例。在评估时,38/56(67.8%)的儿童出现一种或多种临床改变。在7/27(25.9%)的新病例和5/24(20.8%)未确诊儿童中检测到血清阳性。在23/28(82.1%)的新病例和5/26(19.2%)的非病例中观察到DNA扩增。在所有病例中,11/28(39.2%)仅通过主动病例发现期间进行的临床评估确诊。考虑到除qPCR阳性结果外发现的临床改变,检测到17例新病例(60.8%)。在该组中,3/17(17.6%)qPCR阳性儿童在首次评估5.5个月后出现明显临床变化。

讨论

我们的研究检测到的病例数比贝伦市2021年全年记录的儿科病例总数高出5.6倍,这表明该地区15岁以下儿童中麻风病诊断不足的严峻情况。我们建议除了培训初级卫生保健专业人员并在访问地区实施家庭健康战略覆盖外,使用qPCR技术在流行地区识别症状轻微或早期疾病儿童中的新病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/175a/10323681/8f91eba1de86/fmed-10-1218388-g001.jpg

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