Ana Paula Mendes Carvalho

Antigen-specific assessment of the immunological status of various groups in a leprosy endemic region

BackgroundSerological tests can be important tools to assist in the diagnosis of leprosy and can contribute to an earlier diagnosis. The aim of this study was to evaluate the antibody responses against phenolic glycolipid-1 (PGL-1), natural disaccharide linked to human serum albumin via an octyl (NDO-HSA), Leprosy IDRI Diagnostic-1 (LID-1) and natural disaccharide octyl - Leprosy IDRI Diagnostic-1 (NDO-LID) in leprosy patients, household contacts of patients and the general population.MethodsEnzyme-linked immunosorbent assays were used to analyze the antigen-specific antibody responsesof 94 leprosy cases, 104 household contacts of cases and 2.494 individuals from the general population.ResultsA positive correlation was observed for the antibody responses to all antigens studied. A higher proportion of seropositivity for all antigens, along with stronger magnitude of response, was observed in multibacillary (MB) leprosy patients and household contacts of MB leprosy patients compared with the levels observed in paucibacillary (PB) leprosy patients and household contacts of PB leprosy patients. A substantial and significant positive correlation was found between seropositivity and the bacterial index for the leprosy patients. Anti-PGL-1 tests were more frequently positive than anti-NDO-HSA tests among patients with all clinical forms of leprosy and among the group of household contacts. The LID-1 and NDO-LID antigens showed a greater capacity to identify household contacts and individuals from the general population infected with M. leprae.ConclusionsTests that measure the antibody responses against LID-1, NDO-LID, NDO-HSA and PGL-1 were effective tools for the detection of patients with MB leprosy. Our data indicate that the anti-LID-1 and anti-NDO-LID responses were more effective than an anti-NDO-HSA response for the identification of individuals with subclinical infection.

Deformities due to Leprosy in Children under Fifteen Years Old as an Indicator of Quality of the Leprosy Control Programme in Brazilian Municipalities

The present study aims at analysing the degree of deformity in leprosy cases diagnosed in children under 15 years old and its relationship with operational and epidemiological factors. This epidemiological cross-sectional study was carried out at municipalities of three microregions in a Brazilian hyperendemic area. Data between 1998 and 2010 was collected from the Information System for Notifiable Diseases database. The average coefficient of detection was 32.96/100.000 inhabitants; 7.61% of new cases were diagnosed in children under 15 years old; 5% in this age group were grade 2 deformity at diagnosis. Prevalence of leprosy cases in children under 15 years old with deformity was higher in males (PR = 2.65;P = 0.032; CI 95%: 1.09–6.45) and in multibacillary patients (PR = 14.68;P < 0.001; CI 95%: 3.54–60.87) and lower when the detection mode was passive (PR = 0.73,P = 0.47, CI 95%: 0.31–1.73). Such context suggests high transmissibility and early exposure to Mycobacterium leprae since a lot of cases were diagnosed in children under fifteen years old and the incubation period of the leprosy bacillus varies from 02 to 07 years. This situation contributes to maintaining the chain of disease transmission in the area and indicates that health care services should intensify leprosy control.

Perfil epidemiológico da hanseníase na microrregião de araçuaí e sua relação com ações de controle

La lepra representa un problema de salud publica en Brasil debido a los altos indices de deteccion y prevalencia. El objetivo de este estudio es analizar la situacion epidemiologica de la lepra y su relacion con acciones de control en micro region de Aracuai en el periodo 1998-2007. El estudio es epidemiologico, descriptivo y los dados fueran recogidos de formularios de notificacion de casos de lepra de las ciudades de la region, periodo 1998-2007, disponible en el Sistema de Informacion de Agravos de Notificacion - SINAN. Indicadores operacionales y epidemiologicos fueran construidos y analizados de acuerdo con los parametros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la deteccion fue 28,5 casos/100.000 habitantes/ano. La proporcion de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de deteccion sugiere un diagnostico tardio y confirma la importancia de la integracion de las actividades de control de la lepra en atencion primaria.Resumen La lepra representa un problema de salud pública en Brasil debido a los altos índices de detección y prevalencia. El objetivo de este estudio es analizar la situación epidemiológica de la lepra y su relación con acciones de control en micro región de Araçuaí en el periodo 1998-2007. El estudio es epidemiológico, descriptivo y los dados fueran recogidos de formularios de notificación de casos de lepra de las ciudades de la región, período 1998-2007, disponible en el Sistema de Información de Agravos de Notificación SINAN. Indicadores operacionales y epidemiológicos fueran construidos y analizados de acuerdo con los parámetros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la detección fue 28,5 casos/100.000 habitantes/año. La proporción de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de detección sugiere un diagnóstico tardío y confirma la importancia de la integración de las actividades de control de la lepra en atención primaria. Palabras clave: Lepra. Salud Pública. Atención Primaria de Salud. Enfermería. 1Enfermeiro. Doutor em Enfermagem. Professor Associado II do Depar tamento de Enfermagem Materno-Infantil e Saúde Pública da Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo Horizonte-MG. Brasil. E-mail: xicolana@ufmg.br,2Enfermeira. Bolsista de Apoio Técnico pela Fundação de Amparo à Pesquisa do Estado de Minas Gerais FAPEMIG. Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo HorizonteMG. Brasil. E-mail: apmcarv@yahoo.com.br,3Enfermeira. Pesquisadora do Núcleo Interdisciplinar de Estudos e Pesquisa em Epidemiologia NIEPE Escola de Enfermagem da Universidade Federal de Minas GeraisUFMG. Belo HorizonteMG. Brasil. E-mail: raquelferrazl@gmail.com PESQUISA RESEARCH INVESTIGACIÓN The leprosy represents a public health problem in Brazil, due to the high level of prevalence and incidence. The objective of this study is to analyze the leprosy epidemiological situation and its relation with actions control at the micro-region of Araçuaí. It is an epidemiologic descriptive study and the data were collected from reports of leprosy cases in the cities at the micro-region, during the period of1998-2007, available in Sistema de Informação de Agravos de Notificação SINAN. Operational and epidemiological indices were constructed and analyzed based in Ministério da Saúde parameters. 343 cases were notified in the period and the detection rates were 28,5 cases/100.000 habitants/year. The proportion of detected cases with grade II on disability and the prevalence of passive forms of detection suggest a late diagnosis and confirm the importance of integration of leprosy control activities in primary care.

Integrative literature review of the reported uses of serological tests in leprosy management

An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

The Use of Household Survey in Leprosy Endemic Areas

ABSTRACT The objective of this study is to describe a household survey designed to examine how a population perceives leprosy and the prevalence of infection by Mycobacterium leprae in endemic municipalities in the state of Minas Gerais. This is a descriptive study in five steps: the first focuses on the criteria used for selecting the municipalities; the second is the sample calculation; the third describes the routes within each of demographic census tracts that divide the municipalities; the fourth contains the strategies used for selecting individuals in each household; and the fifth is a description of the sample, a comparison with population data for 2010 and preliminary results from the municipality of Almenara about leprosy perceptions. We concluded that the household survey is an important tool for nursing professionals working in dermatology because it allows them to experience the realities of the various populations. It also provides crucial information to support the planning of actions to be implemented mainly in primary health services. Furthermore, when used in investigations on contagious diseases, household surveys can uncover unavailable information and contribute to a better understanding of the exposure, infection, and disease processes.

Integration of leprosy control activities from the perspective of health professionals

Objective: to analyze the factors that influence the integration of leprosy control activities in Primary Health Care. Method: qualitative study from the perspective of health professionals in six municipalities in the micro-region of Araçuaí do Vale do Jequitinhonha/MG. The semi-structured interview and documentary research were used. For processing and analysis of data, the technique of Content Analysis, Thematic mode was used. The study had the research project approved by the Ethics Committee in Research, opinion 149/07. Results: the speeches showed that the following aspects influence the integration of leprosy control activities: professional training, trainings performance, professional profile, the process of hiring of professionals and high turnover. Conclusion: it was highlighted the importance of investment in updates of the teams, once the operational difficulties of the control program are mainly related to the absence of trained professionals and committed to leprosy. Descriptors: Leprosy; Health Personnel; Primary Health Care; Prevention & Control. RESUMO Objetivo: analisar os fatores que influenciam a integração das ações de controle da hanseníase na Atenção Primária à Saúde. Método: estudo qualitativo, na perspectiva dos profissionais da saúde, em seis municípios da microrregião de Araçuaí do Vale do Jequitinhonha/MG. Utilizou-se a entrevista semiestruturada e pesquisa documental. Para tratamento e análise dos dados, foi utilizada a Técnica de Análise de Conteúdo, na modalidade Temática. O estudo teve o projeto de pesquisa aprovado pelo Comitê de Ética em Pesquisa, parecer 149/07. Resultados: os discursos evidenciaram que os seguintes aspectos influenciam a integração das ações de controle da hanseníase: a formação profissional, a realização de capacitações, o perfil do profissional, o processo de contratação dos profissionais e a alta rotatividade. Conclusão: evidenciou-se a importância de investimentos em atualizações das equipes uma vez que as dificuldades operacionais do programa de controle estão principalmente relacionadas à ausência de profissionais treinados e comprometidos com a hanseníase. Descritores: Hanseníase; Pessoal de Saúde; Atenção Primária à Saúde; Prevenção & Controle. RESUMEN Objetivo: analizar los factores que influyen en la integración de las acciones de control de la lepra en la Atención Primaria a la Salud. Método: estudio cualitativo, en la perspectiva de los profesionales de la salud, en seis municipios de la micro-región de Araçuaí do Vale do Jequitinhonha/MG. Se utilizó la entrevista semiestructurada y la investigación documental. Para tratamiento y análisis de los datos, fue utilizada la Técnica de Análisis de Contenido, en la modalidad Temática. El estudio tuvo el proyecto de investigación aprobado por el Comité de Ética en Investigación, parecer 149/07. Resultados: los discursos mostraron que los siguientes aspectos influyen em la integración de las acciones de control de la lepra: la formación profesional, la realización de capacitaciones, el perfil del profesional, el proceso de contratación de los profesionales y la alta rotatividad. Conclusión: se mostró la importancia de inversiones en actualizaciones de los equipos una vez que las dificultades operacionales del programa de control están principalmente relacionadas a la ausencia de profesionales entrenados y comprometidos con la lepra. Descriptores: Lepra; Personal de Salud; Atención Primaria a la Salud; Prevención & Control. Nurse, PhD student, Graduate Program in Nursing, Federal University of Minas Gerais/UFMG. Belo Horizonte (MG), Brazil. E-mail: anapaulamcarvalho@yahoo.com.br; Nurse, Professor, Nursing Degree, Federal University of Juiz de Fora/UFJF. PhD student, Graduate Program in Nursing, Federal University of Minas Gerais/UFMG. Belo Horizonte (MG), Brasil. E-mail: angelicafabri@yahoo.com.br; Nurse, PhD Professor in Nursing, Nursing Degree, Federal University of São João Del Rei/UFSJ. Divinópolis (MG), Brazil. fernandalanza@ufsj.edu.br; Nurse, Master in Nursing. Belo Horizonte (MG), Brazil. E-mail: fabiana.nlopes@yahoo.com.br; Nurse, PhD Professor in Nursing, Nursing Department Maternal and Public Health, Nursing degree, Federal University of Minas Gerais/UFMG. Belo Horizonte (MG), Brazil. E-mail: Email: xicolana@ufmg.br ORIGINAL ARTICLE Carvalho APM, Fabri ACOC, Lanza FM. Integração das ações de controle da hanseníase...

Perfil epidemiológico de la lepra en la micro región de araçuaí y su relación con las acciones de control

La lepra representa un problema de salud publica en Brasil debido a los altos indices de deteccion y prevalencia. El objetivo de este estudio es analizar la situacion epidemiologica de la lepra y su relacion con acciones de control en micro region de Aracuai en el periodo 1998-2007. El estudio es epidemiologico, descriptivo y los dados fueran recogidos de formularios de notificacion de casos de lepra de las ciudades de la region, periodo 1998-2007, disponible en el Sistema de Informacion de Agravos de Notificacion - SINAN. Indicadores operacionales y epidemiologicos fueran construidos y analizados de acuerdo con los parametros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la deteccion fue 28,5 casos/100.000 habitantes/ano. La proporcion de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de deteccion sugiere un diagnostico tardio y confirma la importancia de la integracion de las actividades de control de la lepra en atencion primaria.Resumen La lepra representa un problema de salud pública en Brasil debido a los altos índices de detección y prevalencia. El objetivo de este estudio es analizar la situación epidemiológica de la lepra y su relación con acciones de control en micro región de Araçuaí en el periodo 1998-2007. El estudio es epidemiológico, descriptivo y los dados fueran recogidos de formularios de notificación de casos de lepra de las ciudades de la región, período 1998-2007, disponible en el Sistema de Información de Agravos de Notificación SINAN. Indicadores operacionales y epidemiológicos fueran construidos y analizados de acuerdo con los parámetros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la detección fue 28,5 casos/100.000 habitantes/año. La proporción de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de detección sugiere un diagnóstico tardío y confirma la importancia de la integración de las actividades de control de la lepra en atención primaria. Palabras clave: Lepra. Salud Pública. Atención Primaria de Salud. Enfermería. 1Enfermeiro. Doutor em Enfermagem. Professor Associado II do Depar tamento de Enfermagem Materno-Infantil e Saúde Pública da Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo Horizonte-MG. Brasil. E-mail: xicolana@ufmg.br,2Enfermeira. Bolsista de Apoio Técnico pela Fundação de Amparo à Pesquisa do Estado de Minas Gerais FAPEMIG. Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo HorizonteMG. Brasil. E-mail: apmcarv@yahoo.com.br,3Enfermeira. Pesquisadora do Núcleo Interdisciplinar de Estudos e Pesquisa em Epidemiologia NIEPE Escola de Enfermagem da Universidade Federal de Minas GeraisUFMG. Belo HorizonteMG. Brasil. E-mail: raquelferrazl@gmail.com PESQUISA RESEARCH INVESTIGACIÓN The leprosy represents a public health problem in Brazil, due to the high level of prevalence and incidence. The objective of this study is to analyze the leprosy epidemiological situation and its relation with actions control at the micro-region of Araçuaí. It is an epidemiologic descriptive study and the data were collected from reports of leprosy cases in the cities at the micro-region, during the period of1998-2007, available in Sistema de Informação de Agravos de Notificação SINAN. Operational and epidemiological indices were constructed and analyzed based in Ministério da Saúde parameters. 343 cases were notified in the period and the detection rates were 28,5 cases/100.000 habitants/year. The proportion of detected cases with grade II on disability and the prevalence of passive forms of detection suggest a late diagnosis and confirm the importance of integration of leprosy control activities in primary care.

Specific antigen serologic tests in leprosy: implications for epidemiological surveillance of leprosy cases and household contacts

BACKGROUND There is a lack of straightforward tests for field application and known biomarkers for predicting leprosy progression in infected individuals. OBJECTIVE The aim was to analyse the response to infection by Mycobacterium leprae based on the reactivity of specific antigens: natural disaccharide linked to human serum albumin via an octyl (NDOHSA), a semisynthetic phenolic glycolipid-I (PGL-I); Leprosy Infectious Disease Research Institute Diagnostic-1 (LID-1) and natural disaccharide octyl - Leprosy Infectious Disease Research Institute Diagnostic-1 (NDOLID). METHODS The study population consisted of 130 leprosy cases diagnosed between 2010 and 2015 and 277 household contacts. An enzyme-linked immunosorbent assay (ELISA) was used to analyse the reactivity of antibodies against NDOHSA, LID-1 and NDOLID. The samples and controls were tested in duplicate, and the antibody titer was expressed as an ELISA index. Data collection was made by home visits with application of questionnaire and dermatological evaluation of all household contacts to identify signs and symptoms of leprosy. FINDINGS Significant differences in the median ELISA results were observed among leprosy cases in treatment, leprosy cases that had completed treatment and household contacts. Higher proportions of seropositivity were observed in leprosy cases in treatment. Seropositivity was also higher in multibacillary in relation to paucibacillary, with the difference reaching statistical significance. Lower titers were observed among cases with a longer treatment time or discharge. For household contacts, the differences according to the clinical characteristics of the leprosy index case were less pronounced than expected. Other factors, such as the endemicity of leprosy, exposure outside the residence and genetic characteristics, appeared to have a greater influence on the seropositivity. MAIN CONCLUSIONS Serologic tests could be used as auxiliary tools for determining the operational classification, in addition to identifying infected individuals and as a strategy for surveillance of household contacts.

O estigma em hanseníase e sua relação com as ações de controle

Objective: to analyze the stigma associated with Hansen’s disease from the perspective of health professionals and managers and its relation to the control actions in municipalities of the micro-region of Aracuai. Method: this is a qualitative study conducted in six municipalities. Data were collected through semi-structured interviews with 54 participants, from February to August 2009. The thematic content analysis was used for the treatment and analysis of data. Results: the weak involvement of primary care in the control actions, the detachment of health professionals and the lack of knowledge of the population about the signs and symptoms of the disease contribute to late diagnosis. This favors the maintenance of the negative perceptions of the population towards Hansen’s disease. Conclusion: strengthening the primary health care and publicizing the disease are strategies to cope with the operational challenges of the control of Hansen’s disease.

Epidemiological profile of leprosy at the microregion of araçuaí and its relation with actions control

La lepra representa un problema de salud publica en Brasil debido a los altos indices de deteccion y prevalencia. El objetivo de este estudio es analizar la situacion epidemiologica de la lepra y su relacion con acciones de control en micro region de Aracuai en el periodo 1998-2007. El estudio es epidemiologico, descriptivo y los dados fueran recogidos de formularios de notificacion de casos de lepra de las ciudades de la region, periodo 1998-2007, disponible en el Sistema de Informacion de Agravos de Notificacion - SINAN. Indicadores operacionales y epidemiologicos fueran construidos y analizados de acuerdo con los parametros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la deteccion fue 28,5 casos/100.000 habitantes/ano. La proporcion de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de deteccion sugiere un diagnostico tardio y confirma la importancia de la integracion de las actividades de control de la lepra en atencion primaria.Resumen La lepra representa un problema de salud pública en Brasil debido a los altos índices de detección y prevalencia. El objetivo de este estudio es analizar la situación epidemiológica de la lepra y su relación con acciones de control en micro región de Araçuaí en el periodo 1998-2007. El estudio es epidemiológico, descriptivo y los dados fueran recogidos de formularios de notificación de casos de lepra de las ciudades de la región, período 1998-2007, disponible en el Sistema de Información de Agravos de Notificación SINAN. Indicadores operacionales y epidemiológicos fueran construidos y analizados de acuerdo con los parámetros del Ministerio de la Salud. En el periodo, 343 casos de lepra fueran notificados y la detección fue 28,5 casos/100.000 habitantes/año. La proporción de casos detectados con el grado de incapacidad II y la prevalencia de las formas pasivas de detección sugiere un diagnóstico tardío y confirma la importancia de la integración de las actividades de control de la lepra en atención primaria. Palabras clave: Lepra. Salud Pública. Atención Primaria de Salud. Enfermería. 1Enfermeiro. Doutor em Enfermagem. Professor Associado II do Depar tamento de Enfermagem Materno-Infantil e Saúde Pública da Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo Horizonte-MG. Brasil. E-mail: xicolana@ufmg.br,2Enfermeira. Bolsista de Apoio Técnico pela Fundação de Amparo à Pesquisa do Estado de Minas Gerais FAPEMIG. Escola de Enfermagem da Universidade Federal de Minas Gerais UFMG. Belo HorizonteMG. Brasil. E-mail: apmcarv@yahoo.com.br,3Enfermeira. Pesquisadora do Núcleo Interdisciplinar de Estudos e Pesquisa em Epidemiologia NIEPE Escola de Enfermagem da Universidade Federal de Minas GeraisUFMG. Belo HorizonteMG. Brasil. E-mail: raquelferrazl@gmail.com PESQUISA RESEARCH INVESTIGACIÓN The leprosy represents a public health problem in Brazil, due to the high level of prevalence and incidence. The objective of this study is to analyze the leprosy epidemiological situation and its relation with actions control at the micro-region of Araçuaí. It is an epidemiologic descriptive study and the data were collected from reports of leprosy cases in the cities at the micro-region, during the period of1998-2007, available in Sistema de Informação de Agravos de Notificação SINAN. Operational and epidemiological indices were constructed and analyzed based in Ministério da Saúde parameters. 343 cases were notified in the period and the detection rates were 28,5 cases/100.000 habitants/year. The proportion of detected cases with grade II on disability and the prevalence of passive forms of detection suggest a late diagnosis and confirm the importance of integration of leprosy control activities in primary care.