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Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon
INTRODUCTION: The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community’s early exposure to Mycobacterium leprae and active transmission of the infection. METHODS: In order to detect new cases among children by combining clinical evaluation...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10323681/ https://www.ncbi.nlm.nih.gov/pubmed/37425318 http://dx.doi.org/10.3389/fmed.2023.1218388 |
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author | 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 |
author_facet | 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 |
author_sort | Costa, Izabelle Laissa Viana |
collection | PubMed |
description | INTRODUCTION: The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community’s early exposure to Mycobacterium leprae 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 Mycobacterium leprae 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. |
format | Online Article Text |
id | pubmed-10323681 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-103236812023-07-07 Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon 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 Front Med (Lausanne) Medicine INTRODUCTION: The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community’s early exposure to Mycobacterium leprae 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 Mycobacterium leprae 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. Frontiers Media S.A. 2023-06-22 /pmc/articles/PMC10323681/ /pubmed/37425318 http://dx.doi.org/10.3389/fmed.2023.1218388 Text en Copyright © 2023 Costa, da Costa, da Silva, Gobbo, Pinto, Spencer, da Silva and Salgado. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine 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 Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title | Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title_full | Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title_fullStr | Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title_full_unstemmed | Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title_short | Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon |
title_sort | leprosy among children in an area without primary health care coverage in caratateua island, brazilian amazon |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10323681/ https://www.ncbi.nlm.nih.gov/pubmed/37425318 http://dx.doi.org/10.3389/fmed.2023.1218388 |
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