Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros

The World Health Organization (WHO) endorsed diagnosis of leprosy (also known as Hansen’s disease) entirely based on clinical cardinal signs, without microbiological confirmation, which may lead to late or misdiagnosis. The use of slit skin smears is variable, but lacks sensitivity. In 2017–2018 dur...

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Autores principales:	Sofie Marijke Braet, Anouk van Hooij, Epco Hasker, Erik Fransen, Abdou Wirdane, Abdallah Baco, Saverio Grillone, Nimer Ortuno-Gutierrez, Younoussa Assoumani, Aboubacar Mzembaba, Paul Corstjens, Leen Rigouts, Annemieke Geluk, Bouke Catherine de Jong
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/e984d414b1ff41b4869c7150ea03859e
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spelling	oai:doaj.org-article:e984d414b1ff41b4869c7150ea03859e2021-11-18T09:14:50ZMinimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros1935-27271935-2735https://doaj.org/article/e984d414b1ff41b4869c7150ea03859e2021-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580230/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735The World Health Organization (WHO) endorsed diagnosis of leprosy (also known as Hansen’s disease) entirely based on clinical cardinal signs, without microbiological confirmation, which may lead to late or misdiagnosis. The use of slit skin smears is variable, but lacks sensitivity. In 2017–2018 during the ComLep study, on the island of Anjouan (Union of the Comoros; High priority country according to WHO, 310 patients were diagnosed with leprosy (paucibacillary = 159; multibacillary = 151), of whom 263 were sampled for a skin biopsy and fingerstick blood, and 260 for a minimally-invasive nasal swab. In 74.5% of all skin biopsies and in 15.4% of all nasal swabs, M. leprae DNA was detected. In 63.1% of fingerstick blood samples, M. leprae specific antibodies were detected with the quantitative αPGL-I test. Results show a strong correlation of αPGL-I IgM levels in fingerstick blood and RLEP-qPCR positivity of nasal swabs, with the M. leprae bacterial load measured by RLEP-qPCR of skin biopsies. Patients with a high bacterial load (≥50,000 bacilli in a skin biopsy) can be identified with combination of counting lesions and the αPGL-I test. To our knowledge, this is the first study that compared αPGL-I IgM levels in fingerstick blood with the bacterial load determined by RLEP-qPCR in skin biopsies of leprosy patients. The demonstrated potential of minimally invasive sampling such as fingerstick blood samples to identify high bacterial load persons likely to be accountable for the ongoing transmission, merits further evaluation in follow-up studies. Author summary Leprosy is the oldest infectious disease known to humankind. We still do not succeed in curbing its transmission, with more than 200,000 new patients detected worldwide each year. Identifying persons with a high burden of bacteria is key to curb transmission. To identify these persons, bacteria are counted in invasive and painful samples like slit skin smears and skin biopsies. We evaluated whether we can use less invasive samples, like fingerstick blood or nasal swabs, to determine the bacterial load. We found that the level of antibodies against M. leprae (αPGL-I IgM) in fingerstick blood correlates well with the bacterial load determined in skin biopsies from the same leprosy patient. Therefore, a high level of antibodies against M. leprae in fingerstick blood might identify persons who pose a potential risk for transmission of leprosy and could be prioritized for contact screening, which is essential for control of the disease.Sofie Marijke BraetAnouk van HooijEpco HaskerErik FransenAbdou WirdaneAbdallah BacoSaverio GrilloneNimer Ortuno-GutierrezYounoussa AssoumaniAboubacar MzembabaPaul CorstjensLeen RigoutsAnnemieke GelukBouke Catherine de JongPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Sofie Marijke Braet Anouk van Hooij Epco Hasker Erik Fransen Abdou Wirdane Abdallah Baco Saverio Grillone Nimer Ortuno-Gutierrez Younoussa Assoumani Aboubacar Mzembaba Paul Corstjens Leen Rigouts Annemieke Geluk Bouke Catherine de Jong Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
description	The World Health Organization (WHO) endorsed diagnosis of leprosy (also known as Hansen’s disease) entirely based on clinical cardinal signs, without microbiological confirmation, which may lead to late or misdiagnosis. The use of slit skin smears is variable, but lacks sensitivity. In 2017–2018 during the ComLep study, on the island of Anjouan (Union of the Comoros; High priority country according to WHO, 310 patients were diagnosed with leprosy (paucibacillary = 159; multibacillary = 151), of whom 263 were sampled for a skin biopsy and fingerstick blood, and 260 for a minimally-invasive nasal swab. In 74.5% of all skin biopsies and in 15.4% of all nasal swabs, M. leprae DNA was detected. In 63.1% of fingerstick blood samples, M. leprae specific antibodies were detected with the quantitative αPGL-I test. Results show a strong correlation of αPGL-I IgM levels in fingerstick blood and RLEP-qPCR positivity of nasal swabs, with the M. leprae bacterial load measured by RLEP-qPCR of skin biopsies. Patients with a high bacterial load (≥50,000 bacilli in a skin biopsy) can be identified with combination of counting lesions and the αPGL-I test. To our knowledge, this is the first study that compared αPGL-I IgM levels in fingerstick blood with the bacterial load determined by RLEP-qPCR in skin biopsies of leprosy patients. The demonstrated potential of minimally invasive sampling such as fingerstick blood samples to identify high bacterial load persons likely to be accountable for the ongoing transmission, merits further evaluation in follow-up studies. Author summary Leprosy is the oldest infectious disease known to humankind. We still do not succeed in curbing its transmission, with more than 200,000 new patients detected worldwide each year. Identifying persons with a high burden of bacteria is key to curb transmission. To identify these persons, bacteria are counted in invasive and painful samples like slit skin smears and skin biopsies. We evaluated whether we can use less invasive samples, like fingerstick blood or nasal swabs, to determine the bacterial load. We found that the level of antibodies against M. leprae (αPGL-I IgM) in fingerstick blood correlates well with the bacterial load determined in skin biopsies from the same leprosy patient. Therefore, a high level of antibodies against M. leprae in fingerstick blood might identify persons who pose a potential risk for transmission of leprosy and could be prioritized for contact screening, which is essential for control of the disease.
format	article
author	Sofie Marijke Braet Anouk van Hooij Epco Hasker Erik Fransen Abdou Wirdane Abdallah Baco Saverio Grillone Nimer Ortuno-Gutierrez Younoussa Assoumani Aboubacar Mzembaba Paul Corstjens Leen Rigouts Annemieke Geluk Bouke Catherine de Jong
author_facet	Sofie Marijke Braet Anouk van Hooij Epco Hasker Erik Fransen Abdou Wirdane Abdallah Baco Saverio Grillone Nimer Ortuno-Gutierrez Younoussa Assoumani Aboubacar Mzembaba Paul Corstjens Leen Rigouts Annemieke Geluk Bouke Catherine de Jong
author_sort	Sofie Marijke Braet
title	Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
title_short	Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
title_full	Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
title_fullStr	Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
title_full_unstemmed	Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros
title_sort	minimally invasive sampling to identify leprosy patients with a high bacterial burden in the union of the comoros
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e984d414b1ff41b4869c7150ea03859e
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Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros

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