Leprosy Mailing List – February 11, 2016
Ref.: (LML) What is the actual situation of leprosy and its elimination
From: Isabel Goulart, Überlandia, Brazil
Dear Pieter,
About (LML) what is the actual situation of leprosy and its elimination, here are some considerations for our reflection.
The National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia MG, Brazil (CREDESH/HC/UFU-MG) has worked in the daily routine and has experience in the application of the qPCR M. leprae DNA detection and of the ELISA anti-PGL1 IgM in the patients, household contacts and population; and also with electroneuromyography to identify early neural involvement, essential for the diagnosis and monitoring of this peripheral nerves’ disease. Therefore, during these last years we have worked to produce knowledge in order to identify risk groups for early leprosy diagnosis and wherefore we have worked with various molecular and immunological markers since 2000.
We have built our expertise through the daily work with leprosy patients and monitoring of contacts for +10 years. We can follow the illness process of the contacts and analyzing the clinical and laboratory correlations. Our multidisciplinary team performs 30,000 lab. and clinical procedures/year.
From that our background, I can tell you, we need to turn the page of "leprosy" and work with the leprosy of the twenty-first century. To start this reflection we must remember that M. leprae is a virulent bacillus, not because it is lethal, but because it affects peripheral nerve and it can be devastating to the patient because it leads to disability and /or deformity.
According to the World Health Organization, the disease burden is defined as the full impact of the disease on society beyond the costs of their treatments. It is measured in years of life lost due to illness or disability and is estimated by the difference between total life expectancy and life expectancy adjusted for disability (DALY - Disability Adjusted Life Years - Years of Life Lost Adjusted Disability). Do you imagine if we could actually measure the burden of leprosy by DALY in the world? How many years of life lost due to death and disability by leprosy? I have asked to Ministry of Health/Brazil about the number of cases with grade 2 disabilities by leprosy (which sets stigma), at the diagnosis in Brazil from 2001 to 2011 (10 years). We have found 120,000 leprosy patients with disabilities (grade 2). This is an estimative because we didn't assess the grade disabilities in 100% of patients.
No more! We cannot agree with the stigma of the biblical leprosy! For this, it must be deployed the serological diagnosis of the infection and the detection of the bacillus by qPCR for M. leprae DNA in asymptomatic individuals, even if it generates higher cost of health care for this neglected disease. We cannot wait by the bacillus multiplication reaching 10 million per gram of tissue, so we can find it in the skin smear or biopsies by optical microscopy, when this burden has produced considerable damage in the patients, generating disability and / or deformity.
We should analyse that the benefit is much higher than cost for this early diagnosis approach, given the high costs of a rehabilitation program for this huge amount of people with disabilities in order to give them back their dignity or minimize the lost years as a result of this situation caused by leprosy.
The HIV / AIDS program has a much greater number of infected and diseased than leprosy in Brazil, and these cases have access to CD4 / CD8 counts by flow cytometry, viral load by messenger RNA, several serology exams, etc. Why leprosy patients have no access to serology and DNA qPCR for detecting a bacillus so virulent that attacks peripheral nerves, skin, hands, feet, eyes, testicles, kidney, liver, etc? We can't give up of this question. Please, think about it generously. Let's break this paradigm to really eliminate and perhaps eradicate leprosy, considering the true meaning of these conditions (Novartis Foundation Symposium, 2013)
Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographic area as a result of deliberate efforts; continued intervention measures are required.
Elimination of infection: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographic area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required.
Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.
My best wishes,
Isabela Goulart
Dr. Isabela Maria Bernardes Goulart, MD, PhD
Associate Professor – School of Medicine
Universidade Federal de Uberlândia - UFU
Coordinator and Head of the National Reference Center for Sanitary Dermatology and Leprosy - Clinics Hospital – UFU, Uberlândia - MG, Brazil
www.credesh.hc.ufu.br; credsh@hc.ufu.br; imbgoulart@gmail.com
Phone/Fax: +55 34 3216 7872; (34) 3210-3545
Note editor: DNA qPCR
The method of choice for nucleic acid (DNA, RNA) quantification in all areas of molecular biology is real-time PCR or quantitative PCR (qPCR). The method is so-called because the amplification of DNA with a polymerase chain reaction (PCR) is monitored in real time (qPCR cyclers constantly scan qPCR plates). It is, in contrast to the conventional PCR, quantitative, meaning that it enables us to determine the exact concentration (relative or absolute) of the amplified DNA in the sample. Conversely, in conventional PCR we can see the result of amplification only after the PCR is completed (end-point detection) (BioSistemike).
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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