@article{101184,
  keywords = {phenolic glycolipid-I (PGL-I), Real-Time Polymerase Chain Reaction, Leprosy, Pathology, Treatment Failure},
  author = {de Carvalho Dornelas B and da Costa WVT and de Abreu JPF and Daud JS and Campos FDAR and de Oliveira Campos DR and Antunes DE and de Araújo LB and dos Santos DF and Soares CT and Goulart IMB},
  title = {Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy},
  abstract = {<p><strong>Background: </strong>Treatment failure (TF) in leprosy following multidrug therapy (MDT) presents a significant challenge. The current World Health Organization (WHO) fixed-duration MDT regimen, based on lesion count, might not be adequate. Leprosy lacks clear-cut objective cure criteria, and the predictive value of post-MDT histopathological findings remains uncertain. This study aims to identify predictive factors for TF among leprosy patients who have completed the WHO-recommended MDT.</p>

<p><strong>Methods: </strong>An analysis was conducted on 80 individuals from a national leprosy reference center, comprising 40 TF cases (with a mean relapse at 13.0 months) and 40 controls (with a mean of 113.1 months without disease signs). Various epidemiological and clinical-laboratory parameters were assessed post-MDT.</p>

<p><strong>Results: </strong>In skin samples, the presence of foamy granuloma (OR=7.36; 95%CI2.20-24.60; p=0.0012) and histological bacillary index (hBI)≥1+ (OR=1.55; 95%CI1. 22-1.99; p=0.0004) were significantly associated with TF, with odds ratios of 7.36 and 1.55, respectively. Individuals who experienced TF had a mean hBI of 3.02+ (SD±2.02), while the control group exhibited a mean hBI of 1.8+ (SD±1.88). An hBI≥3+showed a sensitivity of 73% and a specificity of 78% for TF detection (AUC: 0.75; p=0.0001). Other histopathological features like epithelioid granulomas, and skin changes did not show significant associations (p&gt;0.05). Additionally, higher anti-phenolic glycolipid-I (anti-PGL-I) ELISA index (EI) levels were linked to a 1.4-fold increased likelihood for TF (OR=1.4; 95%CI1.13-1.74; p=0.0019). A mean EI of 4.48 (SD±2.80) was observed, with an EI≥3.95 showing a sensitivity of 79% and a specificity of 59% for TF detection (AUC: 0.74; p=0.0001). Moreover, the presence of Mycobacterium leprae (M. leprae) DNA in real-time polymerase chain reaction (qPCR) was associated with a 3.43-fold higher likelihood of TF. Multivariate regression analysis indicated that concurrent presentation of neural/perineural lymphocytic infiltrate, foamy granuloma, hBI≥1+, and EI≥1 markedly increased the likelihood of TF by up to 95.41%.</p>
},
  year = {2024},
  journal = {BMC Infectious Diseases},
  volume = {24},
  pages = {1-13},
  publisher = {Springer Science and Business Media LLC},
  issn = {1471-2334},
  url = {https://bmcinfectdis.biomedcentral.com/counter/pdf/10.1186/s12879-024-09937-2.pdf},
  doi = {10.1186/s12879-024-09937-2},
  language = {ENG},
}