01997nas a2200169   4500000000100000008004100001653006300042100001300105700001300118700001500131700001300146245011200159300001200271490000800283520152200291022001401813       2014                            d10aBrazil; Diagnosis; Leprosy; Mycobacterium leprae; Serology1 aSouza MM1 aNetto EM1 aNakatani M1 aDuthie M00aUtility of recombinant proteins LID-1 and PADL in screening for Mycobacterium leprae infection and leprosy.  a495-5010 v1083 a<p><strong>BACKGROUND: </strong>Despite the widespread use of multidrug therapy, leprosy remains an important public health concern in many regions. Detection is generally limited to clinical exam.</p>

<p><strong>METHODS: </strong>As a two-tiered active case finding strategy, we used the LID-1 (leprosy IDRI diagnostic-1), and PADL (protein advances for the diagnosis of leprosy) antigens for serological examination of 2526 individuals randomly selected from 10 472 residents in a leprosy hyperendemic area (Cajazeiras, Paraiba, Brazil). Almost all seropositive (95%) and a subset of seronegative (17%) subjects then underwent clinical evaluations.</p>

<p><strong>RESULTS: </strong>Prevalence of clinically apparent leprosy was 2.3% (19 cases among 834 fully examined individuals). LID-1 and PADL demonstrated a high sensitivity for supporting leprosy diagnosis at 89% and 87%, with positive predictive values (PPV) of 3.5% and 3.7%. The specificity for clinically apparent leprosy was low at 42% and 38%, respectively, and was likely reduced due to the presence of many asymptomatic individuals infected with Mycobacterium leprae.</p>

<p><strong>CONCLUSIONS: </strong>Our data indicate the utility of the LID-1 and PADL antigens as primary screening tools for the detection of M. leprae infection and identification of leprosy patients. The follow-up of seropositive subjects could clarify the predictive value and utility of detecting anti-LID-1 and PADL antibodies within leprosy control programs.</p>
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