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      Factors associated with anti-phenolic glycolipid-I seropositivity among the household contacts of leprosy cases

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          Abstract

          Background

          The diagnosis of leprosy is based on clinical symptoms of the disease, which may not be sufficient to ensure early diagnosis. The development of effective tools for the early detection of infection, such as rapid tests that can be applied by non-specialists for early-stage leprosy identification, has been considered a research priority and may contribute to overcoming the complications associated with late diagnosis. The aim of this study was to analyze the factors associated with anti-phenolic glycolipid-I (PGL-I) seropositivity among the household contacts of leprosy cases.

          Methods

          A cross-sectional study of individuals from the northeastern municipalities of the state of Minas Gerais, Brazil, was performed. Anti-PGL-I seropositivity was evaluated by assessing specific antibody production using the ML Flow test. A Poisson regression with a robust error variance was used to evaluate the relationship between anti-PGL-I seropositivity and the independent variables investigated.

          Results

          The overall anti-PGL-I seropositivity was 13.5 %, and among the contacts of leprosy cases that were classified as paucibacillary or multibacillary, it was 8.4 and 17.3 %, respectively. The factors associated with the variation of anti-PGL-I seropositivity among the study population were the presence of signs suggestive of leprosy (PR = 3.68; 95 % CI: 1.56–8.71), the operational leprosy classification (PR = 2.17; 95 % CI: 1.22–3.86) and grade 1 (PR = 1.83; 95 % CI: 1.02–3.26) or grade 2 disability (PR = 2.42; 95 % CI: 1.02–5.47) of the index leprosy case.

          Conclusions

          The presence of signs suggestive of leprosy and the operational classification of leprosy cases were associated with anti-PGL-I seropositivity. The serological tests available for leprosy are not considered to be diagnostic tests but can be used as auxiliary assessments in combination with clinical parameters to identify exposed individuals at high risk of developing leprosy and those exhibiting the initial stages of this disease.

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          Most cited references30

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          Leprosy now: epidemiology, progress, challenges, and research gaps.

          Leprosy continues to be a challenge to health worldwide, with about 250,000 new cases being detected every year. Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. A third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services. We review data and make recommendations for research on diagnosis, treatment, and prevention, such as further use of molecular analysis of the Mycobacterium leprae genome, implementation of BCG vaccination, and administration of chemoprophylaxis to household contacts. We also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Hanseníase no Brasil

            A hanseníase é doença infecciosa crônica causada pelo Mycobacterium leprae. A predileção pela pele e nervos periféricos confere características peculiares a esta moléstia, tornando o seu diagnóstico simples. O Brasil continua sendo o segundo país em número de casos no mundo, após a Índia. Aproximadamente 94% dos casos conhecidos nas Américas e 94% dos novos diagnosticados são notificados pelo Brasil. A doença manifesta-se em dois pólos estáveis e opostos (virchowiano e tuberculóide) e dois grupos instáveis (indeterminado e dimorfo). Em outra classificação a doença é dividida em forma tuberculóide, borderline ou dimorfa que são subdivididos em dimorfa-tuberculóide, dimorfa-dimorfa e dimorfa-virchowiana, e virchowiana. A baciloscopia é o exame complementar mais útil no diagnóstico. O tratamento da hanseníase compreende: quimioterapia específica, supressão dos surtos reacionais, prevenção de incapacidades físicas, reabilitação física e psicossocial. A poliquimioterapia com rifampicina, dapsona e clofazimina revelou-se muito eficaz e a perspectiva de controle da doença no Brasil é real no curto prazo.
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              A proposed architecture and method of operation for improving the protection of privacy and confidentiality in disease registers

              Background Disease registers aim to collect information about all instances of a disease or condition in a defined population of individuals. Traditionally methods of operating disease registers have required that notifications of cases be identified by unique identifiers such as social security number or national identification number, or by ensembles of non-unique identifying data items, such as name, sex and date of birth. However, growing concern over the privacy and confidentiality aspects of disease registers may hinder their future operation. Technical solutions to these legitimate concerns are needed. Discussion An alternative method of operation is proposed which involves splitting the personal identifiers from the medical details at the source of notification, and separately encrypting each part using asymmetrical (public key) cryptographic methods. The identifying information is sent to a single Population Register, and the medical details to the relevant disease register. The Population Register uses probabilistic record linkage to assign a unique personal identification (UPI) number to each person notified to it, although not necessarily everyone in the entire population. This UPI is shared only with a single trusted third party whose sole function is to translate between this UPI and separate series of personal identification numbers which are specific to each disease register. Summary The system proposed would significantly improve the protection of privacy and confidentiality, while still allowing the efficient linkage of records between disease registers, under the control and supervision of the trusted third party and independent ethics committees. The proposed architecture could accommodate genetic databases and tissue banks as well as a wide range of other health and social data collections. It is important that proposals such as this are subject to widespread scrutiny by information security experts, researchers and interested members of the general public, alike.
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                Author and article information

                Contributors
                anapaulamcarvalho@yahoo.com.br
                angelicafabri@yahoo.com.br
                correa@cpqrr.fiocruz.br
                xicolana@ufmg.br
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                30 May 2015
                30 May 2015
                2015
                : 15
                : 219
                Affiliations
                [ ]Postgraduate Program in Nursing, Escola de Enfermagem, Universidade Federal de Minas Gerais−UFMG, Belo Horizonte, MG Brasil
                [ ]Department of Basic Nursing, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora−UFJF, Juiz de Fora, MG Brasil
                [ ]Laboratory of Cellular and Molecular Immunology, Centro de Pesquisas René Rachou−CPqRR, Fundação Oswaldo Cruz−FIOCRUZ, Belo Horizonte, MG Brasil
                [ ]Laboratory of Immunology, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto−UFOP, Ouro Preto, MG Brasil
                [ ]Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais−INCT-DT, Belo Horizonte, Brasil
                [ ]Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais−UFMG, Belo Horizonte, MG Brasil
                Article
                955
                10.1186/s12879-015-0955-3
                4449587
                26024906
                a0beb74b-f405-4977-b7ee-963a5028ccf8
                © Carvalho et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 October 2014
                : 20 May 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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