Abstract Slit skin smear and histopathological examinations are currently the main laboratory tools used to aid the diagnosis of leprosy. However, their sensitivity is low, and many cases are not detected. New methodologies have been studied to develop more accurate tests. This narrative review aims to raise attention to the results of molecular (polymerase chain reaction) and serological (Enzyme-Linked Immunosorbent Assay) tests applied to the diagnosis of leprosy, and to summarize the available information about the former. Original scientific articles published in indexed international journals, whose study involved aspects of the diagnosis and classification of leprosy cases or home contacts, were selected. The data were extracted independently using a standardized method that dictated the inclusion of the following information: diagnosis in Paucibacillary and Multibacillary cases and in household contacts; sample number; sample type; study design; studied variables; statistical analysis employed; main results; and limitations identified. In clinical practice, the results from molecular and serological tests are assessed separately, with moderate sensitivity and specificity. However, an integrated study of these methodologies has been suggested for greater accuracy in diagnosis.

BACKGROUND Leprosy remains a health problem in many countries, with difficulties in diagnosis resulting in delayed treatment and more severe disabilities. Antibodies against several Mycobacterium leprae antigens have, however, shown value as diagnostic and/or prognostic markers. OBJECTIVES The objective of this study was to evaluate serum immunoglobulin (Ig) IgM and IgG subclass reactivity against three M. leprae specific antigens: NDO-HSA, a conjugate formed by natural octyl disaccharide bound to human serum albumin; LID-1, the fusion protein product of the ml0405 and ml2331 genes; and NDO-LID, a combination of LID-1 and NDO. METHODS Sera from healthy controls, paucibacillary (PB) and multibacillary (MB) leprosy patients, and their respective household contacts, were evaluated for the presence of antigen-specific IgM, IgG, and IgG subclass antibodies by enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of each ELISA were evaluated by receiver operating characteristic (ROC) curve analysis. FINDINGS Our data confirm that serum IgM antibodies against NDO-HSA and IgG antibodies against LID-1, as well as IgG/M antibodies against NDO-LID, are markedly increased in MB patients. For the first time, our data reveal a selective increase in IgG1 and IgG3 antibodies against LID-1 and NDO-LID in MB patients, demonstrating that these antibody isotypes are suitable for differentiation between MB and PB patients. ROC curve analysis indicates an improved capacity for diagnosing MB leprosy patients using the detection of IgG antibodies, particularly the IgG1 isotype, specific to LID-1 and NDO-LID over the performance levels attained with NDO-HSA. CONCLUSIONS Our findings indicate that serological tests based on the detection of antigen-specific IgG1 antibodies are a useful tool to differentiate MB from PB patients, and indicate the enhanced performance of the LID-1 and NDO-LID antigens in the serodiagnosis of leprosy.

We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.

The aim of this study was to evaluate the assistance to a group of women. We selected eighteen users with the diagnosis of neurotic disorder related to stress and somatoforms. For the evaluation, we used the Evaluation Scale of Hamilton Anxiety (EHA). Our purpose was to verify the anxiety level before and after beginning each group session. We accomplished 16 sessions per week, developing relaxing techniques, art-therapy and as a referential the gestalt-therapy in short run. After the group sessions, the level of anxiety of the women accompanied through the group approach had significant reduction concerning the symptoms which had been relevant characteristics for their psychiatric suffering.

La necesidad de evaluar la asistencia a un grupo de mujeres nos llevó a la aplicación de una escala. Fueron seleccionadas dieciocho usuarias con diagnóstico de trastornos neuróticos, relacionados al estrés y somato formes. Se aplicó la Escala de Evaluación de Ansiedad de Hamilton (HAM-A) con el objetivo de verificar el nivel de ansiedad antes y después de empezar las sesiones grupales. Realizamos 16 sesiones semanales, con desarrollo de técnicas de relajación y arte terapia, y como referencial la Terapia de Gestalt de corta duración. Después de las secciones de grupo, el nivel de ansiedad de las mujeres acompañadas a través de abordaje grupal, tuvo reducción significativa en lo que se refiere a los síntomas que habían aparecido como características determinantes para su sufrimiento psíquico.

A necessidade de avaliar a assistência a um grupo de mulheres levou-nos à aplicação de uma escala. Foram selecionadas 18 usuárias com diagnóstico de transtornos neuróticos, relacionados ao estresse e somatoformes. A Escala de Avaliação de Ansiedade de Hamilton (HAM-A) foi aplicada com o objetivo de verificar o nível de ansiedade antes e depois de iniciar as sessões grupais. Realizamos 16 sessões de grupo, desenvolvendo técnicas de relaxamento e arte-terapia, tendo como referencial a gestalt-terapia de curta duração. Após as sessões de grupo, o nível de ansiedade das mulheres acompanhadas por meio da abordagem grupal, teve redução significativa quanto aos sintomas que haviam se mostrado como características determinantes para seu sofrimento psíquico.

Duzentos e vinte e três indivíduos de área endêmica de baixa morbidade para esquistossomose e nove pacientes hospitalizados com a forma hepatoesplênica foram submetidos ao exame de fezes e clínico e à ultra-sonografia do abdômen. De acordo com os resultado dos exames de fezes e do ultra-som eles foram agrupados do seguinte modo: G1 - 63 indivíduos sem ovos de Schistosoma mansoni nas fezes; G2 - 141 indivíduos apresentando ovos de Schistosoma mansoni nas fezes, sem ecogenicidade periportal. G3 - 19 indivíduos com ovos de Schistosoma mansoni nas fezes e ecogenicidade periportal entre 3-6mm.; G4 - 9 pacientes hepatesplênicos com ecogenicidade periportal > 6mm. Pelo exame físico do abdômen, a hepatomegalia na linha hemiclavicular direita foi constatada em G1, G2 E G3, respectivamente, em 11,1, 12,1 e 26,3%. Nos grupos G1, G2 e G3, houve espessamento periportal somente em esquistossomáticos (8,5%). Alterações patológicas leves em pacientes, as quais não puderam ser detectadas pelo exame clínico, foram evidenciadas no fígado pelo ultra-som e podem ser devidas à fibrose. O grau de fibrose periportal leve foi diminuído em 57,9% dos pacientes 12 meses após tratamento da esquistossomose com oxamniquine. Na ultra-sonografia, a média da medida do lobo esquerdo do fígado dos indivíduos de G3 foi maior que a de G1 e, a de G4 maior que a de G1 e G2. O tamanho médio do baço de G4 foi significativamente maior que o dos outros grupos e o de G3 foi maior que o de G1 e G2.

Two hundred and twenty three subjects from a Schistosoma mansoni low morbidity endemic area and nine hospitalized hepatosplenic patients were submitted to stool test and clinical examination and abdomen ultrasound assessments. According to stool examination and ultrasound results, they were grouped as follows: G1 - 63 Schistosoma mansoni egg-negative individuals; G2 - 141 egg-positive patients and without evidence of periportal fibrosis; G3 - 19 egg-positive patients with periportal echogenicity (3-6mm); and G4 - 9 hepatosplenic patients with periportal echogenicity (> 6mm). Hepatomegaly detected by physical examination of the abdomen evaluated in the midclavicular line was verified in G1, G2 and G3, respectively, in 11.1, 12.1 and 26.3%. In G1, G2 and G3, periportal thickening occurred only in schistosomal patients (8.5%). Mild pathological alterations in patients that cannot yet be detected by clinical examination were detectable in the liver by ultrasound and can be due to fibrosis. The degree of mild periportal fibrosis was diminished in 57.9% of patients 12 months after treatment of schistosomiasis with oxamniquine. At ultrasonography, the mean liver left lobe measurement of G3 was larger than that of G1, and that of G4 larger than that of G1 and G2. The mean size of the spleen of G4 was significantly larger than that of the other three groups, and that of G3 larger than that of G1 and G2.

Objetivamos proceder ao relato da sistematização de um grupo terapêutico como recurso na assistência de enfermagem em saúde mental a mulheres acompanhadas em um Centro de Atenção Psicossocial(CAPS) com transtornos neuróticos, relacionados ao estresse e somatoformes. Coordenamos um grupo de forma sistemática durante quatro meses com mulheres acometidas pelos transtornos já citados e alcançou a resultados satisfatórios. Disponibilizamos aos enfermeiros e demais profissionais de saúde que realizam grupos terapêuticos as estratégias que adotamos na pesquisa para proceder à referida sistematização. Concluímos que a realização de grupos terapêuticos é um empreendimento complexo e valioso pelos bons resultados que traz para à clientela assistida, pelo crescente amadurecimento humano e teórico que proporciona aos profissionais, pela oportunidade de exercer a autocrítica, o que deve ser divulgado para os que atuam na área de saúde mental.

We aimed to proceed the systematic reporting of a therapeutic group as a resource in nursing assistance in mental health for women assisted in a center for psychosocial attention (CAPS) with neurotic disorders, related to stress and somatoforms. We have coordinated the group in a systematic way for four years with women affected by the already mentioned disorders and we have achieved satisfactory results. We made available the strategies we adopted in the research for the nurses and other health professionals that have therapeutic groups in order to proceed with the referred systematization. We conclude that the accomplishment of therapeutic groups is a complex and valuable action because of the good results it gives to the assisted clientele, the increasing human and theoretical growth that it offers the professionals and the opportunity to make self assessments, which should be advertised for people who work in the mental health area.

Objetivamos proceder al relato de la sistematización de un grupo terapéutico con recurso en la asistencia de enfermería en la salud mental a las mujeres acompañadas en un Centro de Atención Psicosocial (CAPS) con trastornos neuróticos, relacionados al estrés y a la somatización de enfermedades. Coordinamos un grupo de forma sistemática durante cuatro meses con mujeres afectadas por los trastornos ya dichos y que logróa los resultados satisfactorios. Se disponibilizo de enfermeros y demás profesionales de salud que realizan grupos terapéuticos y las estrategias que adoptamos en la investigación para proseguir en la sistematización. Concluimos que la realización de grupos terapéuticos es una iniciativa compleja y importante por los resultados efectivos que trae para la clientela asistida, por la creciente madurez humana y teórica que proporciona a los profesionales, y la oportunidad de ejercer la autocrítica, lo cual debe ser propagada para los que actúan en el área de la salud mental.

We aimed to proceed the systematic reporting of a therapeutic group as a resource in nursing assistance in mental health for women assisted in a center for psychosocial attention (CAPS) with neurotic disorders, related to stress and somatoforms. We have coordinated the group in a systematic way for four years with women affected by the already mentioned disorders and we have achieved satisfactory results. We made available the strategies we adopted in the research for the nurses and other health professionals that have therapeutic groups in order to proceed with the referred systematization. We conclude that the accomplishment of therapeutic groups is a complex and valuable action because of the good results it gives to the assisted clientele, the increasing human and theoretical growth that it offers the professionals and the opportunity to make self assessments, which should be advertised for people who work in the mental health area.

Objetivamos proceder al relato de la sistematización de un grupo terapéutico con recurso en la asistencia de enfermería en la salud mental a las mujeres acompañadas en un Centro de Atención Psicosocial (CAPS) con trastornos neuróticos, relacionados al estrés y a la somatización de enfermedades. Coordinamos un grupo de forma sistemática durante cuatro meses con mujeres afectadas por los trastornos ya dichos y que logróa los resultados satisfactorios. Se disponibilizo de enfermeros y demás profesionales de salud que realizan grupos terapéuticos y las estrategias que adoptamos en la investigación para proseguir en la sistematización. Concluimos que la realización de grupos terapéuticos es una iniciativa compleja y importante por los resultados efectivos que trae para la clientela asistida, por la creciente madurez humana y teórica que proporciona a los profesionales, y la oportunidad de ejercer la autocrítica, lo cual debe ser propagada para los que actúan en el área de la salud mental.

Objetivamos proceder ao relato da sistematização de um grupo terapêutico como recurso na assistência de enfermagem em saúde mental a mulheres acompanhadas em um Centro de Atenção Psicossocial(CAPS) com transtornos neuróticos, relacionados ao estresse e somatoformes. Coordenamos um grupo de forma sistemática durante quatro meses com mulheres acometidas pelos transtornos já citados e alcançou a resultados satisfatórios. Disponibilizamos aos enfermeiros e demais profissionais de saúde que realizam grupos terapêuticos as estratégias que adotamos na pesquisa para proceder à referida sistematização. Concluímos que a realização de grupos terapêuticos é um empreendimento complexo e valioso pelos bons resultados que traz para à clientela assistida, pelo crescente amadurecimento humano e teórico que proporciona aos profissionais, pela oportunidade de exercer a autocrítica, o que deve ser divulgado para os que atuam na área de saúde mental.