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Background: Leprosy neuropathy is the most common peripheral neuropathy of infectious etiology worldwide; it is characterized as asymmetric and focal multiple mononeuropathy. Semmes-Weinstein monofilament (SWM) test is a simple method to assess sensory nerve function. Methods and findings: In this prospective cohort study, a dermatologist carried out hands and feet tactile sensation test with SWM in 107 multibacillary leprosy patients at diagnosis and in 76 patients at the end of treatment from 2016 to 2019. At diagnosis, 81/107 (75.7%) patients had some degree of functional disability, and 46 (43%) of them had altered SWM-test in the hands and 94 (87.9%) of them in the feet. After one year of multibacillary multidrug therapy, the disability decreasing to 44/76 patients (57.9%) and decreasing of the percentual of patients with altered SWM-test to 18% for the hands, and to 28.7% for the feet. At the end of treatment, the number of SMW-test points presented improvement in the hands of 22 (28.9%) patients, and in the feet of 47 (61.8%). In the hands, by SWM-test, only the radial nerve point demonstrated a significant asymmetry, while in the feet, the difference between the sum of altered SWM-test points showed significant asymmetry between both sides, highlighting the tibial nerve for the establishment of asymmetric leprosy neuropathy. In Spearman's correlation analysis, a positive correlation with statistical significance was observed between the number of hands and feet SWM altered points at diagnosis and the degree of disability at diagnosis (0.69) and at the end of the treatment (0.80). Conclusion: The patterns of hands and feet tactile sensation at diagnosis and their consequent modifications with the anti-leprosy drugs define the bacterial etiology of neuropathy, an important tool for the clinical diagnosis and follow up of the disease, highlighting the tibial nerve findings, the most affected nerve among leprosy patients by SWM-test, with significant asymmetry and focality impairments. [ABSTRACT FROM AUTHOR]

Background: Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. Methods: A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. Findings: 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1–numbness (5.6), Q3–anesthetizes areas in the skin (7.5), Q5–Stinging sensation (5.8), and Q7–pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. Interpretation: The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools. Author summary: The study was conducted in a Female Penitentiary-Brazil. The Leprosy Suspicion Questionnaire (LSQ) was administered to all the inmates who also underwent, specialized dermato-neurological exam, and anti-PGL-I serology. We evaluated 404 female inmates, 14 new cases were diagnosed (LG-leprosy group), and 390 constituted the Non-Leprosy group (NLG), a new case detection rate of 3.4%. The confinement time was shorter than the time of leprosy incubation. Leprosy cases were followed up during multidrug therapy and it showed clinical improvement. Regarding the LSQ, the most important neurological symptoms were Q1–numbness, Q3–anesthetized areas, Q5–Stinging sensation, and Q7–pain in the nerves, while Q4-spots were fewer. When more than one question was marked, it meant a 12.8 higher chance to get leprosy. The high anti-PGL-I seropositivity among females was higher in the LG than in the NLG. Afterwards, we reevaluated the inmates and 6 additional leprosy cases were diagnosed in two visits. Semmes-Weinstein monofilaments demonstrated that the lower limbs (32.2%) were more affected than the upper limbs (25%) with improvement during the follow-up. Thus, our study in this population showed hidden leprosy as in the male prison. It also showed how efficient the search by a specialized staff with the aid of LSQ, as an auxiliary tracking tool, is. [ABSTRACT FROM AUTHOR]

Background: This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. Methodology/Principal findings: Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. Conclusions/Significance: Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state. Author summary: The prevalence of leprosy in the world and in Brazil is unknown. Although Brazil has effective disease notification systems, the data do not capture reality in the field, due to decreasing leprosy awareness, both in the community and among health professionals. Schools have decreased or stopped teaching about the disease, likely as a result of a massive campaign to eliminate leprosy as a public health problem around the world that focused almost exclusively on dermatological manifestations. The disease is primarily neural, affects mainly the reproductive-age population, and can generate disabilities leading to serious economic impacts on the individual and society. Despite modern diagnostic approaches, diagnosis of leprosy is still focused on clinical observation, given the scarcity of laboratory tests with good performance in terms of sensitivity and specificity. This makes leprosy diagnosis a challenge, especially for mild forms; Mycobacterium leprae can grow slowly and interact variably with the host, making leprosy as a highly complex disease. Only when the leprosy care policy in Jardinópolis municipality, São Paulo state inner, Brazil, was changed to hire a leprosy specialist for surveillance, was it possible to modify leprosy indicators revealing the hidden epidemic in the municipality. This study confirms hidden endemic leprosy in the municipality and informs implementation strategies for primary health teams using the Leprosy Suspicion Questionnaire (LSQ) on symptoms and signs of leprosy. LSQ is a low-cost, highly effective instrument to promote leprosy health education among community health agents and other health team workers, and among communities about the neurological symptoms that precede dermatological leprosy signs. This technique increases the likelihood of early diagnosis and treatment, avoiding disabilities, and consequently effectively halting disease transmission. The LSQ is an effective, low-cost screening tool for detecting new leprosy cases and increasing awareness of leprosy. The LSQ alerts community members and health professionals to detect even mild symptoms/signs of leprosy, a primarily neurological disease. Our data also demonstrate the importance of the leprosy specialist role to train and to supervise health teams to investigate incidence in communities that have long been established as nonendemic. The assumption of nonendemicity can and should change, due to the increase in the number of cases initially, and in view of the chronicity of leprosy and slow future decline. This change will in fact facilitate the much-desired elimination of leprosy as a global public health problem. [ABSTRACT FROM AUTHOR]

Background: This study evaluates an active search strategy for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzing the clinical, immunoepidemiological and follow-up aspects for individuals living in a prison population. Methods: A cross-sectional study based on a questionnaire posing 14 questions about leprosy symptoms and signs that was distributed to 1,400 prisoners. This was followed by dermatoneurological examination, anti-PGL-I serology and RLEP-PCR. Those without leprosy were placed in the Non-leprosy Group (NLG, n = 1,216) and those diagnosed with clinical symptoms of leprosy were placed in the Leprosy Group (LG, n = 34). Findings: In total, 896 LSQ were returned (64%), and 187 (20.9%) of the responses were deemed as positive for signs/symptoms, answering 2.7 questions on average. Clinically, 1,250 (89.3%) of the prisoners were evaluated resulting in the diagnosis of 34 new cases (LG), based on well-accepted clinical signs and symptoms, a new case detection rate of 2.7% within this population, while the NLG were comprised of 1,216 individuals. The confinement time medians were 39 months in the LG while it was 36 months in the NLG (p>0.05). The 31 leprosy cases who responded to the questionnaire (LSQ+) had an average of 1.5 responses. The symptoms "anesthetized skin area" and "pain in nerves" were most commonly mentioned in the LG while "tingling, numbness in the hands/feet", "sensation of pricks and needles", "pain in nerves" and "spots on the skin" responses were found in more than 30% of questionnaires in the NLG. Clinically, 88.2% had dysesthetic macular skin lesions and 97.1% presented some peripheral nerve impairment, 71.9% with some degree of disability. All cases were multibacillary, confirming a late diagnosis. Anti-PGL-I results in the LG were higher than in the NLG (p<0.0001), while the RLEP-PCR was positive in 11.8% of the patients. Interpretation: Our findings within the penitentiary demonstrated a hidden prevalence of leprosy, although the individuals diagnosed were likely infected while living in their former communities and not as a result of exposure in the prison. The LSQ proved to be an important screening tool to help identify leprosy cases in prisons. Author summary: Leprosy looms still as a public health problem. Unfortunately, the drop in the number of leprosy cases in recent decades has been accompanied by general decline in the expertise of health care professionals to recognize signs and symptoms of leprosy, particularly at the early stages. The situation for individuals confined within a prison is likely worse because it would be rare for this population to receive a clinical exam for leprosy even in the case of obvious signs and symptoms. In this study, we used an active search strategy in the prison population providing them a Leprosy Suspicion Questionnaire (LSQ) with 14 simple questions about symptoms and signs related to leprosy. This questionnaire proved to be a simple, low-cost instrument for screening and identifying new leprosy cases among 1,400 prisoners. After responding to the questionnaire, they were evaluated clinically, and samples of blood and earlobe skin smears were collected for later laboratory anti-PGL-I IgM and RLEP-PCR assessment. Neurological symptoms ("anesthetized skin area" and "pain in nerves) were more commonly associated among the 34 new multibacillary cases diagnosed at penitentiary (rate 2.7%). The confinement time among leprosy patients (LG) was slightly longer than time of leprosy incubation indicating that the infection likely occurred before the imprisonment. Anti-PGL-I results in the LG were higher than in non-leprosy group and RLEP-PCR was positive in 11.8% of the patients, demonstrating that this disease is actually present in the confinement community. The application of the LSQ coupled with follow-up clinical exams and laboratory analysis are all actions with a high potential to reveal new leprosy cases in these confined communities. [ABSTRACT FROM AUTHOR]