Exploration of tongue dorsum sampling to support clinical diagnosis of leprosy patients in the Comoros: A cross-sectional study.

IF 3.4 2区医学 Q1 PARASITOLOGY

PLoS Neglected Tropical Diseases Pub Date : 2025-09-17 eCollection Date: 2025-09-01 DOI:10.1371/journal.pntd.0013541

Lena Krausser, Maren Van Nieuwenhove, Nissad Attoumani, Silahi H Grillone, Magalie Van Dyck-Lippens, Leen Rigouts, Abdallah Baco, Wirdane Abdou, Aboubacar Mzembaba, Epco Hasker, Younoussa Assoumani, Bouke C de Jong, Sofie M Braet

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Abstract

Background: The accuracy of the WHO-endorsed clinical leprosy diagnosis depends on the expertise of health care workers. For molecular confirmation of clinically diagnosed patients, skin biopsies have the highest sensitivity to detect Mycobacterium leprae. As less invasive tongue swabs showed promising results for qPCR-based M. tuberculosis detection, this study investigated the presence of M. leprae on the tongue dorsum of clinically diagnosed leprosy patients.

Methods and findings: During the activities of the (BE-)PEOPLE study, 499 clinically diagnosed, consenting patients from the Comoros were recruited. Samples collected included skin biopsies from active lesions, nasal swabs, tongue swabs, and, in some cases, tongue scrapes. M. leprae DNA was quantified with the RLEP qPCR assay and human mitochondrial DNA was quantified as sample adequacy control (SAC). On 18.1% (90/498) of tongue swabs and 13.2% (12/91) of tongue scrapes M. leprae DNA was detected. In only six patients tongue scrapes outperformed the tongue swab based on the number of bacilli/sample. Except for two paucibacillary (PB) patients, all 100/102 positive tongue samples were from multibacillary (MB) patients. Only patients with a RLEP-positive skin biopsy and positive bacteriological index (BI) yielded M. leprae DNA on the tongue scrape. The skin biopsy samples had a sensitivity of 92.5% (248/268) for MB and 74.3% (130/175) for paucibacillary (PB) patients. Nasal swabs were positive for 60.2% (162/269) of MB but only 2.2% (5/229) of PB patients.

Conclusion: This is the first study to identify M. leprae bacilli on the tongue dorsum of clinically diagnosed leprosy patients by RLEP qPCR. Due to low positivity rates, tongue sampling has limited added value over skin biopsies and nasal swabs for the microbiological confirmation of leprosy. However, the mouth in general and the tongue specifically remain interesting sampling sites to gain further insights on the distribution of M. leprae bacilli in the body and potential transmission modes.

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探索舌背取样以支持科摩罗麻风病患者的临床诊断：一项横断面研究。

背景：世卫组织认可的临床麻风诊断的准确性取决于卫生保健工作者的专业知识。对于临床诊断患者的分子确认，皮肤活检对检测麻风分枝杆菌的敏感性最高。由于较少侵入性的舌拭子在基于qpcr的结核分枝杆菌检测中显示出良好的结果，本研究调查了临床诊断的麻风患者舌背上是否存在麻风分枝杆菌。方法/主要发现：在（BE-）PEOPLE研究活动期间，从科摩罗招募了499名临床诊断并同意的患者。收集的样本包括活动性病变的皮肤活检，鼻拭子，舌拭子，在某些情况下，舌刮。用RLEP qPCR法定量麻风分枝杆菌DNA，用人线粒体DNA作为样本充足性对照（SAC）定量。18.1%（90/498）的舌拭子和13.2%（12/91）的舌拭子检出麻风分枝杆菌DNA。根据杆菌/样本的数量，只有6例患者舌刮优于舌拭子。102份阳性舌样除3例少杆菌（PB）外均为多杆菌（MB）患者。只有rlep皮肤活检阳性和细菌学指数（BI）阳性的患者在舌刮上检出麻风分枝杆菌DNA。皮肤活检样本对MB的敏感性为92.5%(248/268)，对少杆菌（PB）患者的敏感性为74.3%（130/175）。鼻拭子检测MB阳性率为60.2% (162/269)，PB阳性率仅为0.87%（5/229）。结论/意义：本研究首次采用RLEP qPCR检测临床诊断麻风患者舌背麻风分枝杆菌。由于阳性率低，与皮肤活检和鼻拭子相比，舌部取样对麻风病微生物确证的附加价值有限。然而，口腔和舌头仍然是有趣的采样点，以进一步了解麻风分枝杆菌在体内的分布和潜在的传播方式。

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来源期刊

PLoS Neglected Tropical Diseases PARASITOLOGY-TROPICAL MEDICINE

自引率

10.50%

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723

期刊介绍： PLOS Neglected Tropical Diseases publishes research devoted to the pathology, epidemiology, prevention, treatment and control of the neglected tropical diseases (NTDs), as well as relevant public policy. The NTDs are defined as a group of poverty-promoting chronic infectious diseases, which primarily occur in rural areas and poor urban areas of low-income and middle-income countries. Their impact on child health and development, pregnancy, and worker productivity, as well as their stigmatizing features limit economic stability. All aspects of these diseases are considered, including: Pathogenesis Clinical features Pharmacology and treatment Diagnosis Epidemiology Vector biology Vaccinology and prevention Demographic, ecological and social determinants Public health and policy aspects (including cost-effectiveness analyses).