Clinical Presentation and Serum Antibody Reactivity of Leprosy Patients Attending a Dermatology Clinic in Caracas, Venezuela

Leprosy is a stigmatising disease that remains a public health problem in the Americas, Asia and Africa. To gain insight as to the extent of the problem in Venezuela, we conducted a cross sectional study of 57 leprosy patients who attended the specialised clinic at the Institute of Biomedicine Dr. Jacinto Convit, Caracas. The majority presented with five or more lesions at the time of diagnosis, with the most commonly observed clinical lesion being nodules (in 66·7% of the patients), followed by maculae (36·8%), papules and plaques (each 28·1%). Following World Health Organisation guidelines for clinical classification, 77·3% of the patients were classified as multibacillary (MB). By Ridley-Jopling classification, 47·4% were LL, 24·6% BL and 5·3% BB, with the rest presenting with pauciballary forms: 12·3% BT, 8·8% indeterminate and 1·8% TT. Regarding bacteriological index, 42 patients (73·7%) were scored as 2 or more, while M. leprae were not observed in skin slit smears of the remaining 26·3%. Upon serological evaluation, enzyme linked immunosorbent assay (ELISA) detected antibodies in MB patients against ND-OHSA, LID-1 and the conjugate of these antigens, ND-O-LID, at similar rates. Together, our data indicate that many patients attending the clinic have advanced M. leprae infection and disease presentation. Our results provide further evidence that LID-1, ND-O-HSA and the ND-O-LID conjugate represent important reagents in the management of leprosy, with the detection of circulating antibodies having the potential to facilitate referrals for clinical diagnosis of leprosy in Venezuela.