{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:22:41Z","timestamp":1783966961998,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0008917","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000}}],"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>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 (<jats:italic>p<\/jats:italic>&gt;0.05). The 31 leprosy cases who responded to the questionnaire (LSQ+) had an average of 1.5 responses. The symptoms \u201canesthetized skin area\u201d and \u201cpain in nerves\u201d were most commonly mentioned in the LG while \u201ctingling, numbness in the hands\/feet\u201d, \u201csensation of pricks and needles\u201d, \u201cpain in nerves\u201d and \u201cspots on the skin\u201d 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 (<jats:italic>p<\/jats:italic>&lt;0.0001), while the RLEP-PCR was positive in 11.8% of the patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Interpretation<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0008917","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T19:52:57Z","timestamp":1607629977000},"page":"e0008917","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Leprosy in a prison population: A new active search strategy and a prospective clinical analysis"],"prefix":"10.1371","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4690-1608","authenticated-orcid":true,"given":"Fred","family":"Bernardes Filho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-3751","authenticated-orcid":true,"given":"Jaci Maria","family":"Santana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina Coeli Palma","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glauber","family":"Voltan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3744-8947","authenticated-orcid":true,"given":"Nat\u00e1lia Aparecida","family":"de Paula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2121-8688","authenticated-orcid":true,"given":"Marcel Nani","family":"Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Maria Lincoln","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1403-8216","authenticated-orcid":true,"given":"Camila","family":"Tormena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3633-6003","authenticated-orcid":true,"given":"Lean","family":"Basoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4993-7614","authenticated-orcid":true,"given":"Joelma","family":"Menezes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3886-7083","authenticated-orcid":true,"given":"Moises Batista","family":"da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-3038","authenticated-orcid":true,"given":"John Stewart","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4589-2749","authenticated-orcid":true,"given":"Wilson","family":"Marques","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3672-2614","authenticated-orcid":true,"given":"Norma Tiraboschi","family":"Foss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-5971","authenticated-orcid":true,"given":"Marco Andrey Cipriani","family":"Frade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"key":"pntd.0008917.ref001","article-title":"Leprosy: Clinical Aspects and Diagnostic Techniques","author":"MBC Maymone","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"pntd.0008917.ref002","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1590\/abd1806-4841.20142450","article-title":"Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects\u2014Part 1","volume":"89","author":"JC Last\u00f3ria","year":"2014","journal-title":"An Bras Dermatol"},{"key":"pntd.0008917.ref003","doi-asserted-by":"crossref","first-page":"e0005375","DOI":"10.1371\/journal.pntd.0005375","article-title":"Unexpectedly high leprosy seroprevalence detected using a random surveillance strategy in midwestern Brazil: A comparison of ELISA and a rapid diagnostic test","volume":"11","author":"MA Frade","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0008917.ref004","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1590\/0074-02760170173","article-title":"Evidence of hidden leprosy in a supposedly low endemic area of Brazil","volume":"112","author":"Paula NA Bernardes F Filho","year":"2017","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"pntd.0008917.ref005","unstructured":"Institute for Crime & Justice Policy Research. World Prison Brief. World Prison Population List, 12th ed. 2018. Available from: https:\/\/www.prisonstudies.org\/sites\/default\/files\/resources\/downloads\/wppl_12.pdf"},{"key":"pntd.0008917.ref006","doi-asserted-by":"crossref","first-page":"496","DOI":"10.3201\/eid2303.161006","article-title":"Increase in Tuberculosis Cases among Prisoners, Brazil, 2009\u20132014","volume":"23","author":"PM Bourdillon","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"pntd.0008917.ref007","first-page":"271","article-title":"Hidden cases of leprosy (in prison)","volume":"69","author":"P Vijayakumaran","year":"1997","journal-title":"Indian J Lepr"},{"key":"pntd.0008917.ref008","first-page":"247","article-title":"Leprosy among inmates of a prison","volume":"68","author":"P Vijayakumaran","year":"1996","journal-title":"Indian J Lepr"},{"key":"pntd.0008917.ref009","first-page":"283","article-title":"Leprosy in the prisons of French Guiana; its evolution during the last century (1852\u20131950); details","volume":"19","author":"H Floch","year":"1951","journal-title":"Int J Lepr"},{"key":"pntd.0008917.ref010","unstructured":"WHO\u2014World Health Organization. Leprosy elimination. What is leprosy?. Avaliable from: https:\/\/www.who.int\/lep\/disease\/en\/ (last accessed 04 Apr 2020)."},{"key":"pntd.0008917.ref011","first-page":"504","article-title":"Techinal resolutions. Classification of leprosy. VI International Congress (Madri, 1953)","volume":"11","author":"Congress of Madrid","year":"1953","journal-title":"Int J Leprosy"},{"key":"pntd.0008917.ref012","first-page":"22","article-title":"Clinical, histopathological and immunological features of the five type classification","volume":"54","author":"IAL\u2014Indian Association of Leprologists","year":"1982","journal-title":"Lepr India"},{"key":"pntd.0008917.ref013","doi-asserted-by":"crossref","first-page":"358","DOI":"10.47276\/lr.82.4.358","article-title":"Anti-PGL-I seroepidemiology in leprosy cases: household contacts and school children from a hyperendemic municipality of the Brazilian Amazon","volume":"82","author":"JG Barreto","year":"2011","journal-title":"Lepr Rev"},{"key":"pntd.0008917.ref014","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.bjid.2016.09.017","article-title":"qPCR detection of Mycobacterium leprae in biopsies and slit skin smear of different leprosy clinical forms","volume":"21","author":"MC Azevedo","year":"2017","journal-title":"Braz J Infect Dis"},{"key":"pntd.0008917.ref015","author":"Departamento Penitenci\u00e1rio Nacional (DEPEN)","year":"2019","journal-title":"Levantamento Nacional de Informa\u00e7\u00f5es Penitenci\u00e1rias\u2013Infopen"},{"key":"pntd.0008917.ref016","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0140-6736(16)30769-3","article-title":"Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners","volume":"388","author":"A Kamarulzaman","year":"2016","journal-title":"Lancet"},{"key":"pntd.0008917.ref017","doi-asserted-by":"crossref","first-page":"e0005381","DOI":"10.1371\/journal.pntd.0005381","article-title":"Spatial clustering and local risk of leprosy in S\u00e3o Paulo, Brazil","volume":"11","author":"AC Ramos","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0008917.ref018","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10286-008-0506-8","article-title":"Sweat testing to evaluate autonomic function","volume":"19","author":"BMW Illigens","year":"2009","journal-title":"Clin Auton Res"},{"key":"pntd.0008917.ref019","doi-asserted-by":"crossref","first-page":"e0006086","DOI":"10.1371\/journal.pntd.0006086","article-title":"Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects","volume":"11","author":"DFD Santos","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0008917.ref020","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1590\/0004-282X20130046","article-title":"Primary neural leprosy: systematic review","volume":"71","author":"JA Garbino","year":"2013","journal-title":"Arq Neuropsiquiatr"},{"key":"pntd.0008917.ref021","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1590\/0037-8682-0245-2015","article-title":"Risk-benefit assessment of Bacillus Calmette-Gu\u00e9rin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients","volume":"48","author":"S Araujo","year":"2015","journal-title":"Rev Soc Bras Med Trop"},{"key":"pntd.0008917.ref022","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade. Secretaria de Vigil\u00e2ncia em Sa\u00fade. Departamento de Vigil\u00e2ncia das Doen\u00e7as Transmiss\u00edveis. Diretrizes para vigil\u00e2ncia, aten\u00e7\u00e3o e elimina\u00e7\u00e3o da Hansen\u00edase como problema de sa\u00fade p\u00fablica: manual t\u00e9cnico-operacional [recurso eletr\u00f4nico] \/ Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Departamento de Vigil\u00e2ncia das Doen\u00e7as Transmiss\u00edveis.\u2013Bras\u00edlia: Minist\u00e9rio da Sa\u00fade, 2016."},{"key":"pntd.0008917.ref023","first-page":"262","article-title":"Anti PGL-1 serology and the risk of leprosy in a highly endemic area in the State of S\u00e3o Paulo, Brazil: four-year follow-up","volume":"6","author":"MTLRF Brasil","year":"2003","journal-title":"Rev Bras Epidemiol"},{"key":"pntd.0008917.ref024","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/s12913-018-2962-8","article-title":"The determinants of individual health care expenditures in prison: evidence from Switzerland","volume":"18","author":"K Moschetti","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"pntd.0008917.ref025","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/S1473-3099(16)30090-1","article-title":"2016. What do we actually know about leprosy worldwide?","volume":"16","author":"CG Salgado","year":"2016","journal-title":"Lancet Infect Dis"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0008917","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0008917","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T19:13:27Z","timestamp":1609269207000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0008917"}},"subtitle":[],"editor":[{"given":"Carlos","family":"Franco-Paredes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,10]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0008917","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0008917","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,10]]}}}