Leprosy neuropathy: clinical presentations

Abstract

Leprosy, a chronic infectious disease caused by My cobacterium leprae, identified by G. H. A. Hansen in 1873, is one of the most common treatable peripheral neuropathy in the world. Leprosy causes a 'mononeuritis multiplex' of immunological origin that results in autonomic, sensory and motor neuropathy 1 . The skin, the peripheral nerves, the nasal mucosa, eyes, and the reticulum-endothelial system are the preferred target sites for this infection. The clinical and pathological manifestations are determined by the natural resistance of the host to invasion of M. Leprae. It still remains a stigmatizing disease. Leprosy can be effectively treated with multidrug therapy (MDT) before disability appears. The early diagnosis of leprosy often leads to a less amount of disabilities. This review has the objective to call attention for the clinical presentations of leprosy neuropathy in clinical practice. EPiDEMiOLOgyThe World Health Organization (WHO), in 2009, informed that 17 countries (including India, and Brazil) reported more than 1000 new cases, performing 94% of the new globally detected. Some sporadic cases can be seen in countries receiving immigrants from underdeveloped countries. This is ABStrACtLeprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. Early detection of leprosy and treatment by multidrug therapy are the most important steps in preventing deformity and disability. Thus the early recognition of the clinical leprosy presentation is essential. Mononeuritis, mononeuritis multiplex (MM), polyneuritis (MM summation) are the most frequent. The frequent anesthetic skin lesions are absent in the pure neuritic leprosy presentation form. Isolated peripheral nerve involvement is common, including the cranial ones. Arthritic presentation is occasionally seen, usually misdiagnosed as rheumatoid arthritis. Attention should be given to autonomic dysfunctions in leprosy. There are clinical presentations with severe neuropathic pain -painful small-fiber neuropathy. Leprous late-onset neuropathy (LLON) clinical presentation should be considered facing a patient who develop an inflammatory neuropathy many years after a previous skin leprosy treatment.Keywords: leprosy neuropathy, clinical presentations, pure neuritic form, neuropathic pain, leprosy late-onset neuropathy, arthritic leprosy, autonomic leprosy, review. rESUMO A hanseníase é uma neuropatia periférica infecciosa, crônica, causada pelo Mycobacterium leprae. As diferentes apresentações clínicas são determinadas pela qualidade da resposta imune do hospedeiro. O diagnóstico precoce e a multi-droga terapia são os passos mais importantes na prevenção de deformidades e incapacidades. Dessa forma, o reconhecimento precoce da apresentação clínica da hanseníase é essencial. Mononeurites, mononeurites múltipla (MM), polineurite (superposição de MM) são as mais frequentes. As frequentes lesões anestésicas de pele estão ausent...

Neuropatia da Doença de Hansen: Um Diagnóstico a Considerar na Investigação da Neuropatia Periférica

“…A mononeurite é a forma mais comum de apresentação da hanseníase 1,4 sendo os nervos dos membros superiores mais frequentemente atingidos. O envolvimento cutâneo cursa com lesões desfigurantes, sendo estas responsáveis pelo estigma que a doença ainda acarreta.…”

Neurologic manifestations of the neglected tropical diseases

“…Leprosy is one of the most common, treatable causes of peripheral neuropathy worldwide [136]. The global elimination campaign has led to a 90% reduction in the global prevalence since 1991, largely by providing free multidrug treatment (rifampicin, clofazimine and dapsone) [137].…”

“…The most common neurologic manifestations of leprosy are peripheral mononeuritis, mononeuritis multiplex, and polyneuropathy, although cranial neuropathy (most commonly nerves V and VII), and autonomic neuropathy also occur frequently [137,138]. Nerve abscess and T2 hyperintensities in the spinal cord on MRI have been rarely reported [136,139]. Leprosy is one of the few NTDs for which multiple clinical trials have been conducted, demonstrating success of RCD (rifampicin, clofazimine, dapsone) for multibacillary leprosy, ROM (rifampicin, ofloxacin, minocycline) for paucibacillary leprosy, and uniform multidrug therapy (U-MDT, rifampicin, clofazimine, dapsone for 6 months) for all types of leprosy [140][141][142].…”

Zika virus infection–associated acute transient polyneuritis

“…It has been described that some forms of infections might result in segmental nerve inflammation with edema, compromising nerve function in an acute fashion. 2,3 For the most part, the Schwann cells are the target of the infectious agent resulting in demyelination, which could evolve into a rapid resolution or further progress, depending on the host's immune response. 2,3 Since symptoms and imaging findings tracked closely with ZIKV viremia, we hypothesize that there may be a direct neuropathic effect of ZIKV leading to inflammation and nerve swelling.…”

“…2,3 For the most part, the Schwann cells are the target of the infectious agent resulting in demyelination, which could evolve into a rapid resolution or further progress, depending on the host's immune response. 2,3 Since symptoms and imaging findings tracked closely with ZIKV viremia, we hypothesize that there may be a direct neuropathic effect of ZIKV leading to inflammation and nerve swelling. Others have published reports of weakness developing soon after the first few days of ZIKV infection symptoms, considered early for postinfectious molecular mimicry mechanism of nerve injury, but in this case series the patients developed clinical, laboratory, and electrophysiologic findings highly suggestive of GBS.…”