The diagnosis of leprosy among patients with symptoms of peripheral neuropathy without cutaneous lesions: a follow-up study

Abstract

-Forty-four patients with neuritic leprosy were individually followed for periods ranging from 4 months to almost 4 years for the purpose of ascertaining the presence and/ or absence of leprosy. The neural symptoms presented were sensory impairment (41), parasthesia (28), nerve enlargement (22), nerve tenderness (20), paresia (20), amyotrophy (8). Leprosy was diagnosed in ten out of the total number of patients studied. Leprosy was confirmed by the appearance of reactional neuritis (4), reversal reaction (2), biopsy of the hypoesthesic area (3) and the appearance of non-reactional cutaneous lesion. We reported an experience in the diagnosis of neuritic leprosy and its most frequent clinical presentation with which clinicians have to be acquainted. We can also state that the clinical follow-up was an effective strategy for the diagnosis of the disease when diagnostic facilities are not available or have not confirmed the diagnosis. A confirmação diagnóstica se deu através da biópsia de áreas hipoestésicas sem lesão dermatológica (3 pacientes), pelo aparecimento de estados reacionais (duas reações reversas e 4 neurites reacionais) e pelo aparecimento de lesão cutânea não reacional característica da forma "borderline" lepromatosa. O acompanhamento clínico regular dos pacientes sem diagnóstico no primeiro exame mostrou ser um método que permitiu o diagnóstico da forma neurítica pura da hanseníase, quando os métodos objetivos de diagnóstico não confirmarem de imediato a doença. PALAVRAS-CHAVE: hanseníase, neurite, neuropatia periférica.

Pain in Hansen's disease patients

“…Superficial nervous trunks normally affected by the disease are ulnar, common fibular, posterior tibial, facial and great auricular 4 . In our study, most frequently affected nerves were tibial, ulnar and fibular, differently from other study where most affected nerves were ulnar, auricular and radial 7 . Physical incapacity was found in 12.5% of patients and is the major problem of Hansen's disease, causing negative impact on the daily life of patients.…”

“…Our study had similar results, however the incidence of neurological manifestations, which was the second most prevalent complaint, was even higher, of approximately 40.6%. It is important to stress that Hansen's disease is not only a dermatological disease with neurological complications and the physician should be careful because a single skin injury does not mean that the disease is restricted to the site of such manifestation, and other signs and symptoms should be investigated 7 . In our study, 56.2% of patients had as most prevalent concomitant symptom skin manifestations, such as white or reddish spots.…”

“…A study carried out in Manaus, including patients up to 15 years of age, has shown an even lower incapacity of approximately 2.9%. Silent neuritis can only be detected by sequential follow-up, allowing the careful evaluation of disease-related incapacities 7 . Hansen's disease neuropathy results from an inflammatory process of peripheral nerves, the intensity, extension and distribution of which depends on the clinical manifestation, on the evolution of the disease and on acutization phenomenon during reaction episodes (reaction type 1 or reverse reaction and reaction type 2 or erythema nodosum leprosum) and may affect cutaneous branches or the nervous trunk, in an isolated (mononeuropathy) or multiple (multiple mononeuropathy) way 1 .…”

Perfil Clínico E Terapêutico Da Neurite Causada Pela Hanseníase

“…Esta é caracterizada apenas por manifestações neurológicas, principalmente em nervos mistos, com alterações sensitivas, motoras e/ou autonômicas nas extremidades, sem evidência de lesões cutâneas 6 . O exame eletroneuromiográfico tem maior especificidade e sensibilidade para investigar a localização e distribuição do comprometimento 8 , mas seu diagnóstico definitivo é estabelecido pela biópsia neural 9 . Os principais troncos nervosos acometidos na hanseníase são radial, ulnar, tibial posterior, fibular comum, mediano, cervical e auricular 1,10 .…”

Neuropatia silenciosa em portadores de hanseníase na cidade de Fortaleza, Ceará, Brasil

“…O dano neural provoca alterações de sensibilidade, que, por sua vez, trazem consequências, como traumas e fraqueza muscular, gerando deformidades físicas, que precisam ser diagnosticadas e tratadas precocemente para prevenir a incapacidade permanente e as sequelas emocionais dos indivíduos infectados 3,4,5,6 .…”