Small-fiber polyneuropathy in leprosy without skin changes: study of 17 cases

Freitas, Marcos R. G. de; Nascimento, Osvaldo Jm; Quaglino, Ernestina; Oliveira, Andréia Cristine Deneluz Schunck de; Hahn, Myrian D.

doi:10.1590/s0004-282x2003000400003

Cited by 37 publications

(31 citation statements)

References 10 publications

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“…Difficulties for the diagnosis can occur in some pure ulnar palsy cases. Only a dorsal ulnar nerve superficial branch biopsy confirms leprosy diagnosis 4 . Sonography and electrophysiology were complementary for identifying ulnar nerve neuropathy in 21 consecutive Brazilian patients with leprosy, with clinical symptoms as the reference standard 8 .…”

Section: Mononeuritis and Mononeuritis Multiplexmentioning

confidence: 94%

“…leprae is morphologically indistinguishable from M. tuberculosis. It damages both myelinated and unmyelinated nerve fibers followed by replacement of functional tissue by conjunctive tissue -fibrosis 4 . The pathogenesis of nerve injury can be summarized with the localization of the M. leprae to nerve, Schwan cell infection and self responses, demyelination and axonal atrophy, accompanying with oedema and characteristic inflammation.…”

Section: Leprae Infectionmentioning

confidence: 99%

“…The most commonly involved nerves are the ulnar, median, posterior auricular, superficial radial, common fibular, superficial fibular and posterior tibial 4 . Also in PNL form, mononeuritis is the most common presentation, comprising 79% of a 19 leprosy patient series 7 .…”

Section: Mononeuritis and Mononeuritis Multiplexmentioning

confidence: 99%

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Leprosy neuropathy: clinical presentations

Nascimento

2013

Arq. Neuro-Psiquiatr.

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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...

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Section: Mononeuritis and Mononeuritis Multiplexmentioning

confidence: 94%

Section: Leprae Infectionmentioning

confidence: 99%

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Leprosy neuropathy: clinical presentations

Nascimento

2013

Arq. Neuro-Psiquiatr.

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“…In all forms of leprosy occurs the presence of the bacilli in the nerves, which is housed in the Schwann cells in both myelinated and demyelinated axons. These not inflammatory phenomena promote early demyelination, occurring even before the body perceives the presence of the bacillus, being called parasitation (14).…”

Section: Discussionmentioning

confidence: 99%

Exercise capacity and pulmonary function in individuals with leprosy

Taglietti

Peres

2014

Fisioter. mov.

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[b][a] Master in Bioscience and Health at Universidade Estadual do Oeste do Paraná, physical therapist, professor at Faculdade Assis Gurgacz, Cascavel, PR -Brazil, e-mail: marcelotaglietti@gmail.com [b] Doctor in Medicine and Health Sciences at Universidade Estadual de Londrina, physical therapist, professor at Universidade Estadual do Oeste do Paraná, Cascavel, PR -Brazil, e-mail: lumarina@certto.com.br [R] Abstract Introduction: In Brazil 23% of leprosy patients have some type of physical disability after discharge. The impact on the respiratory system and correlation with functional exercise capacity is still unknown. Objective: To correlate the functional exercise capacity and pulmonary function in individuals with leprosy sequelae. Materials and methods: We evaluated 20 subjects and 25 controls by sensory evaluation, muscle strength, graduate the grade of physical disability followed by pulmonary function tests with spirometry and manovacuometry, besides the functional exercise capacity through the six minute walking distance (6MWD). Results: The majority (75%) of the subjects showed physical disability grade 1. The mean of the maximal inspiratory pressure were below than normal -71 ± 31 cmH 2 0 and maximal expiratory pressure +89 ± 22 cmH 2 0. Spirometric values presented measures within normal value. The functional exercise capacity found a reduced value with a distance of 404 ± 92m. Positive and statistically significant correlation between the inspiratory pressures with 6MWD (r = 0.49, p = 0.025) and, similarly, expiratory pressure (r = 0.53, p = 0.004). The same evidence is found in maximal respiratory pressures of individuals in grade 1 with significant correlations (r = 0.52, p = 0.036) and (r = 0.51, p = 0.042). Conclusion: Individuals with leprosy sequelae had impaired respiratory muscle strength and functional

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“…In most cases, these neuropathies usually follow the skin manifestations although the neuropathy may be the only manifestation of the disease in the pure neuritic leprosy (PNL) 3 . Out of 19 PNL cases we had studied 4 , 79% presented mononeuropathy, 10.5% multiple mononeuropathy and 10.5% polyneuropathy.…”

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confidence: 99%

Leprosy late-onset neuropathy: an uncommon presentation of leprosy

Nascimento

Freitas

Escada

et al. 2012

Arq. Neuro-Psiquiatr.

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Clinical and pathological findings in leprosy are determined by the natural host immune response to Mycobacterium leprae. We previously described cases of painful neuropathy (PN) with no concurrent cause apart from a past history of leprosy successfully treated. Four leprosy previously treated patients who developed a PN years after multidrug therapy (MDT) are reported. The mean patient age was 52.75 years (47-64). The mean time interval of the recent neuropathy from the previous MDT was 19 years (12-26). A painful multiplex neuritis or polyneuropathy were observed respectively in two cases. Electrophysiological studies disclosed a sensory axonal neuropathy in two cases. Microvasculitis with no bacilli was seen in nerve biopsy. Neuropathic symptoms were improved with prednisone. We consider these cases as being a leprosy late-onset neuropathy (LLON) form of presentation. A delayed immune reaction could explain the late appearance of LLON.

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Small-fiber polyneuropathy in leprosy without skin changes: study of 17 cases

Cited by 37 publications

References 10 publications

Leprosy neuropathy: clinical presentations

Leprosy neuropathy: clinical presentations

Exercise capacity and pulmonary function in individuals with leprosy

Leprosy late-onset neuropathy: an uncommon presentation of leprosy

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