Criteria for diagnosis of pure neural leprosy

Abstract

The clinical diagnosis of pure neural leprosy (PNL) remains a public health care problem mainly because skin lesions-the cardinal features of leprosy-are always absent.Moreover, the identification of the leprosy bacillus is not easily achieved even when a nerve biopsy can be performed. In an attempt to reach a reliable PNL diagnosis in patients referred to our Leprosy Outpatient Clinic, this study employed a variety of criteria. The nerve biopsies performed on the 67 individuals whose clinical, neurological, and electrophysiological examination findings strongly suggested peripheral neuropathy were submitted to M. leprae identification via a polymerase chain reaction (PCR). Mononeuropathy multiplex was the most frequent clinical and electrophysiological pattern of nerve dysfunction, while sensory impairment occurred in 89% of all cases and motor dysfunction in 81%. Axonal neuropathy was the predominant electrophysiological finding, while the histopathological nerve study showed epithelioid granuloma in 14% of the patients, acid fast bacilli in 16%, and nonspecific inflammatory infiltrate and/or fibrosis in 39%. PCR for M. leprae was positive in 47% of the nerve biopsy samples (n=23). PCR, in conjunction with clinical and neurological examination results, can be a powerful tool in attempting to identify and confirm a PNL diagnosis.

Pure neural leprosy: steroids prevent neuropathy progression

“…PNL was clinically diagnosed and confi rmed by nerve histopathology or PCR, as described by Jardim et al 7 . All patients received MDT (rifampicin, dapsone, clofazimine) for paucibacillary (PB) leprosy for 6 consecutive months in accordance with WHO recommendations 8 plus a daily morning dose of 1 mg/kg of PDN for one month followed by a progressive 10 mg/monthly reduction over the remaining fi ve months.…”

Detection of Mycobacterium leprae DNA by polymerase chain reaction in the blood and nasal secretion of Brazilian household contacts

“…But, as seen here, the screening by PCR to detect new cases of leprosy among contacts may not be relevant if it is used as a single test. Our group has been using PCR to solve some difficult-to-diagnose forms of leprosy such as pure neuritic leprosy where PCR proved to be a very important tool (Jardim et al 2003). In some cases where serum and nerve biopsies were available, the serological and histopathogical examination was not clear but the PCR, in association with clinical evaluation, strongly supported the occurrence of the disease.…”

Ulnar neuropathy as a first sign of HIV infection: a diagnostic challenge for leprosy endemic countries

“…These findings, however, were considered insufficient to definitively diagnose either leprosy or HIV neuropathy (Jardim et al, 2003). Furthermore, given that the histopathological findings were associated to serological positivity with an increasing viral load and decreasing CD4 counts (last count in February 2007: 240) in the peripheral blood and were also consistent with HIV mononeuropathy simplex, our contention is twofold: that this patient represented a case of HIV-provoked ulnar neuropathy and that HIV was capable of clinically mimicking leprosy neuropathy.…”

“…In leprosy endemic countries, more refined diagnostic procedures than are currently available are urgently needed to accurately a differential diagnosis between the peripheral neuropathies presenting in both HIV and leprosy since mononeuropathy simplex and multiplex as well as polyneuropathy are known to occur in both diseases (Jardim et al, 2003). Pure neural leprosy (PNL), for example, presents a particularly difficult diagnostic challenge.…”