Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study)

Brakel, Wim H. van; Nicholls, Peter; Wilder-Smith, Einar; Das, Lakshmi; Barkataki, Pramila; Lockwood, Diana N. J.

doi:10.1371/journal.pntd.0000212

Cited by 101 publications

(97 citation statements)

References 31 publications

(34 reference statements)

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“…In this first prospective study investigating ultrasonographic nerve abnormalities in leprosy we found that the neural involvement may not improve after treatment, in accordance with the findings of previous clinical and electrophysiological studies [17–19,24–27]. Furthermore, US findings can worsen despite the operational classification and the presence of reactions, as demonstrated by the CSA increase in the CF nerve in PB and in patients without reactions and by the increased frequency of echogenicity abnormalities detected in the post-treatment evaluation.…”

Section: Discussionsupporting

confidence: 90%

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Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

et al. 2016

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BackgroundPrevious studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.Methodology/Principal findingsWe performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56–38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler.Conclusions/SignificanceUS nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.

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Section: Discussionsupporting

confidence: 90%

“…Previous studies have shown that MDT does not stop the progression of nerve function impairment [5,17,26,27]. The present study shows that, similar to the results concerning nerve function, the anatomic nerve changes caused by leprosy may not improve significantly with treatment.…”

Section: Discussionsupporting

confidence: 71%

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

et al. 2016

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“…Early identifi cation combined with the proper treatment of leprosy reactions can be an effective strategy to prevent physical impairment in leprosy 13,14 . Prednisone is the drug of choice not only for the treatment of leprosy reactions and silent neuritis events 21 but also to reduce swelling and prevent further physical impairment 18 .…”

Section: Discussionmentioning

confidence: 99%

Clinical variables associated with leprosy reactions and persistence of physical impairment

Oliveira

Sherlock

Melo

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Introduction: Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. Methods: We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classifi cation, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. Results: We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. Conclusions: Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.

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“…Neurophysiologische Untersuchungen konnten bei 20-50 % der Lepra-Patienten eine subklinische Neuropathie nachweisen. Dabei fielen die Untersuchungen der Nervenleitung der sensiblen Fasern und der Wärmewahrnehmungsschwelle am frühes-ten pathologisch aus (früher als bei der Kälte-wahrnehmung) [11].…”

Section: Ridley-joping-klassifikation | Diese Beschreibt Inunclassified

Borderline-Lepra als seltene Differenzialdiagnose

Trawinski¹,

Brüning²,

Baum³

et al. 2016

Dtsch med Wochenschr

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History and clinical findings | A 42-year-old migrant from Brazil presented with persistent sensory disturbances, skin discolorations and local alopecia in the upper limbs. Decisive for the presentation in our Tropical Medicine Clinic were new occurrences of severe pain and redness and swelling in the area of the lesions that had already been assessed by a number of medical specialists without a clear diagnosis could be made. Investigations and diagnosis | The histological analysis of skin biopsies showed perivascular, perineural, periadnexial lymphocytic and granulomatous dermatitis. In a direct microbiological preparation individual acid fast bacilli could be detected (Ziehl-Neelsen stain). The electroneurographical examination demonstrated a sensitive peripheral-neurogenic damage with emphasis on the right median nerve and the left ulnar and radial nerves. Thermography revealed an increased heating or cooling threshold. The serological investigation by ELISA for IgM antibodies against the phenolic glycolipid (PGL-1) was positive (titer 1 : 1200). In summary, the diagnosis of borderline leprosy (infection with Mycobacterium leprae) with transition to multibacillary leprosy (according to WHO) and leprosy reaction type 1 was made. Treatment and course | We initiated an oral antimycobacterial therapy (multidrug therapy, MDT) with rifampin, clofazimine and dapsone for 12 months (WHO regimen for multibacillary leprosy). Leprosy reaction type 1 was treated with prednisolone and by increasing the dose of clofazimine. Analgesic therapy on demand was carried out with nonsteroidal anti-inflammatory drugs (ibuprofen). MDT and successful management of leprosy reaction lead to a rapid improvement of symptoms. Conclusions | Leprosy is an infectious disease occurring only rarely in Germany (average incidence of 1-2 cases per year) that is diagnosed almost exclusively among migrants. Main symptoms comprise non-itchy, reddish, touch insensitive skin lesions or nerve deficits. The diagnosis is based primarily on the clinical presentation, supplemented by pathogen detection, histology, neurophysiological findings and serology. Standard therapy is a combination of rifampin, clofazimine and dapsone (WHO scheme) for at least 6 months.

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Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study)

Cited by 101 publications

References 31 publications

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Clinical variables associated with leprosy reactions and persistence of physical impairment

Borderline-Lepra als seltene Differenzialdiagnose

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