High-Resolution Ultrasonography in Leprosy

Suneetha, Sujai; Rao, P Narasimha

doi:10.4103/idoj.idoj_111_21

Cited by 3 publications

(9 citation statements)

References 32 publications

(31 reference statements)

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“…2,3,8,11,12,17,18,20,22,32,34,36,[39][40][41][42][43] A more useful method for diagnosis is high resolution ultrasound, which enables objective visualisation of nerve enlargement and evaluation of underlying soft tissue, and hence should be the preferred choice in suspected cases of pure neuritic leprosy. [2][3][4]8,[10][11][12][16][17][18]20,22,23,[32][33][34][35][36]38,[40][41][42][44][45][46] The most important findings of leprosy on high-resolution ultrasound include thickening of the nerves with loss of normal fibrillary pattern. 3,4,8,[10][11][12]17,18,20,…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] There is skin involvement in the form of hypopigmented patches and loss of sensation over the affected areas, which commonly include the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. 2,[4][5][6][7][8][9][11][12][13] It also involves the peripheral nervous system, mostly in the form of nerve thickening. [2][3][4][5][6][8][9][10][11][12][13][14][15] The eyes and testes are highly susceptible to the disease, as they have a lower temperature than the core body temperature.…”

Section: Introductionmentioning

confidence: 99%

“…2,[4][5][6][7][8][9][11][12][13] It also involves the peripheral nervous system, mostly in the form of nerve thickening. [2][3][4][5][6][8][9][10][11][12][13][14][15] The eyes and testes are highly susceptible to the disease, as they have a lower temperature than the core body temperature. 3,4,16 The ability of the organism to invade the nerve sheath and cause immunemediated reactions gives rise to devitalisation and mutilation promoting coherent psychosocial disruption.…”

Section: Introductionmentioning

confidence: 99%

“…19 Patients with leprosy develop nerve abscesses in all forms of the disease, but those with the borderline tuberculoid form are known to commonly develop nerve abscess of the ulnar nerve. 1,3,5,12,16,20 In literature, other words used as synonyms for pure neuritic leprosy include neural, neuritic, pure neural, primary neural, primary neuritic, simply neural, and polyneuritic leprosy. 5,19,21 This report elucidates the necessity of ultrasonography (USG) in a patient with purely neuritic leprosy.…”

Section: Introductionmentioning

confidence: 99%

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Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

Sultan,

Choudhary,

Siddique

et al. 2023

EMJ Radiol

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Nerve abscess is an infrequently reported complication of leprosy. It is also an uncommon first manifestation of leprosy. In this case, due to the absence of classic signs and symptoms, such as skin lesions, hypoesthesia, and loss of sensation, the swelling was clinically diagnosed as a peripheral nerve sheath tumour on initial presentation. The authors have described an unusual presentation of pure neuritic leprosy that showcased nerve abscess. Clinical presentation was swelling over the medial aspect of the right arm and ulnar aspect of the right forearm, and clawing of the fourth and fifth digits of the right hand, with no signs of inflammation present on the skin surrounding the swelling. Hansen’s disease with pure nerve involvement could not be considered as a differential diagnosis solely based on clinical examination, therefore posing a diagnostic challenge. On ultrasonography, the right ulnar nerve showed diffuse intermittent thickening and a heterogeneously hypoechoic fusiform area with internal echoes at the site of swelling indicating a nerve abscess. These led the authors to the diagnosis of leprosy with perineuronal abscess. Histopathology confirmed the diagnosis by revealing granulomas and acid-fast Hansen’s bacilli. The patient showed dramatic response to surgery, multidrug therapy, and systemic corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

Sultan,

Choudhary,

Siddique

et al. 2023

EMJ Radiol

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“…US measurements were performed at compression sites often affected in leprosy neuropathy. The ulnar nerve was evaluated at the ulnar sulcus in the cubital tunnel (Ut) and at 3 to 4 cm above the medial epicondyle, proximal to the cubital tunnel (Upt) [ 14 , 15 ]. The median nerve was scanned at the wrist in the carpal tunnel (Mt) and 3 to 4 cm above the carpal tunnel (Mpt).…”

Section: Methodsmentioning

confidence: 99%

High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts

Luppi,

Ferreira,

Prudêncio

et al. 2023

PLoS ONE

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Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.

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Advances in the Diagnosis of Leprosy

Sharma¹,

Singh²

2022

Front. Trop. Dis

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Leprosy is a public health issue, and early detection is critical to avert disability. Despite the global attempt to eradicate this disease as a public health problem, it remains an important cause of global neurological disability. India, Brazil and Indonesia share more than 70% of the cases. The reduction of new cases is a priority in the WHO global strategy 2021-2030 which aims to reduce disease transmission in the community by diagnosing cases and identifying subclinical infection. The clinical manifestations of leprosy range from a few to several lesions. The identification remains difficult due to the limited sensitivity of traditional approaches based on bacillary counts of skin smears and histology. To aid in the diagnosis of this disease, molecular biology, and biotechnological technologies have been applied, each with its own set of benefits and downsides despite providing an essential tool to validate the clinical diagnosis of leprosy. Because of this, it is strongly recognized that specific, inexpensive point of care technologies should be developed, particularly to identify asymptomatic M. leprae infections or leprosy nearer to the suspected cases seeking medical attention. Thus, this review will provide an overview of the advancements in leprosy diagnosis over the world. The purpose of this review is to improve our understanding of the outcomes of current tests and technologies used in leprosy diagnosis and to emphasize critical aspects concerning the detection of leprosy bacilli.

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High-Resolution Ultrasonography in Leprosy

Cited by 3 publications

References 32 publications

Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

High-resolution ultrasonography for early diagnosis of neural impairment in seropositive leprosy household contacts

Advances in the Diagnosis of Leprosy

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