Primary neural leprosy: systematic review

Garbino, José Antônio; Marques, Wilson; Barreto, Jaison Antônio; Heise, Carlos Otto; Jardim, Márcia Rodrigues; Antunes, Sérgio Luiz Gomes; Soares, Cléverson Teixeira; Floriano, Marcos C.; Nery, José A. C.; Trindade, Maria Ângela Bianconcini; Carvalho, Noêmia Barbosa; Andrada, Nathalia Carvalho de; Barreira, Amilton Antunes; Virmond, Marcos da Cunha Lopes

doi:10.1590/0004-282x20130046

Cited by 30 publications

(25 citation statements)

References 31 publications

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“…The involvement of the peripheral nerves is present in all clinical forms of leprosy, and in tuberculoid forms, the nerve damage is usually earlier, while in lepromatous leprosy it appears later 48,51 . This variable is an important epidemiological indicator responsible for causing irreversible consequences, resulting in deformities and disabilities 52,53 .…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical data and T helper 1/T helper 2 responses in patients with different clinical forms of leprosy

Rodrigues

Ribeiro

Berber³

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Introduction: Currently, there are no laboratory tests or sensitive and specific molecular markers for the early diagnosis of leprosy. The aim of this study was to analyze the clinical characteristics of patients with leprosy and investigate their immunological profile, comparing this with the type of lesion and the presence or absence of a Bacillus Calmette-Guérin (BCG) vaccination scar. Methods: Statistical analyzes were performed by employing comparative tests (Pearson´s chi-square) to evaluate the variables in different clinical forms, considering significance at the 5% level. Results: The study identified a predominance of lepromatous leprosy (26.9%) in patients aged between 34-53 years. Caucasians predominantly had borderline tuberculoid (BT) clinical forms (42%); a predominance of males with borderline lepromatous (19%) and lepromatous leprosy (26.9%) forms was observed; and the presence of BCG vaccination scars (27.5%) and lower limb nerves were more affected (38%) predominantly in the BT clinical form. Significant differences were identified, which included hypochromic lesions predominantly in the BT clinical form (24%); diffuse-type lesions predominantly in the tuberculoid (TT) clinical form (28%); ill-defined lesion border dominance in lepromatous leprosy (LL) clinical forms (30%); an irregular lesion limit predominantly in LL clinical forms (32%); and a predominant Th1 immune response in the BT clinical form (41.7%). Conclusions: The evaluation of the immunological profile in leprosy patients may contribute to the more detailed diagnosis and possibly better characterization of the prognosis for these individuals.

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Section: Discussionmentioning

confidence: 99%

Analysis of clinical data and T helper 1/T helper 2 responses in patients with different clinical forms of leprosy

Rodrigues

Ribeiro

Berber³

et al. 2017

Rev. Soc. Bras. Med. Trop.

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“…It is important to remember that indeterminate leprosy lesions are not always anesthetic and peripheral nerve thickness is also found in other neurological diseases. Recently, Brazilian leprosy experts proposed a systematic literature review on the current concepts of PNL consulting online databases (Garbino et al, 2013) 30 . Selected studies were classified based on the degree of recommendation and levels of scientific evidence according to the "Oxford Centre for Evidence-based Medicine".…”

Section: Diagnosismentioning

confidence: 99%

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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“…This clinical form is characterized by no skin lesions and negative slit skin smear bacilloscopy. Therefore, diagnosis is mainly based on supplementary tests, such as electroneuromyography, nerve biopsy, serology and molecular analyses [ 12 , 13 , 14 , 15 , 16 , 17 ]. However, most of the leprosy reference services do not have access to advanced diagnostic methods; therefore, diagnosis is based mainly on clinical manifestations, such as the absence of skin lesions and negative skin smears bacilloscopy.…”

Section: Introductionmentioning

confidence: 99%

Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects

et al. 2017

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BackgroundLeprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study.Methodology/Principal findingsSeventy patients diagnosed with primary neural leprosy from 2014 to 2016 underwent clinical, laboratorial and neurophysiological evaluation. All patients presented an asymmetric neural impairment, with nerve thickening in 58.6%. Electroneuromyography showed a pattern of mononeuropathy in 51.4%. Positivity for ELISA anti-PGL1 was 52.9%, while the qPCR of slit skin smear was 78.6%. The qPCR of nerve biopsies was positive in 60.8%. Patients with multiple mononeuropathy patterns showed lower levels of anti-PGL-1 (p = 0.0006), and higher frequency of neural thickening (p = 0.0008) and sensory symptoms (p = 0.01) than those with mononeuropathy.Conclusions/SignificancePNL is not a synonym of pure neural leprosy, as this condition may include a generalized immune response and also a skin involvement, documented by molecular findings. Immunological, molecular, and neurophysiological tools must be implemented for diagnosing primary neural leprosy to achieve effective treatment and reduction of its resultant disabilities that still represent a public health problem in several developing nations. Finally, we propose a algorithm and recommendations for the diagnosis of primary neural leprosy based on the combination of the three clinical-laboratorial tools.

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Primary neural leprosy: systematic review

Cited by 30 publications

References 31 publications

Analysis of clinical data and T helper 1/T helper 2 responses in patients with different clinical forms of leprosy

Analysis of clinical data and T helper 1/T helper 2 responses in patients with different clinical forms of leprosy

Leprosy neuropathy: clinical presentations

Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects

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