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

Abstract

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.

Neurological Complications of Leprosy

“…It was also demonstrated that antiphenolic glycolipid-1 titers can be high even in patients with mononeuropathy. 37 Given the poor reliability of clinical nerve involvement, it has been proposed that nerve biopsy should be a necessary diagnostic step for all primary neural leprosy cases, as histological findings should dictate treatment. 35 Alternatively, some experts argue that all cases of primary neural leprosy should be treated with full MB treatment, especially when nerve biopsy is unavailable.…”

“…35 Alternatively, some experts argue that all cases of primary neural leprosy should be treated with full MB treatment, especially when nerve biopsy is unavailable. 37…”

Kusta Neural Pada Seorang Laki-Laki Berusia 37 Tahun Yang Didiagnosis Melalui Elektroneuromiografi

“…Biopsi saraf merupakan baku emas diagnosis. [1][2][3][4] Berikut dilaporkan sebuah kasus kusta neural dengan disabilitas kusta tingkat 2 yang merupakan kasus jarang dan penting untuk diketahui cara menegakkan diagnosis serta terapi untuk mencegah kecacatan lebih lanjut.…”

“…Pada 80% kasus baru kusta, terdapat riwayat kontak yang jelas dengan pasien kusta yang belum mendapat terapi. [1][2][3] Pada kasus ini pasien adalah laki-laki dengan gejala kelemahan saraf sebelum usia 35 tahun. Perkiraan periode antara pajanan dari teman sekamar pasien hingga timbulnya gejala adalah lima tahun.…”

Recidiva em hanseníase após o término da poliquimioterapia padrão entre 2013-2018 em um centro de referência brasileiro: introduzindo e atualizando conceitos

“…Esta forma frequentemente não é diagnosticada(TALHARI; TALHARI;PENNA, 2015).A hanseníase neural primária (HNP), conceito introduzido inicialmente em 1955 em classificação indiana, compreende os pacientes com comprometimento nervoso periférico como primeira manifestação clínica, sem lesões de pele, e que apresentam baciloscopia negativa. Essa forma clínica geralmente é diagnosticada com a utilização de exames complementares(PANNIKAR et al, 1983;SANTOS et al, 2017). olhos, nariz, mãos e pés, palpação dos troncos nervosos periféricos, avaliação da força muscular e a avaliação de sensibilidade nos olhos, membros superiores e inferiores.…”