11 research outputs found
Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects.
Leprosy 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.Seventy 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.PNL 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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Distribution of patients with primary neural leprosy according to the electroneuromyographic pattern, and comparisons of proportions.
<p>Distribution of patients with primary neural leprosy according to the electroneuromyographic pattern, and comparisons of proportions.</p
Probability of peripheral neural impairment demonstrated by electroneuromyography in household contacts of leprosy patients according to predictor factor combinations (ELISA anti-PGL-I, peripheral blood qPCR and BCG scar).
<p>Probability of peripheral neural impairment demonstrated by electroneuromyography in household contacts of leprosy patients according to predictor factor combinations (ELISA anti-PGL-I, peripheral blood qPCR and BCG scar).</p
Distribution of the most affected peripheral nerves in patients with primary neural leprosy diagnosis.
<p>Distribution of the most affected peripheral nerves in patients with primary neural leprosy diagnosis.</p
Distribution of peripheral nerves most involved in the electroneuromyographic evaluation of the household contacts of leprosy patients.
<p>Distribution of peripheral nerves most involved in the electroneuromyographic evaluation of the household contacts of leprosy patients.</p
Analyses of dependence relation between peripheral neural impairment demonstrated by electroneuromyography and the variables ELISA anti-PGL-I, intradermal smear qPCR, skin biopsy qPCR, peripheral blood qPCR and BCG scar, through multiple logistic regression.
<p>Analyses of dependence relation between peripheral neural impairment demonstrated by electroneuromyography and the variables ELISA anti-PGL-I, intradermal smear qPCR, skin biopsy qPCR, peripheral blood qPCR and BCG scar, through multiple logistic regression.</p
Combination of diagnostic tools for primary neural leprosy diagnosis, considering suspicious clinical cases with positive electroneuromyography.
<p>Combination of diagnostic tools for primary neural leprosy diagnosis, considering suspicious clinical cases with positive electroneuromyography.</p
Distribution of patients with primary neural leprosy according to ELISA anti-PGL1 seropositivity and comparisons of proportions.
<p>Distribution of patients with primary neural leprosy according to ELISA anti-PGL1 seropositivity and comparisons of proportions.</p
Algorithm and recommendations for PNL diagnosis.
<p>qPCR = Real Time Quantitative Polymerase Chain Reaction. ELISA = enzyme-linked immunosorbent assay. PNL = primary neural leprosy.</p