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Publication

Criteria for diagnosis of pure neural leprosy.

Abstract

The clinical diagnosis of pure neural leprosy (PNL) remains a public health care problem mainly because skin lesions-the cardinal features of leprosy-are always absent.Moreover, the identification of the leprosy bacillus is not easily achieved even when a nerve biopsy can be performed. In an attempt to reach a reliable PNL diagnosis in patients referred to our Leprosy Outpatient Clinic, this study employed a variety of criteria. The nerve biopsies performed on the 67 individuals whose clinical, neurological, and electrophysiological examination findings strongly suggested peripheral neuropathy were submitted to M. leprae identification via a polymerase chain reaction (PCR). Mononeuropathy multiplex was the most frequent clinical and electrophysiological pattern of nerve dysfunction, while sensory impairment occurred in 89% of all cases and motor dysfunction in 81%. Axonal neuropathy was the predominant electrophysiological finding, while the histopathological nerve study showed epithelioid granuloma in 14% of the patients, acid fast bacilli in 16%, and nonspecific inflammatory infiltrate and/or fibrosis in 39%. PCR for M. leprae was positive in 47% of the nerve biopsy samples (n=23). PCR, in conjunction with clinical and neurological examination results, can be a powerful tool in attempting to identify and confirm a PNL diagnosis.

More information

Type
Journal Article
Author
Jardim MR
Antunes SL G
Santos AR
Nascimento OJ M
Nery JAC
Sales AM
Illarramendi X
Duppre N
Chimelli L
Sampaio EP
Sarno EP N
Year of Publication
2003
Journal
Journal of neurology
Volume
250
Issue
7
Number of Pages
806-9
Date Published
2003 Jul
Language
eng
ISSN Number
0340-5354
DOI
10.1007/s00415-003-1081-5
Alternate Journal
J. Neurol.
Publication Language
eng