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Pure Neuritic Leprosy in Southern Kerala: Clinico-Epidemiological Characteristics and the Role of Peripheral Nerve Fine Needle Aspiration Cytology as a Diagnostic Aid
In India, pure neuritic leprosy (PNL) cases constitute a good number of all leprosy cases. There is no single easy method to diagnose PNL. The objectives of this study was to estimate the proportion of PNL, to study the clinico-epidemiological characteristics and peripheral nerve fine needle aspiration cytology (FNAC) findings in PNL. A hospital-based cross-sectional study for a period of 2 years was conducted among leprosy patients. All new clinically diagnosed PNL cases were included. PNL was diagnosed when patients presented with thickened peripheral nerve with sensory loss in the area of its distribution with or without associated motor paralysis, in the absence of any skin lesion and negative skin smears. PNL with single peripheral nerve involvement was defined as paucibacillary (PB) and more than one nerve involvement as multibacillary (MB). Though children <10 years, elderly >80 years and pregnant patients were set as the exclusion criteria, none of the leprosy patients met the exclusion criteria. Relevant socio-demographic and clinical details were noted. Slit-skin smear for acid-fast bacilli, a biopsy from anaesthetic skin, FNAC from the most thickened area of one of the affected peripheral nerves and sural nerve biopsy were done. Findings shows that there were 19 (27.1%) PNL cases among the 70 leprosy patients. The th th male to female ratio was 5.3:1. The majority (42.2%) belonged to 5 and 6 decades. Sensory loss with motor deficit was the presenting symptom in 52.6%. MB cases constituted 52.6% and PB 47.4%. Ulnar nerve and common peroneal nerves were the most common single nerves affected (21.1% each). Grade 2 disability was seen in 63.2% and foot drop was the most common deformity (31.6%). Multiple deformities were seen in 10.5%. Slit skin smear for AFB was negative in all cases. Findings suggestive of leprosy were observed in 25% of the skin biopsies and in all the eight patients in whom nerve biopsy was performed. Inflammatory infiltrates and/or epithelioid cell granuloma suggestive of leprosy was observed in 57.9% of nerve aspirates. The proportion of PNL and grade 2 disabilities in PNL were high. It is concluded that leprosy workers and medical officers need to be trained regarding the clinical aspects of PNL. FNAC findings suggestive of leprosy were observed in more than 50% of PNL cases. Nerve biopsy needs to be employed only in those with nonspecific findings on nerve FNAC.