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Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil
- Source :
- PLoS Neglected Tropical Diseases, Vol 16, Iss 1 (2022), PLoS Neglected Tropical Diseases, PLoS Neglected Tropical Diseases, Vol 16, Iss 1, p e0010070 (2022)
- Publication Year :
- 2022
- Publisher :
- Public Library of Science (PLoS), 2022.
-
Abstract
- Introduction Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. Objective This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). Methods Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. Results Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. Discussion The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.<br />Author summary Neuropathy is responsible for most of the disability associated with leprosy disease. The pure neural leprosy (PNL), in spite of being a rare clinical presentation of that, has some singular characteristics that are still poorly studied. In this study, we selected 52 patients at the diagnosis to describe their clinical, neurophysiological and histopathological presentation patterns as well as their evolution during the multidrug therapy (MDT). We confirmed that sensitive symptoms were the most commonly described by PNL patients but neural pain is rare. Also confirmed that mononeuropathy mutiplex was the most common pattern observed at neurological examination and at the nerve conduction studies at the moment of the diagnosis. However we showed that painful nerve enlargement other cardinal signs of leprosy, besides the skin lesions, is not common in this group of patients, There was no statistically significant difference between the neurological examination and NCS performed before and after the MDT.During the MDT88.4% of the patients did not have any leprosy reaction. This may suggest that that MDT was effective in stopping disease progression. Our results highlight the difficulties in the diagnosis of PNL and the progression following MDT in an attempt to prevent further disability in PNL patients.
- Subjects :
- Bacterial Diseases
Male
Physiology
Biopsy
Sensory Physiology
RC955-962
Neural Conduction
Social Sciences
Artificial Gene Amplification and Extension
Leprostatic Agents
Polymerase Chain Reaction
Medical Conditions
Arctic medicine. Tropical medicine
Medicine and Health Sciences
Psychology
Middle Aged
Leprosy, Tuberculoid
Sensory Systems
Mycobacterium leprae
Infectious Diseases
Neurology
Somatosensory System
Sensory Perception
Drug Therapy, Combination
Female
Public aspects of medicine
RA1-1270
Brazil
Research Article
Neglected Tropical Diseases
Surgical and Invasive Medical Procedures
Research and Analysis Methods
Polyneuropathies
Signs and Symptoms
Diagnostic Medicine
Leprosy
Humans
Paresthesia
Molecular Biology Techniques
Molecular Biology
Cognitive Psychology
Public Health, Environmental and Occupational Health
Biology and Life Sciences
Pain Sensation
Tropical Diseases
Neuropathy
Lesions
Cognitive Science
Perception
Clinical Medicine
Neuroscience
Subjects
Details
- Language :
- English
- ISSN :
- 19352735 and 19352727
- Volume :
- 16
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- PLoS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....ecd655f5a378fbb7d9a6afdf9ef282e7