Criteria for diagnosis of pure neural leprosy.
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.
Jardim
Márcia R
MR
Leprosy Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Av. Brasil, 4365 (Manguinhos), 21045-900 Rio de Janeiro, R. J., Brazil.
Antunes
Sérgio L G
SL
Santos
Adalberto R
AR
Nascimento
Osvaldo J M
OJ
Nery
Jose Augusto C
JA
Sales
Anna M
AM
Illarramendi
Ximena
X
Duppre
Nádia
N
Chimelli
Leila
L
Sampaio
Elizabeth P
EP
Sarno
Euzenir P N
EP
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015441:Leprosy, Tuberculoid / Q000175:diagnosis* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae; D010525:Peripheral Nerves / Q000382:microbiology / Q000473:pathology