title: 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.
authors.affiliation: Leprosy Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Av. Brasil, 4365 (Manguinhos), 21045-900 Rio de Janeiro, R. J., Brazil.
authors.forename: Márcia R
authors.initials: MR
authors.lastname: Jardim
authors.forename: Sérgio L G
authors.initials: SL
authors.lastname: Antunes
authors.forename: Adalberto R
authors.initials: AR
authors.lastname: Santos
authors.forename: Osvaldo J M
authors.initials: OJ
authors.lastname: Nascimento
authors.forename: Jose Augusto C
authors.initials: JA
authors.lastname: Nery
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sales
authors.forename: Ximena
authors.initials: X
authors.lastname: Illarramendi
authors.forename: Nádia
authors.initials: N
authors.lastname: Duppre
authors.forename: Leila
authors.initials: L
authors.lastname: Chimelli
authors.forename: Elizabeth P
authors.initials: EP
authors.lastname: Sampaio
authors.forename: Euzenir P N
authors.initials: EP
authors.lastname: Sarno
mesh_terms: 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