title: Histopathological examination of nerve samples from pure neural leprosy patients: obtaining maximum information to improve diagnostic efficiency.
abstract: Nerve biopsy examination is an important auxiliary procedure for diagnosing pure neural leprosy (PNL). When acid-fast bacilli (AFB) are not detected in the nerve sample, the value of other nonspecific histological alterations should be considered along with pertinent clinical, electroneuromyographical and laboratory data (the detection of Mycobacterium leprae DNA with polymerase chain reaction and the detection of serum anti-phenolic glycolipid 1 antibodies) to support a possible or probable PNL diagnosis. Three hundred forty nerve samples [144 from PNL patients and 196 from patients with non-leprosy peripheral neuropathies (NLN)] were examined. Both AFB-negative and AFB-positive PNL samples had more frequent histopathological alterations (epithelioid granulomas, mononuclear infiltrates, fibrosis, perineurial and subperineurial oedema and decreased numbers of myelinated fibres) than the NLN group. Multivariate analysis revealed that independently, mononuclear infiltrate and perineurial fibrosis were more common in the PNL group and were able to correctly classify AFB-negative PNL samples. These results indicate that even in the absence of AFB, these histopathological nerve alterations may justify a PNL diagnosis when observed in conjunction with pertinent clinical, epidemiological and laboratory data.
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil. santunes@ioc.fiocruz.br
authors.forename: Sérgio Luiz Gomes
authors.initials: SL
authors.lastname: Antunes
authors.forename: Leila
authors.initials: L
authors.lastname: Chimelli
authors.forename: Márcia Rodrigues
authors.initials: MR
authors.lastname: Jardim
authors.forename: Robson Teixeira
authors.initials: RT
authors.lastname: Vital
authors.forename: José Augusto da Costa
authors.initials: JA
authors.lastname: Nery
authors.forename: Suzana
authors.initials: S
authors.lastname: Corte-Real
authors.forename: Mariana Andréa Vilas Boas
authors.initials: MA
authors.lastname: Hacker
authors.forename: Euzenir Nunes
authors.initials: EN
authors.lastname: Sarno
mesh_terms: D001706:Biopsy; D016022:Case-Control Studies; D006801:Humans; D015441:Leprosy, Tuberculoid / Q000473:pathology*; D010525:Peripheral Nerves / Q000473:pathology*