High-Resolution Sonography as an Additional Diagnostic and Prognostic Tool to Monitor Disease Activity in Leprosy: A Two-Year Prospective Study.
Early diagnosis and treatment of leprosy and leprosy reactions are essential to prevent stigmatizing deformities and disability. Although the incidence of leprosy has decreased enormously, grade 2 disability due to nerve injury has remained the same. New tools are needed to better diagnose and monitor leprosy reactions and associated neuritis and this study assessed whether high-resolution sonography (HRUS) can be used as such a tool.



During a prospective follow-up period of 2 years at regular intervals, we performed clinical examination to assess sensory and motor function and HRUS of the four main peripheral nerves in 57 patients, of whom 36 were with reactions and 21 were without reactions. Normative data of the cross-sectional area (CSA) of these nerves were obtained from 55 healthy subjects (HS). Color Doppler (CD) was used to study blood flow in the nerves.



At the baseline visit and during follow-up, all four nerves were significantly thicker in patients with leprosy reactions in comparison to HS (p < 0.0001) and to a lesser extent also in comparison to patients without reactions ranging from a p-value of < 0.05 to < 0.0001 in the different nerves tested. During follow-up, the nerve size did not change significantly in patients without reactions, while it decreased significantly in patients with reactions. At baseline, endoneural blood flow was present only in patients with reactions. This occurred in 20 of the 36 (55 %) patients (49 nerves) and decreased to only 1 patient (2.7 %) at the end of the follow-up period.



This prospective study demonstrates the ability of HRUS to monitor disease activity and the effect of treatment in patients with leprosy reactions by determining changes in nerve size and vascularity, which are indicators of peripheral nerve involvement and damage.
Immunology & Molecular Biology division, LEPRA Society Blue Peter Public Health & Research Centre, Hyderabad, India.
Meher Vani
MV
Chaduvula
Dept of Neurology and Clinical Neurophysiology, Postbus 90151, 5000 LC, St Elisabeth Hospital, Tilburg, Netherlands.
Leo H
LH
Visser
Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India.
Sujai
S
Suneetha
Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India.
Lavanya
L
Suneetha
Infectious Disease Research Laboratory, CODEWEL Nireekshana ACET India, Hyderabad, India.
Balakrishna
B
Devaraju
Clinical Division, Near City Civil Court, Chatta Bazar, Purani Havelli, Thalassemia & Sickle Cell Society, Hyderabad, India.
Ramesh
R
Ellanti
Laboratório de Hanseníase, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
Renuka
R
Raju
Clinical Division, Near City Civil Court, Chatta Bazar, Purani Havelli, Thalassemia & Sickle Cell Society, Hyderabad, India.
Suman
S
Jain
D006801:Humans; D007918:Leprosy / Q000150:complications / Q000000981:diagnostic imaging; D010525:Peripheral Nerves; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging; D011379:Prognosis; D011446:Prospective Studies; D014463:Ultrasonography