title: Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study.
abstract: Previous studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.
  
  
  
  We performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56-38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler.
  
  
  
  US nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.
authors.affiliation: Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Helena Barbosa
authors.identifier: 0000-0003-1623-7443
authors.initials: HB
authors.lastname: Lugão
authors.affiliation: Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Marco Andrey Cipriani
authors.initials: MA
authors.lastname: Frade
authors.affiliation: Department of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Marques
authors.affiliation: Dermatology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Norma Tiraboschi
authors.initials: NT
authors.lastname: Foss
authors.affiliation: Radiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, São Paulo, Brazil.
authors.forename: Marcello Henrique
authors.initials: MH
authors.lastname: Nogueira-Barbosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000009:adverse effects*; D007918:Leprosy / Q000150:complications* / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000000981:diagnostic imaging / Q000187:drug effects; D009443:Neuritis / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007917:Leprostatic Agents