Abstract
BackgroundNeurological involvement occurs throughout the leprosy clinical spectrum and is responsible for the most feared consequences of the disease. Ultrasonography (US) provides objective measurements of nerve thickening and asymmetry. We examined leprosy patients before beginning multi-drug therapy aiming to describe differences in US measurements between classification groups and between patients with and without reactions.Methodology/Principal FindingsEleven paucibacillary (PB) and 85 multibacillary (MB) patients underwent nerve US. Twenty-seven patients had leprosy reactions (type 1, type 2 and/or acute neuritis) prior to US. The ulnar (at the cubital tunnel–Ut–and proximal to the tunnel–Upt), median (M) and common fibular (CF) nerves were scanned to measure cross-sectional areas (CSAs) in mm2 and to calculate the asymmetry indexes ΔCSA (absolute difference between right and left CSAs) and ΔUtpt (absolute difference between Upt and Ut CSAs). MB patients showed greater (p<0.05) CSAs than PB at Ut (13.88±11.4/9.53±6.14) and M (10.41±5.4/6.36±0.84). ΔCSAs and ΔUtpt were similar between PB and MB. The CSAs, ΔCSAs and ΔUtpt were similar between PB patients with reactions compared to PB patients without reactions. MB patients with reactions showed significantly greater CSAs (Upt, Ut and M), ΔCSAs (Upt and Ut) and ΔUtpt compared to MB patients without reactions. PB and MB showed similar frequencies of abnormal US measurements. Patients with reactions had higher frequency of nerve thickening and similar frequency of asymmetry to those without reactions.Conclusions/SignificanceThis is the first study to investigate differences in nerve involvement among leprosy classification groups using US before treatment. The magnitude of thickening was greater in MB and in patients with reactions. Asymmetry indexes were greater in patients with reactions and did not significantly differ between PB and MB, demonstrating that asymmetry is a characteristic of leprosy neuropathy regardless of its classification.
Highlights
Neurological involvement is present throughout the leprosy clinical spectrum, and nerve impairment is responsible for the most feared consequences of the disease; some authors advocate that leprosy should be regarded as a chronic neurological condition rather than a skin disease [1,2,3,4,5]
Leprosy is an infectious disease that affects the peripheral nerves, leading to nerve thickening, asymmetry and dysfunction; early detection of leprosy neuropathy is important for preventing deformities and disabilities
We examined peripheral nerve involvement using ultrasonography (US) in 96 leprosy patients prior to treatment, aiming to better understand differences in neuropathy patterns between leprosy classification groups and between patients with and without leprosy reactions
Summary
Neurological involvement is present throughout the leprosy clinical spectrum, and nerve impairment is responsible for the most feared consequences of the disease; some authors advocate that leprosy should be regarded as a chronic neurological condition rather than a skin disease [1,2,3,4,5]. Leprosy reactions (acute neuritis, types 1 and 2 reactions) can lead to additional nerve damage due to immune-mediated mechanisms. They may be superimposed on the chronic course of the disease and require immediate treatment [1,3,5,6]. We examined leprosy patients before beginning multi-drug therapy aiming to describe differences in US measurements between classification groups and between patients with and without reactions.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
