Coexistence of Nerve Enlargement and Neuratrophy Detected by Ultrasonography in Leprosy Patients

Xiaohua Chen,Chunzhi Pan,Xiuli Zhai,Liangfu Zhang,Yan Wen,Meiying Huang

doi:10.1038/s41598-018-26085-1

Xiaohua Chen, Chunzhi Pan + Show 4 more

Open Access

https://doi.org/10.1038/s41598-018-26085-1

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Abstract

The purpose of this study was to evaluate peripheral neural impairment in leprosy patients by ultrasonography (US). The cross-sectional areas (CSAs) of the median (M), ulnar (U) and common fibular (CF) nerves were compared in 71 leprosy patients and 29 healthy controls, and the data were analyzed between the leprosy, multibacillary (MB)/paucibacillary (PB), reaction (R)/no reaction (NR), disability (D)/no disability (ND), and longer/shorter duration groups after treatment. We found that for the nerves located in upper limbs, the CSAs were significantly increased in the leprosy patients vs the controls; the PB group vs the MB group; the R group vs the NR group; the ND group vs the D group; and the longer duration group vs the shorter duration group at some positions of the M nerve and U nerve. In contrast, for the nerves located in lower limbs, the CSAs were significantly reduced in the leprosy patients vs the controls and in the longer duration group vs the shorter duration group at some positions of the CF nerve. This result indicated that nerve enlargement and neuratrophy coexist in leprosy patients.

Highlights

Diagnosis of nerve damage in leprosy patients is possible using conduction studies, thermal perception testing and nerve palpation, but these techniques are examiner dependent and require practical training[6]
The cross-sectional areas (CSAs) was significantly increased in both the R and no reaction (NR) groups compared to the controls at the M and U nerve (Ut, right and Upt, bilateral). These findings suggest that nerve thickening is a common phenomenon in the upper limbs of leprosy patients regardless of the presence of a reaction, which may act as a risk factor of nerve enlargement
Significant increases were noted between the no disability (ND) and control groups at the M nerve and U nerve (Ut, right and Upt, bilateral) and between the ND and D groups at the U nerve (Ut and Upt, right). These findings suggest that leprosy patients without disability are more likely to exhibit nerve enlargement in peripheral nerves (M/U nerves) in the upper limbs

Summary

Introduction

Diagnosis of nerve damage in leprosy patients is possible using conduction studies, thermal perception testing and nerve palpation (to detect thickening), but these techniques are examiner dependent and require practical training[6]. Studies have reported that clinical examination of enlarged nerves in leprosy patients is subjective and inaccurate, whereas ultrasonography (US) provides an objective measure of nerve damage by providing information on the location and degree of nerve enlargement, nerve morphologic alterations, and echo texture, fascicular pattern, and vascularity of the nerve[7,8,9,10,11]. These features reflect nerve histologic changes and are useful for the study of structural changes in nerve sites that cannot be biopsied for histopathologic examination[9]. Differences in the CSAs were compared between the leprosy patients and the controls, the MB and PB groups, the R and NR groups, the disability (D) and no disability (ND) groups and the different treatment durations (>20 years and

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