Abstract
BackgroundLeprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Since the hallmarks of leprosy are nerve enlargement and inflammation, we used high-resolution sonography (US) and color Doppler (CD) imaging to demonstrate nerve enlargement and inflammation.Methology/Principal FindingsWe performed bilateral US of the ulnar (UN), median (MN), lateral popliteal (LP) and posterior tibial (PT) nerves in 20 leprosy patients and compared this with the clinical findings in these patients and with the sonographic findings in 30 healthy Indian controls.The nerves were significantly thicker in the leprosy patients as compared to healthy controls (p<0.0001 for each nerve). The two patients without nerve enlargements did not have a type 1 or type 2 reaction or signs of neuritis. The kappa for clinical palpation and nerve enlargement by sonography was 0.30 for all examined nerves (0.32 for UN, 0.41 for PN and 0.13 for LP). Increased neural vascularity by CD imaging was present in 39 of 152 examined nerves (26%). Increased vascularity was observed in multiple nerves in 6 of 12 patients with type 1 reaction and in 3 of 4 patients with type 2 reaction. Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of nerve echotexture, endoneural flow and cross-sectional area (p<0.001).Conclusions/SignificanceWe conclude that clinical examination of enlarged nerves in leprosy patients is subjective and inaccurate, whereas sonography provides an objective measure of nerve damage by showing increased vascularity, distorted echotexture and enlargement. This damage is sonographically more extensive and includes more nerves than clinically expected.
Highlights
Leprosy is the most common treatable peripheral nerve disorder worldwide [1]
Mycobacterium leprae, which causes leprosy, infects peripheral nerves resulting in functional impairment, ulcer formation and stigmatizing deformities
The sign of inflammation was observed in 26% (39/152) of nerves by color Doppler (CD) imaging
Summary
Leprosy is the most common treatable peripheral nerve disorder worldwide [1]. Leprosy is caused by a chronic granulomatous immune response to infection of the skin and nerves with Mycobacterium leprae, which resides in macrophages and Schwann cells and is the only bacterium known to affect myelination and cause peripheral neuropathy. Leprosy presents as a clinico-pathological spectrum [2] ranging from the localized paucibacillary tuberculoid form with anaesthetic hypopigmented skin patch (TT) to the generalized multibacillary, lepromatous leprosy. Between these poles are unstable forms of borderline tuberculoid, borderline borderline and borderline lepromatous leprosy These are prone to episodic exacerbations (reactions) in 15–50% of patients during the course of the disease and after the completion of multidrug therapy. Efforts to diagnose early (or subclinical) neuritis could ameliorate the nerve damage leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Leprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of nerve echotexture, endoneural flow and crosssectional area (p,0.001)
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