A Hand‐Held Ultrasound Device for the Assessment of Peripheral Nerves in Leprosy

Wheat, Stephen W.; Stryjewska, Barbara M.; Cartwright, Michael S.

doi:10.1111/jon.12797

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…The sensitivity of conventional PCR (17 studies) was 75.3% (95% CI 67.9-81.5) and specificity was 94.5% (95% CI: 91.4-96.5). Regarding peripheral nerve ultrasonography in the evaluation of HD neuropathy, several studies have considered it as a method with good efficacy, reproducibility, and diagnostic accuracy, besides its accessible cost and availability, even for point of care (40,43,47,49,59,(69)(70)(71)(72)(73)(74)(75)(76).…”

Section: Discussionmentioning

confidence: 99%

Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

et al. 2023

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IntroductionHansen's disease (HD) primarily infects peripheral nerves, with patients without HD being free of peripheral nerve damage. Household contacts (HHCs) of patients with HD are at a 5–10 times higher risk of HD than the general population. Neural thickening is one of the three cardinal signs that define a case of HD according to WHO guidelines, exclusively considering palpation examination that is subjective and may not detect the condition in the earliest cases even when performed by well-trained professionals. High-resolution ultrasound (HRUS) can evaluate most peripheral nerves, a validated technique with good reproducibility allowing detailed and accurate examination.ObjectiveThis study aimed to use the peripheral nerve HRUS test according to the HD protocol as a diagnostic method for neuropathy comparing HHCs with healthy volunteers (HVs) and patients with HD.MethodsIn municipalities from 14 different areas of Brazil we selected at random 83 HHC of MB-patients to be submitted to peripheral nerve ultrasound and compared to 49 HVs and 176 HD-patients.ResultsHousehold contacts assessed by HRUS showed higher median and mean absolute peripheral nerve cross-sectional area (CSA) values and greater asymmetries (ΔCSA) compared to HVs at the same points. Median and mean absolute peripheral nerve CSA values were higher in patients with HD compared to HCCs at almost all points, while ΔCSA values were equal at all points. Mean ± SD focality (ΔTpT) values for HHCs and patients with HD, respectively, were 2.7 ± 2.2/2.6 ± 2.2 for the median nerve, 2.9 ± 2.7/3.3 ± 2.9 for the common fibular nerve (p > 0.05), and 1.3 ± 1.3/2.2 ± 3.9 for the ulnar nerve (p < 0.0001).DiscussionConsidering HRUS findings for HHCs, asymmetric multiple mononeuropathy signs (thickening or asymmetry) in at least 20% of the nerves evaluated could already indicates evidence of HD neuropathy. Thus, if more nerve points are assessed in HHCs (14 instead of 10), the contacts become more like patients with HD according to nerve thickening determined by HRUS, which should be a cutting-edge tool for an early diagnosis of leprosy cases.

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Section: Discussionmentioning

confidence: 99%

Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

et al. 2023

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“…It provides an objective measure of the nerve dimensions in addition to revealing structural changes over a longer length of the nerve ( 49 ). Enlarged nerves of patients undergoing leprosy reactions show increased endoneurial and epineurial vascularity that can be measured by ultrasonography with color or power Doppler ( 24 , 28 ). We also used ultrasonography of the posterior tibial nerve to show that armadillos, like humans, show enlargement of peripheral nerves due to M. leprae infection.…”

Section: Discussionmentioning

confidence: 99%

“…Standardized tests that measure nerve damage are well established for humans (23) and there has been some use of these tests to evaluate neuropathy in persons affected by leprosy (2,(24)(25)(26)(27)(28). Validation of such tests in M. leprae-infected armadillos would support its use as an animal model to study leprosy NFI.…”

Section: Introductionmentioning

confidence: 99%

The Armadillo as a Model for Leprosy Nerve Function Impairment: Preventative and Therapeutic Interventions

Peña

Lahiri

Ebenezer³

et al. 2022

Front. Med.

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Mycobacterium leprae infection of peripheral nerves and the subsequent nerve function impairment (NFI), especially in response to reactional episodes, are hallmarks of leprosy. Improved treatments for M. leprae-induced nerve injury are needed, as most if not all of the disability and stigma associated with leprosy arises from the direct or indirect effects of NFI. Nine-banded armadillos (Dasypus novemcinctus), like humans, exhibit the full clinical spectrum of leprosy and extensive involvement of the peripheral nerves. In this study, state-of-the-art technology was used to compare nerve function between uninfected and M. leprae-infected armadillos. Motor nerve conduction velocity (MNCV) and compound muscle action potential (cMAP), which measure changes in the rate of impulse conduction velocity and amplitude, revealed a progression of impairment that was directly correlated with the duration of M. leprae infection and enabled development of an objective nerve impairment scoring system. Ultrasonography accompanied by color Doppler imaging detected enlargement of the M. leprae-infected nerves and increased vascularity, possibly due to inflammation. Assessment of epidermal nerve fiber density (ENFD), which shows a length-dependent innervation in armadillos that is similar to humans, identified small fiber degeneration early after M. leprae infection. Staining for neuromuscular junction (NMJ) integrity, which is an indicator of signal transduction efficiency into skeletal muscle, discerned a markedly lower number and structural integrity of NMJ in M. leprae-infected armadillo footpads. These tools for assessing nerve injury were used to monitor the effects of intervention therapy. Two potential neuro-protective drugs, ethoxyquin (EQ) and 4-aminopyridine (4-AP), were tested for their ability to ameliorate peripheral nerve injury in M. leprae-infected armadillos. 4-AP treatment improved MNCV, cMAP, and EFND compared to untreated animals, while EQ had less effect. These results support the armadillo as a model for M. leprae-induced peripheral nerve injury that can provide insights toward the understanding of NFI progression and contribute to the preclinical investigation of the safety and efficacy of neuro-preventive and neuro-therapeutic interventions for leprosy.

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“…With technological advances, smaller ultrasound machines are available which can be used at the point-of-care. 10 Paramedical field workers can probably be trained to identify thickened nerves more reliably by HRUS than by clinical examination; besides the ultra-sound data can be verified subsequently by an expert or in real-time using tele-medicine services.…”

Section: Superiority Of Ultrasound Above Clinical Palpation To Detect Nerve Thickeningmentioning

confidence: 99%

Peripheral nerve sonography, a novel technique for improving the diagnosis of Hansen’s neuropathy

Nagappa

Visser

Bathala³

2021

LEPROSY

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Leprosy is one of the oldest diseases known to mankind, and the first disease whose etiopathogenesis was linked to a bacterium. Despite efforts to eliminate leprosy through the worldwide leprosy elimination campaign and the enhanced global strategy, it continues to prevail in endemic areas with continued detection of newly infected cases. Although the new case incidence of leprosy has decreased quite tremendously, the level of Grade 2 disability, due to peripheral nerve damage which involves considerable clinical deficits and deformity, has remained unchanged. 1 Early diagnosis and treatment of peripheral neuropathy is essential to prevent stigmatizing deformities and disabilities in leprosy. Diagnosis of leprosy reactions and underlying nerve injury would help to reverse the damage by prompt treatment.Dysfunction of peripheral nerves, the primary targets of Mycobacterium leprae, is the cause of deformity and disfigurement, and the social stigma and ostracism that follow. The spectrum of neuropathy is governed by the host immune response and ranges on a continuum from tuberculoid to lepromatous leprosy. Pure neuritic leprosy, silent neuropathy, leprous ganglionitis and acute neuritis during lepra reactions may also occur. 2 Traditionally, the diagnosis of leprosy relies on the presence of at least one of the three cardinal signs which are hypo-aesthetic skin lesions, thickened nerves and acid-fast bacilli in skin smears. While each of these cardinal signs individually has high sensitivity and specificity, errors arise when they are not correctly identified due to incomplete, inadequate or superficial clinical examination. Enlarged nerves have a limited number of differential diagnoses which include Charcot-Marie-Tooth disease, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), amyloid neuropathy and neurofibromatosis, all of which are quite rare. Among these conditions, leprosy is the only disorder where the identification of thickened nerves is 'central' to the diagnosis. The presence of tender, nodular thickened nerves

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A Hand‐Held Ultrasound Device for the Assessment of Peripheral Nerves in Leprosy

Cited by 9 publications

References 12 publications

Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

Silent peripheral neuropathy determined by high-resolution ultrasound among contacts of patients with Hansen's disease

The Armadillo as a Model for Leprosy Nerve Function Impairment: Preventative and Therapeutic Interventions

Peripheral nerve sonography, a novel technique for improving the diagnosis of Hansen’s neuropathy

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