Comparison between nerve conduction study and high-resolution ultrasonography with color doppler in type 1 and type 2 leprosy reactions

Akita, Juliana; Miller, Luiz Henrique Granja Souza Vieira; Mello, F.M.C.; Barreto, Jaison Antônio; Moreira, Ana Lucila; Salgado, Miguel Angel Castillo; Kirchner, Daniel Rocco; Garbino, José Antônio

doi:10.1016/j.cnp.2021.02.003

Cited by 14 publications

(21 citation statements)

References 17 publications

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“…Studies focusing on demonstrating the importance of increased vascularization (intraneural or perineural) interpreted this as a sign of inflammation, and furthermore, as a sign of inflammatory reaction (acute or subacute) in the nerve 32,34,35,42,43 (Figure 6C). Those signs are of particular significance when the signs of neural damage are few, and when no motor NCS abnormalities are detected 44 . Our study examined all of the different parameters (color Doppler, echotexture, CSA, and epineural thickness) that can be affected in leprotic neuropathy, and these parameters were compared with clinical, functional, electrophysiological, and laboratory parameters.…”

Section: Discussionmentioning

confidence: 99%

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

Nasr‐Eldin,

Cartwright,

Hamed

et al. 2023

J of Ultrasound Medicine

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ObjectivesTo explore neurofilament light chain (NfL) levels in leprotic neuropathy compared to controls, and to determine if the changes correlate with ultrasonographic nerve findings.MethodsIndividuals with leprosy with signs or symptoms suggestive of peripheral nerve involvement were recruited. They were evaluated by clinical examination, functional scores, laboratory assessments (including NfL), nerve conduction studies (NCS), and ultrasound. Ultrasound was conducted in bilateral median, ulnar, tibial, fibular, sural, and vagus nerves as well as cervical roots 5 and 6. Results were compared to age, sex, and body mass index matched healthy controls.ResultsA total of 320 nerves from 20 patients and 480 nerves from 30 controls were evaluated. NfL was significantly elevated in those with leprosy with a mean and standard deviation of 7.50 + 2.83 compared with 3.42 + 1.18 in controls (P < .001). Ultrasound showed focal enlargement of the nerves, particularly at entrapment sites. Additionally, there were noticeable changes in neural Doppler signal, echogenicity, and epineural thickness among the measured nerve sites. NfL levels in those with leprosy correlated closely with nerve cross‐sectional area at all sites (P < .05). Functional and clinical assessment scores correlated with NfL and sonographic cross‐sectional area as well (P ≤ .05).ConclusionsNfL is elevated in leprotic neuropathy. Ultrasound showed specific morphological changes in individuals with leprosy, and nerve enlargement correlated with NfL levels. Thus, both modalities may be useful for the diagnosis, prognosis, and disease monitoring in those with leprotic neuropathy, and further investigations are warranted.

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Section: Discussionmentioning

confidence: 99%

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

Nasr‐Eldin,

Cartwright,

Hamed

et al. 2023

J of Ultrasound Medicine

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“…18 Increased vascularity within the nerves can be detected using colour Doppler that reflects intra-neural vascular dilation due to an inflammatory reaction within the nerves during lepra reactions. 6,17,19,20 Endo-neural vascularity was demonstrated sonographically in 37.5% of nerves with lepra reaction. 16 Increased vascularity correlated with cross-sectional area in some studies, but not in others.…”

Section: Specific Localisation Of Nerve Enlargement In Leprosy and Morphological Characteristicsmentioning

confidence: 98%

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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“…Presence of hypo- or anaesthetic hypopigmented lesions during assessment, and thickened peripheral nerves identified via palpation or ultrasonography, are key diagnostic features of leprosy. 73 – 75 Confirmatory laboratory testing to detect acid-fast bacilli in slit skin smears or biopsies using Fite staining and light microscopy or polymerase chain reaction (PCR) amplification can also be completed. Diagnostic specimens are preferentially collected from persistent and active lesions typically located in cooler parts of the body.…”

Section: Leprosymentioning

confidence: 99%

A review of nutrition in neuropathic pain of leprosy

Klowak

Boggild

2022

Therapeutic Advances in Infection

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Leprosy is a neglected tropical disease (NTD) that continues to burden low- and middle-income countries (LMICs), despite being eliminated as a public health concern by the World Health Organization (WHO) in 2000. The causative agents, Mycobacterium leprae and Mycobacterium lepromatosis, affect nearly 200,000 individuals globally each year, with over 19,000 new cases detected in the Americas in 2020 alone. Canada has experienced an increasing incidence of leprosy, due to rising levels of travel and migration from endemic areas, reaching over 37,000 individuals with leprosy by the end of 2020. Patients experience a spectrum of signs and symptoms including hypopigmented cutaneous macules alongside peripheral neuropathy including peripheral neuropathic pain (PNP) and disabling sensory neuropathies. Despite the development of effective and curative therapeutics via multidrug therapy (MDT), many barriers to treatment adherence and effective immunological control of the pathogen challenge the care of patients with leprosy. Socioeconomic barriers, such as disability-related social stigma and often undiagnosed nutritional deficiencies, have resulted in heightened disease severity. PNP therapeutics are associated with significant side effects and remain ineffective as the majority of individuals will not experience a greater than 30% reduction of symptoms. Nutrient supplementation is known to be instrumental in reducing host oxidative stress, strengthening the immune system and mitigating comorbidities. Likewise, dietary lifestyle interventions known to be physiologically beneficial have recently emerged as powerful tools conferring neuroprotective effects, potentially mitigating PNP severity. However, a significant knowledge gap concerning the effect of adequate nutrition on host immunological control of leprosy and PNP severity exists. Further evaluation of this relationship will provide key insight into the pathogenesis of leprosy, strengthening the current body of literature.

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Comparison between nerve conduction study and high-resolution ultrasonography with color doppler in type 1 and type 2 leprosy reactions

Abstract: Highlights Identifying leprosy reactions is important to prevent disability. HRUS with CD can be useful compared to NCS to diagnose acute inflammatory activity. HRUS with CD helps reactions diagnosis in minimal and complete NCS abnormalities.

Cited by 14 publications

References 17 publications

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

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

A review of nutrition in neuropathic pain of leprosy

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