Evaluation of polymerase chain reaction in nerve biopsy specimens of patients with Hansen's disease

Tiwari, Vandana; Malhotra, Kiran Preet; Khan, Kainat; Maurya, Pradeep Kumar; Singh, Ajai; Thacker, Anup Kumar; Husain, Nuzhat; Kulshreshtha, Dinkar

doi:10.1016/j.jns.2017.07.038

Cited by 14 publications

(11 citation statements)

References 17 publications

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“…However, such discordance has been reported in a previous study. 39 Histopathological features similar to that observed in tuberculoid PNL can also be seen in chronic inflammatory demyelinating neuropathy, vasculitic/noninfective granulomatous neuropathy, and neurosarcoidosis. Clinically, the disease could also mimic hereditary sensory and autonomic neuropathy and needs to be differentiated.…”

Section: Discussionmentioning

confidence: 76%

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

Vengalil

Lavania²,

Singh³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Identification of Mycobacterium leprae DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was extracted. Mycobacterium leprae DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/ fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for M. leprae DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy.

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Section: Discussionmentioning

confidence: 76%

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

Vengalil

Lavania²,

Singh³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…Tiwari et al (2017) evaluated PCR in nerve biopsy specimens of 35 pure neuritic leprosy cases. AFB was positive in 13 (37.14%) cases and PCR positivity was observed in 22 (62.86%) cases [39]. A study involved 43 newly-diagnosed leprosy patients, where quantitative PCR was carried out on whole blood samples (PCR positivity—13.95%) in comparison with SSS of the ear lobe (microscopy—30.23%; PCR positivity—41.86%) [40].…”

Section: Resultsmentioning

confidence: 99%

“…Conventional PCR targeting a single gene has been found to be the most frequently reported method. Several authors have used conventional PCR on slit skin, biopsy, urine, blood [27,37,38,39,40]. On the other hand, few studies have utilized multiplex PCR on slit skin and biopsies, amplifying more than one target sequence, at the same level of laboratory settings as conventional PCR [21,26,35,41].…”

Section: Resultsmentioning

confidence: 99%

Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic Review

2018

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Leprosy is an infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health care levels for the effective control of leprosy. This paper presents a systematic review analysis in order to investigate the performance of polymerase chain reaction (PCR) vis-à-vis slit skin smears (SSS) in various clinical settings and its potential usefulness as a routine lab test for leprosy diagnosis. Records of published journal articles were identified through PubMed database search. Twenty-seven articles were included for the analysis. The evidence from this review analysis suggests that PCR on skin biopsy is the ideal diagnostic test. Nevertheless, PCR on SSS samples also seems to be useful with its practical value for application, even at primary care levels. The review findings also indicated the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic leprosy. The M. leprae-specific repetitive element (RLEP) was the most frequently-used marker although its variable performance across the clinical sites and samples are a matter of concern. Undertaking further research studies with large sample numbers and uniform protocols studied simultaneously across multiple clinical sites is recommended to address these issues.

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“…57 In one study, PCR sensitivity for nerve biopsy samples was estimated at 92.3% and specificity 54.5%, with positive and negative predictive values of 54.5 and 92.3%, respectively. 75 PCR increases the sensitivity in detection of M. leprae, especially in cases of probable primary neural leprosy. Histological findings are also described in leprosy reactions-T1R is characterized by giant cells, granulomas, and intragranuloma edema.…”

Section: Diagnosismentioning

confidence: 99%

Neurological Complications of Leprosy

Lau

2019

Semin Neurol

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Leprosy is a challenging international health concern. Despite tremendous efforts in reducing worldwide disease prevalence in the past decades, some countries remain endemic and are plagued by high levels of disability. The neurological complications of leprosy are varied and complex, with current research focused on evaluating tools for earlier diagnosis of neuropathy, especially in resource-limited countries. While treatment with multidrug therapy is highly effective, active research aims to simplify regimens to improve adherence, minimize adverse effects, and prevent antimicrobial resistance. Although promising progress has been made in the past decades, further efforts are needed to push the international community toward achieving worldwide elimination.

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Evaluation of polymerase chain reaction in nerve biopsy specimens of patients with Hansen's disease

Cited by 14 publications

References 17 publications

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic Review

Neurological Complications of Leprosy

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