Mandating nerve biopsy: A step towards personalizing therapy in pure neuritic leprosy

Kulshreshtha, Dinkar; Malhotra, Kiran Preet; Malhotra, Hardeep Singh; Thacker, Anup Kumar; Garg, Ravindra Kumar; Singh, Ajai; Maurya, Pradeep Kumar

doi:10.1111/jns.12283

Cited by 13 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The biopsies, in turn, were categorized by applying Ridley-Jopling criteria 11 ; in a subsequent study, such categorization was further validated. 15 The results of this study also address the concerns associated with mislabelling multibacillary leprosy as paucibacillary. 14 As a standard procedure, we did a sural nerve biopsy in all patients screened in our study.…”

Section: Discussionmentioning

confidence: 61%

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study

Verma

Garg

Rizvi

et al. 2022

J Cent Nerv Syst Dis

Self Cite

View full text Add to dashboard Cite

Background Leprosy is primarily a disease of peripheral nerves. Some isolated case reports and case series have communicated imaging changes in the central nervous system (CNS) and brachial plexus in patients with leprosy. Objectives To study the neuroimaging abnormalities in patients with lepra bacilli-positive neuropathy in the context of CNS, spinal root ganglion, and brachial plexus. Design Prospective observational study Methods We screened newly-diagnosed patients with multibacillary leprosy presenting with neuropathy. Patients with bacilli-positive sural nerve biopsies were included in the study and subjected to magnetic resonance imaging (MRI) of the brain and spinal cord. Results A total of 54 patients with bacteriologically confirmed multibacillary leprosy were screened; Mycobacterium leprae was demonstrated in the sural nerve biopsies of 29 patients. Five patients (5/29; 17.24%) had MRI abnormalities in CNS, spinal root ganglion, and/or brachial plexus. Three patients had MRI changes suggestive of either myelitis or ganglionitis. One patient had T2/FLAIR hyperintensity in the middle cerebellar peduncle while 1 had T2/FLAIR hyperintensity in the brachial plexus. Conclusion CNS, spinal root ganglion, and brachial plexus are involved in patients with leprous neuropathy. Immunological reaction against M leprae antigen might be a plausible pathogenetic mechanism for brachial plexus and CNS imaging abnormalities.

show abstract

Section: Discussionmentioning

confidence: 61%

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study

Verma

Garg

Rizvi

et al. 2022

J Cent Nerv Syst Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Type 1 reaction (reversal reaction) is a delayed hypersensitivity reaction with increase in Th-1 type immune reaction, whereas Type 2 reaction is an immune complex-mediated reaction with Th2 immune response. Regulatory T cells (CD4 + ) and type 17-T helper cells are important in the immune response [63]. The latter produce interleukins 17, 21 and 22 which are the key inflammatory cytokines.…”

Section: Pathogenesis and Mechanism Of Nerve Damage In Leprosymentioning

confidence: 99%

Neuropathies of leprosy

Khadilkar

Patil

Shetty

2021

Journal of the Neurological Sciences

View full text Add to dashboard Cite

Neuropathies form an integral part of the symptomatology of leprosy. Neuropathies of leprosy take various forms and shapes. At one end is the cutaneous nerve involvement adjacent to the anaesthetic skin patch and the other is of symmetrical pansensory neuropathy and the devastating sensory ataxia of leprous ganglionits. Lepra reactions add to the spectrum. Hosts immunological status largely decides the clinical manifestations seen in nerves and skin. A wide array of diagnostic techniques like ultrasonography, magnetic resonance neurography, serological markers, molecular tests, skin biopsy and in selected cases, the nerve biopsy with special stains and electron microscopy are obtainable to help the clinical diagnosis. The unsuspecting clinician, lack of community awareness and limited availability of diagnostic tests are important adverse factors in the total outcome. Multi drug therapy is efficacious and corticosteroids reduce the impact of nerve damage in leprosy. The efficacy, dose and duration of corticosteroid therapy are presently inexact and other immune suppressants like azathioprine are being evaluated. Chronic disabilities and residual deficits require attention of multiple specialties. In the coming time, focus on prevention could lead to favourable results. This review will discuss the classification systems, common and uncommon clinical features, diagnostic armamentarium and therapeutic and preventive aspects of neuropathies of leprosy.

show abstract

“…The studies emphasized the challenging diagnosis of pure neural leprosy 16,17,25,27,30 and the need for advances in the development of diagnostic methods 18,32 , such as imaging tests (magnetic resonance imaging 27 and ultrasound 22,29,34 ), cytology and histopathology 21,23,24,28,38 , and serological and genomic tests 19,35 .…”

Section: Eligibilitty Inclusionmentioning

confidence: 99%

Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Santos

Fernandes

Barbosa

et al. 2021

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

OBJECTIVE:To review the literature and to report a clinical case with initial suspicion of pure neural leprosy and final diagnosis of amyloid neuropathy. METHODS:The study was conducted in two stages. In stage one, a systematic literature review was carried out, with searches performed in the PubMed, Medline, and Lilacs databases, as well as in the leprosy sectoral library of the Virtual Health Library, using the following descriptors: neuritic leprosy, pure neural leprosy, primary neural leprosy, pure neuritic leprosy, amyloid polyneuropathy, amyloid neuropathies, and amyloid polyneuropathy. The search was carried out on May 28, 2020. Clinical trials, cohort studies, crosssectional studies, clinical cases, and case studies published in Portuguese, English or Spanish between 2010 and 2020 were included.Stage two reports a case with initial suspicion of pure neural leprosy. Laboratory tests, electroneuromyography, ultrasound, and biopsy of the sural nerve were requested.RESULTS: Twenty-three scientific texts were included. No publications were found that contained both topics together. The challenging diagnosis of pure neural leprosy and the possibility of using auxiliary resources in diagnosis were the most emphasized themes in the studies. In the clinical case, the patient's electroneuromyography showed sensitive and motor polyneuropathy of the lower limbs, which was predominantly sensory and axonal, symmetrical, of moderate intensity, and the mixed type (axonal-demyelinating). Ultrasonography of the sural nerve revealed changes in the contour of the deep fibular nerves; biopsy of the sural nerve showed an accumulation of amorphous eosinophilic material in the nerve path, and Congo red stain showed apple-green birefringence of the deposit under polarized light. The final diagnosis was amyloid neuropathy. CONCLUSIONS:The final clinical diagnosis was amyloid neuropathy. The diagnosis of pure neural leprosy in endemic areas in Brasil is still a challenge for the health system.

show abstract

Mandating nerve biopsy: A step towards personalizing therapy in pure neuritic leprosy

Cited by 13 publications

References 19 publications

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study

Neuropathies of leprosy

Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Contact Info

Product

Resources

About