Peripheral nerve biopsies in the diagnosis of leprosy in Aboriginal patients from the Northern Territory of Australia.

McDougall, A C; Harman, D. J.; Waudby, H; Hargrave, John

doi:10.1136/jnnp.41.10.874

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Deformities like claw hand and foot drop were present in 19.57% cases as compared to 50 % cases noted by Mendiratta et al .,[ 14 ] Mc Dougall et al ., found a preponderance of borderline tuberculoid and borderline lepromatous forms similar to the present study. [ 15 ] However Pedley et al ., in their study of 119 patients in Nepal found a preponderance of borderline lepromatous form. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 17 ] Secondly, the major peripheral nerves cannot be easily biopsied and the smaller cutaneous branches may not yield diagnosis due to less number of fascicles. [ 15 ] Sural nerve was the choice of biopsy in our study because of technical advantage; it being a superficial and pure sensory nerve and also has more number of fascicles to avoid a false negative diagnosis. The other studies on PNL have also mentioned sural as the common nerve to be biopsied.…”

Section: Discussionmentioning

confidence: 99%

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Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India

Hui¹,

Uppin²,

Challa³

et al. 2015

Ann Indian Acad Neurol

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Background and Purpose:Demonstration of lepra bacilli is essential for definite or unequivocal diagnosis of pure neuritic leprosy (PNL) on nerve biopsy. However, nerves always do not show bacilli owing to the changes of previous therapy or due to low bacillary load in tuberculoid forms. In absence of granuloma or lepra bacilli, other morphologic changes in endoneurium and perineurium can be of help in making a probable diagnosis of PNL and treating the patient with multidrug therapy.Materials and Methods:Forty-six biopsies of PNL were retrospectively reviewed and histologic findings were compared with 25 biopsies of non leprosy neuropathies (NLN) including vasculitic neuropathy and chronic inflammatory demyelinating polyneuropathy (CIDP). The distribution of endoneurial infiltrate and fibrosis, perineurial thickening, and myelin abnormalities were compared between PNL and NLN biopsies and analyzed by Chi-square test.Results:Out of 46 PNL casses, 24 (52.17 %) biopsies were negative for acid fast bacilli (AFB). In these cases, the features which favor a diagnosis of AFB-negative PNL were endoneurial infiltrate (51.1%), endoneurial fibrosis (54.2%), perineurial thickening (70.8%), and reduced number of myelinated nerve fibers (75%).Interpretation and Conclusion:Nerve biopsy is an efficient tool to diagnose PNL and differentiate it from other causes of NLN. In absence of AFB, the diagnosis of PNL is challenging. In this article, we have satisfactorily evaluated the various hisopthological features and found that endoneurial inflammation, dense fibrosis, and reduction in the number of myelinated nerve fibers are strong supportive indicators of PNL regardless of AFB positivity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India

Hui¹,

Uppin²,

Challa³

et al. 2015

Ann Indian Acad Neurol

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“…In this connection, nerve conduction studies (NCS) are a sensitive method for the investigation of PNL 13,28,30 (C). There is prominence of demyelinating neuropathy of the ulnar nerve at the elbow in 55.0% of the cases 34,36 (C).…”

Section: Nerve Conduction Studies: Diagnostic Of Sensibility and Specmentioning

confidence: 99%

Primary neural leprosy: systematic review

Garbino

Marques

Barreto

et al. 2013

Arq. Neuro-Psiquiatr.

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The authors proposed a systematic review on the current concepts of primary neural leprosy by consulting the following online databases: MEDLINE, Lilacs/SciELO, and Embase. Selected studies were classified based on the degree of recommendation and levels of scientific evidence according to the “Oxford Centre for Evidence-based Medicine”. The following aspects were reviewed: cutaneous clinical and laboratorial investigations, i.e. skin clinical exam, smears, and biopsy, and Mitsuda's reaction; neurological investigation (anamnesis, electromyography and nerve biopsy); serological investigation and molecular testing, i.e. serological testing for the detection of the phenolic glycolipid 1 (PGL-I) and the polymerase chain reaction (PCR); and treatment (classification criteria for the definition of specific treatment, steroid treatment, and cure criteria).

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Primary Neural Leprosy

Garbino

Naafs

2012

Leprosy

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Peripheral nerve biopsies in the diagnosis of leprosy in Aboriginal patients from the Northern Territory of Australia.

Cited by 5 publications

References 9 publications

Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India

Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India

Primary neural leprosy: systematic review

Primary Neural Leprosy

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