Semmes-Weinstein monofilament: A tool to quantify skin sensation in macular lesions for leprosy diagnosis

Frade, Marco Andrey Cipriani; Rosa, Dario; Filho, Fred Bernardes; Spencer, John S.; Foss, Norma T.

doi:10.25259/ijdvl_622_19

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…The diagnosis is essentially clinical, based on a thorough dermatoneurological examination, and in the presence of hypochromic macules, the use of Semmes-Weinstein monofilaments improves its accuracy ( 32 ). Current diagnostic tools such as ELISA, PCR, and electroneuromyography (ENMG) have proved to be effective for an early diagnosis of HD and are useful for the evaluation of the efficacy of therapy, but their use is limited in HD, which has been considered a marginalized disease.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…Semmes-Weinstein monofilaments are widely used in the assessment of tactile sensation in peripheral neuropathies of the upper and lower limbs [ 14 , 22 ]. Although there is other device to assess the sensation for diagnosis and the follow-up of the neuropathy as the pressure-specified sensory device (PSSD), described by Baltodano et al [ 26 ], with perhaps a marginal improvement over the SWM, the major advantages in assessing the sensation of peripheral nerves by using Semmes-Weinstein monofilaments are: its easy application, low cost and the fact that the patient is blindfolded, making it difficult to have false responses in the test [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of altered patterns of tactile sensation in the diagnosis and monitoring of leprosy using the Semmes-Weinstein monofilaments

et al. 2022

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Background Leprosy neuropathy is the most common peripheral neuropathy of infectious etiology worldwide; it is characterized as asymmetric and focal multiple mononeuropathy. Semmes-Weinstein monofilament (SWM) test is a simple method to assess sensory nerve function. Methods and findings In this prospective cohort study, a dermatologist carried out hands and feet tactile sensation test with SWM in 107 multibacillary leprosy patients at diagnosis and in 76 patients at the end of treatment from 2016 to 2019. At diagnosis, 81/107 (75.7%) patients had some degree of functional disability, and 46 (43%) of them had altered SWM-test in the hands and 94 (87.9%) of them in the feet. After one year of multibacillary multidrug therapy, the disability decreasing to 44/76 patients (57.9%) and decreasing of the percentual of patients with altered SWM-test to 18% for the hands, and to 28.7% for the feet. At the end of treatment, the number of SMW-test points presented improvement in the hands of 22 (28.9%) patients, and in the feet of 47 (61.8%). In the hands, by SWM-test, only the radial nerve point demonstrated a significant asymmetry, while in the feet, the difference between the sum of altered SWM-test points showed significant asymmetry between both sides, highlighting the tibial nerve for the establishment of asymmetric leprosy neuropathy. In Spearman’s correlation analysis, a positive correlation with statistical significance was observed between the number of hands and feet SWM altered points at diagnosis and the degree of disability at diagnosis (0.69) and at the end of the treatment (0.80). Conclusion The patterns of hands and feet tactile sensation at diagnosis and their consequent modifications with the anti-leprosy drugs define the bacterial etiology of neuropathy, an important tool for the clinical diagnosis and follow up of the disease, highlighting the tibial nerve findings, the most affected nerve among leprosy patients by SWM-test, with significant asymmetry and focality impairments.

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“…Considering that none of the classifications for HD include all of the clinical manifestations of HD, particularly those involving macular and pure neural forms, we classified the patients considering the guidelines adapted by Madrid (Congress of Madrid 1953) and the Indian Association of Leprology (IAL 1982) classifications as follows: indeterminate (I), polar tuberculoid (TT), borderline (B), borderline lepromatous (BL), polar lepromatous (LL), and pure neural (N); and PB (I and TT clinical forms) and MB (B, BL, LL, and N forms) according to the WHO operational criteria. Considering the classification by Frade et al ( 14 ), patients with atypical hypochromatic macules and with altered sensation and neurological findings were classified as having the B and MB forms. All newly diagnosed patients were referred to a health unit for standard MDT.…”

Section: Methodsmentioning

confidence: 99%

Serological testing for Hansen’s disease diagnosis: Clinical significance and performance of IgA, IgM, and IgG antibodies against Mce1A protein

et al. 2023

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Hansen’s disease (HD) is an infectious, treatable, and chronic disease. It is the main cause of infectious peripheral neuropathy. Due to the current limitations of laboratory tests for the diagnosis of HD, early identification of infected contacts is an important factor that would allow us to control the magnitude of this disease in terms of world public health. Thus, a cross-sectional study was conducted in the Brazilian southeast with the objective of evaluating humoral immunity and describing the accuracy of the immunoassay based on IgA, IgM, and IgG antibodies against surface protein Mce1A of Mycobacterium, the predictive potential of these molecules, the clinical significance of positivity, and the ability to segregate new HD cases (NC; n = 200), contacts (HHC; n = 105), and healthy endemic controls (HEC; n = 100) as compared to α-PGL-I serology. α-Mce1A levels for all tested antibodies were significantly higher in NC and HHC than in HEC (p < 0.0001). The performance of the assay using IgA and IgM antibodies was rated as highly accurate (AUC > 0.85) for screening HD patients. Among HD patients (NC), positivity was 77.5% for IgA α-Mce1A ELISA, 76.5% for IgM, and 61.5% for IgG, while α-PGL-I serology showed only 28.0% positivity. Multivariate PLS-DA showed two defined clusters for the HEC and NC groups [accuracy = 0.95 (SD = 0.008)] and the HEC and HHC groups [accuracy = 0.93 (SD = 0.011)]. IgA was the antibody most responsible for clustering HHC as compared to NC and HEC, evidencing its usefulness for host mucosal immunity and as an immunological marker in laboratory tests. IgM is the key antibody for the clustering of NC patients. Positive results with high antibody levels indicate priority for screening, new clinical and laboratory evaluations, and monitoring of contacts, mainly with antibody indexes ≥2.0. In light of recent developments, the incorporation of new diagnostic technologies permits to eliminate the main gaps in the laboratory diagnosis of HD, with the implementation of tools of greater sensitivity and accuracy while maintaining satisfactory specificity.

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Semmes-Weinstein monofilament: A tool to quantify skin sensation in macular lesions for leprosy diagnosis

Cited by 13 publications

References 18 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

Evaluation of altered patterns of tactile sensation in the diagnosis and monitoring of leprosy using the Semmes-Weinstein monofilaments

Serological testing for Hansen’s disease diagnosis: Clinical significance and performance of IgA, IgM, and IgG antibodies against Mce1A protein

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