Pathological, ultrasonographic, and electrophysiological characterization of clinically diagnosed cases of pure neuritic leprosy
Autor: | Ravindra Kumar Garg, Praveen Kumar Sharma, Imran Rizvi, Manoj Kumar, Kiran Preet Malhotra, Shweta Pandey, Hardeep Singh Malhotra, Ravi Uniyal, Rajesh Verma, Neeraj Kumar, Bhaskar Shukla, Vijay Kumar |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male medicine.medical_specialty Biopsy Neural Conduction India Physical examination Mononeuropathy 03 medical and health sciences Young Adult 0302 clinical medicine Leprosy medicine Humans Prospective Studies Great auricular nerve Ultrasonography Nerve biopsy medicine.diagnostic_test business.industry General Neuroscience Electrodiagnosis Peripheral Nervous System Diseases Middle Aged medicine.disease Peripheral neuropathy 030220 oncology & carcinogenesis Nerve conduction study Female Neurology (clinical) Radiology business Polyneuropathy 030217 neurology & neurosurgery |
Zdroj: | Journal of the peripheral nervous system : JPNSREFERENCES. 25(2) |
ISSN: | 1529-8027 |
Popis: | A subset of neuritic form of leprosy, called pure neuritic leprosy (PNL), seen in a minority of leprosy patients, is characterized by peripheral neuropathy without skin lesions and an absence of acid-fast bacilli on skin smears. Patients with PNL are often started on drug therapy without confirmation of diagnosis. We, therefore, did a prospective study of clinically diagnosed PNL patients with correlation of ultrasonographic and biopsy findings. A total of 100 consecutive patients with PNL, diagnosed according to the consensus case definition, were included in the study. All patients underwent nerve conduction study, peripheral nerve ultrasonography, and sural nerve biopsy. Multiple mononeuropathies were present in 75% of cases, mononeuropathy in 18%, and polyneuropathy in the remaining 7%. Compared to clinical examination, ultrasonographic assessment of the peripheral nerves was not only better at the detection of thickening but also helped in characterization of their fascicular architecture, echogenicity, and vascularity. A total of 32 cases were confirmed on nerve biopsy, out of which 75% had demonstrable lepra bacilli. Cranial nerve involvement, presence of trophic ulcers, and bilateral thickening of the great auricular nerve were significantly associated with the positivity of lepra bacilli. A significant improvement in the disability score happened after multidrug therapy. A comprehensive electrophysiologic, ultrasonographic, and histological evaluation may be helpful in establishing a diagnosis of PNL with greater confidence, while ruling out other non-leprosy diagnoses. |
Databáze: | OpenAIRE |
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