Journal of Neurology

, Volume 250, Issue 7, pp 806–809

Criteria for diagnosis of pure neural leprosy

  • Márcia R. Jardim
  • Sérgio L. G. Antunes
  • Adalberto R. Santos
  • Osvaldo J. M. Nascimento
  • Jose Augusto C. Nery
  • Anna M. Sales
  • Ximena Illarramendi
  • Nádia Duppre
  • Leila Chimelli
  • Elizabeth P. Sampaio
  • Euzenir P. N. Sarno
ORIGINAL COMMUNICATION

Abstract.

The clinical diagnosis of pure neural leprosy (PNL) remains a public health care problem mainly because skin lesions—the cardinal features of leprosy—are always absent.Moreover, the identification of the leprosy bacillus is not easily achieved even when a nerve biopsy can be performed. In an attempt to reach a reliable PNL diagnosis in patients referred to our Leprosy Outpatient Clinic, this study employed a variety of criteria. The nerve biopsies performed on the 67 individuals whose clinical, neurological, and electrophysiological examination findings strongly suggested peripheral neuropathy were submitted to M. leprae identification via a polymerase chain reaction (PCR). Mononeuropathy multiplex was the most frequent clinical and electrophysiological pattern of nerve dysfunction, while sensory impairment occurred in 89% of all cases and motor dysfunction in 81%. Axonal neuropathy was the predominant electrophysiological finding, while the histopathological nerve study showed epithelioid granuloma in 14% of the patients, acid fast bacilli in 16%, and nonspecific inflammatory infiltrate and/or fibrosis in 39%. PCR for M. leprae was positive in 47% of the nerve biopsy samples (n=23). PCR, in conjunction with clinical and neurological examination results, can be a powerful tool in attempting to identify and confirm a PNL diagnosis.

Footnotes
1

Statement: The present manuscript has not been submitted for publication elsewhere and will not be submitted while under consideration for this journal.

 

Key words

pure neural leprosy (PNL) leprosy neuropathy histopathology polymerase chain reaction (PCR) 

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Copyright information

© Steinkopff Verlag 2003

Authors and Affiliations

  • Márcia R. Jardim
    • 3
  • Sérgio L. G. Antunes
    • 3
  • Adalberto R. Santos
    • 3
  • Osvaldo J. M. Nascimento
    • 1
  • Jose Augusto C. Nery
    • 3
  • Anna M. Sales
    • 3
  • Ximena Illarramendi
    • 3
  • Nádia Duppre
    • 3
  • Leila Chimelli
    • 2
  • Elizabeth P. Sampaio
    • 3
  • Euzenir P. N. Sarno
    • 3
  1. 1.Dept. of NeurologyHospital Universitário Antônio Pedro Fluminense Federal University NiteróiRio de JaneiroBrazil
  2. 2.Dept. of PathologyFederal University of Rio de JaneiroR. J.Brazil
  3. 3.Leprosy LaboratoryOswaldo Cruz Institute (FIOCRUZ)Rio de Janeiro, R. JBrazil

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