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Santos GMCD, Byrne RL, Cubas-Atienzar AI, Santos VS. Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study. CAD SAUDE PUBLICA 2024; 40:e00113123. [PMID: 38198383 PMCID: PMC10775965 DOI: 10.1590/0102-311xen113123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.
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Spitz CN, Pitta IJR, Andrade LR, Sales AM, Sarno EN, Villela NR, Pinheiro RO, Jardim MR. Case report: Injected corticosteroids for treating leprosy isolated neuritis. Front Med (Lausanne) 2023; 10:1202108. [PMID: 37396908 PMCID: PMC10313350 DOI: 10.3389/fmed.2023.1202108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
One of the main manifestations of leprosy is peripheral nerve impairment. Early diagnosis and treatment are important to reduce the impact of neurological impairment, which can cause deformities and physical disabilities. Leprosy neuropathy can be acute or chronic, and neural involvement can occur before, during, or after multidrug therapy, and especially during reactional episodes when neuritis occurs. Neuritis causes loss of function in the nerves and can be irreversible if left untreated. The recommended treatment is corticosteroids, usually through an oral regimen at an immunosuppressive dose. However, patients with clinical conditions that restrict corticosteroid use or that have focal neural involvement may benefit from the use of ultrasound-guided perineural injectable corticosteroids. In this study, we report two cases that demonstrate how the treatment and follow-up of patients with neuritis secondary to leprosy, using new techniques, can be provided in a more individualized way. Nerve conduction studies in association with neuromuscular ultrasound were used to monitor the response to treatment with injected steroids, focusing on neural inflammation. This study provides new perspectives and options for this profile of patients.
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Affiliation(s)
- Clarissa Neves Spitz
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Izabela Jardim Rodrigues Pitta
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Neurology, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Ligia Rocha Andrade
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcia Rodrigues Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Silva SR, de Souza SN, Santana MFS, Domingos AM, Martins NDS, de Paula HL, Araujo HA, Dos Santos GMC, Martins-Filho PR, Santos VS. Assessment of neuropathic pain, functional activity limitation and quality of life of people affected by leprosy in an endemic area in Northeast Brazil: a cross-sectional study. Trans R Soc Trop Med Hyg 2023:6986072. [PMID: 36633045 DOI: 10.1093/trstmh/trac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/05/2022] [Accepted: 12/25/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study investigated the prevalence of neuropathic pain (NP) among people affected by leprosy and its effects on functional limitation and health-related quality of life (HRQoL) in an endemic area in Northeast Brazil. METHODS This is a cross-sectional study of 122 leprosy patients. Functional limitation and HRQoL were assessed using the Screening of Activity Limitation and Safety Awareness (SALSA) and WHO Quality-of-Life (WHOQoL-BREF) scales, respectively. Participants were assessed for the presence of pain and completed the Douleur Neuropathique 4 and the Brief Pain Inventory scales. RESULTS The prevalence of NP was 59%. Participants with NP had higher SALSA scores than those without pain (median; IQR: 42; 32-49.5 vs 27.5; 24-34; p=0.002). Increasing SALSA scores were related to decreasing WHOQoL-BREF scores in the physical (r=-0.54; p<0.001), psychological (r=-0.33; p=0.002) and environmental (r=-0.22; p=0.01) domains, but not in the social domain (r=-0.14; p=0.10). Individuals with NP had the lowest scores in all domains compared with individuals without pain. CONCLUSIONS Appropriate tools and training of clinicians for diagnosing NP in leprosy patients are necessary for their appropriate management and better HRQoL outcomes.
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Affiliation(s)
- Sara Ribeiro Silva
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | | | | | - Adriana Maia Domingos
- Professional Master's Program in Family Health - PROFSAUDE, Federal University of Alagoas, Maceió, 57072-900, Brazil
| | - Nathálya da Silva Martins
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Hidyanara Luiza de Paula
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Heloisa Antunes Araujo
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Glicya Monaly Claudino Dos Santos
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil.,Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, 49060-676, Brazil
| | - Victor Santana Santos
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil.,Professional Master's Program in Family Health - PROFSAUDE, Federal University of Alagoas, Maceió, 57072-900, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil
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Frade MAC, Bernardes Filho F, Silva CML, Voltan G, Lima FR, Abi-Rached TLC, de Paula NA. Evaluation of altered patterns of tactile sensation in the diagnosis and monitoring of leprosy using the Semmes-Weinstein monofilaments. PLoS One 2022; 17:e0272151. [PMID: 35947601 PMCID: PMC9365170 DOI: 10.1371/journal.pone.0272151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Marco Andrey Cipriani Frade
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
- * E-mail:
| | - Fred Bernardes Filho
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
| | - Claudia Maria Lincoln Silva
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
| | - Glauber Voltan
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
| | - Filipe Rocha Lima
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
| | - Thania Loyola Cordeiro Abi-Rached
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
| | - Natália Aparecida de Paula
- Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil
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5
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Tomaselli PJ, Dos Santos DF, Dos Santos ACJ, Antunes DE, Marques VD, Foss NT, Moreira CL, Nogueira PTB, Nascimento OJM, Neder L, Barreira AA, Frade MA, Goulart IMB, Marques W. Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression. Brain 2021; 145:1499-1506. [PMID: 34664630 DOI: 10.1093/brain/awab396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/25/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤ 12 months) and long (> 12 months) disease duration. Positive and negative symptoms mediated by small-fibre were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (p < 0,001), as well as motor deficits (p = 0,002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (p < 0,001). Primary neural leprosy progress over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes.
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Affiliation(s)
- Pedro J Tomaselli
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD
| | - Diogo F Dos Santos
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - André C J Dos Santos
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Douglas E Antunes
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Vanessa D Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Norma T Foss
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Carolina L Moreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Patrícia T B Nogueira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Osvaldo J M Nascimento
- Antonio Pedro University Hospital (HUAP), Fluminense Federal University, Niterói, 24033-900, Brazil
| | - Luciano Neder
- Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos, 14784-400, Brazil
| | - Amilton A Barreira
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Marco A Frade
- Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil
| | - Isabela M B Goulart
- National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia, 38400-902, Brazil
| | - Wilson Marques
- Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil.,International Centre for Genomic Medicine in Neuromuscular Diseases, ICGNMD.,National Institute for Science and Technology for Translational Medicine, INCT, Brazil
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6
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Brandsma W, Post E, Wagenaar I, Alam K, Shetty V, Husain S, Prakoeswa CRS, Shah M, Tamang KB. Pure neural leprosy—mind the diagnosis. LEPROSY REV 2021. [DOI: 10.47276/lr.92.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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de Paula HL, de Souza CDF, Silva SR, Martins-Filho PRS, Barreto JG, Gurgel RQ, Cuevas LE, Santos VS. Risk Factors for Physical Disability in Patients With Leprosy: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1120-1128. [PMID: 31389998 DOI: 10.1001/jamadermatol.2019.1768] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The World Health Organization (WHO) 2016-2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than 1 per million population. Objective To systematically identify clinical factors associated with physical disability in patients with leprosy. Data Source Searches were conducted in Scopus, PubMed, and Web of Science databases to identify studies published from January 23, 1988, to May 23, 2018, using the keywords leprosy and physical disability and related terms. Study Selection Studies that evaluated patients using the WHO leprosy disability grading system and reported the number of patients with and without disability by clinical characteristics were included. Data Extraction and Synthesis The odds ratio (OR) was used as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models. Main Outcomes and Measures The primary outcome was physical disability according to the WHO disability classification. The association between clinical features and physical disability was evaluated. Results The search identified 2447 reports. After screening titles and abstracts, 177 full-text articles were assessed for eligibility, and 32 studies were included in the systematic review; 24 of the 32 studies included sex information (39 571 patients), of whom 24 218 (61.2%) were male. Male patients with leprosy were more likely to have physical disability than female patients with leprosy (pooled OR, 1.66; 95% CI, 1.43-1.93; I2, 81.3%; P < .001). Persons with multibacillary leprosy were 4-fold more likely to have physical disability than those with paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I2, 88.9%, P < .001). Patients having leprosy reactions were more likely to have disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I2, 92.1%; P < .001). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability. Conclusions and Relevance This systematic review and meta-analysis confirms the association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation. These findings can guide the development of targeted interventions for early identification of individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and prevent physical disability.
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Affiliation(s)
- Hidyanara L de Paula
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Carlos D F de Souza
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Sara R Silva
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
| | - Paulo R S Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil.,Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Josafá G Barreto
- Spatial Epidemiology Laboratory, Federal University of Pará, Castanhal, Pará, Brazil
| | - Ricardo Q Gurgel
- Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Victor S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
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8
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Chukwu JN, Ekeke N, Nwafor CC, Meka AO, Alphonsus C, Mbah OK, Eze CC, Ukwaja KN. Worsening of the disability grade during leprosy treatment: prevalence and its determinants in Southern Nigeria. Trans R Soc Trop Med Hyg 2018; 112:492-499. [DOI: 10.1093/trstmh/try085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/10/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joseph N Chukwu
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Ngozi Ekeke
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Charles C Nwafor
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Anthony O Meka
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Obinna K Mbah
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Chinwe C Eze
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu
| | - Kingsley N Ukwaja
- Department of Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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9
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dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Revisiting primary neural leprosy: Clinical, serological, molecular, and neurophysiological aspects. PLoS Negl Trop Dis 2017; 11:e0006086. [PMID: 29176796 PMCID: PMC5720806 DOI: 10.1371/journal.pntd.0006086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2017] [Accepted: 10/31/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Leprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study. METHODOLOGY/PRINCIPAL FINDINGS Seventy patients diagnosed with primary neural leprosy from 2014 to 2016 underwent clinical, laboratorial and neurophysiological evaluation. All patients presented an asymmetric neural impairment, with nerve thickening in 58.6%. Electroneuromyography showed a pattern of mononeuropathy in 51.4%. Positivity for ELISA anti-PGL1 was 52.9%, while the qPCR of slit skin smear was 78.6%. The qPCR of nerve biopsies was positive in 60.8%. Patients with multiple mononeuropathy patterns showed lower levels of anti-PGL-1 (p = 0.0006), and higher frequency of neural thickening (p = 0.0008) and sensory symptoms (p = 0.01) than those with mononeuropathy. CONCLUSIONS/SIGNIFICANCE PNL is not a synonym of pure neural leprosy, as this condition may include a generalized immune response and also a skin involvement, documented by molecular findings. Immunological, molecular, and neurophysiological tools must be implemented for diagnosing primary neural leprosy to achieve effective treatment and reduction of its resultant disabilities that still represent a public health problem in several developing nations. Finally, we propose a algorithm and recommendations for the diagnosis of primary neural leprosy based on the combination of the three clinical-laboratorial tools.
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Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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Fonseca ABDL, Simon MDV, Cazzaniga RA, de Moura TR, de Almeida RP, Duthie MS, Reed SG, de Jesus AR. The influence of innate and adaptative immune responses on the differential clinical outcomes of leprosy. Infect Dis Poverty 2017; 6:5. [PMID: 28162092 PMCID: PMC5292790 DOI: 10.1186/s40249-016-0229-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. According to official reports from 121 countries across five WHO regions, there were 213 899 newly diagnosed cases in 2014. Although leprosy affects the skin and peripheral nerves, it can present across a spectrum of clinical and histopathological forms that are strongly influenced by the immune response of the infected individuals. These forms comprise the extremes of tuberculoid leprosy (TT), with a M. leprae-specific Th1, but also a Th17, response that limits M. leprae multiplication, through to lepromatous leprosy (LL), with M. leprae-specific Th2 and T regulatory responses that do not control M. leprae replication but rather allow bacterial dissemination. The interpolar borderline clinical forms present with similar, but less extreme, immune biases. Acute inflammatory episodes, known as leprosy reactions, are complications that may occur before, during or after treatment, and cause further neurological damages that can cause irreversible chronic disabilities. This review discusses the innate and adaptive immune responses, and their interactions, that are known to affect pathogenesis and influence the clinical outcome of leprosy.
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Affiliation(s)
- Adriana Barbosa de Lima Fonseca
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marise do Vale Simon
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Rodrigo Anselmo Cazzaniga
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Tatiana Rodrigues de Moura
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Roque Pacheco de Almeida
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil.,Instituto de Investigação em Imunologia, Institutos Nacionais de Ciência e Tecnologia, CNPq, São Paulo, SP, Brazil
| | | | | | - Amelia Ribeiro de Jesus
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil. .,Instituto de Investigação em Imunologia, Institutos Nacionais de Ciência e Tecnologia, CNPq, São Paulo, SP, Brazil.
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Abstract
BACKGROUND Leprosy causes nerve damage that can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although their long-term effect is uncertain. This is an update of a review first published in 2007, and previously updated in 2009 and 2011. OBJECTIVES To assess the effects of corticosteroids on nerve damage in leprosy. SEARCH METHODS On 16 June 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, and LILACS. We also checked clinical trials registers and contacted trial authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of corticosteroids for nerve damage in leprosy. The comparators were no treatment, placebo treatment, or a different corticosteroid regimen. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in nerve function after one year. Secondary outcomes were change in nerve pain, limitations in activities of daily living, limitations in participation, and adverse events. Two review authors independently extracted data and assessed trial quality. When data were lacking, we contacted trial authors for additional information. MAIN RESULTS We included five RCTs involving 576 people. The trials were largely at low risk of bias, but we considered the quality of the evidence from these trials as moderate to low, largely due to imprecision from small sample sizes. Two out of the five trials reported on improvement in nerve function at one year. These two trials compared prednisolone with placebo. One trial, with 84 participants, treated mild sensory impairment of less than six months' duration, and the other, with 95 participants, treated nerve function impairment of 6 to 24 months' duration. There was no significant difference in nerve function improvement after 12 months between people treated with prednisolone and those treated with placebo. Adverse events were not reported significantly more often with corticosteroids than with placebo. The other three trials did not report on the primary outcome measure. One (334 participants) compared three corticosteroid regimens for severe type 1 reactions. No serious side effects of steroids were reported in any participant during the follow-up period. Another trial (21 participants) compared low-dose prednisone with high-dose prednisone for ulnar neuropathy. Two participants on the higher dose of prednisone reported adverse effects. The last (42 participants) compared intravenous methylprednisolone and oral prednisolone with intravenous normal saline and oral prednisolone. The trial found no significant differences between the groups in the occurrence of adverse events. AUTHORS' CONCLUSIONS Corticosteroids are used for treating acute nerve damage in leprosy, but moderate-quality evidence from two RCTs treating either longstanding or mild nerve function impairment did not show corticosteroids to have a superior effect to placebo on nerve function improvement. A third trial showed significant benefit from a five-month steroid regimen over a three-month regimen in terms of response to treatment (need for additional corticosteroids). Further RCTs are needed to establish optimal corticosteroid regimens and to examine the efficacy and safety of adjuvant or new therapies for treating nerve damage in leprosy. Future trials should address non-clinical aspects, such as costs and impact on quality of life, which are highly relevant indicators for both policymakers and participants.
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Affiliation(s)
- Natasja HJ Van Veen
- Erasmus Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Peter G Nicholls
- University of SouthamptonSchool of Health SciencesUniversity RoadHighfieldSouthamptonUKSO17 1BJ
| | - W Cairns S Smith
- University of AberdeenPublic HealthPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | - Jan Hendrik Richardus
- Erasmus Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
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Santos VS, Oliveira LS, Castro FDN, Gois-Santos VT, Lemos LMD, Ribeiro MDCO, Cuevas LE, Gurgel RQ. Functional Activity Limitation and Quality of Life of Leprosy Cases in an Endemic Area in Northeastern Brazil. PLoS Negl Trop Dis 2015; 9:e0003900. [PMID: 26132166 PMCID: PMC4489006 DOI: 10.1371/journal.pntd.0003900] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Few studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA). Aim To identify the association between FALs and the QoL of patients during and post leprosy treatment. Materials and Methods Cross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs. Results Low SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF. Conclusion Functional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains. Leprosy is still a neglected public health problem. Leprosy causes disability and functional limitations (FALs) if not treated early. We describe the functional activity and quality of life (QoL) of adults with leprosy attending two reference centres in Sergipe, Brazil. Patients with leprosy had low QoL, which was associated to the degree of FALs. Despite increased access to diagnosis and modern multidrug leprosy therapy, leprosy is still strongly associated with FALs and low QoL. We stress here the importance of public health efforts to diagnose the disease early and to provide supportive systems for patients receiving treatment in endemic areas.
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Affiliation(s)
- Victor S. Santos
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Laudice S. Oliveira
- Department of Nursing, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Vanessa T. Gois-Santos
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Ligia M. D. Lemos
- Department of Nursing, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Maria do C. O. Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Nursing, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Luis E. Cuevas
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ricardo Q. Gurgel
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Santos VS, Santos LC, Lôbo LV, Lemos LM, Gurgel RQ, Cuevas LE. Leprosy and disability in children younger than 15 years in an endemic area of northeast Brazil. Pediatr Infect Dis J 2015; 34:e44-7. [PMID: 25389921 DOI: 10.1097/INF.0000000000000592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leprosy in children is still a frequent but sometimes unrecognized public health problem and an important cause of disability. Establishing the risk factors that lead to the development of disability is important for the development of suitable prevention programs. We describe the incidence of leprosy and the prevalence and degree of associated disabilities in children<15 years of age at the time of first presentation to the health services in Aracaju, Sergipe, Northeast Brazil. METHODS A retrospective case series of 266 cases of leprosy in children under 15 years old of Aracaju from 2001 to 2012. Logistic regressions were performed to identify factors for disability. RESULTS The average detection rate was 16.5/100,000 children under 15 years old per year over the study period. Physical disability was associated with the presence of affected nerves and multibacillary leprosy. CONCLUSIONS The detection rate of leprosy in children is still high in Aracaju, Northeast Brazil. Having affected nerves and multibacillary leprosy are associated with the development of disability in children.
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Andrade PR, Pinheiro RO, Sales AM, Illarramendi X, de Mattos Barbosa MG, Moraes MO, Jardim MR, da Costa Nery JA, Sampaio EP, Sarno EN. Type 1 reaction in leprosy: a model for a better understanding of tissue immunity under an immunopathological condition. Expert Rev Clin Immunol 2015; 11:391-407. [DOI: 10.1586/1744666x.2015.1012501] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
PURPOSE OF REVIEW Infectious neuropathies are heterogeneous neuropathies with multiple causes. They still represent an important world health burden and some of them have no current available therapy. RECENT FINDINGS Leprosy incidence has decreased by 50% during the last years, but leprosy-related neuropathies still cause severe disability. The pure neuritic leprosy is a diagnostic challenge that may require nerve biopsy or nerve aspiration cytology. The treatment itself may lead to a 'reversal reaction', which further causes injuries to the nerve. HCV-related neuropathies may be related or not to the presence of cryoglobulins. The absence of vasculitis, the most frequent form is a peripheral sensory neuropathy involving small nerve fibers, and more accurately diagnosed by pain-related evoked potentials. HIV-related neuropathy has become the major neurological complication of HIV infection. Both HIV-induced neuropathy and antiretroviral toxic neuropathy are clinically indistinguishable. The existence of an isolated chronic polyneuropathy due to Borrelia burgdorferi remains highly controversial. Lastly, an active infectious ganglioneuritis caused by varicella zoster virus, producing shingles, is the most frequent infectious neuropathy in the world and may cause various neurological complications. Zoster sine herpete remains frequently undiagnosed. SUMMARY Recent data have improved our knowledge and diagnostic tools of infectious neuropathies. Treatment of the injured nerves is not yet available, and prevention and rapid diagnosis remain the main priorities for the clinician.
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Oliveira DTD, Sherlock J, Melo EVD, Rollemberg KCV, Paixão TRSD, Abuawad YG, Simon MDV, Duthie M, Jesus ARD. Clinical variables associated with leprosy reactions and persistence of physical impairment. Rev Soc Bras Med Trop 2014; 46:600-4. [PMID: 24270251 DOI: 10.1590/0037-8682-0100-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 10/04/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. METHODS We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classification, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. RESULTS We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. CONCLUSIONS Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.
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Garbino JA, Marques Jr W, Barreto JA, Heise CO, Rodrigues MMJ, Antunes SL, Soares CT, Floriano MC, Nery JA, Trindade MAB, Carvalho NB, Andrada NCD, Barreira AA, Virmond MDCL. Primary neural leprosy: systematic review. Arq Neuro-Psiquiatr 2013; 71:397-404. [DOI: 10.1590/0004-282x20130046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 03/14/2013] [Indexed: 11/22/2022]
Abstract
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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Abstract
Leprous neuropathy, which is due to infection of nerve cells by Mycobacterium leprae, still affects millions of people in many developing countries. The clinical and pathological manifestations are determined by the natural resistance of the host to invasion of M. Leprae. Failure of early detection of leprosy often leads to severe disability in spite of eradication of mycobacterium at a later date. In the lepromatous type, bacilli are easily found in the skin and in nerve cells including Schwann cells, endothelial cells, and macrophages. In the tuberculoid type, a strong cell-mediated immune reaction leads to formation of granulomas and destruction of cells harboring bacilli and neighboring nerve fibers. In many cases, treatment of patients with the multibacillary leprosy is complicated by reversal reaction and further nerve damage. Nerve lesions lead to a symmetrical, pseudo-polyneuritic pattern in most cases of lepromatous leprosy, which is usually associated with typical skin lesions, but pure neuritic forms occur in up to 10% of patients with lepromatous leprosy. In the pure neuropathic cases, only nerve biopsy permits diagnosis. The multifocal pattern is more common in tuberculoid leprosy. Treatment is currently based on multidrug therapy with dapsone, rifampicin, and clofazimine. The use of corticosteroids can reduce or prevent nerve damage in reversal reactions. It is important to remember that sequelae, especially sensory loss, are extremely common, which can lead to secondary trophic changes due to repeated trauma in painless areas.
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Affiliation(s)
- Marcos R G de Freitas
- Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, Brazil.
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Foss NT, Motta ACF. Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries. Mem Inst Oswaldo Cruz 2012; 107 Suppl 1:28-33. [DOI: 10.1590/s0074-02762012000900006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
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Véras LST, Vale RGDS, Mello DBD, Castro JAFD, Lima V, Silva KNGD, Trott A, Dantas EHM. Degree of disability, pain levels, muscle strength, and electromyographic function in patients with Hansen's disease with common peroneal nerve damage. Rev Soc Bras Med Trop 2012; 45:375-9. [DOI: 10.1590/s0037-86822012000300018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/07/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: This study evaluated the degree of disability, pain levels, muscle strength, and electromyographic function (RMS) in individuals with leprosy. METHODS: We assessed 29 individuals with leprosy showing common peroneal nerve damage and grade 1 or 2 disability who were referred for physiotherapeutic treatment, as well as a control group of 19 healthy participants without leprosy. All subjects underwent analyses of degree of disability, electromyographic tests, voluntary muscle force, and the Visual Analog Pain Scale. RESULTS: McNemar's test found higher levels of grade 2 of disability (Δ = 75.9%; p = 0.0001) among individuals with leprosy. The Mann-Whitney test showed greater pain levels (Δ = 5.0; p = 0.0001) in patients with leprosy who had less extension strength in the right and left extensor hallucis longus muscles (Δ = 1.28, p = 0.0001; Δ = 1.55, p = 0.0001, respectively) and dorsiflexion of the right and left feet (Δ = 1.24, p = 0.0001; Δ = 1.45, p = 0.0001, respectively) than control subjects. The Kruskal-Wallis test showed that the RMS score for dorsiflexion of the right (Δ = 181.66 m·s-2, p = 0.001) and left (Δ = 102.57m·s-2, p = 0.002) feet was lower in patients with leprosy than in control subjects, but intragroup comparisons showed no difference. CONCLUSIONS: Leprosy had a negative influence on all of the study variables, indicating the need for immediate physiotherapeutic intervention in individuals with leprosy. This investigation opens perspectives for future studies that analyze leprosy treatment with physical therapeutic intervention.
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Affiliation(s)
- Larissa Sales Téles Véras
- Universidade Estadual do Piauí; Universidade Federal do Estado do Rio de Janeiro; Hospital Getúlio Vargas
| | | | - Danielli Braga de Mello
- Universidade Federal do Estado do Rio de Janeiro; Escola de Educação Física do Exército Brasileiro
| | | | - Vicente Lima
- Universidade Federal do Estado do Rio de Janeiro
| | | | - Alexis Trott
- Universidade do Oeste de Santa Catarina; Universidade Federal do Rio Grande do Sul
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Vital RT, Illarramendi X, Nascimento O, Hacker MA, Sarno EN, Jardim MR. Progression of leprosy neuropathy: a case series study. Brain Behav 2012; 2:249-55. [PMID: 22741099 PMCID: PMC3381630 DOI: 10.1002/brb3.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/04/2012] [Accepted: 01/06/2012] [Indexed: 11/11/2022] Open
Abstract
A need still exists to determine the clinical and neurophysiological characteristics of leprosy neuropathy at distinct times of the disease by different methods that measure the various nerve fiber functions. A prospective clinical study was performed with 10 paucibacillary (PB) and 12 multibacillary (MB) patients evaluated at diagnosis and one year after cessation of multidrug therapy (MDT). Peripheral nerve function was assessed clinically and by means of the sympathetic skin response, skin vasomotor reflex, and nerve conduction study (NCS). At diagnosis, 73% of the total 22 patients had nerve function impairment (NFI). Autonomic function (χ(2)= 5.5, P= 0.019) and NCS (χ(2)= 7.765, P= 0.01) were significantly more altered in MB than PB patients. At final evaluation, NFI of the MB patients had worsened, especially among the six who had leprosy reaction. As the NFI of PB patients showed improvement, a significant difference between the two groups (χ(2)= 12.320, P= 0.001) was observed. A high prevalence of neuropathy was observed in newly diagnosed patients. Associating different tests with a thorough clinical neurological evaluation increases detection rates.
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Affiliation(s)
- Robson T. Vital
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
- Department of Neurology, Fluminense Federal University, Niteroi, Rio de Janeiro, RJ, Brazil
| | - Ximena Illarramendi
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Osvaldo Nascimento
- Department of Neurology, Fluminense Federal University, Niteroi, Rio de Janeiro, RJ, Brazil
| | - Mariana A. Hacker
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Euzenir N. Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Marcia R. Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
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Abstract
BACKGROUND Leprosy causes nerve damage which can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although the long-term effect is uncertain. OBJECTIVES To assess the effects of corticosteroids on nerve damage in leprosy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Register, the Cochrane Central Register of Controlled Trials (Issue 4), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1980), LILACS (from 1982) in January 2006. We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com), conference proceedings and contacted trial authors. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of corticosteroids for nerve damage in leprosy. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects and cost effectiveness information from the trials and non-randomised studies. MAIN RESULTS We included three randomised controlled trials involving 513 people. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than six months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined an effect twelve months from the start of treatment. There was no significant difference in nerve function improvement between people treated with prednisolone or with placebo. The third trial compared three corticosteroid regimens for severe type 1 reactions. This trial did not report the prespecified outcomes. However, after 12 months, a significantly higher proportion of individuals on a 3-month course of prednisolone required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of five months duration. Diabetes and peptic or infected ulcer were sometimes reported as serious adverse events in the placebo-controlled trials, but not significantly more often in the corticosteroid than placebo groups. AUTHORS' CONCLUSIONS Corticosteroids are used for treating acute nerve damage in leprosy, but evidence from randomised controlled trials does not show a significant long-term effect. Randomised controlled trials are needed to establish their effectiveness, the optimal regimens and to examine new therapies.
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Affiliation(s)
- N H J Van Veen
- Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
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