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Dos Santos DF, Antunes DE, Dornelas BC, da Cunha BA, Oliveira TJ, Pereira RC, Goulart LR, Goulart IMB. Peripheral nerve biopsy: a tool still needed in the early diagnosis of neural leprosy? Trans R Soc Trop Med Hyg 2020; 114:792-797. [PMID: 32710545 DOI: 10.1093/trstmh/traa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/20/2020] [Revised: 05/27/2020] [Accepted: 07/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The early recognition of neural impairment in leprosy, especially in primary neural forms, represents a challenge in clinical practice and a peripheral nerve biopsy may be required for diagnostic confirmation. This study aims to characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural cases in leprosy. METHODS A total of 104 patients with peripheral neuropathy who were referred to a national reference centre for leprosy were biopsied from 2014 to 2018. All cases underwent clinical, laboratory, histopathological and electroneuromyographic evaluations. RESULTS Of 104 biopsied patients, leprosy was confirmed in 89.4% (93/104). The biopsied nerves were the ulnar (67.8% [63/93]), superficial fibular (21.5% [20/93]), sural (8.6% [8/93]), radial (1.1% [1/93]) and deep fibular (1.1% [1/93]). Twenty-nine percent (27/93) presented histopathological abnormalities and 4.4% (4/93) presented acid-fast bacilli. Nerve and superjacent skin quantitative polymerase chain reaction were positive in 49.5% (46/93) and 24.8% (23/93) of cases, respectively. Patients with multiple mononeuropathy had a higher frequency of histopathological abnormalities (p=0.0077). CONCLUSIONS This study reinforces peripheral nerve biopsy's role as an important tool in the investigation of primary neural cases, contributing to the early diagnosis and also reducing diagnostic errors and the need for empirical treatment.
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Affiliation(s)
- Diogo Fernandes Dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Carvalho Dornelas
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Bruno Araujo da Cunha
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Thales Junqueira Oliveira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Institute of Genetics and Biochemistry, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil.,Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), 1720 Pará Avenue, Uberlândia, MG, 38400-902, Brazil
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